Losing a patient is always brutal for physicians. But what about cases in which they've taken their own life?
In a recent Real Talk column, I wrote about suicidal patients, recalling a 53-year-old patient, a high-level executive who had just lost his job. While he denied having suicidal thoughts, six weeks later, his wife told me he'd shot himself.
It was devastating—to his family, of course, but also to me as his physician. The patient's suicide could also have put my career in jeopardy when blame was assessed.
In that initial column, I focused on how to recognize warning signs, assessing risk, and reporting a them to authorities.
This follow-up discusses what we as physicians can do to help families, manage our professional risk, and navigate our own feelings after a patient dies by suicide.
Likelihood of patient suicide
Suicide is a leading cause of death for adults in the US.
As healthcare professionals, it’s likely that we’ve taken care of a suicidal patient without even knowing it, as many patients who commit suicide (20%–76%) visit their primary care doctor’s office within 30 days of their death.
Studies show that 20% to 60% of psychiatrists experience a patient suicide at some point. And many providers will be unprepared for the emotional and professional devastation that can follow.
It makes sense that mental health care providers have higher chances of experiencing patient suicide compared to physicians who don’t work with mental health conditions regularly, such as surgeons or dermatologists. However, all healthcare professionals must support each other and take the appropriate steps.
Professional risk management
One of the first (and most important) steps to take when your patient dies by suicide is to contact your direct supervisor and follow hospital or clinic protocols.
If you work in a hospital, immediately contact the risk management team. Notify your malpractice insurance carrier, seek legal counsel as soon as possible, and involve counsel throughout the process.
Although this may seem harsh and defensive, it’s important to protect yourself if anything goes sideways. Unfortunately, suicides and suicide attempts are common triggers for malpractice suits.
Pay close attention you're when documenting in the patient’s medical chart.
Describe the facts exactly how they occurred, date your records accurately, and clarify any notes in the chart. Avoid drawing conclusions, apologizing, passing judgment, or justifying your treatment decisions.
Provide support to the family
Once your supervisor or risk management team permits it, contact the patient’s family to express your grief and condolences, and give them the time to ask questions. Early communication with the family can reduce anger and blame directed at physicians. Offer to meet with them, and emphasize that all efforts were made to help the patient.
The grieving process is complex when a loved one dies by suicide.
Let the family express their feelings, including venting anger and hostility. Offer to attend the funeral and discuss the autopsy report (if the family requests it). Support the family during future anniversaries and birthdays.
Seek support for yourself
"Allow yourself to experience your entire range of emotions and reactions."
— Kristen Fuller, MD
Initial emotions range from shock and disbelief to denial and depersonalization. Second-phase reactions range from grief, shame, and fear of blame to anger, internal conflict, and relief. Take care of yourself and talk to others about this experience.
It’s common to feel alone, as it may be hard to connect with co-workers who’ve not yet experienced a patient death by suicide. Lean in tight to your support network, go to therapy, adopt daily self-care routines, take time off if needed, and use online support groups to help you navigate this complex, challenging experience.
One helpful resource is the American Association of Suicidology, which provides education and training to healthcare professionals, suicide survivors, and the general public.
This organization also has established a task force to support “clinician-survivors” (healthcare professionals who've lost a patient by suicide).Read Next: Real Talk: When your patient is suicidal
Each week in our "Real Talk" series, mental health advocate Kristen Fuller, MD, shares straight talk about situations that affect the mental and emotional health of today's healthcare providers. Each column offers key insights to help you navigate these challenging experiences. We invite you to submit a topic you'd like to see covered.