Lecture Discussion 302 

Timothy Spruill, MA, EdD  

It’s been over 30 years since Tom O'Dowd coined the adjective “heartsink” in the medical literature to describe a certain type of patient. Heartsink refers to that sinking feeling in the physician’s gut when they see the names of these patients on their daily schedule. In part, the feeling derives from the fact that such patients tend not to adhere to recommended diagnostic testing and when they do, results often come back negative leaving the physician with nothing but medically unexplained symptoms and uncertainty on how best to proceed. In like manner, when treatments are suggested, they may reject them and if they comply, they report that their symptoms remain. Yet they keep coming back despite their physician’s unspoken hope that they will disappear. Numerous other characteristics of these patients found in the literature will be described in the lecture. Physicians often feel helpless in the face of these patients who seek relief from psychological, social, and spiritual problems at a biomedical level. Ineffective physician efforts to free themselves from these encounters will be covered but most of the lecture time will be spent reviewing ways research has shown can reduce the incidence of the sinking feeling such patients evoke starting with physician attitudes and finishing by describing proven ways to cut in half the percentage of a physician’s clinic schedule perceived as heartsink patients.  The role of integrated behavioral health professionals as a potential relief factor will also be covered. Time will be allotted for questions, answers and discussion. 

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