An 80-year-old man with chronic back pain died by self-inflicted gunshot wound to the head on 1 March 2011. Five days before his death, he mentioned suicide using a rifle to his long-term general practitioner, Dr Daniels, but this was documented in handwritten notes. Dr Daniels, who had treated the patient for 25 years and noted he was pragmatic with a deadpan sense of humour, did not regard the comment as serious, particularly because the patient also mentioned waiting for kitchen renovations to complete. The coroner found Dr Daniels was not obliged to report under the Firearms Act, accepting his clinical judgment based on long-standing rapport and absence of documented depression. Clinicians should recognise that chronic pain patients expressing suicidal ideation require explicit assessment of intent and access to means, regardless of apparent personality context or prior clinical history.
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Specialties
general practiceorthopaedic surgery
Error types
diagnosticcommunication
Drugs involved
oxycodonediazepamparacetamolwarfarin
Clinical conditions
chronic back painprolapsed intervertebral discthoracolumbar scoliosisspinal stenosisosteoarthritisatrial fibrillationhypertensionheart failure
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