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Losing a patient to suicide is one of the most difficult and painful experiences a psychiatrist will face. In addition to concern for the patient and his or her family, psychiatrists may experience thoughts of responsibility and what they could have done to prevent the suicide. Although often trained in helping patients address grief, psychiatrists may not be as comfortable processing their own grief after the loss of a patient to suicide.
On April 24, MDedge Psychiatry hosted a conversation on Twitter to help psychiatrists examine some of their own feelings about losing patients in this way. Two psychiatrists – Dinah Miller, MD, and Eric Plakun, MD – responded to questions on this topic.
Dr. Miller is the author of numerous books and articles, including “Committed: The Battle Over Involuntary Care” (Baltimore: Johns Hopkins University Press, 2016), which she wrote with Dr. Annette Hanson, and a piece in the New England Journal of Medicine about her own experience with the death of a patient to suicide. She has a private practice in Baltimore and is affiliated with Johns Hopkins University there. Dr. Plakun is the medical director and CEO of the Austen Riggs Center based in Stockbridge, Mass., a “Top 10” U.S. News and World Report “Best Hospital” in psychiatry. He also serves on the board of trustees of the American Psychiatric Association representing New England and Eastern Canada, and was the founding leader of the APA Psychotherapy Caucus. Dr. Plakun is a board-certified psychiatrist, psychoanalyst, former member of the Harvard Medical School clinical faculty, and author of more than 50 publications.
Some of the conversation focused on the impact of patient suicide on young doctors. “I tell the residents: Never Worry Alone,” Dr. Miller wrote. “When in doubt, get supervision, curbside consult, formal paid supervision, or send the patient for a second opinion. Have friends.”
Dr. Miller also wrote that these kinds of losses are difficult for experienced doctors, but “just awful when you’re just starting out. A young psychiatrist I knew lost two patients early on in her career. Hang in there – sending support.”
Dr. Plakun wrote. “Questioning whether one wants to do such work is not unusual.”
The following is an edited version of the discussion.
Question: Have you ever lost a patient to suicide?
Dr. Plakun: This is an important subject and worth bringing to wider discussion. Thirty-eight percent of clinicians experience a significant reaction to this kind of loss.
Dr. Miller: I spent decades worrying that a patient might die by suicide. The reality was more troubling to me than I imagined. It left me more hesitant, less trusting of both the patients and myself. Not always, just at moments. The work we do is hard.
Dr. Plakun: Not one I was working with, but several after we terminated. And it has happened to patients I admitted to Austen Riggs during 35 years as director of admissions.
Dr. Miller: You know, I was struck by the fact that we have no formal way to approach this ... the APA info is for residents. This was part of why I wrote the NEJM piece, to open the conversation.
Question: How do you think the loss of your patient changed your approach to psychiatry?
Dr. Miller: One of the things I’ve heard is that recovering from this tremendous loss helps doctors/therapists to know that others have had a rough time, and that this isn’t weird or odd, and that they are not alone.
Question: How did the loss change you?
Dr. Miller: I did not feel a sense of “blame.” I imagine that would have made it much more difficult. An internist wrote to me discussing how he’d dismissed a patient’s chest pain and the patient died – there are so many layers of complexity here. So many different stories.
Dr. Plakun: I think the impact on us is great because in suicide the deceased is both victim and perpetrator of murder, while we have tried to empathize with both sides.
Dr. Miller: I imagine everyone feels some distress, some emotional response. It’s hard to imagine that a doctor or therapist would hear a patient under their care died of any cause and would feel nothing.
Closing observations
Dr. Plakun: If you lose a patient to suicide, seek consultation and support from a trusted colleague. Remember that isolation will be part of the problem, not the solution. Remember to call your insurance carrier for consultation regarding risk-management issues.
Dr. Miller: I think this topic is difficult for docs/therapists to listen to. It’s hard to sit with a friend/colleague’s pain.
Dr. Plakun: Meeting with family is an issue. The primary purpose of such meetings is to meet their needs – not your own. Help them deal with a traumatic loss causing powerful and complicated feelings. If it helps you, that’s a bonus rather than the goal of the meeting.
References
Miller D. When a patient dies by suicide –The physician’s silent sorrow. (N Engl J Med. 2019 Jan 24;380:311-3).
Plakun EM. Psychotherapy with suicidal patients, Part 1: Expert consensus recommendations. (J Psychiatr Prac. 2018 Nov;249[6]:420-3).
Plakun EM and Jane G. Tillman. Responding to clinicians after loss of a patient to suicide. Directions in Psychiatry. 2005 Oct.
Connect with Dr. Miller on Twitter at @shrinkrapdinah and with Dr. Plakun at @EricPlakunMD. And look for #MDedgeChats to find the complete conversation on Twitter. Dr. Miller and Dr. Plakun will be joining Lorenzo Norris, MD, and Jane Tillman, PhD, for a discussion of this topic from noon to 1 p.m. on Monday, May 20, at the American Psychiatric Association annual meeting in San Francisco for a live recording of the MDedge Psychcast. Join them at booth 1518!
Also, as in past years, Dr. Plakun will join Dr. Tillman to offer a workshop at the APA meeting called “Responding to the Impact of Suicide on Clinicians.” The workshop (session ID: 1054) will be held on Sunday, May 19, 10 a.m. – 11:30 a.m., in Room 153, upper mezzanine, Moscone South.
Losing a patient to suicide is one of the most difficult and painful experiences a psychiatrist will face. In addition to concern for the patient and his or her family, psychiatrists may experience thoughts of responsibility and what they could have done to prevent the suicide. Although often trained in helping patients address grief, psychiatrists may not be as comfortable processing their own grief after the loss of a patient to suicide.
On April 24, MDedge Psychiatry hosted a conversation on Twitter to help psychiatrists examine some of their own feelings about losing patients in this way. Two psychiatrists – Dinah Miller, MD, and Eric Plakun, MD – responded to questions on this topic.
Dr. Miller is the author of numerous books and articles, including “Committed: The Battle Over Involuntary Care” (Baltimore: Johns Hopkins University Press, 2016), which she wrote with Dr. Annette Hanson, and a piece in the New England Journal of Medicine about her own experience with the death of a patient to suicide. She has a private practice in Baltimore and is affiliated with Johns Hopkins University there. Dr. Plakun is the medical director and CEO of the Austen Riggs Center based in Stockbridge, Mass., a “Top 10” U.S. News and World Report “Best Hospital” in psychiatry. He also serves on the board of trustees of the American Psychiatric Association representing New England and Eastern Canada, and was the founding leader of the APA Psychotherapy Caucus. Dr. Plakun is a board-certified psychiatrist, psychoanalyst, former member of the Harvard Medical School clinical faculty, and author of more than 50 publications.
Some of the conversation focused on the impact of patient suicide on young doctors. “I tell the residents: Never Worry Alone,” Dr. Miller wrote. “When in doubt, get supervision, curbside consult, formal paid supervision, or send the patient for a second opinion. Have friends.”
Dr. Miller also wrote that these kinds of losses are difficult for experienced doctors, but “just awful when you’re just starting out. A young psychiatrist I knew lost two patients early on in her career. Hang in there – sending support.”
Dr. Plakun wrote. “Questioning whether one wants to do such work is not unusual.”
The following is an edited version of the discussion.
Question: Have you ever lost a patient to suicide?
Dr. Plakun: This is an important subject and worth bringing to wider discussion. Thirty-eight percent of clinicians experience a significant reaction to this kind of loss.
Dr. Miller: I spent decades worrying that a patient might die by suicide. The reality was more troubling to me than I imagined. It left me more hesitant, less trusting of both the patients and myself. Not always, just at moments. The work we do is hard.
Dr. Plakun: Not one I was working with, but several after we terminated. And it has happened to patients I admitted to Austen Riggs during 35 years as director of admissions.
Dr. Miller: You know, I was struck by the fact that we have no formal way to approach this ... the APA info is for residents. This was part of why I wrote the NEJM piece, to open the conversation.
Question: How do you think the loss of your patient changed your approach to psychiatry?
Dr. Miller: One of the things I’ve heard is that recovering from this tremendous loss helps doctors/therapists to know that others have had a rough time, and that this isn’t weird or odd, and that they are not alone.
Question: How did the loss change you?
Dr. Miller: I did not feel a sense of “blame.” I imagine that would have made it much more difficult. An internist wrote to me discussing how he’d dismissed a patient’s chest pain and the patient died – there are so many layers of complexity here. So many different stories.
Dr. Plakun: I think the impact on us is great because in suicide the deceased is both victim and perpetrator of murder, while we have tried to empathize with both sides.
Dr. Miller: I imagine everyone feels some distress, some emotional response. It’s hard to imagine that a doctor or therapist would hear a patient under their care died of any cause and would feel nothing.
Closing observations
Dr. Plakun: If you lose a patient to suicide, seek consultation and support from a trusted colleague. Remember that isolation will be part of the problem, not the solution. Remember to call your insurance carrier for consultation regarding risk-management issues.
Dr. Miller: I think this topic is difficult for docs/therapists to listen to. It’s hard to sit with a friend/colleague’s pain.
Dr. Plakun: Meeting with family is an issue. The primary purpose of such meetings is to meet their needs – not your own. Help them deal with a traumatic loss causing powerful and complicated feelings. If it helps you, that’s a bonus rather than the goal of the meeting.
References
Miller D. When a patient dies by suicide –The physician’s silent sorrow. (N Engl J Med. 2019 Jan 24;380:311-3).
Plakun EM. Psychotherapy with suicidal patients, Part 1: Expert consensus recommendations. (J Psychiatr Prac. 2018 Nov;249[6]:420-3).
Plakun EM and Jane G. Tillman. Responding to clinicians after loss of a patient to suicide. Directions in Psychiatry. 2005 Oct.
Connect with Dr. Miller on Twitter at @shrinkrapdinah and with Dr. Plakun at @EricPlakunMD. And look for #MDedgeChats to find the complete conversation on Twitter. Dr. Miller and Dr. Plakun will be joining Lorenzo Norris, MD, and Jane Tillman, PhD, for a discussion of this topic from noon to 1 p.m. on Monday, May 20, at the American Psychiatric Association annual meeting in San Francisco for a live recording of the MDedge Psychcast. Join them at booth 1518!
Also, as in past years, Dr. Plakun will join Dr. Tillman to offer a workshop at the APA meeting called “Responding to the Impact of Suicide on Clinicians.” The workshop (session ID: 1054) will be held on Sunday, May 19, 10 a.m. – 11:30 a.m., in Room 153, upper mezzanine, Moscone South.
Losing a patient to suicide is one of the most difficult and painful experiences a psychiatrist will face. In addition to concern for the patient and his or her family, psychiatrists may experience thoughts of responsibility and what they could have done to prevent the suicide. Although often trained in helping patients address grief, psychiatrists may not be as comfortable processing their own grief after the loss of a patient to suicide.
On April 24, MDedge Psychiatry hosted a conversation on Twitter to help psychiatrists examine some of their own feelings about losing patients in this way. Two psychiatrists – Dinah Miller, MD, and Eric Plakun, MD – responded to questions on this topic.
Dr. Miller is the author of numerous books and articles, including “Committed: The Battle Over Involuntary Care” (Baltimore: Johns Hopkins University Press, 2016), which she wrote with Dr. Annette Hanson, and a piece in the New England Journal of Medicine about her own experience with the death of a patient to suicide. She has a private practice in Baltimore and is affiliated with Johns Hopkins University there. Dr. Plakun is the medical director and CEO of the Austen Riggs Center based in Stockbridge, Mass., a “Top 10” U.S. News and World Report “Best Hospital” in psychiatry. He also serves on the board of trustees of the American Psychiatric Association representing New England and Eastern Canada, and was the founding leader of the APA Psychotherapy Caucus. Dr. Plakun is a board-certified psychiatrist, psychoanalyst, former member of the Harvard Medical School clinical faculty, and author of more than 50 publications.
Some of the conversation focused on the impact of patient suicide on young doctors. “I tell the residents: Never Worry Alone,” Dr. Miller wrote. “When in doubt, get supervision, curbside consult, formal paid supervision, or send the patient for a second opinion. Have friends.”
Dr. Miller also wrote that these kinds of losses are difficult for experienced doctors, but “just awful when you’re just starting out. A young psychiatrist I knew lost two patients early on in her career. Hang in there – sending support.”
Dr. Plakun wrote. “Questioning whether one wants to do such work is not unusual.”
The following is an edited version of the discussion.
Question: Have you ever lost a patient to suicide?
Dr. Plakun: This is an important subject and worth bringing to wider discussion. Thirty-eight percent of clinicians experience a significant reaction to this kind of loss.
Dr. Miller: I spent decades worrying that a patient might die by suicide. The reality was more troubling to me than I imagined. It left me more hesitant, less trusting of both the patients and myself. Not always, just at moments. The work we do is hard.
Dr. Plakun: Not one I was working with, but several after we terminated. And it has happened to patients I admitted to Austen Riggs during 35 years as director of admissions.
Dr. Miller: You know, I was struck by the fact that we have no formal way to approach this ... the APA info is for residents. This was part of why I wrote the NEJM piece, to open the conversation.
Question: How do you think the loss of your patient changed your approach to psychiatry?
Dr. Miller: One of the things I’ve heard is that recovering from this tremendous loss helps doctors/therapists to know that others have had a rough time, and that this isn’t weird or odd, and that they are not alone.
Question: How did the loss change you?
Dr. Miller: I did not feel a sense of “blame.” I imagine that would have made it much more difficult. An internist wrote to me discussing how he’d dismissed a patient’s chest pain and the patient died – there are so many layers of complexity here. So many different stories.
Dr. Plakun: I think the impact on us is great because in suicide the deceased is both victim and perpetrator of murder, while we have tried to empathize with both sides.
Dr. Miller: I imagine everyone feels some distress, some emotional response. It’s hard to imagine that a doctor or therapist would hear a patient under their care died of any cause and would feel nothing.
Closing observations
Dr. Plakun: If you lose a patient to suicide, seek consultation and support from a trusted colleague. Remember that isolation will be part of the problem, not the solution. Remember to call your insurance carrier for consultation regarding risk-management issues.
Dr. Miller: I think this topic is difficult for docs/therapists to listen to. It’s hard to sit with a friend/colleague’s pain.
Dr. Plakun: Meeting with family is an issue. The primary purpose of such meetings is to meet their needs – not your own. Help them deal with a traumatic loss causing powerful and complicated feelings. If it helps you, that’s a bonus rather than the goal of the meeting.
References
Miller D. When a patient dies by suicide –The physician’s silent sorrow. (N Engl J Med. 2019 Jan 24;380:311-3).
Plakun EM. Psychotherapy with suicidal patients, Part 1: Expert consensus recommendations. (J Psychiatr Prac. 2018 Nov;249[6]:420-3).
Plakun EM and Jane G. Tillman. Responding to clinicians after loss of a patient to suicide. Directions in Psychiatry. 2005 Oct.
Connect with Dr. Miller on Twitter at @shrinkrapdinah and with Dr. Plakun at @EricPlakunMD. And look for #MDedgeChats to find the complete conversation on Twitter. Dr. Miller and Dr. Plakun will be joining Lorenzo Norris, MD, and Jane Tillman, PhD, for a discussion of this topic from noon to 1 p.m. on Monday, May 20, at the American Psychiatric Association annual meeting in San Francisco for a live recording of the MDedge Psychcast. Join them at booth 1518!
Also, as in past years, Dr. Plakun will join Dr. Tillman to offer a workshop at the APA meeting called “Responding to the Impact of Suicide on Clinicians.” The workshop (session ID: 1054) will be held on Sunday, May 19, 10 a.m. – 11:30 a.m., in Room 153, upper mezzanine, Moscone South.