Don't blame the clinicians for not identifying suicidal patients? Why not?
Clinicians sadly fail to detect suicide potential in their patients all the time,
and in spite of the fact that the patient's indicate they are having
suicidal thoughts or have symptoms of depression or anxiety which should trigger a suicide assessment. I would not schedule a return visit to an internal medicine physician who asks me to draw my own blood and tell him the platelet count. That's the clinician's job. But in delivering services to those with mental health issues, the
burden of disclosure of suicidal ideation, feelings and plans is at times inappropriately
placed upon the patient, not on the clinician. When this happens the clinician is practicing below the standard of care. It is no wonder clinicians are are "surprised" when their patient dies by suicide. When suicidal thinking is not properly explored by a clinician and the patient later suicides, a properly trained lawyer should be contacted to determine if the clinician is at fault for the suicide.
Should clinician blame the patient for not telling the clinician he/she is suicidal?
The short answer is no. But a patient should tell his clinician if he/she is thinking about suicide. But this frequently is not easy for the patient to do. There are times that certain fears prevent honest discussion. For example, there is a concern that acknowledgment of suicidal intent will void the patient's insurance coverage (Not True)...Second, the patient may be afraid that if he or she acknowledges suicidal intent, the clinician will "put them away." Patients need to understand that It is useful to explain to their clinicians how they are feeling about suicidal issues. The absence, rather than the presence, of clear information on this point may obligate your clinician to recommend inpatient treatment. Having more accurate information actually may allow the patient and clinician to consider less restrictive alternatives."
It is clear, however, that a clinician is obligated to inquire about suicidal thinking if the patient does not bring the subject up.
Where does the warning label belong?
Consider the several year flap that antidepressant medications need warning labels by the FDA because of their potential for increasing suicide risk. While a warning is needed,I think the FDA recommendation misses the point; the warning label needs to be put on the forehead of many clinicians and over the doorways of some psychiatric units, not the pill.
When it comes to assessing and managing suicide, the mental health industry is under-trained
With few exceptions, the American healthcare industry is under-trained and
generally incompetent to detect and assess suicide risk in the patients for
whom they prescribe these otherwise helpful agents.
Among the findings published in the 2002 Institute of Medicine (IOM) report, Reducing Suicide, a National Imperative, are following:
a.. Most people who complete suicide had contact with a health
professional within a year of death, and 40 percent of these contacts were
within one month of their death. Many people die by overdose on the
prescription medications provided them at these visits.
b.. Screening for depression, substance abuse and suicide potential is not
routine in primary care, even though primary care providers are often the
"first and only medical contact" suicidal patients have with the healthcare
system. As a result, suicide risk is not detected. If questions about suicide are not asked, is it any wonder clinicians are surprised by a suicide?
Bottom line: If you have a loved one who has died by suicide while under the care of a hospital or clinician, contact a trained lawyer for a consult.
I review about 40-50 suicide cases each year. I accept on average about 5-6. I approach these cases just like I approached federal criminal cases as an assistant United States Attorney: very carefully. Unless a clinician has clearly failed a patient, and those failures resulted in an attempted or completed suicide, I will not take the case. I spend a great deal of my time teaching clinicians how to avoid the malpractice snare. If a clinician has properly assessed a patient and that fact is documented before the suicide, I uniformly decline the case.
On the other hand, if a clinician has negligently causes a loved one to die by suicide, I then spend a lot of time with a potential client explaining the pros and cons of a law suit. If after that explanation the potential clients wants to file suit, suit is filed.
I am trying to reduce suicide first by prevention (see "The Suicide Lawyer: Exposing lethal secrets "& clinician training) and if that fails, by enforcment in the courts.