Pattaya Hospitals

[Bagwan]

Musing on dealing with medical services

What is it with the services provided by Thai hospitals? The two that I used to use in Pattaya are housed in very nice, modern buildings, the staff are usually smartly attired and at first sight, induce a feeling of confidence on the unwary.

But then you run into what passes for administration. What on earth is the point of having an appointment system when one is kept waiting seemingly for hours while others walk in and are seen and attended to almost immediately? I fully recognize that hospitals have to respond to emergencies and that keeping to a schedule is not always possible, but my blood pressure rises when I see a gaggle of young ladies standing around, apparently doing nothing, when they should be advising the waiting customers (forget patients, you are paying and therefore a customer) why there is a delay in being attended to. Waiting for more than 15 minutes without some explanation should be unacceptable.

On one occasion my wife and I had an appointment at one of the preeminent Pattaya hospitals to attend at 0800 for blood samples to be taken. I had called in a few days previously to ask a doctor to issue the required authority so that when we came we could spend the least possible time waiting around. We both were required to eat or drink nothing but water for 12 hours previous to the taking of blood. Since I have a coffee addiction I was in serious caffeine deficit not to mention ravenously hungry. After fighting off four (4) attempts to subject us to the vital signs routine (sic) at 0820 I told the senior nurse that my wife and I had a busy schedule for the day and asked why we had not been attended to. She replied that the nurse ‘who did bloods’ didn’t start work until 0830! I received no answer when I asked if that was the case, why had we been given an appointment for 0800. We walked out in search of immediate sustenance – and coffee.

One particularly vexatious practice is the ‘checking of vital signs’. I am sure that this is yet another con to bump up the bill a few hundred baht. To what end is this almost mandatory procedure carried out? We want to check your blood pressure and weight they say. Why, for God’s sake? Do I look at deaths door? Didn’t I walk in here in a quite sprightly manner, do my auditory, ocular, cerebral and perambulation facilities seem impaired to you? Are they not pretty vital signs? I’ve got a painful in growing toenail for God’s sake. Is the refusal of this service communicated to the other members of the reception staff? Nope. Within two minutes somebody else will try to coerce you into submitting to a totally pointless exercise.

At check up time I grudging accede to being weighed and a reading taken of my blood pressure. Why is it that they cannot accept that I know what my weight is, within a kilogram of being accurate? My bathroom scales are accurate enough. Perhaps some will think I am unnecessarily cautious but I insist on my blood pressure reading being taken the good old fashioned way, i.e. using a sphygmomanometer. I once submitted to being subject to a machine and on enquiry was told that I had given a reading of 160 over 100. When seeing the doctor I asked him to try again using the tried and tested method. 120 over 80. Perfect! Since then I have refused the machine. Why should I trust it when they can’t even get the traffic lights in town to work properly? To underline my distrust, at the next check-up, after the reading had been taken the way that I almost had to insist upon and found to be normal, I allowed the nurse to take another reading using the infernal machine. Her face was a picture. I asked her what the reading was and she said 200. I told her I didn’t want to know the diastolic reading. It is clear that the calibration of the modern machines is not checked regularly.

The over prescribing by doctors has already been well documented both in this place and others and so I’ll leave that to one side but it does seem that the doctors, like bar ladies, have a quota that they must achieve. The owners and management of private hospitals come out of the same mould as the pooyais in other industries, so there is no reason to doubt that their concern for your wellbeing is well down their list of priorities - as elsewhere, money No.1. At least a couple of my friends have in the past taken note of the medicines prescribed for them and then refused to purchase them from the hospital dispensary. They then obtain them from a local pharmacy at a fraction of the cost. I am a little wary about this as one can never be sure that one is sold the real McCoy

Others too have commented on the presumed arrogance of some (qualifying term added by Moderator) doctors, , and their reluctance to discuss your medical problem. Many certainly seem discomforted if questions are asked and explanations are sought. I would say that it pays to shop around to find a doctor that you can converse with – and trust. I now prefer to travel up to BKK to attend one of the excellent hospitals there – well the one me and ‘er use now is excellent in all respects and no more expensive than the ones in Pattaya.

One final item that is worth a mention is the invidious situation that nurses in the out patients department are in. Once after seeing a doctor and receiving treatment I found that I had left my wallet at home. Being left to my own devices for a moment I decided to go home and then return loaded with credit cards and wherewithal and told a member of staff that this is what I was going to do. When I returned, the nurse attending the doctor thanked me profusely for returning to settle my bill. She explained that if I had done a moonlight flit, she would have to reimburse the hospital. She stated that this was common practice.

[Sheryl]

First of all, let me say that I too have a poor impression of the care available in the Pattya area and routinely advise people to nmake the trip upt to Bangkok wgere for the same price a substabntiaklly better level of care can (with some prior researxh and careful selection of doctor) be had.

Nonethless, your rant does seem a bit over the top. Told to come in at 8 but they don't draw the blood until 8:30..OK, a hassle (altho it may also be done as a precaution to allow time for people to register and the fact that patients often arrive late), and certainly the staff could and sghould ahve taken the time to apologize for and explain the wait, but still we are only talking 30 minutes here and your reaction is pergaps a bit extreme. (not that I don't go off the deep end myself when frustrated before having my morning caffeine, but...in the overall scheme of things and of all the complaints one might have about medical care this is pretty low down on the list.)

The taking of vital signs on a routine basis is absolutley necessary adn indeed mandatopry by international dtandards of care and does not involve an extra charge to the patient, at kleast not anywhere that I have ever seen. It is (or should be) an integral part of any doctor visit. I won't bother to go into all the reasons why it is a wise precaution. Just suffice it to say that failing to that would be grounds for non-accreditation and it is hospitals that you should be concerned about any hospital that fails to do this. They aren't trying to get money out of you by it, they are complying with internationally accepted stabdards of care and ensuring that adequate information is on hand to evaluate you. It can also serve to detect undiagnosed problems.

If you were uncooperative about having your vital signs taken -- and let's face it, it is really not that big of a bother -- this would certainly have made a poor imopression on the nursing staff and added to their discomfort in dealing with you. next time, cooperate. It really is in your best interests.

About the overprescribing bit, absolutely true, altho I think not entirely because of profit motive,. there is a widespread perception in Thailand that the more medicines given, the better the care and Thai doctors tend to assume patients want to be given many drugs i,.e. they think they are doing what the consumer wants. I have actually had hopital staff flush in deep embarassment and profusely apologize tio me with a nervius laugh because "only one medicine" was ordered for me (which I deckined, since I needed no medicines at all(. It's a cultural thing. Grabnted the doctors whould be trying to educate people againts it rather than catering to it, but this is Thailand and that's just not Thai culture. Making it clear to the doctor that you do not want any unncessary medications and will be perfectly happy to leave with none at all if none are indicated will help; believe it or not this will come as a surprise to most Thai doctors without prior triaining or exposure in the west. Better yet, stick to doctors whio have trained.worked in the west and thus have been socialized to what western patients want and expect. (Which will, indeed, mean a trek up to Bangkok).

On drugs costing more at hospitals than in pharmacies -- absolutely true. Unless you ahev been prescribed one of the few drugs that are only available through a hospital, always buy your meds elsewhere. Just stick to large air-conditioned pharmacies staffed by actual pharmacists, or bname places like Fascino's and you'll be fine. Before leaving the doctor specifically ask what if any medications are being prescribed, what they are for and whether they are (a) completely necessary and ( available over the counter.

As for doctors that won't explain things/get offended when you ask questions...change doctors ASAP. There is no need or reason to put up with this and while cultural issues are a part of it more often than not the negative reaction is defensiveness because the doctor actually doesn't know the answer to your questions very well. I have consistently found a direct inverse corellation between a doctor's expertise and his willingness tio entertain questions. The very top men in their fields are not fazed or defensive about a patient asking questions.

[gymshark]

The taking of vital signs on a routine basis is absolutley necessary adn indeed mandatopry by international dtandards of care and does not involve an extra charge to the patient, at kleast not anywhere that I have ever seen.

????? I have never had vitals checked in a UK hospital unless the smptoms required it. And they do charge for it everywhere, they charged me 3 days ago at Vibhavhadi in BKK.

[lopburi3]

I have never visited a doctor anywhere, for anything, that did not check (but never lived in the UK) - that is how most people find out they have high blood pressure. There may be a 30-50 baht nursing charge but really don't believe that is excessive.

[Tammi]

I am very happy to have my vital signs done at all the hospitals and I believe it is included in the 'use of facility fee' charged at all the hospitals. One may find that BP and pulse readings will differ quite a lot between being done by the nurse and later on by the doctor because one will usually have had a rest period between nurse and doctor. Thai nurses also usually zoom down with the old blood pressure machine while doctors take more care.

I have found that BPH doctors prescribed lots of medicines and later at B'grad specialist said 'stop this , this and this and why on earth did they prescribe this?'

But nursing care at BPH is much, much better than at Bumrungrad and it is nice that BPH do a follow up a few days after discharge.

And the food and rooms at BPH are certainly much much better than at Bumrungrad and one can have the use of the floor portable computer to check email and do other online work.

[Bagwan]

Nonethless, your rant does seem a bit over the top. Told to come in at 8 but they don't draw the blood until 8:30..OK, a hassle (altho it may also be done as a precaution to allow time for people to register and the fact that patients often arrive late), and certainly the staff could and sghould ahve taken the time to apologize for and explain the wait, but still we are only talking 30 minutes here and your reaction is pergaps a bit extreme. (not that I don't go off the deep end myself when frustrated before having my morning caffeine, but...in the overall scheme of things and of all the complaints one might have about medical care this is pretty low down on the list.)

The taking of vital signs on a routine basis is absolutley necessary adn indeed mandatopry by international dtandards of care and does not involve an extra charge to the patient, at kleast not anywhere that I have ever seen. It is (or should be) an integral part of any doctor visit. I won't bother to go into all the reasons why it is a wise precaution. Just suffice it to say that failing to that would be grounds for non-accreditation and it is hospitals that you should be concerned about any hospital that fails to do this. They aren't trying to get money out of you by it, they are complying with internationally accepted stabdards of care and ensuring that adequate information is on hand to evaluate you. It can also serve to detect undiagnosed problems.

If you were uncooperative about having your vital signs taken -- and let's face it, it is really not that big of a bother -- this would certainly have made a poor imopression on the nursing staff and added to their discomfort in dealing with you. next time, cooperate. It really is in your best interests.

To put this in true perspective. I have written on three separate occasions to the Director of the hospital in question commenting upon the appalling service and the attitude of staff in the reception area. Nothing changes. Am I being unreasonable to suggest that motivated management should make regular checks on the efficiency and smooth running on the point of entry for customers to their business? And correct shortcomings? Are not first impressions of the utmost importance? There are shops and garages in the Pattaya area who no longer enjoy my custom for much the same reason as I have stated. Now both the major shops, er hospitals, are in that category.

My wife has one day off in every week and our time together is very precious to us. 30 minutes may not seem a lot to you, but to us, particularly for me at such an early hour and in need, it felt like several lifetimes. I had gone to the trouble of making all the necessary preparations and the senior nurse was politely appraised of the situation and our service needs. Could not she have stuck a needle in our arms and taken the blood sample? She was after all doing nothing else. Oh, I forgot. This is Thailand. Exercising initiative is not a good career move.

Incidentally, it has been a stroke of extreme good fortune that we did walk out, never to return. My wife suffers from an as yet incurable viral disease of the blood and as soon as we spoke to a specialist doctor at *&^%$#@ hospital in BKK he stated, without examination or comment from us, that it was clear that her current medication was not working, indeed was doing her harm. The clinical signs were obvious, he said. She is now taking alternative medicines and thriving once more. By seeking to get good value for our money elsewhere we may have saved her life, certainly saved us both from a great deal of additional concern and heartache.

I was not aware that the 'vital signs' procedure was common international practice. I have never experienced it before and it still smacks of bulldust and/or the 'nanny state' to me. The point was clearly made to the receptionist and the senior nurse that we did not want to submit to the procedure - and yet we get pestered. Lack of communication? Which easily leads to errors being made? Which, it being a hospital, could result in terrible consequences? As for evaluating our condition, we need to be weighed and our blood pressures taken to ensure that we are fit enough to have a needle jabbed into a vein? We were not in my view being uncooperative, the hospital staff were. They simply ignored our requests. Is this any different to driving into a garage to refill the tank and being in a hurry, decline an offer to clean your windscreen and check oil and tyre pressures? What would be anybody's normal reaction be if the garage staff insisted?

I do not attend hospitals to create a good impression with the staff or to make them feel uncomfortable. It is their job to create a good impression on me and make me feel comfortable and confident in their abilities, the relevance of what they propose, and the level of service provided. Then, and only then, will I be as nice as anybody could be.

[JSixpack]

I was not aware that the 'vital signs' procedure was common international practice.

Your own ignorance, then.

I have never experienced it before and it still smacks of bulldust and/or the 'nanny state' to me.

You poor thing. Do try to get over it. Is there some pill that you can take?

The point was clearly made to the receptionist and the senior nurse that we did not want to submit to the procedure - and yet we get pestered. Lack of communication?

No, they needed to take your vital signs for your own good, and to help prevent misdiagnosis on their part.

We were not in my view being uncooperative, the hospital staff were.

But in fact you were, no matter your "view."

They simply ignored our requests.

Good on them, too.

Is this any different to driving into a garage to refill the tank and being in a hurry, decline an offer to clean your windscreen and check oil and tyre pressures?

Completely different, and Sheryl explained the matter to you already.

What would be anybody's normal reaction be if the garage staff insisted?

The analogy is just too silly to warrant any response.

I do not attend hospitals to create a good impression with the staff or to make them feel uncomfortable.

You mean, "comfortable?" Ain't THAT the truth, pal! So then, do you attend to make a fool of yourself?

It is their job to create a good impression on me and make me feel comfortable and confident in their abilities, the relevance of what they propose, and the level of service provided.

There's some truth to that, but what about you . . .

Then, and only then, will I be as nice as anybody could be.

Ha! No, you see your job is to be nice to people from the beginning as well and not make it difficult for them to do the jobs they need to do. It's a two-way street.

Problem seems mostly to be that you're just so full of yourself. While you're visiting hospitals, you might drop into Psychiatrics and get some counseling to control anger, childishness, arrogance, etc. Maybe get some pills too. Also, get some training in cultural sensitivity. Then you'll be well on your way to making friends and influencing people--and getting much better service.

[Tammi]

Incidentally, it has been a stroke of extreme good fortune that we did walk out, never to return. My wife suffers from an as yet incurable viral disease of the blood and as soon as we spoke to a specialist doctor at *&^%$#@ hospital in BKK he stated, without examination or comment from us, that it was clear that her current medication was not working, indeed was doing her harm. The clinical signs were obvious, he said. She is now taking alternative medicines and thriving once more. By seeking to get good value for our money elsewhere we may have saved her life, certainly saved us both from a great deal of additional concern and heartache.

Then it was all for the best - your guardian angels were looking after you both!

[torrenova]

Fantastic post by the OP and totally in line with many years experience of Pattaya hospitals. I too refuse the gouging of the blood pressure and weight scam; they will do it again even if you return the same day !

Doctors over prescribe and one doctor at one hospital prescribed some drugs for my baby which were banned in the US donkey's years ago (my wife was alone on that visit).

When their is a problem they lose your contact details, files go missing, people do not respond to your requests, people go missing, like ostriches they bury their heads in the sand, miraculously everyone you need to see is on holiday (forever), off sick or dead. Utter bullshit.

The care inside the hospitals is often very good and my baby was born at one of them but they tried to pad the bill for tens of thousands. The owners went to threaten me and her family with all kinds but I am made of sterner stuff.

As to the OP's comment that the owners and staff are similar to bar girls with quotas, bill padding and lacking in customer care then I unfortunately have to concur.

[Westerner]

JSixpack - Post #7 - absolutely spot on!

[Mobi]

While as many of you will know I am no fan of BPH, I am inclined to the JSixpack point of view on this.

The OP's complaints seem to be mainly over the top, and somewhat pedantic. Every hospital in Thailand checks for vital signs, and it is all included in standard charges. It is very easy to decline this service, as I have done on many occasions. A 30 minute wait is not excessive, and I have waited up to 5 hours to for pre-arranged appointments with specialists in UK private hospitals.

My issue has always been with the high charges, often unnecessary treatment and procedures, and not infrequently - miss diagnosis. The ethos of BPH is to generate as much income as possible from those who are able to pay.

However, in the times I have visited BPH as a patient, and also having taken my wife there, as well as guests from the UK, I have always received perfect and timely service and attention from all staff.

I am not saying this is the case with the OP, but I frequently hear and read about farangs having problems with service from Thais in walks of life and business, whereas I very rarely do, from the same sources. I know for a fact that many farangs are arrogant and demanding in their dealings with Thais, and that this often results in Thais responding a like manner.

"Do unto others as you wish them to do unto you", and you will have a much more pleasant stay in LOS, and how about learning a bit if Thai? It works wonders.

[Sheryl]

Just to return again tio the "vital sign"issue -- which is quite a different matter from the issues of over-prescribing and the like --

1) In most hospitals and also many doctor's offices, taking vital signs on arrival is policy. In the case of a hospitals, failure to do so would affect accreditation. When a patient refuses to let staff do this, they put the staff member in the awkward position of being unable to compkly with their own job requirements. You can refuse anything you want to, but when it ios something that is medicall indicated or required by hospital policy you'll need to sign a paper indicating your refusal and releasing the hospital of liability. The poor staff member who takes routine v ital signs (who is usually just a nurse's aid) is in no position to arrange this, would have to inform higher ups who would inform higher ups and being Thai they are very afraid to do this. And the whole bit would involve far more time and trouble than simply going along with this very quick procedure.

2) No adcditional costs are incurred by having your vital signs taken and none are saved by refusing.

3) As to why it is necessary:

- while you are a patuient in the hospitalm, they are responsible for your welfare. It happens that people coming in for another reason suffer heart attacks, strokes, falls etc. In dealing with this it is important that the staff have readily available to them baseline vital signs to compare with. If they should have to give emergency treatment they will need immediate access to an accurate weight to determine dosage.

- some people faint during or after having blood taken. In order to make sense of this, i.e. determine if it's just a reflex faint or something more serious, again they need to know what your vital signs were before hand.

- a fair number of people suffer from conditions such as hypertension without knowing it. The routine taking of vital signs is often the first point at which such problems are found.

These are just a few reasons for this standard practice.

You should be much more concerned with a place which does not take and record your vital signs on every visit.

[robblok]

I hear everyone say about no costs are charged for the blood pressure thing. I was in a hospital in Nothaburi last week and they did charge me for it they in fact took my weight and my blood pressure 2 times and i got charged for it twice. It wasnt that much 60 bath a time but i was beeing charged.

[Bagwan]

Suffice to say in precis that I do not willingly submit to being afforded poor service for which I am paying. Most sentient farangs would understand and accept this since, they too have voted with their feet, and left their native countries where their lives proved to be less than satisfying, to come to live here in Thailand where they find life more amenable.

I should apologise for my ignorance in not being fully conversant with WHO rules and regulations. I am quite sure however that they do not make it mandatory to follow laid down guidelines. I choose to be adult, exercise my options and to take responsibility for my body and not subcontract it to persons whose capabilities are, to me, unproven. When I find a doctor who can walk on water I promise to follow his/her instructions implicitly.

[JSixpack]

I agree completely w/ Sheryl and other posters who have told you that the vital signs check is a common practice, necessary, and a very good thing.

In fact your service wasn't poor, though probably nobody wants to serve you with that attitude. Mobi's experience, for example, is typical and his is the sane and reasonable perspective on the matter.

If some condition went undetected or misdiagnosed or you suddenly fell over in the doc's office and then discovered that the vital signs would have prevented or ameliorated the problem, you'd be screaming incompetence at the hospital and threatening lawsuits and whatever. Why should the hospital take your word for it? That would be stupid and poor care on their part. You can't ask the hospital to take responsibility for your care then claim that it doesn't have any responsibility.

Edited June 11, 2008 by Sheryl
civility