Don't Blindly Trust Doctors

[Neeranam]

A friend of mine decided to go to Bamrungrad's sleep clinic to try and fix a sleeping problem. He had tried some local doctors here in Isarn but guess what they all prescribed? Xanax, Diazepam etc.

He is an alcoholic, sober for more than 2 decades, so I warned him of the dangers of Benzodiazepines. I also warned him about Thai doctors - not liking being challenged about any of their diagnoses.

Anyways, after their expensive overnight testing and follow-up , the doctor gave him some Ambien and suggested that he take it for the rest of his life.

I'm no doctor but think this is disgraceful! An international hospital handing out dangerous sleeping medication at their Sleep Clinic!

Does anyone have any advice to give my friend(65).

My daughter was born in Bamrungrad 5 years ago and I was ripped off for 70,000 baht. I've also heard so many more cases of money being more important that care.

[Tammi]

I had a sleep test done at Bumrungrad. Technician handed me a handful of pills. I asked what were they for? She went off presumably to telephone the doctor came back and said I had to take. By this time I am hacked off, tired, worried about my condition, and surely the doctor knows what is best, so I took them. Technician said to sit on chair while she attached EEG and ECG leads. I remember her fiddling on my head and that's the last I knew until I came to next morning! I really do not believe this was a correct way to conduct a sleep test. Anybody?

[ignoramus]

Ambien ???

Huh???

Think................Heath Ledger..................yes?????

Yeah baby....

Don't they read Med journals in LOS?? Or watch television??

[Tammi]

How should I take Ambien?Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Ambien comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

Take Ambien only if you are able to get a full night's sleep before you must be active again. Never take this medication during your normal waking hours, unless you have a full 7 to 8 hours to dedicate to sleeping.

Take this medication with a full glass of water. Ambien is for short-term use only. Tell your doctor if your insomnia symptoms do not improve, or if they get worse after using this medication for 7 to 10 nights in a row. Do not take Ambien for longer than 4 or 5 weeks without your doctor's advice.

You may have withdrawal symptoms if you stop taking Ambien after taking it over several days in a row. Do not stop taking this medication suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely.

Withdrawal symptoms include behavior changes, stomach pain, muscle cramps, nausea, vomiting, sweating, anxiety, panic, tremors, and seizure (convulsions). Insomnia symptoms may also return after you stop taking this medication. These symptoms may seem to be even worse than before you started taking the medication. Call your doctor if you still have worsened insomnia after the first few nights without taking Ambien.

Do not crush, chew, or break an extended-release tablet. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking the pill would cause too much of the drug to be released at one time. Store this medication at room temperature away from moisture and heat.

Source: www.drugs.com

Your friend should read the whole article on www.drugs.com

[RueFang]

I think that should read "Don't trust doctors" it's not about being Thai..

My 89 year old grandmother was put on full strength antidepressants last week which 4 days later caused her to have a complete mental and physical breakdown. 89 for goodness sake! They have since reduced the dose to a small fraction of what she was on but it's lucky he didn't kill her. I'm under the impression that doctors have a quota to fill regarding how much medication they prescribe to get a big bonus from the companies or something.

[Irene]

How should I take Ambien?Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Ambien comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

Take Ambien only if you are able to get a full night's sleep before you must be active again. Never take this medication during your normal waking hours, unless you have a full 7 to 8 hours to dedicate to sleeping.

Take this medication with a full glass of water. Ambien is for short-term use only. Tell your doctor if your insomnia symptoms do not improve, or if they get worse after using this medication for 7 to 10 nights in a row. Do not take Ambien for longer than 4 or 5 weeks without your doctor's advice.

You may have withdrawal symptoms if you stop taking Ambien after taking it over several days in a row. Do not stop taking this medication suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely.

Withdrawal symptoms include behavior changes, stomach pain, muscle cramps, nausea, vomiting, sweating, anxiety, panic, tremors, and seizure (convulsions). Insomnia symptoms may also return after you stop taking this medication. These symptoms may seem to be even worse than before you started taking the medication. Call your doctor if you still have worsened insomnia after the first few nights without taking Ambien.

Do not crush, chew, or break an extended-release tablet. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking the pill would cause too much of the drug to be released at one time. Store this medication at room temperature away from moisture and heat.

Source: www.drugs.com

Your friend should read the whole article on www.drugs.com

No, not your friend should have read the whole article. That doctor in charge should also have read the article.

[Tammi]

Irene, of course the doctor should know everything about what he is prescribing but farangs living in Thailand (and many other countries) have to try to educate thenselves. Pharmacists should also give information to the patient on the medicines they hand over to the patient. I always make a point of asking pharmacists for the contra-indications and side effects. They know diddleysqat. So when I get home I read up on the internet and decide what to take and what to flush down the toilet. At the moment I am taking a drug that on some internet sites is described as "the drug from hel_l' and the doctor had prescribed to the equivalent of 40 mgs of Valium! Immediately on reading that I cut the tablets into smallest possible pieces and took only one little piece - I absolutely did not need the eqivalent of 40 mgs of Valium! Next time I saw the doctor I told him what I was taking and he was completely unfazzed and gave me 1/2 mg tablets which are bigger and so much easier to cut into tiny pieces! I am now in the process of weaning myself off this medication - without the doctor telling me to. Let's hope I can do it without side effects.

[peter991]

I give higher regard to Pharmacists over Doctors. It seems Doctors do not have the time to keep up to date with advances in medical science.

Peter

[Thai at Heart]

I give higher regard to Pharmacists over Doctors. It seems Doctors do not have the time to keep up to date with advances in medical science.

Peter

Was diagnosed with Hepatitis despite having all jabs up to date with nothing more than the doctor looking in my eyes Called a doctor friend in the US, demanded an ultrasound and as if by magic, had gall stones.

Be very wary of doctors giving any diagnosis and if not sure get always get a second opinion.

[samtam]

They know diddleysqat. So when I get home I read up on the internet and decide what to take and what to flush down the toilet.

Me too! I also try and get it into their heads, (the quacks), that I prefer not to take any drugs if at all possible. But here more than anywhere else I have found they foist drugs on to you as the answer to all problems. I think it's important to have a healthy scepticism of doctors and their diagnoses. They are not gods.

[Irene]

Irene, of course the doctor should know everything about what he is prescribing but farangs living in Thailand (and many other countries) have to try to educate thenselves. Pharmacists should also give information to the patient on the medicines they hand over to the patient. I always make a point of asking pharmacists for the contra-indications and side effects. They know diddleysqat. So when I get home I read up on the internet and decide what to take and what to flush down the toilet. At the moment I am taking a drug that on some internet sites is described as "the drug from hel_l' and the doctor had prescribed to the equivalent of 40 mgs of Valium! Immediately on reading that I cut the tablets into smallest possible pieces and took only one little piece - I absolutely did not need the eqivalent of 40 mgs of Valium! Next time I saw the doctor I told him what I was taking and he was completely unfazzed and gave me 1/2 mg tablets which are bigger and so much easier to cut into tiny pieces! I am now in the process of weaning myself off this medication - without the doctor telling me to. Let's hope I can do it without side effects.

Tammi, yes, you have a good point. Doctors are normally pressed for time and I sometimes doubt whether they have updated themselves as much as some patients. Furthermore when you raise some questions from what you have read with them, they tend to get annoyed. Patients are in no-win situation. My tactic is to be nice to all of them and buy them Xmas gifts etc. Once they become accustomed to you, they could become your family doctors and know all your family DNA. Presently, I am able to involve them in long consultation more than other patients to the disliking of nurses. Some of the doctors even asked me for a few tips on the stock market. Now I have to buy some sweets for the nurses just to complete my system. Knowing lawyers and doctors well is a must in Thailand.

In one highly recommended book called, "How Doctors Think" by Jerome Groopman, M.D., it was noted at the side cover that "On average, a physician will interrupt a patient describing her symptoms within eighteen seconds. In that short time, many doctors decide on the likely diagnosis and best treatment......"

[PeaceBlondie]

For years now, sleep disorders have been the new buzz, complete with $2000 diagnoses and tests. The EKG is not an exact science. I had a neurologist honestly say he wouldn't know what sleep/attention disorder I had if he opened my brain and looked at it. My diagnosis from a Thai neurosurgeon is 'idiopathic somnolence' which means I fall asleep at the wrong times, and they have no idea why.

The biggest ripoff I ever had was for a sleep center EKG. Technician failed to show up, and we did it the next day. Results were inconclusive but they charged me for two complete tests!

[Tammi]

For years now, sleep disorders have been the new buzz, complete with $2000 diagnoses and tests. The EKG is not an exact science. I had a neurologist honestly say he wouldn't know what sleep/attention disorder I had if he opened my brain and looked at it. My diagnosis from a Thai neurosurgeon is 'idiopathic somnolence' which means I fall asleep at the wrong times, and they have no idea why.

The biggest ripoff I ever had was for a sleep center EKG. Technician failed to show up, and we did it the next day. Results were inconclusive but they charged me for two complete tests!

Dear Blondie, you really should go back and have your brain examined! You paid for 2 complete tests when you only had one!!!???

I really only know Bumrungrad or BKK Pattaya and if the test was either of those and within last 12 months I would be on the executive floor demanding my money back nicely at first, of course, but gradually getting more strident.

At B'grad a doctor did a procedure that cost over 60,000 baht. I hadn't seen it done before, doctor was in a hurry, and at end of procedure it became clear that it hadn't been successful and would need to be repeated on following day. I said very nicely that he would have to do it for nothing the second time. Within hours I had a couple of hospital people in the room to hear what I had to say. The procedure was done properly the following day. I paid once. I know I paid once because I always insist on being told, in advance, what the cost will be, and I get detailed bills and go over every item and ask about anything I don't understand.

[Tammi]

I give higher regard to Pharmacists over Doctors. It seems Doctors do not have the time to keep up to date with advances in medical science.

Peter

I know a Thai surgeon who told me he has to get up early every day to read all the new medical articles that come in over the internet.

[dr_Pat_Pong]

For years now, sleep disorders have been the new buzz, complete with $2000 diagnoses and tests. The EKG is not an exact science. I had a neurologist honestly say he wouldn't know what sleep/attention disorder I had if he opened my brain and looked at it. My diagnosis from a Thai neurosurgeon is 'idiopathic somnolence' which means I fall asleep at the wrong times, and they have no idea why.

The biggest ripoff I ever had was for a sleep center EKG. Technician failed to show up, and we did it the next day. Results were inconclusive but they charged me for two complete tests!

Hey PB herein comes a free lesson in commercial reality with all my best wishes. For a double charge ( particularly where a service was not provided but nevertheless charged for ) one firstly and calmly remonstrates in the matter with the punter in charge, or the non attendee at the first scheduled procedure, and if he cannot see even a skerrick of merit in your sincere postulations, tell him to " go and get *****D " ( PM me for the secret word ) Additional adjectivals can of course be introduced to reinforce your angst if you feel that there is any need to so reinforce them. No Court anywhere would find for the errant so called professional setup unlawfully charging for a service not even attempted let alone concluded.

[freitag1]

I had only bad experiences at Bumrungrad and Bangkok Hospital. It seems they make money with the standard bag of pills they hand out for every occasion.

[deejah]

I give higher regard to Pharmacists over Doctors. It seems Doctors do not have the time to keep up to date with advances in medical science.

Peter

nurses have a lot of first hand experience as well

[ArtfulD]

After going to any Dr I always look up online any medication prescribed and the problem they concluded and see if i then agree with their prognosis/treatment.....may sound like stupid self Doctoring but to be frank i dont trust Drs, had far too many f88k ups from them over the years.....

[Jingthing]

I have a friend who was also prescribed Ambien for life by a US doctor and has also gone through numerous sleep studies. Why do you assume it was bad advise?

Edited January 25, 2008 by Jingthing

[Boo]

Suggest your freind email or call Papworth NHS sleep clinic. Regarded as one of the best places for this kind of disorder. I am hoping to be referred there myself sometimes this year as I suffer severe night terrors & sleep walking so know how awful a sleep disorder can be. Even though he is in Thailand he may be able to ask them advice on medication or a referal to a known specialist in either thailand or his own country.

[geriatrickid]

Was diagnosed with Hepatitis despite having all jabs up to date with nothing more than the doctor looking in my eyes Called a doctor friend in the US, demanded an ultrasound and as if by magic, had gall stones.

Be very wary of doctors giving any diagnosis and if not sure get always get a second opinion.

Well if he/she tested properly and that's what the tests results indicated, then perhaps you may very well have had hepatitis. The jabs don't always work. I used to dose myself with vaccines for Hepatitis A & B. During my annual checkup I said hey I need my boosters. Doc, said, ok here's your boosters, come back and see me in a few weeks for the other ones. So I come back and he pulls out his dam_n syringe to take blood and I go <deleted>, just inject em dorkus. He says, not so fast Mr. knowitall, let's check for antibodies in case you don't need these. Mmkay, so we do the test, I come back and he goes, hey smartass, you don't need them because your B antibodies are robust but you don't have any for A. I'm like <deleted>, that's impossible. He goes, well if you were in this business instead of playing with dead people maybe you'd have known that Hepatisis vaccines don't work for alot of people. I go ooops, smile and say, me dumb. Moral of the story, jabs don't always work.

[Sheryl]

What the OP and some others described is most certainly not what should occur in a Sleep Clinic. Full stop.

This is the first feedback I've had on the Bummers "Sleep Clinic" & leads me to think that for all practical purposes there still isn't one in LOS, altho there may be a few docs with advanced training in sleep disorders.

I've said it before & will say it again: doctors come in all types and if you want quality medical care, you need to put some research into selecting one. Just as you would probably do considedrable research before investing in real estate or buying a particular model of car. After all, you are investing in your heal;th and life; isn't that at least as important?

Doing that is far easier in LOS that in many of our home countries and I am constantly amazed at how many people don't bother, or think that by selecting a "name"hospital they are automatically going to get a competent doctor. It just doesn't work that way. There are probably some hospitals here without a single really good doctor on staff, but there are none that don''t have a single bad one. Furthermore, since the bad ones in general are in less demand, a walk-in who doesn't state a preference is at high risk of winding up with one. (Not always, of course).

Some of the finest specialists I've ever encountered have been here in Thailand. But I chose doctors very, very carefully, taking the time to know where they trained, whether they are board certified and if so where, how many years experience, areas of special interest etc.

Another tip: the nurses know who the really good & bad doctors are. They won't be able to say it outright but if you ask in an indirect way ("I'm looking for a doctor who is especially skilled in such-and-such, can you siggest any one in particular?"-- and say that in private where her answer won't be widely overheard) you may benefit. Especially try to talk with the more senior nurses (older, head nurse etc).

I once took a Cambodian friend to a hospital for an IUD insertion which, due to the position of her uterus, docs in Cambiodian had been unable to perfrom. Doctor of choice was unavailable and time was short so we wound up walking in cold to a medium sized nonprofit private hospital. Requested a female gyn per my friend's sensibilities. While waiting I chatted with the head nurse and mentioned that the reason this Cambodian lady was here was that it was a difficult IUD insertion...at which point the nurse indicated that in that case she might be better off with Dr X (a male) instead. Being a nurse myself I got the message and prevailed on my friend to accept the male doc, modest or no modesty. I have no doubt that this little hint saved my friend considerable pain and probably an unsuccessful procedure.

Re pharmacists: they are indeed more knowledgable about side effects and congraindications than doctors. Problem is, more often than not the person behind the counter is not a pharmacist. If you can find a pharmacy with a true pharmacist who is usually there on duty, frequent it and make use of him. Also -- there are package inserts in the drug boxes, request to have one. All the international brand drugs and many (not all) of the Thai generics will have info in English. The pharmacy staff are usually happy to let you have an insert.

[Sheryl]

Title has been changed as the original smacked of Thai-bashing, and problem is hardly unique to LOS.

[Maestro]

Was diagnosed with Hepatitis despite having all jabs up to date with nothing more than the doctor looking in my eyes Called a doctor friend in the US, demanded an ultrasound and as if by magic, had gall stones....

Well if he/she tested properly and that's what the tests results indicated, then perhaps you may very well have had hepatitis.

Geriatrickid, you quoted correctly the relevant part of the post to which you replied, and then proceeded to post nonsense. Doing nothing more than looking into the patient’s eyes is certainly not testing properly for hepatitis.

Gall stones, which the patient was eventually found to have, can obstruct the flow of bile from the liver to the duodenum and this can result in jaundice, but not hepatitis, as far as I know.

--

Maestro

[PeaceBlondie]

I was not referring to Thailand, but to the toilet of Texas, and if it makes you feel any better, when I realized I had been doublecharged it was too late, so I refused to pay the second bill.

There are some very serious sleep disorders, but that does not mean getting an EKG will identify the problem. But some of my diagnoses were prior to CAT scans and other new imaging techniques.

[Tammi]

What the OP and some others described is most certainly not what should occur in a Sleep Clinic. Full stop.

This is the first feedback I've had on the Bummers "Sleep Clinic" & leads me to think that for all practical purposes there still isn't one in LOS, altho there may be a few docs with advanced training in sleep disorders.

I've said it before & will say it again: doctors come in all types and if you want quality medical care, you need to put some research into selecting one. Just as you would probably do considedrable research before investing in real estate or buying a particular model of car. After all, you are investing in your heal;th and life; isn't that at least as important?

I did research and went with the doctor who has a huge good reputation as the best in Thailand. Then GP (not a Thai and not in awe) said I should have a second opinion so I went to a doctor who also has a very fine reputation but who, when I consulted , was obvioulsy in awe of the first doctor. So I stayed with the first doctor and then came the sleep test fiasco so I went to another doctor who I get on very well with and who told me, in his opinion, I have none of the dire diseases diagnosed by the first doctor. I hope he is right!!

Glad to have you agree that one shouldn't be knocked out for a sleep test!

[Irene]

Sheryl,

That was good posting. I never thought of scouting for a right doctor before. Have always been at the mercy of receptionists and nurses. Thanks a lot!

[thaigene2]

I was told some time ago that Doctors in Thai private hospitals receive a commission/percentage of the fee for all medicines they prescribe through the hospital's dispensary. While I can't say for sure this is true, it was told to me by someone who works in one of the big private hospitals in BKK. It may also go some way to explaining why they won't write a repeat prescription in the Medical Certificate (for insurance purposes) as they want to ensure you only buy the scripts from the hopsital in which they work (as it's much cheaper - less than 50% for many Rx at the big drug stores).

A complete conflict of interest of course..but TIT

In other words, it's in the doctor's personal financial interests (and those of his employer's) to write you an expensive prescription.

Edited January 26, 2008 by thaigene2

[thaigene2]

What the OP and some others described is most certainly not what should occur in a Sleep Clinic. Full stop.

This is the first feedback I've had on the Bummers "Sleep Clinic" & leads me to think that for all practical purposes there still isn't one in LOS, altho there may be a few docs with advanced training in sleep disorders.

I've said it before & will say it again: doctors come in all types and if you want quality medical care, you need to put some research into selecting one. Just as you would probably do considedrable research before investing in real estate or buying a particular model of car. After all, you are investing in your heal;th and life; isn't that at least as important?

I did research and went with the doctor who has a huge good reputation as the best in Thailand. Then GP (not a Thai and not in awe) said I should have a second opinion so I went to a doctor who also has a very fine reputation but who, when I consulted , was obvioulsy in awe of the first doctor. So I stayed with the first doctor and then came the sleep test fiasco so I went to another doctor who I get on very well with and who told me, in his opinion, I have none of the dire diseases diagnosed by the first doctor. I hope he is right!!

Glad to have you agree that one shouldn't be knocked out for a sleep test!

Don't know if you did this or not...

But never tell the second doctor the name of the first doctor. The way I do this in Thailand is to arrive at the first place and every subsequent place (even if there aren't any other places) and say "I'm a bit worried about this and so I'm seeking a range of concenses. I chose you as one of several doctors I'll visit as I like to do things scientifically with a range of preofessional opinions. Oh and by the way, can you please write down your daignosis and recommended treatment in the Medical Certificate - er, in English for sure? It won't be shared with any other doctor. Thanks"

Edited January 26, 2008 by thaigene2

[Tammi]

I was told some time ago that Doctors in Thai private hospitals receive a commission/percentage of the fee for all medicines they prescribe through the hospital's dispensary. While I can't say for sure this is true, it was told to me by someone who works in one of the big private hospitals in BKK. It may also go some way to explaining why they won't write a repeat prescription in the Medical Certificate (for insurance purposes) as they want to ensure you only buy the scripts from the hopsital in which they work (as it's much cheaper - less than 50% for many Rx at the big drug stores).

A complete conflict of interest of course..but TIT

In other words, it's in the doctor's personal financial interests (and those of his employer's) to write you an expensive prescription.

I can tell you, sure and certain, that doctors at a Thai private hospital will give prescriptions for medicines to be bought outside where they are much cheaper. The drugs can even be delivered to the hospital for use in the hosptal. The patient does have to pay more for the administration but certainly does save money. I am not saying that this applies to all medications but patients on long term expensive treatments should ask their doctor about buying outside the hospital.