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General hospital doctors and general practitioners are at the forefront of suicide prevention and frequently assess patients following an following an episode of self-harm or with suicidal thoughts alongside a medical condition. However, traditional assessment tools, which are designed to predict individual-level risk, have been shown to be unreliable and offer no usefulness when the clinician interacts with an individual patient. Additionally, the suicide rate in the UK is relatively low compared to the suicide rate in other high-income countries, further undermining the validity of attempts to determine who is at (greater) risk of suicide at any given time point. We argue that all patients presenting with self-harm and suicidal thoughts should be taken seriously, met with compassion and understanding, and offered personalised assessments which seek to identify risk factors, needs and strengths, instilling hope and empowering help-seeking and acceptance of support. Suicide is preventable; we need a new narrative away from ‘characterizing, quantifying and managing risk’ towards focusing on ‘compassion, safeguarding and safety planning’. We provide an overview of current research and offer clinically useful suggestions to support assessment and intervention, including signposting helpful resources for clinical encounters within primary care and the general hospital.