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In 2014, . What can be done to improve this terrible record?

This is a politically charged and divisive question in a nation where , and resistance to change is considerable.

Critics of gun control object to government involvement in the ownership, storage or use of firearms as they see it as infringing the Second Amendment to the US constitution, which has been interpreted as enshrining an individual’s right to own a gun.

And 20 years ago, federal funding for research into gun violence was . Despite an executive order in 2013 by President Obama to overturn this, the US Centers for Disease Control and Prevention is still unable to fund firearm injury studies.

So the role of doctors on the front line would seem crucial. The hope is that they can avert more gun-related tragedies by counselling patients who may be at risk of firearm injury. Unfortunately there are barriers to this too, including fear of offending patients or being sued.

The concern about lawsuits is the result of some states – – considering or enacting laws to prevent what they view as inappropriate questioning about firearms by healthcare providers.

Use of the term in relation to this may have unintentionally oversimplified matters and perpetuated the myth that such rules ban physicians from discussing firearm safety with patients. They don’t – a situation we, with a colleague, have clarified by analysing relevant federal and state laws, the results of which are published today.

We are speaking up because medical professionals need to understand that no active federal or state law in the US prohibits them from asking a patient about their access to guns when it is relevant to the health and safety of the patient or others.

Make counselling routine

As a result of our work as emergency doctors and from published research, we know that many people are open to respectful, non-judgemental discussions with medical professionals about preventing gun injuries. Such counselling may advise on locked storage at home and reduce the risk of suicide, homicide and unintentional injury.

But counselling is generally not routine because of the legal confusion. We want it to become routine where relevant.

Situations where it may be relevant include where there is imminent risk to the patient or others as a result of suicidal or homicidal thoughts. Of those tens of thousands of deaths in 2014, 63 per cent were suicides. Many of these might have been prevented by limiting the access of patients in crisis to firearms.

Doctors should also counsel where there are risk factors such as a history of violence (particularly domestic violence), alcohol or substance abuse, serious mental illness or cognitive impairment, and where patients are in a demographic group with raised risk of gun injury – , .

Attitudes about guns differ widely. So we urge medical professionals not just to think about when to ask about guns, but also how. Every day we work with patients with religious beliefs, political affiliations, sexual orientations and cultural heritages different from our own, and we seek to understand their perspectives and to provide care that is non-judgemental.

The same should be true when talking about preventing firearm violence. But if we don’t even talk about it, we can’t change it.