Chiang Mai Ram I Hospital

[Mapguy]

The last "organized" discussion I could find on Chiang Mai Ram I Hospital (NW corner of the moat), which is obviously used often by the expatriate community, is dated about two years ago. This is an invitation to discuss this hospital specifically, not other hospitals, in an attempt to focus the discussion. Perhaps others will start topics on the other hospitals for specific discussions about them.

There is an emotional but interesting story in this week's Chiang Mai Mail about inpatient service in the "FeMail" column.

My own personal experience with outpatient service has been mixed. Expressing a particular concern, I question the service provided for routine periodic physical examinations.

The physician (4th floor) who is generally available seems very, very cursory in his approach. The physical includes a variety of laboratory tests (blood, urine, EKG, xray) depending in part on the age and gender of the patient, but the physician does not determine what tests should be taken in an initial interview. That is done by a nurse who plays it "by the numbers" presenting the customer with a computer screen of choices like a menu from which the customer should select the appropriate tests. She functions more like a waitress than a medical professional.

There are quite a number of lab tests available, one of the most elaborate of which is an abdominal ultrasound done by a specialist. The "attending" physician does only the most cursory physical exam. In fact, temperature is not even taken, nor any examination of reflexes, eyes, ears, nose, throat or "nether regions."

After the work is done and evaluated, the results are available for analysis by the attending physician who, again, provides a cursory report unless pressed about the meaning of the tests or about their effectiveness for diagnostic purposes. This is wrapped up in a package, which is paid for in advance --- USD 500 or more for a fairly complete lab workup.

[Dustoff]

The last "organized" discussion I could find on Chiang Mai Ram I Hospital (NW corner of the moat), which is obviously used often by the expatriate community, is dated about two years ago. This is an invitation to discuss this hospital specifically, not other hospitals, in an attempt to focus the discussion. Perhaps others will start topics on the other hospitals for specific discussions about them.

There is an emotional but interesting story in this week's Chiang Mai Mail about inpatient service in the "FeMail" column.

My own personal experience with outpatient service has been mixed. Expressing a particular concern, I question the service provided for routine periodic physical examinations.

The physician (4th floor) who is generally available seems very, very cursory in his approach. The physical includes a variety of laboratory tests (blood, urine, EKG, xray) depending in part on the age and gender of the patient, but the physician does not determine what tests should be taken in an initial interview. That is done by a nurse who plays it "by the numbers" presenting the customer with a computer screen of choices like a menu from which the customer should select the appropriate tests. She functions more like a waitress than a medical professional.

There are quite a number of lab tests available, one of the most elaborate of which is an abdominal ultrasound done by a specialist. The "attending" physician does only the most cursory physical exam. In fact, temperature is not even taken, nor any examination of reflexes, eyes, ears, nose, throat or "nether regions."

After the work is done and evaluated, the results are available for analysis by the attending physician who, again, provides a cursory report unless pressed about the meaning of the tests or about their effectiveness for diagnostic purposes. This is wrapped up in a package, which is paid for in advance --- USD 500 or more for a fairly complete lab workup.

As with past threads about CM Ram and other local hospitals, you will get only subjective opinions which will vary greatly.

CM Ram seems to be about as good as any in this town and I go there for basic yearly tests which I choose in cooperation with my doctor who is more than willing to discuss any changes in my physical experience over the last year and the tests that I would to have performed.

In anyone's experience, finding a good/communicative diagostician is like finding a capable car mechanic. If you don't like the treatment you get from one, investigate others.

CM Ram is fine for common ailments and tests (altho their x-ray quality has been poor over the last few years and I go elsewhere since they seem to have no interest in repairing it), but for anything serious, I would head for Bumrangrad in Bangkok. But, even there, I would suggest caution and investigating your suspected ailments yourself because if you think physicians are elitist in your own country, wait til you experience them in Thailand.

Since I believe that most ailments will show up in very complete blood labwork and have need to keep an eye on my heart, I see a very good Cardiologist who is at CM Ram in addition to his own clinic.

Best of luck and health...

[nikster]

If you go to a place that sells medical treatment, and ask them "what's wrong with me", that's generally not such a good idea. The ethics at RAM are very much bent towards selling services, which should really not surprise anyone. How else would it be?

In addition, western medicine is best when fixing a broken bone or doing something else that's obvious and doesn't require a holistic approach. Use the RAM in an emergency. Otherwise, use chinese doctors, there are several very good ones in Chiang Mai. Or for serious scheduled surgery or something like that, one of the big ones in Bangkok.

My last experience there was a natural birth of my son and I have to say the nurses at the RAM were really the best. There were always three nurses around throughout the entire labor, and they were helping, advising, and generally doing everything that could possibly be done - I was there to help but ended up standing back and letting the professionals do their job since they were obviously in total control of the situation. The biggest help I could provide was to get out of their way

We used a doctor from outside the RAM for actual delivery so don't know about that.

On the way out, we got seriously overcharged for everything and anything. Typical RAM

[mouse]

I was recently examined and treated at RAM. After receiving help from a well versed friend in what test to get, I was off to the Hospital. Although a bit steep for the battery of test required by Thai standards, I was more than satisfied with the test and follow up report. The same treatment and test would have cost more than triple in Europe or in the States.

Edited June 11, 2008 by mouse

[Ulysses G.]

I have only had good experiences with Ram Hospital and also its Dental Clinic where I always go for anything that might be serious.

[PeaceBlondie]

I have only been to RAM for emergency shoulder surgery, July 2005. I guess they did a good job. Later it got infected and my surgeon at Ram just provided antibiotics, which did nothing. I finally got the needed surgery at Maharaj, after the best in Bangkok could do nothing, either.

I will use Doctor Rashada at Ram if I need something special in the way of ophthamological prosthesis, but her colleague down the road is good for everything else optical.

During recovery, the room at Ram was just as nice as the one that I used twice down the road, and the nursing care equal. In my limited experience, I find Ram to be no better or worse than Sripat-Maharaj.

[mcgriffith]

I was there on Monday, day before yesterday.

Without going into a lot of detail, suffice to say I had a sore throat that persisted for nearly a month (anything more that 10 days/2 weeks is not good), accompanied by swollen lymph nodes under my jaw, and general fatigue and malaise. In other words, I felt like cr_p for 3+ weeks.

I first went to our friend at Loi Kroh Clinic- Dr. Tawatchai about a week prior. He thought it might be a sinus infection, took x-rays, and prescribed antibiotics and an antihistamine.

I wasn't getting any better, and on Monday I went to Ram. At 11 AM they gave me an appointment same day at 1 PM with one of their ENT (ear nose throat) doctors. Came back at 1, saw the doctor, who did a thorough physical exam, and listened carefully to my recounting and time line of all the symptoms. Diagnosis? Sialoadenitis, an infection of the sub mandibular salivary glands. Caused by dehydration mainly, with advancing age also being a factor. He told me drink lots more water, cut down on dehydrating beverages (alcohol, caffeine), and showed me how to massage (yes massage!) the glands to help expel the infection. I turned down the offer of antibiotics as he said they really weren't critical at this stage.

I have to say I was impressed by the level of care and the expertise of the doctor.

Of course, I was charged about 4 times the going rate for this office visit- 400 THB. That's Ram Hospital for you....

Still worth it, to me.

[Maejo Man]

Diagnosis? Sialoadenitis, an infection of the sub mandibular salivary glands. Caused by dehydration mainly, with advancing age also being a factor. Of course, I was charged about 4 times the going rate for this office visit- 400 THB. That's Ram Hospital for you....

Still worth it, to me.

Bottom line Macca.......was the diagnosis correct, and are you improving?

[richard10365]

My expierence with CM Ram is they will over charge you. You have to look at your bill very closely at CM Ram. Pay particular attention to the amount your insurance covers and the amount they want you to pay. They over charged me 4000 baht. Which I eventually got back and showing them their mistake. I suspect it happens more than not.

[JuniorExPat]

Chiang Mai Ram is my hospital of choice for all of my family. I have never had a serious complaint, most of the complaints I hear relate to cost and to those people I usually say "insurance".

I regularly hear good things about Suan Dok but have yet to follow up on my intention to try them out, consequently I only have McCormick and Rajavej to compare them to. Although I would still use Rajavej for minor matters, I would never allow anyone I cared about to go to McCormick.

I have a few provisos regarding Chiang Mai Ram:

- always check the bill and when possible ask for confirmed costs prior to any major procedure or treatment

- do not forget that you are not only the patient but also the customer

- there is a note on my file and my children's files that antibiotics are not acceptable unless critical/chronic

- more often than not I will purchase any prescribed medication that is not covered by insurance outside of the hospital

The majority of the children's, the pre-natal and the post-natal staff are excellent. There is a large pool of doctors at the Ram and you can "shop around" within the hospital (see the second of my provisos).

JxP

[vagabond48]

Before I left the US late last year, I had a minor bicycle fall. At the beginning of this year, I went to to RAM to have my hand checked out by a "specialist" since it wasn't improving (fast enough for me). He looked at it and said nothing was wrong except some trauma caused by the fall and prescribed medicine to reduce the limited inflamation. I checked the web and found the med was removed by Merck for FDA approval. He did not suggest any exercise regiment or even to see a physical therapist. Upon recommendation of a TV member, I want to another specialist at his private office and he checked out my hand out. He said I didn't need any medicine, just daily exercise and that it would take along time to return to normal. He had a physical therapist in the office, who gave me a number of exercises to do. I felt he was much more attentive to me than the doctor at RAM. Of course, the lack of attentiveness by the RAM doctor may not be a reflection of the hospital but rather his personal trait.

Having gone to RAM several times, I have found except for the doctors at RAM, the nurses do not have a decent command of the English language. Since I believe most good doctors speak English pretty well, the limited language skill at RAM didn't match my perception of it being farang language friendly hospital.

So, what's so special about RAM?

I am wondering if the specialist' at RAM or other hospitals typically have their own private practice and if "yes", whether they would be much more attentive since it is their name on the door sign and they wouldn't be sharing the responsibility or loss of face with their hospital?

[mcgriffith]

Bottom line Macca.......was the diagnosis correct, and are you improving?

Thanks, MM for your kind concern. Yes, it appears the diagnosis given at Ram was correct. I stopped all the antibiotics, have been drinking copious amounts of water, etc. Seem to be improving.

On a side note, I will mention that I am also a patient/customer at Maharaj (Suan Dok) hospital. I go there yearly for my physical exam. Their prices are about 50-60% overall of the same tests offered at Ram for blood work, x-rays, etc.(I've done a line-item comparison). I still intend to go there in a month. The reason I didn't go to Maharaj on Monday was that as good as the hospital is (I refer to the Special Clinic on the 13th floor) it is a bit of a zoo; rather crowded and busy and noisy. Also Thai language abilities much more necessary there. When you feel like cr_p and the room is spinning, one doesn't want to sit in a busy crowded waiting room with loudspeakers going off constantly.... If you have a favorite doctor there who you know and trust (I don't) I imagine it would be much more pleasant at Maharaj- make appointment and go directly to that doctor's office.

[tigerbeer]

JxP made some good points on what to look out for while visiting RAM.

My main complaints would be:

-Incompetent pediatrics department who are always quick in prescribing antibiotics.

-100% overpriced pharmacy. Tell them you rather buy your medications outside. And tell them why!

Yes i still visit Ram cause I do not know where else to go to.

[Mapguy]

Regarding the pharmacy and drug prices at Chiang Mai Ram I, I have had limited experience with a limited number of drugs. I do not normally go to the bother of comparing prices among pharmacies. Recently, however, given the need for a large supply of two medications, I did do a cost comparison with two "chain" pharmacies that was easy to do. No "back alley" or Internet deals! One drug was 42% higher in cost at Ram I than in a local pharmacy; another was 33% higher.

I suspect that comparisons are not consistent, but I would not be surprised to find the hospital generally charging more than you might otherwise have to pay. For small quantities of most drugs, the cost difference is probably not significant, but it could well be of benefit to shop around. For that you might need to request a separate prescription from the physician instead of the order normally provided automatically for fulfillment at the hospital pharmacy.

[Mapguy]

I have only been to RAM for emergency shoulder surgery, July 2005. I guess they did a good job. Later it got infected and my surgeon at Ram just provided antibiotics, which did nothing. I finally got the needed surgery at Maharaj, after the best in Bangkok could do nothing, either.

I will use Doctor Rashada at Ram if I need something special in the way of ophthamological prosthesis, but her colleague down the road is good for everything else optical.

During recovery, the room at Ram was just as nice as the one that I used twice down the road, and the nursing care equal. In my limited experience, I find Ram to be no better or worse than Sripat-Maharaj.

There are differing opinions about physicians, but I'd like to second this recommendation for Dr. Rachada.

[Ajarn]

I have found a good doc at CM Ram 1, and I have been going once a month. No problems with anyone at all. Everything goes as I expect it. I have always felt that your hospital experience depends largely on your doctor.

[PeaceBlondie]

I think McGriffith, who can be more thrifty with his baht than a legendary Scotsman, only complained that he was charged 400 baht for a thorough exam, diagnosis, and advice from a highly qualified surgeon at Ram. Heck, I usually pay 350 baht for the same at Sripat-Maharaj. I thought most specialty surgeons at Ram charged more like 800 for a visit.

[Ajarn]

I think McGriffith, who can be more thrifty with his baht than a legendary Scotsman, only complained that he was charged 400 baht for a thorough exam, diagnosis, and advice from a highly qualified surgeon at Ram. Heck, I usually pay 350 baht for the same at Sripat-Maharaj. I thought most specialty surgeons at Ram charged more like 800 for a visit.

I thought that 200 baht was the standard fee to see any doctor, 400 baht if you're a patient there. Anyway, it has always been the price I've paid at Ram..

[ProThaiExpat]

The foregoing posts seem "spot on" in my experience, about thirty days inpatient last year and four surgeries.

Each time I went in, I took more of my own medicines that I anticipated needing in with me. Doctor cooperated by indicating no meds unless patient asked in advance if he wants them. No paracetamol, per their standard dose at an outrageous price.

I actually got better nursing care on the 12th floor in a non falang wing than I did on the falang floor. However, since the electric bed costs 500 a day extra, if you want it in a non-falang floor room, your cost is the same.

I found the nursing care to be mostly poor, the real nurses stay at the nurses station and work the charts and send in the lowest common denominator to service the patients complaints.

Had to remind them the catheter should be removed, they were clueless which leg was broken when they moved me or rendered care to my leg, etc. But then again, most restaurant staff arrive at your table and are clueless who ordered what, so I wasn't shocked the nursing staff was not much better.

Yes, injections were professional. In four inpatient visits, they never mastered the art of keeping the tape on the IV shunt. The last time in, when they were about to put my ID bracelet on, I did it myself and passed it over the IV shunt and closed it relatively tightly, thus the IV tape didn't come loose and the shunt was secure, thanks to the ID bracelet.

An the beat goes on.

The post regarding their x-ray machine is not up to date, they bought a new xray machine about six months ago.

You guessed it, I feel I am responsible for the level of care I get, I am not a passive patient. Thus I usually get good care and I am pro-active.

I went into emergency on a Friday night, evening and weekend orthos are CMU Med School Professors. Thus mine ended up well qualified and his assistant surgeon was one of his seniors at CMU Med School.

I asked if it would be easier for him if I came to Marejev for follow up care (The government hospital affiliated with CMU Medical School) where the professors spend most of their time, and he said no, the waits are very long and Ram doesn't charge that much more for more agreeable service.

I had laser eye surgery at Ram a few years ago and their equipment was not the latest. Result was fine.

Dermatology is good, both doctors are excellent and good on laser, but the young female doctor is more agreeable and much better bedside manner.

I would stay miles away from their Plastic Surgeon, and one of the doctors there

confirmed my opinion.

My own experience with their Cardiologist, Dr. Pat, was good and I have read nothing but good things about him from others.

Need anything more specific from me, PM me anytime.

[Rotweiler]

I think it is time to jump into this topic....

My wife became ill in late January and after some questioning of locals, we went to the RAM Hospital. After almost immediate Triage, she was referred to a specialist within 30 minutes, who ordered immediate tests and when those were inconclusive, made an educated guess that turned out to be confirmed by the MRI performed within 30 minutes.

The diagnosis as well as the recommended treatment program were later confirmed by our NoAm specialists as being right on the mark.

We found the staff efficient and courteous and very well trained, and we were NOT over-charged!

Accolades to Dr. Sampote and the entire hospital.

[JuniorExPat]

Each time I went in, I took more of my own medicines that I anticipated needing in with me. Doctor cooperated by indicating no meds unless patient asked in advance if he wants them. No paracetamol, per their standard dose at an outrageous price.

I hadn't considered doing this as an in-patient - excellent to know that it can be done and, I assume, without conflict.

You guessed it, I feel I am responsible for the level of care I get, I am not a passive patient. Thus I usually get good care and I am pro-active.

Essential, it seems, in any hospital (medical care retailer!) these days.

Dermatology is good, both doctors are excellent and good on laser, but the young female doctor is more agreeable and much better bedside manner.

Agreed, I'd probably add "cute" as well!

My own experience with their Cardiologist, Dr. Pat, was good and I have read nothing but good things about him from others.

The ever growing fleet of Chiang Mai Ram "Heart Attack Ambulances" would seem to confirm this.

JxP

[ThaiPauly]

Most of the posts on this thread have been positive.

They have some good doctors, Sompoj & Tossaporn and some very bad ones.

I told the story of why I will not set foot in he place again 2 years ago, where they nearly killed me whilst doing a very simple procedure.

I will not go into all the details again, the story was told in June 2006.

However many seem satisfied with the service and level of care they provide, which is good.

TP

[Mapguy]

An item and a question:

1. Bills: Yes, they are worth checking, but an error I discovered was rectified with a cash refund very, very efficiently and quickly 9even though I had paid by credit card). It was an honest error, and I received an apology. I think it is fair to say any hospital bill anywhere should be checked.

2. Surgery: Does anyone have experience or opinion to share about Dr. Sumeth Handagoon?

[Shah Jahan]

firstly I want to say that I have had great personal experience at CM Ram

had a son born there no hitches - very pleased

and also a few months ago was pleasantly surprised upon visiting the ENT for an ear sucking that he did not prescribe anti-bodics-

so I have had great experiences

on the other hand there was a very nice older gentleman that some of us knew (now passed on) that swore on his deathbed that the place in question killed him. Something about a botched and unnecessary surgery and infection.

We also knew another (now passed on too) that claimed a similar thing. whatever the truth is I dont know, but that is what was said.

but really its probably like the guy who fixes your motorbike, If you stand over him and watch closely, he will do a great job - but if you just dump your bike on him and come back later in the afternoon- then he will probably be drinking red bull and forgot all about your bike

[Blinky Bill]

The foregoing posts seem "spot on" in my experience, about thirty days inpatient last year and four surgeries.

Each time I went in, I took more of my own medicines that I anticipated needing in with me. Doctor cooperated by indicating no meds unless patient asked in advance if he wants them. No paracetamol, per their standard dose at an outrageous price.

I actually got better nursing care on the 12th floor in a non falang wing than I did on the falang floor. However, since the electric bed costs 500 a day extra, if you want it in a non-falang floor room, your cost is the same.

I found the nursing care to be mostly poor, the real nurses stay at the nurses station and work the charts and send in the lowest common denominator to service the patients complaints.

Had to remind them the catheter should be removed, they were clueless which leg was broken when they moved me or rendered care to my leg, etc. But then again, most restaurant staff arrive at your table and are clueless who ordered what, so I wasn't shocked the nursing staff was not much better.

Yes, injections were professional. In four inpatient visits, they never mastered the art of keeping the tape on the IV shunt. The last time in, when they were about to put my ID bracelet on, I did it myself and passed it over the IV shunt and closed it relatively tightly, thus the IV tape didn't come loose and the shunt was secure, thanks to the ID bracelet.

An the beat goes on.

The post regarding their x-ray machine is not up to date, they bought a new xray machine about six months ago.

You guessed it, I feel I am responsible for the level of care I get, I am not a passive patient. Thus I usually get good care and I am pro-active.

I went into emergency on a Friday night, evening and weekend orthos are CMU Med School Professors. Thus mine ended up well qualified and his assistant surgeon was one of his seniors at CMU Med School.

I asked if it would be easier for him if I came to Marejev for follow up care (The government hospital affiliated with CMU Medical School) where the professors spend most of their time, and he said no, the waits are very long and Ram doesn't charge that much more for more agreeable service.

I had laser eye surgery at Ram a few years ago and their equipment was not the latest. Result was fine.

Dermatology is good, both doctors are excellent and good on laser, but the young female doctor is more agreeable and much better bedside manner.

I would stay miles away from their Plastic Surgeon, and one of the doctors there

confirmed my opinion.

My own experience with their Cardiologist, Dr. Pat, was good and I have read nothing but good things about him from others.

Need anything more specific from me, PM me anytime.

You're a mess.

[cloudhopper]

My wife and I have both received good care there. Very accessible. Sure some of their prescribing practices are over the top but that can usually be dealt with. I had a crown done at their dental clinic several years ago that has done well. The reading and distance glasses prescribed by the eye doc there after a thorough exam were both spot on. Sometimes I have cultural issues with the docs there but this would likely be the same or worse at another hospital.

[eek]

Im not a huge fan of Ram personally. Reason why is here (scroll to post #11 if you want to read the section quickly about why I distrust Ram): http://www.thaivisa.com/forum/Hypothyroidi...;hl=hypothyroid

I now go to Suan Dok, where I am given excellent advice and care (as well as a healthier bank balance). I agree, its not the easiest place to wait around in (loud tanoi (sp?), hot and packed full of people). If I have something small to take care off, or quick, I will visit Ram, but for anything important I doubt their level of care and motives im sad to say. The Docs come across as very competent, and give the impression that they are 100% sure about their diagnosis, but I have lost faith after the turmoil my health went through over such a long period of time.

(Suan Dok accurately diagnosed me with Hashimoto's Thyroid condition and I now take just a small inexpensive pill every day to counter act the imbalance).

Edited July 13, 2008 by eek

[PeaceBlondie]

I know this is a thread about CM Ram I, but we keep comparing it to the far larger medical complex down the road, outside Suan Dok Gate. Maharaj is immense, and the Special Clinic on the 13th floor of the Sripat Building is air conditioned, not too crowded, and staffed by excellent caregivers. Only twice have I had to wait with the masses of Thais who were on the 30-baht scheme. But that was for a special surgical consultation that nearly saved my life, so no complaints (and my follow-up after surgery shifted to a private clinic).

Because Maharaj is a huge public hospital, and the surgical suites are fully scheduled, I once had a choice of waiting three days in the general ward of Maharaj to get my surgery, and I didn't want to wait six hours, So I went to Ram and was quickly operated on. Later, the massive bacterial infection in the surgical wound was probably not Ram's fault. I suspect that for most things, nobody does it better than Ram, but some places do it just as well, and slightly cheaper.

[Blinky Bill]

I know this is a thread about CM Ram I, but we keep comparing it to the far larger medical complex down the road, outside Suan Dok Gate. Maharaj is immense, and the Special Clinic on the 13th floor of the Sripat Building is air conditioned, not too crowded, and staffed by excellent caregivers. Only twice have I had to wait with the masses of Thais who were on the 30-baht scheme. But that was for a special surgical consultation that nearly saved my life, so no complaints (and my follow-up after surgery shifted to a private clinic).

Because Maharaj is a huge public hospital, and the surgical suites are fully scheduled, I once had a choice of waiting three days in the general ward of Maharaj to get my surgery, and I didn't want to wait six hours, So I went to Ram and was quickly operated on. Later, the massive bacterial infection in the surgical wound was probably not Ram's fault. I suspect that for most things, nobody does it better than Ram, but some places do it just as well, and slightly cheaper.

I often wondered about you Pee Bee. So the special surgical procedure didn't quite save your life? You've done a reasonable impersonation of a live person everytime I've seen you.

[jaideeguy]

over the last decade, I've had good and bad experiences with Ram 1 [like most hospitals] and have seen their prices go up and their maintenance go down, so that it is becomming quite run down. In their favor, they are the falang friendliest hospital around town, but you pay 2x the price of other hospitals, especially when they 'over prescribe meds'. For most routine complaints, I patronize Ram2, where the prices are half of ram1 and fewer specialists, but quick cheap service.

And I take all doctors [both here and in the west] with a huge grain of salt and always confirm diagnosis and drugs with 'DR. GOOGLE'.