Thai Medical Standards

[cindy36]

Hi all,

I am greatful to find sudh a resourceful site. I wouls like to know where I can get thje published Thai Medical Standards. I am particularly interested in how a Thai doctor might treat his patient, compared to that in USA, or elsewhere. What leeway does a Thai doctor have? Especially with a patient who he feels has disrespected him? The reason I ask is, I am a transgendered person who had a sex change operation in Thailand recently, and I have strong belief that I disrespected my doctor, and as a result, my neo-vagina was injected with a numbing agent in an effort to sabotage the surgical result. The nature of the rejection was in the form of emails I sent to a friend while I was in my hospital bed recovering (with full sensation in neo-vagina), and in those emails I explained that I (effectively) fudged the psychological requirements for the surgery. I'm assuming the hospital monitored my wireless internet usage of course, which may be a leap. But I still would like to know what the possibility is, what the leeway is for a Thai doctor to abandon a patient, and possibly use his medical knowledge to hurt his patient.

Thank you,

Cindy

[Dakhar]

I think u may be better of researching the side effects of the surgery you had done...

ie permanent nerve damage... http://en.wikipedia.org/wiki/Sex_reassignm...male-to-female)

[Sheryl]

I agree with Dakhar. And I think the likelihood of anyone at the hospital troubling to do surveillance on patient's emails is very, very low to nil.

With regards to the stabdards expected of Thai physicians, physician code of ethics, aptient rights and the like, the place to get them would the the Medical Council of Thailand, but their website at least is in Thai only.

There are no major differences in what you would find with respecty to such things as abandonment of a patient or intentional harm from what would hold true in the west. In addition, intentional harm would fall under the Thai penal code.

But doubt that any of this occurred in your case. They are not at all strict about psychological requirements/screening for SRS in Thailand. And the doctors who do these procedures derive a significant livelihood from them so very doubtful that anyone would deliberately produce a bad result. It would only hurt future business.

[hhgz]

"I explained that I (effectively) fudged the psychological requirements for the surgery"

You lied to the doctors so you could have sexual reassignment surgery, and now you think that the doctor is unethical? There are few standards for patients, and you purposely circumvented them.

[cindy36]

"I explained that I (effectively) fudged the psychological requirements for the surgery"

You lied to the doctors so you could have sexual reassignment surgery, and now you think that the doctor is unethical? There are few standards for patients, and you purposely circumvented them.

Okay, well that's what I'm getting at... is it possible for a Thai surgeon to .... interpret what I did as "unethical" and in turn be unethical toward me? Forget whether or not or how or whatever about how I may have been unethical, or disrespectful, or even SEEMED unethical or disrespectful. What would a Thai surgeon do in such circumstances? Particularly, what does the Thai medical standards and/or Thai culture allow for a Thai doctor to do in such circumstances?

cindy36

[Sheryl]

Thai medical ethics and Thai law, both, would not permit a surgeon to intentionally harm a patient, regardless of what the patient may have done. Thai culture would frown on it, too. Culturally disrespeted a doctor is considered poor form but it is not considered justification for intentional malpractice. As it was elective surgery, the surgeon would have been within his rights to refuse to operate on you if offended by your behvior or concerned about the ethics of it, but once deciding to operate he had full obligation to do his best.

Possibly you did p*ss off the doctor, you would know best on that score, but it seems he proceeded with the surgery nonetheless. The idea that he, in the course of the surgery, intentionally did something to cause your new genitalia to be dumb is very, very, very far fetched IMO. Furthermore I can't think of any "numbing agent" that could be injected to cause a permanent loss of sensation.

The degree of sensation in the neo-vagina after SRS is variable and varying extents of numbness do occur even with the best of surgeons and best efforts thereby. Also, after any type of plastic surgery, temporary loss of sensation may be present for some time until nerves regenerate.

While Thai surgeons are not at all likely to do what you suspect, Thai doctors are often not good at communicating with patients and managing patient expectations. Have you discussed your concerns with the doctor? That would be the place to start. You need to know, for example, if it is likely that you will have more sensation as time elapses or of what you have now is pretty much it.

P.S. Not sure what exactly you said or did, but from a Thai perspective there is a big difference between lying to a doctor and being disrespectful/offensive. Patients lie to doctors all the time, and Thai patients more than most. It's not a good idea, but they do, for a whole range of reasons. Doctors know this and, as a consequence, pretty well always take what patients have told them with a grain of salt.

[cindy36]

Thai medical ethics and Thai law, both, would not permit a surgeon to intentionally harm a patient, regardless of what the patient may have done. Thai culture would frown on it, too. Culturally disrespeted a doctor is considered poor form but it is not considered justification for intentional malpractice. As it was elective surgery, the surgeon would have been within his rights to refuse to operate on you if offended by your behvior or concerned about the ethics of it, but once deciding to operate he had full obligation to do his best.

Possibly you did p*ss off the doctor, you would know best on that score, but it seems he proceeded with the surgery nonetheless. The idea that he, in the course of the surgery, intentionally did something to cause your new genitalia to be dumb is very, very, very far fetched IMO. Furthermore I can't think of any "numbing agent" that could be injected to cause a permanent loss of sensation.

The degree of sensation in the neo-vagina after SRS is variable and varying extents of numbness do occur even with the best of surgeons and best efforts thereby. Also, after any type of plastic surgery, temporary loss of sensation may be present for some time until nerves regenerate.

While Thai surgeons are not at all likely to do what you suspect, Thai doctors are often not good at communicating with patients and managing patient expectations. Have you discussed your concerns with the doctor? That would be the place to start. You need to know, for example, if it is likely that you will have more sensation as time elapses or of what you have now is pretty much it.

P.S. Not sure what exactly you said or did, but from a Thai perspective there is a big difference between lying to a doctor and being disrespectful/offensive. Patients lie to doctors all the time, and Thai patients more than most. It's not a good idea, but they do, for a whole range of reasons. Doctors know this and, as a consequence, pretty well always take what patients have told them with a grain of salt.

Perhaps "numbing agent" is the wrong term to use. I think anything that could be injected that would cause numbing, including anything that might cause a blockage of blood flow but yet preserve the tissues from dying right away. But that is getting beyond the initial question I posed. Forget the likelihood of my scenario. Assume you have the scenario, and a disrespected Thai surgeon, with a choice of sabotaging his work or not in retaliation for the disrespect (which BTW may or may not be considered "harm [to] the patient", especially since the SRS patient may still retain vaginal depth and cosmetic appearance, can urinate and defecate normally, but only has complete lack of sensation --which might pass the Thai medical standards, but would be a complete failure by most SRS surgeons standards).

On a side note, is there any truth to the notion that a Thai doctor can wash his hands of a patient that seeks a second opinion (under the table, but is found out)? Or is it simply illegal for the second Thai doctor to give an opinion if he knows you are still seeing the first doctor? Keep in mind the west does not practice this way.

Cindy36

[Sheryl]

It is perfectly legal and normal to seek a second opinion -- or for that matter to change doctors altogether. And in your case I think a good idea. You definitely need a second opinion to address your concerns about sensation and, given your complete lack of trust in the doctor, would do well to change to someone else.

If by "wash his hands" you mean stop treating the patient that would depend on the circumstances. If by doing so he put's the patient in jeopardy, no. But if not then yes, a Thai doctor can decline to treat a patient and advise them to get another doctor. So can a doctor in the West -- perhpas not in countries where the treatment is under a national health system (altho I suspect that even then, a doctor might be able to engineer a switch by finding someone else to take over) but most definitely in a fee-for-service arrangement. It is not done often, but it is done.

Can't say I have ever encountered a case where that happened only because the patient got a second opinion, tho-- neither in Thailand nor the West.

And one wonders why, if the doctor is as enraged with you as you apparently believe him to be, he hasn't already dropped you as a patient.

In any case, do some research, find an SRS specialist who has treated many westerners and gotten positive reviews from them, and go get his opinion on your situation