'bad Medicine' Or: A Bangkok Butchering

[samasama]

nothing life threatening just a psychologically traumatizing 10cm long x 2cm deep wound on my bum, so the histrionic title may be a bit much. but still..

i am, i really am. disturbed. this is after having visited a few of bkk's hospitals, including the venerable bumrungrad medical resort. brief background: been traveling/working for going on nearly a year now throughout asia. about 5 months back, i developed a bit of an embarrassing skin abscess (ie - an infected pus-filled mass beneath the skin). embarrassing because it was huge, embarrassing because it was on my bum (not in my bum, on my bum, extending nearly 8-9cm radially from the center of my left cheek towards my thigh and to the side of my anus. so i had to put it off. it'll go away on its own or so i thought.. instead it decided to grow... and grow it did to the point that i needed to do something about it. it would drain at random, thus forcing me to wear 'panty liners' at one point. i'm a dude i should also mention. couldn't have that.

so fast forward to bkk. first to bumrungrad. you have a 'fistula in ano' i'm told. basically it's a tunnel that runs from inside your anus, expressing itself somewhere in the skin outside. you sure about that? 60-70k baht for a fistulotomy. when would you like to schedule? whoa <deleted>? no way i'm outta there.

i had an abscess in the same spot about 4-5 years ago. it was just an abscess. i had it lanced, i went on my merry way. off to bangkok general for a 2nd opinion. this time the exam was more thorough, including an unpleasant rectal exam. "no - you don't have a fistula, don't worry," i'm told. but you do have a chronic condition called hidradenitis suppurativa. what? i've only had a serious boil just one other time in my life; i get some pimples on my face, back and butt but that's about it. could you just lance the thing? no no, that won't fix the problem, it'll come back. i can do the surgery for you. it must be inpatient though (would you like the vip suite?) and requires spinal anesthesia (and thus an anesthesiologist). it requires a long incision to be made and the total will be (ballpark figure here) just around 50k baht. to remove an abscess/cyst? in thailand?

so i hit up the internet and looked for a few hospitals that don't specifically target medical tourists. bangkok christian comes up, st. louis, camillian and a few others. fine. i happened to be staying near camillian. sure, it wasn't as impressive as bumrungrad or bangkok, but that was exactly what i was looking for or so i thought. after registering, i'm in the doctor's office in about 10 minutes. fast service here, very nice i thought. after briefly explaining the problem, he says 'let me have a look' and we head off to the er. ok after motioning me back to his office, the doctor suggests that i need surgery to have it removed, but i explain 'no no'. i just want the thing lanced so i can be on my way. can you just drain it? make a small incision and drain? ok, ok, just small incision and drain he agrees. i'm back in the waiting room. i'm not fully impressed by the doctor but i figure any idiot can do a lancing; i'd easily entrust my 15yo younger brother to do it. one of the nurses comes over and tells me that they need to prep the operating room first. no no, i repeat myself to her, i don't want surgery for this, just a draining.

we head back to the same examination table in the er. i confirm, just 'drain it' ok? 'yes', he agrees. and in about a minute flat, i'm pricked with local anesthesia and though i can't see nor feel it, i'm pretty sure the scalpel is in me as i do feel something warm oozing down my skin. when i ask how it's going, he responds, 'all done.' the whole thing? it took maybe 3-5 minutes. seemed about right for a lancing. they bandage me up, but something's not right. there's a whole lot of gauze for what should be a small incision. 'how large was the incision?' i ask one of the nurses, gesturing at about a cm. instead, her eyes widen and she gestures at about 10cm. at this point, i'm reeling. what?!? where's the doctor? trying to keep my cool. i confront him and ask him what the hel_l he did. he said draining isn't enough, it won't fix the problem. he had to open up the entire thing in order to treat it properly. but without asking?! i need to travel. you can travel fine he says. it's no problem. i want to hit him. i really want to smack him good. he doesn't seem to understand the concept that you can't just cut someone open without telling them first. moreso when the patient specifically explains that they do not want surgery. seemingly unconcerned, he starts to hurry off to see another patient. i start to follow him but what am i going to do here? with him? with my anger? i get ready to leave. there's just the matter of the bill. only 1500 baht! for EVERYTHING. what?! this was supposed to be a 50-70k baht procedure. i argue at first. i shouldn't have to pay anything but then i stop myself.. money really wasn't the issue at the moment. i just needed to leave and see for myself. i toss the money at the cashier and sprint back to my hotel.

seeing it for myself just made things worse. not having a lot of faith in the doctor's work, i went to samitivej for the follow-up. the wound would have to stay open, he explained to me. he couldn't stitch it up since there's an active infection. it made sense, he seemed quite competent as well, but again i got that uncomfortable feeling of being more of a customer than a patient over there. the feeling that comes when you see a charge of 980 baht for 2 pieces of gauze with 'silver for its antiseptic properties' which would cost just 4 baht for the standard cotton variety at the local pharmacy. when you're hit with a 640 baht medicine charge even though no medicine was dispensed, after the medicine was explicitly declined. i'm convinced after my experiences in thailand and elsewhere that for minor ailments, you're always better off away from the big cities. as of now, the wound's healed up enough so that i think i can move on with my travels. so it's off to india finally next week. wow bangkok, you've left me with quite a memory. thanks for reading my tale of minor woe.. take care in these parts, folks! ;-)

[Carib]

So, you let this all get worse because you do not want to show your ass to anybody.

Than when it really gets irritating and grows to a non acceptable level you go showing your bum to several hospitals, amongst the one who really cleaned out whatever it is/was, and now it is everybody's fault but yours??

You shouldn't have waited, it could have been a one cm cut than.

[JSixpack]

> i confront him and ask him what the hel_l he did. he

> said draining isn't enough, it won't fix the problem. he had to open

> up the entire thing in order to treat it properly. but without

> asking?!

Not atypical in Thailand, actually. The docs will sometimes just go

ahead and do what they believe needs to be done. And in this case, it

needed to be done; otherwise, why go to extra effort? The charge would

be the same, so there's no big money to be made.

If he'd asked, you'd have had to say yes anyway, unless you're just an

idiot, which is probably what the doctor had you pegged for.

> i need to travel. you can travel fine he says. it's no

> problem. i want to hit him. i really want to smack him good. he

> doesn't seem to understand the concept that you can't just cut

> someone open without telling them first.

Over-the-top response. The doc was trying to help and it seems DID

help.

> i get ready to leave. there's just the matter of the bill.

> only 1500 baht! for EVERYTHING. what?! this was supposed to be a

> 50-70k baht procedure. i argue at first. i shouldn't have to pay

> anything

I dunno what you're on about. Great price for received care and yes

you should pay it and more.

But the docs at Bumrungrad and Bangkok Hospital still may be right

that the problem will just come back unless you fix it permanently.

The jury's still out on that one.

[WarpSpeed]

I can't even be arsed to respond to all the contradictions and ignorance in that thread (and not from the doctors) Six pack and Carib did well enough..

Next time if you don't want surgery instead of making an issue with the medical professionals who know better then just scrub your backside better, that is providing the first 2 weren't correct and it isn't something more serious or chronic...

Edited April 4, 2010 by WarpSpeed

[samasama]

interesting responses.. looking over my post, i realize it comes across as more whiny than i intended. and this on a board where there are people with serious ailments: hiv, cancer, among others. i realize this and can therefore understand the kind of feedback i get for what amounts to no more than just a flesh wound. anyway - entertained, incredulous was what i was aiming for. anyway it looks like my point was clearly lost. i should've been more brief, clearer:

1 - really i just wanted to see if anyone else found it unusual that a doctor would just cut you wide open without so much as a heads up for an elective procedure (not unusual according to jsixpack). this after you thought it was agreed that only a lancing would be done. it was definitely not an emergency, the infection always remained local to the abscess and even the doctor at bkk general pointed out that it could wait till i got back home. he merely added that surgery would be necessary since, at the stage it was at, it wouldn't resolve on its own. i understood that, i really did, which is why i wanted only the temporary relief of a lancing with the actual surgery being done back home.

2 - i was surprised at the cost of the treatment. after getting the follow up, it seems that the procedure i got was essentially the same as what i would've gotten at bumrungrad or bangkok general had i chosen one of them. but at like 2-3% of the cost and without the conflicting, mildly scary diagnoses. 1500thb versus 50-70kthb.. it was completely no nonsense, almost too basic at camillian. i know you're paying for the bumrungrad/bkk general cachet/comfort and whatnot but doesn't anyone find that price difference absolutely staggering?

@carib:

i realize in hindsight that waiting on it was stupid, but aside from the nasty drainage, there was no pain or no other symptoms. i really did believe that it might get better on its own as they often do.

@jsixpack:

found your response to be the most insightful while remaining sharply critical at the same time. i don't get one thing:

> If he'd asked, you'd have had to say yes anyway, unless you're just an idiot, which is probably what the doctor had you pegged for.

why would anyone have to say yes to an elective surgery like that? i can understand that you should shut your mouth and forfeit your own judgment if you're being wheeled in on a stretcher in the midst of a heart attack or even if you've just broken your arm and it needs to be set. but for a persistent abscess/cyst that's been around for months? and not knowing the patient's circumstances?

@warpspeed:

> I can't even be arsed to respond to all the contradictions and ignorance in that thread (and not from the doctors) Six pack and > Carib did well enough..

ok, my ignorance, i'll always volunteer it gladly. but what contradictions specifically?

[hhgz]

"i'd easily entrust my 15yo younger brother to do it."

If it was so easy, why didn't you do it? Too, antibiotics are very cheap in BKK, and I can't imagine walking around BKK with a festering carbuncle on my butt, window-shopping for medical treatment.

[samasama]

"i'd easily entrust my 15yo younger brother to do it."

If it was so easy, why didn't you do it? Too, antibiotics are very cheap in BKK, and I can't imagine walking around BKK with a festering carbuncle on my butt, window-shopping for medical treatment.

i gave it a shot, but it didn't work out. figured it's much easier done by someone else and not by myself with a mirror and a box cutter. also tried self-prescribing antibiotics.. it worked just fine for the infection/inflammation, but the mass was still there under the skin. after getting off the antibiotics for a little while, it came back.

[JSixpack]

@jsixpack:

> If he'd asked, you'd have had to say yes anyway, unless you're just an idiot, which is probably what the doctor had you pegged for.

why would anyone have to say yes to an elective surgery like that?

Obviously to fix the problem (at least temporarily), right then, cheaply and efficiently. But I'm giving you credit for sanity and rationality.

You already had 2 doctors at respectable hospitals disagree with your own "solution." This doc did, too. To drain "an infected pus-filled mass . . . extending nearly 8-9cm radially" and try to stem all the infection required MORE than just lancing.

Now, you did say "make a small incision and drain." That could be interpreted in terms of width and depth, not necessarily length. Better to make a longer cut, get out a lot more of the bad stuff, and fill medication into the whole area. That's what he did.

The 4th doc at Samitivej expressed no shock & horror at the procedure. And he said there's an active infection in the whole area, which indirectly supports Camillian. If stitches were appropriate, the doc at Camillian would have used them.

As for the difference in price, the docs at Bumrungrad and Bangkok were talking about entirely different procedures that would have been proportionately much more expensive. Apples & oranges.

So you have no case here at all. In fact I think your post amounts to libel against Camillian, where you received competent care.

"Butchered!"

[WarpSpeed]

Jsixpack noted some of the contradictions I noted and I have no interest in noting anymore though they exist. I also realize it was intended as being humorous but it fell far short of that and as stated you were advised 3 times of the potential seriousness of not properly draining it and as well now you even mention having taken oral antibiotics and it not subsiding but rather spreading that is a contradiction of the medical advice you've gotten and you don't recognize it either..

The term surgery is anything related to what he did and it was more a matter of semantics and lost in translation then it was "butchering" or "bad Medicine" as your OP states..

[FBN]

There are some lessons to be learnt here which may be of benefit to other travelers with the same attitude as the OP.

Firstly, a "buttock" abscess is a really serious condition and can be permanently disfiguring if not managed properly and if treatment is delayed. An abscess in this area has lots of space and is usually many times larger than what is apparent on casual inspection. It can literally contain substantial amounts (several 100mls) of dead tissue and pus. If a simple drainage procedure is attempted (as the OP insisted be done), the surgeon has little control over what dead tissue will drain and has to open the area large enough to effectively drain the dead tissue and prevent this from becoming an even more disfuguring and possibly life-threatening infection.

Secondly, at some point in time, as a patient, you have to listen and accept advice. If you do not have any confidence in the skills or capabilities of the physician, it is your right to "refuse treatment" and seek a second opinion elsewhere. To accept help and then try and agressively direct treatment (as a non-medical person) is short sighted and, in this part of the world, (perhaps most parts of the world) will not earn you any cooperation and sympathy from anybody.

The physician, in these cases also has the right to refuse to treat and may refer such cases to another physician or facility if the treatment that the patient insists on having is clearly against best medical practice.

[shows]

I had a Thai friend in Australia with what sounds like the same problem. He was very embarrassed. By the time I'd got him to the doctor it was hospital. Would he stay? NO - he kept sneaking out for some REAL Laos Food!

The THIRD time I got him to hospital the doctor put him in one quite isolated so he couldn't escape. He was there for 3 months! After the operation the wound was left open. When nurses tried to change the dressing on day one he fainted with the pain. After that they would "put him out" just to change the dressing and a doctor changed the dressing, not the nursing staff. This went on for over a week.

Three months in hospital did have 2 great effects - he learned English and he began to understand Australian politics (there was an election on at the time).

Anyway what I'm saying is that if HE had followed proper medical advice at the beginning the end result would not be the huge crater he now has on one buttock.

I, like the poster Samasama, have little faith in Thai medical practices - GET THE MONEY, dam_n THE CONSEQUENCES - as I'm about to go back to Oz to have a procedure redone which Bumrungrad charged me around 500,000 baht to fix!! They didn't and their only response was "Do it again!" NO WAY MATE!

BUT don't let the initial problem get out of hand. It is a nasty thing and will make you VERY ill!

All the best anyway.

[WarpSpeed]

There are some lessons to be learnt here which may be of benefit to other travelers with the same attitude as the OP.

Firstly, a "buttock" abscess is a really serious condition and can be permanently disfiguring if not managed properly and if treatment is delayed. An abscess in this area has lots of space and is usually many times larger than what is apparent on casual inspection. It can literally contain substantial amounts (several 100mls) of dead tissue and pus. If a simple drainage procedure is attempted (as the OP insisted be done), the surgeon has little control over what dead tissue will drain and has to open the area large enough to effectively drain the dead tissue and prevent this from becoming an even more disfuguring and possibly life-threatening infection.

Secondly, at some point in time, as a patient, you have to listen and accept advice. If you do not have any confidence in the skills or capabilities of the physician, it is your right to "refuse treatment" and seek a second opinion elsewhere. To accept help and then try and agressively direct treatment (as a non-medical person) is short sighted and, in this part of the world, (perhaps most parts of the world) will not earn you any cooperation and sympathy from anybody.

The physician, in these cases also has the right to refuse to treat and may refer such cases to another physician or facility if the treatment that the patient insists on having is clearly against best medical practice.

Absolutely! Well stated and being in such a difficult place for the patient to even assess the severity is another primary reason for following said advice..

[Orion76]

You could have gone septic or require to have your glutes amputated and you're upset about Samitivej charging you a few hundred bht for medical supplies?

Find a doc you trust and have this checked out on a regular bases, you horror story may only have just started.