# Doctors Often Fail to Spot Suicidal Patients



## Halo (Sep 25, 2007)

Doctors Often Fail to Spot Suicidal Patients

MONDAY, Sept. 24 (HealthDay News) -- Pointing to a disconnect between doctors and some of their neediest patients, a new study suggests that large numbers of physicians fail to spot symptoms that raise suicide risk. 

U.S. researchers recruited actresses to act as patients and visit physicians while showing signs of depression or a similar disorder.

Only 36 percent of the doctors asked the "patients" about suicidal thoughts, the team found. 

"There is often a window of opportunity for doctors to screen for suicidality and intervene appropriately, but, as we found, they frequently miss this opportunity," said study lead author Dr. Mitchell Feldman, professor of medicine at the University of California at San Francisco. 

According to Feldman, an estimated 2 percent to 7 percent of patients who visit primary-care physicians are thinking about suicide. In fact, as many as 75 percent of people who commit suicide visited a primary-care provider in the 30 days before killing themselves, the research shows.

Still, patients at risk of suicide rarely mention the topic directly to physicians, leaving it up to doctors to figure out what's going on.

"Remarkably little is known about the factors that influence whether primary-care physicians broach the topic of suicide with their depressed patients," Feldman said. 

In the new study, researchers recruited 152 physicians from northern California and Rochester, N.Y., to take part. All were told they would get unannounced visits by actors portraying patients who would tape-record their conversations.

A total of 18 actresses visited the doctors playing two types of patients -- a person with major depression or a person with an "adjustment disorder," a catch-all term encompassing a variety of mental problems. Some of the "patients" asked for medication.

The findings are published in the September/October issue of the Annals of Family Medicine. 

Doctors were more likely to pursue the prospect of suicide if the "patients" said they had major depression or asked for medication. Doctors who had personal experience with depression were three times more likely to look into suicide. 

"Most physicians are not adequately trained to diagnose and treat mental and behavioral problems generally, and this problem is magnified with an issue like suicide that may evoke discomfort in some physicians who will then avoid the topic," Feldman said. "Some mistakenly believe that if they inquire about suicide, they will prompt the patient to consider it."

Feldman added: "I describe suicide as another of the Pandora's Box issues -- like domestic violence -- that doctors may avoid broaching for fear that once they bring it up, they will be unable to contain the patient's emotional responses. And, in addition, they will put themselves way behind schedule."

David Rudd, chair of the psychology department at Texas Tech University, agreed with Feldman. Rudd, who's familiar with the study findings, blamed physician inaction on inadequate training, a fear of making things worse, and "anxiety and apprehension about handling suicidal crises."

What to do? Feldman said doctors need better education about suicidal patients, and patients need to know more about depression and feel comfortable asking for help. "We found that patients who make requests get more thorough and appropriate care including more inquiries about suicide from their physician."

Rudd put it this way: "Physicians are the primary access point for the majority of distressed, suicidal patients. This is critical to saving lives


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## ladylore (Sep 25, 2007)

> that doctors may avoid broaching for fear that once they bring it up, they will be unable to contain the patient's emotional responses. And, in addition, they will put themselves way behind schedule."



I see the point but I still don't agree with it.

But I am wondering - when a patient discloses they want to commit suicide are doctors legally bound to report it? I know counsellors are legally bound to call the police. So I am also wondering, if reporting is mandatory, would that not be a reason why someone would not disclose as they are looking for help but not to be locked up.

What would a doctor do in this type of situation? Anyone out there know?

Ladylore


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## Halo (Sep 25, 2007)

If I am correct, yes I believe that all doctors, therapists, counsellors etc. are obligated to report a patient that is a danger to themselves or others.  That could definitely be why some patients fail to disclose to their doctors that they are suicidal.

As for what the doctor would do, I would think that they would probably have the patient brought to the local emergency department.

This is just what I think but someone may know different.


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## Retired (Sep 25, 2007)

I am not sure that there is an obligation to report a person who is believed to be suicidal, only a person believed to be a threat to someone else, but I stand to be corrected.

This may vary as to jurisdiction, also.

I would suggest that there may be a deficiency in the training of physicians in suicide intervention.

Although physicians working as general practitioners or family practice physicians do a rotation in Psychiatry during their training, many may not adjust well to treating mental illness.



> Doctors who had personal experience with depression were three times more likely to look into suicide.



This statement seems very telling about how personal bias can affect the performance of a physician's patient care.

Suicide intervention is a very specific skill that should be learned by all health professionals who might be in a position to encounter potentially suicidal patients.

Once the intervention is started, it must be taken to its conclusion, for the safety of the patient.



> that doctors may avoid broaching for fear that once they bring it up, they will be unable to contain the patient's emotional responses. And, in addition, they will put themselves way behind schedule."



Although the motivations are different in the U.S. and in Canadian practices, each patient visit is, regrettably, under a time constraint.


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## Cat Dancer (Sep 25, 2007)

I told my doctor once that I was suicidal and he didn't report it. He just made me promise to hospitalize myself which I did a few days later.


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## ladylore (Sep 26, 2007)

> I am not sure that there is an obligation to report a person who is believed to be suicidal, only a person believed to be a threat to someone else, but I stand to be corrected.



You have the correct wording Steve. I know the agency where I recieve counselling is the need to report whether someone is actively suicidal or of course where children are involved. 
For myself, because the policy is stated to you from the onset, I have never disclosed suicidal feelings - even if the feelings are blatantly visible, on the off chance I would be locked up and not recieve proper assistance.


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## Halo (Sep 26, 2007)

That is what I thought too Ladylore, that a doctor has an obligation no matter what to take action if a patient is suicidal.  I know my current psych has told me that if I express suicidal intentions then she, by law must take action.  Although she hasn't stipulated exactly what that is, I believe and fear that it will be hospitalization so I haven't been honest with her when I am feeling that way.  

I can say that we have come to an understanding that the use of certain other words can have the same meaning without me actually have to be using the word Suicide.  She can also tell now when I am feeling really low and the thoughts of suicide are on my mind and I don't need to tell her when I am feeling that way.  We also are really big on the use of promises, even short term ones which we are both comfortable with.


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## Mari (Sep 26, 2007)

> But I am wondering - when a patient discloses they want to commit suicide are doctors legally bound to report it? I know counsellors are legally bound to call the police. So I am also wondering, if reporting is mandatory, would that not be a reason why someone would not disclose as they are looking for help but not to be locked up.
> 
> What would a doctor do in this type of situation? Anyone out there know?



H! My understanding so far is that there is no legal requirement but therapists are given specific guidelines and sometimes request patients sign a form to let them know of their obligation to report specific situations such as suicide, homicide, and certain abusive situations. I have spoken with police, a lawyer, and various counselors with no consensus. I have an appointment tomorrow and if things go well I might ask her opinion. :heart: Mari


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## Into The Light (Sep 27, 2007)

when i was in an acute crisis my doctor sent me to the emergency room. after they took all my information and then interviewed me they asked me what i wanted to do. i said i wanted to stay, but i am pretty sure had i told them i wanted to go home that they could not have made me stay.


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## Mari (Sep 27, 2007)

H! I posed the question to my counselor today and basically received the same answer as I have from everyone else. She does not know of any specific law or regulation that requires reporting of suicidal patients although she assumes that there is one. She outlined what she might do in a particular situation but that is based on her own sensibilities and her professional responsibilities. She did say that she would follow up on this and would also speak with the doctor on this matter. Maybe when Dr. Baxter is feeling better he can offer some insight on this. I can understand that someone would not want to mention certain feelings or thoughts to a therapist if they were worried about being locked up against their will. Hugs to everyone who needs one. :heart: Mari


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## David Baxter PhD (Sep 28, 2007)

Mari said:


> H! I posed the question to my counselor today and basically received the same answer as I have from everyone else. She does not know of any specific law or regulation that requires reporting of suicidal patients although she assumes that there is one. She outlined what she might do in a particular situation but that is based on her own sensibilities and her professional responsibilities. She did say that she would follow up on this and would also speak with the doctor on this matter. Maybe when Dr. Baxter is feeling better he can offer some insight on this. I can understand that someone would not want to mention certain feelings or thoughts to a therapist if they were worried about being locked up against their will. Hugs to everyone who needs one. :heart: Mari



It may not be a criminal code issue but there most certainly is a legal and ethical responsibility to do whatever is necessary to try to prevent imminent harm to self or others. As far as I know, there is no distinction in terms of legal responsibility between harm to self and harm to others - if you have credible information which would reasonably lead you to conclude that a person is an imminent danger and you fail to act on that information, you can and likely will be held legally and ethically responsible for failure to act.


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