Heartsink patients management in health centres. A Delphi consensus

Background. In 1988, O'Dowd introduced the term "Heartsink patient", which refers to patients with behavior considered as "exasperating" or "exhausting" by their doctors, whom they place in emotional, intellectual or scientific difficulty, eliciting deep distress. The management of these patients is complex. Aim. To provide consensual management of Heartsink patients in health care centers. Method. Consensus study using the conventional Delphi method with general practitioners working in health care centers. Results. The first round achieved a favorable consensus on the importance of multidisciplinary exercise, shared medical records, work experience, multidisciplinary staffs, participation in Balint groups and consultation dedicated to the development of individual health programs. In the second round, a favorable consensus was reached on the participation in training programs on communication with patients, use of alternative therapies and psychological counseling. Only one proposal was rejected: systematic referral to other specialists. Conclusion. Six recommendations were put forward for management of Heartsink patients. Implementation of some of these recommendations seems facilitated by practice in health care centers (organizational advantages, team exchanges, multidisciplinary staff meetings, and supervisory meetings). Additional research is needed to assess the differences between the different form of medical practice (clinical, private, hospital-based). In addition, interventional studies based on the recommendations of this study, could assess their impacts on the management of Heartsink patients.