Coping with patient suicide

A regular patient, a young high-achieving university student had died by suicide. Dr A had seen him a week ago. Shocked and with an overwhelming feeling of sadness, she sat down with many thoughts racing through her head. He seemed okay at that last consultation … He told me he’d see me next week … Did I ask him about thoughts of suicide? Did I miss something?

The death of a patient by suicide can be one of the most stressful moments in a GP’s career. While needing to provide support to the bereaved family, you may be managing your own sense of loss.

And this can be accompanied by a sense of professional responsibility. Could I have prevented this? Will I be blamed? What will the family think?

In an already devastating situation, medico-legal concerns can add to the stress.

Talking to the family

It’s common for bereaved families to want to speak with the doctor to gain an understanding of what occurred. However, a duty of confidentiality to the patient remains, even after death.

According to the Medical Board’s code of conduct:¹

4.13.11: When your patient dies, being willing to explain, to the best of your knowledge, the circumstances of the death to appropriate members of the patient’s family and carers, unless you know the patient would have objected.

If a request is made for a release of the deceased patient’s medical records,² we recommend you contact MDA National for advice.

The General Practice Mental Health Standards Collaboration (GPMHSC) resource, After suicide,3 may be helpful for GPs in responding to questions and supporting the bereaved.

Documentation and medical records

The details of notification of the suicide should be documented in the patient’s medical records. It’s important not to alter the medical records.

If you need to add something to a previous entry, make an addendum including the time and date, explaining what entry it refers to. Ensure the additional information is not gratuitous or defensive.

Coronial investigations

All suicides are reported to the coroner, whose primary role is to determine the identity of the person who died, the date and place of death, and the manner and cause of death. The coroner may ask a treating doctor for their medical records and/or a statement to assist in their investigation.

Occasionally, after reviewing the available evidence, the coroner may decide to hold an inquest. The coroner’s role is not to lay blame on any person or organisation. They may make recommendations with a view to improving public health and safety or preventing similar deaths.

We recommend you contact MDA National for advice if you’re asked to provide information to the police or the coroner regarding a patient’s death.

Getting support

Dr A’s practice manager organised a debriefing meeting with the practice staff to have an open, supportive discussion about the events surrounding the suicide.

A psychologist at the practice had also seen the patient, and the receptionists who knew him well were particularly affected.

While Dr A found this helpful, she had ongoing thoughts of what had occurred and a sense of personal failure. A large part of her practice involved managing mental health issues, and she found herself questioning whether she should continue in general practice.

She found it difficult to talk to her GP colleagues about what had happened. A sense of guilt or shame can make it difficult to reach out for support.
Speaking with a trusted colleague helped Dr A view the situation differently. She recognised that suicides are multifactorial and began feeling less personally responsible. She also thought of ways to manage her workload.

Dr A found a regular peer group to discuss difficult cases and spoke to the practice about sharing the load of complex patients.

MDA National provides a confidential peer support service for Members during a medico-legal matter.

 

Doctors are encouraged to seek formal support services if required – from their GP or the DRS4DRS service⁴ in their state or territory.

 

The RACGP offers the GP Support Program⁵ – a free service to foster self-care among general practitioners.

If you’re dealing with a patient suicide, contacting MDA National can help reduce your stress by gaining an understanding of medico-legal concerns and processes, particularly if a coronial statement is requested. Freecall: 1800 011 255, 24/7 for emergencies. 

References

1. Medical Board of Australia. Good medical practice: a code of conduct for doctors in Australia. 2020. 4.13.11: medicalboard.gov.au/codes-guidelines-policies/code-of-conduct.aspx
2. MDA National. Access to a deceased patient’s medical records. 2016: mdanational.com.au/advice-and-support/library/articles-and-case-studies/2016/11/access-deceased-patient-records
3. GPMHSC. After suicide: a resource for GPs: gpmhsc.org.au/getattachment/f4679f63-cd5a-4dfc-92b0-ee1fee04a357/gpmhsc-after-suicide-a-resource-for-gps.pdf (accessed 16 August 2021)
4. DRS4DRS: drs4drs.com.au/about-us/
5. RACGP. The GP Support Program: racgp.org.au/racgp-membership/member-offers/the-gp-support-program

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