Thai Hospital Which Doesn't Force Their Medicines

[jfchandler]

I had a visit to St. Louis Hospital today re a possible minor infection. Saw the doctor, who correctly took a culture to determine if I had one, and if so, what kind... We talked a bit, and I thought he said he'd wait on any medication until next week when I come back for a follow-up to see the results of the lab test. In the consult, of course, he didn't mention to me anything about any specific medicines at all, and I wasn't expecting him to, since he had no test results to work with. The "wait for the results" approach certainly seemed the right one to me.

But when I went to the cashier to check out, and examined the proposed bill, I found two different medicines (without any names listed on the bill) had been charged. I told the cashier, no, no medication prescribed for me today. We went back and forth a bit. Finally she called the department, and I spoke to the nurse, who said yes, the doctor had prescribed two meds. I said, no, he hadn't. But she said yes, so at that point, I went back up to the department to talk to the doctor again.

Back in his office, after I explained why I was back, he said, I must have misunderstood him, because he said yes, he had prescribed two antibiotics. I asked, what kind did you prescribe. He answered, antibiotics. I replied, yes, I understand that, but what kind/brand of antibiotic. And finally then he told me the named medicines, both broad spectrum antiobiotics. I asked, why are you prescribing antibiotics today when you did a culture and will have the results back next week, and know then if I do or don't have an infection, and if so, what kind and what antibiotic would be suitable. At that point, he said something like, IF I had an infection, why not start the medicine now...

Politely, I told him at that point, I'd rather wait and actually see what the lab culture says, before starting any medicine, and, even deciding what the right medicine should be. At that point, he relented and crossed out the medicines on my document. Went back down to the cashier, gave her the revised billing statement, waited a bit, and got handed a bill for the second time that still included charges for the medicines.

Told her politely... NO.... no medicine today. Then apparently, she finally got the message, and after a few minutes, handed me a revised bill that FINALLY had the correct amount without any medicines.

Just to be clear, whatever I have, if I have anything, is a minor thing without any major symptoms or consequences. And the doctor knew, from me telling him, that it was something that I thought I might have had for some time. So it struck me as very strange that, after ordering up cultures, he would haul off and prescribe two broad spectrum antibiotics before getting the results in a few days that would 1) confirm whether I have an infection or not and 2) if so, what kind and what medicine it would be susceptible/resistant to.

I know the medical culture here is different than elsewhere. But the episode is one of those kinds of things that reminds and reinforces for me.... you really do need to be knowledgeable and responsible for your own health care decisions, and follow a prudent course, check on the medical advise you are given, inform yourself as to the potential side effects or other issues with any medicines you may be prescribed.

If you're trusting that you can rely on the doctor to always do the right things, and make the right calls, you're likely to find your trust betrayed.

[SurfRider]

"I asked, what kind did you prescribe. He answered, antibiotics. I replied, yes, I understand that, but what kind/brand of antibiotic. And finally then he told me the named medicines, both broad spectrum antiobiotics."

It would be interesting to know which two he prescribed and what the hospital attempted to charge-- and what you would have paid at some legit outside pharm like Fascino.

I recently had to buy a 14 day regimen of 500mg Cephalexin ( "Ibilex", etc, in Siam ) -- I checked Internet pricing to get some basic idea of cost and found the lowest pricing in Canada ranging from US$113 to US$130.

Sounded expensive to me, so I was prepared for the shock when I went to Fascino -- Well, I definitely got a shock, but not the one I was expecting -- 540 Baht ( US$16.12 ) for a 14 day supply! ( 60 capsules )

I told them that couldn't possibly be correct -- he said "is the price too high?" -- I asked them to check the computer again and they showed me the price on the screen. Needless to say, I departed a bit perplexed, but happy.

.

[jfchandler]

Surfrider, I don't know all the particulars, because today I didn't get into how many days of a supply the doctor had ordered up, and am not entirely clear on the name of the second medicine he was profering...

I do know two things... one of the meds was Cipro..and that by subtracting the two medicines out of my bill today, it reduced the bill by about 1,100-1,200 baht.

That doesn't tell me, or you, anything much about St. Louis Hospital's pricing for their meds. I'll cross that bridge next week when I go back and discover if I actually am in need of any medication!

[junkofdavid2]

As an update...

I still don't like the way Saint Louis "whisked away" the prescription before I could say "stop" and then "kinda" forced me to buy the medicines from them.

However, I checked with a reputable pharmacy today (in Paragon Supermarket) how much the exact same set of meds would've cost me in that pharmacy instead of at Saint Louis...

Surprisingly, Saint Louis was CHEAPER by around 500+ baht.

(2,500+ at Saint Louis instead of 3000+ at the outside pharmacy).

FYI.

[jfchandler]

A pharmacy in Paragon might not have been the best pricing comparison for the non-hospital market in BKK....

[junkofdavid2]

A pharmacy in Paragon might not have been the best pricing comparison for the non-hospital market in BKK....

Agree, but I wanted to compare it to a "reputable" pharmacy...

I go to pharmacy in my soi for simple cheap things like paracetamol, but I'm not too sure I'd trust him with heavy duty (and high risk) very expensive stuff like Celebrex. The temptation to sell copies of these expensive drugs is just so strong, because it is so high priced and thus, creating/selling a fake copy would bring very high margin to the manufacturer and/or seller.

[junkofdavid2]

As an update...

I went back to Saint Louis for a follow up session... and as per the suggestion of some posters above, I asked the doctor to give me the meds names instead. Absolutely no problem... so I guess you should just ask the doctor before he gives the list to the nurse who then whisks it away.

Moreover, just to compare, I asked the hospital pharmacy how much the meds would be if I got it there, and then later compared it to prices in drugstores outside.

I conclude that Saint Louis does not at all make a huge mark-up on med prices compared to outside drugstores I canvassed, and are sometimes even cheaper; as long as you compare the same brand.

However, what Saint Louis does NOT have are the local Thai-made versions... which are available in outside pharmacies, albeit difficult to find (even in these outside pharmacies).

After much looking, I was able to find an outside pharmacy selling a Thai-manufactured comparable medicine (same generic make-up) of Allopurinol 300mg, branded "Puride" for 2.50 baht each; and it seemed well-made and each tablet was individually packaged. Also, no harsh reactions in my stomach (as was my original concern, as allopurinol can have that effect on me).

In contrast, Saint Louis only had the very expensive brands Zyloric or Xandase for 19 baht each (Although at outside pharmacies, it can cost 20 or more each).

[lopburi3]

Also, no harsh reactions in my stomach (as was my original concern, as allopurinol can have that effect on me).

Not sure that is a good sign or not - it may indicate less active ingredient. There is a reason most hospitals (including Government) dispense name brand if you can afford them. That said I am all too aware of the ripoff price of Zyloric - when I did take the name brand I bought from Save Drug in Carrefoure malls as they seemed to sell for the best price. I take a hospital provided version from Vejthani at 6 baht each currently. The problem finding 300mg is that most Thai only take 100mg so most do not stock unless have regular customers enough to keep supply fresh. That you found packaged units must be new as previously only available in large bottles so not many places had.

[MrHammer]

They do tend to prescribe more expensive medicine, but when I've been to Samitivej, I have just asked for the generic and gotten it. Just ask at the pharmacy. You don't have to buy medicine there at all. At one of the Payathai hospitals, when I was in with bruised ribs, the doc and nurse were very helpful in giving different alternatives for painkillers etc.

[TravelerEastWest]

 I have had usually had no problems with the doctors at Samitivej if I politely ask them to write down the medications.

Yes, there will be some midications that end up on the bill but a simple polite request to remove them does the job quickly.

[PeaceBlondie]

When I go to same clinic run by medical school, there are no high prices, no over medication. But the corner druggist prescribes too much.