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Thailand: Time to limit working hours for our stressed out doctors?

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Time to limit working hours for our stressed out doctors?


BANGKOK: -- Over the past 16 months, patients have filed 200 civil complaints and 35 criminal complaints against doctors in public hospitals in Thailand.

Judging from the statistics, the risk of doctors falling into legal problems has risen dramatically.

Victims of suspected malpractice have loud complaints about doctors and say any wrong move during treatment can change their lives for the worse. In the eyes of many patients, doctors are often seen as aloof, passionless and often too busy to look carefully into each case.

But the truth is that doctors, particularly those at state hospitals, are overwhelmed with their workloads.

Quality problems, incorrect decisions or wrong diagnoses are probably a result of long working hours.

A foreign patient was upset when his doctor at a private hospital appeared reluctant to discuss his ailment. He switched to another private hospital, where the doctor was willing to answer his questions until he felt satisfied.

Indeed, he was lucky to have got the chance for a long chat with a doctor. Most Thais have one to two minutes -particularly those who can't afford pricey service charges at private hospitals - for each medical visit. Many complain that doctors at public hospitals spend too little time with patients. Is it true?

According to the Medical Council of Thailand, doctors at public hospitals have to perform about 180 million outpatient consultations a year. It estimated that in each shift in outpatients department, a doctor has to see 100-200 patients, leaving just a few minutes for each person.

Government data shows there are 47,000 physicians in Thailand, but only 13,500 work at public hospitals. It is estimated that in 2015, 2,000 medical students will graduate. About 2,000 will be assigned to work at over 840 public hospitals nationwide under the Public Health Ministry's care. Of these, some will pursue studies after completing their residency. Meanwhile, physicians' permanent jobs need endorsement from the Civil Servant Commission, which can do that only on a yearly basis.

The World Health Organisation says Qatar has the highest ratio of doctors to patients of any country, at 7.7 per 1,000 population. That is higher than the 2.3 per 1,000 in Japan or 1.9 per 1,000 in Singapore and 1.2 per 1,000 in Malaysia.

In Thailand, there are 0.4 doctors for every 1,000 patients. That's the average rate. The proportion is lower in small provinces, as most doctors are in big cities, which have more private hospitals.

Medical Council secretary-general Ittaporn Khanacharoen says some countries have introduced a Working Time Directive, to limit the service hours each doctor has to perform each week, to ensure quality service. He believes this practice would be good here, particularly at public hospitals in the provinces, which have fewer doctors.

Ideally, each doctor should see only 30 patients a day. This would allow quality time with patients and doctors to work on preventive care, to reduce ailments in areas they treat.

Ittaporn acknowledged this could be done without depriving others' rights to see doctors.

He has a good point. Several doctors at public hospitals that I know often complain about their long work hours.

Meanwhile, patients sent to the wards feel they have to wait too long.

Few people know or want to acknowledge that some doctors have to work for up to 30 hours in a shift. With that long at work, it is difficult for any individual to keep perfect sense, let alone someone who has to take care of another's health condition.

Here is a story from a neurosurgeon working at a public hospital: On one day, he was scheduled to operate on four patients. After he completed his daily assignment, he learnt that another surgeon had taken sick leave.

"I was assigned to take over his cases. What could I do? If I refused, saying I had done enough, what would happen to the four patients? They would have been dead by now," he said.

Another heart surgeon said he had to be on call for seven nights in a row. Each morning in the week, he had to make rounds as usual.

While I admired his dedication, I could not help feeling concerned about the quality of his work. What if a patient died under his care?

What if the diagnosis was wrong? Who would take responsibility?

Doctors are human. When they lack sleep or adequate rest, there is a risk their judgement might not be as sharp as usual. As their service directly affects the health of others, all relevant authorities should give serious attention to this issue.

The National Legislative Assembly should review the law concerning treatment liability. Given the increasing pressure on doctors, many must want to flee to private hospitals, which pay better and offer less work. In the end, without the work time limit, it is the general public who will suffer the consequences.

In the United Kingdom, the Working Time Directive stipulates that a doctor must serve no more than 56 hours a week and the longest shift must not exceed 14 hours. After four hours of work, doctors earn a break of at least 30 minutes.

In the US, there is a similar directive for specialist doctors.

Ittaporn is right to say such a directive would answer the quality issue. It remains to be seen how the council will ensure that the directive does not deprive others' rights to get medical services from doctors.

There have been complaints that the number of doctors is insufficient, leading to poor quality work. For decades, we have never been able to address both issues. If the directive can tackle the quality issue, it should be implemented.

Hopefully, we can deal with the quantity issue later. Public health bosses don't need to focus on producing new doctors alone - they also need to get the public to take better care of their health.

The best scenario is that all people do their best to keep themselves in good health. This way, their need for medical care would be minimised. And when they really need medical help, they will get the full attention of quality doctors.

Source: http://www.nationmultimedia.com/national/Time-to-limit-working-hours-for-our-stressed-out-d-30248487.html

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-- The Nation 2014-11-25

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I think pretty much everyone in Asia is worn out with these 6 day work weeks for low pay that a lot of people make.

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How many of these stressed out doctors, have caused bigger problems due to total incompetence?

Just the other week, one of my staff. Her old mother fell down and hurt her shoulder.

Doctor prescribed an antibiotic, mind you did not even ask about the allergy.

She did not need antibiotic, she needed antiflammatory.

2 weeks prior, same doctor prescribed anti diarrhea medicine for her, because she has bleeding ulcer.

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Thais need to stop going to the hospitals with a runny noses or mild temperatures. The small town I live in the hospital is packed, and I'd say 50% of those patients needn't be there.

My wife is a doctor and worked a year in a small town as part of repayment for the government paying for her studies (normal practice in Thailand and a fine way to give back to the community). From her experience there I can confirm your observation completely, although i do think that your 50% estimate is way too low.

When I was staying with her in that town the record set by a doctor was handling 64 patients in an hour. That includes the greeting, asking what is wrong, and letting the patient out. That is less than 60 seconds per person to find out what was wrong and suggesting how to solve it.

Most conversation went like this:

- Hello doctor

- Hello, what is wrong with you?

- I have a headache/cold/cannot sleep/dizzy/tired/not hungry

- For how long do you have this already?

- A few hours

- Come back if you still have it in 2-3 days, bye bye

If i spoke better Thai i could take over those shifts without having a medical education:

Dripping nose? Turn off AC

Headache? Paracet

Cannot sleep? Go try again, eventually you will be tired enough

Tired? Go to bed

The worst thing I have heard a patient going to the hospital for was that he had the hiccups. And that lasted over 10 minutes already, so time to go see a doctor.

The biggest risk though is that after 100 patients who bother you with the common cold you miss that one who has signs of something serious and who drops dead a few hours after you tell them to go back home and turn off the AC.

Reasons for the chronic problems in public hospitals:

1. doctors get paid too little. My wife switched to a private hospital for the simple reason she now works less and gets paid twice as much. Plus the patients are much better (they don't bother you for a common cold if you charge them 1,000 baht), the staff is better (the nurses actually work instead of watching soaps on TV), the facilities are much better (doctor room with AC instead of a fan), better general conditions of employment (i get 75% of all medical costs reimbursed made at that hospital, she gets lots of holidays, etc)

2. hospital visits are for free. Patients come to the hospital with a common cold because they do not get charged for it. Reintroducing the 30 baht fees would be a start, but it should be much higher to avoid people wasting the doctor's and their own time (find another way to cover the costs for truly poor people who do get ill a lot).

3. remuneration system is crooked. People get paid on seniority, not on performance. They did introduce a pay-for-performance scheme, but as always things go wrong when the person deciding who gets it comes from the old system. Guess this is a cost that appears in every government organization where it is almost impossible to fire people.

4. general corruption and stupidity. A nice example from the hospital where my wife did her specialization: the director decided to increase the monthly extra pay (you get extras for many reasons like not having your own practice on the side, or being far upcountry) from 5,000 to 10,000 baht. This lasted for 2 months till he ran out of money and the 10K total pay became zero. Instead of securing the budget first he had just started paying out extra from the limited amount of money he had. And if you pay out 2 times what you do normal, you run out of money twice as fast meaning you have to stop paying completely near the end of the year.

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100 - 200 patients a day???? That's almost general rate in EU. Every GP in NL, D, F, IRL got these figures

30 patients a day? Well, Thainess means Thai leisure then

Better diagnosis? Why not better education to avoid all the mistakes they make every day

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Why not better education to avoid all the mistakes they make every day

Yes, after working 6 days a week, 12 hours a day (minimum), they should spend time studying instead of having a life and sleeping.

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My experience with Thai Public Hospital Doctors is, regardless of time constraints, tiredness or whatever they NEVER do exhibit any "Doctor / Patient Relationship" (Bedside Manner) with their Patients. I see it as a situation (regardless of training, time, or lack thereof) that they regard themselves as somewhere close to the "Right Hand Of God" and the patient is an "Uneducated, Poor Rice Farmer Peasant" and is treated as such. The Usual handful of medication is passed out, sometimes without so much as a "Grunt" or word of explanation. Inefficiency at its best.

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".. the truth is that doctors, particularly those at state hospitals, are overwhelmed with their workloads."

The Truth? There is no information in the report that supports the "truth." It all follows an assumption which makes the entire story a speculation. At least give the public a Dusit survey showing that 95% of doctors are "overwhelmed with their workloads."

It might be that the problem is more basic than doctors being stressed: not enough doctors to shorten workhours or see more patients, restricting use of foreign doctors to increase staff size, lack of funding to increase staff size, inadequate training facilities or qualified resident programs to produce more doctors, inadequate pay, etc. Little Cuba exports doctors in high demand throughout the world. The US gives priorty visas to foreign doctors to fill needs.

The story is basically a filler.

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Perhaps it's time to consider a makeover, starting with the introduction of a GP system, something that would not only shift much of the workload away from hospitals but would reduce the chances of infection transmissions.

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This is true, I have seen it first hand, how many cases state Doctors in Thailand have to complete during a normal working day, is just incredible.

The main problem in Thailand is a lack of state surgeries, to ease the burden for less serious cases, and the dispensing of medication.

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Thais need to stop going to the hospitals with a runny noses or mild temperatures. The small town I live in the hospital is packed, and I'd say 50% of those patients needn't be there.

Are you indicating they dont believe it is due to rain drops ?

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Perhaps it's time to consider a makeover, starting with the introduction of a GP system, something that would not only shift much of the workload away from hospitals but would reduce the chances of infection transmissions.

Can you maybe further explain what a GP system is and how that will help?

In Holland we also have a sort of GP system (but maybe you are referring to a different system) where you visit your GP who will handle the case himself when it is something simple or redirects you to a hospital if it is serious.

The exact same is happening in Thailand already with the only difference that the GP is located in the hospital. If they see a serious case they will redirect you a specialist (if available), to another hospital where they have the right specialists/equipment, or you will be admitted in the hospital for observation/more tests/etc. Moving the GP out of the hospital will create more problems than it will solve (they all need to hire their own nurses, have their own administration, no more economies of scale, etc).

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