Patient-Centered Care Offers Solutions for Thai Medical System

Doctors In Thailand practicing primary care medicine in 2019 have likely met this familiar greeting from a patient: “I Googled my symptoms and I think the problem is [insert condition].” Obviously, this can be unsettling for many providers – doctors in the past were often the first point of reference for patients who otherwise had no way of researching their health concerns on their own. Considering the increasing web access of the Thai population and the proliferation of online medical information (both flawed and accurate), this trend of self-evaluation will likely continue into the future. It is crucial, therefore, that doctors adapt to these new realities. As explored further below, a patient “taking charge” of their own healthcare through self-motivated research can be a valuable tool to achieve results for physicians who learn to harness it. Through a model of patient-centered healthcare delivery, the doctor and patient can shift paradigms to act as a team rather than relying on the antiquated caregiver-receiver model of the past. The digital age demands innovation and  Thailand Healthcare has to evolve to accomodate this.

How Patient-Centered Care Re-Imagines the Thai Doctor-Patient Relationship

Patient-centered care means the shifting of primary control and responsibility for decision-making to the patient rather than the provider. In other words, the patient becomes an active participant in his or her health management rather than a passive receiver of care. The “buy-in” of patients to become stakeholders in their health outcomes has been ;https://www.ncbi.nlm.nih.gov/pubmed/11032203">proven to improve reported health outcomes (subjective and demonstrable) as well as to alleviate burdens on providers by reducing the frequency of diagnostic tests and referrals.

Western medicine provides the Thailand Medical system many examples of what patient-centered care looks like in practice. Self-reported data using applications or other internet-based programs – for example, dietary adherence by diabetes patients – allows patients to take responsibility for their health management. Patients in many programs enjoy the ability to self-refer directly to specialists rather than requiring a referral from a primary care physician eliminating unnecessary and costly visits). Peer-to-peer support groups for chronic illnesses reduce dependency on providers and increase patient accountability, which has consistently proven beneficial for outcomes.

The medical journal Radiologic Technology, in an article published by the National Institutes of Health, determined that “patient-centered care is associated with a higher rate of patient satisfaction, adherence to suggested lifestyle changes and prescribed treatment, better outcomes and more cost-effective care.” The further self-education of the public, combined with the adoption of the patient-centered approach by Thai providers, promises improved health outcomes for Thai patients moving into the future – if the Thai system takes advantage of the opportunity.
How Technology Assists Healthcare Transformation into a Patient-Centered Practice

Websites offering diagnostic tools, symptoms checklists, dietary advice, prescription drug recommendations, and all manner of health advice are ubiquitous.

Medical research is widely available online. Scholarly studies from respected institutions are published by PubMed and the National Institutes of Health, free for the general public. In the pre-internet era, before the 21^st century, gaining access to these documents was much more time-consuming and inconvenient. As such, the medical establishment acted as a kind of gatekeeper to this information.

Previously, medical journals were mostly only read by doctors or other professionals in the industry. Efficacy studies of certain medications were interpreted by researchers and the results relayed to doctors through medical textbooks, during residency programs, or more informally at medical conferences. Strategies to treat conditions were left up to the doctor with little input from the patient, and the protocols for treatment dictated by the doctor as a set of instructions for the patient to follow. Modernity has rendered this type of top-down healthcare obsolete. In the new world, patients are armed with vast amounts of information – much of it, legitimate information based on real data that they can use to form their own conclusions.

Various Medical News sites also provide updates about latests medical breakthroughs and also discoveries and latests medical protocols or research and clinical trial results, all of which can assist patients make their own decisions and queries when they are in joint consultations with their Doctors or Hospitals in Thailand.

Health-monitoring applications and devices have further empowered patients. Smartwatches gather data on a growing number of health markers. Heart rate and other basic vital signs are only the beginning of the torrent of data that will soon become recordable with these tools. In the near future, oxygen levels, blood pressure, blood glucose levels, dietary habits, physiological responses to medications, and emergencies like stroke or heart attack will all become detectable via smartwatch. The device will aggregate this data and compile reports across that can be sent to healthcare providers.

As of now, smartwatches that monitor the health status of the wearer have not been evaluated or approved by the Thai FDA, or any international counterparts, to be used for clinical diagnoses. Rigorous testing must be done by these regulatory bodies to further measure accuracy and effectiveness. However, their future use for data-gathering in the medical field is inevitable.  
All of this new information, unlocked by technology and available to both patient and doctor, could potentially revolutionize the way that Thai physicians evaluate patients’ conditions – if they embrace the technology.

In a systematic review of 24 studies on the application of smartwatch capabilities to healthcare, Applied Clinical Informatics concluded that “smart watch technology supplied with biosensors has the potential to be useful in a variety of healthcare applications” and that the “clinical application of smart watches as assistive devices deserves further attention” while noting the need for further development by the manufacturers and increased scrutiny from research groups.

The Thai Mindset:  Cultural Barriers to Implementing the Patient-Centered Healthcare Approach in Thailand

Sociologists have long noted important cultural differences between East and West. Western (European) societies tend toward individualism – valuing the autonomy, rights, and interests of individual members over the collective. In the worldview of the West, institutions like healthcare exist to serve the needs of each individual with distinct preferences. Populations in those nations, like the US, intuitively accept the patient-centered concept.

Eastern (Asian) cultures (including Thai), conversely, tend to be more collectivist in nature – meaning that the interests of maintaining the structure of society are more important than any one individual’s desires. Activities perceived to “divide” or “disrupt” institutions, such as questioning the prescriptions of leaders, are discouraged.

In short, the West places a higher value on freedom of expression; the East emphasizes social harmony more.
Research has demonstrated some health-related benefits to the collectivist orientation; one study published by Community Mental Health Journal suggests that “collectivistic orientation alleviated depression through reducing acculturative stress.”
However, there are drawbacks to collectivist attitudes. This East-West philosophical divide has major implications for healthcare. Successfully introducing the patient-centered model to Thailand will require modification to the doctor-patient relationship which many may struggle to adjust to. Whereas Westerners question authority figures reflexively, Thais generally do not. Here, the culture has instilled a deep respect for the position of authority that a doctor has earned. Thai patients hesitate to openly disagree with their physician or to assert their rights to make their own decisions; likewise, Thai doctors hesitate to oblige patients who assert their right to self-determination of care.

The Thai medical establishment must make large-scale institutional adjustments, from modifying university curriculum to revamping clinic protocols, to cope with the inevitable rise of patient-centered care.

A Patient-Centered Healthcare System Saves Money

The Journal of Family Practice reports that “Patient-centered practice improved health status and increased the efficiency of care by reducing diagnostic tests and referrals”. The Journal of the American Board of Family Medicine concluded in its study that patient-centered care “decreased utilization of health care services and lower total annual charges.”  Similar findings abound throughout the research field, consistently proving the cost-reduction advantage of a patient-centered model.

Hospitals In Thailand  under the administration of the Thai Ministry of Public Health are facing extreme debt. Dozens face hundreds of million baht shortfalls and struggle to serve the 60-million-plus Thais who seek healthcare in the public system. Inefficiency and redundancy are rampant. Shifting toward patient-centered care is one way to improve performance and save money in the cash-strapped public system.
 

Practical Steps to Implement Patient-Centered Healthcare in Thailand

1.Encourage the Ministry of Public Health Websites , Government and Public Hospitals to Post Detailed Doctor Profiles on Websites

Public facilities in Thailand operated by the government  especially most of the hospitals in thailand, do not have information available on their websites regarding doctors’ specialties and experiences. Many patients seek this information when searching for the right provider. Instead, when this information is not available and the patient cannot specify which physician they would like to see, the administration will simply refer the patient to whatever doctor is available that day regardless of his or her particular skill set or the patient’s preference. This kind of missed opportunity to connect patients to the most qualified available doctor often means a drop in health outcomes and further burdens on an already overtaxed public health system.

2. Allow Pharmaceutical Developers to Advertise in Thai Media

In the United States, advertisers have access to consumers through media advertising to market new pharmaceutical drugs and other medical advancements. This direct connection between manufacturer and patient does not exist in Thailand. When Thai companies are allowed to operate in the same way as advanced Western nations like the US, Thai patients will become better informed of ways to treat their conditions. Currently, Thai law prohibits drug companies from shining light on their products in the form of advertising – in newspapers, television, radio, etc. Opening up these markets will encourage patients to consider treatment options on their own. It will also assist the Pharmacies In Thailand, as most customers will be armed with knowledge of what exactly they are seeking.

3. Encourage Patient-Directed Digital Health Monitoring

Thai providers should encourage patients to utilize smartphone apps, smartwatches, and other technologies that monitor and record data. Devices and software that perform these functions will become more advanced, more accurate, and more affordable in the next decade, making them both useful and universally accessible.The recent Thailand Medical Devices Fair held at Impact last year showed that there were numerous devices already available in the country but not yet encouraged by Doctors In Thailand and also Hospitals In Thailand that could aid in improving Thailand Healthcare structure and also cut costs for Patients in Thailand.

The rapid increase in availability and transmission of information via technology stimulates patients’ active involvement in their own healthcare. Major adjustments in the administration of Thai healthcare, both public and private sector, must be made to accommodate this new reality. When carefully executed, such forward-looking changes will offer enormous systemic benefits to healthcare in Thailand – extensive research has proven that patient-centered models improve health outcomes and reduce cost for providers.