Trainer

The ‘heartlift’ patient

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There is much discussion and reflection around ‘heartsink’ patients and their effect on consultation style and doctor gratification. I was recently in surgery seeing a patient well known to me. I reflected on the doctor–patient relationship and how it makes you feel when things go well. I started to feel a strong sense of reward that I was being valued but also had immense respect for my patient who was able to bring out the positive aspects in his life despite significant challenges. It made me think about the lack of discussion and reflection with colleagues that there is about those patients that make us feel good or even look forward to seeing them.

So, why are these patients not acknowledged in the same way as heartsink patients? Does this say something about our reflections in education and training? Is it because we are too humble or modest to focus on things that go well?

We sometimes see patients that we admire. It may be that we feel the goodness oozing out of them, or they may leave you with that warm feeling inside that you are valued or even reassure you that you are making a difference to their troubled lives. It may be that they give you a card or a gift or just that they offload their gratitude for your time and help. In general practice, we are privileged to see and try to help patients with difficult circumstances. I am sometimes inspired to see these patients coping and it makes me realize what an easy life I have.

When you look at your morning surgery before it starts, you may spot the heartsink and sigh but also see ‘Mr X’ who you enjoy consulting with and even feel a sense of excitement about seeing. Yet, why does my previous GP training, and indeed the literature, seem to focus almost entirely on the heartsink and not on the patient that makes me feel good? I am not even aware of a ‘title’ to give such patients and, during my consultation, thought of the expression ‘heartlift’ in contrast to the pessimistic and negative heartsink expression that I hear so much of. A google search of heartlift patient revealed my thoughts are not original and in fact studies have researched GP reflections on this concept. There is much discussion, both anecdotally and in journals around the heartsink, how to deal with that negative internal feeling, consultation styles that offer relief and ‘Balint’ groups and peer support for offloading those challenges. But is there significant educational value in giving more emphasis to the heartlift?

Now, one could argue that heartlift patients need less focus as they rarely present a challenge. However, if it makes you feel good to consult with a heartlift, it will more than likely make you feel good when you discuss it with colleagues and that may offer some light relief amid the angst of successive heartsink discussions.

Are we afraid of mentioning heartlifts for fear of being perceived as too ‘self-valued’ or perhaps even arrogant? I don't think that I have ever witnessed a discussion where a colleague has said ‘Hey! I saw this patient last week and the consultation went really well, I felt so much better after it and got a sense of worth and happiness by the end’. Perhaps, one model to facilitate such discussions would be to follow one heartsink discussion by one heartlift, which may engage some balance. Or even 2:1 perhaps?

Some may argue that discussions around heartlift patients offer less educational value; but I disagree. Colleagues can share what it was that made that consultation feel good, and there is always scope around what could have been done better. Furthermore, discussions around a heartsink is a ‘known unknown’, but a heartlift may uncover the holy grail of unknown unknowns, for a colleague may challenge you on your ‘good management’. In fact, could a heartlift become a heartsink by the end of a heated peer support group chat around your ‘good consultation’? Perhaps, you may end the discussion with the intent of re-calling the patient to address what you missed?

Thus, your homework is to bring a heartlift patient to your next Balint or peer support group and reflect on the educational value. Enjoy!