Depressed patients should be regularly assessed for suicide risk

After receiving a small number of complaints that criticized GPs for failing to appreciate that a patient represented a suicide risk, GPs are being advised to ensure they regularly assess patients with depression for risk of suicide. The latest issue of Good Practice, the MDU's journal for PGs and GPSTs, features an analysis of complaints with regard to depression and anxiety, which shows that GPs are generally good at diagnosing and managing this common condition. The report shows that from 24 complaints regarding the treatment of depression, only 1% of all complaints was notified to the MDU over a one-year period ending in April 2010. The MDU, however, believes that there may, in fact, be a greater risk of adverse events that result in patients becoming harmed, given the nature of the condition and the drugs that are used for treatment. MDU medico-legal adviser, Dr Louise Dale, declared: "It is encouraging to see that complaints from patients with depression and anxiety are rare in primary care, suggesting GPs are managing these common conditions successfully. Where problems do arise however, there is a significant potential for an adverse incident, including the small number of cases where patients harm themselves. Another common theme among the complaints we reviewed was concern that a patient had been prescribed antidepressants for a long period without review. It is important that practices have systems in place to review patients on long term medication." Half of the 24 complaints the MDU was notified of involved a complaint stating that a patient's depression had been treated inadequately or inappropriately, whilst four complaints alleged a failure in diagnosing an unrelated condition, four patients complained of a delay in referral or failure to refer to other services, like counseling, whilst three complaints were raised regarding a patient's risk of suicide. MDU's previous analysis of 30 medical negligence claims in terms of depression in general practice over a ten-year period revealed an overall payment of £3m in compensation to patients. To avoid problems in the future, the MDU advises GPs to: Regularly assess all patients with depression for risk of suicide. Be aware of current guidelines for treating depression, including aspects of non-drug interventions. Ensure patients fully understand what they are being prescribed with and to warn them about the risks involved, as well as of any side effects and treatment alternatives. Have a system in place whereby patients on long-term medication can be reviewed. Refer patients for specialist treatment wherever necessary. Referrals should be part of a traceable system. Be especially vigilant when prescribing drugs with similar names and with dosages.