YOUR FIRST: heartsink.

Dr Chris Hall offers some advice on dealing with the various types of patient who fall into the heartsink category

There are as many types of heartsink patient as there are types of GP. The politically incorrect notion of the weeping middle-aged tissue- wringer is an unfortunate stereotype, for in truth, heartsink status is independent of age and sex (reassuringly I have yet to meet any paediatric heartsinks, though it may only be a matter of time).

You can be certain that somebody, somewhere, has authored a highly incisive treatise on the dynamics of what we shall call the `challenging consultation', but I doubt that beyond suggesting coping mechanisms, such research can be of much practical use.

Many GPs consider the heartsink patient to be part of life's rich tapestry - indeed, while preparing for the video component of the MRCGP examination the registrar may find his or her heart leaping with joy when Mr Vague sits down and unfolds his list of (current) ailments. How quickly that joy changes to weary resignation when the same patient graces your consultation room for the umpteenth time with the same intractable ailments. You open with `How are you?' only to be greeted with dough eyes and a familiar resigned shrug of the shoulders.

You try: `What can I do for you today?'

Bad mistake. `Dunno, where do I start?' is the usual reply.

A few hints then for a couple of common scenarios.