As an American medical student doing an elective in Thailand, I was initially troubled when I saw how Thai patients were treated. I’m not speaking of the way Thai physicians apply medical science, mind you — they rely on UpToDate and sundry U.S. guidelines just as we do — but that was mostly where the similarities ended.
Morning rounds with the team of residents (sans attending, but apparently there was one somewhere they could call if they needed help) took place in two alcoves of a long hallway — the male inpatient ward. Each alcove had a desk for the nurses, a computer, and six beds. There were curtains against the wall beside each bed that could be drawn as needed, although they infrequently were. A shared bathroom was down the hall, but bedpans were readily available.
We grabbed the first patient’s chart and stood at the foot of his bed while we briefly discussed his plan for the day. One of the residents had pre-rounded, which I guess meant that no more needed to be said to the patient because we wrote our orders and moved on to the next patient with no more than a smile of acknowledgment.
The next patient had some wounds on his buttocks that needed to be looked at, so we drew the curtains (most of the way, at least) and started pulling the bandages off. The problem was, these bandages were incredibly adherent to this patient’s wounds, so the removal process involved serious skin tenting as layers of tissue were being pulled free along with the bandages. Before the resident began, he had warned the patient that he was about to remove the bandages, but during the painful removal process (complete with writhing and soundless gritting of teeth), the resident discussed with me, in English, American cars.
The rest of rounds proceeded with more discussions about the patients, more writing of orders, plus an occasional physical exam maneuver or inquiry about a patient’s symptoms. In total, 15 patients took under three hours including stoppage time to translate for me.
And here is the amazing thing: Not once did I see a patient complain. The lack of communication, the lack of medical and personal privacy, the cramped conditions, the occasional painful procedure; none of them seemed to be a problem. The Thai residents explained to me that when Thai people are admitted to the hospital, they enter with the expectation that the doctors know what they’re doing and will send them home when they’re done fixing them.
A major lesson I took from this is that there is no universally perfect level of privacy or comfort or paternalism; the patients’ culture and, even more importantly, the patients’ expectations are what determine the best mix of trade-offs.
This gives me hope. As the U.S. continues its quest to stabilize and reduce health care spending, I believe American patients will be willing to lower their expectations in many respects as well, but probably only if they see a direct financial benefit for doing so. The challenge, then, will be linking the two.
Taylor J. Christensen is physician who blogs at Clear Thinking on Health Care.
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