--- title: "PCP responses to seniors' suicidal thoughts. | Sutter Health" description: "Identify patterns in physician-patient communication regarding suicide to inform QI interventions." url: "https://www.sutterhealth.org/research/publications/pcp-responses-to-older-adults-thoughts-of-suicide-1055312695" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. PCP responses to seniors' suicidal thoughts. # Now what should I do? Primary care physicians’ responses to older adults expressing thoughts of suicide. Vannoy SD, Tai-Seale M, Duberstein P, Eaton L, & Cook M. _J Gen Intern Med. 26(9):1005-11. doi: 10.1007/s11606-011-1726-5. Epub 2011 May 4._ 2011-09-01 ## Abstract BACKGROUND: Many older adults who die by suicide have had recent contact with a primary care physician. As the risk-assessment and referral process for suicide is not readily comparable to procedures for other high-risk behaviors, it is important to identify areas in need of quality improvement (QI). OBJECTIVE: Identify patterns in physician-patient communication regarding suicide to inform QI interventions. DESIGN: Qualitative thematic analysis of video-taped clinical encounters in which suicide was discussed. PARTICIPANTS: Adult primary care patients (n = 385) 65 years and older and their primary care physicians. RESULTS: Mental health was discussed in 22% of encounters (n = 85), with suicide content found in less than 2% (n = 6). Three patterns of conversation were characterized: (1) Arguing that "Life's Not That Bad." In this scenario, the physician strives to convince the patient that suicide is unwarranted, which results in mutual fatigue and discouragement. (2) "Engaging in Chitchat." Here the physician addresses psychosocial matters in a seemingly aimless manner with no clear therapeutic goal. This results in a superficial and misleading connection that buries meaningful risk assessment amidst small talk. (3) "Identify, assess, and…?" This pattern is characterized by acknowledging distress, communicating concern, eliciting information, and making treatment suggestions, but lacks clearly articulated treatment planning or structured follow-up. CONCLUSIONS: The physicians in this sample recognized and implicitly acknowledged suicide risk in their older patients, but all seemed unable to go beyond mere assessment. The absence of clearly articulated treatment plans may reflect a lack of a coherent framework for managing suicide risk, insufficient clinical skills, and availability of mental health specialty support required to address suicide risk effectively. To respond to suicide's numerous challenges to the primary care delivery system, QI strategies will require changes to physician education and may require enhancing practice support. [PubMed abstract](http://www.ncbi.nlm.nih.gov/pubmed/?term=Now+What+Should+I+Do%3F+Primary+Care+Physicians%E2%80%99+Re) ## Research topics - [Aging and Longevity](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Aging+and+Longevity%5C%22%22) - [Mental Health](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Mental+Health%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [How do primary care physicians respond when patients cry during routine ambulatory visits?](https://www.sutterhealth.org/research/publications/how-pcps-respond-when-pts-cry-in-outpt-visits-1055312766) Stults CD, Elston Lafata J, Diamond L, MacLean L, Stone AL, Wunderlich T, Frankel RM, Tai-Seale M. J Comm Healthcare. 7(1):17-24. DOI: http://dx.doi.org/10.1179/1753807614Y.0000000044 2014 Mar 01 - Publication ### [Expressing uncertainty in clinical interactions between physicians and older patients: what matters?](https://www.sutterhealth.org/research/publications/expressing-uncertainty-in-clinical-interactions-1055312608) Tai-Seale M, Stults C, Zhang W, Shumway M. Patient Educ Couns. 86(3):322-8. doi: 10.1016/j.pec.2011.06.005. Epub 2011 Jul 20. 2012 Mar 01 - Publication ### [Two-minute mental health care for elderly patients: inside primary care visits.](https://www.sutterhealth.org/research/publications/two-minute-mental-health-care-for-elderly-patients-1055312643) Tai-Seale M, McGuire T, Colenda C, Rosen D, Cook MA. J Am Geriatr Soc. 55(12):1903-11. 2007 Dec 01 - Publication ### [Patients with mental health needs are engaged in asking questions, but physicians’ responses vary](https://www.sutterhealth.org/research/publications/md-responses-to-pts-with-mental-health-needs-1055312583) Tai-Seale M, Foo P, Stults C. Health Aff. 32(2):259-67. doi: 10.1377/hlthaff.2012.0962. 2013 Feb 01 - Publication ### [New Era Of Patient Engagement](https://www.sutterhealth.org/research/publications/new-era-of-patient-engagement-1055312777) Tai-Seale M. Health Affairs website. 2013 Feb 06 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/pcp-responses-to-older-adults-thoughts-of-suicide-1055312695#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"PCP responses to seniors' suicidal thoughts."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/pcp-responses-to-older-adults-thoughts-of-suicide-1055312695#medicalscholarlyarticle","name":"Now what should I do? Primary care physicians’ responses to older adults expressing thoughts of suicide.","headline":"PCP responses to seniors' suicidal thoughts.","abstract":"BACKGROUND: Many older adults who die by suicide have had recent contact with a primary care physician. As the risk-assessment and referral process for suicide is not readily comparable to procedures for other high-risk behaviors, it is important to identify areas in need of quality improvement (QI). OBJECTIVE: Identify patterns in physician-patient communication regarding suicide to inform QI interventions. DESIGN: Qualitative thematic analysis of video-taped clinical encounters in which suicide was discussed. PARTICIPANTS: Adult primary care patients (n = 385) 65 years and older and their primary care physicians. RESULTS: Mental health was discussed in 22% of encounters (n = 85), with suicide content found in less than 2% (n = 6). Three patterns of conversation were characterized: (1) Arguing that \"Life's Not That Bad.\" In this scenario, the physician strives to convince the patient that suicide is unwarranted, which results in mutual fatigue and discouragement. (2) \"Engaging in Chitchat.\" Here the physician addresses psychosocial matters in a seemingly aimless manner with no clear therapeutic goal. This results in a superficial and misleading connection that buries meaningful risk assessment amidst small talk. (3) \"Identify, assess, and…?\" This pattern is characterized by acknowledging distress, communicating concern, eliciting information, and making treatment suggestions, but lacks clearly articulated treatment planning or structured follow-up. CONCLUSIONS: The physicians in this sample recognized and implicitly acknowledged suicide risk in their older patients, but all seemed unable to go beyond mere assessment. The absence of clearly articulated treatment plans may reflect a lack of a coherent framework for managing suicide risk, insufficient clinical skills, and availability of mental health specialty support required to address suicide risk effectively. To respond to suicide's numerous challenges to the primary care delivery system, QI strategies will require changes to physician education and may require enhancing practice support.","description":"Identify patterns in physician-patient communication regarding suicide to inform QI interventions.","keywords":["Aging and Longevity","Mental Health"],"datePublished":"2011-09-01","url":"https://www.sutterhealth.org/research/publications/pcp-responses-to-older-adults-thoughts-of-suicide-1055312695","inLanguage":"en-US","identifier":[{"@type":"PropertyValue","propertyID":"DOI","value":"10.1007/s11606-011-1726-5"}],"sameAs":["https://doi.org/10.1007/s11606-011-1726-5"],"isPartOf":{"@type":"Periodical","name":"J Gen Intern Med"},"author":[{"@type":"Person","name":"Vannoy SD"},{"@type":"Person","name":"Tai-Seale M"},{"@type":"Person","name":"Duberstein P"},{"@type":"Person","name":"Eaton L"},{"@type":"Person","name":"Cook M"}],"sourceOrganization":{"@type":"MedicalOrganization","name":"Palo Alto Medical Foundation Research Institute"},"about":[{"@type":"DefinedTerm","name":"Aging and Longevity","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Aging+and+Longevity%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Mental Health","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Mental+Health%22%5D%7D%5D&verticalKey=research_publication"}],"mainEntityOfPage":{"@type":"WebPage","@id":"https://www.sutterhealth.org/research/publications/pcp-responses-to-older-adults-thoughts-of-suicide-1055312695","breadcrumb":{"@id":"https://www.sutterhealth.org/research/publications/pcp-responses-to-older-adults-thoughts-of-suicide-1055312695#breadcrumblist"}}} ```