HEARTSINK PATIENTS - A STUDY OF THEIR GENERAL-PRACTITIONERS

Background. A number of attempts have been made to investigate the hea rtsink, difficult, dysphoric or problem patient. Most studies have emp hasized the role which the patient plays in evoking despair, anger and frustration in the doctor However, one doctor's list of difficult pat ients may not necessarily be the same as another's. Aim. A study was u ndertaken to determine if the individual characteristics of general pr actitioners are associated with the number of heartsink patients they report on their patient lists. Method Sixty out of 137 urban general p ractitioners drawn at random from the Sheffield Family Health Services Authority list were surveyed by structured interview and questionnair es in 1990. Outcome measures were interview data and scores on the 12- item general health questionnaire, Warr-Cook-Walljob satisfaction scal e and the Bortner personality profile measure, Results. Sixty per cent of the variance in the number of heartsink patients that general prac titioners reported on their lists could be accounted for by the follow ing four explanatory variables: greater perceived workload; lower job satisfaction; lack of training in counselling and/or communication ski lls; and lack of appropriate postgraduate qualifications. No other var iables considered could account for the variance in the number of hear tsink patients reported by general practitioners. Conclusion. The indi vidual characteristics of doctors are associated with the number of he artsink patients reported by general practitioners. To reduce the numb er of such patients experienced, it may be necessary for general pract itioners to reduce their workload and increase their job satisfaction and their level of relevant postgraduate training.