Don’t Reject Good Advices From Your Doctor

[smokie36]

Ultimately it's a judgment call.

I've lived in Bangkok over 20 years and I could share a long list of 'mistakes' my family has experienced at the so called '5 star' hospitals, including most recently with my 4 year old grandaughter, took her to one '5 star' place three times in one evening, every time a quite different diagnosis, on third visit we inisted/demanded that she be taken to a ward for further close observation. Next morning the childrens outpatients doctor we had seen many times before (same hospital) came and gave another different diagnois which subsequently turned out to be correct. I complained bitterly, never had any response from the hospital. I could go on with a long list.

Seems to me:

- There are good doctors who are very genuine and very profesional in their diagnosis and care.

- There are doctors who are lazy and not very capable.

- There are hospitals which are so called '5 star' which are only interested in how to jack up the bill.

Somehow we all must make a case by case judgment call.

Good advice. I have worked in many hospitals in the UK over the last 20 odd years. The level of treatment and care has varied hugely. Some places I was simply disgusted with the treatment dished out to patients by doctors/ other so called professionals. A few places are superb. Most fall into the OK category.

With regard to the question of private vs government hospitals I can speak from only a UK perspective. Here in the NHS you can choose the consultant who is in charge of your treatment but the person who actually carries this out may be his junior(how do you think they gain this experience?) and the consultant may not even be present.

In private hospitals you can be certain this will be carried out by your consultant.

I can't imagine this situation is any better in Thailand and its more likely as one poster pointed out that your consultant is if not enjoying a round of golf then busy looking after his private interests. This situation has changed with new contracts etc in the UK but in Thailand....I doubt it.

When I eventually move full time to Thailand I will have good medical insurance and I recommend all TV readers to do the same.

[BusyB]

Recently I got very sick and was taken to a good hospital in our region where I have been registered since many years. As my condition was serious the doctors wanted to put me into intensive care unit which I first refused. The reason why I at first rejected it was I have heard so many stories about the hospitals trying to do anything to increase their profit. I gave in only after a doctor told me straight on it was a must due to my condition and according to his opinion as a doctor anything else would be suicide.

After a night at their intensive care unit I was removed to an international hospital in Bangkok and they managed to cure my illness in a very professional way. At that time cost did not matter at all and the money spent have been very well used. I am now slowly recovering but home again and very happy looking forward again.

Why do I post this? I want to tell all readers that in this case my suspicions about farangs being overcharged – and my dislike of it – almost ended my life. From now on I will trust the hospitals and try to listen and understand good advices.

I don't want to take issue with the negative posts here. But in my experience most doctors want to treat someone successfully. Same as anyone wants to be successful at what they do. And the best are those who are happy wth patients who ask questions, disagree, and work with them together to find the solution to a problem. If they don't like answering my questions I go elsewhere. But I also remember they've been through medical school, not me. Here's a cuppla my experiences.

2006. Kata. Lolling at the pool a day after completing a rescue divers licence. Suddenly I'm gripped by stark chest pains. Feels as if a rib-eye steak's stuck in my gullet. Finding it hard to breath. I have no previous heart condition, but know that the worst kind of  angina pectioris is the kind that strikes at rest, not when under physical stress. It is life threatening.

Taxi. Patong hospital. Present myself at reception. Explain condition, they ask me to take a seat at the back. I refuse, repeat the symptoms, insist I may be about to have a heart attack and wanna see a doctor like NOW!. All with a smile of course. I don't like doing that. In Bangkok I was once offered to be fast tracked for a minor ailment past a waiting room with masses of huddled suffering. I refused and waited over three hours with the rest, for obvious reasons. 

This time I got my doctor fast and an ECG. No irregularities. But he said if I was worried (I was) I should maybe go to BKK-Phuket over the hill, and see a cardiologist. Cost so far ca. 500B. Covered by (affordable, European) private insurance.

Taxi. Cardiologist. Stress ECG. Swift, professional, friendly, competent. The way it should be. He finds nothing wrong, says it's just rib-muscle cramps. When I question that he says with a smile "Look, if I had the slightest suspicion, if there was the slightest murmur, I'd be stenting you in my surgery right now - it's what I live off." Then he asked me if I'd had any stress recently. On thinking I realised I'd finished with my girlfriend of 2 years just before leaving for Phuket, and with the travel, diving tests etc. hadn't really had time to come to terms with it properly. A broken heart that simply wanted to be heard that's all. But at least I knew that now, and it was better than risking a heart attack. Cost, a few thousand B, paid by (same same) private insurance. He could possibly have earned a small car off me if he'd wanted.  

Compare and contrast with this:

A European hospital on Xmas Eve last year. I've come off my (push) bike at 2 in the morning on my way home from work. High speed, flat-slam-down-hard on my left side, roll three times, split my head open on a wall, can barely move or breathe, bleeding. Making strange noises.

Ambulance. A+E at a city centre hospital. They find no serious damage. 5 x-rays. Still no serious damage evident. Can still barely move or breathe. Need 2 stitches in my forehead. Then they want to send me home. I say "you're joking - after doing that to my head?" "Oh," they say, "if you get dizzy you can call an ambulance." "If I get dizzy I'll press the red button next to the bed you're gonna fix me on one of your wards right now! - get it!?"

I got my bed. Ultra sound scan - still no damage uncovered. The doctors upstairs were horrified A+E'd tried to send me home after a head-butt into a wall like that. So there were some professionals in the place - I just had to locate them.

Long story short: My own physician found the 2 broken ribs. An MRI scan found the smashed hip socket. I was off work for 6 months on almost full pay. That and all treatment paid for by employer's mandatory insurance, because I was on the way home from work. (Communist I tellya - think of all the money they could have given to the bankers while bankrupting me instead of healing me!).

So ... most doctors want to help. Some are better than others. A few are downright cr*p. Another few are undoubtedly scoundrels. Anywhere. But you are ultimately responsible for yourself as long as you are conscious and lucid. Anywhere. Anytime.

[Sam125]

As some have posted there are good and bad people and doctors everywhere - end of story.

There is a another reason many drugs are prescribed in Thailand and elsewhere at times - people want them.

I have spoken to doctors with a smile and asked for only what I need and they have always done just that.

The doctors have also told me which drugs can be bought at a lower price outside the hospital - some simply can't be found at any price outside a pharmacy.

[crocodilexp]

A doctor is usually an ethical and knowledgeable professional. However, they are also always a service provider with an agenda[/b]. In private healthcare, the doctor's agenda is first and foremost to bill you as much as possible, while still improving your health and giving you the impression of competence.

In Thailand, since you pay directly, doctors have every incentive to increase the quantity of procedures and medicine they sell you. When incentives are different (e.g. state pays, HMO pays), doctor's agenda is different.

Be informed and use your doctor as a resource to find out what needs to be done. Ask questions, check which procedures or medicines are required and which are optional, examine alternatives.

[thaibkk]

from my experience, doctors, even in the most expensive one's are 10-20 years behind...

if children are sick, they will automatically give anti-biotics... for soar throat, for some fever, and other useless things...

they will give now and do a culture of mucus or whatever later...

giving antibiotics for anything and everything, specially virus where it has no effect is damaging the body

but try to explain that to thai family...

it is like old people in western countries: they go see the doctor and pressure him to prescribe even useless medications....

my 2 satang...

[Sam125]

from my experience, doctors, even in the most expensive one's are 10-20 years behind...

if children are sick, they will automatically give anti-biotics... for soar throat, for some fever, and other useless things...

they will give now and do a culture of mucus or whatever later...

giving antibiotics for anything and everything, specially virus where it has no effect is damaging the body

but try to explain that to thai family...

it is like old people in western countries: they go see the doctor and pressure him to prescribe even useless medications....

my 2 satang...

Actually many people old and young ask for the medicines perhaps more in Thailand than the West (not sure..) so it really is not the fault of the doctors unless you feel that they should hold their ground and "just say no" which probably is what they should do in a perfect world.

As for cultures they take time and cost money - again in a perfect world where cost was not an issue they would be done but they are expensive and if there is a good chance that a patient can have pain relieved and their health improve because they take antibiotics on a chance then it is a calculated gamble that should be made by a good doctor and patient together.

As for being 10-20 years behind - yes, new doctors will have more more modern training but less experience. Really good doctors will have both.

[Thunder26]

My (former) Thai doctor used to beg me to take (buy) the unnecessary pills that he prescribed for me because he told me that the hospital management had a sales quota for him to achieve. If he didn't push a certain amount of pills, he would get a dressing down from his boss. (Once, one of the pills on my hospital bill was described as a "pain killer" - and I was charged fifty baht a piece for them. Upon closer inspection, this pain killer turned out to be paracetamol - with the hospital's name stamped on the side of it - presumably as a way to add value.)

I tried to explain to him that by selling people pills that they didn't need, he would end up losing customers. Alas, Thais can't think that far ahead - and my prediction came true: he lost me as a customer.

Agreed. In my experience, going to Thai hospitals, you should expect being prescribed a huge variety of medicine with the statement "drink till the end". What I do, if I really feel bad, drink only what I believe is good for me after checking the medication in the internet. Then if I feel better in 2 days, I just stop drinking them and keep those pills in my box, in case if I get sick again through the time (no need going to see a doctor if I have the same symptoms again, like earache or flu). Antibiotics will never make your body stronger, so I don't see the point drinking a pile of them for 1-2 weeks even if your disease left your body in 2 days.

[chiang mai]

For JRinger - apologies but it seems I cannot quote your post:

This is a difficult one. Angioplasty is the preferred method of intervention in heart attacks and it is a very successful procedure. An alternate approach is to thin the patients blood using anti coagulants such as Plavix and Aspect and both approaches have, according to latest Mayo Clinic findings, the same morbidity rate outcome. But in an ER environment I suspect that using the anticoagulant approach is high risk since the attack has already taken place. I'm not qualified to dispense advice on this subject since I'm not a physician but I have had angioplasty and I do take anticoagulants and from what you wrote it sounds as though your friend was very fortunate. His inherent distrust of Thai doctors could easily have cost him his life!

As for the broader picture on health care here and the quality of physicians: I rate Bumrungrad physicians very very highly, at least the ones that I have had contact with. I trust my cardio without any reservation and would travel to be seen by him from anywhere in the world, if I have choice. I can think of others I have seen at Bumrungrad who also have my complete confidence. As for lesser regional hospitals, I have no experience, thankfully.

Edited August 9, 2009 by chiang mai