'And then one day he'd shot himself. Then I was really shocked': general practitioners' reaction to patient suicide

Abstract

Objective: Patients who commit suicide have often seen their GP shortly before the suicide. This study explored the emotional effect of patients' suicides on GPs, and whether this effect was linked to the GPs' propensity to explore suicide risk.

Methods: Semi-structured interviews were carried out with 14 GPs sampled purposively aiming at maximum variation. Analysis by Interpretative Phenomenological Analysis.

Results: Patients' suicides had a substantial emotional effect on all GPs. Some developed a feeling of guilt and of having failed. If patients had contacted the GP about physical symptoms and the suicide ideation had not been diagnosed, this led to considerable self-scrutiny. GPs differed in their propensity to explore suicide ideation, but all were emotionally shaken and struck by guilt, failure, and self-scrutiny if a patient committed suicide.

Conclusion: A patient's suicide can be experienced as a 'critical case' that greatly affects all GPs irrespective of other differences among the GPs. The feeling of insufficiency was linked to not having realized during the visit that the patient may have had suicidal thoughts.

Practice implications: GPs' need for support in emotionally stressful situations should be investigated, and training should be directed towards discovering suicide ideation masked by vague physical symptoms.