Adverse Experiences in Psychiatric Training. Part 2

Abstract

The high response rate of both trainees and consultants gives these results a level of representative validity. Recommendations in relation to future training and research are put forward. Specific training in the management of potentially assaultive patients and facilitating trainee recovery from assault or threat of assault should be a priority of the Royal Australian and New Zealand College of Psychiatrists. Support and education in relation to patient suicide is also important. Training and recognition of teachers within the College should be encouraged.

The role of the doctor when a patient commits suicide

“…In their questionnaire survey of consultant psychiatrists in Scotland, Alexander et al (2000) reported that 68% had a patient who committed suicide under their care. Looking at trainees in particular, for whom the impact of suicide may be greater, Dewar et al (2000) found that 47% had experienced the suicide of a patient and many trainees consider it one of the most adverse experiences of their training (Kozlowska et al, 1997). Similarly, Courtenay and Stephens (2001) report that 54% of their sample of trainees had a patient under their care who had committed suicide, a figure consistent with a rate of 0.23 suicides per training year.…”

“…Initially there are often feelings of shock or disbelief (Kozlowska et al, 1997), which may evolve into denial that the death has taken place or that the death was in fact suicide. Anger may become prominent and may be directed towards the deceased or his/her family (Jones, 1987).…”

“…Feelings of guilt and self-doubt (Kozlowska et al, 1997), which may be both strong and persistent, are frequently associated with relentless self-questioning about whether something important had been missed (Ness & Pfeffer, 1990). Such guilt and self-doubt may be exacerbated by anger and blame from others, such as the deceased's family and legal representatives (Ruben, 1990).…”

“…Fear concerning the family's reaction to the suicide and the prospect of litigation may cause anxiety (Kozlowska et al, 1997). This fear, together with that of censure from colleagues or of adverse publicity, may lead to increasing withdrawal and isolation (Jones, 1987).…”

“…The stakes are high and psychiatrists work with the constant background pressure that arises from the real possibility that the patient may commit suicide during treatment. Patient suicide is a relatively frequent event (Kozlowska et al, 1997) and may even be regarded as an occupational hazard (Chemtob et al, 1988). The reluctance of the profession as a whole to address systematically the issues that arise in the aftermath of patient suicide has far-reaching implications for mental health professionals, the families of patients who have committed suicide and, of course, the patients themselves.…”