Doctors can better help patients with mental health concerns by adopting a different questioning style around self-harm and suicide, experts have said.
New research warns that patients may find it difficult to express thoughts of self-harm because of the way GPs ask about them.
Academics who consulted on consultations found that GPs tended to ask questions in a way that invited a “no” answer (eg “Have no thoughts of harming yourself?” ) And that patients were later when they reported thoughts about themselves. -harm.
The study says conversations about self-harm could be developed by GPs using a more open-ended questioning style. This would mean recognizing that patients may say “yes” when asked about thoughts of self-harm.
Researchers also say that doctors can better help patients with mental health concerns if they ask them individual questions about self-harm and suicide. Doctors should do more to stimulate discussion when there are ambiguous responses and carry out wider studies to see if patients have anxious thoughts.
Academics examined video-recorded consultations from the One in a Million data archive. These consultations took place between 2014 and 2015. The researchers selected all consultations with a discussion of self-harm and suicide (18 in total) and analyzed how which broadened those conversations.
The research was carried out by Joseph Ford and Felicity Thomas of the University of Exeter, Richard Byng of the University of Plymouth and Rose McCabe of the City of the University of London and is published in the journal Patient Education and Counseling.
Many patients who die by suicide have seen their GP in the month before death, which shows the importance of these conversations. We know from earlier research, however, that many doctors find these conversations difficult. They worry about reducing patients’ thoughts about suicide, or even putting those thoughts in their heads. “
Joseph Ford, University of Exeter
“Our goal with this research was to find out how these conversations expand in practice. By looking closely at real records, we are able to identify ways to communicate around has developed these important topics. “
During the consultations, patients who admitted to having thoughts of self-harm often did so in a lazy manner that reduced the severity of those thoughts. This may mean pausing long before you answer or reply as “I am in some ways” rather than a clear “yes”.
Dr McCabe said: “People with suicidal thoughts and / or suicides are less likely to share them with friends or family so conversations with professionals are very important. It’s hard to admit it to yourself. and for others that you are worried about.thought and thoughts feel a lot of shame and guilt.So there are questions that keep those thoughts further under the surface of the difficult conversation.G GPs should and other professionals be aware of this and ask, for example, ‘Sometimes people think that they will hurt themselves when they feel this way, is this something you have experienced? Sometimes people have thoughts of ending their lives when they feel like this, is this something you experienced? ‘”.
Patients also kept themselves away from the negative stigma associated with self-harm, describing how they would not act on their thoughts because of the impact it would have on their family.
The study suggests that doctors can alleviate such stigma by asking about the patient’s positive reasons for wanting to survive rather than the negative impact the self- killed those around them.
The study also found that GPs focused heavily on the potential for patients to put their ideas into action. While this allowed them to implement appropriate measures, there was a risk of not noticing those patients who experienced thoughts of self-harm. It can also be to avoid examining what some patients want to actively do to address their condition.
Dr Byng said: “While we recognize the distress experienced by patients and the anxiety experienced by doctors at these events, we suggest that practitioners can be supported to engage in conversations. move to a more therapeutic listening mode or even further around to help people see hope through the results. of their own positive future actions. “
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Magazine Reference:
Ford, J., et al. (2020) Asking about self-harm and suicide in primary care: moral and practical dimensions. Patient Education and Counseling. doi.org/10.1016/j.pec.2020.09.037.