Medical culpability must not begin with the end of a life

Thai officials keep speaking about Thailand being a medical hub of whatever; you name it and we’ll go there – the region, the continent, maybe the world too. Narcissism is one of our most obvious character traits these days, so why not?

But if we take a good and honest look at the actual state of healthcare provision in this country, we should question the sanity of the official stance.

Many people dare not criticise or question the medical advice or care quality they are receiving. Some have been chided for even posing questions to their doctors, who are, mind you, mortals, just like the rest of us. And as such, they can and will err. 

And just like every other mortal, they must accept responsibility for their errors.

There are only a handful of professions that are treated with the utmost reverence by members of most societies, and doctors are front and centre of them. For the most part, it must be added, deservedly so. Their work can mean the difference between life and death, absolute joy and utter sorrow, an able body and infirmity.

According to the World Bank’s latest published report in 2012, Thailand in 2010 ranked among the countries with the lowest number of physicians per 1,000 people – 0.3 to be exact. This is in stark contrast to the number of vehicles per the same number of people in 2011 – 165.

In addition, our healthcare sector further suffers from the maldistribution of physicians, which leads to severe shortages in some areas of the country, especially in non-core provinces with low per capita income.

Many parents might hope that one of their children grows up to be a doctor. It’s not only that doctors’ earnings are high, but perhaps more importantly it is believed that they can help improve the livelihood of others. Here, that is supremely good karma.

Doctors command the highest respect in Thai secular society. A nonagenarian, upon entering a doctor’s office, will willingly put palms together in a wai gesture, normally reserved for older or more senior people in rank and social status. In the most intimate and meaningful ways, doctors are trusted and perceived as failsafe. Some doctors, as a result, perceive themselves as invincible.

That’s how it becomes a problem. The notion of invincibility can easily lead to hubris that leads to sloppiness, callousness, condescension and negligence.

Medical horror stories are thus in abundance. All you have to do is listen and look around.

Many doctors do not read patients’ medical records, not because they are not available, but because they do not bother to pay attention. They dispense prescriptions without giving an iota of thought to drug interactions and side effects that can vary from patient to patient. Some potent painkillers are prescribed without the doctor telling the patient that the drugs are highly addictive because they contain opiates. A patient can be prescribed a “date-rape” drug to sedate him, and at the same time a derivative of methamphetamine to bring him back up from the deep hole into which he was sent by the first drug.

Some physicians opt to treat symptoms rather than the root causes of health issues. Steroids are a favourite panacea drug because they make patients feel better quickly, albeit deceptively, as they suppress the nasty symptoms. The patients are not told the adverse consequences of the drugs. Even a minor eye infection can receive a prescription for steroid eye drops.

Unnecessary surgeries are performed. Expensive procedures and tests are ordered, not because they are needed, but because the doctors do not want expensive machines sit idle.

Last year, I underwent a simple surgery. I walked into the hospital as a normal person. Today, my right leg is literally dead as the result of the operation on an organ that had nothing to do with the leg. I was told that I had nerve damage. I went through intense physical therapies that ran electricity through the dead muscle. I exhausted all the treatments that could possibly stimulate the nerves that control the key muscle used for walking. To compensate, I use my knee and hip to move my body, and thus the left and right legs do not coordinate. Now I am told I have avascular necrosis and need hip replacement surgery. I expect a knee replacement will be next. And then what? Pains mark every moment of my life. Before that surgery, I had a normal and functional body; now I am a cripple and soon will be an invalid. It is “a fate worse than death”. 

That’s why the untimely passing of the patient during the spinal analgesia hit close to home. Thais are, by nature, forgiving. We like to say everything in life happens for a reason – our good or bad karma because of acts we committed in our previous lives. However, as we cannot alter our previously good or bad karma, granted their existence and influence, we must try our hardest to prevent bad karma being committed by doctors on patients and their families.

Doctors are humans, and to blunder is human. But just like every other human, doctors can and must be held liable. We do not have to go as far as in many first-world countries where medical malpractice insurance premiums have sent medical expenses sky-high. We can learn from their experience on what to do and what not to do when it comes to medical accountability. But we must not wait until more lives are wasted before we make the culprits answerable.

As a reminder, the essence of the Hippocratic Corpus calls for a doctor to do no harm.