Too many of our patients suffer when bullets maim or kill them or their loved ones. And those not yet personally harmed by guns worry about the potential for future harm presented by the ubiquity of guns in America. Regardless of whether one believes guns hurt people or that people hurt people with guns, we have a public health crisis and health care professionals have an obligation to do what we can to combat it.

Annals of Internal Medicine has raised the alarm about guns since at least 1998 (1–3). More recently, we have published strong recommendations to reduce firearm injury from the American College of Physicians (ACP) (4) and another from the ACP with 7 other health organizations together with the American Bar Association (5). Improvements in public health require careful study. We've published rigorous reviews to help synthesize what is and is not known (6). The dearth of evidence to inform sensible gun regulation led us to solicit original research and work hard to help authors report it accurately so that the most may be learned by others seeking to learn from and build upon the findings (7–17). Firearms have also been the subject of On Being a Doctor essays (18, 19). We've repeatedly called on ourselves and our colleagues to examine the evidence, take action, and raise our voices (20–34). We've cried out that we must use our voices.

Nowhere are our voices more important than in the privacy of the examination room. This is where our work is done, where all the research and learning come together. Of all the times and places where we might speak, this is where our voices stand to do the most immediate good. We must commit to using that time and place to help protect our patients from firearm-related harm.

In this issue, Wintemute calls on each of us to make a commitment to ask our patients about firearms when, in our judgment, it is appropriate and to follow through (35). We know the factors that should alert us to the risk for alcohol, tobacco, and other substance use disorders; sexually transmitted disease; intimate partner abuse; suicidality; and other preventable harms to our patients. We ask about these risks and counsel accordingly. The risks for harming oneself or exposing others to harm from a firearm are also known. And we know we should speak up (34).

While changes in U.S. gun regulations are sorely needed to address population-level threats presented by the availability of military-style firearms and unlimited ammunition, physicians and other health professionals at the frontline of patient care can help prevent firearm-related harm one patient at a time. Go to http://go.annals.org/commit-now and make the commitment to start doing this right now. By making a public commitment to ask our patients about firearms and counsel them to reduce this risk, we show our patients and their communities that we are committed to their safety and health.

Feeling uncomfortable about how to talk with patients about guns is not a reason to shy away. Read when and how to do it (36). Let's start now. Too many of our patients are in danger. This simply cannot wait.

当子弹致残或杀死他们或他们的亲人时，我们太多的患者遭受痛苦。那些尚未受到枪支个人伤害的人担心，由于美国无处不在的枪支所带来的未来伤害的可能性。无论是相信枪支伤害了人们，还是认为枪支伤害了人们，我们都面临着公共卫生危机，医护人员有义务尽其所能来与之抗争。

内科学纪事至少从1998年开始（1-3），人们就对枪支发出了警告。最近，我们已经发布了减少内科医生枪支伤害的强烈建议，美国医师学院（ACP）（4）和ACP的另一项建议与其他7个卫生组织以及美国律师协会（5）一起。公共卫生的改善需要认真研究。我们已经发布了严格的评论，以帮助综合已知和未知的内容（6）。缺乏明智的枪支法规依据的证据导致我们进行了原始研究，并努力帮助作者准确地举报，以便其他人可以从中汲取最大的经验教训，并从中汲取经验教训（7-17）。枪支也是“成为医生”论文的主题（18、19）。我们一再呼吁自己和我们的同事检查证据，采取行动，并提高我们的声音（20–34）。我们大声疾呼，我们必须使用自己的声音。

在检查室的私密性中，我们的声音比任何地方都重要。这是我们工作完成的地方，所有研究和学习都在这里进行。在我们可能会说的所有时间和地点中，这是我们的声音可以立即发挥最大作用的地方。我们必须承诺利用那段时间和地点来帮助保护我们的患者免受枪支相关伤害。

在本期杂志中，温特姆特呼吁我们每个人做出承诺，向我们的患者询问枪支的适用性，并根据我们的判断进行追踪（35）。我们知道应该使我们警惕酒精，烟草和其他物质使用失调风险的因素；性病; 亲密伴侣的虐待；自杀 以及对我们患者的其他可预防的伤害。我们询问这些风险，并据此提供咨询。还已知伤害自己或使他人受到枪支伤害的风险。我们知道我们应该说出来（34）。

尽管迫切需要改变美国枪支法规以应对由军用火器和无限制弹药带来的人口级威胁，但在患者护理第一线的医生和其他卫生专业人员可以帮助预防与枪支相关的伤害。时间。转到http://go.annals.org/commit-now，并承诺立即开始执行此操作。通过公开承诺向我们的患者询问枪支并建议他们减少枪支的风险，我们向我们的患者及其社区表明我们致力于他们的安全和健康。

对如何与患者谈论枪支感到不舒服并不是逃避的理由。阅读何时以及如何做（36）。让我们现在开始。我们太多的患者处于危险之中。这简直无法等待。