A heartsink survival kit

A pilot workshop of managing 'heartsink' patients described by Mathers and Gask 4 led to the formulation of a 'heartsink survival' model for the management of patients with somatic symptoms of emotional distress.

The first part of the three-part model, which is called 'feeling understood', includes a full history of symptoms, exploration of psychosocial cues and health beliefs, and a brief focused physical examination. In the second stage, termed 'broadening the agenda', the basic aim is to involve discussion of both emotional and physical aspects during the consultation. It includes reframing the patient's symptoms and complaints to provide insight into the link between physical, psychological and life events.

In the third stage, 'making the link', simple patient education methods are used to explain the causation of somatic symptoms such as the way in which stress, anxiety or depression can exaggerate symptoms. It also includes projection or identification techniques using other sufferers as examples.

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