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Abstract
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'I'm really sorry, it's just something we have to ask everyone, but you've not had any thoughts of hurting yourself or anything like that, have you?'
I cringed as I read the article by Ford and colleagues1 that had somehow found its way into my Twitter feed, seeing my own half-hearted phrasing reflected back at me.
I generally consider myself all right at mental health consultations and often find the need to directly ask these questions quite clunky, preferring to rely on my rapport with the patient, the history of their distress, and an instinctive impression of the seriousness of the presentation. Like a lot of the doctors in the recorded consultations that the research team analysed, I ask them -- but I'm not asking them in a way that invites a 'yes'.
WHAT IF THEY SAY YES?
We have it drummed into us that asking about self-harm and suicide is one of the key parts of a mental health history, particularly in patients presenting with depression. However, some of us worry that it might interrupt the flow of the consultation, or even put the idea in their head.2 That's not ideal.
At the same time -- what if we ask it and they say yes? That's going to be awkward. What do we do then? Spend an hour on the phone to Crisis? Can't really be having that either. And they're probably fine anyway; they seem fine. Perhaps this is partly why we frame the question in the way that is seeking a negative answer. Sure enough -- a 'no' answer was found to close down the conversation around self-harm in nine out of 10 cases in the study.
I'm not suggesting that all GPs are as awkward as me about this and I'm sure some people do it excellently, but clearly there is room for improvement. For what it's worth, the psychiatrists aren't much better
Language: en |