Questioning a doctor in Thailand

[bazza40]

A couple of nights ago I acquired a fever, hitting a body temperature of 40 C. The next day, I dragged myself over to the hospital with muscle aches, fever, headache, bone pain in my shins, and weak as a newborn kitten. Saw a very pretty young female doctor who ordered blood tests after compiling my medical history. Tests inconclusive, not influenza. Problems mostly gone after dosing for two days on paracetamol and a foot/leg massage today.

I am wondering how other posters approach questioning a doctor in Thailand. I wanted to ask if she had excluded dengue fever, and why the hospital did not have my medical history on file - I've been a registered patient there for six years now. However, I am aware asking these types of questions could result in a loss of face - how would you handle it?

[Morakot]

There seems to be a rather different approach to the doctor-patient relationship in Thailand in comparison to Western European/ North American countries.

For many Thai patients it would be highly usual to have an informed conversation about treatment options or to receive detailed explanations about underlying causes or deployed procedures.

However having said this, most doctors in Thailand had some exposure to Western culture and often had some training in the West. Many seem to be aware of these differences and would not understand this as a confrontation.

Personally, when going to see a doctor in Bangkok, I specifically asked them to tell me the "whats, hows, and whys". It has never resulted in awkwardness and most readily provided the information.

[Sheryl]

Just ask, nicely of course and with a smile.

Some things - like "why the hospital did not have my medical history on file" (chances are they did but the notes were sketchy in the extreme and possibly also no one bothered to read them) - I would not advise asking/saying as they sound accusatory and won't gain you anything.

But questions about diagnosis and treatment, certainly ask. Phrase simply and in a way that doesn't sound judgemental i.e. "could it possibly be dengue?" rather than "have you excluded dengue?" , the former is more respectful and also face-saving in case the doctor had in fact not yet considered it (though in the case of dengue that's unlikely).

Wherever it is possible, choose doctors who trained in a western country as they will be socialized to expect and respond to patient questions. Thais truly aren't but you can still usually get away with it if done politely with a smile. Sometimes an apology and a wai before asking, if for example the doctor appears in a hurry or not disposed to discuss further.

If you encounter a doctor who does not respond to even such polite and neutral questions -- change doctors.

BTW in addition to dengue there are several other mosquito-borne viral diseases very similar to it endemic in Thailand. Chikungya, for one; Zika is another (and contrary to what the news hype might lead one to think, usually a quite mild disease). Mild cases of dengue, also, will not be diagnose-able by the limited range of blood tests usually available in small upcountry hospitals. It doesn't really matter in management of an individual patient, as the management of all 3 is the same: rest, fluids, paracetemol. When there are epidemics, of course, then for public health reasons it becomes important to get a handle on what is causing it, but in terms of treatment all that really matters is excluding bacterial infection etc.

[Bosse137]

In the more than 20 years I`ve lived here,I have consulted lots of doctors;for my self and for my wife,who I use to accompany when she sees the doctor.I always asks all the questions I find relevant,and I always got a good respons from the doctor! Many times it even seems as if the doctor likes to explain to somebody who shows interest...When it comes to my behavier,I act in the same way as I do in my home country and as I do with any person I consult,that is with normal respekt for that person and his/hers opinion.(Even if I sometimes do not agree with it,in which case I find another doctor for a second opinion...)

[hgma]

15 years and not a single problem, in fact sometimes i feel a bit embarrased while asking questions while the patients waitinglist to see the doc is so long that i have the feeling 'steeling time' when answers take "too long"..........sincerely ask questions and you WILL get answers.

Only when NOT speaking Thai, take a Thai partner/friend with dual language capability with you!

[Utley]

You are a fool if you do not question the doctor thoroughly. If you sit quietly like a bump on a log, you deserve what you get - IMHO.

[JMWPACIFIC]

You are a fool if you do not question the doctor thoroughly. If you sit quietly like a bump on a log, you deserve what you get - IMHO.

Speaking of responding respectfully...

[samuijimmy]

I have always used the Samui Government hospital and always found the doctors to be good, ...every single visit I have made over the last 8 or so years is in the computer system, including medications given...

I find it strange the OP's history was not brought up on the computer .... that is partly what the Number on the hospital card is for....

(Perhaps smaller hospitals are not as advanced?)

[Sheryl]

I have found, even with some very highly qualified Western trained doctors, that (1) chart notes are brief in the extreme giving little information and (2) doctors will often not read prior chart entries. Making it essential that the patient know and verbally convey relevant past history.

[Utley]

You are a fool if you do not question the doctor thoroughly. If you sit quietly like a bump on a log, you deserve what you get - IMHO.

Speaking of responding respectfully...

Point taken; I could have been a little more diplomatic in my choice of words. However, it is your life; in a potential life threatening situation, why in the world would you leave the decision making process up to someone else? Even if a nurse was simply going to apply a plaster to my finger, I would ask her when was the last time she washed her hands!

[chubby]

i'm sure it all depends on the doctor, worldwide, many doctors prefer not to elaborate on their advice, often because here in the US, they get 15 min max for each patient!

<br><br>

having worked in the medical world for 20 years, as a professional, i could understand the language, as some of the basis for the advice, but find, that many doctors, just prefer not to have a discussion,

<br><br>

then again, what i experienced in Bumrumgrad, was that the Doctor, heard my idea, then just quickly said yes, good idea, and added a test to my list, that i may or may not have needed ; at another hospital, i tried to help my friend, as i work in a hospital, but the dr's english was apparently not great, or he didn't offer much of anything to what he was doing, and if you don't get a warm and fuzzy, the risk, is pissing off the dr., who then just get harder to ever get any information.

<br><br>

this happens in particular with surgeons , it seems...

Edited March 28, 2016 by chubby

[gandalf12]

Thai's consider doctors as god's I dont and the reason is I have worked in a hospital and seen varying levels of incompetence. I think something should be checked and the doctor hasnt I ask why have you not checked for whatever it is. I look on doctors like this, they do the best they can but they are not infallible. At the end of the day it is my body and my life so if I m not happy with what they have done I just question it outright.

I would doubt if you were a lot better after 2 days that you had Dengue fever but you could have had something that needs treatment or it may return.

Just ask the question and in particular ask what is it you had. If they cant answer that then ask what they checked for and what you didnt have. Progress it from there

Edited March 28, 2016 by gandalf12

[Toscano]

Latin and English are the languages of modern medicine , so all doctors in Thailand will speak a little English .

i have been living in Thailand for 10yrs and have regular appointments with a cardiologist , but also visit our local village cottage hospital .

I find the doctors as thorough and competent as anywhere . Doctors are busy people , so discussing your symptoms with them is helpful to them and their ability to diagnose correctly .

I do not find any Thai doctors suffer loss of face if you ask them about possible causes of an ailment they haven't already suggested .

[1FinickyOne]

I have found that anywhere these days you have to be pro-active about your health. If you suspect Dengue, ask for a blood test checking for Dengue...

I noticed that too, there never seems to be a follow-up after they mention what to keep an eye on - you can go back a year later or 5 years later and it always feels like the first time.

Maybe you can work something out with a private clinic and the doctor who works there... if you need that sort of follow-up. It seems that you are going to be the best judge for yourself. I have found that if asked a specific question a Thai doc will do their best to answer and address the issue, though they might not bring something up.

Doctors anywhere rarely seem interested beyond your ten minutes... go pro-active.

Good luck

[bcrglobal]

Both the Mrs. and I have found that Doctors are generally welcoming of informed questions, but their support staff are definitely not. Remember that most of your treatment is triaged and managed by support staff, and you need to remain in their good graces--based on experience NEVER do anything other than smile and wai with receptionists, nurses, etc as they feel threatened in their positions by your having any knowledge--however you can have the hard-hitting discussions with the doctors and they will generally respect you for it.

[akentryan]

Even more disturbing than the failure to communicate is to be given incorrect information that usually would require expensive tests and/or surgery. A doctor at the big boy here in Pattaya told me I needed two stents to relieve partial blockages. I opted to have it done in the USA. My cardiologist there said "You do not need stents. We will adjust your medication a little and you'll be just fine." That was two years ago and I'm doing just fine - knock on wood. If it is serious get a second opinion.

[bark]

When the matters concern your health, you are crazy not to ask questions. Most doctors will be happy to ask any question you have.

Ask politely and not like a cop.

Glad you are feeling better.

[Surasak]

Arriving at the hospital with a past history before arrival in LOS, I explained my symptoms and asked for a further check up to ensure all was well. The look of total horror on the docs face was a picture. However, I persisted and explained quite politely why I was asking for further investigation. I did get my way and later in the day the results showed what I had feared. Doc was most apologetic and prescribed medication to ease symptoms. I see this same doctor on a regular basis now and he always asks, 'Anything else I can help you with'? He did tell me later, Thai people do not generally question their doctor's diagnosis and I was the first person to do so. I have regular annual check up's now with the same doctor and he always explains the outcome.

[BangkokKen]

You can go around hospitals in BKK and spend a fortune without ever having been looked at or even directly talked to.

Doctors while staring at their screen mumble something about more tests, hand you an appointment for next time, a booking for an ICT/MRI/blood test/ and off you go.

My mate got told off by his wife for actually asking a question when the doctor asked if they had any -questions-.

This is a rhetorical question, she said, in Thailand you are grateful for the doctor to see you and you don't ask any question to a doctor, it's rude.

[atyclb]

OP; speaking of appropriateness, how pertinent is it to specify the doctor was a "pretty young female"

#16; you can find places in the usa that would like to do an income generating procedure over a non invasive one. in thailand one would think theres a lot less oversight in reducing such optional-unnecessary procedures.

[zaZa9]

I have been going to International Hospital Phuket for years , and went last week with a problem I had spent a day there with about 3 years back , only to have the Dr check the computer and ask me what was wrong.

He had no details so i had to start again - which was a bummer.

Ive no idea why they wouldnt keep records.

It bodes well for those claiming insurance refunds whilst denying this illness wasnt a "previous condition", I must say...

[Jeffkp]

I have appointments every three months with my Cardiologist and Diabetes doctor at a hospital in CM. I go in at 8:00 AM and have my blood drawn. I return at 10:00 AM and my Doctors have the results. Great! However, the young girl (a child!) takes my vitals, she she uses one of those automated blood pressure cuffs and it shows some outlandish reading. Last time it 196/45. Not a word was said. Just smiled and wrote it down.

I always ask my cardiologist to take another reading and it's 120/80. I never ask support staff anything, Totally useless, I think.

BTW, I find my doctors helpful and happy to answer any of my questions.

[Songlaw]

Just ask, nicely of course and with a smile.

Some things - like "why the hospital did not have my medical history on file" (chances are they did but the notes were sketchy in the extreme and possibly also no one bothered to read them) - I would not advise asking/saying as they sound accusatory and won't gain you anything.

But questions about diagnosis and treatment, certainly ask. Phrase simply and in a way that doesn't sound judgemental i.e. "could it possibly be dengue?" rather than "have you excluded dengue?" , the former is more respectful and also face-saving in case the doctor had in fact not yet considered it (though in the case of dengue that's unlikely).

Wherever it is possible, choose doctors who trained in a western country as they will be socialized to expect and respond to patient questions. Thais truly aren't but you can still usually get away with it if done politely with a smile. Sometimes an apology and a wai before asking, if for example the doctor appears in a hurry or not disposed to discuss further.

If you encounter a doctor who does not respond to even such polite and neutral questions -- change doctors.

BTW in addition to dengue there are several other mosquito-borne viral diseases very similar to it endemic in Thailand. Chikungya, for one; Zika is another (and contrary to what the news hype might lead one to think, usually a quite mild disease). Mild cases of dengue, also, will not be diagnose-able by the limited range of blood tests usually available in small upcountry hospitals. It doesn't really matter in management of an individual patient, as the management of all 3 is the same: rest, fluids, paracetemol. When there are epidemics, of course, then for public health reasons it becomes important to get a handle on what is causing it, but in terms of treatment all that really matters is excluding bacterial infection etc.

Whoa. Not bad. Accurate, and well written. (If we had a hat-tipping emoticon, it'd be placed here.)

[bazza40]

OP; speaking of appropriateness, how pertinent is it to specify the doctor was a "pretty young female"

#16; you can find places in the usa that would like to do an income generating procedure over a non invasive one. in thailand one would think theres a lot less oversight in reducing such optional-unnecessary procedures.

Just an observation, I wouldn't try reading too much into it.

The way I felt at the time, she could have danced naked on her desk without a flicker of response from me.

[sugarcane24]

Paracetamol is a dangerous drug which is in my opinion best avoided.

A fever caused by an infection should in any case never be lowered by a drug or by other means, as such fevers are an organism's way of dealing with an infection. Lowering a fever is like shooting the policemen on the way to deal with a crime.

http://www.vaccinationinformationnetwork.com/paracetamol-acetaminophen-tylenol-warning/

[chilli42]

I have actually found them to be good sports when dealing with an unexpectedly well informed patient. At first they are a bit gob smacked that someone is asking them questions and start to give you platitudinal answers. Once they get over their shock (sometimes asking if you are a doctor) nearly all have been willing to put in the time for a good give and take. You can tell when you have asked a tough question they have no answer for. You can usually dig one level deeper but then they start to feel uncomfortable. At that point it's best to move on or the conversation comes to an abrupt end.

[richard_smith237]

If I have a question I've always asked.

I've always felt it ok to double check and even question judgement.

At one time back was in agony after a sporting accident. Dr. Moved me around a little and suggested I'd pulled a muscle. I simply said he was wrong and walked out - I wasn't wasting time with someone being lazy.

Another hospital & 1 MRI later showed 3 ruptured disks.

Another incident, I caught my sons paediatrician out in lie (supposedly one of the more senior paediatricians at Bumrungrad). After confironting him I demanded another Dr.).

A further incident. My son fell ill. At the hospital the Jr Dr wanted to place my son on a saline IV but couldn't explain why. I requested another Dr who agreed it was unnecessary.

I'm short: the Drs in Thailand are good. But always be prepared to ask questions and if you are unhappy you are free to discuss and even disagree.

[Morakot]

You are a fool if you do not question the doctor thoroughly. If you sit quietly like a bump on a log, you deserve what you get - IMHO.

Not sure what this means 'question the doctor thoroughly.' If, however, the doctor perceives your questioning as disruptive behaviour, I have bad news for you. Because it will increase the likelihood of being misdiagnosed.

There is evidence that: 'Disruptive behaviours displayed by patients seem to induce doctors to make diagnostic errors.' (Schmidt et al 2015). Hence those who sit quietly are less likely to be misdiagnosed.

Inappropriate questioning seems to affect the limited supply of mental capacity per consultation, by doctors redirecting their efforts to diffuse a tense situations or stop someone complaining, instead of using it to make the best diagnosis.

http://qualitysafety.bmj.com/content/early/2016/02/09/bmjqs-2015-004109

Edited March 28, 2016 by Morakot

[bazza40]

Paracetamol is a dangerous drug which is in my opinion best avoided.

A fever caused by an infection should in any case never be lowered by a drug or by other means, as such fevers are an organism's way of dealing with an infection. Lowering a fever is like shooting the policemen on the way to deal with a crime.

http://www.vaccinationinformationnetwork.com/paracetamol-acetaminophen-tylenol-warning/

In part, I agree with you. It's true fevers are part of the body's defence mechanism. I also don't particularly like paracetamol as a drug.

On the other hand, a prolonged fever is harmful. Going without sleep for 48 hours is not good for me either.

[connda]

I tell my doctor up front that I'm going to talk to him/her like I do Western doctors. But with that said, don't think for a second that they will not pull the greng jai card out of the deck. But if you think that is the case - call them on it. It's your life, not theirs. And get a second opinion. Or a third.

Edited March 29, 2016 by connda