PROFESSIONAL ATTITUDES TO REQUESTS FOR SECONDARY FACIAL RECONSTRUCTION IN PATIENTS WHO HAVE ATTEMPTED-SUICIDE

Two patients sustained multiple facial fractures after a suicide attem pt, After a period of convalescence, both wished to undergo secondary reconstructive surgery to improve the cosmetic appearance and function , On the ward, patients induced strong emotional reactions in medical staff and nurses, It should be realised that in most cases suicide att empts are not fatal, It is essential that a psychiatrist is consulted who establishes a psychiatric diagnosis and has an active role in furt her treatment. What may interfere with the indications for operation i s countertransference from the surgeon to the patient who consciously injured himself, Five types of countertransference hatred are distingu ished and described; repression of countertransference, projection of countertransference, reaction formation, reversion, and distortion or denial of reality, Failure to recognise this mechanism will result in undertreatment of these patients, A good professional understanding be tween the consultation liaison psychiatrists and the surgeons may faci litate a positive outcome of consultations in this area.