Doctor-patient relations tested
Thai society must find a balanced approach to protect patients' rights while preventing excessive litigation
The Medical Council, the governing body for physicians, has issued an announcement on "Medical Facts" to inform the public about problems and limitations faced by doctors. This is part of a campaign to seek protection for Medical Council members from "unfair" malpractice lawsuits. The statement has been met with strong reactions from human rights and consumer protection groups, who accuse the Medical Council of being biased in favour of members of the medical profession at the expense of patients' rights. The most controversial aspect of the announcement is a move to grant doctors the right to refuse to treat patients in non-emergency cases while offering them protection against malpractice lawsuits.
In the "Medical Facts" issued on November 30, the council states that it is the doctor's right - in cases of a lack of expertise, or excessive workload, or the hospital's lack of equipment or capability - to refuse to treat people who are not in a life-threatening condition. Doctors, particularly those working at public hospitals, are often overwhelmed by patients, which forces most of them to spend less than one minute with each patient, thus increasing the risk of misdiagnoses and giving the wrong treatment. The announcement also says: "Sometimes in the medical treatment procedure, unwanted, unforeseen circumstances may occur despite sufficient caution and care taken by the physician, and that shall be regarded as a force majeure".
The council's move follows a rise in the number of criminal and civil lawsuits filed against doctors for alleged malpractice. Some 60 cases are awaiting court decisions. The council said the announcement was designed as a guideline to promote better understanding of doctor-patient relationships and that it offers a balanced approach toward protection of doctors' and patients' rights. But critics suspect that the "Medical Facts" issued by the council are a smokescreen for something more sinister. Health consumer groups say that if doctors, especially those employed by government hospitals, are allowed to refuse cases considered not to be severe, those patients, who are entitled to free healthcare at state hospitals, may be compelled to go to private healthcare facilities where they are charged. Many doctors who are state employees also work part-time for private hospitals and clinics.
The doctors' rights versus patients' rights controversy is a continuation of a long-running, usually emotionally-charged, debate over the National Health Insurance Bill. This contained some problematic clauses that doctors considered unfair because they would make doctors liable to "undeserved punishment" in the form of malpractice lawsuits. The clauses in question provided for the establishment of a fund to compensate victims for medical damage, as well as for an authorised body to demand financial responsibility in cases where wrongdoers could be identified. That bill, which was set to be considered by the Senate, lapsed in the aftermath of the September 19 coup. But similar legislation is expected to be tabled again - either to the present government and National Legislative Assembly, or to the future democratically elected government and Parliament.
Proponents of the clauses hail them as the remedy that victims of medical malpractice have long needed. But many doctors fear they will encourage more patients to sue, and that this will lead to excessive litigation. Both sides have legitimate concerns that need to be addressed with a cool head and rational discussion. It is important to understand that what Thailand, as a society, is trying to do is find a middle path that will provide adequate protection to members of the medical profession against unnecessary or unjustified malpractice lawsuits while at the same time promoting patients' rights in case something goes terribly wrong through negligence or unethical practices in the course of medical treatment. Both doctors and patients must also be assured that a safeguard will be put in place to prevent frivolous claims for compensation. For example, a satisfactory list of criteria must be established before a medical malpractice lawsuit can be initiated.
This issue could have wide-ranging effects on society at large, so all parties involved - doctors, patients, the general public - must continue to engage in dialogue with a view to finding a mutually beneficial solution. Doctors who perform their duty well must be free from unnecessary anxiety, while patients and their loved ones must be assured of an avenue to seek fair compensation in case of medical malpractice.