Why are MUS conflated with heartsink?

All letters are subject to editing and may be shortened. General letters can be sent to bjgpdisc@rcgp.org.uk (please include your postal address for publication), and letters responding directly to BJGP articles can be submitted online via eLetters. We regret we cannot notify authors regarding publication. For submission instructions visit: bjgp.org/letters

In response to the two letters regarding medically unexplained symptoms (MUS), in the April issue of BJGP, I would like to question why MUS are being conflated with ‘heartsink’ patients?^1,2 Although MUS provide the often fascinating detective work challenges that we should be using to attract potential new recruits into general practice, heartsink patients, in my view, are the ones that challenge me on an emotive — rather than clinical — level. My heartsink patients are the ones that make me feel inadequate, cross, or miserable for a variety of reasons that are rarely simply my lack of diagnostic acumen. Some of the ‘consultation models’ help us understand these reasons: personality clash, communication problems, manipulative behaviour, and issues of consultation dominance, and sometimes the challenges of fixedly held cultural beliefs or illness behaviours.

To move beyond heartsink labels, we should learn to understand the psychology of ourselves first — more than furthering my clinical knowledge, learning to be aware of my own set of prejudices has helped me to avoid letting them govern my consultations. I’m an imperfect human and doctor — but I shouldn’t have to feel omnipotent towards my patients in order to act professionally.