How bad are the hospitals really

[Plern]

Took ME two years to dial in my wife's cholesterol medicine. Doctor's kept re-perscribing same ineffective medicine.

 

Med school is six years not eight. No internship in any meaningful sort of way that I'm aware of. There are 22 med schools in Thailand none are anywhere close the equivalent of the top 3.

Edited June 15, 2023 by Plern

[fceligoj]

In 2021, I had open-heart surgery at the Queen Sirikit Heart Center of the Northeast.  I won't go into details but I felt the care taken from admittance, initial testing, the surgery, recovery, 2-days in a hospital room, and the continuing follow-up (including in the emergency department to replace the gauze bandages from the removal of the leg vein and the incisions into the body cavity as well as appointment with my surgeon (now every 6 months)) were all first class. Also, prior to surgery and during recovery, my wife was allowed to stay with me, had to sleep on a couch bed though.  (I had a private room.)  All costs associated with this illness was out of pocket other than a small hospital insurance policy with AIA.

 

From your description, even in the US, the medical profession would prefer, from the patient's point of view, for the patient expiring to be in constant contact with their nearest relatives at home.  If not, they would 'push them out of the hospital' and suggest the family put the patient into a hospice.  So, really no difference.

[Andycoops]

What you described is entirely normal in the Thai health care system because you are comparing it with, I assume, with a health care system from your country of birth.

Which in the UK is paid for by taxpayers, there aren't many tax payers here and the rate is low for those that do.

The Thais don't get angry about this as they already know what to expect.

 

[Sheryl]

4 hours ago, Andycoops said:

What you described is entirely normal in the Thai health care system because you are comparing it with, I assume, with a health care system from your country of birth.

Which in the UK is paid for by taxpayers, there aren't many tax payers here and the rate is low for those that do.

The Thais don't get angry about this as they already know what to expect.

 

 

I think it has more to do with timeline and evolution of a system which, in Thailand, is still quite new. Universal health care here is less than 20 years old and still evolving. It does not yet extend beyond acute care, and is struggling to finance even that.

 

For an aging society to finance not only universal access to acute/curative care but universal access to hospice and long-term (e.g. nursing home) type care is a huge challenge.

[Celsius]

Some negative stuff that is written here is completely justified. Hospitals here are simply bad for Thais and like someone said poor foreigners. I don't see why, for example, OP's wife's mum can't at least get some painkillers to help her out during this time.

 

The reason I got good "care" here is because I paid for it. Simple as that. Some mugs here keep harping about the same thing over and over how great Thai healthcare is here. Fortunately I learned early on that is is not. Far from it.

 

10 years ago during my first month in Bangkok when I met my ex wife, her 30 something year old friend got diagnosed with bone cancer. She worked at the same place as my wife - Siemens (BTS project). Germans do have great benefits and great insurance. Her insurance refused to pay (it was still Thai insurance)., so she was stuck at the government hospital (the famous hospital that everyone harps here about being so great) which I thought was something out of a horror movie.... literally. Four months later, she died.

 

I don't trust this place at all.

 

 

[Sheryl]

31 minutes ago, Celsius said:

 I don't see why, for example, OP's wife's mum can't at least get some painkillers to help her out during this time.

 

Nothing in the OP suggests she is lacking in pain medication. Government hospitals will provide it, and some have special palliative care programs specifically for this.

 

The issue seems to be that she -- like most terminally ill patients -- requires an immense amount of nursing care.  In a Western country such patients would be referred to a long term care/skilled nursing facility or residential hospice, or given in-home nursing support. This is still lacking in Thailand, the burden falls entirely on the family to either provide the care themselves or pay for it.

[jaideedave]

On 6/15/2023 at 11:15 AM, brianthainess said:

Not only rooms, but when I was in Gov Hospital upgrade for 500b a night to a different ward with extra space and a fold down sofa. but none of this helps if they just want to send you home. 

I had a cancer operation at Sirikit hospital in Sattahip.Somehow I ended up in a huge ward.Worst experience ever.Zero privacy and patients yelling and screaming at all hours.Staff was very overworked.

My wife had to sleep in some waiting room infested with mosquitoes.

I asked for a private room but none were available for a week or so.I gladly paid the extra 3k/day.

I did have one intern who kept wanting to up sell me all kinds of tests that were unnecessary. 

[xylophone]

I have to say that my experience here with hospitals is mixed/varied, ranging from the treatment received in the public and private hospitals (as is to be expected).

 

Examples here would be my ex-girlfriend's mother who had mouth cancer and who was being treated at a hospital in Phitsanulok, and when I say treated, it was a visit to the hospital, painkillers dispensed and then sent home, which happened every month until she died. No other treatment was offered or available.

 

A similar thing happened to my ex-girlfriend's brother here in Patong, who developed a very large lump in his throat, which started off about the size of a ping-pong ball and grew to about the size of a tennis ball, making it very difficult for him to eat/swallow, hence he lost a lot of weight and didn't look well at all.

 

The treatment given to him by the local government hospital was iodine tablets, which didn't seem to do much good at all and he was getting more sick by the week, so I decided to take some action and took him along to the Bangkok Phuket hospital and saw a specialist there who said she would need to take a biopsy and would advise further steps from thereon in.

 

It was a tumour and it was benign, and she said she could operate at a cost of 120,000 baht, which I agreed to and footed the bill, and he has been healthy ever since and that was about 12 years ago.

 

My main worry was that the government hospital would keep supplying him with tablets until the day he died, which didn't seem too far away before I took some action.

 

Trying to balance this out somewhat, I have had good treatment at Bangkok Phuket hospital, even though the urologists there are sadly lacking in knowledge and experience IMO as compared to others I have seen.

 

Staying on the "balancing" aspect, my father in the UK was diagnosed with throat cancer and when it became obvious that it was incurable and that he was going to die, he (actually his wife) was given some very strong painkillers to administer, before being sent home, in effect to die, and looking back, there was probably nothing else that could be done, and it doesn't seem that different from what often happens here in such cases.

 

I agree with the posts here which state that in the case of terminally ill patients, where not a lot can be done other than administering painkillers, patients can be sent home to die with some dignity in the care of their relatives/families, and I'm not sure that the treatment for terminally ill patients differs greatly between, for example, the UK and here.

[jaideedave]

23 hours ago, PeterA said:

"Wifes mum has severe cancer and is in hospital, she cant poo or pee by herself and her kidneys have shut down now as well,  they want us to take her home to take care of her ."

 

Most hospitals I assume will give the home patient a morphine drip or equivalent to stop or minimize pain, and show you how to maintain it, as well as come by to check on the patient. That's how I have seen it done in Nakhon ratchasima.  From my experience, they give enough to keep the patient in a "near-coma" like state.

Cancer here is real common and is usually not caught until late stage 4. When symptoms occur, it is usually too late to stop it. Unless you have big money for treatments that might give a little extra time only. Weeks, not years.

 

 

 

 

The old chemo scam has been going on for years around the world.After my cancer operation the Dr insisted I go for 2-3 months of chemo etc. treatment.I'd been having severe kidney issues post op and reckoned that the chemo would finish me off.

Eventually I mostly recoved from the kidney issue and paid to have the PET scan at Princess Chulabhorn in bkk. Not cheap but they detected no cancer at all.We all know of people who underwent long periods of painful Chemo to only survive a couple weeks or months if at all.

Yes there are some success stories out there but no many.

 

[Yellowtail]

16 hours ago, zzaa09 said:

Indeed. Even with the added facetious twist, not a decent or wise comparison. 

The American systems are unattainable and heartless without a soul. 

Hilarious 

[Yellowtail]

17 hours ago, DavisH said:

Or back to the US with their wonderful free health care for everyone.....oh, wait a minute....

I have had plenty of wonderful free healthcare in the US. 

[Sheryl]

24 minutes ago, jaideedave said:

The old chemo scam has been going on for years around the world.After my cancer operation the Dr insisted I go for 2-3 months of chemo etc. treatment.I'd been having severe kidney issues post op and reckoned that the chemo would finish me off.

Eventually I mostly recoved from the kidney issue and paid to have the PET scan at Princess Chulabhorn in bkk. Not cheap but they detected no cancer at all.We all know of people who underwent long periods of painful Chemo to only survive a couple weeks or months if at all.

Yes there are some success stories out there but no many.

 

Need to avoid blanket discussions of chemo for "cancer". Cancer is not one disease but many with widely different treatments and prognoses and the utility of chemo varies enormously according to type of cancer and stage.

 

In no case can chemo be termed a "scam". But its value varies greatly  according to cancer type and stage.

 

Chemo is completely curative for some cancers (e.g. leukemias).

 

For some other cancers , if at early stage, it extends the chance of long term survival/ decreases risk of recurrence, but the issue is by how much and to weigh this against the risks of the chemo, which do vary by drug and by the age and general health of the patient

 

For still other cancers/stages, chemo is only "palliative" (put in quotes as one could debate the definition of "palliative" in this instance) i.e. extends survival, sometimes by a lot and sometimes by just a little and at a cost in terms of time spent in hospitals and side effects.

 

What is largely lacking in Thailand, unless one is very pro-active in seeking it out and assertive in claiming it, is for patients to be fully involved in the decision making process, given full facts and then allowed to decide. Especially in the public system, but also in the private if the doctor has not been socialized to western approaches, the norm here is still for the doctor to "tell' the patient what should be done and the patient is expected to passively comply. This is not because of an intention to "scam" the patient, rather it is an mindset which does not consider quality of life variables sufficiently nor accept that patients are the best agents to ultimately decide whether a particular treatment, all considered, is worthwhile.

 

 

[The Fugitive]

On 6/15/2023 at 2:47 AM, ChipButty said:

They do that in England send them home to die they can get home help from the social services, 

Only if you're lucky. My mum was dying of ovarian cancer aged 88 in a UK NHS hospital. I was promised all the help I needed at home (I lived alone). When the time came for discharge the hospital social worker told me that no domestic/auxiliary nursing would be provided by the council because my mum "didn't need it". Medical treatment provided by NHS is three fifteen minute visits per day by district nurse.

[The Fugitive]

50 minutes ago, xylophone said:

I'm not sure that the treatment for terminally ill patients differs greatly between, for example, the UK and here.

My Thai mother-in-law died 12 months ago. She was sent home to die. Fortunately, plenty of family to assist. Same as UK NHS she had 3 fifteen minute visits per day by a nurse. However, in addition, one daily visit by a doctor, something you don't get in UK.

[NativeBob]

Private or public = you still deal with same doctors. Duh!

(Defamatory comments on specific removed by Moderator)

 

PS: This is not even close to "thai bashing". Is not.

PPS: On the other hand: if they are so bad how come medical tourism was and still is quite successful biz? Thousands of arrivals to thai private hospitals. I think I was either unlucky or expected too much )

[jaideedave]

15 hours ago, fceligoj said:

In 2021, I had open-heart surgery at the Queen Sirikit Heart Center of the Northeast.  I won't go into details but I felt the care taken from admittance, initial testing, the surgery, recovery, 2-days in a hospital room, and the continuing follow-up (including in the emergency department to replace the gauze bandages from the removal of the leg vein and the incisions into the body cavity as well as appointment with my surgeon (now every 6 months)) were all first class. Also, prior to surgery and during recovery, my wife was allowed to stay with me, had to sleep on a couch bed though.  (I had a private room.)  All costs associated with this illness was out of pocket other than a small hospital insurance policy with AIA.

 

From your description, even in the US, the medical profession would prefer, from the patient's point of view, for the patient expiring to be in constant contact with their nearest relatives at home.  If not, they would 'push them out of the hospital' and suggest the family put the patient into a hospice.  So, really no difference.

Did you have bypass surgery?2 days seems quite short of time in the hospital.I had a quadruple bypass 13 years ago.It was at Bangkok Pattaya because I had insurance with my employer.The total bill was about 30+ pages and north of 1 million baht.They charged per aspirin and anything you can imagine.

I was discharged after 7 days.Interestinly they took the veins from both of my arms? I often wondered why as most Drs take them from the legs.

[Sheryl]

1 hour ago, NativeBob said:

 I think I was either unlucky or expected too much

Or failed to carefully research and choose your doctor.

 

There are good and bad doctors at all hospitals.

 

P.S. It was necessary to edit your post in keeping with Forum rules and Thai law on defamation.

[digbeth]

1 hour ago, Sheryl said:

...

What is largely lacking in Thailand, unless one is very pro-active in seeking it out and assertive in claiming it, is for patients to be fully involved in the decision making process, given full facts and then allowed to decide. Especially in the public system, but also in the private if the doctor has not been socialized to western approaches, the norm here is still for the doctor to "tell' the patient what should be done and the patient is expected to passively comply. This is not because of an intention to "scam" the patient, rather it is an mindset which does not consider quality of life variables sufficiently nor accept that patients are the best agents to ultimately decide whether a particular treatment, all considered, is worthwhile.

I just had visit with relative to the only government oncology department in the whole province, after we had operations at the local amphur hospital (breast cancer) we were referred to the central hospital of the province, got an appointment within 2 weeks, on the day of the appointment, we sat waiting for about 5 hours for the doctor, which looks like there are only 2 for the whole province sharing the load,

upon being called from the crowded waiting rooms patients was lined up in a queue to go see the doctor, musical chair styled, the examination rooms door were left open so all in the queue are able to hear each decision and interaction with the doctor, privacy was none, but it gets those in the queue in the right mindset and knows what to expect from the doctor. Plus before getting in the queue, in the waiting area we see those that's already on chemo coming for their weekly dose had a nice discussion among the patient themselves as a sort of quasi-support group.

 

Most were prescribed chemo after being sent for other tests from CT to MRI which, to the system's credit, we never had to paid but often need to travel to private facilities to get it done. In all, we had about 5-10 minutes with the doctor each time and it was understandable due to the mass of people in the waiting area outside, in the end we decided chemo wasn't for our relative as she's not strong enough to eat properly already and the doctor was understanding and prescribe us letrozole and appointment for monthly checkup. 

 

Going private would just mean less waiting time and maybe the doctor going through the patient needs and maybe spend 20 minutes more discussing things with us

Throughout the whole ordeal through the system, we never paid a single baht except for the private room during the surgery, they never hesitate to order tests or refrain from giving treatments or medication, 

[Sheryl]

2 minutes ago, digbeth said:

 

Going private would just mean less waiting time and maybe the doctor going through the patient needs and maybe spend 20 minutes more discussing things with us
 

Exactly. I have on occasion brought Thais to meet the same senior doctor that oversees their care at  the public hospital, at a private hospital, just for the sake of having a longer consultation and discussion. It is simply not possible in the public system. Not something to do often, but every once in a while, can be well worth the 1000- 2,000 baht that a simple consultation costs privately.

 

I was however responding to a poster's report of doctors trying to "push" chemo on him. It does indeed sometimes happen (and not just for chemo). Even in private hospitals. I have recently been involved in trying to help someone in ICU of an expensive private hospital with poor prognosis being  pressured to have  unwanted surgery by doctors who would just show up and announce "the plan" with no room for patient input despite doctor acknowldging that odds were the surgery would leave the patient permanently on a ventilator which patient had made clear he did not want to risk. (ICUs are particularly bad places to be in such circumstance).

 

It is slowly improving but many Thai doctors still do not grasp the idea of collaborative decision-making with patients ... and even if they do, the crowded and rushed conditions of public facilities is not conducive to it.

[jaideedave]

2 hours ago, Sheryl said:

Need to avoid blanket discussions of chemo for "cancer". Cancer is not one disease but many with widely different treatments and prognoses and the utility of chemo varies enormously according to type of cancer and stage.

 

In no case can chemo be termed a "scam". But its value varies greatly  according to cancer type and stage.

 

Chemo is completely curative for some cancers (e.g. leukemias).

 

For some other cancers , if at early stage, it extends the chance of long term survival/ decreases risk of recurrence, but the issue is by how much and to weigh this against the risks of the chemo, which do vary by drug and by the age and general health of the patient

 

For still other cancers/stages, chemo is only "palliative" (put in quotes as one could debate the definition of "palliative" in this instance) i.e. extends survival, sometimes by a lot and sometimes by just a little and at a cost in terms of time spent in hospitals and side effects.

 

What is largely lacking in Thailand, unless one is very pro-active in seeking it out and assertive in claiming it, is for patients to be fully involved in the decision making process, given full facts and then allowed to decide. Especially in the public system, but also in the private if the doctor has not been socialized to western approaches, the norm here is still for the doctor to "tell' the patient what should be done and the patient is expected to passively comply. This is not because of an intention to "scam" the patient, rather it is an mindset which does not consider quality of life variables sufficiently nor accept that patients are the best agents to ultimately decide whether a particular treatment, all considered, is worthwhile.

 

 

I defer to you Sheryl

You are the expert on these things.I shouldn't have responded like that.Fact is I had a poor relationship with the surgeon.He refused to reverse the colostomy until I submitted to the chemo.(I had renaI failure) got another opinion with a Dr at Sinakarin hospital and he said he would make arrangements for the surgery only if the PET Scan came out negative which it did. I eventually had the reversal done at Ramatibodi by a colleague of his in Bkk.

[NativeBob]

45 minutes ago, Sheryl said:

Or failed to carefully research and choose your doctor.

Good point, @Sheryl
First years we just followed directions from reception, later turns out that unless we know exactly which doctor. So I can say last 16 years we are as careful with doctors as minesweepers. 

[Sheryl]

30 minutes ago, NativeBob said:

Good point, @Sheryl
First years we just followed directions from reception, later turns out that unless we know exactly which doctor. So I can say last 16 years we are as careful with doctors as minesweepers. 

Never let reception decide this for you

 

They will send you to whomever is least busy which is not a good sign (if they even send you to the right type of specialist, not unusual for them to confuse things like urology and neurology)

 

One might think international relations dept would do better but they do not.

[Sheryl]

A post has been removed 

[TimeMachine]

I understand your disgust. I am from Australia where elderly care is quite good. It is bizarre that there is yet to be a Prime minister that tries to match with other countries. The money is there. The people are there. Just the strong willed desire is not. Even though I can get some big support in Oz my plan is for organised exit  if you are not from rich loving family it can get tuff either way.

[dingdongrb]

On 6/14/2023 at 9:47 PM, KhunLA said:

People seem to take better of their vehicles, with regular check ups & maintenance.  Mind boggling.

Yeah, just like the need to wear a mask while on a scooter but neglecting to wear a helmet.

 

I would also like to say that my experiences between a few private hospitals and government ones, I'll be completely satisfied using a government one.

Edited June 20, 2023 by dingdongrb
Add hospital experience

[connda]

On 6/14/2023 at 8:17 PM, seajae said:

They say she doesnt have long to live but are reducing her to be in severe pain etc at home where no one can do anything for her, this has to be the most pathetic medical care I have ever heard of, even in the hospitals the nurses do nothing for the patient and family has to do everything, feed, give drinks, tell the doctor whats wrong, change colostomy bags & nappies etc and sleep on the floor of a night as well,


Thailand really is a third world country that cant even take care of their people properly,

Think of it this way.

In First World countries, you can pay someone to "do everything, feed, give drinks, tell the doctor whats wrong, change colostomy bags & nappies etc" - and therefore completely sanitize the dying process and make it someone other than the "Family's" problem.
The "Family" can just stay drunk and gossip about the dying's life while someone lower on the social spectrum takes care of the dirty-work.

Unless they can't.

And to be really, really honest?  Here in Thailand, most middle class people can afford to hire someone (for 10K a month) to do all of that.  To be a caregiver.  And you could probably find a good caregiver too as an expat

Instead?  Complain.  "Thailand Medical Bad."

Thailand isn't First World.  Nope. It is not.
Culturally until recently, family would take care of all of that "messy and dirty" work of caring for dying family members until the last moment.  And even then?  Many die at home. 

Imho the biggest issue here in Thailand is the lack of Palliative Care for Joe Sixpack and Sonchai TaMaDa.  There is a real lack of compassion when it come to alleviating pain in terminal patients. Well - unless you have ฿฿฿฿Cha-Ching฿฿฿฿
If pain can be addressed, then dying is just a matter of marking time.

[connda]

Let's get to reality.

Westerners.

"My (Mom/Dad) **** her/his pants.  ORDERLY.  NURSE!  Clean that up!!!"

How about - Your dying Mum/Dad just **** her/his pants.  They cleaned your pants for how many years during your infancy.  Now they need YOUR HELP. 

Step The Hell Up!

[brianthainess]

On 6/15/2023 at 11:29 AM, Kwaibill said:

My experience at public hospitals has been excellent. As an elderly diabetic I am essentially uninsurable here. I have been well treated at Sirikhorn and the old Cholera hospital, also provincials at Mai Hong Son and near Chiang Mai.

Wait times can be long, but I have more time than money. I usually lose a couple kilos if in for any time as the food is not great, but that’s a plus for me.

I might beg my wife for an upgraded semi private room if I have to be readmitted, but the medical service has been great   (Gall bladder removal, strokes, broken pelvis, et Al) and at lower cost than with US Medicare, believe it or not.

We have a routine now, take pillows and mattress cover from home, small fan, extension lead, if I'm still able to drive, and the wife takes a M/C taxi to Lotus/ 7/11 for food/drinks, she eats my hospital food 

[dingdongrb]

Let me add something as I forgot to mention it in my earlier post.

 

In my wallet I carry a contact paper identifying myself as well as providing contact information in case of my death or an accident. That paper not only identifies my choice for 'DNR' it also states to take me to a government hospital and not a private one.

[Yellowtail]

5 hours ago, TimeMachine said:

I understand your disgust. I am from Australia where elderly care is quite good. It is bizarre that there is yet to be a Prime minister that tries to match with other countries. The money is there. The people are there. Just the strong willed desire is not. Even though I can get some big support in Oz my plan is for organised exit  if you are not from rich loving family it can get tuff either way.

The money is there? You understand the GDP per-capita of Australia is almost ten times what it is in Thailand?