Know these 7 steps for responding to physician suicide

Losing a colleague to suicide is shocking and traumatizing, and can have devastating long-term effects on those left behind. While many health care organizations have made strides in preventing physician suicide by tackling the systemic drivers of physician burnout and promoting doctors’ well-being, a number remain uncertain on how best to respond in the event of a suicide.

A new AMA STEPS Forward™ open-access toolkit, “After a Physician Suicide,” developed in collaboration with the American Foundation for Suicide Prevention, has step-by-step guidance for providing immediate help to family members and close colleagues, as well as reducing the risk of suicide contagion and further distress among colleagues. The toolkit also features a framework for organizational change to reduce physician burnout and the risk of suicide.

“In the event of a physician suicide, it is extremely beneficial to have a plan of action already in place,” the toolkit notes. Physician practices and other health care organizations should follow seven key steps to ensure they respond compassionately and effectively.

Following are highlights of each of these steps.

This group carries out all the critical aspects of crisis management, including communicating with, and supporting, the community and preventing suicide contagion. It should have four to five people, drawn from organizational leaders and faculty and nonclinical team members, as well as mental health or spiritual professionals. The toolkit includes a checklist to use as a starting point for the crisis response team or work unit leader.

“Making contact is difficult but necessary,” the toolkit says of the need to reach out to the family or emergency contacts of the physician who has died of suicide. The purposes are not just to share condolences but also to summarize support and benefits available and learn what information is appropriate to share with the deceased’s colleagues. The toolkit includes a list of topics to cover in the ensuing days and weeks.

Sharing only the information that the deceased’s family or emergency contact approves, leadership should arrange an initial notification meeting with the physician’s close colleagues. The toolkit cites the points to discuss and includes sample scripts for in-person notification.

“It is critically important to take steps to minimize” the risk of suicide contagion, the toolkit notes, adding that this is accomplished by continually including support and mental health resources in communications. It includes specific responses to each of a half dozen sensitive topics, as well as a sample media statement and key messages for media spokespeople.

For those in the practice or work unit of the physician who died of suicide, the AMA toolkit suggests arranging workload and inbox coverage, rescheduling appointments or procedures and notifying patients.

“This can be done in the same manner as nonsuicide deaths,” the toolkit says. But “no mention of death should be made to patients until after the emergency contact or family representative has made a public announcement.”

“The approach for responding to the death of a physician from suicide should be the same as from a car crash or cancer,” the toolkit notes, adding that this minimizes stigma and reduces the risk of suicide contagion. It includes a memorial service planning checklist and more than a dozen important things to remember when holding the service.

“Organizations should deeply investigate how physicians are supported in the aftermath of medical errors, during malpractice litigation suits and in response to local drivers of burnout, implementing necessary system-level change from the top down,” the toolkit says.

The AMA provides additional resources for preventing physician suicide. In the event of the suicide of a resident, fellow or medical student, organizations should consult dedicated resources from the American Foundation of Suicide Prevention.