CCFP priority topic 96 of 105
Suicide on the CCFP exam
7 key features, the mistakes that cost marks, and a practice question.
Checked by a Canadian family physician, MD, CCFP. Updated October 20, 2026.
What the exam tests
Key features
The CFPC’s 7 key features for Suicide. Each one below has how the exam asks it, the common mistakes and the approach.
Practice question
Try one before you read
A real case from the bank, in the new short-menu format. Answer it first. Then read the key features.
Key feature 1 of 7
Ask directly
Ask higher-risk patients about thoughts of suicide and of harming others.
CFPC skill Clinical reasoning, selectivityPhase History
On the exam
A girl in her early teens swallowed ten ibuprofen minutes after an online argument. She says it was for a headache. Expect a short menu (pick several from a list).
Pick the questions that tell you she is safe.
Common mistakes
Taking the headache story at face value. Asking about meals, school marks, her stimulant or screen time is wrong too. None of it tells you if she is safe tonight.
Approach
- Ask in plain words about thoughts of dying, thoughts of suicide, a plan, intent and past attempts.
- Ask about thoughts of hurting someone else too.
- Raise it sooner with depression or another psychiatric disorder, alcohol or drug use, or a long-lasting physical illness.
- Raise it sooner after a loss, a fight or a break-up, in impulsive patients, and after past attempts or past suicidal thoughts.
- See a teen alone for part of the visit. Say what you keep private, and when you cannot.
- Pills taken minutes after a fight need a direct question about intent, whatever reason the patient gives.
Key feature 2 of 7
Judge the risk
In a suicidal patient, weigh how serious the danger is, then match care to it.
CFPC skill Clinical reasoningPhase Diagnosis
On the exam
A teen judged low risk after an overdose lives on a farm with rifles and a full medicine cabinet. Expect one best answer.
Pick the best home-safety advice.
Common mistakes
Locking the rifles in a cabinet, or teaching gun safety. Both leave the guns at home. Removing the guns but leaving acetaminophen within reach ignores the method used.
Approach
- Ask about thoughts, a plan, how lethal it is, intent, and what the patient can reach at home.
- Weigh impulsivity, alcohol or drug use, hopelessness, past attempts, and who can supervise at home.
- After an attempt, ask the family to move firearms out of the home. A locked cabinet is not enough: keys and codes get found.
- Lock away or remove all medicines, including over-the-counter pain relievers, not only the drug taken.
- Low risk with a family who can supervise: home with a structured plan. Admission adds little over that.
- Clear intent, a lethal plan, psychosis or no safe home: arrange emergency psychiatric assessment.
| Picture | Where | Also do |
|---|---|---|
| Thoughts only, no plan or intent, safe home | Office, with close follow-up | Safety plan; remove lethal means |
| Attempt or plan, low intent, family can supervise | Home after assessment, with a structured plan | Firearms out; medicines removed or locked; early review |
| Clear intent, lethal plan, psychosis or no safe home | Emergency psychiatric assessment; often admission | Do not leave the patient alone; arrange a safe transfer |
Key feature 3 of 7
Cutting
With cutting, check suicide risk without assuming intent, then explore feelings and better coping.
CFPC skill Clinical reasoning, patient-centred approachPhase History, treatmentSources Choosing Wisely Canada
On the exam
A 12-year-old girl with type 1 diabetes has fresh, parallel cuts on her arm. Her A1C (average blood sugar) is rising. Expect a short menu (pick several from a list).
Pick what to ask her first.
Common mistakes
Calling the cuts a suicide attempt and sending her to emergency before you assess. Opening with wound care, scars or her sugar control misses why she cuts.
Approach
- Ask open questions, with the parent out of the room. A leading question invites her to agree with a cover story.
- Ask what the cutting does for her: relief, release, control or punishment.
- Then ask about suicide: thoughts, a plan, intent. Some who cut are suicidal; many are not.
- Ask what is going on at school, with friends and at home, including bullying and abuse.
- With diabetes, ask whether she skips insulin or takes extra on purpose. Insulin can be far more dangerous than a blade.
- Build other ways to cope: naming the feeling, delaying, distraction, a trusted adult, talking therapy.
- Do not reach for an antidepressant for mild low mood. A full assessment, including suicide risk, comes first.
Key feature 4 of 7
Low risk at home
For a lower-risk patient sent home, set a firm review date and a written plan for worse thoughts.
CFPC skill Communication, patient-centred approachPhase Follow-up, treatment
On the exam
A girl in her early teens is judged low risk after an overdose and goes home tonight. Expect one best answer.
Pick the best discharge plan.
Common mistakes
A waitlist referral with “come back if she seems low”, or a signed promise not to self-harm. Neither gives a date, or a plan for the night her thoughts return.
Approach
- Book the first review for a set date within a few days. Do not leave it to need.
- Write a safety plan together: warning signs, coping steps, people and places, and professional contacts.
- Give the crisis line: call or text 9-8-8, any time.
- Tell the family when to go to emergency or call 9-1-1: a new plan, an attempt, or she cannot keep herself safe.
- Remove lethal means before she gets home.
- Skip the no-harm contract. It does not protect her and can falsely reassure everyone.
- Give the plan in writing to her and her family.
Key feature 5 of 7
Reports from others
When someone else warns that a patient may be in danger, weigh privacy against everyone's safety.
CFPC skill Clinical reasoning, professionalismPhase Diagnosis, treatment
On the exam
An anonymous caller says your teen patient posted a message naming tonight. Her father can be reached. Expect a short menu (pick several from a list).
Pick the steps to take tonight.
Common mistakes
Refusing to hear the call for privacy reasons, or waiting for her booked visit. Calling police when her father can act, or naming the caller, goes too far.
Approach
- Listen to the report. Hearing it discloses nothing about the patient.
- Judge how urgent it is. A stated time or method moves action to today.
- Reach the patient or the family now. Share only what they need to keep the patient safe.
- Protect the caller. You do not need to name the source to act.
- Ask police for a welfare check only when the patient or family cannot be reached or will not act.
- Write down what you heard, what you shared, with whom, and why.
Key feature 6 of 7
Overdose bloodwork
In every suicidal overdose, check acetaminophen and ASA levels, whatever drug is named.
CFPC skill Clinical reasoningPhase Hypothesis generation, investigationSources Health Canada, Choosing Wisely Canada
On the exam
The girl who took ibuprofen looks well in emergency an hour later. Expect a short menu (pick several from a list) of tests.
Pick the tests to send.
Common mistakes
Watching and waiting because she looks well, or chasing the drug she named. Heart monitoring or a broad urine drug screen in place of the two blood levels misses the real danger.
Approach
- Send acetaminophen and salicylate (ASA, acetylsalicylic acid) levels in every suicidal overdose, whatever the patient names. The exam expects both.
- Early acetaminophen poisoning can look well. A patient may carry on normally for a day or two before the liver fails.
- Draw the acetaminophen level at least 4 hours after ingestion. An earlier level can mislead.
- Acetylcysteine, the antidote, protects the liver best when started within 10 hours. Time unknown: start it now, without waiting for results.
- Also check liver tests, INR (a clotting test), creatinine, glucose and electrolytes.
- ASA poisoning: fast, deep breathing, vomiting, ringing ears and sweating. Severe cases bring acid-base upset, seizures and coma.
- A child going to psychiatric admission needs no routine screening bloodwork unless something clinical calls for it. An overdose does.
| Acetaminophen | ASA | |
|---|---|---|
| Early picture | Often looks well for a day or two | Fast, deep breathing, vomiting, ringing ears, sweating |
| Main danger | Liver failure | Acid-base upset, seizures, coma |
| Treatment | Acetylcysteine, best within 10 hours | Fix acid-base and fluids; sodium bicarbonate; glucose if low |
Key feature 7 of 7
Injury as an attempt
When a patient is injured, consider that the injury may have been a suicide attempt.
CFPC skill Clinical reasoningPhase History, hypothesis generation
On the exam
A man in his 40s drove alone into a bridge support on a dry, clear night, with no braking. Expect a short menu (pick several from a list) of history.
Pick what to ask once he is stable.
Common mistakes
Calling it an accident because he says he swerved. A lone crash with no braking on a clear night needs a direct question about intent.
Approach
- Stabilize first. Ask about intent as soon as the patient can talk.
- Suspect an attempt with a single-vehicle crash, a fall from height, a gunshot wound, or an injury that does not fit the story.
- Ask plainly: did you mean to get hurt? Have you thought about ending your life?
- Ask about recent losses, mood, alcohol and drugs, and past attempts.
- Think of a hidden overdose as well.
- If the injury was intended, assess suicide risk before discharge, as for any attempt.
Flashcards
Answer it first, then check.
KF 1Does asking about suicide put the idea in a patient's head?
No. Ask directly about thoughts, a plan, intent and past attempts.
KF 2A teen overdosed at home, where rifles sit in a locked cabinet. What do you advise?
Move the firearms out of the home. Remove or lock away all medicines too.
KF 3A 14-year-old has straight, parallel cuts on her forearm. What do you assume?
Nothing yet. Ask what cutting does for her, then ask about suicide.
KF 4Name the parts of a safety plan.
Warning signs, coping steps, people to contact, professional help and 9-8-8, and safer surroundings.
KF 5A caller asks to stay anonymous. Must you name them to act?
No. Reach the patient or family, share only what keeps the patient safe, and protect the caller.
KF 6When do you draw the acetaminophen level after an overdose?
At least 4 hours after ingestion. An earlier level may not show the peak. Source: Health Canada
KF 6The time of an acetaminophen overdose is unknown. Do you wait for the level?
No. Start acetylcysteine now. It protects the liver best within 10 hours of ingestion. Source: Health Canada
KF 7A man crashes his car alone on a clear night. What must you ask?
Whether he meant to get hurt. Then ask about suicidal thoughts, alcohol, drugs and recent losses.
FAQ
Which Canadian guideline covers suicide risk?
No single national guideline anchors this topic. The exam rewards the approach: ask directly, judge risk, remove lethal means and set firm follow-up. Know your province's mental health act too.
Should a risk scale decide whether to admit?
No. A scale can guide your questions. The decision rests on your full assessment: plan, intent, means, impulsivity, supports, and how safe home is tonight.
Is a no-suicide contract ever useful?
Not as protection. A signed promise does not keep a patient safe and can lull you and the family. Spend the time on a written safety plan and removing lethal means.
Can I share private details to keep a patient safe?
Yes, when the danger is serious. Share only what is needed, with people who can act, and tell the patient when that is safe. Record what you shared and why.
Sources
Written from the CFPC Assessment Objectives and Canadian guidelines first. Checked by a Canadian family physician, MD, CCFP.
Last reviewed October 20, 2026For exam study. Not advice for a patient in front of you.
- Assessment Objectives for Certification in Family Medicine, 2nd editionCollege of Family Physicians of Canada · 2020
- Choosing Wisely recommendationsChoosing Wisely Canada
- Drug Product DatabaseHealth Canada