title: Collaborative engagement with colleagues may provide better care for 'heart-sink' patients.
abstract: BACKGROUND
  In this article we show how a group of general practitioners' (GPs') professionalism was enhanced through collaborative engagement. Complexity, uncertainty and so-called 'heart-sink' patients are naturally embedded in clinical practice. GPs need to deal with, and even embrace, uncertainty, enabling them to provide patient-centred care.
  
  
  METHODS
  A relatively fixed group of Danish GPs have met regularly for more than 14 years, discussing difficult and complex cases. Their experiences were researched through two focus group interviews using semi-structured interviews comprising open and closed questions, which were audiotaped and transcribed. The qualitative findings were analysed employing grounded theory principles.
  
  
  RESULTS
  Participation in the GP group was perceived to have had a positive impact on participants' personal and professional lives by reducing the number of 'heart-sink' patients, by strengthening their ability to reflect and deal with uncertainty, by boosting self-confidence by improved professional selfawareness, by providing them with a safe environment and by enhancing their working enjoyment and professional motivation. A number of features of the group's structure and ways of working, which appear to have secured the long-lasting sustainability of the group, have been identified.
  
  
  CONCLUSIONS
  This group of Danish GPs experienced personal and professional growth through collaborative engagement. They have apparently learned to embrace and even value the fundamental uncertain and complex nature of primary care, which seems to benefit their 'heart-sink' patients. The features, which have ensured the long-lasting sustainability of this group, could perhaps inspire other younger GPs to work in such reflective groups.
authors.affiliation: University of Southern Denmark, Lindevej 18, Sonderborg 6400, Denmark. niels.kjaer@dadlnet.dk.
authors.forename: Niels Kristian
authors.initials: NK
authors.lastname: Kjaer
authors.affiliation: Sydals, Denmark.
authors.forename: Bent
authors.initials: B
authors.lastname: Stolberg
authors.affiliation: Faculty of Education, Health and Social Care, University of Winchester.
authors.forename: Colin
authors.initials: C
authors.lastname: Coles
mesh_terms: D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D003718:Denmark; D017144:Focus Groups; D058005:General Practitioners / Q000523:psychology*; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D009042:Motivation; D018802:Patient-Centered Care; D011320:Primary Health Care / Q000379:methods*; D036301:Qualitative Research