This will upset the Thai bashers

[tamada]

Why is Thai health care so good?
The country could become a model for the region

https://www.economist.com/asia/2024/07/ ... re-so-good

[AlexO]

I am not a Thai basher by any means Tam, but.
I would, with experience of the system, question the claim that Thai Healthcare is good.
First and foremost Thai trained doctors are not permitted to practice in Europe including the UK or North America as their standard of training is below minimum standards required in the west. If they want to practise additional training and further exams are required.
I would concur with this assessment, example, Doctor no1, the strange discolourations in your ankle area is just bruising.
One week later, Doctor No 2 the open ulcers on your leg are not too serious, given antibiotics.
One week later Doctor number 3, Ah your ulcers are drying up nicely, stop antibiotics,and she proceeded to cut away some dead flesh while sitting in non sterile environment under local anesthetic.
One week later Doctor No 4 took one look and did an emergency admission.
Over next 10 weeks a myriad of doctors attempted to cut out the problem (Necrotising fasciitis) so after 7 operations including 2 full amputations I was finally rid of the black death.
Point being that 3 early doctors misdiagnosed the problem and probably added to the end result because of delay in effective treatment.
The current older generations in Thailand lived a mostly simple life, were not overweight, ate quite a health diet which has led to the current longevity, will be interest to see what the current younger generations life expectancy will become with the increase intake of sugars, fast foods etc. How many fat Thai' did you see 25 years ago.
Doctors in Thailand do not ask questions about previous health problems, family medical history etc that is standard practice in the west just make up their minds what is the likeliest cause and hand over prescriptions for carrier bags full of meds.
Private Hospitals tend to be much better but they have no impact on the general population. A bit of a long rant but there are serious problems in the Thai Public Medical System.

[anefarious1]

I am not a Thai basher by any means Tam, but.
I would, with experience of the system, question the claim that Thai Healthcare is good.
First and foremost Thai trained doctors are not permitted to practice in Europe including the UK or North America as their standard of training is below minimum standards required in the west. If they want to practise additional training and further exams are required.
I would concur with this assessment, example, Doctor no1, the strange discolourations in your ankle area is just bruising.
One week later, Doctor No 2 the open ulcers on your leg are not too serious, given antibiotics.
One week later Doctor number 3, Ah your ulcers are drying up nicely, stop antibiotics,and she proceeded to cut away some dead flesh while sitting in non sterile environment under local anesthetic.
One week later Doctor No 4 took one look and did an emergency admission.
Over next 10 weeks a myriad of doctors attempted to cut out the problem (Necrotising fasciitis) so after 7 operations including 2 full amputations I was finally rid of the black death.
Point being that 3 early doctors misdiagnosed the problem and probably added to the end result because of delay in effective treatment.
The current older generations in Thailand lived a mostly simple life, were not overweight, ate quite a health diet which has led to the current longevity, will be interest to see what the current younger generations life expectancy will become with the increase intake of sugars, fast foods etc. How many fat Thai' did you see 25 years ago.
Doctors in Thailand do not ask questions about previous health problems, family medical history etc that is standard practice in the west just make up their minds what is the likeliest cause and hand over prescriptions for carrier bags full of meds.
Private Hospitals tend to be much better but they have no impact on the general population. A bit of a long rant but there are serious problems in the Thai Public Medical System.

Not to mention that pursuing any malpractice claim is a laughable idea here.

[AlexO]

Not to mention that pursuing any malpractice claim is a laughable idea here.

Absolutely. What gets me is the will not allow anyone to query their opinions. Its all about Face with Thai trained doctors, they stick to their original decisions even to the detriment of the patient.
The Thai doctor who took me of meds and did the debridement in an open wound dressing room was in the same room when Doc 4 was examining me and telling me immediate admission, she would not even look in my direction, totally ignored me.

[tamada]

From the cited article.

"Thai health care is among the most effective in the world. The average Thai can expect to live to 80, much longer than their regional counterpart (the South-East Asian figure is 73) and even slightly longer than the average American and European (each roughly 79), according to the latest data from the United Nations. Last year a whopping 99.5% of the population of 72m was covered by health insurance. ..."

I believe I am correct in thinking the 99.5% of the population referred to is the indigenous Thai population that includes their indigent.

[anefarious1]

Not to mention that pursuing any malpractice claim is a laughable idea here.

Absolutely. What gets me is the will not allow anyone to query their opinions. Its all about Face with Thai trained doctors, they stick to their original decisions even to the detriment of the patient.
The Thai doctor who took me of meds and did the debridement in an open wound dressing room was in the same room when Doc 4 was examining me and telling me immediate admission, she would not even look in my direction, totally ignored me.

Unlike many foreigners here, your perception comports with reality.

[AlexO]

As much as I decry Thai medical services its superior to many of the peer group nations in SEA.
Laos, (admit this was 10 years ago) medical services were virtually non existent with only a clinic type facility in Vientiane. Judging by the number of Laos number plates currently in BU hospital would seem no great improvement.
Vietnam, listened to horror stories from my staff in both HCMC and Hanoi about doubling up of patients in a bed (head to toe). Seen with my own eyes crowds of people outside hospitals offering to take care of patients at a price, for families who could not be there for 24h a day. Seems no one wanted to go into hospital as many of those that came out were in a box.
Cambodia. Apart from Phnom Phen where there is a hospital of sorts there is nothing but clinic type medical facilities, one reason why I did not retire to Sihanoukville back then. May be different with the Chinese money that flooded in but doubt it.
Myanmar. Virtually nothing, Witch Doctors are busy.
So while far from good Thailand does at least have a system that works, within limitations.

[anefarious1]

As much as I decry Thai medical services its superior to many of the peer group nations in SEA.
Laos, (admit this was 10 years ago) medical services were virtually non existent with only a clinic type facility in Vientiane. Judging by the number of Laos number plates currently in BU hospital would seem no great improvement.
Vietnam, listened to horror stories from my staff in both HCMC and Hanoi about doubling up of patients in a bed (head to toe). Seen with my own eyes crowds of people outside hospitals offering to take care of patients at a price, for families who could not be there for 24h a day. Seems no one wanted to go into hospital as many of those that came out were in a box.
Cambodia. Apart from Phnom Phen where there is a hospital of sorts there is nothing but clinic type medical facilities, one reason why I did not retire to Sihanoukville back then. May be different with the Chinese money that flooded in but doubt it.
Myanmar. Virtually nothing, Witch Doctors are busy.
So while far from good Thailand does at least have a system that works, within limitations.

yes, it's bad but could be worse!

[Bandung_Dero]

Off topic:

[Mod]: If you know that a post is off topic, please don't post it.

[AlexO]

A long read but shows that the Thai medical system is not all its deemed to be.
I Know Doc Martyn, he's a Brit born Aussie doctor running a voluntary medical advisory practice previously in Buriram now based in Pattaya.
Doc Martyn
·
Medical Bytes Thailand no 113: ‘Be skeptical of home grown doctors’.
Published 13/7/24
1. Jack, not his real name, suffered recent onset haematuria, blood in his urine, and dysuria, pain with urination. He consulted a urologist at the Bangkok Hospital Pattaya, BHP, who diagnosed a UTI and prostatomegaly, his prostate was four times the normal size. He was treated with the antibiotic Meiact and Prostagut (saw palmetto) to assist his prostate health {there is no scientific evidence whatsoever that saw palmetto improves prostate health}. At review 3 days later, Jack’s urine culture was negative for infection. Despite a normal PSA reading (1.8ng/ml) and a non tender prostate on digital examination, the urologist changed the diagnosis to chronic prostatitis. He added Levofloxacin to Jack’s antibiotic medication. Levofloxacin, a fluoroquinolone antibiotic, often causes particularly nasty, disabling and sometimes irreversible side effects, for example; achilles tendon rupture, neuropathy and epidermal necrolysis, see MBT no 105. After two weeks Jack’s dysuria and bleeding had not settled. He sought my opinion.
2. Jack, a 69 year old mild mannered American, was justifiably concerned and confused about his urinary problems and the lack of response to treatment. I listened to Jack’s story. I asked him the following questions: Is the blood in your urine slightly pink or full blood? Both. Is the pain you experience at the end of your phallus or inside? Inside. Does the pain occur at the beginning or end of urination? At the end. On the basis of his three answers, I told Jack he had a Transitional Cell Carcinoma, TCC, a bladder cancer, and Trigonitis, inflammation of his trigone. The trigone is the triangular area between the ureters from his kidneys and the exit of the urethra, see photo 1. Trigonitis type pain occurs when the bladder empties and the top of the bladder contacts the trigone, the probable site of his TCC.
3. How could I make such a serious diagnosis without investigations? By taking a full medical history, asking the right questions and deductive reasoning. This is the art of Medicine. Reviewing Jack’s hospital records confirmed my suspicion. It was clear that Jack did not have a UTI. It was clear that Jack did not have acute or chronic prostatitis. I instructed Jack to cease all treatment, which he did. Because the BHP urologist had failed to diagnose Jack correctly, I arranged an appointment for him with a urologist at the PhyaThai Hospital, Sriracha. In my opinion, if my diagnosis was correct, Jack needed a cystoscopy and biopsy of the lesion. Unfortunately, the PyaThai hospital did not have the equipment to perform a cystoscopic bladder biopsy, consequently the urologist referred Jack back to the BHP.
4. On June 20, 2024, Jack, reluctantly, returned to the BHP. I accompanied him. I introduced myself to the urologist as Jack’s advocate, not his doctor. The urologist was quick to criticise Jack for ceasing his medication and not following his instruction. He insisted that Jack’s bleeding was from his prostate. He then explained that; because of Jack’s refusal to comply with his recommended treatment, his only option was to perform a cystoscopy, which was music to my ears. At this point I ceased being Jack’s advocate and became his doctor. As I explained my opinion to the urologist, that Jack had a TCC, he appeared not to understand what I was saying. That may be because in Thailand, as in the West, some doctors use the term Urothelial Carcinoma in preference to TCC. That said, I was talking to a purported urological specialist who should be fully aware of all urological nomenclature. When I started to discuss Jack’s trigonitis, it became clear that the urologist had no idea what I was talking about. I closed the conversation. The Urologist arranged to perform a flexible cystoscopy that afternoon.
5. The scope demonstrated: A. Huge prostate gland with bladder outflow obstruction, B. Swollen bladder neck and suspected papillary bladder lesion (aka TCC) on the posterior bladder wall, see photo 2. This lesion was the origin of Jack’s haematuria. It confirmed my provisional diagnosis. Jack has bladder cancer in his trigone.
6. Three days later Jack underwent a Trans-urethral Resection of Prostate, TURP, and lesion biopsy. Microscopy confirmed Jack’s tumour. He has a high grade invasive urothelial cancer (TCC), without perineural or lymphovascular invasion, ipso facto his cancer had not spread outside the bladder. If treated appropriately, he should survive his malignancy.
7. When Jack returned to see me on July 6th, he was no longer mild mannered. He was furious. The requisite cancer treatment required removal of his bladder and his prostate. Why then did the surgeon perform a TURP, at a cost to Jack of THB 200,000 (THB 48,000 of which went to the surgeon) which was unnecessary for his management? Jack’s anger and frustration were justified: Symptomatically, his bleeding arose from his bladder. Despite his prostatomegaly he was urinating freely and following the cystoscopy on June 20, the urologist was aware that Jack had a tumour in his bladder. There was absolutely no medical indication for the surgeon to perform a TURP. I reassured Jack that his anger was justified. In Thailand, as in the west, consent to an operation must be informed. Informed consent means exactly that: The patient must be fully informed about the procedure, the after effects and the possible complications BY THE SURGEON. Because of the pecuniary greed, Jack underwent unnecessary expensive surgery.
8. Since moving to Pattaya, I have become painfully aware of the poor standard of the doctors working in the local private hospitals. I have been reliably informed that over 50% of the doctors in the private hospital system are not overseas trained. By Western standards Thai medical school training is deemed to be inadequate. A Thai doctor trained only in Thailand is unable to work in the west without additional training and examination. Irrespective of the proficiency and standard of the private hospitals in Pattaya, over 50% of the care provided is deemed to be inadequate, which, in my experience, it is. The urologist in Jack’s case failed to care for Jack in accordance with the Buddhist medical doctor’s oath. His drug knowledge was inadequate and he prescribed drugs that had no proven therapeutic benefit, oaths B and C, and he treated Jack for pecuniary gain, oath D (see addendum). So, how can you ensure that you are receiving western standards of medical care in the private hospitals in Pattaya and around the country? Ask to see the doctor's overseas qualification(s). Refuse to be treated by a doctor with only Thai qualifications. ‘Be skeptical of home grown doctors’.
Vejjavatapada, the Buddhist medical doctor’s oath, circa BCE 3rd century, is an oath to be taken by Buddhist doctors and other professionals working with the sick:
(B) I will be able to prepare medicines well.
(C) I know what medicine is suitable and what is not. I will not give the unsuitable, only the suitable.
(D) I minister to the sick with a mind of love, not out of desire for gain.

[Laan Yaa Mo]

This reminds me of an experience related by a friend of mine in which a number of incorrect decisions were made by medical staff that resulted in the death of her son after surgery. To make a very long story short, 'The Division of Legal Services and Compliance of the Wisconsin Department of Safety has determined that my son’s premature transfer from the ICU on July 13, the year of his death, will be opened for investigation.' My friend does not expect anything positive will result 'I’m not expecting the state investigation to make a difference. Since his death, I’ve learned that his situation is systemic and entrenched as cost-saving measures can take precedence over clinical outcomes. His circumstances match many others and little can be done except having the courage to add another voice.'

This took place in a U.S., not Thai, hospital.