Sense and sensitivity: on situated questioning about self-harm and suicidal inclination in the primary care consultation

Miller, Paul K. (2012) Sense and sensitivity: on situated questioning about self-harm and suicidal inclination in the primary care consultation. In: University of Cumbria Research and Enterprise Conference, 7 July 2012, University of Cumbria, Lancaster, UK. (Unpublished)

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The link between depression and suicide is, in modern medical knowledge, a ‘given’. The canons of contemporary psychiatry, without exception, specify that ‘suicidal ideation’ (like the physical acts of self-harm and actual suicide) is at once a symptom of the illness and, simultaneously, a ‘characteristic’ (if not inevitable) outcome (American Psychiatric Association, 1994; World Health Organization, 1994). National Health Service directives in the UK, meanwhile, specify that, in any primary care consultation where a patient either demonstrably has - or is suspected to have - a depression, it is incumbent upon a General Practitioner to assess any danger they may present to themselves (National Institute for Clinical Excellence, 2009; NHS Centre for Reviews and Dissemination, 2002). Guidelines recommend this be done through ‘direct questioning’ of the patient (National Institute for Clinical Excellence, 2007) regarding their thoughts or activities relating to self-harm or suicide. Given that 'suicidal ideation' is itself not only classified as a ‘possible outcome’ of depression but also a key symptom of the condition, such a question has, in some cases, to be asked pre-diagnosis as part of diagnostic assessment. In this paper, examples of such questioning in three different consultations are explored in detail using Conversation Analysis (Sacks, 1992a; Sacks, 1992b; Silverman, 1997) with a view to describing some of the organised interactional methods employed by GPs, and patients, in negotiating this potentially highly ‘tricky’ activity. These observations are then used to highlight a range of issues pertinent to the formulation of ‘normative’ frames of ‘good practice with respect of handling such sensitive issues (Petit & Sederer, 2006; Tylee, Priest, & Roberts, 1996).

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Item Type: Conference or Workshop Item (Speech)
Departments: Academic Departments > Medical & Sport Sciences (MSS) > Health and Medical Sciences
Depositing User: Paul Miller
Date Deposited: 02 Mar 2018 16:30
Last Modified: 05 Jul 2021 14:47


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