TY - JOUR T1 - A farewell to heart sink? JF - British Journal of General Practice JO - Br J Gen Pract SP - 504 LP - 504 VL - 57 IS - 539 AU - Gwenda Delany Y1 - 2007/06/01 UR - http://bjgp.org/content/57/539/504.abstract N2 - So let's say then for the sake of argument that ‘A’, our ‘heartsink’ patient, may well have experienced some form of abuse — physical, sexual, or emotional — early in life. Why take it out on us, in our consultations? Or even in our myriad social, familial, and domestic encounters?With the best will in the world, there is a power imbalance between patient and doctor in a medical consultation: one that easily recalls the original power imbalance between child and adult, the emotions that went with it, and the expectations that follow from it. If these experiences involved abuse of any kind, then on some level, however unconsciously, the patient may see the doctor, the ‘figure of power’ in charge of the consultation, as an abuser. The doctor's offers of help may then be seen as deceit, seduction, or attack; or grossly wanting in some other way. This state of affairs in turn will require the ‘once bitten, twice shy’ patient to be ready with tactics and strategies for repulsing and outwitting the hapless doctor; to go on the defensive, or on a ‘pre-emptive’ offensive, often both. The patient, self-perceived as victim, gives in and appears to comply, prompted by old fears of powerful parent figures, … ER -