Thai hospitals: More tests, more money? What is it all about?

[moogradod]

On 4/9/2023 at 3:45 PM, OneMoreFarang said:

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But it is difficult not to get the impression that the hospital does lots of things which brings them a lot of money. Maybe necessary, and maybe not so necessary.

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I can only confirm this feeling. I am actually quite convinced that it is absolutely true for some hospitals. I even suspect a general policy in some cases behind it. Our doctors do tend to make appointments for regular "control checkups" in a short timeframe, although  the history shows (for example blood values) that nothing new is to be expected.

 

It is not the Thai way, but I am not shy to ask why they think such a follow-up is necessary in certain situations and what they would do if the values would be higher or lower. I would then either propose a date more in the future or decline and say that I would contact them if I felt worse. I saved a lot of money this way in cases where my condition had become much better or completely disappeared without their continuous control.

 

I have as well found that some doctors might not be educated to the max. I am no doctor but I have a very good friend in Switzerland who is. When I ask him and confront my Thai doctor then with what he said or proposed it could well change the treatment. In some cases it has worked out like this.

 

My stepdaughter is pregnant and she changed to the Chonburi (Government) hospital which had a very profound positive impact of the (then much lower) cost.

 

Bottom line: I became much more sensitive to some doctors advice and avoid the hospital if I believe that it is not really necessary. All well within certain risk limits of course.

[IvorBiggun2]

From my experiences of Thai hospitals, private and government, they over prescribe medication.

[moogradod]

Just now, IvorBiggun2 said:

From my experiences of Thai hospitals, private and government, they over prescribe medication.

True to a certain degree.  But not always overpriced (much) although it happens for sure as well (in one case I did a comparison - it was almost the same), but they might not prescibe Generica which would save you HUGE amounts of money if they would exist.

[Lacessit]

1 hour ago, OneMoreFarang said:

In principle you are right.

But it seems there are many patients who want medicine. And somehow, they think antibiotics is the wonder medicine against anything.

If the go with any problem to the doctor, they think the perfect doctor gives them antibiotics and maybe two or three more medications. Take this 3 times a day and all will be fine. That is what many patients want.

 

Is that a good reason for a proper doctor to give patients antibiotics or other medicine which doesn't make sense? I think it makes no sense. But maybe that is the Thai way of "solving problems". If the doctor would try to explain to them that antibiotics don't make any sense in this case, then I am sure lots of patients would just go to the next doctor or a pharmacy or a quacksalver who pretends to know.

 

TiT

 

When my Thai GF goes to the government hospital, she usually comes back with 5 or 6 different medications. When I search the names on the internet for what they are treating, and their side effects, I sometimes find what is prescribed is unrelated to the condition she has, or has dangerous side effects.

 

When I go to a doctor in Australia, or a hospital, there is an exhaustive examination of my previous medical history. Only then will a doctor change or prescribe medication. With a hospital, it is 5 or 6 pages of information they seek, even down to whether I or a relative have had CJD.

 

IME that has only happened once in Thailand, with a urologist. None of the other doctors I have seen have bothered to ask.

 

Doctors in Thailand are treated like gods by the average Thai. They are very uncomfortable with being questioned.

 

You may be right in some cases about patient expectations. An alternative explanation is doctors in Thailand are incentivized by the pharmaceutical industry to prescribe whatever is remotely related to the ailment.

 

The average layman is blissfully unaware almost all medications place a burden on the kidneys and liver.  It may partially explain why 17.5% of the Thai population has chronic kidney disease ( CKD ).

[Sheryl]

Overprescription/consumption of medicine is indeed a deeply ingrained cultural habit. Thai patients expect to receive multiple drugs at every visit.

 

Government hospitals  to only do nto make money by over-prescribing, they lose money  (since the national health schemes pay on a capitation basis). Yet they still do it.

[voyagerUSA]

Another surprising thing about medication prescriptions here is doctors most often dont ask what other medications you are on to check for interactions or redundancies. I got into the habit of bringing a written list with me to every appointment, because only when seeing it in front of them in writing do they pay some attention to that.

[proton]

2 hours ago, IvorBiggun2 said:

From my experiences of Thai hospitals, private and government, they over prescribe medication.

Both do that true. Private a few weeks ago over 2k, Institute of Dermatology last week 400 baht for same amounts but different types. Even if you answer no it does not itch they still give something for that! 

[Sheryl]

2 hours ago, voyagerUSA said:

Another surprising thing about medication prescriptions here is doctors most often dont ask what other medications you are on to check for interactions or redundancies. I got into the habit of bringing a written list with me to every appointment, because only when seeing it in front of them in writing do they pay some attention to that.

 

Absolutely true and there is also a widespread tendency to shrug off the risk of side effects.

 

Very necessary to yourself research any and all medications you take, including possible side effects and interactions with other medications. But be sure to do so on a reliable website. Lots of nonsense can be found through google.

 

In particular, many Thai doctors seem never to have "gotten the memo" about risks of NSAIDs (they prescribe them like candy) and quinolones (often prescribe them when alternatives are possible).

[GarryP]

49 minutes ago, Sheryl said:

 

Absolutely true and there is also a widespread tendency to shrug off the risk of side effects.

 

Very necessary to yourself research any and all medications you take, including possible side effects and interactions with other medications. But be sure to do so on a reliable website. Lots of nonsense can be found through google.

 

In particular, many Thai doctors seem never to have "gotten the memo" about risks of NSAIDs (they prescribe them like candy) and quinolones (often prescribe them when alternatives are possible).

I have side effects to some NSAIDs and other drugs so always make sure to inform the doctor of the same. 

[moogradod]

1 hour ago, Sheryl said:

 

Absolutely true and there is also a widespread tendency to shrug off the risk of side effects.

 

Very necessary to yourself research any and all medications you take, including possible side effects and interactions with other medications. But be sure to do so on a reliable website. Lots of nonsense can be found through google.

 

In particular, many Thai doctors seem never to have "gotten the memo" about risks of NSAIDs (they prescribe them like candy) and quinolones (often prescribe them when alternatives are possible).

And then there are so called pharmacists who have the tendency not to check anything, but are obviously allowed to sell you quite potent drugs without prescription. How could they check for they do not have your history (some have it to a certain extent for you might buy most of the medicaments at the same pharmacy). But they do not ask you as well. Only sell - being antibiotics their all can do favourite. Beware.

[jaywalker2]

Girlfriend start having pain around on the right side around the liver region a few days ago. It was uncomfortable so she went to the hospital. Right off the bat they recommended a full body CT scan. It revealed that all of her organs were functioning normally but there was two "hypodense masses" (not the cause of the pain). Next, they wanted to do an MRI. They had also given her an ultrasound and according to the technician it revealed nothing.

 

So said forget it. They never diagnosed the cause of the pain which went away by itself anyway right after she saw the bill.

[dingdongrb]

It seem that many have different experiences than others.

 

When I had a stent placed at a government hospital they did prescribe me 3 different prescriptions on my release. Looking at what they were I felt all 3 were justified:

 

- A medication to help with my cholesterol level

- A medication that thins the blood and reduces the chance of a clot

- An aspirin 

 

I was given a 30 day supply as I had a scheduled check up in 30 days.

 

Well needless to say I dislocated a finger about 2 weeks later and went back at that same hospital to have it X-rayed and looked at. I was then told it wasn't fractured and only dislocated. I was given a pain killer prescription but before they issued it they looked on the computer and saw that I was just in there weeks earlier for the stent. They asked me if I was still taking the meds they proved then. I said, 'yes'. They then said that the pain killer they just prescribed wouldn't be a problem with my previously prescribed meds. That tells me that they looked and saw what I was taking.

 

As far as over prescribing. (I haven't read all the pervious posts). But has anyone mentioned why the USA is currently having an opioid crisis?

 

 

[Sheryl]

14 hours ago, moogradod said:

And then there are so called pharmacists who have the tendency not to check anything, but are obviously allowed to sell you quite potent drugs without prescription. How could they check for they do not have your history (some have it to a certain extent for you might buy most of the medicaments at the same pharmacy). But they do not ask you as well. Only sell - being antibiotics their all can do favourite. Beware.

Most of the people behind pharmacy counters here -- even in white coats -- are not actual pharmacists. 

[whereyougo]

2 friends over the last 15 years ended up at Bumrungrad after collapsing. Less than 2 weeks was 1 million baht plus. one had pneumonia the other passed out probably heat stroke but head injury , both elderly.  Im 10 mins away from there and have a tattoo on my chest saying IF BUMRUNGRAD DO NOT REVIVE

Edited May 25, 2023 by whereyougo

[Ralf001]

On 4/10/2023 at 2:51 AM, still kicking said:

That is the reason I moved back to my country after years in Thailand I don't pay a single cent for hospital or doctors 

Bludging off tax payers ?

Edited May 25, 2023 by Ralf001

[billd766]

On 4/9/2023 at 8:06 PM, connda said:

I agree.  I have a Living Will and Advanced Directive which explicitly states:
1. Take me to a government hospital
2. Do not take me to a private hospital. 

If something happens out where I live, the nearest hospital is a government hospital where I know the staff and one of the head doctors has our Living Wills and Advanced Directives for both myself and my wife.
As long as my wife is with me (which is about 99% of the time) she's there to make sure the LWAD is carried out.  I've got copies in the car, in the house, my son's got a copy, and the doctor.  In Thai and English.
The other aspect of our LWAD is a "No ICU", "No CPR", "Do Not Resuscitate" 
I'm thinking about getting that tattooed on my chest in Thai.  <laughs>

I'm in my 70s.  I've lived a productive life.  If **** happens, then imho it's time to let it all go and move on. My wife feels that same.  It's definitely is not most peoples approach as most people want to keep living no matter how ****y their quality of life is.  Personally I don't get that.  I see people in the late 80s wanting expensive advance treatment so they can continue living in a busted, broken-down body that isn't going to last more than a few more years anyway.  It tells me these people are terrified of death.  Part of a good life is coming to grips with your eventual demise.  It's sad for those who can not.

Now, should I get that tattoo?  ????  Hummmm.

I truly hope that you improve quickly.

 

I agree with you 100%, especially about the worn out old body.

 

I must start carrying my DNR forms when I go to the hospital and to tell my wife that she HAS to tell the staff, no DNR.

 

I am 79 and not going through a good patch in the last couple of weeks, but this week I feel that I am improving about 1% a day.

Edited May 25, 2023 by billd766
corrected some bad spelling

[DavisH]

On 4/9/2023 at 7:44 PM, FritsSikkink said:

If you work here you pay into Social Security.

Some jobs, not all. 

[DavisH]

6 hours ago, Lacessit said:

Doctors in Thailand are treated like gods by the average Thai. They are very uncomfortable with being questioned.

I've actually never had a problem asking questions with a Thai doctor (and I've seen many). But if you are questioning their ability, I would understand they would become uncomfortable. 

[scubascuba3]

11 hours ago, jaywalker2 said:

Girlfriend start having pain around on the right side around the liver region a few days ago. It was uncomfortable so she went to the hospital. Right off the bat they recommended a full body CT scan. It revealed that all of her organs were functioning normally but there was two "hypodense masses" (not the cause of the pain). Next, they wanted to do an MRI. They had also given her an ultrasound and according to the technician it revealed nothing.

 

So said forget it. They never diagnosed the cause of the pain which went away by itself anyway right after she saw the bill.

They're taking advantage of the sick again, should be a crime. A govt hospital wouldn't do all that