I am a general practitioner. Where I practice, there is public hospital system, which is free for residents/citizens. But there is a threshold – only the severe cases get offered an appointment to see a specialist/free investigations. Patients see me, then I refer to public system and they either get accepted or rejected.

There is a 62 year old lady, with a vague tummy symptom.  So far her examination, and free blood test and fecal test all came back reassuring. But she is very worried about bowel cancer. It is very unlikely that it is bowel cancer, but I know the gold standard examination is a colonoscopy for which I have referred her to the public system.  I expect that it will be rejected and she doesn’t have private health insurance – or enough cash in the bank to just pay outright for a $5000 private colonoscopy.

There are a lot of circumstances that I cannot change – the public threshold system, how much money patient has, the thoughts that patient has about bowel cancer.

But what I am making the situation mean is that – if she was my mother (they are similar age, my mum a bit older) and mum is worried, I would just pay the $5000 (which gratefully I have the means) and then I am happy. And the fact that this patient very likely will not get a colonoscopy, my brain is making it mean that “I am failing this patient”.

C- Patient said “Can you refer me for colonoscopy? I cannot pay for private colonoscopy”
T- I am failing this patient
F- hate job
A- I dread going to work. I dread seeing patients. I consider changing job – stopping being a doctor, even just being a stay at home mum. Ignoring all the other service/help I provide to other patients. I am looping thoughts of depressed background self talk – or anxiety that I am missing something. ( Is this a specific enough action? These actions are all related to my job – but may not be specific to this particular patient)
R- I am not creating enjoyment in my job.