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Independents' Day

I’ve had a change of heart(sink)


Ho hum. Or, more accurately, f**k the f***ing f**k, if I have to f***ing go through this one more f***ing time I’m going to f*** off out of f***ing general f***ng practice for f***ing good.

Now, that’s the feeling I used to get with heartsink patients when I was a bit younger. Then a wise old GP patted me condescendingly on the head and explained that, actually, there are no such things as heartsink patients, only heartsink doctors, and that the issues – and therefore the solutions – lay with me, not the patient. And I thought this through calmly and considered its implications rationally. Then I went back to the wise old GP and told him he didn’t know what the f***ing f**k he was talking about.

But he did. Because it’s true. Now I’m older and wiser myself and I, too, have learned the condescending head-pat, I realise I no longer have any heartsink patients. Because years of experience have taught me how to manage them properly and effectively (massive doses of amitriptyline).

What I have instead are very frequent, irksome and difficult heartsink moments. That is to say, whereas once I had a tiny number of patients who induced in me an intense desire to poke their eyes out each time I saw them, I now have a large number of patients who induce in me an intense desire to poke their eyes out, just the once. Or, if you’d rather, there are no such things as heartsink patients, but any patient is a heartsink moment waiting to happen.

These episodes are almost inevitably triggered by certain phrases, including:

• ‘We keep coming here and no one’s doing nothing’

• ‘The pain clinic’s sending me to a psychologist but it’s not in my head’

• ‘All I ever get told is it’s a virus’

• ‘I need something stronger than tramadol’

• ‘He keeps being fobbed off’

• ‘I’ve come for the results of my hospital tests’

• ‘This is the fourth antidepressant I’ve been on and it’s not working’

And so on and so forth.

My heart sinks and my fingers twitch in anticipation of ocular assault. I don’t know what your response is, but I bet it isn’t listed in the GMC’s Duties of a doctor.

Partly it’s the overfamiliarity: I will hear one of these trigger statements, or something similar, every day of my working life, and have done for 29 years. Yet each time it’s like nails down a blackboard, with increasingly long nails. Mainly, though, it’s just a feeling of exhausted boredom. I know that will I have to shift the patient’s way of thinking from current location A to ultimate destination Z.

I know exactly what I’m going to say, I know how long it’s going to take and I know how difficult it’s going to be. But, as the next one will be the X thousandth time I’ve done it, and it’s a long, tiring and tedious journey, I’m not sure I can be arsed any more. Oh, and it never works.

So I think what I’m saying is that there’s no such thing as a heartsink. But there is such a thing as burnout.

Dr Tony Copperfield is a jobbing GP in Essex




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Readers' comments (17)

  • All too familiar.

    Look after yourself, everyone x

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  • Went on holiday to Goa a few years back and met a Swedish doctor there who told me that in Sweden GPs referred heart sink patients to a heart sink service. She was there on a recce just to see what the place was like, as apparently in Sweden heart sink patients could be referred to the service and in certain circumstances patients are sent away for Yoga/Ayurvedic treatments...! Imagine the NHS paying for that.

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  • The DM and Jezza might be doing everyone a good turn when they how overpaid and lazy we are and that we should cease to exist. i agree but for the reasons Copper states so well. Perhaps we should start a campaign to save all those very bright young things, Don't do it don't be a doctor, otherwise you might turn out like
    old Coppy here or in fact like any one of us, just the same.

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  • Maverick

    This helps....

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  • Maverick

    If the link doesn't work, google "machine gun cat gif". You'll find it, and if you don't, then GP is the career for you. Go well.

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  • Nail. Head. Bang.

    The only consolation is this is a universal experience.

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  • I appreciate how you feel and I have always enjoyed your insight and humour. The 'hamster wheel' feeling is all too common, especially if you are overstretched as many of us are and have been for too long.
    I often look back at the aphorisms from 'House of God' by Samuel Shem, which has had more influence on my medical practice than perhaps is altogether healthy. e.g.
    Law 4 - The patient is the one with the disease
    Law 8 - They can always hurt you more
    I'm sure we can come up with modern variants for general practice.
    Law 99 - When they walk out of the door - you'll still be you and they will still be them (would you swap places?)
    Law 212 - Show me a DoH/CCG/NHS initiative that only triples my work and I'll kiss Jeremy Hunt's feet.
    Law 350 - Despair is directly proportional to numbers attending a multidisciplinary meeting
    Law 400 - Health care can be good or quick or cheap
    Take a break - you've earned it.
    Best wishes

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  • Well said malcolm, "House of god" looks like a great book. got it for the kindle just now. cheers.

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  • End of the line?

    As a locum.... Potential heart sinks always ask.... are you my regular doctor now? Unfortunately no..... :-(.
    (Secret sigh of relief)

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  • End of the line?

    Everyone's fobbing me off....
    Ok here's some magical calpol...
    Or..what would you like to happen...promptly followed by...You're the doctor.!!
    Ok here's some magical...

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