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Published on January 9, 2008

To put things in perspective, under Thai law a driver who collides with and kills a pedestrian has a good chance of getting probation, enabling him to lead a normal life in the weeks or months before his case comes to trial.

To err is human; that much is still true. For a doctor, part of a profession dedicated to high standards in caring for human life and wellbeing, mistakes can mean an individual patient's quality of life is affected, potentially a tragedy for both the patient and his family. However, as long as there are doctors still practising, unintentional or unavoidable effects of their actions will occur. But these should be recognised and handled correctly and quickly, communicated frankly and apologised for when appropriate. Most lawsuits fought over medical matters in this country are not about money but rather communication breakdown, a lack of satisfaction with patient care, and system failure.

Most new doctors are vulnerable to making mistakes. Each year, about 1,400 new graduates take up obligatory service as interns in their first year of practice and do two more years upcountry. All these doctors lack a seasoned clinical judgement but shoulder the majority of the burden of healthcare on the country's frontlines. Ex-president Ronald Reagan once said at a Vietnam Veteran's Day observance, "we will never again send our young men to fight and die before giving them the means to gain victory". This statement should be taken to heart by our medical colleges and Ministry of Public Health, who should then ask themselves whether we are sending out these young recruits adequately equipped with weapons of knowledge, skill and attitude. In addition to the hands-on medical knowledge, communication skills, medical ethics and legal standpoints, and some administrative skills should be offered.

According to the Thai Medical Council's Professor Viratt Panichabhongse, with people demanding better healthcare from their government, and medical knowledge and management improving along with technology, doctors who don't keep up to date by reading the relevant literature or attending medical conferences risk malpractice and obsolescence.

Most hospitals in remote areas are understaffed, under-equipped and overloaded. If something isn't done to remedy this situation, the country's brain drain will worsen. Hospital accreditation should be implemented at all levels and throughout the country. Standards of medical practice should be strengthened, fed by a system of competency appraisal and evaluation where appropriate.

As urgent first aid for these unsolved problems, individual physicians should use their own careful judgement based on their practical experience. All physicians must:

1. Recognise the limits of their professional competence in terms of knowledge, understanding, skill and experience before proceeding with any procedures on an elective basis.

2. Make sure that their medical technicians are fit physically and mentally to work effectively as a team both in elective (non-urgent) and emergency situations.

3. Recognise the adequacy of their resources. If there are deficiencies here that might impact on the safety of patients, transferring is recommended to a colleague or hospital where the required resources are available.

4. Be willing to benefit from the support of your senior or director and your organisation when needed.

5. Recognise locals' traditions, attitudes, beliefs and levels of participation or contribution to your hospital and act accordingly.

6. Seek advice from your superior or medical council if you feel the situation warrants it.

7. Above all, be honest and make the care of your patient your first concern; treat every patient politely and considerately, respect patients' dignity and privacy and make time to listen to them.

By supakorn rojanin, md

Deputy dean of public relations and special affairs, Siriraj Hospital's Faculty of Medicine 

The Nation