New-world and transcultural impact on Thai medical practices and professional behaviour.

Thailand, which is barely recovering from the 1997 economic collapse, has passed a new constitution, has a new government and all of this will have a profound effect on the way doctors practice and interact with their patients. Some of the factors that have been responsible for this are 1) Passage of a patient's rights bill 2) Legal definition of what is a proper consent form 3) The public's demand for openness, better communication and transparency in medicine These concepts, which now have a legal as well as moral basis, will impact directly on doctors and nurses as their practices will be subject to increasingly intense scrutiny and criticism. Doctors and nurses in past generations were among the most respected members of Thai society. They were trusted almost without exception and their judgment was not questioned. Only rare cases of malfeasance and malpractice came to public notice though, no doubt, they existed but to a much lesser degree. A physicians' life was much simpler for our teachers, fathers and grandfathers. Life was inexpensive, families were less demanding and the doctor did not have to surround himself with expensive foreign-made apparatus which can bankrupt the doctor as well as the patients who have to pay the bills. Medical decisions were made mostly on the basis of observation, past experience at the bedside and not in the laboratory or imaging rooms. Honest errors in diagnosis were common, treatment was limited and simple and this was all tolerated or expected by the public. Few if any disappointments on the part of patients ended up before a judge.

Humanistic learning in medical curriculum.

This paper argues for more attention and exposure to humanistic learning in the Thai medical curriculum. Humanistic learning traditionally consists of literature, history and philosophy, and is advantageous for medical education in that it tends to foster sensitivities to feelings, awareness of social traditions, and creating of skills in deliberating complex, ethical issues. These dispositions are necessary for a doctor in the world where there is an ever increasing public demand for communication, accountability and transparency on the part of doctors. It is proposed that the Thai medical curriculum should include more humanistic learning, and that medical students should be given opportunities to interact more with students from other disciplines throughout their studies and later professional life.

Medical ethics in the changing cultural milieu of Thai society.

Thai Society is changing from an agrarian one to a more individualistic one based on rule of law and impersonal relationships. This has far reaching implications on the relation between doctors and their patients and especially on medical ethics. Traditional communal ties and the honor accorded doctors by the public can no longer be relied on as sole measures enforcing ethical principles. Measures have shifted from one based on honor to one based on law. One implication of this is that medical ethics have to change from the traditional to one based on rational discourse. Measures must be found in order that ethics based on rational discourse become ingrained in Thai culture. One such measure is that radical separation of arts and science in the schools be demolished, and that medical students interact academically and substantively with their peers in other disciplines.