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.

Outcome of preterm premature rupture of membranes.

OBJECTIVE: To study the incidence and outcome of preterm premature rupture of membranes (PPROM). DESIGN: Cross-sectional study. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University. SUBJECTS: Ninety five PPROM women who were expectant management and delivered between January 1, 1997 and December 31, 1997. RESULTS: The incidence of PPROM was 7.2 per 1000 deliveries. There were 51 women in the gestational age group at or below 34 weeks and 44 women in the gestational age group above 34 weeks. Gestational age, total antenatal care visits, total weight gain and neonatal birth weight were significantly lower in the gestational age group at or below 34 weeks (p < 0.05). Abnormal delivery, maternal and neonatal complications were significantly more common in the gestational age group at or below 34 weeks (p < 0.05). Total maternal and neonatal hospital-stay comprised significantly more days in the gestational age group at or below 34 weeks (p < 0.05). CONCLUSION: Maternal and neonatal outcome were more unfavorable in the gestational age group at or below 34 weeks of PPROM. Expectant management should intervene at the gestational age at or below 34 weeks of PPROM due to unfavorable maternal and neonatal outcome.

Double uterus with unilaterally obstructed hemivagina and ipsilateral renal agenesis: a variety presentation and a 10-year review of the literature.

A double uterus with a unilaterally obstructed hemivagina is a rare condition, usually associated with ipsilateral renal agenesis. Herein, we report two cases, the first case presenting with abdominal pain and pelvic mass. Hemihysterectomy was performed leaving the contralateral uterus intact. The second case presented with chronic foul smelling vaginal discharge. The diagnosis was a double uterus and pyocolpos of the left vagina. Excision of the left vaginal septum and drainage were performed. The postoperative course of both cases was uneventful and the patients were well at the six-week follow-up. An accurate diagnosis, appropriate management and the prevention of future fertility problems are discussed.