Cassel and colleagues' article [1] left me wondering about the importance of some physicians saying that physicians should talk to patients about guns.

Did the respondents who said that physicians should talk to patients about guns truly believe this? If they did, why did so few actually do so? Were they asked about this discrepancy? Although one could hypothesize explanations that would not invalidate the authors' conclusion, one could also imagine respondents simply giving the answer they thought the authors wanted.

Even if it were established that the respondents believed what they reported, what will have been shown? Only that some physicians believe that they should talk to patients about guns. Why does this matter? Nowhere in the article or in the accompanying editorial [2] were the more fundamental questions addressed: whether physicians, in their role as physicians, should talk to patients about guns, and why. Do the authors believe that this type of question can be resolved by a vote and that their study did so? This is not that type of question. Professional attitudes and behavior can set the standard of care but cannot determine whether a particular duty exists. The existence of a moral duty cannot be established or abrogated by referendum.

Is gun talk properly part of medical practice? I don't think so. If I see a fellow pedestrian about to be run down by a car, I have a moral duty to call out a warning to that person. That duty, however, does not derive from my role as a physician because such a warning is devoid of the special knowledge and skills that characterize the practice of medicine. Nor would it be magically transformed into a medical duty merely if the pedestrian or the driver were my patients. Why, then, view a warning given in the office 2 weeks earlier-"Look both ways before you cross the street!"-differently?

Do physicians then have a general duty (not derived from the physician-patient relationship) to talk to patients and nonpatients alike about guns? Perhaps, but only if everyone has a duty to talk to everyone else about guns. But then there would be no time for everyone to talk to everyone else about alcoholism, narcotics abuse, domestic violence, and tobacco.

Even if no specific or general duty to talk to patients about guns exists, physicians who choose to are free to do so. Whether this is prudent is another question, for when physicians spend their patients' time talking about matters so far afield from the core of medical practice, they risk not merely incredulous looks but loss of moral authority.