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Current use of the term heartsink has clearly moved beyond reference to O’Dowd’s paper and the ‘problem’that he perceived. None of the references in Box 1 cites O’Dowd and none of them upholds O’Dowd’s patientspecific and specific-patient meaning of heartsink. Moreover, the phrase ‘heartsink patient’has come under attack: branded ‘derogatory, unhelpful and inaccurate’by the author of Using CBT in General Practice. 8 She instead advocated reference to heartsink ‘reactions’ or ‘responses’ with the assertion that these responses were wholly the responsibility of the GP,‘rather than being an inherent characteristic of any particular patient’. This re-formulation usefully facilitates contemplation of coping mechanisms that can be used in practice. It also sensibly challenges ill-considered labelling of patients. However, in discouraging reference to ‘heartsink patients’ there is a risk of permitting, even encouraging …