The heartsink patient: a preliminary study.

Eight GPs identified 78 heartsink patients; in an open-ended interview they were asked to explain why they regarded them in this way. A GP's definition of a heartsink patient was influenced by GP sex, practice location, and time of surgery, although the number of participating GPs was too low to make any definite assertions. Practitioners' anticipations of heartsink consultations were generally over-exaggerated, with most of the encounters going better than expected. GPs expressed the view that these patients raised serious professional issues for them, whilst there was also a dislike for these patients' personalities and behaviour. Two levels of the heartsink state are hypothesized: one, a state of inertia, is when the heartsink patient has been a chronic high user of the primary health care system, and a GP has exhausted all avenues. The other is an acute situation with those heartsink patients who have been low users of the system in the past. Recent, new events in these patients' lives have raised an issue that is just as much to do with patient and doctor reaction to these events, as it is about finding a diagnosis or solution to the problem. We present the results and hypotheses to provoke further discussion and research.