Talking firearm safety at the doctor’s office

UW Health’s James Bigham teaches health care professionals how to broach the topic of safe gun protocols

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For UW Health’s Dr. James Bigham, speaking with patients about firearm storage safety is a critical but overlooked aspect of preventative care — a topic absent from his medical school curriculum yet essential to his daily work.

During routine visits, he asks patients: “Are firearms kept in or around spaces where your children spend time?”

More than just starting the conversation, Bigham is prepared to offer practical support, distributing trigger and cable locks at visits, and connecting patients with targeted safety resources.

Bigham has found a kindred spirit in Steve D’Orazio, owner of Max Creek Outdoors, a gun shop and indoor gun range just outside of Madison in Oregon. Together they host monthly training sessions with health professionals at D’Orazio’s gun shop.

D’Orazio takes a similar approach to firearm safety with his customers, underlining his message by talking about kids.

A father and grandfather, D’Orazio says “it’s all about the kids.” He tells customers: "We’re adults, so let’s protect our kids." 

Though the conversations Bigham and D’Orazio have in their everyday lives take place in different settings, they are bound by their shared goal of prioritizing safe firearm storage in Dane County.

The latest available data from Public Health Madison and Dane County shows that three-quarters of the 44 firearm deaths in Dane County in 2023 were suicides. Additionally, just over half of the reported firearm injuries among Dane County residents were fatal.

While data on firearm deaths in 2024 is not yet available, the Dec. 16, 2024, shooting at Abundant Life Christian School in Madison left two dead, excluding the shooter, who also died. The shooting’s impact was felt both in the local community and across the nation, serving as a reminder of the impact of gun violence in the U.S.

Gun safety has become a highly partisan and divisive issue but Bigham, a family medicine doctor and clinical professor at the UW School of Medicine and Public Health, aims to help other health professionals “cross over the threshold” and engage with patients in this crucial dialogue.

“There’s an imaginary line, a cultural line that’s been drawn,” Bigham says. “I want people to recognize that just because something is politicized, doesn’t mean it’s something we shouldn’t talk about in the clinic.”

Training for healthcare providers expands from Madison to Milwaukee

Together Bigham and D’Orazio have trained more than 150 current and future healthcare providers in the Madison area. It’s a model that’s proven effective, and Bigham has now begun taking his workshops on the road.

In January, he held a training for health professionals at the Milwaukee area gun shop Bear Arms. Days after the training, Gov. Tony Evers visited the facility to learn about its firearm storage program — part of his broader initiative that includes a newly established Office of Violence Prevention to support statewide gun safety efforts.

Bigham told attendees his goal was to take an “agnostic approach” to this often politicized issue. Patients have already made the decision to own a firearm, he added, so the role of healthcare providers is to give them the tools for responsible ownership.

Firearms instructor Jieire Vance led the session, focusing on firearm mechanics, secure storage solutions, and prevention resources providers can share with patients.

“When you hear .45- or .40-caliber or .38, that’s not the gun size, that’s the ammunition size,” he said, passing the different-sized pieces of non-live ammunition around the room.

He showed the providers how to check if a firearm is loaded and how it needs to be properly cleaned. These mechanical elements are important parts of firearm safety, making sure people are comfortable around their firearms, Bigham said.

“I actually encourage my patients, if they have a firearm, to be using it at least once or twice a year,” Bigham said. “It can help folks realize if they’re no longer feeling comfortable.”

When speaking about storage options, participants weighed in, building on one another’s knowledge. A psychologist told the group about a site where people can get free cable locks from a vending machine, while a veteran peer support specialist highlighted the state’s Live Today – Put It Away initiative, which allows veterans to store firearms at a number of gun shops across the state.

Vance also talked about family safety plans, a way of preparing members of a household for an emergency situation. Bigham added that this is a place where physicians can step in should someone be at risk of firearm injury due to mental health concerns.

The group also discussed language used in current firearm legislation in Wisconsin, and what this may mean for patients.

Everytown Research & Policy, a group that conducts research on firearm violence in the U.S., most recently ranked Wisconsin as 21st in the country for gun law strength. The group classified Wisconsin as “missing key laws,” such as the requirement of background checks and purchase permits. 

Wisconsin also doesn’t have a so-called extreme risk law, that would allow law enforcement to petition for a court order to temporarily prevent someone in crisis from accessing firearms, according to Everytown. To encourage safe storage, Republican lawmakers in January introduced a bill offering tax exemption on gun safes, and Evers has included a tax exemption for gun safes, gun barrel locks and trigger locks in the 2025-27 budget, among other gun safety measures. It’s an effort that aligns with Bigham’s goal of focusing on practical solutions.

Bigham concluded the training by offering participants the chance for hands-on experience at the indoor shooting range. Before heading to the range, Vance had each participant practice loading and unloading a firearm with non-live ammunition

Project grows from local partnership into statewide model

In 2022, Bigham was invited to speak about firearm safety and suicide prevention on a webinar hosted by Safe Communities, a Madison-based nonprofit. A northern Wisconsin gun shop owner was also on the panel, and as the two spoke and answered questions, the importance of a partnership became clear.

“There was nothing but common ground and appreciation for one another,” Bigham says.

After that webinar, Jean Papalia, a suicide prevention specialist with Safe Communities, suggested that Bigham partner with a local gun shop owner to continue the conversation and build on this work. She introduced Bigham to D’Orazio, and the pair began holding their training sessions for clinicians.

“Physicians talk about childproofing your house, they talk about seat belts, they talk about wearing life jackets,” Papalia says. “So I thought — why can’t they also talk about keeping firearms safe in their homes?”

Safe Communities has long worked to address firearm injuries and deaths in Dane County. The organization celebrated its 25th anniversary in November 2024, and the “Lock, Stock, and Barrel” program with Bigham and D’Orazio is just one of many initiatives they oversee.

Some of these initiatives are modeled after work in other states, but Safe Communities has adjusted the programming to best meet the needs and culture of Wisconsin residents. Bigham says this is essential given that many residents have long been firearm owners due to the state’s hunting culture. About 47% of Wisconsin’s residents own guns, 17th highest in the nation.

Though mostly focused on Dane County, Safe Communities has collaborated with gun shop owners across Wisconsin to promote safe firearm storage and responsible ownership. In the process, she’s continued to build out this network of partners dedicated to increasing safety around firearms.

The efforts have been independent of statewide initiatives, and Safe Communities has not yet received funding from the state’s new Office of Violence Prevention. D’Orazio has also not yet received funding from the office, but said he would love to take part in the statewide work.

Bigham is doing the same, building a network of partners in this work. His January training session in Milwaukee helped grow the number of providers prepared to have these conversations with patients across Wisconsin. And in April, he’ll travel to Pittsburgh to collaborate with Western Pennsylvania healthcare providers on initiating patient conversations about firearm safety. He also serves as vice chair of the national board for Scrubs Addressing the Firearm Epidemic, where he is working with medical schools to develop and implement curriculum around firearm safety. 

“Safe Communities has taught me a ton about the fact that firearm injury prevention is going to benefit from gun shop owners really helping us as we’re thinking about secure storage training,” Bigham says.

Though anecdotal, Bigham’s received feedback that shows him having these conversations — and practical solutions on hand — are making a meaningful difference. While this model of bringing clinicians into a gun shop is the first of its kind in the nation, Bigham is actively working to expand its reach.

“I’ve had patients report back, and it’s anecdotal, but many times they’ll say ‘Hey, thank you so much. I did put those to use, and I feel much better now knowing that my shotgun has a cable lock on it,’” Bigham says.