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