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I recently participated in a registrar education discussion about 'heartsink' patients. What is a heartsink patient? O'Dowd1 appears to have coined the phrase and refers to patients who 'exasperate, defeat and overwhelm their doctors by their behaviour'. He implemented a plan to identify, discuss and actively manage the heartsink patients at his practice and his definition has led to a classification of typical trigger patients and guidelines on how to best manage these patients.2
Another approach explores the characteristics of doctors who report high numbers of heartsink patients. A study from the US found that doctors who are younger, work longer hours, have more symptoms of anxiety or depression and those who sub-specialise report higher numbers of heartsink patients.3 Similarly, in the UK, those with higher perceived workloads, lower job satisfaction and less training overall - particularly in counselling and communication skills - reported more heartsink patients.4 This approach turns the tables, prompting action centred on doctors themselves.
Butler and Evans5 take a more philosophical approach, where heartsink stems from 'clinicians feeling helpless in the face of those patients who seek salvation for psychological, social and spiritual problems at a biomedical level'. They conclude that the phenomenon 'seems to be a symptom of tension within the philosophical foundations of general practice' and call on doctors to embrace heartsink...