Resisting blame and managing emotion in general practice: the case of patient suicide

Abstract

UK Governing bodies are imposing increased forms of regulation on General Practitioners (GPs). This paper explores one example of such governance - the audit of GP practice through Critical Incident Reviews (CIRs) following patient suicide. Drawing on interviews with 16 GPs about their involvement in a CIR of a patient's suicide, we found that the review process initially provoked strong emotions of sadness and guilt as well as fear of blame. Ultimately, however, most GPs felt comforted by the CIRs because their findings confirmed that they were not responsible for the suicide. At the same time, the GPs indicated that such comfort was tenuous due to the broader blame culture and because they foresaw many future audits as part of an inflationary spiral of surveillance and risk management. While the GPs adopted strategies to manage and resist surveillance, the effects of CIRs on patient care may be mixed, with the potential both to improve clinical practice and contribute to adverse outcomes. We argue that CIRs paradoxically contain and create anxieties about suicide among GPs and society more broadly.