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Transitions in the Health Care Systems in Times of Uncertainty–
Exploring Views by Experts through Mindfulness and Emotional
Intelligence in Bangkok, Thailand
Bhavna Khemlani*
Bangkok School of Management, Bangkok University, Thailand
*Corresponding author: Bhavna Khemlani, Bangkok School of Management, Bangkok University, Thailand, Tel: + 024073888; E-mail: bhavzparadise@gmail.com
Received date: September 11, 2018; Accepted date: September 18, 2018; Published date: September 25, 2018
Copyright: © 2018 Khemlani B. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
This research focuses on the Transitions in the Health Care Systems in Times of Uncertainty–Exploring views by
Experts through Mindfulness and Emotional Intelligence in Bangkok, Thailand. Gratitude to all the experts who were
part of this research, making the study interesting and sharing real life experiences and views. The awareness of
Emotional Intelligence and changes in the Health industry in Thailand shared by Dr. Davin Narula, Mrs. Rasee
Govindani, Ms. Anette Pollner, and Dr. Anand Sachamuneewongse has given a valuable insight about quality health
services, well-being, experience, and expressing possible changes and integration of services in the health industry.
Aim: The objectives of this research were whether the regular practice of Guided Mindful Meditation/training
could improve patients’ emotional intelligence. To distinguish the effect of pressure from the internal and external
environment of health system in Bangkok. To evaluate the differences of between practitioners, experts, and doctors
on various practices and handling transitions in the Health Care systems in Times of Uncertainty. To bring
awareness on valuable techniques and resources for practitioners, doctors, and patients to creating Balance and
practicing Mindfulness in their daily life. To analyze the shared experience of Mindfulness performed by the four
experts in this research.
Methods: All four experts fulfilled the questions and answered all questionnaires of Philadelphia Mindfulness
Scale (PHLMS), Emotional Intelligence (DERS) questionnaire, and the Global Health PROMIS 10. Dr. Davin, Mrs.
Rasee, Ms. Anette, and Dr. Anand were aware of their emotional intelligence in terms of thoughts, environment,
mood, and there are situations that may bring some difficulties to deal with the internal state, however, they tend to
find a suitable approach to deal with it. Dr. Anand did not usually focus on emotional intelligence and mindfulness
approaches and this research guided him to reflect on several aspects that relate to him and his work in a deeper
perspective. Face to face audio interview was conducted the insightful sharing on various aspects of uncertainty,
transitions, mindfulness, and emotional intelligence was expressed.
Results: The challenges in the health industry with having less doctors and advance equipment in the public
sector was acknowledged by Dr. Anand and Ms. Anette. Dr. Davin on NLP and how neuro programming and
mindfulness programmes can be utilized in medical training, educating patients through awareness, and in daily
practice of one’s life. Mrs. Rasee and Ms. Anette stressed on integration of alternative/complementary healing/
therapies with hospitals and having counselors on call to provide emotional; and moral support to patients and
people working in the hospitals in both provide and public hospitals.
Conclusion: There is a need to bring awareness in acknowledging emotional intelligence, mindfulness, and
integration of balance through neuro programming that can enhance people from all walks related to the health
industry. Emotional intelligence should be taught at schools for children to acknowledge how the feel and speak
about it. Further research encourages to be explored in rural areas and other clinics and hospitals on emotional
intelligence and mindfulness training. Future studies can apply mindfulness training approaches on doctors and staff
at the hospitals to test the efficacy of before and after practicing the mindfulness programmer. It will be efficient to
check the brain waves of before and after the practice of mindfulness training to check progress.
Keywords: Transitions; Health care systems; Uncertainty;
Mindfulness; Balance; Emotional intelligence; Bangkok; ailand
Introduction
Health care systems have an immense and valued responsibility to
bring awareness and make available right medical care for the entire
nation. Over the years, with the advancement of technology and the
marketing of medical tourism various types of health care facilities and
services have been advertised. Nevertheless, during the times of
transitions there is growing awareness of disadvantages and issues
faced during the times of uncertainty.
Government health care and any other product or service managed
by government is the foundation of any nation. e core values of
products and services reveal, restore, revive, and help progress a
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ISSN: 2380-5439
Journal of Health Education Research
& Development
Khemlani, J Health Educ Res Dev 2018, 6:3
DOI: 10.4172/2380-5439.1000275
Research Article Open Access
J Health Educ Res Dev, an open access journal
ISSN: 2380-5439
Volume 6 • Issue 3 • 1000275
nation’s economy, well-being, investment, and generations of
populations within a nation.
With reference to today online news, ailand is facing various
challenges in the health care system. As stated in May 2017, “the
Federation of Physicians and Nurses released a table showing 18 state
hospitals were suering decits. For instance, Pranangklao Hospital
had a decit of 355 million baht, Saraburi Hospital was 322 million
baht in the red, and Uttaradit Hospital suered a decit to the tune of
277 million baht. e hospital decit is just the tip of the iceberg. ere
have been concerns in the healthcare system that need to be urgently
reformed,” said the president of the Federation of Physicians and
Nurses of regional and general hospitals, Pradit Chaiyabud,” [1].
State hospitals get income from three sources: e state Budget;
operators of three healthcare schemes, namely the universal healthcare
scheme, civil servants healthcare scheme and social security scheme;
and money earned by hospital operators themselves, such as
donations. Contributions from the Universal Coverage (UC) scheme
account for the largest portion of state hospitals’ income. Hospitals
normally receive an annual Budget of about 80 million baht,
depending on the size and population of the district. e NHSO also
dispenses money according to the number of patients suering specic
illnesses, such as kidney failure or heart disease [1].
e challenge for the NHSO is how to manage the budget eciently
with limited funds and an ageing society. Moreover, civil society
groups have urged the government to invest more in healthcare
because it is a matter of long-term human security. According to Mr
Viroj Na Ranong who is a research director for the health economics
and agriculture sector at the ailand Development Research Institute,
his study reveals that the health expenditure of low-income countries is
approximately 4 per cent of GDP compared to 8 to 13 per cent for
high-income countries. Health expenditure in the US is 15-17 per cent.
e civil service healthcare scheme is more expensive, because its
nances are based on open-end funding, meaning beneciaries can get
expensive drugs and treatment [1].
On the other hand, with reference to the cover story about Health
care on life support published by Bangkok Post in November 2017 by
Paritta Wangkiat, ailand’s healthcare scheme is most critical since
2002. For more than ten years the system has been praised globally in
providing healthcare access to over 48 million and lling the gap le by
the government. Going back to the 1980s, there was an ambition to
establish health care for all aer witnessing the experiences of patients
who could not aord medical treatment. e capitation method also
allows government to fund universal coverage within its capacity limit.
Furthermore, in relation to a research under the American
Psychosomatic Society on behavioral medicine conducted on
examining the Changes in Brain and Immune Purpose produced by
Mindfulness Meditation by Davidson, Richard J. PhD; Kabat-Zinn, Jon
PhD; Schumacher, Jessica MS; Rosenkranz, Melissa BA; Muller, Daniel
MD, PhD; Santorelli, Saki F. EdD; Urbanowski, Ferris MA; Harrington,
Anne PhD; Bonus, Katherine MA; Sheridan, John F. PhD, 2003
revealed that the short program in mindfulness meditation does
produce positive and demonstrates eects on brain and immune
function. Moreover, various studies shows stress-related health
complications are accountable for up to 80% of appointments to the
doctor and account for the third highest health care expenditures,
behind only heart disease and cancer. But few doctors essentially share
to patients about how to decrease stress. Mind-body practices like yoga
and meditation have been shown to reduce your body’s stress response
by reinforcing one’s relaxation reaction and lowering stress hormones
like cortisol. Additionally, Harvard Health publications disclose the
numerous dierent mind-body methods, comprising meditation, yoga,
mindfulness, cognitive behavioral skills, and positive psychology result
in relaxation and reduction of medical services. With this the
understanding of Emotional Intelligence and Mindfulness
practitioners in the health industry can improve their health as well as
their clients/patients.
is research study emphasizes and explores the demographics
changes, healthcare transitions, alternative healing approaches,
challenges faced during the time of uncertainty, assess experiences of
experts in the Health Care system in Bangkok, ailand. is study
will enable respond to needs on the increasing of specic issues and
pressure within the internal and external environment of health system
in Bangkok, ailand. Additionally, to understand more about how
practitioners working in the Health Care industry are aware of their
own emotional state before treating or providing any kind of service to
their clients/patients.
Mindful training has been adopted in some primary schools and
local universities in ailand; however, the need for Mindful training is
becoming a growing necessity which more schools, universities (local
and international, private or public) should utilize this to bring
awareness so students of all ages can nd a balance from within and
external factors.
Mindful training and bringing awareness in the Health Care
Systems is very much needed to assess and making sure that service
provided is being delivered from the expert is emotionally and
mentally satised. Moreover, emotional intelligence is one of the ve
pillars, as stated by Daniel Goleman published “Emotional intelligence:
why it can matter more than IQ.” e growing consciousness of mental
health and an apprehension with emotional intelligence are attaining
signicance as fundamental concerns for the twenty-rst century.
Educators, therapists, and parents have become more worried about
how to enhance their children’s emotional intelligence and there is
more to that. Teenagers and young adults need it as this eects their
productivity, increases stress, and may increase emotional, physical,
and mental issues which may lead to serious illnesses.
As a result, the present study is conducted using a qualitative and
quantitative research method. Diculties in Emotion Regulation Scale
(DERS) Serenity Programmed consisting 36 statements on various
aspects of emotions and how one feels and what one does about it
using the calculation in percentage-Higher scores suggest greater
problems with emotion regulation will be assesses as the experts being
interviewed will ll in the questionnaires. e Philadelphia
Mindfulness Scale (PHLMS) and the Global Health PROMIS 10
questionnaire are also being completed to bring awareness about the
experts. e present study is designed to assess and analyze the
transitions in the health cares in times of uncertainty in Bangkok,
ailand.
Research objectives
e researcher is interested in the way body and mind is being taken
of, and how experts in the elds of Health care mange the transitions
during the times of uncertainty.
For this research the research objectives formulated are:
Citation: Khemlani B (2018) Transitions in the Health Care Systems in Times of Uncertainty–Exploring Views by Experts through Mindfulness
and Emotional Intelligence in Bangkok, Thailand. J Health Educ Res Dev 6: 275. doi:10.4172/2380-5439.1000275
Page 2 of 18
J Health Educ Res Dev, an open access journal
ISSN: 2380-5439
Volume 6 • Issue 3 • 1000275
• To determine whether the regular practice of Guided Mindful
Meditation/training could improve patients’ emotional
intelligence.
• To distinguish the eect of pressure from the internal and external
environment of health system in Bangkok.
• To evaluate the dierences of between practitioners, experts, and
doctors on various practices and handling transitions in the Health
Care systems in Times of Uncertainty.
• To bring awareness on valuable techniques and resources for
practitioners, doctors, and patients to creating Balance and
practicing Mindfulness in their daily life.
• To analyze the shared experience of Mindfulness performed by the
four experts in this research.
Rationale of study
e researcher is aware of numerous cases that come her way and
the need to start to understand how to deal and mindfulness training is
essential for everyone in all working industries. With experience of
being an Educator, Author, Academic and Creative Writing Coach,
Reiki Energetic Master Teacher, and practicing Raja Yoga Meditation
for many years conducting a research to facilitate options and
resources is signicant for providing the right Social and Emotional
Learning (SEL) as a process that clearly develops life skills. It is an
integrated approach that can support many people in self-awareness
and management on handling emotions and behavior skillfully. Where
service is being provided to clients and patients the balance of the
service provider is as important.
Limitations of the study
e results also depend on how the participants of this study
understand the factors and deal with factors that bring awareness to
his/her life and bring a change in his/her life. Some limitations of this
study are:
•e research is limited to Bangkok geographically.
•ere was a challenge on how much and whether the experts
would be able to share as many aspects on transitions in the health
care systems and provide suggestions in times of uncertainty from
their perspectives. ere is privacy and the researcher cannot
monitor the experts but trust in what they share with due respect
of their years of experience and work with reputable health
corporations.
•e participants perform their duties and follow the protocols of
the place they work in. With due respect and privacy of the place
suggestions oered were based on their experience and
observation over the years, hence, they faced boundaries of what
can be done and what cannot be done.
Health care system and challenges in ailand
ailand’s health insurance system is a restructure that has been
utilized over thirty years. e Medical Welfare Scheme (MWS), was
established in 1975, to oer health care to the underprivileged.
However, over the years e ai health system has endured an
incredible transformation. Additionally, objectives of ailand’s health
restructuring include achieving widespread health insurance treatment
with adequate level of assistances, limiting the growth of health
spending, stimulating ecient health care delivery, distributing more
health resources to the underprivileged and to rural areas, and
sustaining the health system’s ability to supply services. e nancial
sustainability of ailand’s health system is aected by aspects that are
mutual across countries. Use of health services is anticipated to
increase, determined by an aging population, rising national income,
and the progress of medical technology. Income to pay for that rising
trend in demand is less certain, aected by changes in the work force
over a period of time and challenging demands for revenue in the
government’s budgeting process [2].
Alternatively, e Kingdom of ailand has its own structure of
traditional medicine called “ai Traditional Medicine” (TTM). It
initiated during the Sukhothai period (1238-1377) and advanced in
equivalent with the country as a means of national health care until the
early 20th century. e “Practice of the Arts of Healing Act B.E. 2542”
outlines ai traditional medicine as “the practice of the art of healing
that is based on ai traditional knowledge or textbooks that have
been passed on and developed from generation to generation, or based
on the education from academic institutes that the Professional
Committee approved,” [3]. As quoted, the reasons of illness According
to TTM, human illness can be triggered by the following factors: 1.
Mystical power, e.g., ancestor’s soul, prevailing spirit of the forest, evil
spirits, and penance from a heavenly spirit of those who disobey. 2.
Power of Nature, e.g., inequality in the four fundamentals of the body,
inequity of heat and cold, and inequity of the body’s balance. 3. Power
of the universe, e.g., optimistic and pessimistic impacts from the sun,
the moon and the stars on human health. 4. Kimijati, which may be
reected as bacteria in modern medicine. Furthermore, the impact of
Western medicine, which was presented into ailand by missionaries
and Western physicians starting during the reign of King Rama III,
that eventually increased. In 1888, Siriraj Hospital, the primary
Western-style hospital and medical school, was legitimately opened.
Primarily, both TTM and contemporary medical services were
delivered and the medical school that trained both disciplines of
medicine was established in 1889 [4]. In addition, the hospital also
originated a health tourism programme for tourists to join several
health promotion programmes, i.e., health food, exercise, ai
massage, herbal steam baths, meditation, yoga training, learning about
holistic medicine and TTM, and to visit numerous tourist attractions
in Prachinburi Province [5].
ailand’s health care system needs improvements. ere are
several areas that could be enhanced as there are problems with the
system in the urban areas, but they are even worse in the rural areas.
e rural areas have problems with the amount of time the doctors are
there, and also the means of transportation to the clinics. e
accessibility of doctors can be a lack of service and the choice of
doctors wanting to be there in relation to the package they are oered
could possibly inuence their interest to work at rural areas.
In turn, doctors work long hours and if something occurred aer an
appointment, it would be a hassle to contact a specialist. is is
because they could be in a dierent hospital or rural location with
other patients. Another concern is that ailand does not have
operative emergency transportation system. e deciency of number
of ambulances, emergency situations can oen lead to serious
problems due to heavy trac. In November 2006, a reform was made
and the health programmer was called the Universal Coverage Scheme.
e Universal Coverage Scheme provides entirely free health care (at
liberty) to any ai citizen who does not have the Civil Servant
Medical Benet or the Compulsory Social Security Schemes [6].
As follows, the ais need an improved emergency transportation
system in the urban areas. Also, a special lane for emergency vehicles is
Citation: Khemlani B (2018) Transitions in the Health Care Systems in Times of Uncertainty–Exploring Views by Experts through Mindfulness
and Emotional Intelligence in Bangkok, Thailand. J Health Educ Res Dev 6: 275. doi:10.4172/2380-5439.1000275
Page 3 of 18
J Health Educ Res Dev, an open access journal
ISSN: 2380-5439
Volume 6 • Issue 3 • 1000275
required. To x the problem with patients not being able to meet their
doctors aer their appointments and the doctors could improve their
approaches in communication. ey could get more improved network
service, or have specialty doctors available when called. is would
increase the availability of the doctors and improve the process of
medication, curing, and also attend to mindful needs in various
locations in ailand (Figure 1). However, in its extensive networks of
Provinces there are hospitals and health structures of a relatively good
standard within some 700 districts that have responded well in
reducing the prevalence of communicable diseases [7].
Figure 1: ai District Health System.
According to Chularat Sae [8], publication in e Nation newspaper
Nurses and doctors at public hospitals are seemingly under stress
demanding to cope with time so all the patients can see a doctor. e
inadequate circulation of doctors at state related to private hospitals is
serious. Long queues are normal at state hospitals. e more famous
the hospital, the longer the queue. Patients with enough money can
skip these long queues by pursuing medical services from private
hospitals.
us, to address this visible problem, it’s signicant to develop the
right standards and requirements for the hospital doctors, nurses, sta,
and patients. It is quite obvious the ignorance of Emotional Intelligence
is not being taken care of and if the doctors, nurses and/or
practitioners are stressful, how will the right needs of the patients and
clients be met.
Demographic structures for health care in ailand
With reference to the World Health Organization Southeast Asia [9],
the life expectancy at birth and health life expectancy of ailand has
improved over the years as shown in Figure 2.
Moreover, ailand faces challenges to further improve its
education and health-care systems to various demographics with
characteristics of environmental destruction from its speedy growth.
e country has made remarkable development in providing education
and health care to most of the population. Nevertheless, substantial
inconsistencies continue, principally for poorer households and
between rural and urban areas that require to be addressed. Education
quality must be improved, principally highly procient teachers, and
increasing health-care costs should be controlled through reforms to
improve eciency in the delivery of services [10]. ailand also needs
to address environmental damage from past growth and achieve
greener growth in the future by reducing carbon emissions and other
forms of pollution to the changing needs of demographics and the
learning of new health practitioners.
Also, there are health inequality problems concerning care for the
dependent elderly who require constant care because of their fragile
health status. Strengthening and necessary development of current
reforms are needed to gain greater access to health-care services in an
aordable manner. e government should attempt to improve
awareness among the public, especially the poor and underprivileged,
about the existence of the health insurance system and its services. is
is important for the elder demographics to gain awareness about the
transitions in the health system of ailand. In contrast, the record-
keeping system for foreign workers needs to be enhanced so that they
can get admittance to health services at a reasonable fee [11].
e changes in the health policies have benetted many and also
aected many in the negative way. With the growing population in
ailand and the modern inuence of social media, lifestyle, not
appropriate consumption of healthy resources, sicknesses, illnesses,
and manipulation of peers and/or society can also lead to inadequacy
of understand the changes in the health system which some people
may think its political and ignore the reforms and don’t update
themselves. e transitions in the policy and during the time in
uncertainties have favored private hospitals, drug companies and
medical tourism. is can be a leading threat to universal healthcare.
A population pyramid of ailand in 2016 published by Central
Intelligence Agency, represented the age and sex structure of a
country's population and shows the male and female populations
broken down into 5-year age groups represented as horizontal bars
along the vertical axis, with the youngest age groups at the bottom and
the oldest at the top. e form of the population pyramid progresses
over time related to fertility, mortality, and international migration
developments. e Age structure is 0-14 years: 17.18% (male
6,000,434/female 5,714,464), 15-24 years: 14.47% (male 5,030,930/
female 4,839,931), 25-54 years: 46.5% (male 15,678,250/female
16,038,155), 55-64 years: 11.64% (male 3,728,028/female 4,208,624), 65
years and over: 10.21% (male 3,047,938/female 3,914,070) [12].
Figure 2: Life Expectancy in ailand 2000-2015.
It is understood that the age construction of a population inuences
a nation's signicant socioeconomic problems. ailand’s rise with
young populations require to invest more in schools, while the older
populations are required to invest more in the health sector. is can
support in determining aordable and suitable packages from public
and private hospitals. However, the concern here is to also understand
the practitioners, the pressure, and long working hours which need to
be taken care of.
Citation: Khemlani B (2018) Transitions in the Health Care Systems in Times of Uncertainty–Exploring Views by Experts through Mindfulness
and Emotional Intelligence in Bangkok, Thailand. J Health Educ Res Dev 6: 275. doi:10.4172/2380-5439.1000275
Page 4 of 18
J Health Educ Res Dev, an open access journal
ISSN: 2380-5439
Volume 6 • Issue 3 • 1000275
Mindful training and alternative healing approaches
In various literature and researches, ndings have revealed a
positive relationship between mindfulness and Emotional Intelligence
[13,14]. Since the objective of Mindful Meditation is to improve the
level of mindfulness, it can enhance with the progress of EQ. Practicing
MM regularly can enrich the aptitude to understand one’s own
emotions [15]. Meditation training entails practitioners to carefully
witness their thoughts and feelings moment-to-moment without any
judgment or intrusion, practitioners tend to improve a higher
inclination to be aware of their emotional state and change than those
who do not. is contribution is supported by a study conducted by
Feldman et al. [16], which found that the level of mindfulness was
connected positively with more transparency of feelings, attention to
feelings, and lower disruption.
Furthermore, Feldman et al. [16] found that people with a higher
level of mindfulness inclined to recover fast from emotional distress
associated with those with a lower level of mindfulness. Moreover,
research found that practicing MM could enhance one’s meta-
cognitive ability [17], which reected a higher-level cognitive
capability that allows people to observe and control their thought
process [18]. In the same manner, Gundlach et al. [19] suggested,
“without consciousness or inclination to decipher and understand how
one produces beliefs about his/her own work capability, it will be
difficult to clarify, comprehend, or progress existing self-efficacy
levels.”
Moreover, people who frequently practice Mindful Meditation can
easily cultivate the ability to perceive and comprehend the emotions of
others. Especially, being mindful permits an individual to focus their
attention on how other people around them are feeling [15], which
consequently helps them interpret emotional signs of others more
precisely [20]. us, practicing Mindful Meditation can essentially
improve the ability of individuals to regulate and control their
emotions [21].
Additional prospects of non-pharmacological interferences are
based on several meditation methods. e inuence of meditation on
health has been a keen scientic interest. e consequence of these
practices has been studied from diverse views (depression, anxiety
disorders, eating disorders, addictions, and disorders caused by the use
of psychoactive drugs) [22-25]. e inuence of meditation on stress
reduction, the prevention of psychosomatic disorders, blood pressure,
and other cardiovascular diseases is a substance of numerous studies
[26,27]. Meditation can benet chronic pain and musculoskeletal
disorders, respiratory diseases, and dermatological problems. It may be
helpful as a support of the immune system or as a symptomatic
treatment of cancer [22].
Mindfulness practice comprises several meditational approaches,
for instance undertakings concentrating on breath and physical
awareness or applying metaphors enlightening the principle of
mindfulness. All these methods have a mutual goal that is intensifying
a subject’s mindfulness. Such as, the capability to concentrate on the
present moment and to observe without any judgment from internal or
external compulsions, which are emerging at a given moment of
consciousness. Mindfulness consequently consents one to stay “above”
the specic content of views, emotions, or imaginations and empowers
one to become aware of the process of consciousness itself [28]. ere
are numerous psychotherapeutic schools and methods, which use the
techniques, based on the concept of mindfulness, for instance, Gestalt
therapy or Morit’s therapy. ere are numerous new expanses
combining a mindfulness method with cognitively behavioral therapy,
like mindfulness-based cognitive therapy, dialectical behavior therapy,
and acceptance and commitment therapy [29].
An evaluation by Chiesa et al. [30] suggested a substantial progress
of selective and executive consideration in early stages of meditation,
which targets at cultivating focused attention. Non-focused, long-term
attention can be enhanced through following phases of meditation,
which are considered by non-judgmental observation of external and
internal stimuli. Moreover, this method can improve the capability of
working memory and many executive functions.
In contrast, Complementary and Alternative Medicine (CAM) or
alternative healing approaches from Reiki Energetic Healing,
Acupuncture, various Meditation approaches, Aromatherapy,
Ayurveda remedies, Nature therapy, Ozone therapy, detox, chelation
therapy, cupping, naturopathy and much more. CAM practices are
reected as a portion of traditional medical practices which connect to
historical roots in the progressing world. ey have continued in the
West though they have been viewed as traditional medicine, the keen
interest in recent years, as options to the Western model of medicine
[31]. Moreover, the increase with various researches and collective
support to alternative healing methods is increasing globally. With this
awareness, it’s important to sustain the healthier approaches than to
increase consumption of medicines with high risk of side eects.
Emotional intelligence and Diculties in Emotion
Regulation Scale (DERS)–serenity programmer
In 2006, a research conducted on Chulalongkorn medical students’
in enhancing emotional skills of medical students was a valuable
insight to understanding emotional intelligence for doctors. e results
showed that having hobbies, participating in supplementary activities
and genuine need to be doctor associated with high emotional
intelligent scores may be helpful for evaluation and development of
emotional intelligence in medical students. e human brain
encompasses two minds and two dierent kinds of intelligence:
rational and emotional. ese two profoundly diverse modes of
consciousness interrelate to establish our mental life. e emotional
and rational minds are semi-independent faculties [32]. ey operate
in tandem most of the time: emotion contributes to, and informs the
operations of the rational mind, which renes and sometimes vetoes
the inputs of these two partners interact well. erefore, both E.Q and
I.Q abilities enhance each other. Reecting the ai culture, there is a
high social expectation of a “Doctor”. ere is not only a requirement
of a knowledgeable doctor but also a need of a doctor who is
empathetic, has devotion toward patients, high morality, and high
degree of tolerance, good communication skills, and good self-control.
Understanding the emotional intelligence of a doctor during the
practice of being a medical student may be essential for developing
emotional and intellectual growth so the future doctors can assess
emotional quotient during the practice and study as Chulalongkorn
medical students.
e questionnaire used in the study was established by a team of
ai psychiatrists and psychologists based on ai culture that
emphasized goodness, mindfulness, peace, happiness as well as
competency. People who recognized their feelings and aims in life
would set a direction to progress and handled their emotions properly
[33].
On the other hand, Gundlach et al. [19] debated that emotional
awareness and emotional regulation are reected as prime aspects that
Citation: Khemlani B (2018) Transitions in the Health Care Systems in Times of Uncertainty–Exploring Views by Experts through Mindfulness
and Emotional Intelligence in Bangkok, Thailand. J Health Educ Res Dev 6: 275. doi:10.4172/2380-5439.1000275
Page 5 of 18
J Health Educ Res Dev, an open access journal
ISSN: 2380-5439
Volume 6 • Issue 3 • 1000275
enable the perception of self efficacy because they help people from
being interfered by their negative emotion when creating natural
acknowledgement between their abilities and consequences.
Nonetheless, Tsai et al. [34] reasoned that a positive mood not only
enables people to reminisce an exceptional performance that they had
experience in the past, however it also enriches their positive feelings
about their past experiences, thus permitting them to increase
expectation about their aptitude. Additionally, their study conducted
on employees and supervisors from insurance companies in Taiwan
resulted to a strong positive relationship between positive mood and
task-specific self-efficacy measure [34].
Mayor et al. [35] suggested that EQ entails of four functions. First,
appraisal and expression of emotion in the person referring to the
capability to understanding one’s own deep emotions and be able to
voice out naturally. Second, appraisal and expression of emotion in
others refers to the capability to perceive and understand the emotions
of other people [36]. ird, observing of emotion in the self-denotes to
the ability to regulate one’s own emotion, which is signicant for the
person to recuperate when experiencing a negative emotion. Fourth,
using emotion to implement in decision making shows the ability to
direct one’s own emotions to help improve performance.
In ailand, Department of Mental Health (MOH) has categorized
the Emotional Intelligence (EI) into three classications. Firstly,
“Intelligence” signies one’s awareness, motivation, and capability to
handle problems. Secondly, “Goodness” directs the ability of
controlling oneself such as emotions and desires. Lastly, “Happiness”
infers the ability of living happily, being proud of oneself [37].
In contrast, a survey conducted by e Shepellfgi Research Group
[38], over 40% of call center agents associate with angry clients daily.
ey are frequent situations of victims of verbal aggression from clients
or reect themselves in a state of emotional dissonance, for instance,
they have to sustain a professional, cooperative and considerate
attitude while feeling angry, sad or diminished. Such emotional sta
may illuminate why there are considerably more emotional problems,
such as anxiety and depression, in call centers than in other workplaces
(19% vs 15%; e Shepell•fgi Research Group). ese results showed
that there is a requirement for interferences that could assist and
encourage services for mental health emotion regulation strategies
among call center employees.
As for this research Emotion regulation was assessed with six
subscales of the Diculties in Emotion Regulation Scale [39,40], no
acceptance of emotional responses (6 items), diculties engaging in
goal-directed (5 items), impulse control diculties (6 items), lack of
emotional awareness subscale (6 items), limited access to emotion
regulation strategies (8 items), and lack of emotional clarity (5 items).
e DERS was created to evaluate diculties in emotion regulation.
e inadequacy of emotional awareness subscale reveals an inattention
to, and lack of awareness of, emotional responses (e.g., “When I’m
upset, I take time to gure out what I’m really feeling”, reverse scored),
while the impulse control diculties reects diculties remaining in
control of one’s behavior when experiencing negative emotions (e.g.,
“When I’m upset, I have diculty controlling my behaviors”). Higher
scores for each subscale indicate greater diculties in emotion
regulation (i.e., more emotion dysregulation). With the brief
explanation stated, this makes it clear and an opportunity for the
experts’ part of this research to monitor and reect the emotional
regulation.
Mindfulness scale (PHLMS) and global health PROMIS 10
is researched used the e Philadelphia Mindfulness Scale
(PHLMS) [41]which is 20-item, bi-dimensional measure assessing
distinct components of present-centered awareness and acceptance
that is based on both clinical and non-clinical samples without any
meditation experience. Awareness items evaluate observing of internal
and external experiences. Acceptance items evaluates non-judging and
openness to experience and refraining from attempts to escape or
avoid them. e assessment of present-moment awareness and
acceptance which is valuable to practitioners working in the health
industry. Clients and patients are regularly visiting and each one of
them has dierent diagnosis and/or visit for a specic purpose. With
this, the research can gain an insight on the present-moment
awareness and acceptance of themselves and the situation they are
dealing with at that point. For example, ‘I am aware of what thoughts
are passing through my mind. When someone asks how I’m feeling, I
can identify my emotions easily. I tell myself that I shouldn’t have
certain thought’ are some statements asked where the experts can
reect and reconnect with their state of mind and emotions on how
they deal with a stressful environment being mindful and/or nd it a
challenge to do so.
On the other hand, Global Health-PROMIS Global Health (10
items) was used to know about the expert’s health condition. is can
support the research on emotional regulation, stress and mindfulness
working in the hospital and/or clinic. is also enables understanding
that during the times of uncertainty how one manages with being
aware of self-health and well-being. Questions were asked under
subscales of physical and mental health. For instance, “would you say
your health is, quality of life, physical health, how would you rate your
mental health, including your mood and your ability to think?” are
some of the questions from the ten items. Hence, the use of these
questionnaires is essential for this research study to establish a valuable
insight of practitioners.
Neuroimaging studies explore the neural mechanisms essentially in
mindfulness meditation practice with methods such as EEG [42] and
functional MRI [43-46]. Various researches have revealed and show
insight on how neural systems are modiable networks and changes in
the neural structure can occur in adults as a result of training. Since the
early 1980s, mindfulness meditation has escalated and gained
profound awareness in mainstream health care and medicine because
of evidence that it's good for emotional and physical health. For
instance, facilitating to decrease anxiety, stress, depression, chronic
pain, psoriasis, headache, high blood pressure, and high cholesterol.
Several research ndings suggest that it can improve immune function.
Methods
is is a qualitative research method research where four experts
from the Health industry will participate in bringing awareness and
valuable information.
e researcher conducted a mix of a quantitative (brief) and
qualitative research (more focus) where an in-depth-interview face to
face, open ended questionnaire about the Health Industry, Challenges,
Health Care Financing, Health Care Management through email and
Emotional Intelligence (DERS) questionnaire with four participants
where answered.
e rst participant was Dr. Davin Narula who is the Hospital
Director of Sukumvit Hospital, Bangkok, ailand who will be sharing
Citation: Khemlani B (2018) Transitions in the Health Care Systems in Times of Uncertainty–Exploring Views by Experts through Mindfulness
and Emotional Intelligence in Bangkok, Thailand. J Health Educ Res Dev 6: 275. doi:10.4172/2380-5439.1000275
Page 6 of 18
J Health Educ Res Dev, an open access journal
ISSN: 2380-5439
Volume 6 • Issue 3 • 1000275
about Mindfulness, Emotional Intelligence and the changes in the
Health Care system and emergency treatment in Bangkok over the
years. Dr. Davin completed the Quantitative and Qualitative Research
requirements where an in-depth-interview face to face, open ended
questionnaire, e Philadelphia Mindfulness Scale (PHLMS),
Emotional Intelligence (DERS) questionnaire, and the Global Health
PROMIS 10 questionnaire about the Health Industry, Challenges,
Health Care Financing, Health Care Management was answered. e
second participant was Mrs. Rasee Govindani, who is a certied birth
doula with DONA International and a postpartum doula and
childbirth educator in process of being certied by Childbirth
International. She is also a Gottman Institute Bringing Baby Home
Educator who has taught the English childbirth education classes at
Bumrungrad International Hospital from 2011 until 2016. She has
attended over 100 births in Bangkok hospitals. She is also a breast
cancer survivor who was treated at Bumrungrad International and
currently being followed at Chulalongkorn Hospital. Along with a
fellow breast cancer ghter she started Beyond Boobs, a source for
information and support for breast cancer ghters and survivors in
Bangkok (Facebook link to Beyond Boobs: www.facebook.com/
beyondboobsbangkok). Mrs. Rasee completed the Quantitative and
Qualitative Research requirements where an in-depth-interview face to
face, open ended questionnaire, e Philadelphia Mindfulness Scale
(PHLMS), Emotional Intelligence (DERS) questionnaire, and the
Global Health PROMIS 10 questionnaire about the Health Industry,
Challenges, Health Care Financing, Health Care Management was
answered.
e third participant was Ms. Anette Pollner a senior Counselor at
NCS Counseling Center, Bangkok who also completed the
Quantitative and Qualitative Research requirements where an in-
depth-interview face to face, open ended questionnaire, e
Philadelphia Mindfulness Scale (PHLMS), Emotional Intelligence
(DERS) questionnaire, and the Global Health PROMIS 10
questionnaire about the Health Industry, Challenges, Health Care
Financing, Health Care Management was answered. e fourth
participant was Dr. Anand Sachamuneewongse, Orthopedic Surgeon
at Samrong General Hospital, Bangkok, ailand who will be sharing
about Mindfulness, Emotional Intelligence and the changes in the
Health Care system and emergency treatment in Bangkok over the
years. Dr. Anand completed the Quantitative and Qualitative Research
requirements where an in-depth-interview face to face, open ended
questionnaire, e Philadelphia Mindfulness Scale (PHLMS),
Emotional Intelligence (DERS) questionnaire, and the Global Health
PROMIS 10 questionnaire about the Health Industry, Challenges,
Health Care Financing, Health Care Management was answered.
e four expert participants from dierent areas of the Health
industry provided an insight to the principal objective of the research
topic and assess experiences in the transitions of the health systems,
where knowing more about the organizational structure and
responsibilities to cope with the existing system in the health industry.
Mindfulness draws upon the recent convergence of modern science
and it is the cultivation of both attention skills and emotional balance.
erefore, the questionnaire on Diculties in Emotion Regulation
Scale (DERS) Serenity Programmed consisting 36 statements on
various aspects of emotions and how one feels and what one does
about it using the calculation in percentage-Higher scores suggest
greater problems with emotion regulation will be assessed as the four
experts being interviewed will ll in the questionnaires.
All questionnaires are in English. e questionnaire given is on the
Diculties in Emotion Regulation Scale (DERS)–Serenity
programmer, e Philadelphia Mindfulness Scale (PHLMS),
Emotional Intelligence (DERS) questionnaire, and the Global Health
PROMIS 10. Questionnaire survey through email was an open ended
questionnaire about the Health Industry, Challenges, Health Care
Financing, and Health Care Management with eight main questions
that would accomplish the objectives. Questions such as, Health
Systems may be perceived as a specic institutional involvement in the
implementation of tasks related to the maintenance and improvement
of a patient’s health. What are your views and opinion on this with the
job you do? What are the challenges you face when it comes to sharing
knowledge and information to the patient? What is it that you can say,
want to say, or don’t want to share/say to the patient when dealing with
their health issues/service given to them? How do you deal and what
are the current pressures within the internal and external environment
of health systems in Bangkok, ailand? What are the changes/
transitions in the health care system and management and how has
that aected you? In times of uncertainty what approaches do you
take? Share about your daily work responsibilities. What are your views
on Alternative healing therapies? Is it important to be Mindful and be
aware of Emotional Intelligence? Please share your views. What would
you like to change about the Bangkok health care system and anything
you feel needs changes in the place you work to have better approaches
to enhance healthcare management and communication? Is there or
has been a health problem you dealt or is dealing with? How did or are
you coping with it? Do you apply the similar approaches with your
patients?
Face to Face audio recorded interview consisted of four main
questions: Has this research been benecial for you? Give your views
on answering the questionnaire on Diculties in Emotion Regulation
Scale (DERS)-Serenity programmer, Global Health and the
Philadelphia Mindfulness Scale (PHLMS); Are you able to understand
more about Emotional Intelligence and Mindfulness? Share your
experience; Have you meditated or taken and alternative healing
before? How did you feel and what you recommend to people
concerned about health or dealing with health problems? What are
your views on reforming, and/or developing a new horizon to
Bangkok’s Health care system and management?
e research method was a mix of qualitative and quantitative
approach. Descriptive tables, analysis showing the four dierent
Emotional Intelligence Regulation Scale and Mindfulness scores by the
four experts were applied.
Formulated hypotheses
•ere is an impact of Diculties in Emotion Regulation Scale
(DERS) – Serenity programmer on performing hospital/clinic
duties.
•ere is an inuence of being Mindful when performing hospital/
clinic duties.
• Not being aware of emotional, mental, and physical stress can
aect productivity and service provider.
• Doctors and professionals working in the clinic/hospitals are aware
about Emotional Intelligence and Transitions in the Health Care
Systems in ailand.
•ere is awareness in emotional regulation pattern.
Citation: Khemlani B (2018) Transitions in the Health Care Systems in Times of Uncertainty–Exploring Views by Experts through Mindfulness
and Emotional Intelligence in Bangkok, Thailand. J Health Educ Res Dev 6: 275. doi:10.4172/2380-5439.1000275
Page 7 of 18
J Health Educ Res Dev, an open access journal
ISSN: 2380-5439
Volume 6 • Issue 3 • 1000275
Results
For Quantitative requirements diculties in Emotion Regulation
Scale (DERS) – Serenity programmer, Global Health and the
Philadelphia Mindfulness Scale (PHLMS) were answered by the four
experts.
Table 1 shows the dierences in scores and how each expert
answered the Global Health PROMIS 10, Emotion regulation scale
(DERS), and e Philadelphia mindfulness scale (PHLMS). In relation
to the health scores, the four experts’ scores are quite similar. e
global physical health score of Dr. Davin: 13, Mrs. Rasee: 14, Ms.
Anette: 13, and Dr. Anand: 12 depict that each of them are healthy and
aware of their health status with regular check-up. On the other hand,
with the global mental health score two experts have the same score
(Mrs. Rasee and Ms. Anette 16), Dr. Davin has the highest score (17)
and Dr. Anand with the lowest (13). is depicts that Dr. Davin, Mrs.
Rasee, and Ms. Anette have their scores more towards very good as for
Dr. Anand as good mental health. is show that all the experts’ have
good physical and mental health.
Moreover, regarding emotion regulation each expert have similar
scores in terms of non-acceptance of emotional responses, diculties
engaging in goal directed behavior, impulse control diculties, lack of
emotional awareness, limited access to emotion regulation strategies,
and lack of emotional clarity. From the table it shows that all four
experts do not have a problem and almost never have a problem not
accepting emotional responses and only sometimes based on a
situation may feel so. In terms, of diculties engaging in goal-directed
tasks when upset sometimes have some diculties and about half the
time may have diculty in engaging in goal directed tasks but almost
always can get things done.
Regarding, impulse control diculties, Dr. Davin, Mrs. Rasee, and
Dr. Anand can control their behaviors and seldom become out of
control. However, Ms. Anette sometimes may have diculty
controlling her behavior. is shows that the participants are in
awareness of their emotions and know how to control and when to
voice out. When it comes to lack of emotional awareness all
participants are emotionally aware about their feelings and know how
to acknowledge their emotions. Ms. Anette scores the highest with
being aware of her emotions and pays attention on how she feels and
believes that are feelings are valid and important. Additionally,
regarding too limited access to emotion regulation strategies, all four
participants do not feel they limited access to emotion regulation
strategies. Ms. Rasee may feel it sometimes based on an unexpected
case; however, Ms. Anette, D. Davin, Dr. Anand do not feel
overwhelmed too easily; do not believe that they will end up feeling
very depressed. is shows all four participants can manage their
emotions and do not jump into conclusions about their emotions.
ere will be times when they may take some time to feel better about
a situation, but in most cases they are ne.
In relation to the lack of emotional clarity, three participants (Dr.
Davin, Mrs. Rasee, and Dr. Anand) have emotional clarity almost
always and almost never feel they have no idea about they feel. In
contrast, Ms. Anette may sometimes have diculty in making sense
out of her feelings and sometimes has no idea how she feels about a
situation. is shows that all four experts have clarity almost always
about their emotions.
Conversely, regarding mindfulness scale, in reection to the
awareness score all four experts are aware (mindful) about their
emotions and conscious about their thoughts. Conversely, Dr. Anand’s
score is slightly lesser showing that there might be times he may not be
aware (mindful) about his emotions at all times and about his thoughts
at all times. However, this does not mean that the participants are not
aware of their emotions. In relation to the acceptance score, Dr.
Anand’s has the highest score depicting that he is more acceptable
(mindful) about his emotions, mood, feelings, and aware of how the air
feels against his face. Dr. Davin, Mrs. Rasee, and Ms. Anette have
similar scores depicting they accept and are mindful about their
emotions and thoughts.
Questions Dr. Davin Mrs. Rasee Ms. Anette Dr. Anand
Global Health PROMIS 10 Scale 1-5 for health Scale 1-10 for pain
Global physical health score
Global 03: In general, how would you
rate your physical health?
Raw Score:
13
Raw Score:
14 Raw Score: Raw Score:
Global 06: To what extent are you able
to carry out your everyday physical
activities such as walking, climbing
stairs, carrying groceries, or moving a
chair?
13 12
Global 07: How would you rate your pain
in average? T-score: T-Score: 44.9
Global 08: How would you rate your
fatigue on average? 42.3 T:Score: T-Score:
42.3 39.8
Global mental health score
Global 02: In general, how would you
say your quality of life is: Raw Score: Raw Score:
16 Raw Score: 16 Raw Score:
Global 04: In general, how would you
rate your mental health, including your
mood and your mobility to think?
17 13
Citation: Khemlani B (2018) Transitions in the Health Care Systems in Times of Uncertainty–Exploring Views by Experts through Mindfulness
and Emotional Intelligence in Bangkok, Thailand. J Health Educ Res Dev 6: 275. doi:10.4172/2380-5439.1000275
Page 8 of 18
J Health Educ Res Dev, an open access journal
ISSN: 2380-5439
Volume 6 • Issue 3 • 1000275
Global 05: In general, how would you
rate your satisfaction with your social
activities and relationships?
Global 10: How often have you been
bothered by emotional problems such as
feeling anxious, depressed or irritable?
T-Score: T-Score: T-Score:
56 53.3 53.3 T-Score:
45.8
Questions Dr. Davin Mrs. Rasee Ms. Anette Dr. Anand
Difficulties in Emotion Regulation Scale (DERS)
1.Non-acceptance of emotional responses
(NONACCEPT) SCORE 11 7 6 8
2. Difficulties engaging in goal directed behavior
(GOALS) SCORE 8 13 15 13
3. Impulse control difficulties (IMPULSE) SCORE 9 10 13 9
4. Lack of emotional awareness (AWARE) SCORE 26 27 30 26
5. Limited access to emotion regulation strategies
(STRATEGIES) SCORE 13 18 15 15
6. Lack of emotional clarity (CLARITY) SCORE 12 11 14 11
Mindfulness-Philadelphia Mindfulness Scale (PHLMS)
Awareness Score 42 45 50 39
Acceptance Score 25 25 21 31
Table 1: Scores of Global Health PROMIS 10, Diculties in Emotion regulation scale (DERS), and e Philadelphia mindfulness scale (PHLMS).
In relation to the Qualitative study, open ended questions and a face
to face audio recorded interview were conducted. e rst participant
is Mr. Dr. Davin Narula who is the Hospital Director and Internal
Medicine Specialist of Sukumvit Hospital, Bangkok, who is above 45
years old. His years of expertise and currently in the late 60s of age has
enables him to see changes, potential in the young specialists, and
provide insightful knowledge. He usually sleeps early by 10:00 pm and
he surely likes his job. He usually discusses his daily stress with his
voice and believes in one’s thought process applying the NLP approach
in dealing with stress and emotions. His view on Neuro-linguistic
programming thinking approach enhances and enables a person to
change perception, it’s scientic, logical, guide to communication,
psychotherapy, and behavior through neurological process in a positive
way where one has the ability and will power to change the thought
process which can in turn change the cell system in decoding and
become xated on any thought that can cause stress. He believes and
practices sleeping early and waking up early.
When asked:
Health Systems may be perceived as a specic
institutional involvement in the implementation of tasks related to the
maintenance and improvement of a patient’s health. What are your
views and opinion on this with the job you do?
Dr. Davin’s feedback
was prevention beats treatment; health promotion is the key approach
where education on health and self-care is better than consistent
consumption of medication. However, this may vary depending on any
patient with serious illnesses and chronic diseases. rough education
life will be better physically, mentally, and emotionally. Positive
thinking can help in cell repair and people should become more aware
of this.
When asked:
What are the challenges you face when it comes to
sharing knowledge and information to the patient? What is it that you
can say, want to say, or don’t want to share/say to the patient when
dealing with their health issues/service given to them?
Dr. Davin’s
feedback was he shares with his patient. e only problem he faces is
sometimes it can get time consuming and next patient may get upset.
At times, patients may not appreciate honesty.
When asked:
How do you deal and what are the current pressures
within the internal and external environment of health systems in
Bangkok, ailand?
Dr. Davin’s feedback was to keep updated with
new studies and resources that are created by health experts, Harvard,
and many more. External pressure can be the patient’s stubbornness.
Also, when there is a psychological problem doctors would send
patients to the psychiatrist where in many cases may not be needed.
Hospitals need to have better care on wellness through communication
(counselling, NLP approach development, listening to patients, etc)
and see the severity then it can be guided, and recommended to
another approach.
When asked:
What are the changes/transitions in the health care
system and management and how has that aected you?
Dr. Davin’s
feedback was on emphasizing the transitions in technology where
patients embrace individual treatment with the help of medical
knowledge in the internet. Articial Intelligence is enhancing and has
transformed the medical industry with various types of cures,
Citation: Khemlani B (2018) Transitions in the Health Care Systems in Times of Uncertainty–Exploring Views by Experts through Mindfulness
and Emotional Intelligence in Bangkok, Thailand. J Health Educ Res Dev 6: 275. doi:10.4172/2380-5439.1000275
Page 9 of 18
J Health Educ Res Dev, an open access journal
ISSN: 2380-5439
Volume 6 • Issue 3 • 1000275
surgeries, and science is being researched and taken more seriously in
present times with the help of information technology.
When asked:
In times of uncertainty what approaches do you take?
Share about your daily work responsibilities.
Dr. Davin’s feedback was
he discusses with his family members and people around him. He
never discusses patients’ information as they are always kept
condential.
When asked:
What are your views on Alternative healing therapies?
Is it important to be Mindful and be aware of Emotional Intelligence?
Please share your views.
Dr. Davin’s feedback was his trust in
knowledge, studies, research, and meditation. Emotional stability plays
a role on physical health as well. ere is a diculty in healing the
body if the mind is not ready and not healthy as well. Being mindful is
essential and meditation surely helps.
When asked:
What would you like to change about the Bangkok
health care system and anything you feel needs changes in the place
you work to have better approaches to enhance healthcare
management and communication?
Dr. Davin’s feedback was emphasis
on Time. Having time for patients is eective and providing a
meditation class may restore and help patients. Patients appreciate
time given to them.
When asked:
Is there or has been a health problem you dealt or is
dealing with? How did or are you coping with it?
Do you apply the
similar approaches with your patients? Dr. Davin’s feedback was on
focusing on all aspects from medical, social, and spiritual conducts to
gain the most benet in health.
In relation to the face to face audio recorded interview which
consisted of four main questions: Has this research been benecial for
you? Give your views on answering the questionnaire on Diculties in
Emotion Regulation Scale (DERS) – Serenity programme, Global
Health and the Philadelphia Mindfulness Scale (PHLMS); Are you able
to understand more about Emotional Intelligence and Mindfulness?
Share your experience; Have you meditated or taken and alternative
healing before? How did you feel and what you recommend to people
concerned about health or dealing with health problems? What are
your views on reforming, and/or developing a new horizon to
Bangkok’s Health care system and management?.
Dr. Davin’s views and feedback was that it’s important to be
professional and with the help of journals and various researches one
can be mindful as well as become aware of being emotionally
intelligent. He stated, ‘we have a very interesting network in our brains
and when we have repetitive thoughts in increases our cells with those
thoughts slowly covering up our brain with thoughts that are not
needed in a couple of days feeling depressed. However, if one goes in a
positive way, one can also change the thought process and the cells can
change from feeling depressed to happiness through the neuro network
programming in the brain.’ He expresses the motivation behind a
research conducted like this for Bangkok and sees this as a benet that
can bring awareness to many people. However, the questionnaires can
be good, but it may leave out many aspects of a situation, so based on
certain situations the answers may vary. With this research and
interview he has been able to share many aspects and sees this as the
opportunity to understand more about being mindful and be aware of
emotional intelligence.
He suggests and emphasizes on three factors: sleep, exercise, and
energy. Sleeping between 10 pm-4 pm is the best time for body/cell
repair (for instance tissue repair, growth hormone–melatonin is
produced, blood supply to the muscles, and energy is restored etc) and
this is a signicant period of time where every person should embrace
and become aware of. With the current lifestyle and consumption of
unhealthy intakes aects the patterns of sleep. More people put work as
a priority where there is no balance and that constant thought of
wanting to complete work and sleeping late also aects sleep patterns.
e body needs oxygen and energy needs to be restored so that one
can perform at the best in every way. Hence, exercise is important, 150
minutes per week or 30 minutes ve times a week will help oxygen
ow in the entire body system. Energy is vital for human physiology.
God food given by nature is mandatory, which means fruits and
vegetables are essential for the diet. ere is nothing extra as all the
elements the body cells need are in the fruits and vegetables that can
help in stem cells. Stress cannot be seen but felt, thus, energy and other
aspects need to be taken into consideration.
With regard to mindfulness and emotional intelligence in the
context where people do sleep and exercise yet face problems. Dr.
Davin’s addressed aspects on spiritual requirements practicing a
positive lifestyle, believing in the presence of God/Divine where people
should understand the spiritual aspects of the context written in the
religious books to assist in embracing a positive lifestyle. Many people
don’t understand and are not aware of the spiritual aspects or guidance
shared by masters. Having gratitude every day and not asking what one
does not have but thanking about what one has brings about an
amazing positive change and a fulllment of goals can be achieved. On
the other hand, meditation is important and a proven fact by various
researches and scientists on how the approach and practice helps in
cell repair, brain function and neurology. Meditation if guided properly
and understood clearly can surely benet anyone in many ways; for
instance, if a person is overworked can always feel better aer a thirty–
sixty minutes meditation. Meditation is a growing awareness and is
being practiced over centuries where people are becoming aware at
present times and people should practice it as it helps in positive
thinking, cell repair, healing, and being healthy. Medication only is not
always the only way but utilizing sleep, conserving energy, exercise,
and meditation is eective.
When concerns about society, norms, and how hospitals can add
meditation as a mindful program where addressed Dr. Davin was
impressed and saw this as a great aspect of concern. He encouraged if
the right people would develop programs and propose to the hospitals
there could be a possibility of acknowledging the approach for well-
being programs. Moreover, studying medicine is a big step and medical
schools apply medicine to treat. For psychological concerns patients
are sent to the psychiatrist and medical practitioners’ don’t treat them.
Emotional intelligence and being mindful is not very much addressed
and he agrees with the researcher that if the combination of
approaches are being proposed and taught this could be quite
benecial for the health industry not only for patients but for people
working in the health industry. He encouraged with the fact that if
society understands about this more there would denitely be a huge
change in the health industry. He looks forward to integrate two ways
into the health programs as this has never been thought and taught in
medical schools. Medical schools focused more on treatments and
medication to bet the drug industry. Certain aspects people don’t talk
about to avoid conicts which is an ethical dilemma. Hence, emotional
intelligence, psychology and mindfulness programs are needed with
medication too.
e second participant is Mrs. Rasee Govindani is Self-employed
birth and postpartum doula and childbirth educator aged between
Citation: Khemlani B (2018) Transitions in the Health Care Systems in Times of Uncertainty–Exploring Views by Experts through Mindfulness
and Emotional Intelligence in Bangkok, Thailand. J Health Educ Res Dev 6: 275. doi:10.4172/2380-5439.1000275
Page 10 of 18
J Health Educ Res Dev, an open access journal
ISSN: 2380-5439
Volume 6 • Issue 3 • 1000275
36-40 years. She self-employed, but support women at whichever
hospital they birth at; mainly her clients birth at Samitivej, Sukumvit
and Bumrungrad International. Having worked since year 2010 she has
gained the expert knowledge and experience. Usually she sleeps early
around 10 pm; however, it depends on the day. She likes her job very
much so.
She stated that, ‘stress and emotions are two dierent things. She
does not oen let herself become stressed. If she feels overwhelmed,
she considers the situation and xes what she can, then let go of the
rest. She is not the one to dwell on the things she cannot control or
change. If she needs to unwind she likes to read or watch a movie or
TV show or go window shopping. She is a bit of an emotional eater so
she likes comfort food and sometimes a glass of wine. As for emotions,
she knows that feelings come and go, and just because she feels
something in the moment, it does not accurately reect reality. She
likes to feel my emotions and she don’t shut them out, run away from
them, and does not overthink them.’
In relation to sleep disturbance from work being called oen called
in the middle of the night to attend a birth. She only takes on two to
three clients a month so the sleepless nights are limited. It takes her a
few days to recover from overnight births. She sleeps a little more for a
couple of days and does not do a lot during the day and being used to
this as part of her job.
When asked:
Health Systems may be perceived as a specic
institutional involvement in the implementation of tasks related to the
maintenance and improvement of a patient’s health. What are your
views and opinion on this with the job you do?
Mrs. Rasee’s feedback
was on how she supports a couple during pregnancy as well as during
labor and birth. is means that, during pregnancy, she talks to a
pregnant client about food, exercise, sleep, and how she can prepare
her body (and mind) for labor. A normal labor and birth begins with a
healthy woman; how she takes care of her body can impact how her
pregnancy progresses, how her labor unfolds, and how well she
recovers in the postpartum. She also focuses on her mental well-being
and tries to make sure that she’s in a good place in her head as well as
in her relationship with her partner. Mrs. Rasee supports that both
aspects are important when entering into labor.
As a postpartum doula she tries to make sure that her client, who
has just given birth and is likely breastfeeding, continues to eat
healthily and takes care of herself by sleeping as much as she can,
taking time to herself each day, and eventually, moving her body in a
way that is comfortable for her. She also checks in with her client
emotionally during this time as hormonal changes can aect how she
feels immediately postpartum as well as in the coming days and weeks.
Most women will experience the “baby blues” and a small amount will
go on to develop postpartum depression. She reminds women of what
is normal and what isn’t so she can continue to be supported in an
appropriate way.
As a childbirth educator she does the combination of what she has
already covered and tries to prepare a pregnant woman physically,
mentally, and emotionally for the journey ahead.
When asked:
What are the challenges you face when it comes to
sharing knowledge and information to the patient? What is it that you
can say, want to say, or don’t want to share/say to the patient when
dealing with their health issues/service given to them?
Mrs. Rasee’s
Feedback was she wears many hats and each has limitations so it
depends on the services she is providing a client. As a doula she shares
only what she feels is relevant to the client and what she wants to know.
Information is kept as positive as possible while also making sure the
client knows everything she needs to know to make the right decisions
for herself in the hospital during labor and birth. She does not share
negative outcomes and does not make things too personal. She does
not her own birth story (which was negative). Her job is to support her
client in achieving the birth she wants, even if it’s not the birth Mrs.
Rasee would choose for herself. She will talk through her choices with
her client (if she wants) and give her the risks and benets of each
option that is (or may be) presented to her by her doctor or medical
team, but ultimately she will make the choice that’s right for her.
As a childbirth educator her job is to give all the information
provide evidence-based childbirth education to couples who are
planning all sorts of births: natural, medicated, surgical, and so on. She
gives pros and cons for all choices available and tries to be as objective
as she can. She shares her personal choices and stories of births she has
attended as examples and “possibilities.”
When asked:
How do you deal and what are the current pressures
within the internal and external environment of health systems in
Bangkok, ailand?
Mrs. Rasee’s feedback was in in ailand doctors
have all the power and most ai patients do what the doctors tell
them to do, without doing any of their own research or asking
questions about risks and benets. Doctors are also not used to
explaining or defending their decisions. She works with a lot of
foreigners who, in their home countries, are used to being able to ask
questions, get second opinions, and say no to procedures they are not
comfortable with, and so on. So there’s always a need for balance when
she works with clients. She makes sure all her clients understand the
hierarchy in ai hospitals and how best to navigate that. It usually
comes down to choosing the right care provider who is used to
supporting foreign patients and understands their culture. At the same
time she has to remind her clients that this is not their home country
and things will be dierent. Hence, there’s always that pressure of
making sure that everyone gets what they want and everyone feels safe
with the decisions made.
As a survivor of breast cancer, she denitely felt the pressure of
doing what her doctors wanted her to do, without questioning them.
But she also learned through her diagnosis and treatment that she had
to advocate for myself, that she had to ask the questions, and that she
was entitled to information.
When asked:
What are the changes/transitions in the health care
system and management and how has that aected you?
Mrs. Rasee’s
feedback was when it comes to pregnancy and birth, as time goes on,
women are treated as patients who are sick rather than women who are
experiencing a very normal biological process. It’s as if women don’t
know how to be pregnant and birth babies anymore without doctors
managing their entire beings. is means, for her, that women no
longer have an instinct about their bodies. ey no longer trust their
bodies to work. She has to remind them that they are made to birth
their babies while their doctors remind them how “dangerous” birth is
and how women need their doctors’ help to give birth. ere’s
denitely conict between how she perceive birth and how it is
managed by the medical institutions.
ere’s also a rush to medicate every symptom. As a mother she
sees this when her daughter is sick, usually with the common cold. She
believes in her body’s ability to ght these, but when she is unsure,
such as if her fever lingers too long or she’s struggling to be
comfortable, she knows that there is only one or two doctors that she
can take her to who will not automatically prescribe a number of
Citation: Khemlani B (2018) Transitions in the Health Care Systems in Times of Uncertainty–Exploring Views by Experts through Mindfulness
and Emotional Intelligence in Bangkok, Thailand. J Health Educ Res Dev 6: 275. doi:10.4172/2380-5439.1000275
Page 11 of 18
J Health Educ Res Dev, an open access journal
ISSN: 2380-5439
Volume 6 • Issue 3 • 1000275
medication she really doesn’t need. Same goes for pregnancy and birth.
Spotting during pregnancy? Here’s progesterone. Having contractions?
Here’s magnesium. Let’s not forget iron and calcium supplements as
well as prenatal vitamins-all things that women don’t necessarily need
if they are eating well. is is just one more way of telling women that
their bodies are simply not enough.
When asked:
In times of uncertainty what approaches do you take?
Share about your daily work responsibilities.
Mrs. Rasee’s feedback was
her job is uncertain. Not every woman labors the same way and not
every birth goes the same way so she always tries to be open to being
surprised. She tries to remember that nothing is permanent and
nothing stays the same and it is signicant to learn to go with the ow.
She holds on to the core things that are important to her-her daughter,
family, health, work--and those anchor her when everything else is
uncertain.
Her routine varies from day to day. e morning is for getting her
daughter fed and dressed and sent o to school. She might have a full
day of meetings with potential clients, contracted clients, clients who
have given birth, and so on. Sometimes she teaches private classes and
postpartum/breastfeeding support. When she does not have those she
usually stays home to catch up with other work or emails or so on.
en she picks her daughter up from school and they go to whatever
activity she has or they go play or go home and hang out until
dinnertime. She might work aer she's asleep, but usually it's her time
to watch Netix or read.
When asked
: What are your views on Alternative healing therapies?
Is it important to be Mindful and be aware of Emotional Intelligence?
Please share your views. Mrs. Rasee’s feedback was that there is a
strong mind-body connection and she thinks a positive outlook and
attitude can only be helpful in living life, especially when dealing with
illness. But does believe that having a positive outlook can cure
sickness? No. she believes in medicine. She believes in science. But she
also believes in miracles and sometimes wonderful, unexplainable
things happen. ere’s no telling what can make someone “feel” better,
which can lead them to be stronger or healthier or more willing to
ght. She is open to most things.
She doesn’t believe in “alternative” as much as “complementary.” She
thinks that acupuncture, homeopathy, reiki, and the like can be helpful
along with “conventional” medicine. (Which really is just medicine?)
She knows many people that have benetted from acupuncture and
chiropractic care, and there is more and more research on these.
Anything without real research she views with a grain of salt. She is
happy for clients to try whatever they like, as long as it’s not going to
hurt them. She does not believe, say, substituting chemotherapy with
energy work if you have cancer. What she does know and what science
has shown people is mindfulness and living life with gratitude does
something to a person’s brain to make one happier and healthier. So
she does believe it is important to nd the good in even the worst
places.
When asked:
What would you like to change about the Bangkok
health care system and anything you feel needs changes in the place
you work to have better approaches to enhance healthcare
management and communication?
Mrs. Rasee’s feedback was she
thinks Bangkok hospitals could benet from a more integrated
approach to healthcare, in every eld. For example, a medical doctor
being willing to work with other doctors as well as practitioners of
complementary therapies, so a patient is oered all options to improve
their health. ere’s also quite a bit of competition between doctors in
the same eld so it’s nearly impossible to get objective second opinions
at the same hospital. Doctors need to become a little more professional
and realize that the objective is to help the patient.
Doctors need to learn to explain things better and go over actuals
risks and benets of procedures as well as oer alternatives rather than
tell the patient that this is their only choice and discourage questions.
Consent is considered given even before it’s really asked for. A patient
has the right to understand the risks and benets or procedures and
medication. ey have the right to do research. ey have the right to
more opinions. And they have the right to say no.
Additionally, in some elds Bangkok is keeping up with the rest of
the world, such as oncology, and obstetrics are years and years behind
current research and practices. For example, family-centered Cesarean
sections, where babies are allowed to be skin-to-skin with their
mothers immediately aer surgery and there is no separation of
mother and baby. Even in the “best” hospitals, this is considered
outrageous. ere is also a fail to mothers of premature babies by not
encouraging kangaroo care and breastfeeding. ey know better, but
fail to do better.
When asked:
Is there or has been a health problem you dealt or is
dealing with? How did or are you coping with it? Do you apply the
similar approaches with your patients?
Mrs. Rasee’s feedback was
sharing about when she was diagnosed with breast cancer in June of
2016 and underwent surgery (a mastectomy of my right breast),
chemotherapy, and radiation. She is currently on hormone therapy. She
has come through the worst of it and life will forever be dierent, but
she take things one day at a time and does not worry too much about
the future that is not in her control. Some days are better than others.
Some days she can handle her worries and fears well than other days.
Cancer and childbirth are very dierent things, but as she has
always said that labor and birth are very mental, getting through
cancer was also that way for her. She tried to stay positive and count
her blessings, even on the worst days. She did not believe that would
make her healthier, but it made dealing with treatment easier. It helped
her nd joy in between the dicult moments. She learned to be her
own advocate when she was sick so she encourages her clients to do
the same, to ask for what they want and ght for what’s important to
them. To research and ask questions and get expert opinions.
With reference to the face to face audio recorded interview which
consisted of four main questions: Has this research been benecial for
you? Give your views on answering the questionnaire on Diculties in
Emotion Regulation Scale (DERS)– Serenity programmer, Global
Health and the Philadelphia Mindfulness Scale (PHLMS); Are you able
to understand more about Emotional Intelligence and Mindfulness?
Share your experience; Have you meditated or taken and alternative
healing before? How did you feel and what you recommend to people
concerned about health or dealing with health problems? What are
your views on reforming, and/or developing a new horizon to
Bangkok’s Health care system and management?
Mrs. Rasee’s views and feedback on this research was positive. e
research made her think more about the work she does and how she
does not view it as work and not medical related. is was a good
reection when questionnaires were answered and the process gone
through or what approaches are being utilized for her clients. Her life
is busy and usually from one client to the other. As part of labor,
understanding emotional intelligence is mandatory and having labeled
those helps people to understand better. When it come her own
emotional intelligence she is a good compartmentalizer and focuses on
Citation: Khemlani B (2018) Transitions in the Health Care Systems in Times of Uncertainty–Exploring Views by Experts through Mindfulness
and Emotional Intelligence in Bangkok, Thailand. J Health Educ Res Dev 6: 275. doi:10.4172/2380-5439.1000275
Page 12 of 18
J Health Educ Res Dev, an open access journal
ISSN: 2380-5439
Volume 6 • Issue 3 • 1000275
the work she does and does not take things to her heart as the work she
does cannot be seen that way. ere will be days where there is a hard
birth and she would talk it through or have a good cry when she is at
home. She has been very good in separating her emotions and her
clients’ emotions. She has taken her work seriously and never mixed
the two. As for alternative healing or meditation she does breathing
exercises and as doulas she tells her clients about relaxation (guided
and visualization), mindfulness, and breathing exercises. When she
walks into her room she always relaxes her mind and clears her head
for a fresh start and being at peace.
On the other hand, the transition in the health industry with
alternative healing or complementary medicine has emerged over the
years with better access for clients/patients. For instance, back then
there were less Reiki practitioners, Tapping, NLP, EFT, Chiropractors,
and many more, but at present times this is much more available. is
is not integrated with the hospital system, conventional medicine and
is separated. It would be better if it was integrated. ere is much more
research and information available online now for side eects of
chemotherapy for cancer patients and acupuncture helps with those
side eects. As a cancer survivor, she has seen the changes and noticed
the changes over years. It will always be good if there is a team to
support the person and have integrated approaches. Doctors don’t do
much of the referrals so doulas usually end up making referrals for
chiropractor care and acupuncture for the clients. She encouraged
researches conducted like this for data and she believes in researches
where it can benet many people with valuable insight.
She shared her experience on how she managed emotions and days
she broke down during the time she had breast cancer where she had
to nd balance between her, her work, and daughter with the help of
her good friend who reminded her that her emotions where not real
but based on the situation and how it can change. Emotion changes,
they are not real and are not concrete. She embraced her emotions at
that very moment and knew it will change eventually. She is not the
person who would block her emotions and also tells her clients to not
rationalize their emotions and they would feel exactly what they feel
and it was ne to feel emotional. An emotional state is not a lifetime
conclusion but a situational outcome. e sad will surely go away and
there is no needing justify. Sadness is not bad and how should one be
happy if one does not know sadness.
e third participant is Ms. Anette Pollner a senior Counselor at
NCS Counseling Center, Bangkok who is above 45 years old and been
part of the health industry for 20 years. She usually sleeps at around
1:00-2:00am and likes her job. As a counselor dealing with stress and
emotions is part of her training and is still part of her practice to work
on her own issues. She does that through her own personal
mindfulness practice, through creative writing and through Jungian/
Gestalt dream work. She also has therapy and therapy supervision
sessions. Over the years, she has become more aware. She tracks her
emotions and reactions–this is especially important in order to be
aware of what some people call counter-transference, where the
therapist projects their own issues on to the client.
Countertransference is a dangerous dynamic and not at all helpful
for the client, and can only be managed through constant self-
exploration and self-awareness. She attended many group trainings in
the US, at Esalen and at the Process Work Institute in Portland, Esalen,
where she learned a lot about herself and about group dynamics,
personal dynamics and communication. She also led creative writing
and dream work groups on a regular basis, and that also helps her to
understand herself.
When there is a life crisis or when she is sick, she gets scared and
sometimes angry, like everyone else. Sometimes that’s very natural and
appropriate. She does not try to avoid or bury unwanted emotions; she
tries to explore them and what they can tell her about herself. She deals
with stress and emotions (and welcomes all emotions) by engaging
with them and trying to understand them. She also tries not to add on
extra stress by expecting to ‘x’ all this. Some things are very dicult
to deal with and tries to show herself compassion.
Ms. Anette’s expressed how she is one of those people who can sleep
in almost any situation. e only times when she was unable to sleep
because of stress was on the night before surgery, or when her partner
broke up with her, or when someone close to her was dying. And when
she didn’t know if her ai visa would be renewed or if she would be
deported.
Moreover, when she studied to be a counselor she worked on the
night shi, the so-called ‘graveyard shi’ from midnight to 8AM at a
large international investment bank in London. She surprised herself
by how easy it was for her to switch to a night shi. She has always
been a night person and does her best creative work aer 10 PM. Until
recently, she found it dicult to get up early in the morning, so she
mostly sees clients aer 10 AM, and oen until 9 PM/10 PM which
works out very well for those many clients who are working and
cannot see a counselor during ‘normal’ oce hours.
In turn, some of her friends who are geneticists at Cambridge
University, the gene for attachment to the Circadian cycle (day/night
cycle) is strongly switched on (has to be awake in the day and has to
sleep at night), weakly switched on (usually night person) or even
switched o at all. Hers probably hardly there and is very exible with
sleeping.
When asked:
Health Systems may be perceived as a specic
institutional involvement in the implementation of tasks related to the
maintenance and improvement of a patient’s health. What are your
views and opinion on this with the job you do?
Ms. Anette’s feedback
was for most of her adult life she lived, studied and worked in the UK
with its public health system, the NHS. Before that she lived in
Germany which has a mandatory public health insurance system
which also means that almost everybody is covered. She believes that
this is vital to individual health and to the health of a society.
Unfortunately, in ailand, the public health system is not easy to
access for foreigners and many foreigners have either no health
insurance or their insurance doesn’t cover mental health. is means
that they have to pay for their own therapy. On the other hand, in the
UK the public health system also doesn’t cover mental health issues
very well and she paid for all her own therapy both as a counseling
student and before, as an ‘ordinary’ client working out her issues, out of
her own pocket. But it was denitely worth it.
NCS Counseling Center oers people a discount for the sessions if
they don’t have a lot of money. is can sometimes be tricky since she
has to rely on clients being honest with her and it has happened once
or twice that a client has tried to take advantage of NCS. But generally,
she want people to be able to come as she lives on what she earns. She
would very much prefer to have a regular salary and the center to work
out the nances.
When asked:
What are the challenges you face when it comes to
sharing knowledge and information to the patient? What is it that you
can say, want to say, or don’t want to share/say to the patient when
dealing with their health issues/service given to them?
Ms. Anette’s
Citation: Khemlani B (2018) Transitions in the Health Care Systems in Times of Uncertainty–Exploring Views by Experts through Mindfulness
and Emotional Intelligence in Bangkok, Thailand. J Health Educ Res Dev 6: 275. doi:10.4172/2380-5439.1000275
Page 13 of 18
J Health Educ Res Dev, an open access journal
ISSN: 2380-5439
Volume 6 • Issue 3 • 1000275
feedback was counseling and psychotherapy are client-centered. In
other words, the client is in charge of their healing process.
It is her job to enable the client to understand themselves better and
to nd ways of healing themselves. erefore, it would be
inconceivable to her not to share knowledge and information about the
client’s situation or mental health condition with them. On the
contrary, she tries to explore it together with them as much as possible
and encourage them to nd out more for themselves.
She does explain how counseling works in general, what kind of
counseling school she personally belongs to (humanistic/integrative),
and how the counseling center operates. She also explain whatever
issues come up and some of the theories about psychology,
psychotherapy and sometimes even sociology, politics, social studies
etc. In all of this, she follows the client’s lead. Some people want a lot of
explanation. Others prefer to follow their immediate experience and
probable Google the rest at home. She would never even consider
withholding information of any kind that is relevant to the client.
Counseling is condential and information about the client is only
shared with her clinical supervisor. Nobody else has access to the
information except of course the client themselves.
When asked:
How do you deal and what are the current pressures
within the internal and external environment of health systems in
Bangkok, ailand?
Ms. Anette’s feedback was that main issues are the
fact that most clients have to nance the counseling themselves, the
lack of ‘modern’ psychiatrists in Bangkok, and the preponderance of
the American ‘medical’ system of mental health, which means that
hospital psychiatrists and even general doctors over-prescribe anti-
depressives and anti-anxiety drugs. is would not happen so much in
Europe where she was trained and where she grew up.
Talking therapies for ais are not part of the general health system
in ailand which is very disappointing. ey do have many ai
clients but they are mostly well-educated, wealthy, and have oen spent
parts of their lives outside ailand. e main issue in her view is a
lack of ai counselors and psychotherapists who do NOT practice
according to the American medical model but focus on the talking
therapies.
Another huge issue is the lack of a suicide prevention hotline (the
English language version of the ai Samaritans is only ‘callback’
systems where someone will call you back within a week!) and the way
suicidal patients are treated at ai hospitals. ere were cases where
hospitals refused to accept suicidal patients.
On the other hand, hospitals with dedicated psychiatric units have
frequently not cooperated very well with them and other counseling
centers.
When asked:
What are the changes/transitions in the health care
system and management and how has that aected you.
Ms. Anette’s
feedback was there is not much change since it is operated outside the
system as a private health center and has worked in ailand for 9
years now.
When asked:
In times of uncertainty what approaches do you take?
Share about your daily work responsibilities. Ms. Anette’s responsibility
is to her clients and to be the very best counselor she can be and help
them to process their psychological and emotional issues.
Sometimes she feels uncertainty, but she works it out together with
her client. She can get a lot of feedback from them, directly or
indirectly through body language and behavior. e one thing that is
dicult for her in the context of a private counseling center is the issue
of short notice cancellations.
e counseling center has a policy of a 24 hour cancellation notice
period and if someone cancels within less than 24 hours, the session
has to be paid. is is absolutely necessary or the center would have to
close.
When asked:
What are your views on Alternative healing therapies?
Is it important to be Mindful and be aware of Emotional Intelligence?
Please share your views Ms. Anette’s feedback was she practices
mindfulness and other forms of meditation every day. To her, this is
one aspect of the deeper psychological work she does, also every day,
and also links in with her creative life as a writer and creative writing
coach.
She believes working on her underlying issues is very important, not
just for therapists, but also for other health practitioners. e
relationship with the client/patient is a form of therapeutic
relationship, and aects the healing process enormously. In England,
she also worked as a sta counselor at Bart’s hospital in London where
most of the clients were nurses and hospital sta (excluding doctors
who had their own service). She experienced there rsthand how
stressful the lives of hospital sta were, how dicult the dynamics in
the workplace could be, and how it aected the patients. Sadly, this
service has suered greatly from funding cutbacks since then
When asked:
What would you like to change about the Bangkok
health care system and anything you feel needs changes in the place
you work to have better approaches to enhance healthcare
management and communication?
Ms. Anette’s feedback was for about
2 years, the center had access to a very good ai psychiatrist who
worked at various hospitals in Bangkok and had studied in the US. He
was very supportive of talking therapies, came twice monthly for
intervision meetings and worked with those clients who needed
psychiatric help.
e center never had a psychiatrist like this before or since – and he
went back to the US. us, that’s what we need. Generally ailand
needs more education in the value of talking therapies and more access
to them.
When asked:
Is there or has been a health problem you dealt or is
dealing with? How did or are you coping with it?
Do you apply the
similar approaches with your patients? Ms. Anette’s feedback was she
has had a number of health issues during her time in ailand.
She dealt with them in the ai health system – with varying success
and varying levels of stress. Some of her experiences were excellent,
others were very bad. Since she deals with mental health, there is no
direct way she can apply this to her own work, except to remember
that every client is a person, a person with a life, a life history, with
emotions, with complex life circumstances. A person who deserves my
help and respect. Being seriously ill is very frightening.
Interestingly, there is one sentence she remembers from a young
ai dentist who she only saw once. She said, ‘I learned to treat every
patient as if they were my own family member.’ She would never forget
that. Of course, in psychotherapy we cannot treat own family
members. But clients are unique human beings who deserve respect
and positive regard.
In relation to the face to face audio recorded interview which
consisted of four main questions: Has this research been benecial for
you? Give your views on answering the questionnaire on Diculties in
Citation: Khemlani B (2018) Transitions in the Health Care Systems in Times of Uncertainty–Exploring Views by Experts through Mindfulness
and Emotional Intelligence in Bangkok, Thailand. J Health Educ Res Dev 6: 275. doi:10.4172/2380-5439.1000275
Page 14 of 18
J Health Educ Res Dev, an open access journal
ISSN: 2380-5439
Volume 6 • Issue 3 • 1000275
Emotion Regulation Scale (DERS)–Serenity programmer, Global
Health and the Philadelphia Mindfulness Scale (PHLMS); Are you able
to understand more about Emotional Intelligence and Mindfulness?
Share your experience; Have you meditated or taken and alternative
healing before? How did you feel and what you recommend to people
concerned about health or dealing with health problems? What are
your views on reforming, and/or developing a new horizon to
Bangkok’s Health care system and management?
Ms. Anette’s views and feedback on this research was positive and
certainly encourages more works like this being produced to help
enhance various health practices and well-being programmers. She
found it interesting to write down her thoughts and reect on it. As a
counselor she deals with uncertainty all the time. e clients are always
in uncertainty and the tolerance level in psychotherapy is much more.
Most of the clients are private clients so she does not work directly with
the hospital. Understanding about emotional intelligence and being
mindful is a prerequisite for counseling and psychotherapy. One must
be self-aware, non-judgmental, and not project to them becoming
useful to the clients. In contrast, it is dicult to reect something so
profound like mindfulness in a questionnaire. Also for meditation it is
more of a free form, thus, it cannot be answered specically in a
questionnaire. Some questions may not be suitable for a mindful
activity and it is situational. Mindfulness cannot be measured
completely with questions used like that.
In relation to emotional intelligence and mindfulness as a practical
practice is better and she was under therapy for ve years before seeing
her rst client. She worked with her deep issues rst before meeting
her clients. Psychotherapy also works with mindfulness and she even
works on dream patterns, visualization, and deeper work is being done
like meditation where one gets into this zone where one does not
connect with time and space. Being a creative person enables her to
use her own materials in an imaginative way and help the clients.
Ms. Anette has embraced various approaches in her life. She has
done various workshops and trainings over the world and done
meditation. She has also done the shamanic journey, mindfulness
workshops in various aspects, and classic meditation. She likes the
aspect of mindfulness where it connects one with sensory inputs and
directs you to being in the moment and not worrying about the future
which is very similar with Gestalt therapy. Mindfulness has become
aware over the recent years and with the western inuence through
research, workshops, and promoting it. Mindfulness needs to connect
with the life one lives and not just a practice once in a while, let’s be
mindful for ten minutes or a trend people like to follow. It is an
everyday individual practice. Meditation is not about being calm but
connecting with the world inside a person and the world outside a
person through a deep process and being in the moment. Being in the
moment is not an easy thing and for many therapies that is a practice.
From experience she has noticed that many people are guilty about
the past and anxious about the future. What is missing is living in the
moment. Everything is either a memory or a fantasy. is is where
meditation and creativity comes in where it helps in being in the
moment. Also, when dreaming, that is also being totally in the
moment. Personally she believes being calm is not the case but
connecting to reality is very important. Emotions are very important
and one must feel what one feels and being calm in a state of happiness
or sadness can be a problem as emotions are to be shown or expressed.
Even when going through a surgery at that point a person is quite
scared and their emotions are justied. Nurses lack the knowledge and
counseling to connect with the patients where they should be able to
communicate with the patient rather than telling the patient not to be
afraid when the patient will be afraid. It is a natural situation that
should be addressed properly and acknowledge the patients feeling
especially with the terminally ill. Doctors and nurses should have
training programmers to learn how to acknowledge and communicate
with patients. is is very important for nurses and doctors and can
benet hospitals. Sometimes, assumptions are made based on statistics
and it’s necessary for doctors in ailand to become aware and connect
with patients so it can help in the treatment process.
Long walks in the parks and nature therapy are very important. In
Japan this is a very important approach and ailand should adopt this
approach in the healing process. Listening to the sounds of the nature
is essential for human physiology and health. e public hospitals and
private hospitals in ailand are very dierent. Private hospitals have
more services and public hospitals don’t. Personally she feels that
hospitals should have counselors on call so they can always see the
patient and provide emotional support to patients and sta. Having
experienced working as a counselor in a hospital in London, nurses’
sick rate is very high as nursing jobs are very stressful. It is because of
the hierarchy and when they are sick they would stay home and
sometimes nurses would bully each other. en counseling services
were oered for nurses which was a great opportunity and one nurse
came for counseling and she learnt that that nurse was the bully. Once
they admitted the problem there was healing provided which was good
and counseling is very important. In public hospitals in ailand
nurses are very much in charge and some very old nurses have worked
in hospitals for a very long time and empowerment is needed. It’s
important to see how the main nurses run certain department which
can be good and some bad. Hence, empowerment and counseling
services is very much needed to enhance a better service and healing
for nurses too. is will become a health benet and invest in better
machines for public hospitals in ailand to provide a better healing
atmosphere for everyone.
e fourth participant was Dr. Anand Sachamuneewongse,
Orthopedic Surgeon at Samrong General Hospital, Bangkok aged
between 30-35 years of age has been in the health industry for seven
years. He usually sleeps late around 1:00am and likes his job. He
expressed that stress cannot be avoided especially when patient’s
complication arises. He usually keeps his stress to himself; however,
does consult and/or discuss with co-workers and family members.
When overwhelmed with stress or emotions he would usually exercise
or play sports.
When asked: Health Systems may be perceived as a specic
institutional involvement in the implementation of tasks related to the
maintenance and improvement of a patient’s health. What are your
views and opinion on this with the job you do? Dr. Anand’s feedback
on these aspects suggests that even though patient’s improvement and
maintenance for health is the main role, he believes that the health
system consists of interconnected institutions and individuals that have
a role not only to restore and maintain but to also educate the
community regarding disease prevention knowledge and activities.
When asked:
What are the challenges you face when it comes to
sharing knowledge and information to the patient? What is it that you
can say, want to say, or don’t want to share/say to the patient when
dealing with their health issues/service given to them?
Dr. Anand’s
feedback was apart from the actual treatment communication is a
signicant part. When it comes to dealing with patient’s emotions and
understanding there is no straightforward guideline to follow. On the
other hand, one of the challenges that are faced that nowadays there is
Citation: Khemlani B (2018) Transitions in the Health Care Systems in Times of Uncertainty–Exploring Views by Experts through Mindfulness
and Emotional Intelligence in Bangkok, Thailand. J Health Educ Res Dev 6: 275. doi:10.4172/2380-5439.1000275
Page 15 of 18
J Health Educ Res Dev, an open access journal
ISSN: 2380-5439
Volume 6 • Issue 3 • 1000275
an easy access to resources and patients will be doing some research
and read about their conditions before coming to the hospital.
Sometimes, the information read will contradict with what they have
read and that may cause some problem along the course of their
treatment. In such cases telling them they are wrong can cause
conicts which can delay or aect the outcome of the treatment. All
the doctor can do is to provide unbiased evidence and information that
can help them makes the decision in relation to the treatment choices.
Also, government funding is limited and many people cannot aord
treatments and updated equipment is needed.
When asked:
How do you deal and what are the current pressures
within the internal and external environment of health systems in
Bangkok, ailand?
Dr. Anand’s feedback was one of the main
pressures in the internal environment is the increase in patients in the
tertiary health care center including both inpatients and outpatients.
For the outpatients department there is limited number of doctors and
patients have to wait for a long period of time for their treatment. For
inpatients department the number of beds and operating room
available oen causes delay for surgical treatment and prolong hospital
stay. ese problems are caused by the external environment factors
which are due to the insucient government funding. He deals with
this problem by communicating with the patients and gives them the
information about the current situation to avoid conicts.
When asked:
What are the changes/transitions in the health care
system and management and how has that aected you?
Dr. Anand’s
feedback was on the awareness of the updated equipment in the
teaching hospitals and doctors have better access to research database.
Patients have easier access to health care services due to advance
referral systems and communication methods. Content over the
internal can easily go viral and the sue rate has increased over the
years. In order to avoid public conicts or law suits, patients are
usually recommended specialized physicians in tertiary care center
without no proper initial treatment and because of this the number of
the patients in the tertiary care center are increasing.
When asked:
In times of uncertainty what approaches do you take?
Share about your daily work responsibilities.
Dr. Anand’s feedback was
he discusses with his family members and consults with other seniors
at work if necessary.
When asked: What are your views on Alternative healing therapies?
Is it important to be Mindful and be aware of Emotional Intelligence?
Please share your views. Dr. Anand’s feedback was on having limited
experience on Alternative healing therapies. He is not against it and
does encourage patients to take alternative healing of their choice as
long as it does not harm them physically. He thinks that it’s important
for patients to be mindful and be aware of their emotional intelligence.
When asked:
What would you like to change about the Bangkok
health care system and anything you feel needs changes in the place
you work to have better approaches to enhance healthcare
management and communication?
Dr. Anand’s feedback was on
limited government funding and inadequacy of resources in the rural
areas. With not enough equipment and physicians to investigate or
perform treatments patients are then referred to the tertiary care
center where the number is increased with insucient resources and
causes delay for the treatment.
When asked:
Is there or has been a health problem you dealt or is
dealing with? How did or are you coping with it? Do you apply the
similar approaches with your patients?
Dr. Anand’s feedback shared his
experience in being aected with chronic back pain which aected his
work performance. Instead of getting rid of the pain with medication
he tried physical therapy and exercise which helped him reduce the
pain and improve symptoms. He applies similar approach with his
patients so it can help them with reducing the pain and improve the
symptoms.
With reference to the face to face audio recorded interview which
consisted of four main questions: Has this research been benecial for
you? Give your views on answering the questionnaire on Diculties in
Emotion Regulation Scale (DERS) – Serenity programmer, Global
Health and the Philadelphia Mindfulness Scale (PHLMS); Are you able
to understand more about Emotional Intelligence and Mindfulness?
Share your experience; Have you meditated or taken and alternative
healing before? How did you feel and what you recommend to people
concerned about health or dealing with health problems? What are
your views on reforming, and/or developing a new horizon to
Bangkok’s Health care system and management?
Dr. Anand’s views and feedback on a research conducted like this is
very interesting. He never thought about emotional intelligence and
being mindful and through the questionnaires and research process it
helped him understand and become aware about being mindful. ere
were times when things can be stressful and he usually focuses on the
root cause and nds a solution. He exercises and listens to music to
reduce stress and nd a solution. His patients usually embrace religious
beliefs to stay mindful and their thinking process for ai people. e
questions addressed in the mindfulness scale are ne; however, in
every situation things are dealt dierently and a deeper approach is
needed outside the questionnaire. During his training years, in the case
of emergency and the patient dies there is no straight protocol but
right facts and information is given to the family to share the news.
Emotions are taken into consideration and enough information is
given for emotional support leaving out an elaborated information that
can aect them emotionally and mentally. At that particular time the
situation is quite delicate and avoiding blame game or pointing out any
hesitance that was taken at that point.
He has never meditated and does advice his patients to practice the
approach. He does consider taking meditation and nature therapy into
consideration. Alternative healing like Ayurveda and acupuncture is
good. From his experience working in public hospitals is that people
versus the doctors as there were patients and less doctors which was
the main problem because there was a delay in treatment and less beds
for patients. Many patients did get anxious and with not enough
equipment aects the patients in the tertiary care center. Paramedic
systems in ailand are needed to be monitored and improvement is
very much needed. Even though there has been some improvement,
the government should take all this into consideration to help the
country’s well-being and emotional intelligence should be trained and
practitioners and sta should be educated about these aspects [47-54].
Discussion
is research study emphasized and explored the demographics
changes, healthcare transitions, alternative healing approaches,
challenges faced during the time of uncertainty, assess experiences of
experts in the Health Care system in Bangkok, ailand. Additionally,
to understand more about how practitioners working in the Health
Care industry are aware of their own emotional state before treating or
providing any kind of service to their clients/patients a qualitative and
quantitative research study was developed to accomplish the objectives.
Citation: Khemlani B (2018) Transitions in the Health Care Systems in Times of Uncertainty–Exploring Views by Experts through Mindfulness
and Emotional Intelligence in Bangkok, Thailand. J Health Educ Res Dev 6: 275. doi:10.4172/2380-5439.1000275
Page 16 of 18
J Health Educ Res Dev, an open access journal
ISSN: 2380-5439
Volume 6 • Issue 3 • 1000275
Conclusion
All four experts fullled the questions and answered all
questionnaires on the Philadelphia Mindfulness Scale (PHLMS),
Emotional Intelligence (DERS) questionnaire, and the Global Health
PROMIS 10. Dr. Davin, Mrs. Rasee, Ms. Anette, and Dr. Anand are
aware of their emotional intelligence in terms of thoughts,
environment, mood, and there are situations that may bring some
diculties to deal with the internal state, however, they tend to nd the
suitable way to deal with it. Dr. Anand did not usually focus on
emotional intelligence and mindfulness terminologies and this
research guided him to reect on several aspects that relate to him and
his work in a deeper perspective.
In contrast, when the face to face audio interview was conducted the
insightful sharing on various aspects of uncertainty, transitions,
mindfulness, and emotional intelligence was expressed. e challenges
in the health industry with having less doctors and advance equipment
in the public sector were acknowledged by Dr. Anand and Ms. Anette.
Dr. Davin on NLP and how neuro programming and mindfulness
programmers can be utilized in medical training, educating patients
through awareness, and in daily practice of one’s life. Mrs. Rasee and
Ms. Anette stressed on integration of alternative/complementary
healing/therapies with hospitals and having counselors on call to
provide emotional; and moral support to patients and people working
in the hospitals in both provide and public hospitals. Many
psychotherapeutic schools and approaches, which use the techniques,
based on the concept of mindfulness, for example, Gestalt therapy or
Morit’s therapy, which was addressed by Ms. Anette as she had
practiced these during her training. Detailed answers can be read in
the analysis part and the answers relate to the current situation stated
in the literature review. Due to limited funding and a well-developed
health care systems people in the rural areas and people in the lower
social status do face diculties in having suitable medications.
ere is a need to bring awareness in acknowledging emotional
intelligence, mindfulness, and integration of balance through neuro
programming that can enhance people from all walks related to the
health industry. e essential approaches to emotional, mental,
physical, and spiritual practices are needed throughout the Nation
which will progress in every way. It is not only the prots that need to
be focused on but the implementation of integrated programmers that
nurture every person as their very right to health benets.
e understanding of how mindfulness training and emotional
intelligence programmers enhance brain waves and human physiology
has been researched and with this research it will certainly help anyone
reading the perspective of experts in the health industry. Furthermore,
emotional intelligence should be taught at schools for children to
acknowledge how the feel and speak about it. Oen, people feel guilty
of how they feel or people around them make them feel guilty and
direct them to be quiet about it and/or not being able to speak the
truth. Being mindful is a necessary resource everyone can embrace.
is research does acknowledge that if hospitals would introduce
guided mindful meditation or training is could improve patients’
emotional intelligence, there is an eect of pressure from the internal
and external environment of the health system, and dierent
practitioners experience dierent challenges and transitions.
Conversely, every participant practices mindfulness dierently and in
some cases mindfulness is not even thought about which in this case
because of this research it encourages the participant’s to reect and
consider various approaches to mindfulness training.
e research was limited to Bangkok geographically. ere was a
challenge on how much and whether the experts would be able to
share as many aspects on changes in the health care systems and
provide suggestions in times of uncertainty from their perspectives.
e participants perform their duties and follow the protocols of the
place they work in. With due respect and privacy of the place
suggestions oered were based on their experience and observation
over the years, hence, they faced boundaries of what can be done and
what cannot be done.
Further research encourages to be explored in rural areas and other
clinics and hospitals on emotional intelligence and mindfulness
training. Future studies can apply mindfulness training approaches on
doctors and sta at the hospitals to test the ecacy of before and aer
practicing the mindfulness programmer. It will be ecient to check the
brain waves of before and aer the practice of mindfulness training to
check progress.
Conicts of Interest
ere are no conicts of interest.
Ethics Approval
e experts had given the consent so did not face any ethical
conict.
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Citation: Khemlani B (2018) Transitions in the Health Care Systems in Times of Uncertainty–Exploring Views by Experts through Mindfulness
and Emotional Intelligence in Bangkok, Thailand. J Health Educ Res Dev 6: 275. doi:10.4172/2380-5439.1000275
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ISSN: 2380-5439
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