Skip to main content

Advertisement

Advertisement

Overworked doctors at Thai state hospitals soldier on despite 24-hour shifts

BANGKOK — In Thailand, being a doctor means having a good income, an honourable career, and a life of comfort.

The waiting area for patients at Buddhachinaraj Hospital. Photo: Bangkok Post

The waiting area for patients at Buddhachinaraj Hospital. Photo: Bangkok Post

Follow TODAY on WhatsApp

BANGKOK — In Thailand, being a doctor means having a good income, an honourable career, and a life of comfort.

This is not necessarily true, especially for those working at state hospitals. With inadequate staff and facilities as well as a heavy patient load, many of these hospitals often face complaints of long queues and inattentive care.

Last month, news went viral when a state doctor in Chiang Rai submitted a resignation letter stating that he found Thailand’s bureaucratic system unbearable. He had had enough with the workload after attending to almost 100 patients in a day in a small local hospital staffed with only three doctors, not to mention facing conflicts with patients and emotional breakdowns.

Recently, a 15-year-old boy died at a state hospital in Phetchaburi after a long wait with severe stomach pain. It was revealed later that he had been suffering from a rare disease, and an artery in his stomach had ruptured.

The doctor-to-patient ratio in Thailand is inadequate, and rural areas are most adversely affected. Based on 2015 figures from the Ministry of Public Health, the doctor-to-patient ratio in Bangkok is 1:720. In the northern provinces, it is approximately 1:2,300. It is even worse in the north-east where the figure is 1:3,200.

There are around 18,000 doctors registered with the Public Health Ministry, but only 57 per cent work in state hospitals, including regional and community hospitals. The rest are in private hospitals and other places. That perhaps explains why doctors in state hospitals can get as little as two days off per month. The total monthly income is around 80,000 baht (S$3,280). For the same job, a doctor in a private hospital can make over six times more or about 500,000 baht than one at a state hospital.

But say this to Dr Warin Yuyangket, 39, a neurosurgeon at Buddhachinaraj Hospital in Phitsanulok, there is more than just lucrative pay when it comes to working as a doctor at her neurosurgery unit — a place she has been working for the past seven years.

As a regional hospital in the lower northern part of Thailand, Buddhachinaraj Hospital is responsible for patients in Phitsanulok, Phetchabun, Sukhothai, Uttaradit and Tak, as well as other nearby provinces. Between 2013 and 2015, the neurosurgery unit at Buddhachinaraj Hospital saw over 4,700 outpatients a year, and handled about 1,500 operations, 2,700 inpatients, and 200 emergency patients. The team consists of only four neurosurgeons and they treat everything: accident wounds, strokes, brain tumours, broken spines and so on.

Every day, in the waiting areas and hallways of the hospital, patients wait, along with family of all ages, with some sitting in wheelchairs or lying in beds.

For Dr Warin, work starts around 8am each day when she checks on 50 patients in her unit.

If she is due for a night shift — seven or eight days a month for each neurosurgeon — she will stay to care for patients outside of office hours. Her work ends around 8am the next day, bringing it to a 24-hour shift. She also has to give lessons to medical students, or complete paperwork pertaining to patient data.

“I try to spend time with my patients, like five minutes for each of them in outpatient department,” she said. “Some came really far from other provinces, leaving their houses at 3 or 4am and waiting until 10am before they see a doctor. It won’t do to spend 30 seconds just to say hi and prescribe medicine.”

“We do get some rest,” Dr Warin said. “But let’s say we’re about to eat and our phone rings, then everything else is dropped. We save our patients first. And on days when we have surgery, we could go from morning to night with no time to eat.”

Dr Warin is only one example of a state doctor who handles an overload of patients on a daily basis. Of course, situations at other state hospitals, especially small ones, can get worse.

She added that there are only about 40 new graduates in neurosurgery a year. Half of them choose to work in Bangkok; most of the rest head to private hospitals, with only a few coming to state hospitals.

As a Phitsanulok native, Dr Warin chose to stay close to home. She believes that while money matters, it is not the answer to everything.

“I have great mentors — other doctors who set an example that, even though they’re not local here, still choose to stay and care for our patients. We have both local patients and those coming from other provinces. Some are very poor. They have no other options. If we choose to go elsewhere, the patients will have a hard time.”

A patient’s smile, and the realisation that her hands make them better, are some of the best rewards of a medical career, noted Dr Warin with pride. At the same time, negative reactions from patients and family are something that really wear her down. Still, she insists she will continue to stay at her current workplace.

Addressing the issue of doctors quitting state hospitals, Dr Jaras Wacharaprapapong, the chief of neurosurgery at Buddhachinaraj Hospital, said there is a high turnover rate among doctors at state hospitals. This is part of an unfortunate cycle, making it hard to cope with ever-increasing patients.

From his three decades working at the Phitsanulok hospital, the 58-year-old said it is crucial for the government, the doctors, and the patients to work together to solve this problem.

There is a need to take a look at how doctors are distributed to rural areas, he said. The budget also needs to be sorted out, with additional support going to smaller, local hospitals so they will be able to treat more patients and more conditions on their own. “This would, in turn, reduce the burden put on bigger hospitals that have to take in referred cases,” he suggested.

Dr Jaras believes it is equally important for doctors and patients to show courtesy and understanding towards one another.

Also, it would be helpful if people can recognise whether their conditions really require urgent treatment.

“We’ve had people coming in at 2am after they finish partying because they weren’t free during the daytime,” he said. Some had just a slight headache. Some demanded to see a specialist even when their conditions could be treated by general practitioners at any hospital near them.

“When this happens, the people who really suffer aren’t just us, but the patients who are in actual critical, life-threatening situations,” he added. “They may receive less care and attention than they should be getting as we have to divide our time among other patients, too.” BANGKOK POST

Read more of the latest in

Advertisement

Advertisement

Stay in the know. Anytime. Anywhere.

Subscribe to get daily news updates, insights and must reads delivered straight to your inbox.

By clicking subscribe, I agree for my personal data to be used to send me TODAY newsletters, promotional offers and for research and analysis.