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

Excerpt

It is a dirty little secret that every provider has patients that make their “heart sink” when they see them on their schedule.1 Such patients have been variously called “black holes,”2 “difficult,”3 “frustrating,”4 “disliked”5 and in the sentinel 1978 article, even “hateful.”6 What is perhaps surprising is that they are so common, accounting for up to 15 % of primary care patients worldwide. At first, we tried to blame the patients. We “discovered” that dreaded patients share a number of characteristics. They usually have medically unexplainable symptoms,7 even after an exhaustive, expensive and fruitless search. They often have excessive worry,7 low functional status,8 personality disorders9 and poor functional status.3 Making matters worse from the doctor’s perspective, they are high utilizers;3 they visit their primary care provider more often than the provider would like and are also well known to local urgent care clinics and emergency departments. A typical phone call from the ER provider to the primary care provider is “Your patient, Mr. Smith is here in our ER…[pregnant pause]…again!” What the ER provider doesn’t know is that instead of provoking a guilty feeling that we haven’t done a better job of managing Mr. Smith so he wouldn’t need to be a burden to the emergency room provider, we’re just glad he’s not in our clinic this morning. …