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Heartsinks are about relationships not villains

I am writing with reference to the front-page article headlined 'Get tough with heartsinks' (Pulse,

May 17).

The editorial in Family Practice was not specifically about heartsink patients, but about the difficulties in the doctor-patient relationship that doctors reported in a series of qualitative studies, exploring GPs' views and attitudes about their work with patients with back pain, depression and medically unexplained symptoms.

The study illustrates limitations in the current primary care system, and the training and support of GPs.

In my view it is not patients who are difficult, but relationships that have got stuck. Supervision and mentoring, in particular using Balint groups, might be helpful in supporting GPs through the difficult consultations that result.

While 'passing a patient to a colleague' or 'ending a consultation if a verbal contract is broken' may be options in some cases, our editorial certainly does not advocate this approach.

Dr Carolyn Chew-Graham

Senior Lecturer in

Primary Care

University of Manchester

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