The Role of General Practitioners in Suicide Prevention—What You Said and Did then Actually Saved My Life
2. Materials and Methods
2.1. Setting and Recruitment
- What is the role of the GP in suicide prevention?
- What are the GPs doing to prevent suicidal behavior among their patients?
- How do the GPs experience meeting with suicidal patients?
- What do they experience as negative and difficult?
- What will they advise other GPs?
2.3. Data Analysis
3.1. Initial Diagnosis
3.2.1. Unrecognized Symptoms
I met a very interesting man for about x years ago, I still have him on my list, that’s why I remembered him. He received a severance package, was fired from work or pre retired or something. Came and complained about ..(thinking) … very straight forward kind of type without any reflections about emotions or something like that. And he came and explained how he was doing, I listened and asked a bit..and at the end I said to him: Do you feel sad and down? “Yes, I do” he said, “Are you depressed?” “O yes.. (curses).. yes so that is what it is..”
So, he understood that this was an emotional reaction he had and that he could live with, you know… he was afraid that he had gotten cancer.
I recently had a patient that came to me, for not psychiatry, but I started to suspect that there was “some psychiatry here”. A smart man, in fulltime job, in his 50s, but as I understood was a little… um… what can I say “weird” and I felt it was ok to ask questions about that and then he became very denying as he came to me for problems with his knee. And one week later he was hospitalized with suicide attempt where he had cut himself in the arm: I hadn’t seen that coming even though I thought that something was wrong with that man, so it was not possible to pressure him to talk about it, but I sort of invited him to an appointment or open dialog if he needed it, so… and when he came to me for a consultation after the suicide attempt and told that he did it because of the knee problem. I really didn’t believe that.
3.2.2. Masking Actual Problems
“.. very often there are patients that come to us with a defined problem that is not the case, and after a while we learn that they can come to us with a slow concrete banal ailment. It can be something physical, like:
“I have pain somewhere and wonder what it might be.” in the way that one senses that it may not only be this, but think that they have scheduled an appointment for something they come up with to make contact…
«It might be that they make up something to avoid the receptionist” … And that they don’t want to tell others than the GP.. maybe even difficult to talk about with the GP and I think as a GP you should be very aware of that… If you can sense it and ask that question.
3.3. Cues and Concerns: Patient Disclosure of Problems
3.3.1. Explicit Verbal Implication Example
.. I have called the acute team several times when I have suspected that something has to be done immediately, for example I had a woman in her fifties, very up- and coming resourceful woman who said: “If nothing happens now I will drive into a wall.. or I am like complete out now..um.. It has been psychiatric problems all the way, and she was like all out now.. I called, then I called the team right way, and they took care of her and initialized hospitalization.
And if someone is so open and direct it is much easier to deal with, it’s difficult when someone just turn their back and pretend that everything is ok, and it isn’t. That is difficult.
“Because if you don’t ask and dig into it…um.. then you often will only get information about something that might be rooted in something deeper, and so it is not always you get it in a twenty-minute consultation, but then, if I sense it, in this case it is important to seize, I often end the conversation by having a dialog with the patient in order to have a new conversation … and they think of that as positive and I schedule one hour to talk more about the psychiatric part, then it is incredible how much that is disclosed and revealed because then we are both prepared to talk and if you dig deeper and ask you will find out a lot”.
3.3.2. Indirect Verbal Implication
3.3.3. Non-Verbal Implication
“ If I am sitting with a bad gut feeling”, “Sometimes I just get concerned” and “You have to be aware of whether this trigger any tears or feelings in yourself”.
“But there are these youngsters, like they are really ill and stuff… they don’t get in touch to get help and you have to grab a hold of yourself and I get very worried for them if they don’t pick up the phone when I try to call them several times”.
“It is most often the boys I have noticed, like around 30 to 45 years. In these age groups is it a lot… I don’t know if I is because I am female doctor that they are maybe don’t able to talk about, they somatize a lot and some come and say that they have migraine and I say that if you have so much migraine maybe we have to figure it out, and then it actually was anxiety…”
3.3.4. Non-Explicit Patients and the “Black Box”
“I follow up if I have a feeling that there is something and then I call, but it was to late, but I don’t know really, it isn’t always possible to do something…”
“I think that among some patients it is impossible to enter the patients inner “black box”, and in some cases it is not possible to crack it, they never reveal their inner thoughts.”
3.4. Clarifying Phase: Tuning into the Essence of the Problem and Forming an Alliance
“I think that… as a new general practitioner… you have to do a thorough anamneses and get to know the patient and that is the positive thing about being a general practitioner, that you know the patient and can schedule a new appointment soon and you can tell them that you can call the next day… it is a low threshold to come back, the MADRS is useful, because then you get to catch sleep, anxiety and different things in a good way..”
“…But the ones that don’t quite understand that they might have a depression, you have to be careful and take it slowly to get them to follow and agree to the fact that this might be due to depression.”
“You cannot just throw a depression diagnose into their lap»
“Of course, we examine all kinds of possible explanations, with blood samples, cardiologist, and neurologist, but if we don’t find anything, we have to cut the crap and find the real problem”
“So why can you not listen to me for the twentieth time, instead of your friend that happened to read about this in a magazine or at Google…”
“We have to look them in the eye, endure latency and show them interest and understanding”
3.5. Identification of Suicide Ideation
“We don’t ask about suicidal thoughts when they get a prescription on p-pills you know”
“We bring it up after a while, it is a reason why that question is the last one I MADRS”
3.6. Preventive Interventions in General Practice
“..But in the aftermath some patients have come to me and said: That thing you said at that point, or what you did then, that saved my life”
Some try without a specialist and then we try other things, routines, sleep, eat properly…. just come to talk and figure out things. It is often helpful to come and talk about and turn around on things, it is often job stuff. Many are unsatisfied at work, but then you must do something about it… I am a mother, a coach a psychologist…
“I will help you getting through this”, “I will be here for you”, “I can help you get through this”, “I am good at this”, “It is not dangerous”, and “It will be better when we have found out of these problems that you have” “I will take care of you, I am good at this”.
“If I have a feeling that something is wrong, I call them”
4.1. Summary of Main Findings
4.2. Strengths and Limitations of the Study
4.3. Comparison with the Existing Literature
4.4. Clinical Implications
4.5. Implications for Future Research
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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Styrvold, M.; Grimholt, T.K. The Role of General Practitioners in Suicide Prevention—What You Said and Did then Actually Saved My Life. Reports 2021, 4, 23. https://doi.org/10.3390/reports4030023
Styrvold M, Grimholt TK. The Role of General Practitioners in Suicide Prevention—What You Said and Did then Actually Saved My Life. Reports. 2021; 4(3):23. https://doi.org/10.3390/reports4030023Chicago/Turabian Style
Styrvold, Marte, and Tine K. Grimholt. 2021. "The Role of General Practitioners in Suicide Prevention—What You Said and Did then Actually Saved My Life" Reports 4, no. 3: 23. https://doi.org/10.3390/reports4030023