The following is a guest opinion article from Doc Martyn. His opinions and advice are entirely his own and may not necessarily be those of The Pattaya News Company Limited. His contact information can be found at the end of the article.
1. Traditional Thai Medicine (TTM) is an umbrella term for 5 holistic and natural approaches to health care, namely: Internal Medicine, External Medicine, Spirit Medicine, Divination and Buddhism. Over the centuries, the development of these 5 approaches corresponded closely to the development of medicine in the West:
Internal medicine: The use of herbs and diet.
This approach was used in the West before science became the foundation of Western Medicine. The treatments remain the domain of naturopaths and alternative therapists.
External medicine: Manipulation, cupping, massage, and the external application of herbs etc.
This form of therapy was practiced in the West. It now rests in the hands of physiotherapists and chiropractors.
Spirit medicine: Amulets and Sak Yan tattooing for spiritual protection and assistance with healing.
Amulets are meant to protect against evil spirits.
Amulets are used in the West; rosary beads, the ubiquitous catholic symbol of Jesus on the cross, the Jewish Mezuzah which protects the home.
Sak Yan tattooing, see photo 1. Most bar girls in Thailand are adorned with these tattoos. They reflect the wishes of the tattooed; e.g. good fortune, good health etc. When tattooed by a traditional Thai tattooist, these tattoos include a personally specific design formulated from the subject’s date and time of birth.
Likewise, the West has used symbolic tattooing for centuries.
Divination: To seek knowledge of the future or the unknown by supernatural means. In the west this is called meditation.
Buddhism: The mental health branch of TTM, see photo 2. The philosophy: A healthy existence depends on the four elements of life; Earth, Water, Wind and Fire, being maintained in perfect balance and harmony. Illness occurs when this balance is lost.
Western science does not support this philosophy. The scientific process relies upon reproducible evidence, not philosophical doctrine. Empirical evidence takes precedence over theory and logic. The introduction of science in the west heralded the separation of TTM and Western medicine.
2. Western medicine first entered Siam in 1686. The first government funded Thai Hospital, the Siriraj Hospital, was built in 1887. The King (Rama V) Chulalongkorn Memorial Hospital was finished in 1914 and the Chulalongkorn University was established, with its Faculty of Medicine, in 1916.
TTM was removed from the Thai medical curriculum in 1915.
With the assistance of the French and the Portuguese governments, King Prajadhipok (Rama V11, the last absolute Thai Monarch, 1926-1935) introduced western style primary health care into Thailand. He established over 102 hospitals, called Healing Halls.
But, following two World Wars, the 1932 Thai revolution, Rama V11’s abdication in 1935 and the 10 coup d’etats between 1947-2014, the growth of western style medicine in Thailand was, understandably, slow.
3. There are two prominent reasons why the performance of Thai trained doctors remains below par:
Reason 1: Their medical training is limited: By Western standards, Thai medical training is deemed to be inadequate. Thai trained doctors lack the basic and essential training to take a complete medical history and perform an adequate physical examination, part of the art of medicine. 91% of diagnoses can be made on history and examination alone (Ref: JR Hampton: Relative contributions of history-taking, physical examination, and laboratory investigation to the diagnosis and the management of medical outpatients: BMJ, May 1975.).
Without additional training and examination, a Thai medical degree does not allow a Thai doctor to work independently in the West.
If given the opportunity, many Thai doctors seek additional training overseas. Naturally, male doctors are more likely to be able to access this training than their female counterparts. Procedurally, they return as excellent physicians in their chosen discipline, but they may lack the art of treating the patient as a whole.
When these overseas trained doctors return to Thailand, they tend to seek employment in the large private Hospitals, where they enjoy their Hi So status, their medical prowess, and their Mercedes.
Only a few are altruistic and return to the public system from whence they came. Those that do are usually exceptional doctors.
Reason 2: Their cultural bias. A significant component of Thailand tradition rests in Confucian ideology (Ruism). In China Confucius (Kong Fuzi. 551-479BC), see photo 3, championed the five beliefs of his Confucianism, which included the concept of ‘face’.
Face revolves around self-abnegation (self-denial) when the people relinquish their individuality to concentrate on their duties to society. Under Confucianism, following self-abnegation the subjects are guaranteed to be treated with kindness and respect by all. In this philosophy, happiness is not realised through personal success and material pleasures, as in the West, but through human things; coming to terms with oneself, one’s family and one’s community.
6. Confucius said: ‘To lose face is bad’, ‘To make someone lose face is unforgiveable’.
The concept of face is anti-intellectual and face has terrible repercussions.
According to John Guther’s ‘Essays about the East’: ‘Face meant that nobody dared to take a risk, never to take an intellectual gamble, nor a stab in the dark; since failure would cause a loss of face and thence personal shame and ridicule. In adopting such a tenet; there would never be a Chinese Thomas Edison, or a Chinese Henry Ford or a Chinese Albert Einstein’.
7. In modern day medicine, face has no place. It is both inappropriate and counterproductive, as inadequately trained Thai doctors hide behind their Hi So status and face, never to learn from their mistakes.
An additional cultural problem with Thai doctors is the Thai patient’s inappropriate reverence for the doctor: Mostly, Thai patients accept their doctor’s medical opinion without question and typically they are not allowed to question their doctor. Then they diligently follow their treatment recommendations without question.
But, due to their inadequate training, Thai doctors lack essential skills, rendering them prone to errors.
8. “What’s wrong with Thai medicine?”
Problem 1: As stated, the difficulty that Thai doctors experience in the diagnostic process is their lack of training in the art of medicine. They rely heavily on the science of medicine; pathology and radiological investigations, the reason why, often before the patient has become seated, Thai doctors reach for such request forms. Yet, as stated previously; 91% of diagnoses can be made on history and examination alone, obviating the need for scientific investigation.
This is not the fault of the doctors. It is the fault of their compromised and limited training which has become the responsibility of the government.
The authorities must realise this deficiency, and use western trained doctors to teach the art of medicine. But there is a hurdle: Face. I have offered my services for free but my offers have been overlooked.
Problem 2: Cultural bias: The Thai Government is heavily vested in Medical Tourism. Both Thailand patients and international patients will not receive the competent and adequate medical care they deserve until Thai medical schools produce doctors who set aside the 2500-year-old philosophy of Confucianism.
Post scriptum: For your information, I have included the Hippocratic Oath, adopted by the West, and the Vejjavatapada Oath, taken by Buddhist doctors. Both Oaths were formulated in or about the 3rd Century BC. There is a significant difference.
The Hippocratic Oath, circa BC 3rd century:
I swear to fulfill, to the best of my ability and judgment, this covenant:
“-I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
-I will apply, for the benefit of the sick, all measures that are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
-I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.
-I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.
-I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know.
-Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty.
-Above all, I must not play at God.
-I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
-I will prevent disease whenever I can, for prevention is preferable to cure.
-I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
-If I do not violate this oath, may I enjoy life and art, respected while I live and be remembered with affection thereafter.
-May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.”
Vejjavatapada, the Buddhist medical doctor’s oath, circa BCE 3rd century, is an oath to be taken by Buddhist doctors and other professionals working with the sick:
The Lord said: “Health is the greatest gain.” He also said: “He who would minister to me should minister to the sick.”
I too think that health is the greatest gain and I would minister to the Buddha.
Therefore:
(A) I will use my skill to restore the health of all beings with sympathy, compassion and heedfulness.
(B) I will be able to prepare medicines well.
(C) I know what medicine is suitable and what is not. I will not give the unsuitable, only the suitable.
(D) I minister to the sick with a mind of love, not out of desire for gain.
(E) I remain unmoved when I have to deal with stool, urine, vomit or spittle.
(F) From time to time I will be able to instruct, inspire, enthuse, and cheer the sick with the Teaching.
(G) Even if I cannot heal a patient with the proper diet, proper medicine and proper nursing I will still minister to him, out of compassion.
Addendum: Over the past 6 years, as a retired medic living in Buriram I offered second opinions on any medical issue. I recently moved to Pattaya. As in this case, if you reside outside of Pattaya, telephone consultations are provided. For assistance; please contact me, Doc Martyn, on Facebook or call Dao on 095 414 8145.
