Very disappointed with the Thai "specialists"

[mistitikimikis]

I am very disappointed with some “specialists” in various hospitals! I was informing my frequent doctor (Nick Walters, the only local farang doctor I guess; highly recommendable!) about ¾ years ago that I started suffering of dizziness. After frequent changing some medicines which didn't help he suggested me to take a MRI (head) scan. This showed besides a partly blocked artery (high bad cholesterol) only a “mild mucoperiosteal thickening of the bilateral ethmoid and right frontal sinuses” is seen.

As I had also always mucus which wasn't coming out (I swallowed it), I even didn't get it out for a test, I blamed a sinusitis for my dizziness which was getting worse and I'm ending up now with a “heavy” and heated head, walking like I'm a bit drunk; like a robot, tiredness, slight headache etc.

I went just before the scan to a throat, ear and nose specialist, mentioned already a sinusitis but she said it was my throat and gave me anti-biotics.

The brain-specialist in the first hospital gave me “baby aspirin” to make the blood thin(ner), not even looking at the second case.

I went then to Bumrungrat, mentioned “sinusitis”, the “specialist” ignored it and said, after a hearing-test that it was a unbalance in between the three points of my head “normal with my age”, gave me medicines and that was it.

I went to the Nose, Throat and Ear Hospital where the “specialist” did even better, told me “that's a long story but I have to operate a patient within five minutes”, sent me to his neighbor and disappeared.

His neighbor-“specialist” cleaned my ears with a machine, gave me a bag of medicines and that was it.

To-morrow I'll try a governmental hospital, but I'm afraid that they cannot follow English properly so I take my wife as translator.

I think, although the Thai hospitals are widely praised, that the doctor / “specialist” isn't listening to the patient at all an follows his / her own opinion!

As I'm getting very upset about this all I start considering to go to Barcelona to ask their opinion!

[Michael8511]

They have good doctors here, it sounds that you have already made up your problem, then it can be difficult for doctors to diagnose you. It's probably safer to let the professional diagnose your problem.

[lovelomsak]

I feel the same.9 years ago i had a muscle spasm in my hip.I could hardly walk. I went to Bumrangrad they sent me to a surgeon to see if I needed a new hip. He got xrays and said nothing was wrong to go home. I limped out. The next day I went back again to try and get some help. The nurses sent me to the same doctor he took xrays again and told me may be rub the area with a tennis ball and relax it. I limped out.A friend in Pitsanulok took me to a government hospital the doctor there sent me to physio and after 3 treatments of physio was back to normal.

I had blood in my urine so I went to Bumrangrad to see urologist. Did tests and scoped .He gave me antibiotics to stop bleeding sent me home.A year later I was back same tests and antibiotics sent me home. 6 months later went back same routine. Then 3 months later went back same routine..then he said he could do nothing for me gave me my records and told me to find another doctor and hospital.

It got so bad I could not urinate and pure blood I went to local hospital and got a cathater to survive till i could get to a good doctor. Spent 2 weeks in Srinakarin hospital on meds and cathater till my bladder was cleaned. Now cannot urinate have to self cathater 4 times a day.Odd a high paid urologist at an international hospital couldnot have prevented some of this. It sure would have been nice to start cathatering well I was still urinating and only do 1 or 2 times a day have some quality of life.

[onetime]

Went in to see why I had a drop of blood in my urine. She started talking about, 'thai people believe....'. I shut her down and told her let's work on my sitch, not your cultures beliefs. She wanted to, at that point, give me an expensive test before the results of the first one were in. Never went back

[mistitikimikis]

They have good doctors here, it sounds that you have already made up your problem, then it can be difficult for doctors to diagnose you. It's probably safer to let the professional diagnose your problem.

I am afraid that you aren't reading my post well!

[kkerry]

The listening aspect is one thing I've also noticed. Maybe it's a communication issue. Back home I feel I get listened to more, notes taken, and some basic tests ordered as a starting point if there is no obvious reason why something is happening. Here, at times you can feel like what you say is going in one ear and out the other, even in an expensive private hospital. When I'm back home I still pay a visit to my local doctor just for some reassurance.

Anyone remember the tv show House? Nearly every show was about a patient being diagnosed first with one illness, then another, before they finally nailed it.

[mistitikimikis]

The listening aspect is one thing I've also noticed. Maybe it's a communication issue. Back home I feel I get listened to more, notes taken, and some basic tests ordered as a starting point if there is no obvious reason why something is happening. Here, at times you can feel like what you say is going in one ear and out the other, even in an expensive private hospital. When I'm back home I still pay a visit to my local doctor just for some reassurance.

Anyone remember the tv show House? Nearly every show was about a patient being diagnosed first with one illness, then another, before they finally nailed it.

I think you hit the nail on the head kkery!

Only my (American) local doctor was / is listening. The others ignored what I came for (sinusitis) and started doing other things. My opinion is when I have a (photo)-proof that there is sinusitis we start first attacking this "problem" before navigating to other things! They even didn't suggest to make an X-Ray of the front of my head. But I'm afraid that's part of the Thai mentality: "I'm the doctor, I know, and you listen to me!" connected with the, might be, lack of English communication!

In Europe there is also far more communication in between the different specialists concerning certain (health)-problems. Here they all act on their own.

More is that nobody knows my background and starts distributing bags of medicines without even knowing if, what, I'm already taking, my blood pressure etc. etc. The only thing the pharmacy is asking if I have an allergy against medicines!

I am backed by my local doctor whom I am asking (by email) if I can take the prescribed medicines without a problem.

I think also that one of the big issues is that they try to keep Thailand as closed as possible from ages before until now!

Edited December 15, 2015 by mistitikimikis

[lovelomsak]

I really question the credibility of some doctors.

My wife's son was in the lowest class in Mattyom when he graduated. Before i married his mother he thought he would be a farmer so why study. His marks were very low.I offered him university. He was refused by universities all over Thailand. Finally Rangsit took him on a medical technician course. After 2 years into his studies the university told the wife if the son wanted to be a doctor he could change course and go an extra 2 years at the university.total of 6 years..So here's a kid who after 12 years of studying english cannot say more than hello is being told he is doctor material. Makes me shudder to think what doctors are out there.and specialists may be the same.

i have a story about their listening also. when i was in the hospital on the cathater I was given2liters of water a day but was producting more than 2 liters of urine or a little under 2 liters everyday,for just about all the time I was there..The doctor refused to believe I wasnot drinking more fluids than the 2 liters. I could not convinse them otherwise.They just considered me a liar. i felt maybe they were missing something in their diagnoses or treatment.

Edited December 15, 2015 by lovelomsak

[mistitikimikis]

That's why I am very happy with my American doctor; at least a bit of "handhold"!

I think it has everything to do with the culture and keeping the country as closed as possible.

[debrakfurlow]

There's an American Dr here? Please where. I'm having the same listening and no one wants by med background info.

[BKKdreaming]

Also I think in America the Doctors "shame" you more , which is a good thing for most of us

ohh your blood pressure is too high , you could lose some weight ,

have you been eating well etc

Does not seem to be a Thai thing that might make them lose "face"

[Sheryl]

There's an American Dr here? Please where. I'm having the same listening and no one wants by med background info.

He is referring to Dr. Nick Walters at Mission Hospital http://www.mission-hospital.org/component/k2/item/54-dr-nick-walters.html

Thai doctors are indeed not socialized to listen to or explain to their patients. I find however that Thai doctors who trained and practiced in a Western country for at least a few years are much better in this regard, and fortunately there are quite a few of them (in Bangkok - upcountry is another matter)

[Gsxrnz]

I find that with all professionals such as doctors, lawyers, accountants etc., irrespective of the country, believe their expertise is beyond reproach and should not be questioned. This makes them often prone to misdiagnose or make poor professional decisions based on their own arrogance. That arrogance is rarely physically displayed, but is in the very nature of their training and professional environment. It might be called "God Syndrome" by those more critical than me.

I always insist that they listen, and listen again, and discuss what the possibilities might be, before allowing them to draw a conclusion. Doctors are probably at the low end of the scale of professional arrogance, but it exists. Just push and probe the doctor until they at least consider that your own self diagnosis is worthy of consideration.

Don't get me started on lawyers. Most arrogant bunch of professional bawstards. My lawyer refused to listen to my advice/opinion on a contract. Luckily all the communication was on email. He wasn't so arrogant when I sued him for some serious dollars to compensate me for the losses I suffered.

[cumgranosalum]

It doesn't matter how good an individual doctor is, the system in Thailand is flawed from top to bottom. If no-one can proerly diagnose you problem how can any doctor treat it?

[chiang mai]

It doesn't matter how good an individual doctor is, the system in Thailand is flawed from top to bottom. If no-one can proerly diagnose you problem how can any doctor treat it?

Rubbish, it's the doctors who do the diagnosis and not the system!

And in order to make a diagnosis the doctor needs the co-operation of the patient, as discussed earlier the OP's self diagnosis seems to be getting in the way of that.

[cumgranosalum]

It doesn't matter how good an individual doctor is, the system in Thailand is flawed from top to bottom. If no-one can proerly diagnose you problem how can any doctor treat it?

Rubbish, it's the doctors who do the diagnosis and not the system!

And in order to make a diagnosis the doctor needs the co-operation of the patient, as discussed earlier the OP's self diagnosis seems to be getting in the way of that.

Comments like this just go to show how incredibly unaware and ill-informed people can be of how healthcare systems work .Without this understanding it is very hard to appreciate how incredibly shaky the Thai healthcare system is even at its "best" - yet time and time again foreigners who should know better put their faith in a SYSTEM that by its very nature cannot function properly.....

[Sheryl]

I have both received and witnessed excellent health care being delivered here. It does need some effort put into selection of a doctor, though. Just taking "pot luck" on whomever a hospital sends you to (likely to be the least busy person of that specialty...which is often not a good sign!) is never a good idea.

The really good doctors I have observed here practice medicine exactly as a really good doctor in any country would. There is nothing in the "system" that prevents them from doing so.

[Tolley]

I find that with all professionals such as doctors, lawyers, accountants etc., irrespective of the country, believe their expertise is beyond reproach and should not be questioned. This makes them often prone to misdiagnose or make poor professional decisions based on their own arrogance. That arrogance is rarely physically displayed, but is in the very nature of their training and professional environment. It might be called "God Syndrome" by those more critical than me.

I always insist that they listen, and listen again, and discuss what the possibilities might be, before allowing them to draw a conclusion. Doctors are probably at the low end of the scale of professional arrogance, but it exists. Just push and probe the doctor until they at least consider that your own self diagnosis is worthy of consideration.

Don't get me started on lawyers. Most arrogant bunch of professional bawstards. My lawyer refused to listen to my advice/opinion on a contract. Luckily all the communication was on email. He wasn't so arrogant when I sued him for some serious dollars to compensate me for the losses I suffered.

Based on my experience with specialists in Australia I don't think they are that good either.

First off they base everything on blood tests and imaging tests.

They often fail to listen to the patient and even worse if you question their diagnosis or treatment plan they become very defensive.

To top all that off you are very lucky if you get to spend more than 5 minutes with them and this is even if you are in a life threatening disease situation.

They charge you somewhere between 200-300 dollars for that 5 mins as well.

[NickJ]

Same things happen here as they do elsewhere. It takes some people a long time to come to the realization that the all powerful White Tower of Medicine is an illusion. Same with the legal systems. People expect real life to be like the TV shows they watch. It just isnt so in many cases.

[CaptHaddock]

While I have no trouble believing that diagnostic errors among Thai doctors could be high, the question arises, "Compared to whom?" This New York Times article, "Why Doctors So Often Get it Wrong", points out that US doctors misdiagnose fatal illnesses 20% of the time. Furthermore, the rate of misagnosis is the same now as it was in the 1930's!

http://www.isabelhealthcare.com/info/newyorktime.html

There is a telling quote in the article: "You get what you pay for," Mark B. McClellan, who runs Medicare and Medicaid, told me. "And we ought to be paying for better quality." The US healthcare system is, with a few exceptions, based on the fee-for-services model, just like the Thai system. When you pay doctors for performing services you get a lot of services, but you don't necessarily get good results. Misdiagnosis doesn't cost the doctor anything, unless it rises to the level of malpractice, so it persists.

In the US there are some alternative systems to fee-for-services, such as the Veteran's Administration's total lifetime coverage of medical costs for veterans, or the private "integrated care" model practiced by the Cleveland Clinic and the Mayo Clinic. We would expect misdiagnosis, as well as treatment errors, to be less frequent when the organization must routinely bear the cost of them, but I can't find side-by-side statistical comparisons. It must be true that much of the reason that the UN rates the French healthcare system as number one in the world while the US system is number thirty-eight is due to system effects and not just the sum of individual qualities of the practitioners.

So in that sense I agree with Mr. Grain-of-Salt, that the nature of the healthcare system itself has a huge effect on the resulting quality of care. As a consumer of medical services however I will naturally seek out the best practitioner I can find.

[cumgranosalum]

While I have no trouble believing that diagnostic errors among Thai doctors could be high, the question arises, "Compared to whom?" This New York Times article, "Why Doctors So Often Get it Wrong", points out that US doctors misdiagnose fatal illnesses 20% of the time. Furthermore, the rate of misagnosis is the same now as it was in the 1930's!

http://www.isabelhealthcare.com/info/newyorktime.html

There is a telling quote in the article: "You get what you pay for," Mark B. McClellan, who runs Medicare and Medicaid, told me. "And we ought to be paying for better quality." The US healthcare system is, with a few exceptions, based on the fee-for-services model, just like the Thai system. When you pay doctors for performing services you get a lot of services, but you don't necessarily get good results. Misdiagnosis doesn't cost the doctor anything, unless it rises to the level of malpractice, so it persists.

In the US there are some alternative systems to fee-for-services, such as the Veteran's Administration's total lifetime coverage of medical costs for veterans, or the private "integrated care" model practiced by the Cleveland Clinic and the Mayo Clinic. We would expect misdiagnosis, as well as treatment errors, to be less frequent when the organization must routinely bear the cost of them, but I can't find side-by-side statistical comparisons. It must be true that much of the reason that the UN rates the French healthcare system as number one in the world while the US system is number thirty-eight is due to system effects and not just the sum of individual qualities of the practitioners.

So in that sense I agree with Mr. Grain-of-Salt, that the nature of the healthcare system itself has a huge effect on the resulting quality of care. As a consumer of medical services however I will naturally seek out the best practitioner I can find.

Compared to whom - is a n interesting point....in many cases it is "apples and pears"

The fact that some healthcare systems have problems does not mean they are all the same......Thailand' problem are in many ways unique.....partly due to the rigidly hierarchical nature of the system, partly due to the almost total lack of comeback and impunity of doctors and for a large part the effects of corruption on every aspect of healthcare right from training to administering of hospital finances and services offered.

These factors set Thailand apart from most of the countries that expats come from....including even the USA which has the most inequitable and decrepit system in the western world....but it's faults are publicised and discussed....

at the end of the day when we watch programs or rad reports about western health systems have failed their customers, we do BECAUSE WE CAN - there are people and bodies that INVESTIGATE, gather stats and analyse our healthcare systems and expose their failings - in Thailand this happens so infrequently as to be negligible.

[thaiduncankk]

While I have no trouble believing that diagnostic errors among Thai doctors could be high, the question arises, "Compared to whom?" This New York Times article, "Why Doctors So Often Get it Wrong", points out that US doctors misdiagnose fatal illnesses 20% of the time. Furthermore, the rate of misagnosis is the same now as it was in the 1930's!

http://www.isabelhealthcare.com/info/newyorktime.html

There is a telling quote in the article: "You get what you pay for," Mark B. McClellan, who runs Medicare and Medicaid, told me. "And we ought to be paying for better quality." The US healthcare system is, with a few exceptions, based on the fee-for-services model, just like the Thai system. When you pay doctors for performing services you get a lot of services, but you don't necessarily get good results. Misdiagnosis doesn't cost the doctor anything, unless it rises to the level of malpractice, so it persists.

In the US there are some alternative systems to fee-for-services, such as the Veteran's Administration's total lifetime coverage of medical costs for veterans, or the private "integrated care" model practiced by the Cleveland Clinic and the Mayo Clinic. We would expect misdiagnosis, as well as treatment errors, to be less frequent when the organization must routinely bear the cost of them, but I can't find side-by-side statistical comparisons. It must be true that much of the reason that the UN rates the French healthcare system as number one in the world while the US system is number thirty-eight is due to system effects and not just the sum of individual qualities of the practitioners.

So in that sense I agree with Mr. Grain-of-Salt, that the nature of the healthcare system itself has a huge effect on the resulting quality of care. As a consumer of medical services however I will naturally seek out the best practitioner I can find.

Compared to whom - is a n interesting point....in many cases it is "apples and pears"

The fact that some healthcare systems have problems does not mean they are all the same......Thailand' problem are in many ways unique.....partly due to the rigidly hierarchical nature of the system, partly due to the almost total lack of comeback and impunity of doctors and for a large part the effects of corruption on every aspect of healthcare right from training to administering of hospital finances and services offered.

These factors set Thailand apart from most of the countries that expats come from....including even the USA which has the most inequitable and decrepit system in the western world....but it's faults are publicised and discussed....

at the end of the day when we watch programs or rad reports about western health systems have failed their customers, we do BECAUSE WE CAN - there are people and bodies that INVESTIGATE, gather stats and analyse our healthcare systems and expose their failings - in Thailand this happens so infrequently as to be negligible.

Considering nearly all doctors practise in Government hospitals as well as extortionate private hospitals, do you think you will get a better diagnosis because you are paying for the privilege ?

[cumgranosalum]

While I have no trouble believing that diagnostic errors among Thai doctors could be high, the question arises, "Compared to whom?" This New York Times article, "Why Doctors So Often Get it Wrong", points out that US doctors misdiagnose fatal illnesses 20% of the time. Furthermore, the rate of misagnosis is the same now as it was in the 1930's!

http://www.isabelhealthcare.com/info/newyorktime.html

There is a telling quote in the article: "You get what you pay for," Mark B. McClellan, who runs Medicare and Medicaid, told me. "And we ought to be paying for better quality." The US healthcare system is, with a few exceptions, based on the fee-for-services model, just like the Thai system. When you pay doctors for performing services you get a lot of services, but you don't necessarily get good results. Misdiagnosis doesn't cost the doctor anything, unless it rises to the level of malpractice, so it persists.

In the US there are some alternative systems to fee-for-services, such as the Veteran's Administration's total lifetime coverage of medical costs for veterans, or the private "integrated care" model practiced by the Cleveland Clinic and the Mayo Clinic. We would expect misdiagnosis, as well as treatment errors, to be less frequent when the organization must routinely bear the cost of them, but I can't find side-by-side statistical comparisons. It must be true that much of the reason that the UN rates the French healthcare system as number one in the world while the US system is number thirty-eight is due to system effects and not just the sum of individual qualities of the practitioners.

So in that sense I agree with Mr. Grain-of-Salt, that the nature of the healthcare system itself has a huge effect on the resulting quality of care. As a consumer of medical services however I will naturally seek out the best practitioner I can find.

Compared to whom - is a n interesting point....in many cases it is "apples and pears"

The fact that some healthcare systems have problems does not mean they are all the same......Thailand' problem are in many ways unique.....partly due to the rigidly hierarchical nature of the system, partly due to the almost total lack of comeback and impunity of doctors and for a large part the effects of corruption on every aspect of healthcare right from training to administering of hospital finances and services offered.

These factors set Thailand apart from most of the countries that expats come from....including even the USA which has the most inequitable and decrepit system in the western world....but it's faults are publicised and discussed....

at the end of the day when we watch programs or rad reports about western health systems have failed their customers, we do BECAUSE WE CAN - there are people and bodies that INVESTIGATE, gather stats and analyse our healthcare systems and expose their failings - in Thailand this happens so infrequently as to be negligible.

Considering nearly all doctors practise in Government hospitals as well as extortionate private hospitals, do you think you will get a better diagnosis because you are paying for the privilege ?

Are you talking about Thailand? If so you are totally misinformed about doctors and government hospitals. They are only obliged to work for a couple of years after their scant training...then they are free to chase up any lucrative linr they wish.......obviously plastic surgery is a favourite.

As the "system" is crucial in diagnosis the kind of doctor you get is largely lottery in Thailand which has a very poor primary care service.

[thaiduncankk]

While I have no trouble believing that diagnostic errors among Thai doctors could be high, the question arises, "Compared to whom?" This New York Times article, "Why Doctors So Often Get it Wrong", points out that US doctors misdiagnose fatal illnesses 20% of the time. Furthermore, the rate of misagnosis is the same now as it was in the 1930's!

http://www.isabelhealthcare.com/info/newyorktime.html

There is a telling quote in the article: "You get what you pay for," Mark B. McClellan, who runs Medicare and Medicaid, told me. "And we ought to be paying for better quality." The US healthcare system is, with a few exceptions, based on the fee-for-services model, just like the Thai system. When you pay doctors for performing services you get a lot of services, but you don't necessarily get good results. Misdiagnosis doesn't cost the doctor anything, unless it rises to the level of malpractice, so it persists.

In the US there are some alternative systems to fee-for-services, such as the Veteran's Administration's total lifetime coverage of medical costs for veterans, or the private "integrated care" model practiced by the Cleveland Clinic and the Mayo Clinic. We would expect misdiagnosis, as well as treatment errors, to be less frequent when the organization must routinely bear the cost of them, but I can't find side-by-side statistical comparisons. It must be true that much of the reason that the UN rates the French healthcare system as number one in the world while the US system is number thirty-eight is due to system effects and not just the sum of individual qualities of the practitioners.

So in that sense I agree with Mr. Grain-of-Salt, that the nature of the healthcare system itself has a huge effect on the resulting quality of care. As a consumer of medical services however I will naturally seek out the best practitioner I can find.

Compared to whom - is a n interesting point....in many cases it is "apples and pears"

The fact that some healthcare systems have problems does not mean they are all the same......Thailand' problem are in many ways unique.....partly due to the rigidly hierarchical nature of the system, partly due to the almost total lack of comeback and impunity of doctors and for a large part the effects of corruption on every aspect of healthcare right from training to administering of hospital finances and services offered.

These factors set Thailand apart from most of the countries that expats come from....including even the USA which has the most inequitable and decrepit system in the western world....but it's faults are publicised and discussed....

at the end of the day when we watch programs or rad reports about western health systems have failed their customers, we do BECAUSE WE CAN - there are people and bodies that INVESTIGATE, gather stats and analyse our healthcare systems and expose their failings - in Thailand this happens so infrequently as to be negligible.

Considering nearly all doctors practise in Government hospitals as well as extortionate private hospitals, do you think you will get a better diagnosis because you are paying for the privilege ?

Are you talking about Thailand? If so you are totally misinformed about doctors and government hospitals. They are only obliged to work for a couple of years after their scant training...then they are free to chase up any lucrative linr they wish.......obviously plastic surgery is a favourite.

As the "system" is crucial in diagnosis the kind of doctor you get is largely lottery in Thailand which has a very poor primary care service.

I am sorry, but you are misinformed. The majority here practice in both.

[Briggsy]

Regulatory body compliance and oversight are extremely weak or non-existent for doctors in Thailand.

When doctors know there is virtually no chance they will be struck off, reprimanded, investigated, suspended, sued, fined or censured in any way for malpractice, negligence, over-prescribing, mis-prescribing, unnecessary treatment or even causing the death of patients, then other priorities are moved up the chain. Primarily this would be the interests of the doctors themselves and the hospital management. These are likely to be prescriptions and tests which can be charged for and the reduction of doctor time.

The same applies in any industry. When oversight is lax or non-existent and there is no enforcement of compliance with codified standards, then performance tends to fall way below equivalent industries or countries where there is oversight.

Edited December 26, 2015 by Briggsy

[cumgranosalum]

THaidunkankk - No your assessment is incorrect and gives a misleading image. Doctors in Thailand after training are only obliged to work in government hospitals for a couple of years or so. Most then end up being "specialists" and have their own private clinics which take up most of their time. They seldom ever work in residency at a hospital they travel about from one to another depending on fees offered. They also frequently transfer patients who can pay to their private practices.

None of this constitutes a serious contribution to government healthcare.

Edited December 26, 2015 by cumgranosalum

[slipperylobster]

I had surgery 30 years ago, which left me with bone ridges blocking proper drainage of my sinuses. I now develop sinus infections frequently....the kind that never drain. This is further complicated by allergic reactions to dust, pollen and certain fauna. I love flower gardens, and blooming mountainside resorts....but the past two trips left me totally disabled. Side effects (besides the obvious congestion, coughing, sneezing...etc) are lethargy, joint pain, disorientation (not quite dizziness), fever and chills. Add to this, sleep apnea. I feel like I am suffocating when I lay down...and must sleep in a reclining chair during these episodes.

Bottom line.....sinus infection brings many of the symptoms you have concerns about...for myself. I am not sure about your case.

[thaiduncankk]

THaidunkankk - No your assessment is incorrect and gives a misleading image. Doctors in Thailand after training are only obliged to work in government hospitals for a couple of years or so. Most then end up being "specialists" and have their own private clinics which take up most of their time. They seldom ever work in residency at a hospital they travel about from one to another depending on fees offered. They also frequently transfer patients who can pay to their private practices.

None of this constitutes a serious contribution to government healthcare.

Nobody mentioned residency in Government hospitals, but if your assumption is right, surely they must be practicing in a Government hospital, if they then refer you to their more lucrative private practice ?

[CaptHaddock]

While I have no trouble believing that diagnostic errors among Thai doctors could be high, the question arises, "Compared to whom?" This New York Times article, "Why Doctors So Often Get it Wrong", points out that US doctors misdiagnose fatal illnesses 20% of the time. Furthermore, the rate of misagnosis is the same now as it was in the 1930's!

http://www.isabelhealthcare.com/info/newyorktime.html

There is a telling quote in the article: "You get what you pay for," Mark B. McClellan, who runs Medicare and Medicaid, told me. "And we ought to be paying for better quality." The US healthcare system is, with a few exceptions, based on the fee-for-services model, just like the Thai system. When you pay doctors for performing services you get a lot of services, but you don't necessarily get good results. Misdiagnosis doesn't cost the doctor anything, unless it rises to the level of malpractice, so it persists.

In the US there are some alternative systems to fee-for-services, such as the Veteran's Administration's total lifetime coverage of medical costs for veterans, or the private "integrated care" model practiced by the Cleveland Clinic and the Mayo Clinic. We would expect misdiagnosis, as well as treatment errors, to be less frequent when the organization must routinely bear the cost of them, but I can't find side-by-side statistical comparisons. It must be true that much of the reason that the UN rates the French healthcare system as number one in the world while the US system is number thirty-eight is due to system effects and not just the sum of individual qualities of the practitioners.

So in that sense I agree with Mr. Grain-of-Salt, that the nature of the healthcare system itself has a huge effect on the resulting quality of care. As a consumer of medical services however I will naturally seek out the best practitioner I can find.

Compared to whom - is a n interesting point....in many cases it is "apples and pears"

The fact that some healthcare systems have problems does not mean they are all the same......Thailand' problem are in many ways unique.....partly due to the rigidly hierarchical nature of the system, partly due to the almost total lack of comeback and impunity of doctors and for a large part the effects of corruption on every aspect of healthcare right from training to administering of hospital finances and services offered.

These factors set Thailand apart from most of the countries that expats come from....including even the USA which has the most inequitable and decrepit system in the western world....but it's faults are publicised and discussed....

at the end of the day when we watch programs or rad reports about western health systems have failed their customers, we do BECAUSE WE CAN - there are people and bodies that INVESTIGATE, gather stats and analyse our healthcare systems and expose their failings - in Thailand this happens so infrequently as to be negligible.

It's not "apples and pears" at all. Healthcare systems may easily be compared in various ways. Costs are easily comparable as is the health of the population.

We might focus on how well the system does the overall job of providing care to all of its citizens, factoring in access, cost, and quality along with measurements of outcome like longevity. Or we might evaluate them from the narrow perspective of what quality of care we expats can expect to receive. In my opinion the former is the better measure, although I myself do care very much about the quality of the care my family and I receive.

One way of comparing is by the relative efficiency of the system, i.e. cost as a percentage of GDP vs. health benefits. In Bloomberg's annual survey for 2014 the US ranked number 46 out of 48 countries while Thailand ranked 29th. Singapore was number one. The US spends 18% of its GDP for healthcare while Thailand spends 4.1%.

http://www.bloomberg.com/visual-data/best-and-worst/most-efficient-health-care-2014-countries

I wouldn't be surprised to learn that corruption is a factor in Thai healthcare, but I have never encountered actual data. Do you have references? It's true that some aspects of the deplorable US healthcare system are widely discussed, such as the extremely high cost, but the low quality of average care is seldom mentioned and few Americans know how bad it is. And the vested interests in the healthcare system were completely effective at preventing even discussion of a single-payer system when US Senator Max Baucus managed the passage of the ACA in the Senate. So the most important items are not discussed.

I don't find your identification of the sources of weakness in the Thai system to be particularly persuasive. It's true that Thai doctors enjoy relative impunity for poor job performance compared to US doctors who live in fear of malpractice suits. However, I don't think US doctors practice better medicine as a result. At least, I haven't seen evidence.

As to the relative bedside manners, most Thai and most US doctors are arrogant and insufferable, but in culturally different ways. I doubt that the differences are actually important though. Salience is not importance. Focusing on personalities as a fundamental explanation is generally a mistake.

[cumgranosalum]

" Costs are easily comparable as is the health of the population. " - and there your argument falls down....

i'm talking about the prmise that if there are problems tyhat look similar in other healthcare systems then people argue that the problems in Thailand are in common with the rest of the wworld - when in reality they are quite individual for the reasons I've cited.

"but I have never encountered actual data" - precisely one of the problems I've referred to...there is no real monitoring of healthcare in Thailand

..and why oh why do you keep referring to the US system as if it is either a yardstick or some mitigation for the Thai system?

as for "cost & efficiency - well quite apart from actually defining criteria like these, they are just a couple from a multiple of criteria you could choose to justify a healthcare system, but why pick those as if they are the be-all and end-all? I'd go for quality, equitability and primary care myself....

Edited December 26, 2015 by cumgranosalum