Assesing Suicidiality

[DO-Riz]

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Hey........as a new PGY-1...I feel that probably dealing with suicidal patients gives me the most anxiety as it is soo tough to accurately asses the intentions of a person in question. In our program during ur Call we also get phone-calls from patients via a physician hotline that they use for after hours with all sorts of questions. Some of them may be suicidal and we have to use our judgement over the phone.
I just wanted to throw the thread open to all, especially the senior Residents on here to discuss pragmatic ways when dealing with suicidal patients, be it over the phone or in person. Also what strategies that you have used that tend to deliver better results... And also what are some of the things Never to say to a suicidal patient.
any input appreciate

Riz
PGY-1

 

[whopper]

There are a number of excellent articles, especially in Kaplan & Sadock dealing with this.

However after you've read the articles, only practice helps.

I'd refer to the attending doctor heavily for at least the first month. After that you'll be able to tell with increasing ability. I didn't feel comfortable for about the 1st 6 months with this issue more or less.

 

[Anasazi23]

There are some standards, such as always obtaining the name and address of the person calling. Some go as far to say that you cannot provide any feedback or intervention whatsoever without this information. The theory being that you need an address to which to send an ambulance should you feel compelled to do so.

You'll likely find out that many callers are actually borderline chronics, and that some even get a sadistic pleasure out of getting a rise out of a hard-working doctor on call. You'll find that many of the callers call frequently...some even every day.

Practical advice, with short, brief, and professional interactions are generally all that's required. You shouldn't be expected to do counseling over the phone, or provide any other medical advice. It is inappropriate to ask a psychiatry resident to do this. Simply take their name and address, phone number, ask what the problem is, and refer them to the nearest ER if they feel they need an evaluation. Remember that the calls are often recorded, and should someone actually kill themselves, you'll be covered by providing these instructions.

 

[Anuwolf]

You'll likely find out that many callers are actually borderline chronics, and that some even get a sadistic pleasure out of getting a rise out of a hard-working doctor on call. You'll find that many of the callers call frequently...some even every day.

Us Borderlines are not evil and we do not get a sick pleasure off of getting a rise out of a doctor or to anybody else

 

[Psyclops]

Some might call every hour, but then those are the easy ones.