Why Do Thai Doctors Always Love To Give Antibiotics?

[drronnie]

I went to the hospital with fever and severe coughing. The doctor siad it is a regular cold and gave a couple of meds and antibiotics. I wonder why Thai doctors always like to give antibiotic even it is useless again flu virus.

[bkkjames]

$

[Pakboong]

If you don't go home with something, you haven't really been to the doctor.

Why do people with colds need to go to a doctor? You can ask yourself the same questions the doctor will ask you.

[DP25]

No trip to a doctor in Thailand is complete without at least 3 bags of different coloured pills.

[carmine]

This is a simple one to answer... to make more MONEY....

[joskydive]

They have commission off each prescription and also have a quota to fill which is decided by the hospital. If they don't fill their quota of prescriptions their contract will not be renewed.

[WarpSpeed]

CTA and snake oil salesmen....

[toybits]

Gives the patient the impression that they are doing something about the patient's medical problem. It takes a very confident doctor to tell the patient that they do not have any problem and do not need any medication. Sometimes it also helps to ease the patient's anxiety. Perhaps it would be better to just give them sugar pills (placebo) - because at least with placebos, they will not cause anti-biotic resistance.

[tonititan]

You can refuse medications, though. At my hospital at least, I have gone to the cashier/pharmacist to get my prescriptions and discovered some medicine I didn't want (one was just Tylenol, which I already had stocked at home, and one was a cough suppressant that has never helped me before). They were a little confused at first, but then they were fine to take it off the bill and send it back to the pharmacy. If you think something is unnecessary, then don't buy it.

[toybits]

What I really hate is that some doctors will not even write the name of the medicine on the packets they give out. When I asked the girl giving me the medicine, I asked what the name of the medicine was. She said that I should as the doctor. hmmm. That really bugged me.

[Samuian]

What I really hate is that some doctors will not even write the name of the medicine on the packets they give out. When I asked the girl giving me the medicine, I asked what the name of the medicine was. She said that I should as the doctor. hmmm. That really bugged me.

Mostly it on the back of the package or strip of pills!

if it's not clearly marked what I have to take I will refuse it straight away

I consider paracetamol already a drug, certainly not popping any thing they want me to!

[Briggsy]

Apart from the very definite commercial pressure on doctors to prescribe pills, there is a traditional aspect to the prescribing of pills too.

Reading the memoirs of a European doctor working here about 100 years ago, he complains that Thai patients want all ailments treated by a medicine taken orally. Any other kind of treatment is ignored and failure by the doctor to provide a tincture, pill, tablet, paste or gum to be taken orally would result in the patient telling his friends the doctor was incompetent.

It appears this may have become a Thai tradition resistant to change.

[bkkjames]

Apart from the very definite commercial pressure on doctors to prescribe pills, there is a traditional aspect to the prescribing of pills too.

Reading the memoirs of a European doctor working here about 100 years ago, he complains that Thai patients want all ailments treated by a medicine taken orally. Any other kind of treatment is ignored and failure by the doctor to provide a tincture, pill, tablet, paste or gum to be taken orally would result in the patient telling his friends the doctor was incompetent.

It appears this may have become a Thai tradition resistant to change.

or they have a fear of needles.

[purplehaze]

It's a bit like the middle ages in Europe when the leech was the cure for just about everything.

Fast forward 500 hundred years same same but different the Thai Leech(antibiotic).

[bina]

philipinos on the other hand seem to prefer creams, salves, oinments etc... from filipnia girls ive met here.

today my duaghter went to teh nurse clinic on kibbutz. she has sinusitis. i know it. she gets it often. she's also asthmatic so we go to the clinic to make sure they know she is at home, slightly ill, and getting her meds according to neccessity (inhalations whatever).

we went to get her regular meds. thai hubby couldnt understand why no 'peniciliin'... and why hot compresses and saline nasal solution was the prescribed treatmetn (it works, for her. if things dont improve, then antibiotics might be given). sigh.......

sometimes he wants meds for a cold/flu (i give him vitamins and tell him its 'penicillin').

bina

btw, moving to health....

[britmaveric]

Always wonder why doctors always give mild sedative with everything they prescribe. This one help you go sleep is always the answer.

[simcity]

Be careful with antibiotic given by most doctors, if you cannot communicate with him, they have been the same around for long time and often ineffective.

Most Thai people do not follow treatment full course, microorganism became immune

If you feel you have something serious, go to the best doctor you know around, few times it happen to me with inefficient antibiotic and prolong pain!

[Sheryl]

Mixture of factors:

1. Perceived consumer demand (which in fact is true of many Thai patients)

2. Profit - their own or the hospital's as case may be

3. Laziness/"mai ben rai" -- since in many cases it would be necessary to do time-consuming tests to rule out bacterial infection (e.g. throat culture etc), easier to just routinely give antibiotics.

4. Loss of face -- doctors working out of small clinics may not have laboratory back-up to do the tests necessary to decide if antibiotics are needed. So they just treat for the worst case scenario rather than tell the patient to go elsewhere for a culture etc.

5. Lack of confidence in the patient following instructions/coming back. Whereas in the West a doctor might tell a patient to come back if XYZ occurred, or to come back for the results of a test, Thai doctors tend to assume patients won't follow instructions like that and treat accordingly. This even extends as far as performing surgery rather than regular testing/follow up in cases which don't need surgery now might might later on. I have heard this from several Thai physicians, good ones with good intentions. "Thai patients don't understand/don't come back so this is safer". That the very poor compliance of Thai patients might be related to the fact that Thai doctors seldom explain the reasons for their advice in any detail doesn't seem to occur to them.

obviously not all reasons apply to every case.

NB: Never, ever agree to take a medication without knowing what it is. Full stop. By law (Health Act 2007) the doctor is required to give you this and other information pertinent to your treatment.

One is also well advised to personally research the contraindications and side effects of any drug being taken as physicians in general and Thai physicians in particular rarely give this information. If you are on more than one medication, also research drug interactions.

[PMNL]

Thats so true what Sheryl said.

eventhough doctor explain to the thai patients what was the problem and how to dealt with it. They do not satisfy without pills to take home.

For example back strain, Told them to go for physiotherpy for deep heat ultrasound( at another place with schduled appointment)

told the patient to take celebrex with norgesic,apply NSAID cream,which he/she have them all at home so no need to prescribe anything.

The next day the patient told all the neighbor friends and family, the doctor is incompetent. so what the doctor react?? prescribe every single medication in house for thex next customer!

For doctor who does not put the name of the tablets on, they are afraid that the patient will go buy tablets from the pharmacy (well you can get almost everything over the counter here and some under the counter)and will not return to them.

[richieudon]

You should never question a doctor in Thailand!!

Seriously, I took our little girl to the doctors for a cold and sore throat and came back with FIVE different bottles of crap!

If you have a cold it's not worth going, nothing cures a cold.

It's all about money and losing face and it'll never change.... mai pben rai....

[Sisaketmike]

$

Because you need at least five different types of medicine to stop a running nose…..

[Sisaketmike]

You should never question a doctor in Thailand!!

Seriously, I took our little girl to the doctors for a cold and sore throat and came back with FIVE different bottles of crap!

If you have a cold it's not worth going, nothing cures a cold.

It's all about money and losing face and it'll never change.... mai pben rai....

How do you know that it was crap?

[Old Man River]

I can't say about the smaller hospitals, but I have found at Bamrungrad and Samitivej it is just the opposite. Doctors do not want to give out antibiotics unless there is a fever. Maybe it is different at the other hospitals.

[phetaroi]

A couple of things that I always keep in mind for doctors in both the west and here. First, you may not have a virus OR a bacterial infection; it is very possible that one will accompany the other. Second, when was the last time you had even a western doctor actually identify the bacterial agent causing your sore throat (for example). No, they mostly give a wide-spectrum antibiotic that matches current strains "going around".

[balo]

And in Thailand you have the best hospitals in the world, people keep telling me.

But the doctors are a joke. If you get sick just stay home and eat some vitamins.

Edited February 10, 2010 by balo

[PeaceBlondie]

I nearly died from a bacterial infection, and a specialist in Houston was clueless. I accidentally got cured. The best specialists in BKK couldn't cure me of a flesh-eating bacteria, so I moved to Chiang Mai to be operated on with success. There are a lot of unknowns in medicine.

[Sheryl]

You should never question a doctor in Thailand!! .........

I beg to differ.

You should most certainly question your doctor (politely of course). Reading up on your problem before hand so that you have a better idea what to ask is also helpful.

There are doctors in Thailand who do not mind answering questions. Those who have spent some time/had some training in the west in particular are accustomed to doing so and understand that western patients expect explanations. Of course, be sensitive to Thai cultural norms e.g. wai when you first go in, speak politely, preface your questions with a smile, and it also helps to be nicely dressed. These things count for a lot in Thailand.

What you should not do is continue to see a doctor who does not react well to being asked reasonable questions or accept treatment that was prescribed with inadequate explanation. Go elsewhere.

I once discussed this issue with some Thai nurses who are friends of mine. When I mentioned that I thought the tendency of some Thai doctors to get angry when questioned related to the cultural sense of hierarchy they burst out laughing and assurred me it usually meant that the doctor didn't know the answer or had such limited knowledge that he was afraid of revealing his ignorance and thus losing face. I must say that I have consistently found that the really top specialists in their field -- and over the years I have met quite a few of them here -- are almost always very willing to be questioned, even humble in manner. They don't need to put on an invincible act as their expertise and record speaks for itself.

Chose your doctors with at least as much care and preliminary research as you'd choose a contractor to build your house!!! You've got only one body and it has to last you a lifetime. A bit of research first -- on this forum, or by reviewing doctor's credentials on a hospital website -- will yield much better results than taking pot luck.

[GarryP]

I remember going to see my GP in the UK when I was suffering from the squits. He just laughed, told me to go home and drink lots of liquids and come back the following week if I wasn't better. When I first came to Thailand, I suffered the same squittish problem and visited the doctor. I got three or four different tablets to take including antibiotics.

Edited February 11, 2010 by GarryP

[sleepyjohn]

They have commission off each prescription and also have a quota to fill which is decided by the hospital. If they don't fill their quota of prescriptions their contract will not be renewed.

I'd be very interested to know if this has an evidential basis or is a waste of space.

I'm going to add to Sheryl's list of reasons.

The placebo effect is a very real phenomenon. Measurably real. The largest metastudies suggest that antidepressants owe just about all to the placebo effect. There is actually a debate going on whether their lack of effectiveness should be made public as one would lose the placebo effect.

What's more the nastier tasting, the bigger, the more red(!), the medicine the better it works, and an amazing thing is the that even the medical fol de rol, the doctor in the white coat with the stethescope and diplomas on the wall, makes a difference to people's relief.

Somehow I think this isn't why there's overprescribing in Thailand and that Briggsy was nearer the mark.

Edited February 11, 2010 by sleepyjohn

[hhgz]

"I wonder why Thai doctors always like to give antibiotic even it is useless again flu virus."

I wonder why you accepted and paid for the antibiotics.