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. For those who do not know, I provide an advocate support service for patients attending any of the private hospitals in Pattaya. The private hospitals are up-selling their management of you, ordering expensive investigations which are either unnecessary or should be recommended only after the initial investigations have been performed and reviewed. My input has saved many members tens of thousands of Thai Baht. If you wish to avail yourself of this service, please join Pattaya Club Medical, then call Dao on 095 414 8145.
Following his nearly fatal illness a couple of Thursdays ago (see MBT no 118: Dying with Dignity) I escorted Aldente to a private hospital (name withheld for legal reasons) in Pattaya for a brain MRI. Before meeting the neurologist, I asked Aldente to refer to me as his advocate, not his doctor.The attending neurologist, who will remain nameless, questioned Aldente about his admission to another hospital. Aldente had no recollection of the reason for admission, nor of his overnight stay as an inpatient. So, I related the story told to me by his partner. Following my description Aldente stated: “I was very ill and Doc Martyn saved my life, he visited me every day for 10 days”. That was the last time the neurologist looked at me or engaged with me.
2. Aldente’s inability to remember his illness frustrated the neurologist. After performing a curt and totally inadequate physical examination, he suggested epilepsy and/or neurological damage. These diagnoses were made without any history or understanding of Aldante’s 10 days of illness. Despite knowing that I had managed Aldente at home, the neurologist continued to treat me with contempt, choosing not to ask me about his illness, nor the treatment I provided. This ‘specialist’ doctor had no idea what was wrong with Aldente. Guessing constitutes second rate medical care.
3. Initially, when Aldente was brought to my office, he had a fever, he was unsteady on his feet, he was unable to walk independently, he was confused and disoriented. His speech was severely impaired. Extrapolating from these signs and symptoms, I formulated the following opinion: Aldente was right-handed, therefore the speech centre was in the left side of his brain, Broca’s area, see photo 1 (if he had been left-handed, Broca’s area would have been in the right side of his brain). His inability to communicate suggested he had suffered a stroke in the left side of his brain. In addition, his weakness and instability suggested that the CVA had interfered with his Motor Cortex, see photo 2. His BP (212/96) and pulse (122) were elevated, suggesting raised intracranial pressure. His treatment: I changed his antibiotics, managed his hypertension, slowed his heart rate and reduced the pressure in his brain.
4. Because of the nature and severity of his illness, I instructed Aldente to ask for an urgent MRI brain scan. By the end of the consultation the neurologist had made the most ridiculous provisional diagnosis: Epilepsy. He proceeded to arrange a series of unnecessary expensive tests, most of which I cancelled. The ‘urgent’ MRI was not performed for two weeks. Considering the severity of Aldente’s illness the MRI should have been performed with priority. Failing to adequately care for a new patient constitutes second rate medical care. This doctor was not second rate, he was third rate.
5. I have been providing second opinions in Thailand for over 6 years. In that time, I have worked with some exceptional Thai doctors, all of whom had received additional training overseas. I have had robust medical discussions with neurosurgeons, head and neck surgeons and general surgeons all of which benefited patient outcomes. But, as in Aldente’s case, I have also been treated with disapproval and contempt. Such belligerent treatment of a fellow medic is very disrespectful and, in my experience, such treatment is exclusively the domain of home-grown Thai doctors working in private hospitals.
6. After 6 years of training at medical school, Thai doctors are awarded a Doctor of Medicine, an MD. This qualification, however, does not allow a Thai trained medic to practice in the West. The West considers the Thai Medical School training to be inadequate. Thai doctors may work in Myanmar, Cambodia, Vietnam and the like but, without further education and examination, they are not eligible to practice in the West.
7. There is little doubt that Thai doctors who do not seek additional training in the West remain medically challenged in both knowledge and skill. These doctors choose to train in their preferred speciality. But, by extrapolation and necessity, the training of these ‘specialist’ medics is inadequate. As such, they are not qualified to become a specialist medic in the West. Their training is equivalent to that of a western medical technician, not that of a Western trained medical specialist. These substandard medics hide behind the, unjustified, adoration of their Thai patients, their self-righteous arrogance and Face Saving. The inadequate level of the Thai Medical School education is not the fault of the doctor(s), it reflects the inadequacy of the education system. It is a government problem. But the intolerant and overbearing attitude of these home-grown doctors towards their patients is, in my view, clear evidence of their lack of facility.
8. Over 50% of the doctors practicing in the Private Sector in Pattaya are home-grown medics. As patients, you should protect yourself against poor management by substandard specialists. When next you attend a Private Hospital for medical care do not accept allocation to any of these home-grown medics. Check the doctor’s medical qualifications before you accept their treatment. All medics trained overseas will hold extra international qualification(s). By employing the services of an overseas trained Thai doctors, you should receive the quality of care that you are entitled to and paying for. Beware the home-grown Thai doctor; many have ‘feet of clay’.
Addendum: Aldente’s MRI; encephalomalacic change from haemorrhagic changes at the anterior aspect of the left external capsule.The external capsule carries association fibres which lie below Broca’s area and the motor cortex.My formulation, diagnosis and management were correct.
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.