Dr. Joel Aronowitz - Suicide Awareness: Dealing with Depressed and Suicidal Patients During COVID19 Pandemic
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| Dr. Joel Aronowitz |
Dr. Joel Aronowitz: “So, this week I've had a couple of very troubled patients, one that had a suicide attempt and broke her ankle in several places. The wound broke down and she needed care of the wound to prevent a more serious complication. Another patient who had a serious psychiatric problem exacerbated by current conditions and had a big wound on his chin and a big wound on his hand, both of which hadn't been taken care of very well because of his psychiatric condition. And it brings to mind the problem that we're facing in mental health right now. As a doctor, I see a lot of patients, obviously with physical problems, but a lot of these have emotional problems or psychiatric problems at the same time. And it's exacerbated by the fact that we have a lot of social isolation right now. We have people that are shut in that can't even get outdoors. They're afraid to go outdoors. They're afraid to have contact with the people close to them in their life. And I wanted to speak to that just a little bit. So as a person on the front-line seeing patients, whether you're a nurse or a medical assistant, a PA, doctor, whatever, you should be aware of that.
First of all, you should be aware of it in your own self because that depression is many times present in people in the healthcare field. But you should also be aware of that in your patients. So, patients that are more cranky that complain to the staff that are more difficult with you, probably a component of that is the depression or despair that the patients are feeling because of their isolation. So, I want to just share a couple of pointers. One is be aware. Number two is to evaluate that patient as a suicide risk. And one of the best ways is just to have that on your checklist. And if it seems like that patient may be suicidal, in my case, the patient actually had committed suicide, attempted suicide. So obviously, that's something I should be aware of and I should assess that person right then when they're in front of me as to whether or not they're currently a risk. So how I address that is simply by asking a couple of questions that probe it a little bit. And then I'll ask the patient directly, are you thinking about suicide? Is that a possibility? And the patient will be honest with you most times. The other thing is, obviously, most patients are not suicidal, but may be depressed, have an element of despair, or they have flattened affect. Their emotions are flattened. They're not very responsive. When you see this in the patient, engaging the patient longer than you normally would many times can be very helpful. So, a patient who either doesn't want to talk to you very much or wants to talk excessively, that patient usually will benefit from a prolonged social encounter beyond just the medical visit itself. If you have the time or the medical assistant, somebody else in the office has the time, that kind of social engagement, even if it's fairly brief, a minute, two minutes, something like that, that can be very helpful because the fact that you're willing to spend that time to give that person eye contact and exchange a few words, that can be very uplifting. And that may be the only social contact that person has for that entire day or maybe two or three days because with these shut-in patients, they may not be having any direct social interaction for days at a time.
And as human beings, we really need social interaction. We really need to interact with people on a one-to-one basis, socially in person. Just think of it, if you have somebody in jail and you want to punish them even more, what you do is you put them in solitary confinement. And that's what we've done with many patients, many people in our society. We've basically given them a sentence of solitary confinement. So, the fact that they've come out to the doctor's office or wherever you're seeing that person, the fact that you give them some social interaction, that is a huge pill of goodness, if you will. And even if the person doesn't need it, everybody appreciates it. The fact that you're taking that trouble means you care about that other person. That's basically what it means. And the fact that you have somebody who cares about you means a lot. And that can really cheer you up and that can really keep you going. So, I think that that same advice about encouraging social interaction, engaging in it, making a little bit of extra effort, showing people a smile, showing people a little concern about their lives, that goes for our interactions with people outside of the office as well. And I would encourage everybody to take that little extra effort, even though we have our masks on and we're hiding behind the mask and some of us are hiding behind the face shield and all that, to take that little bit of extra effort to engage that person.
Eye to eye, to have some verbal interaction with them so that they know there's another human being out there that cares about them. We're all members of the same society. We're all people on the same planet. And showing that concern for our fellow man or woman really does a lot of good for them. And you know what is interesting is when you do something good for somebody else, you actually are the one getting the better end of that deal. It really helps you more than it helps them. You'll find that out if you try it a little bit. So, I hope that helps. And I hope that increases the level of sensitivity and awareness as we try to deliver medical care during this time that's a little bit more difficult than normal. So, I hope you have a great day and hope to see you again soon right here on Aronowitzland.”
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