Most ambulance services experience frequent callers or high-volume user populations. It is not an isolated issue but a worldwide problem. Frequent users are a heterogeneous population, with complex physical, mental and social needs. These patients often have numerous conditions or compounding factors, such as frequent falls, psychiatric illness, substance misuse and long-term conditions. As a result, these patients are often vulnerable to poverty, social isolation, reduced quality of life and higher than expected mortality rates. Attending to these patients requires intense emotional investment from clinicians. Without this, communication can break down and practitioners can rapidly become frustrated. Patients who fail to provide validation of the clinician's role as a provider of care and assistance threaten the clinician's sense of control, create demand and risk moral jeopardy. Moral appraisal is intrinsically bound to human development and difficult to avoid without deliberate moderation. This article seeks to explore literature on the frequent caller population, the development of frustration, the consequences for practice and how empathy can restore the therapeutic relationship.

Kate Snowdon -