The Great Medical Lottery – 20th April, 2014

The Great Medical Lottery


I read this week that a study by University College London has found that half of foreign doctors would not be able to practise in Britain if they were subjected to the same level of scrutiny as British doctors. More than 88,000 foreign-trained doctors are registered to work in Britain, including 22,758 from Europe

The report stated that half of all foreign doctors in Britain do not have the necessary skills to work there but can practise because the competency exam is too easy. The majority of the 88,000 foreign doctors in the health service would fail exams if they were held to the same standard as their British colleagues.

I am sure that doctors from European countries receive their training in their own language – which is how it should be – provided that the text books they are learning from are of a sufficiently high standard. Clearly, in some countries, this is not the case, hence the apparently lower levels of competency achieved in the British exams.

Whether we like it or not, we all live in a world where most scientific and medical text books and research papers are published in the English language, and it strikes me that however hard they try, European doctors will not achieve the required level of competence  if they are studying to be doctors  in their own language, rather than in English, which is the internationally accepted language for all matters medical.

This report, whether or not it is correct, led me to thinking about the doctor situation in Thailand.

In Thailand, a far as I am aware, all doctors learn the nuts and bolts of  their profession in the English language. All their text books and other aids to learning medical matters are in English.

This often brings about the very strange situation where a Thai medical specialist seems to speak very little English – often incomprehensible – yet will write his reports in English and appears to be fully familiar with English medical terms.

The reason for this is because the doctors have indeed learnt from English medical text books and understand all the medical terms in English and can write them  fluently, but their ability to converse in English is often severely limited. It is not their fault – many have never had a chance to practice their English with an English speaker.

Of course, the very top Thai specialists do speak passable – sometimes very good – English, and this is because they have realised that English is an essential skill they must acquire in order to become a good doctor. Without a good command of English they would be unable to properly absorb all the minutiae in English language medical tomes or keep up to date with the latest advances in medicine and to read new medical research papers.

Many Thai doctors are from rich families and will have attained a good level of competence in English at their expensive private schools. Some of the very rich students are educated overseas – often in the UK or USA. Additionally, many of the top specialists have also worked abroad as doctors, and this will have greatly improved their English fluency

If you attend any of the top private hospitals in Bangkok or Pattaya), you will find that most of the doctors there speak good English and are able to discuss your medical problems with you.

The further down the line you go, in terms of the medical establishment’s standing, the lower will be the doctor’s ability to converse with you in English. Sometimes, they will speak with you in English but you have no idea what they are saying as their Thai accents are so strong – they know the words but cannot pronounce them properly – as they  have never practised speaking English with a natural English speaker.

On other occasions I have come across doctors who tell me that they cannot speak English, yet proceed to speak very passable English and when it comes to medical terms and matters, they are quite fluent. This is because although they learnt English to a high standard, they are nervous and lack confidence when speaking with foreigners.

Finding the right doctor anywhere – especially in Thailand – is always a great lottery. In general terms, a Thai doctor who speaks passable English is probably more on top of his medical abilities and knowledge than a doctor whose spoken English is very poor. This is not always the case, but in my experience, it’s a pretty reliable guideline.

A few months ago I went to see a GI specialist in a quite respectable private hospital in Sri Racha. It is a big hospital, has all the latest equipment and is a little cheaper than the top ‘international hospitals’ . It mainly caters to the well- off local Thai population.

The doctor who I saw spoke pretty bad English. She spoke to me in English but I could only understand about 20 % of what she was saying, but whenever she wrote something down, I immediately understood.

She suggested I have a CT scan to try and find out what was causing all my abdominal problems. This was duly carried out the following morning and I went back to see the specialist to get the results.

She told me (and wrote in my medical report), that I had chronic pancreatitis and prescribed some extremely expensive medication. At first, she prescribed the wrong dosage and we subsequently had to consult her drug book together, (in English of course), so that we could establish the correct dosage.

After a couple of months, there was no improvement in my condition, so I was advised to go and see a top GI specialist at Siriraj Hospital – TheKing’s Hospital’ – in Bangkok.

The new specialist spoke very good English and his attitude was very caring and concerned. He looked at my CT scan report from the previous hospital and told me that he  doubted very much from my symptoms and the CT scan that I had chronic pancreatitis.

He asked me to undergo yet another test to make sure his diagnosis was correct and I was booked in the following week to have an ultrasound camera inserted in my stomach to take a close look at my pancreas.

It is now established there is absolutely nothing wrong with my pancreas and as soon as  my medication was changed, I started to feel much better. Now, several months have passed and I feel better than I have in a very long time.


By the way, the Thai surgeon who replaced my aortic heart valve back  in 2012 spoke better English than I do!


What does all this tell me?

It tells me how risky it is to put my trust into a doctor who speaks little English – especially in Thailand , and maybe also in the UK. The mere fact that a doctor’s English is poor suggests that they may not have learnt their medical subjects very well in the first place, and more importantly, that they probably do not bother to keep up to date with the latest medical advances, as their English is simply not up to it.

Of course there are exceptions to this and I have no doubt that there are some excellent Thai doctors who speak poor English, and some fluent speakers of English who are lousy doctors.

But for someone like me – fighting my way through the mysteries of  medical diagnosis and treatment – checking on the  level of a Doctor’s spoken English ain’t a bad guide to go by.

Maybe the same rule might apply in the UK, but unfortunately under the national health system, patients have little opportunity to choose their specialist. There, it really is a great medical lottery.


By the way my GI specialist at Siriraj hospital has published a number of learned medical papers in international medical journals concerning the latest treatments for pancreatitis – and guess what? They are all in English.


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