Medical errors in the management of suicidal patients is a death sentence. Suicide rates are climbing in the U.S., so primary care providers (PCPs) are facing more encounters with suicidal patients. In this blogpost, I will discuss treatment guidelines set forth in the Primary Care Companion to the Journal of Clinical Psychiatry for suicidal patients.
The patient-PCP relationship is important in preventing future suicides. The Journal reports that “between 20% and 76% of patients who commit suicide have seen their primary care physician in the prior month.“ Likewise, PCPs may assume care of a suicidal patient after the patient is stabilized following a suicide attempt.
When a patient has attempted suicide, the first step is to treat the patient and also ensure the patient’s safety so no further attempts can be made while convalescing. In an acute care setting, the patient should be watched and kept in a room that is designed to minimize the risk of another suicide attempt (e.g., no sharp objects, no open windows, etc.). In an office-based setting, the suicidal patient should not be allowed to leave alone.
After the acute phase, the PCP must assess the patient for future suicide risk. The guidelines recommend that the physician undertake a thorough history and mental and physical assessment, and “
Risk assessment is a crucial part of the treatment plan. Physicians should assess for risk factors, such as past suicide attempt, the seriousness of the past attempt, history of suicide among family/friends, drug/alcohol abuse, social isolation, preoccupation with death, psychiatric disorder, history of loss, underlying health problems and feeling hopeless.
Treatment consists of medications, treatment of underlying conditions, referral to specialists and close monitoring. Physicians should first be familiar with “local mental health resources … so that the patient can be directed to appropriate treatment.”
Medical errors occur when PCPs fail to stabilize the patient in an acute care setting or take steps to prevent further harm, or allow a suicidal patient to leave the acute care or office-based setting without a thorough risk assessment or proper treatment plan. Like with other medical conditions, the PCP owes a duty to provide safe care that falls within accepted standards of care. Though a psychiatrist should be better trained to treat a suicidal patient, a PCP owes a duty to provide the same competent care. If they are unable to do so, they need to refer the patient to a specialist or facility that can. A medical malpractice case may exist if a PCP fails to properly evaluate and treat a suicidal patient.
