230 Butler.qxd

The term ‘heartsink patient’ is now part of the vocabulary of general practice. But what and where is the heartsink? How should the phenomenon be studied? What are the implications of differing interpretations for general practice? The heartsink patient presents personal, social, and soteriological (pertaining to salvation) problems in physical terms. This poses a fundamental challenge to the philosophical foundations of general practice. Emphasizing a biomedical role justifies questioning the legitimacy of ‘heartsinks’ as patients. Alternatively, general practice should reassert its acceptance of suffering, whatever its origin and presentation. This would justify accommodating a far greater range of problems than simply those explained by biomedicine alone, and make general practice soteriological to the core.