Medical Diagnostic Skills In Thailand?

[DaiMai]

Yesterday my wife's niece, aged 31 was admited to hospital with a headache.

She died 3 hours later.

Cause of death given as AIDS...................????

[Ajarn]

Yesterday my wife's niece, aged 31 was admited to hospital with a headache.

She died 3 hours later.

Cause of death given as AIDS...................????

<{POST_SNAPBACK}>

Sounds like a stroke??

[ProfessorFart]

Sounds more like brain haemorrage.

Maybe you should have a private autopsy done.

[Falang Pan]

I always research my symptoms on the net before going to any doctor. I have been feeling numb all over my body, and after a stool sample the Docs diagnosis was alcohol withdrawl. I asked him if the symptoms could be caused by anemia, he looked at the whites of my eyes, and told me confidently no, he doesn't think so. I pushed for a blood test, and sure enough, I have anemia equal to missing two or three bags of blood. I don't feel the doc is inadequate - he is busy diagnosing all day, he doesn't have time to research all symptoms as thouroughly as I did. Together we were able to come across the right treatment - I couldn't have done without his help.

[Spee]

Yesterday my wife's niece, aged 31 was admited to hospital with a headache.

She died 3 hours later.

Cause of death given as AIDS...................????

<{POST_SNAPBACK}>

Sorry for your loss.

I'm no expert but it sounds like more questions should be asked, like what was her recent health history, line of work, etc. People just don't drop dead from AIDS (as is said in the documentaries, AIDS really stands for "as I die slowly").

Don't want to be crude either, but an autopsy is going to bring her back, and may cost a lot of money. If the main thing is saving face with the family by providing a different cause of death, then perhaps it would be easier or cheaper to get a second opinion from another doctor.

If there is possible medical malpractive suspected, then perhaps you may want to get a pathologist and an attorney involved. Again this is time for more questions (who treated her, what was the diagnosis, what medications were provided, etc.).

If this is something along the lines of your thinking, then perhaps you may want to start putting together a timeline of the last 24-48 hours of her life. Start with what you know and don't know and try to fill in the blanks for as much time as possible.

Again sorry for your loss and good luck.

[lukamar]

3 hours is not a long time to try and diagnose something and I don't think you can fault the doctor. By the time the doctor sees the patient and orders some tests it is probably that long, and unfortunately your niece ran out of time. From what i remember from talking to some MD friends - you rule out the obvious first - in this case migraine, skull fracture or ? and then you look for the underlying cause.

Then again there are doctors that are very good clinicians and seem to be able to diagnose almost anything is a few minutes, Unfortunately they are not all like that. Maybe the guy that can diagnose well would be the last person you would want in the event you were having a major coronary because he doesn't think well under pressure. Every doctor is different and in an emergency situation sometimes you just have to take the chance that he's up on that particular subject that day.

[penzman]

My condolences to you and the family.

I have just spent 2 weeks in a hospital in Chonburi. For a few days I had been suffering from a headache, dizziness and pain when moving my eyes around and in the end was vomiting. I then rushed to the hospital.

From what I found on the net, I thought I was suffering from meningitis.

The doctor's

1st diagnosis was... meningitis

2nd diagnosis was... hepatitis

3rd diagnosis was... a tumor... which turned out to be a benign tumor I have since birth.

4th diagnosis mentioned a partially collapsed lung, from a pleuritis I had years ago.

There were a few more scary diagnostics I can t remember.

Turns out I had some sort of viral infection, cause STILL unknown.

I was treated with antibiotic caplets at first but then received two huge injections daily for 2 more weeks.

I feel fine now, all symptoms have subsided.

Still puzzled by the "unknown cause" ...

I still think they were very competent and caring.

[DaiMai]

Thanks to all for the kind words.

We knew about the AIDS, but to say that is the cause of death........

Not in three hours.

She died in a goverment hospital, and there was distinct feeling of don't care, next please.

They were wrapping the body in plastic bag while it was still warm.

[lopburi3]

Thanks to all for the kind words.

We knew about the AIDS, but to say that is the cause of death........

Not in three hours.

She died in a goverment hospital, and there was distinct feeling of don't care, next please.

They were wrapping the body in plastic bag while it was still warm.

<{POST_SNAPBACK}>

As all have said we understand your feelings but I also know that Government hospitals very often only see AIDS patients in the last hour or so of life as few families want to admit it and wait until the last possible moment to bring relatives to the hospital. This could help to account for what you see as a poor attitude. In most cases these people are hugely overworked and underpaid and this things will show up in service; unfortunately.

[Pink Mist]

Thai doctors are not the only ones who can mis-diagnose, my son has been diagnosed with thallasemia after 2 visits to our quack, again it flared up today, so back to another clinic, another doctor, diagnosis, urticaria, antihistamine treatment immediately, guess what, immediate success.

[Ajarn]

I always research my symptoms on the net before going to any doctor.  I have been feeling numb all over my body, and after a stool sample the Docs diagnosis was alcohol withdrawl.  I asked him if the symptoms could be caused by anemia, he looked at the whites of my eyes, and told me confidently no, he doesn't think so.  I pushed for a blood test, and sure enough, I have anemia equal to missing two or three bags of blood.  I don't feel the doc is inadequate - he is busy diagnosing all day, he doesn't have time to research all symptoms as thouroughly as I did.  Together we were able to come across the right treatment - I couldn't have done without his help.

<{POST_SNAPBACK}>

I couldn't have done without his help.

Of course you could have, and you did...

Your SOP with Thai docs follows mine. I've lived here for a long time and have a very extensive history with docs and hospitals here. You MUST be proactive and never fully trust what you're being told. A couple of times I would have died had I followed the doc's advice about my heart condition- doc presecribed me a drug, which, during clinical studies, was found to have a higher mortality rate than those taking no meds.... He had simply accepted the drug salesman's info and never check further for more current studies. I found the info in 10 minutes on the internet..

and Diabetes... Doc told me 'under 300' was within normal range for Blood Glucose level (In fact, above 120 is considered damaging) He also prescribed a drug, which it was recommended that the doc give a liver function test first due to possible averse side-effects involving liver damge....Never mentioned it to me.

Lots and lots of these kinds of experiences- Like the drunk doctor who operated on my two severed tendons after an accident...Or the doc who missed a stich when he removed my stitches, and when I noticed and pointed it out to the nurse after he left, she came back and said the doctor told her that he was sure he got them all and couldn't be bothered to return again. The nurse apologized and removed it herself.

And if you have a malpractice complaint against a doctor, good luck The Thaksin government has made that virtually impossible by changing the regs to limit the exposure by doctors and hospitals. It is still common for a hospital to file a countersuit against anyone accusing them of malpractice, the idea being that they will discourage you financially. There were proposed amendments to the law to disallow hospital counter-suits until the original suit was settled, but Thaksin killed that, too.

As usual, Buyer beware here. Beautiful nurses and beautiful hospitals don't mean shit. Don't be fooled by the polished facade one sees everywhere here. Beautiful, but dangerous, is my rule of thumb

[tedkarma]

I have to second and even "third" what falang pan and ajarn have said. And I don't really care what country you are in. Thank God for the internet! (though you may have to plow through some real cr*p). There are some great websites out there - reputable and thorough.

A close relative was diagnosed with a very serious problem in July - and luckily we had the very best of care on Phuket - ended up in BKK with a super specialist. All more than excellent. But, researching the problem and issues - helped immeasurably with asking the right questions - and also at putting us at ease with what MAY be the final resolution.

Nobody can look out for you or your family - better than you can.

[Dradam]

I have to second and even "third" what falang pan and ajarn have said.  And I don't really care what country you are in.  Thank God for the internet!  (though you may have to plow through some real cr*p).  There are some great websites out there - reputable and thorough.

A close relative was diagnosed with a very serious problem in July - and luckily we had the very best of care on Phuket - ended up in BKK with a super specialist.  All more than excellent.  But, researching the problem and issues - helped immeasurably with asking the right questions - and also at putting us at ease with what MAY be the final resolution.

Nobody can look out for you or your family - better than you can.

<{POST_SNAPBACK}>

As a doctor, I agree with this as well. I once had a patient who I saw in the clinic with a rare disorder that had been treated for several years. I was treating her something separate but she obviously knew much more than me about the condition that she had.

After meeting with her, I went back and researched the disease myself but found very little more than she had already told me. If anything her information was more detailed than any of the textbooks or articles that I read. My background in medicine was very helpful and I certainly understood a few things better than she must have but it is impossible for any one person to know everything there is to know about every disease and every treatment.

By attempting to cut medical costs, patient time with a doctor is also limited as well. Many providers expect a doctor to see a minimum number of patients per hour. Unless the patient is willing to pay more for a private clinic doctor, they will receive only a limited amount of time with the doctor.

Certainly, the prettiness of the hospital is only a mild indication of the skill of the doctors. Some of the best doctors work in less than pristine hospitals. I have to say though that a doctor's skill in English is partly an indication of their skill in medicine. Their willingness to answer questions is another indication.

[taxexile]

As usual, Buyer beware here. Beautiful nurses and beautiful hospitals don't mean shit. Don't be fooled by the polished facade one sees everywhere here. Beautiful, but dangerous, is my rule of thumb

Certainly, the prettiness of the hospital is only a mild indication of the skill of the doctors. Some of the best doctors work in less than pristine hospitals. I have to say though that a doctor's skill in English is partly an indication of their skill in medicine. Their willingness to answer questions is another indication.

from the experiences of my family members here in thailand, i have little faith in the diagnostic capabilities of thai doctors. the thai attitude to death and karma and the lack of moral responsibility so prevalent here may have something to do with it. as may the fact that the doctors are unsueable and therefore if they make mistakes they will not be held accountable.

the failure of thais to ask questions and demand answers is also part of the problem, as well as the incredible lack of knowledge of most thais about many of the more common complaints.

thankfully , there are some very good tv and radio programmes that deal with health issues in an educational but non-patronising way , there seems to be more and more of this kind of programming these days, with lots of up to date advice on cancer,heart disease,problems of ageing (other than how to keep your skin beautiful) given by what appear to be dedicated professionals.

if i am able to choose a doctor to see then i would one who studied abroad (western country or australia). in an emergency i hope my wife will know who to take me to and what questions to ask.

[Sheryl]

Thanks to all for the kind words.

We knew about the AIDS, but to say that is the cause of death........

Not in three hours.

She died in a goverment hospital, and there was distinct feeling of don't care, next please.

They were wrapping the body in plastic bag while it was still warm.

I am a nurse with 30+ years of experience including AIDs. If it is any help, I can tell you the most likely cause of death. As you already know, no-one dies of AIDs syddenly.

If your niece was known to have AIDS and in addition to the headache had a fever she probably had meningitis. In addition to the usual forms, AIDs patients are susceptible to meningitis from "opportunistic" organisms such as cryptococcus.

If one the other hand, she had a sudden severe headache that seemed to come out of the blue, and no fever, then intercranial (brain) hemorrage (" stroke" ) is the most likely explaination. In a person her age, this is usually the result of an aneurysm or vascular malformation which has been present from birth (congenital) breaking.

They should have done a spinal tap, especially if she had fever. This would have helped identify meningitis. However, given how fast she died, even a prompt diagnosis and immediate therapy might not have saved her. And, if it was an intracranial hemorrhage from a ruptured aneurysm or vascular malformation, from the sounds of things she would have died regardless.

There is no question that the treatment she received was sub-standard, but in this particular case it probably didn't effect the outcome. However I would advise against you or anyone in your family going to that particular hospital in the future if you can avoid it.

Sorry for your loss and that you encountered such callous care from health professionals. There are some very good hospitals, doctors and nurses in Thailand, but also plenty of bad ones.