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Tragedy in Phi Phi island |
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Written by Administrator
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Sunday, 24 May 2009 |
.gif) You may have already heard about an American tourist who died of mysterious illness while vacationing in Phi Phi island.
If not, read about it here, here, and here.
My condolences to the St. Onge family.
In my experience, emergency care in Thailand is substandard. Most ER doctors in Bangkok are not even trained in Emergency Medicine, let alone in an island far from a metro area. Graveyard-shift ER docs are usually a resident-in-training moonlighters who want to make some extra money. I wouldn't trust any of them.
A few years ago, someone close to me had a misfortune of visiting an ER department at St.Louis hospital. An accident caused a laceration at the back of his head. He drove himself to the hospital, got a few stitches, and was discharged. Several hours later he lost his conscious, went into coma and passed away peacefully two days later, at the same goddamn hospital.
It turned out that he had a subdural hematoma. He was 70 years old and he was on Heparin. However, the ER doctor never ordered any imaging study when he first went to the ER.
Any competent ER doctor with half a brain would instantly know those three combinations never result in a good outcome. Yet, he was discharged.
I wonder where that ER doctor is practicing today.
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All those cases we evaluate people ,by history ,physical exam and +/- investigation In case of laceration ,we may film X-ray, if we see fracture ,then CT brain is next step , but if not seen any fracture and patient is good consious ,do we have to go on further investigation ???? for what ?? ,...we ADVICE patient to observe their neuro sign , if there's something's wrong ,then we need more investigation ,we can't afford every one who have laceration with CT brain (my hospital is government owner ),we don't order X-ray either if it's not gonna change management (case evaluation first) ,while in severe or borderline case we do full investigation as logic ,I don't think those hospital is wrong at all ,....several time progression of disease uncover itself ......and if you are health care worker , the question will not be asked