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Losing a Patient to Suicide
My Secretary: (calling on the telephone): Dr. Myers, are you sitting down?
Me: Well, no… but yes… now I am.
My Secretary: I’ve got some upsetting news. Dr. Green just called from the hospital emergency room. Your patient, Stan Brewer (not his real name), has died. He hanged himself. They tried to resuscitate him, but he didn’t make it. I’m sorry.
Me: Thanks. I’m sorry too.
This fragment of conversation contains the kernel of what every psychiatrist dreads— the news that one of their patients has died by suicide. It’s estimated that 50% of us will lose at least one patient to suicide in the course of our careers. It is also sobering to know that 10-15% of patients with major psychiatric disorders will die by suicide— despite careful suicide risk assessment, appropriate treatment, and best standards of care. Losing a patient to suicide is ranked as one of the most difficult professional experiences.
Survival Tips:
- Immediately notify your liability insurance carrier. A risk management appraisal will be helpful even if no litigation occurs. Do not alter your clinical record in any way.
- Reach out to the newly bereaved family and offer to meet with them. You can be genuine and empathic “I’m sorry to convey this sad news…” “I’m sorry for your loss…”. Not only do survivors appreciate this, but kindness and genuineness also reduce hostility, anger at caregivers, and the urge to sue. In a face-to-face meeting you can provide support and answer many questions without breaching physician-patient confidentiality. It is critical not to make culpable or self-incriminatory statements about the management of your deceased patient.
- Be prepared for some disequilibrium in your emotional state and behavior. Short-term symptoms are not uncommon: shock, anger, grief, guilt, withdrawal, diminished self-esteem, and shame. You may worry about your clinical judgment, and your professional confidence may get jarred, resulting in obsessive checking of your patients’ diagnoses, charting, and treatment plans.
- Attending the funeral or memorial service helps healing and resolution. Your presence will mean a lot to the family.
- Take care of yourself. Don’t isolate. Watch your alcohol intake. Talk to your family and colleagues. Attorneys advise against discussing clinical details, but seeking support is acceptable and salutary. Consider psychotherapy and/or spiritual sustenance if so inclined. Two wonderful resources are the Clinician Survivor Task Force of the American Association of Suicidology ( www.suicidology.org ) and the Physician Litigation Stress Resource Center ( www.physicianlitigationstress.org ).
References:
1. Hendin H, Lipschitz A, Maltsberger JT et al: Therapists’ reactions to patients’ suicides. Am J Psychiatry. 2000;157:2022-2027.
2. Gitlin M: Psychiatrist reactions to patient suicide. In: Simon RI, Hales RE, eds. Textbook of Suicide Assessment and Management . Washington, DC: American Psychiatric Publishing, 2006: 477-494.
3. Myers MF, Gabbard GO. The Physician as Patient: A Clinical Handbook for Mental Health Professionals . Washington, DC: American Psychiatric Publishing, 2008:185-203.
Dr. Myers is Professor of Clinical Psychiatry and immediate past Vice-Chair of Education and Director of Training in the Department of Psychiatry & Behavioral Sciences at SUNY-Downstate Medical Center in Brooklyn, NY. He is the author of seven books the most recent of which are “Touched by Suicide: Hope and Healing After Loss” (with Carla Fine) and “The Physician as Patient: A Clinical Handbook for Mental Health Professionals” (with Glen Gabbard, MD). He is a specialist in physician health and has written extensively on that subject. Currently, Dr Myers serves on the Advisory Board to the Committee for Physician Health of the Medical Society of the State of New York. He is a recent past president (and emeritus board member) of the New York City Chapter of the American Foundation for Suicide Prevention.
The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors. Blog entries are not medical advice.
