Letters “Heartsink”

Using established forums to improve difficult doctor-patient relationships

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i760 (Published 09 February 2016) Cite this as: BMJ 2016;352:i760
  1. Clare Lister, higher trainee in psychiatry1,
  2. Joe Reilly, professor of mental health2,
  3. Helen Beckwith, trainee clinical psychologist3
  1. 1Tranwell Unit, Queen Elizabeth Hospital, Gateshead NE10 9RW, UK
  2. 2Mental Health Research Group, Wolfson Research Insititute, Durham University Queen’s Campus, Stockton on Tees, UK
  3. 3School of Psychology, Ridley Building 1, Newcastle upon Tyne, UK
  1. clare.lister{at}nhs.net

We read Cocksedge’s personal view with interest, having recently completed a systematic review into this area ourselves.1 The idea of difficulty within the doctor-patient relationship is not new. Doctors are trained to care for and treat patients to cure or improve their symptoms, yet it can be a struggle to fulfil this responsibility. Difficulty ensues. This can be viewed as a complex interaction between many factors. The doctor is left feeling helpless or out of control, and this may be a reflection of the same emotions the patient is grappling with. This mismatch between wishes and what is possible can elicit troublesome and sometimes extreme behaviours in doctors. An article from as far back as 1957 refers to “heroic surgical attack” when doctors enthusiastically treat their patients to the point of harm.2

After reading this personal view and O’Dowd’s original work on “heartsink patients” it might be thought that these observations apply solely to the field of general practice. But the concept of a difficult relationship between patients and their doctors is widespread and well recognised in areas as diverse as surgery and respiratory medicine. Doctors and patients know the problem when they encounter it, but definition and measurement have proved difficult. We suggest that practical support measures should be actively and systematically encouraged. Well established forums, such as Balint groups and Schwartz rounds,3 4 may serve as useful outlets to discuss and arrive at strategies to help improve these difficult relationships for the patients and doctors involved.


Cite this as: BMJ 2016;352:i760


  • Competing interests: None declared.


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