Heartsink Doctors (revisited)!

We all know that feeling; we crawl out of bed in the morning, not quite full of the joys of spring but near as dammit, and then ten tonnes of reality drops on our head as we realise that we are on Dr Nasty's list that morning, and our heart sinks.  We are filled with anger, despair and frustration as the all pervading feeling of doom overwhelms us.  What should be a therapeutic encounter will be the exact opposite.  Why oh why was Dr Bubbly not available?

Oddly enough, Betty next door swears by Dr Nasty - one man's meat is another man's poison - and has elevated his status to that of a living saint and you begin to think is the problem me or has Betty got something wrong with her mind?

You arrive at the surgery and take your place in the waiting room.  Your anxiety levels rise and if you weren't hypertensive before you came - you certainly are now!  You are buzzed and make your way to his room - like a lamb to slaughter - and the consult was as awful as you thought it would be.  But was it a self fulfilling prophecy?  Was he the heartsink or were you his heartsink?

The following consults are based on appointments I have experienced.  Was I the heartsink or were the docs?  Dr Bubbly perhaps doesn't really deserve a place there - but he had his moments!

Dr Computer

Dr Computer is (in his own mind) a time management wizard and he can fit almost everything re logging data of a ten minute consultation slot into 10.5 minutes - the only thing that prevents him reaching 100% perfection is the damn patient!

He will be keying in info as you enter his room and doesn't acknowledge your existence for the run over thirty seconds.  "Ah and what are you here for erm, erm, Mrs Erm?"  He has no idea who you are or your history as he has just finished detailing his last patient - who coincidentally was also a Mrs Erm!

"Mrs Brown.  The hospital said I should visit you monthly to check on how my thrumbocritis (fictitious condition - but real for the purpose of this exercise) is progressing.  They said it's required to prevent deterioration."

"Don't know anything about it."

"But you referred me!"

"Did I?  Erm - just let me check the computer.  Ah!  Yes - so I did!  What did you say you've got?"

"Thrumbocritis."

"Never heard of it!  You'll have to tell me what it is!"

"Surely you'll have a scanned letter from the hospital on your computer?"

"Have I?  Hang on a minute... ah... yes I have!  But I still don't know what it is.  What is it ?"

"Why don't you Google it?"

"Google it?  That's a good idea!  Hang on!  Googles it and spends three minutes scanning.  "Mmmm... that's interesting - never heard of it.  Hang on a minute!"  Spends two minutes entering details of the consult on his beloved comp.  "Look, I'll have to read up on this!  How are you feeling?"

"Okay I suppose."  I'm not! - Why the hell am I saying I am?  Because I feel like I am intruding on his quality time with his damn computer!  "Should you not check something?"

All eye contact with me has now ceased and he is glued to his computer screen.  "Nooo: you look fine!  Tell you what; come back in a month and I'll have had a chance to read up on this.  Come back sooner if you think you must.  Okay?"

"I suppose so.  Thanks?"

"Fine Mrs erm, erm, Erm?"  He is still glued to the computer!  Little fingers typing away.  I leave feeling totally bewildered.  What was all that about?

Dr Nasty

As you enter his room, Dr Nasty engages you in his (I am not interested in you at all!) glare.  His facial expressions and body language betray all.  "What's the problem then?" he demands.

"The hospital said I should visit you monthly to check up on how my thrumbocritis is progressing.  They said... "

"Ah yes," he cuts in.  "The thrumbocritis lady!  I don't buy into it!  God!  They'll be medicalising burping as Postprandial Stress Disorder next!"

I can feel my hackles rising - determined to stay calm I smile pleasantly and ask "Pardon?"

"I don't buy into it.  It's anxiety!  Why don't you accept that?"

"Because I know it isn't.  I know me!"  Getting a little defensive but still smiling pleasantly, I add "And it's medically demonstrable, evidence based medicine and all that!"

"Oh - have it your way!  How are you then?"

"I feel awful."

Utter disbelief in his voice he says "How can you say you feel awful when you're smiling all the time?"

"I am smiling all the time because I refuse to rise to your bait and I refuse to adopt the sick role.  I am me - not my condition."  All said in a perfectly calm voice.

He shakes his head and his eyes roll.  "What do you want me to do then?" he demands.

"I have just realised I don't want you to do anything Dr Nasty.  I'm going now.  Goodbye."

Dr Nasty is the doctor who (apart from Betty) nobody, but nobody wants to see.  When you leave you think - What the hell did I do to deserve to be treated like that?

Dr Bubbly and Nice but sometimes Role Reverser

Most of the time Dr Bubbly is just bubbly and nice;  he makes you feel valued and comfortable and dammit - sometimes you just want to marry him and have his babies!  He is so lovely that I am sure that if you entered his room with depression - you would leave elated!  Sometimes though his dark side enters the consult - but it won't be obvious at the start and therefore takes you by surprise!  Really 95% of the time he is not a heartsink - but when his is, well, you leave very confused.  What did I do?

"Hello Mrs Brown!" he enthuses as you enter, "How's things?"

"Fine thanks Dr Bubbly!"  If someone is kind to me, why do I say I'm fine?  I am not a miserable sod perhaps?

"Mrs Brown, our thrumbocritis Lady!  Y'know, I am really excited.  I've read about it but never seen it before!"

There follows a general discussion about thrumbocritis, his favourite football team and his holiday in Bulgaria and life is tickety boo!  BP and heart rate checked.

"You'll need a new sick note then?"

"Yes please."

"You're quite tachycardic there!  The hospital suggest I up your meds if this happens.  I'll write you a script for Thrumbosolol 150mgs.  Okay?"

"I've still got a months supply of 100mgs left, so a months supply of 50mgs..."

"No!  I will write you up for 150mgs," he says harshly.

Thinking of the dire straits of the NHS, practice budgets,etc, I persist "But I have a months supply of 100mgs left, would it not make sense to... "

"No!  I will write you up for 150mgs!"

As this is the second time this 'change' has occurred during a consultation, I ask "Are you fed up with me?"  After all, I might be a heartsink and not realise it!

"No.  What makes you think that?"

"It's the second time you've become short with me, treated me differently.  I just wondered if you are fed up with me?"

"No - not at all; its just, well; I'm fed up with being put upon here.  I want to be a partner - but Dr Computer doesn't want a partner.  I want to make a difference to the practice."  He chats on about his unhappiness with his position and honestly - I don't mind - we all need to vent at times.  He finishes with "Did it come across?  I didn't realise."

We part as friends.  Often, when I go for my sick note we end up talking about him or he ends up talking about him really.  And I really don't mind but wonder who's seeing who?

Dr Bubbly finally left after achieving a partnership elsewhere.  Our practices loss is another practices gain.

Dr I Am the Doctor - You Are the Idiot

Dr I am the Doctor is a strange woman.  She is delightful with children and nobody minds making an appointment with her in this case.  With adults it is a totally different matter; she is very intimidating, very brusque and if she should visit you at home - when you have broken your toenail - she is able to diagnose from the door.  She has the propensity to make the happy depressed; the calm enraged and the sane mad.

"Yes!"

"The hospital said I should visit you monthly to see how my thrumbocritis is progressing.  They said it's required to prevent deterioration."

"Oh, they said, did they?  Well, I suppose they must  know what they're talking about."  She sighs and shakes her head.  "Well!  How are you then?" she demands.

"I feel awful most of the time - but I am adapting.  I am not going to let this rule my life."

"Bully for you!" she snorts.  "What do you want me to do?"  She is beginning to make me angry - I knew she would!

"I think it says in the letter that you should monitor my BP and heart rate."

"Oh does it now?" she sneers.  "Well, I'd better do it then!"  I am really getting hot under the collar!  "Arm!"  She takes my BP, twice, and then takes my pulse.  She writes out a script increasing the Thrumbosolol and shoves it across the desk.  "There!"

"Whats that for?"

"Well you must know you're tachycardic and your BP's through the roof!" she sneers, eyes widening by the second.  I'm not surprised my bloody BPs raised - I am surprised that steam is not coming out of my bloody ears!  I wouldn't dare mention the month's supply of meds that could be topped up with a month's supply of 50mgs!

I leave totally enraged!

All these doctors existed at the practice I attend several years ago.  No more - just them.  At this time I actually was on the sick and noticed the waiting room became emptier and emptier across the months.  Now perhaps the doctors' approaches led to patients not attending with trivial complaints - but I don't think so, as an ANYONE WISHING TO REGISTER AT THIS PRACTICE WILL BE ACCEPTED appeared on the board at the Health Centre entrance and remains there to this day.

Heartsink patients are the bane of a doctors life - but heartsink docs are the bane of a patients life too.  Do heartsink patients/docs really exist or is it about transference and counter transference - or simply the doctor-patient relationship, poor communications skills and a lack of shared understanding?  I realise that difficult patients exist and are a poor example of humanity - but difficult doctors exist too!

Anna :o]

Heartsink Doctors and Dr Google - a Patient Opinion

I am grateful to Dr Philyerboots for his post on "Heartsink" patients, for it opened my eyes.  I think most patients - if they know the term exists - regard heartsinks as the moaning hypochondriacs who plague a GP practice on a regular basis - I did, that is, think that, not plague a doctor!

But this is not only the case; a heartsink is also "...the most common one is of patients under my care who steadily deteriorate despite all that I and modern medicine can do", it is the "very few I object to on a personal level", it is "the patient that has consulted Dr Google before coming", it is "those who ask the same question, again and again an again.  It is as if they ask the question often enough that I will tell them that I have a miracle cure", it is "the insane", it is those "who seemingly just want a chat" or those "who have complaints about BGH, or about my colleagues or their GP..."

I think that most of us, as patients, regard doctors as super-human who are void of negative emotions.  If they are cool/cold with us - it offends us - it certainly offends me!  We are the patient - they are the doctor.  Forget the heartsink patient who is the eternal hypochondriac and let us think of ordinary Joe who visits the surgery with perhaps, a minor complaint.  He has a minor problem which he wants nipped in the bud.

Say Joe has not visited the surgery for three years - he is a seldom attendee - and he has a wart on the end of his nose and wants it removed.  Request over - he is met with a barrage of questions required to meet the QOF.  He is asked if he smokes - yes he does - but he thinks what the hell has this to do with the wart on my nose? and internally, becomes angry.  He then has his BP taken and it shows he is hypertensive (white coat and anger) and he is asked to return and have his BP rechecked and his bloods ta\ken.  He leaves the surgery in a state of angst.

After three visits to check his (white coat) hypertension he is commenced on meds and also meds for high (who says - Big Pharma?) cholesterol, and suffers side effects which are viewed as another problem and he is prescribed meds for this and that, and this no meds man suddenly takes home a carrier bag full of drugs from the chemist all due to the wart on the end of his nose.

But this entire aside, what if the patient is Jessie who has multiple comorbidities?  She likes Dr Smith for he is kind to her and treats her with compassion.  She needs to see a doctor, but the only doctor available is Dr Jones.  Nobody, but nobody wants to see Dr Jones, for he makes a patients heart sink.  Dr Jones meets the definition of a total w*nker!

Yes!  There are doctors that make a patients heart sink!  Whether in a GP or hospital setting,  patients leave thinking what the hell did I do to deserve to be treated like that!?

Then there is Janet who is also a seldom attendee who visits her doctor as she knows that something is not right.  She doesn't know what it is as she is not a doctor.  She has all the usual investigations and nil is found.  She is told she is anxious - for after all she is a woman - and is left on the outside looking in.  But she knows that something is wrong and consults Dr Google - for that is all she has left.  He does not listen - but he talks to her in the written word.  She is not stupid and discounts all that does not apply to her.  But then, she finds her illusive dx and consults her GP with a printout - bad move - for a sure sign of hypochondria!  She also takes a list of symptoms as NHS sites suggest that she should - but GPs and hospital docs hate lists and must take control of same and a list is another sure sign of hypochondria!  But months down the line - after much professional abuse (?) by doctors - she is proved right.

I need two pairs of hands to count the number of close family or friends who after routine investigations have been told there is nothing wrong with them, only to discover later down the line that there is - at times with terminal consequences!

Doctors are not perfect and neither are patients.  We need to meet in the middle!

Rant over!   I love doctors really!

Anna o]