{"id":2524,"date":"2022-09-28T11:39:14","date_gmt":"2022-09-28T10:39:14","guid":{"rendered":"https:\/\/springerhealthcare.nl\/france\/?p=2524"},"modified":"2023-01-24T15:57:06","modified_gmt":"2023-01-24T15:57:06","slug":"doctors-need-to-learn-to-talk-about-suicide","status":"publish","type":"post","link":"https:\/\/springerhealthplus.nl\/shmigrate\/doctors-need-to-learn-to-talk-about-suicide\/","title":{"rendered":"Doctors Need to Learn to Talk about Suicide"},"content":{"rendered":"

[vc_row full_width=”stretch_row” content_placement=”middle” css=”.vc_custom_1663187695627{padding-bottom: 37px !important;background-image: url(http:\/\/springerhealthcare.nl\/wp-content\/uploads\/sites\/24\/2022\/09\/science_connect_back.png?id=2486) !important;background-position: center !important;background-repeat: no-repeat !important;background-size: cover !important;}” el_class=”sciencetitle”][vc_column][vc_custom_heading text=”Science Connect” font_container=”tag:h2|text_align:left|color:%23ffffff” use_theme_fonts=”yes” link=”url:https%3A%2F%2Fspringerhealthcare.nl%2Ffrance%2Fscience-connect-november-2022%2F”][vc_column_text css=”.vc_custom_1663186747780{margin-bottom: 40px !important;}”]A Springer Healthcare Initiative For Pharma Professionals<\/span>[\/vc_column_text][vc_column_text]JANUARY 2023
\n<\/span>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=”.vc_custom_1538651642953{padding-top: 75px !important;}”][vc_column width=”3\/4″ css=”.vc_custom_1538657061395{border-right-width: 1px !important;padding-top: 0px !important;border-right-color: #8faec1 !important;border-right-style: solid !important;}”][vc_custom_heading source=”post_title” font_container=”tag:h1|font_size:40px|text_align:left|line_height:60px” google_fonts=”font_family:Merriweather%3Aregular%2Citalic|font_style:700%20regular%3A700%3Anormal” el_class=”title” css=”.vc_custom_1664358136969{margin-bottom: 30px !important;}”][vc_column_text el_class=”intro-box”]Medical schools have neglected suicide, one of the leading causes of death. Teaching specific skills, including empathy, can help doctors save lives.<\/strong><\/span><\/p>\n

Rodolfo Bonnin, Leonard M. Gralnik<\/span>[\/vc_column_text][vc_single_image source=”featured_image” img_size=”full” el_class=”hero-img”][vc_column_text]Credit:\u00a0insta_photos\/Getty Images<\/a><\/span>[\/vc_column_text][vc_column_text]The numbers are stark when it comes to\u00a0suicide<\/a>: It is a\u00a0leading cause of death in the United States<\/a>, and was the\u00a0second leading cause of death in the U.S.<\/a>\u00a0for people\u00a0ages 10 to 14<\/a>\u00a0and 25 to 34 in 2020. That year, millions of American adults thought of, planned or\u00a0attempted suicide<\/a>, and nearly 46,000 died by suicide according to the Centers for Disease Control and Prevention.<\/p>\n

Most people who take their own life receive services in primary care and other medical settings\u00a0in the year prior to death<\/a>. This raises many critical questions: Did the doctor note any overt or subtle signs of suicidal ideation? Did the doctor\u00a0discuss suicide with the patient<\/a>? And if not, why not? Was the doctor uncomfortable broaching the subject? Did they feel unprepared to talk about suicide? Was the patient hesitant to bring it up? If so, was there\u00a0something about the doctor-patient interaction<\/a>\u00a0that led to the patient\u2019s hesitancy?<\/p>\n

We are a board-certified academic psychiatrist (Gralnik) and a psychologist experienced in training clinicians (Bonnin) who have witnessed patients, practicing physicians, residents and students struggle with this topic. In our experience, as well as that of others, doctors in many specialties\u00a0have difficulty asking important questions about suicide<\/a>\u00a0because of the long history of stigma, stereotypes and misunderstandings about this topic. This must change.<\/p>\n

To that end, we have implemented an innovative training program at Florida International University\u2019s Herbert Wertheim College of Medicine that is\u00a0embedded throughout all four years of the curriculum<\/a>. The significance of this training is that it is a required component of several medical school courses\u2014in contrast to wellness programs, which are usually voluntary and designed to offer emotional support for students. While wellness programs may help medical students to manage their own feelings of depression, helplessness and hopelessness, they don\u2019t give them the skills needed to talk to their future patients about suicide. In our training program, sessions beginning in the first year of medical school instruct students about the prevalence of suicide, actively train them in how to interview suicidal patients and help them\u00a0develop empathy<\/a>\u00a0as a fundamentally important clinical skill. Students also participate in interactive sessions where they role-play as a patient and as a clinician assessing a suicidal patient and creating a safety plan.<\/p>\n

Based on our experience, doctors sometimes are more awkward than empathetic, beginning this conversation with a preamble or even an apology: for example, \u201cThis may seem like a strange question,\u201d \u201cI have to ask you a question that we ask all patients\u201d or \u201cI\u2019m sorry if this question seems too personal.\u201d These types of statements, while meant to put the patient at ease, may actually increase their anxiety, reinforcing the idea that suicide is a taboo subject. How can we expect our patients to be forthcoming in disclosing their suicidal thoughts if we, as doctors, remain apprehensive about the subject?<\/p>\n

Significant training about suicide usually does not begin until the third year of medical school, during psychiatric rotations in clinical settings, which gives the message that this subject is of limited importance to doctors in nonpsychiatric fields. Limiting training about suicide to psychiatric rotations also perpetuates the misconception that\u00a0suicide occurs<\/a>\u00a0only in the context of a diagnosed mental illness We think that all required clinical rotations, including surgery, pediatrics, internal medicine, neurology, family medicine, and obstetrics and gynecology should incorporate enhanced training about suicide.<\/p>\n

By including training about suicide as a fully integrated part of the curriculum, we can reduce stigma, and the topic of suicide becomes viewed as an essential part of medical training. The training also includes information about suicide as it affects medical students, residents and practicing physicians, who have\u00a0high rates of anxiety<\/a>, burnout and depression. It is ironic that medical students often neglect their own mental health struggles even while receiving training about psychiatric disorders.<\/p>\n

Our long-term objective is to prepare all doctors and other medical professionals to discuss suicide openly with their patients, paving the way to better patient care and safety. As we have implemented this curriculum, we have witnessed a significant increase in the comfort level, confidence and competency of students when interviewing real patients with suicidal thoughts.<\/p>\n

Because many suicidal people initially visit a doctor who is not a psychiatrist, it is crucial that doctors in other specialties be prepared to detect suicidal ideation, evaluate the person and take appropriate actions. Patients may feel intimidated talking to their doctor about suicide and may be more comfortable when speaking with a physician assistant, nurse or medical assistant. It is crucial that these health care professionals also receive adequate training about suicide assessment and prevention.<\/p>\n

To see any tangible change in suicide prevention in the foreseeable future, implementation of enhanced suicide-training programs in all medical schools should begin now. Continuing medical education on this topic also needs to be developed and implemented to train current practicing physicians, and to maintain the clinical skills related to suicide assessment and prevention for future graduates.<\/p>\n

A new number for the service formerly called the National Suicide Prevention Lifeline was activated recently: 988 replaces the old number, 1-800-273-8255 (TALK), for what is now the 988 Suicide & Crisis Lifeline. The much simpler three-digit number is a long-overdue step in the right direction toward helping those in need. Providing easier access to crisis intervention services and raising awareness about suicide are important, but there remains a real need to improve doctors\u2019 skills when dealing with individuals with suicidal ideation.<\/p>\n

The goal of the American Foundation for Suicide Prevention is to\u00a0reduce by 20 percent<\/a>\u00a0the annual suicide rate in the U.S. by 2025. Suicide is preventable, but this will require a shift in medical education. We still have a long way to go.<\/p>\n

IF YOU NEED HELP If you or someone you know is struggling or having thoughts of suicide, help is available. Call the 988 Suicide & Crisis Lifeline at 988, use the online\u00a0Lifeline Chat<\/a>\u00a0or contact the Crisis Text Line by texting TALK to 741741.<\/em><\/p>\n

This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of\u00a0<\/em>Scientific American.<\/p>\n

Copyright \u00a9 2022, Scientific American, Inc.<\/p>\n

About the author(s)<\/h4>\n

Rodolfo Bonnin<\/strong>\u00a0received his Ph.D. in counseling psychology from the University of Missouri. He completed his internship training at Florida State University. Bonnin is an associate professor in the department of psychiatry and behavioral health, an assistant dean and director of assessment and evaluation at Florida International University’s Herbert Wertheim College of Medicine. He is also a course co-director for professional behavior courses at the college.<\/p>\n

Leonard M. Gralnik<\/strong>\u00a0received his Ph.D. and M.D. from the University of Miami School of Medicine. He completed residency and fellowship training in general psychiatry and child and adolescent psychiatry at the University of Miami\/Jackson Memorial Hospital. He is board-certified in general psychiatry and in child and adolescent psychiatry. Gralnik is currently an assistant professor of psychiatry and behavioral health, director of the psychiatry clerkship and chief of psychiatry education at Florida International University’s (FIU’s) Herbert Wertheim College of Medicine. He is also the senior medical director of the FIU Health Psychiatry Faculty Group Practice. He is a co-author, with Douglas Flemons, of a book on suicide assessment,\u00a0Relational Suicide Assessment: Risks, Resources and Possibilities for Safety<\/em>\u00a0(Norton Professional Books, 2013).[\/vc_column_text][\/vc_column][vc_column width=”1\/4″ css=”.vc_custom_1538657003956{padding-top: 0px !important;padding-bottom: 0px !important;}”][vc_custom_heading text=”ISSUES” font_container=”tag:h3|font_size:12px|text_align:left|color:%23333333|line_height:18px” use_theme_fonts=”yes” el_class=”titlewidget”][vc_column_text el_class=”columnflex” css=”.vc_custom_1664403842065{margin-bottom: 40px !important;}”]

October 2023<\/a><\/p>\r\n

September 2023<\/a><\/p>\r\n

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