This is a busy time for doctors, patients get stressed and depressed in the pre-Christmas time and it is a time of coughs and colds.
But today, I was thinking about a specific type of patient- the “heartsink”.
They are called that because the doctor’s heart sinks when he or she sees this patient’s name on the appointment list.
A definition I found was: “patients who ‘exasperate, defeat and overwhelm their doctors by their behaviour”
You would think that these patients are all dreadful nasty creatures that deserve to be banned from attending the surgery.
But it is not so simple. I have been working as a family doctor for many years, and I found that it does not depend just on the patient, but also on the doctor.
Take me. The patients that I find difficult are often polite, nice people. Not the people most of my colleagues would call heartsink.
I love my job, I am interested in my patients, and I like solving the puzzle:
Why are they here?
What is wrong with them? (Not always the same thing)
How can I find out?
What can I do about the problem?
What if I am wrong?
I do not mind spending as much time as they need and I love to help.
But I am an impatient woman who does everything fast. I am very chatty, my friends and family would tell you that I never shut up, but I hate small talk.
The constant talk of the weather, which is actually never too extreme in England anyway. “Isn’t it freezing today?” (Temperature in London hardly ever gets below freezing point). But it is allegedly either too cold, too hot, too wet or too dry, and I find it boring even in normal conversation, but even more so at the surgery. If the patient wants to discuss the weather, perhaps they should see a meteorologist!
The “How are you?” to which the automatic answer is “Very well, thank you.” Even if you are in the middle of a painful divorce or are about to be evicted from your house.
I have once played a game. I tried to ask my patients: “How are you?” instead of my usual:
“What can I do for you today?”
They all had the same answer. “Very well, thank you.” I said “So why are you here?” They chuckled and started to tell me what was wrong. Five minutes gone.
After ten patients reacted the same way, I was running half an hour late and got bored with the experiment.
There are of course some other reasons why I get a bit exasperated.
Patients with invisible rashes and symptoms that have completely resolved but who think they should come anyway.
People who never get to the point and ‘ramble’. I know it is sometimes hard. But perhaps organising your thoughts while you are sitting in the waiting room would come useful.
The last sentence the patient says just when leaving. “By the way I also wanted to ask ….” which comes to be the main reason why they booked the appointment in the first place.
What is interesting is that all studies show that the amount and type of heartsink patients a GP has almost entirely depends on the character of the GP, and their particular dislikes, so the best thing a heartsink can do is just change a GP to one who shares their character.
I am sure there are many doctors who like small talk, and talking about the weather. It relaxes them, and makes their job less stressful.
But if you are my patient, get to the point.
And I will give you as much time as you need to discuss your medical problem or your worry. It is my job, and I love doing it.
And after that, you can go and talk about the weather to someone else. And if they ask you “How are you?” you can tell them “Very well, thank you”. Back in the order of a normal British conversation.
You can even joke about that ridiculous Central European doctor who only wants to talk about the reason why you booked the doctor’s appointment. Nothing more, nothing less.