Battle between courts and doctors benefits no one
A court ruling awarding Bt2 million in compensation to a couple whose daughter suffered brain damage during the course of medical treatment will have huge repercussions.
The couple’s claim – that the damage stemmed from the first doctor’s failure to diagnose tuberculous meningitis in time – is disputed by many medics.
“Treatment, even if delayed by five days, will not change the results in such cases,” Prof Dr Yong Poovorawan said on his Facebook page.
A member of the Royal Society who has also taught at a prestigious medical school, Prof Yong has expressed concerns that the court ruling will significantly affect doctors’ treatment approach in the future.
Other doctors have already vented their frustration at the ruling online. The legal precedent has prompted them to consider whether they should now prioritise self-protection in their treatment decisions.
On March 31, the Supreme Court ruled that a government doctor in a rural province had been reckless in failing to seek the opinion of a radiologist or to ask the patient’s guardians whether they had ever contracted tuberculosis.
However, the shortage of radiologists in Thailand means that not all X-rays are read by specialists. The fact is that most community hospitals do not have a radiologist.
A female doctor at a community hospital in Loei province said the court ruling had prompted her to ask why she should take risks.
Meanwhile a cartoon strip posted on a popular Facebook page depicted the chaos that would ensue if every rural patient with complex symptoms was automatically referred to a medical specialist.
“I am told I am not a specialist,” says a doctor to her elderly patient, explaining why she can no longer treat all her symptoms.
The strip has been shared more than 23,500 times since being posted on April 9.
Responses like these show that many doctors feel threatened by the court’s decision.
Yong said he had always taught his students to use a holistic approach, taking into account the patient’s history, physical condition and feelings.
“If we require the help of specialists at every step, there will be damage. … Today, there are more cases of ruptured appendix because doctors refuse to provide operations if an anaesthetist is not present. But in the past, doctors have performed hundreds of such operations successfully without the help of an anaesthetist.”
Yong said that resolving the issue required the cooperation of all stakeholders, “or else suspicion will prevail and lead to rifts at the expense of Thai society in the long run”.
Preeyanan Lorsermwattana, head of the Thai Medical Error Network, reckons she must look like a devil now in the eyes of many doctors. She’s even played on that perception in the title of a book she wrote. Her critics may see money as her motivation for suing doctors, but to people who claim they’ve been the victims of malpractice, Preeyanan is an angel. Among those are the parents of the brain-damaged daughter, whose case she worked on. Preeyanan has proposed that the the government draft a medical malpractice act to better protect victims.
In the wake of complaints about the ruling from Medical Council secretary general and defence witness Dr Somsak Lolekha, court spokesman Seubpong Sripongkul said the ruling had been based on evidence presented by both sides.
Somsak said he took the witness stand as a medical expert and president of the Asian Society of Paediatric Infectious Diseases. He did not know the accused in the case.
No matter what Somsak and Seubpong say, both sides should keep in mind that society won’t benefit from a battle between the courts and doctors. What patients need are effective ways to reduce the risks of malpractice and also of the over-investigation that doctors may resort to in a bid to avoid being labelled reckless.
We should applaud the move by the Medical Council, the Consortium of Thai Medical Schools, and the Medical Association of Thailand to set up a committee to seek collaboration and promote mutual understanding among all stakeholders.
Doctors are encouraged to send comments to the committee via prasit.wat@mahidol.ac.th, and urged not to vent anger unproductively on the social media.
Established on April 13, the committee is expected to report its progress within two weeks.
