Heart Sink Research Articles

Where is the Black doctor!?

I was a first-year resident in downtown Toronto when I got a page. The emergency physician started the conversation in a way that makes every resident’s heart sink. “I’ve got an interesting one for you.” “Eighty-seven-year-old gentleman with an incarcerated hernia. I reduced it, but he

Why pairing up with a psychologist helped to reduce risky opioid prescribing

It makes your heart sink when you receive referrals along the lines of ‘Please see Mrs Smith for support with reducing opioids. She has been on fentanyl patches 100mcg and Oramorph 20mg PRN for ten years for her back pain, and has tried reducing her medication but had issues with withdrawal. She is struggling with […]

Breaking & Mending: A junior doctor’s stories of compassion & burnout

Joanna Cannon entered medicine at a later age, she worked in a number of specialties as a junior doctor before moving into psychiatry. While working in the NHS she began penning her first novel, which became a bestseller. This book feels very different to those she’s written in the past, because unlike her other books she can’t hide behind fictitious storylines, these words are real and this story is her own. Most occupational health practitioners started their careers in the hospital wards, many of us will see healthcare workers on a daily basis, their livelihood involves the same work that we once did. Some of us may have forgotten what it’s like to tread through the hospital corridors in the dead of the night. I have felt my heart sink on a number of occasions when I’ve heard comments such as: ‘it’s not as bad as it used to be,...

Chasing Dreams, Finding Nightmares: Exploring the Creative Limits of the Music Career

Chasing Dreams, Finding Nightmares: Exploring the Creative Limits of the Music Career

Does the combination of spinal manipulation with acupuncture provide better pain relief for low back pain patients?

Low back pain (LBP) is a heart sink consultation for many practitioners. Although a large proportion of patients presenting with LBP will improve within few weeks, many will continue to have pain or experience a new episode within the next year (1).

Reigniting compassion in healthcare: Manaakitia Reflective Rounds.

The reported levels of staff stress and burnout at all levels of training and disciplines is significant and recognised to impact on the care of patients and families. We present an initiative to support staff at Auckland City Hospital based on the Schwartz Center Rounds. To evaluate the efficacy of monthly case-based, staff support reflective rounds to discuss complex emotional and psychosocial issues that arise in caring for patients and families. At Auckland City Hospital, a pilot programme called Manaakitia Reflective Rounds was conducted between April 2014 and September 2015. These were facilitated 1-h, monthly, case-based, staff support groups to discuss complex emotional and psychosocial issues in caring for patients. Staff evaluations and feedback were collated. A total of 12 rounds was conducted exploring a range of challenging issues, from difficulty in achieving a patient's wish to die at home to coping with the 'heart sink' patient. There were 276 attendees in total, with an average attendance of 23 participants per round. A total of 218 evaluations was returned (79%) with rounds being rated as either exceptional or excellent by 87.5% of participants. Attendees reported positive benefits, such as gaining knowledge to help them care for patients (94%), working better with colleagues (87%) and gaining insight into how others think and feel in caring for patients (97%). Attendees reported a sense of having a 'shared experience' with better understanding of each other's professional perspectives and acknowledgement of the limitations (practical and human) in caring for patients and families. Evaluations of the rounds indicate a need for staff to have a safe and supportive space to explore the emotional aspects of their work. Staff particularly appeared to value having a 'shared understanding' with the recognition that they are 'not alone' when managing challenging situations.

Why medically unexplained symptoms and health anxiety don't need to make your heart sink.

Why medically unexplained symptoms and health anxiety don't need to make your heart sink.

Am I about to start work on a sinking ship?

It is impossible to avoid all the negative headlines about healthcare and, as someone who is about to embark on a career in the NHS, they make my heart sink.

'The poor historian': Heart sink? Or time for a re-think?

In this commentary article, the oft-heard expression, 'the poor historian', will be discussed. We will consider who the poor historian is and reflect on medical training to speculate how and why the expression has entered the medical lexicon. The potential negative impact of this terminology on patients and junior learners will be considered and strategies for re-framing this concept, for both clinical teachers and learners, will be presented.

Mechanics of stretchable electronics on balloon catheter under extreme deformation

Stretchable electronics has been applied to balloon catheters for high-efficacy ablation, with tactile sensing integrated on the surface, to establish full and conformal contact with the endocardial surface for elimination of the heart sink caused by blood flow around their surfaces. The balloon of the catheter folds into uniform ‘clover’ patterns driven by the pressure mismatch inside (∼vacuum) and outside of the balloon (pressure ∼1atm). The balloon catheter, on which microelectrodes and interconnects are printed, undergoes extreme mechanical deformation during its inflation and deflation. An analytic solution is obtained for balloon catheter inflation and deflation, which gives analytically the distribution of curvatures and the maximum strain in the microelectrodes and interconnects. The analytic solution is validated by the finite element analysis. It also accounts for the effect of inflated radius, and is very useful to the optimal design of balloon catheter.

Heartsink Hotel, or “Oh No, Look Who’s on My Schedule this Afternoon!”

Heartsink Hotel, or “Oh No, Look Who’s on My Schedule this Afternoon!”

The smartest, greenest grid

What a little Danish island is showing the world about the future of energy. On Christmas night, Maja Bendtsen and her husband were curled up on the couch watching TV in their cozy house on the Danish island of Bornholm. Suddenly the house lost power. "The lights flickered briefly and then everything went black," Bendtsen recalls. Peeking out the window, they saw that the whole neighborhood was dark. A few quick phone calls confirmed that all of Bornholm was without power. Bendtsen, an engineer with the island's utility, Ostkraft Net, mentally ruled out the obvious culprits: It wasn't a particularly busy night, as Christmas festivities had wrapped up with the midday meal, nor was the weather particularly cold or stormy. She thought of one thing, though, and it made her heart sink. She phoned the Ostkraft control room, where the chief engineer confirmed her suspicion: A ship dragging its anchor in the narrow Baltic Sea channel between Bornholm and Sweden had severed the 60-kilovolt, 70-megawatt undersea power cable that is the island's only external source of electricity. It would take a repair crew more than six weeks to pinpoint the damage, haul the cable to the water's surface, and fix it.

Primary care practitioner and patient understanding of the concepts of multimorbidity and self-management: A qualitative study.

Objectives:The aim of this article is to offer insight into how professionals and patients understand and experience multimorbidity and how these accounts differ, and how they affect attitudes and engagement with self-management.Methods:Semi-structured interviews with 20 primary healthcare practitioners and 20 patients with at least 2 long-term conditions (including coronary heart disease, diabetes, osteoarthritis, chronic obstructive pulmonary disease and depression). Thematic analysis was used, and themes were identified using an open-coding method.Results:Practitioners associated multimorbidity with complexity and uncertainty in the clinic, leading to emotional strain and ‘heart sink’. Patient accounts differed. Some described multimorbidity as problematic when it exacerbated their symptoms and caused emotional and psychological strain. Others did not perceive multimorbidity as problematic. Self-management was seen by practitioners and patients to be a key element of managing multiple conditions, but drivers for prompting and engaging in self-management differed between patients and practitioners.Conclusion:This study suggests that recommendations for clinical practice for multimorbid patients should take into account the gap in perceptions between practitioner and patients about experiences of multimorbidity. Not least, practice would need to reflect the tension between practitioners’ and patients’ accounts about the role and benefits of self-management in the presence of multimorbidity.

Hints, tips and clues in dermatopathology

There are a number of excellent dermatopathology texts available and a plethora of journals. However, day to day problems frequently arise for which the traditional textbook approach is lacking. In this workshop, we use cases from daily practice to illustrate diagnostic approaches and techniques and to highlight some valuable hints, tips and clues to the diagnostic process. Cases for discussion are available as virtual images on the precirculated DVD. In addition, practical details of the methods presented will be available on the post-meeting CD. Topics covered include: • Three benign processes readily misdiagnosed as malignancy. • How do you immunostain highly pigmented lesions? • Heart sink biopsies– what do you do when it all looks normal? • Why we don’t use Congo red. • When and how your dermatologist should biopsy alopecia.

The Difficult Pediatric Encounter: Insights and Strategies for the Pediatric Practitioner

1. Andrea Gottsegen Asnes, MD, MSW* 2. Ambika Shenoy, MD* 1. *The Department of Pediatrics, Yale University School of Medicine, New Haven, Conn All pediatric practitioners are familiar with the concept of the “difficult” encounter with a family. Such encounters can range from those that leave clinicians with a slightly uneasy feeling once the family has left the office to those in which actual disputes occur. Barbara Korsch, MD, wrote, “There are certain names on the day's schedule that make the practitioner's heart sink and feel fatigued in advance.” (1) Although the responsibility of an effective partnership between pediatric practitioner and parent is shared, the larger part of the task falls to the clinician. A recent policy statement published by the American Academy of Pediatrics (AAP) refers to pediatric clinicians as “privileged and trusted advocates for the well-being of children.” (2) With privilege and trust comes the responsibility to foster relationships with families and to fortify such relationships when they are threatened. The AAP states that “communication and collaboration” are principles of professionalism in pediatric practice to be upheld. In addition, the statement says that pediatric practitioners must recognize that “patients’ families and the health care team must work cooperatively with each other and communicate effectively to provide the best patient care.” (2) Our own experience leads us to believe that although not all difficult encounters with families can be overcome or smoothed over, many can. Recognizing patterns of interaction that can lead to conflict with parents and addressing them early can be highly effective in preventing escalation. Many conflicts, once understood, even can lead to an enhancement of the partnership between clinician and family. The following case vignettes illustrate several types of difficult interactions with families that we have had in our pediatric practices. Each is followed by suggestions that the pediatric practitioner may find useful. Although it can feel awkward, even false, to try these responses when faced with …

Using hypnosis in dentistry

When an anxious patient presents at your practice does your heart sink and a feeling of stress descend on the whole team? How are you going to cope with delivering treatment to a person who is so scared that they sit in the chair, gripping the arms, shaking and sweating? Wouldn't you like to have a way to easily and quickly relax the patient so that treatment would be easy and less stressful for both them and yourself? Hypnosis is one such way of achieving this.

Conduct disorders and us: from heart sink to heart warming?

The “Child in Mind” initiative and the appointment of a new specialist consultant in child mental health offer hope for the future

Gregory of Nazianzus: Images and Reflections. Edited by JOSTEIN BORTNES and TOMAS HAGG.

Here are 15 essays about the Theologian. Twelve are revised versions of papers delivered at a conference on Gregory at Bergen in 2003 which was part of a general research project devoted to aspects of early Byzantine theology; three were papers delivered separately in Oslo to the Norwegian Academy of Science and Letters. As always with such collections most contributions contain useful information, some languish outside their original context, some are irrelevant or superfluous, some are perceptive and justify the volume. The first four essays attempt a sort of map of how Gregory thinks of himself and expresses his relation to the divine: Jostein Børtnes on ‘Prompting for meaning in Gregory's Rhetoric’ (making the heart sink by the ridiculous opening error that Eunomius claimed that the Son is unlike the Father, as if anybody in the whole history of Christian thought ever proposed such obvious folly!) and ‘Rhetoric and mental images in Gregory’; Frederick W. Norris on ‘Gregory contemplating the beautiful: Knowing human misery and divine mystery through and being persuaded by images’; and Stratis Papaioannou on ‘Gregory and the constraint of sameness’. One or two good points are made but the map is too vague and abstract. All four pieces include quotations from Gregory more interesting and intelligible than anything said about them; all would have benefited from analysis of the basic notions involved.

What makes your heart sink?

I detest labels, especially the “heartsink” one that some doctors use to describe their patients. One labelling approach goes even further—classifying “hateful patients” as either “dependent clingers,” “entitled demanders,” “manipulative health rejecters,” or “self-destructive deniers.” I doubt there are many doctors who haven't, from time to time, felt angry, frustrated, or inadequate after a consultation with a patient who …

A plague on projects

If there is one thing which makes my heart sink, it's the expression ‘special project’. Whenever I hear those two doom-laden words I wince, not just because I suspect that someone is almost certainly about to waste a great deal of time and effort, but also from embarrassment. I too bear the scars of being dragged into other folks’ fantasies.