A registrar survival guide - Surviving heartsinks

Dr Barney Tinsley, a GP partner in Harrogate

Every practice has them
The frequent attendees, the consistently-ill, the somatisers and the just plain frustrating, 'heartsinks' are unavoidable. When a doctor joins a practice, open season begins. The chance of a fresh listening ear is too tempting to miss. Many new GPs, enthused with knowledge-overload, try to re-invent the wheel, when a gentle polish would be better.- Hear them out

As with almost all consultations, heartsinks will have an agenda. Whether this is a fixed determination to impart their life story and medical history to you, or a 12th or 13th opinion on a long-standing problem, be prepared to listen.

It is not possible to mark all these patients' records with 'Watch out for this one', so a cursory glance through the problem summary and last couple of consults is a good habit to adopt, for every patient. This can often be done in a few seconds while buzzing the patient in. - Prioritise the problems

Allowing the initial information splurge that many patients start with is good practice - there may be several problems within this. Prioritising which one or two of these cause the most concern and concentrating on them might curtail a long consultion. A separate appointment may be needed at a later date for the others. - Keep to time

Emphasis placed on 'others in a busy waiting area' and 'exceeding allocated appointment time' are fall-back options if desperation sets in. If time allows, glance over the patient's record in more detail when not in a booked surgery, and familiarise yourself with any specialists' diagnoses.

Don't miss red flags
Care must be taken not to brush over red flag symptoms, or to dismiss a potential 'cry wolf' scenario. Good clinical practice advises consistency in history taking, note keeping, appropriate referrals, and ability to justify investigation or inactivity from the GP's perspective. Be prepared to ask for opinions from your colleagues, and double check your plan of action.


  • The patient's notes
  • A clear agenda
  • Awareness of red flags

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