Sarradon-Eck, Aline

Dealing with “heartsink” patients. How do young, newly qualified physicians (de)medicalize medically unexplained symptoms? - 2020.


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Using group and individual interviews conducted with young, newly qualified physicians and interns, this article examines the reasons why patients with medically unexplained symptoms tend to be labelled “heartsink” or “difficult” patients. The authors examine the reasons why these labels are used by physicians who are struggling to meet the medical ideals that they incorporated during their professional socialization. Failure to achieve these ideals makes them take stock of their knowledge and expertise and view these clinical cases from a different perspective, which involves demedicalizing some demands for care in order to bolster their own sense of professional identity. This de facto process of demedicalization takes two main forms, the first of which involves refusing to recognize the severity of these patients’ symptoms, minimizing them and/or considering them outside of the usual framework of general medical treatment. The second form involves redefining these patients’ symptoms and behavior by attributing them to the category of moral or medical deviance.