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Articles: Sharon R. Foley and Brendan D. Kelly When a patient dies by suicide: incidence, implications and coping strategies Adv Psychiatr Treat 2007; 13: 134-138 [Abstract] [Full text] [PDF]

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How do we break the bad news?

Anna M Lund   (2 April 2007)

How do we break the bad news? 2 April 2007
Anna M Lund, Senior House Officer in Psychiatry North Trent Rotational Scheme Send letter to journal: Re: How do we break the bad news? earlid{at}yahoo.com Anna M Lund	The recommendations that Foley and Kelly (2007) describe to lessen the adverse impact of patient suicide on psychiatrists are clear and very helpful. It is likely that in the course of our psychiatric careers we would experience a patient suicide (Chemtob et al, 1988). I would like to suggest that the way clinicians are informed of the suicide of a patient should also be part of these formal support and education structures. Communication of bad news to patients has improved with awareness in medical schools and post graduate training of the need to teach medical staff better ways of breaking bad news. Despite this I believe we are still poor at telling other professionals bad news. It is of note that there is very little literature in this area despite the severe emotional impact patient suicide can have (Courtenay and Stephens, 2001). I have heard reports of fellow colleagues hearing about a patient suicide via the television or radio or by being invited to the critical incident review meeting. We would be castigated for treating a relative in this way if it could be avoided, however we don't seem to have this same level of concern and need to sensitively communicate this difficult information to our colleagues. I would remind colleagues that psychiatric trainees can easily become lost in the system. It is of interest that colleagues are consistently identified as an important source of support (Chemtob at el, 1988). Unfortunately, SHOs as a necessity of their training move every 6 months and therefore lose their immediate work support structures and need to rebuild these every time they move post. Therefore I would wholeheartedly support enhanced formal support structures and a greater emphasis on patient suicide during training. References Foley, S. and Kelly, B. (2007) When a patient dies by suicide: incidence, implications and coping strategies. Advances in Psychiatric Treatment, vol. 13, 134-138. Chemtob, C.M., Hamada, R.S., Bauer, G., et al (1988) Patients suicides: frequency and impact on psychiatrists. American Journal of Psychiatry, 145, 224-227. Courtenay, K.P. and Stephens, J.P. (2001) The experience of patient suicide among trainees in psychiatry. Psychiatric Bulletin, 25, 51-52.