Going Round In Circles

[chiang mai]

The original complaint many months ago was a painful neck and a hard moveable ridge in the lower part of my mouth along the jaw line. Three ENT doctors, four Orthopaedic doctors and one endocrinologist later I still have the same symptoms and I'm starting to get tetchy, forgive me if I rant a little! Granted, in the course of this journey I've uncovered a potentially serious thyroid issue which hopefully, under the care of the Endocrinologist, will be resolved. But I still have the original complaints and it's been many months.

I've spent endless hours trying to research the problem and I've finally concluded that it's most likely to be a blocked salivary gland and this has resulted in an infection which is why my neck is slightly swollen and my neck hurts, heck, I've even seen pictures of it on the web and it's identical. So I've booked in to see an oral surgeon and we'll see what he has to say. My question is, why does the patient have to try and join up the dots on something like this, for goodness sake, at least two ENT doctors have had their hands on the swelling in my mouth and confirmed that it's not a tumour. OK, so what is it I ask and why are next steps so hard to figure out.

Increasingly I'm beginning to believe that having the equivalent to a GP in Thailand is really important, someone you can go back after each foray into a different medical speciality and say, that didn't work, what's next, or am I being too simplistic?

[Lite Beer]

Moved to Health.

[Deserted]

Don't under-estimate the power of self-diagnosis.

Edited December 2, 2010 by Deserted

[Sheryl]

You are absolutely correct. Unfortunately, good GPs are extremely hard to come by here. The best/brightest -- and pretty well everyone who trains abroad -- all specialize.

And indeed, this does create problems and put a huge burden ion the patient to know whom to consult.

As to your problem, have you in the course of all this had a CBC? (complete blood count). If so, is the white count elevated? (would expect it to be so if an infection).

[chiang mai]

Not in the past six months Sheryl but consider it put on the shopping list and I'll report back.

[Tolley]

You are absolutely correct. Unfortunately, good GPs are extremely hard to come by here. The best/brightest -- and pretty well everyone who trains abroad -- all specialize.

And indeed, this does create problems and put a huge burden ion the patient to know whom to consult.

As to your problem, have you in the course of all this had a CBC? (complete blood count). If so, is the white count elevated? (would expect it to be so if an infection).

The majority of GPs in AUstralia aren't that good either so it is not just a Thai thing.

[NikhilBkk]

Having stayed in Thailand for the last 15 years and seeing doctors at BNH and Bumrungrad, Chula and Samitivej, my advice is not to trust Thai Doctors......you got to understand the local education is simply shits! So what do u expect from the doctors who come out of it. I always fly back to Singapore for whatever medical ailments I have......its cheaper these days and better.

Regards

[chiang mai]

Having stayed in Thailand for the last 15 years and seeing doctors at BNH and Bumrungrad, Chula and Samitivej, my advice is not to trust Thai Doctors......you got to understand the local education is simply shits! So what do u expect from the doctors who come out of it. I always fly back to Singapore for whatever medical ailments I have......its cheaper these days and better.

Regards

Do you use any special clinic or hospital in Singapore, that might be an option?

[Sheryl]

There are a couple of private hospitals in Singapore aiming for the expat market (Mt Elizabeth etc) but you'll find the best range of expertise at somewhat less cost at the National University Hospital

http://www.nuh.com.sg/patients-and-visitors/find-a-doctor.html

[chiang mai]

There are a couple of private hospitals in Singapore aiming for the expat market (Mt Elizabeth etc) but you'll find the best range of expertise at somewhat less cost at the National University Hospital

http://www.nuh.com.sg/patients-and-visitors/find-a-doctor.html

That looks like a very viable alternate so many thanks, yet again!

I've just come back from a trip to BKK where I tried to see an oral surgeon at Bumrungrad. Unfortunately I got caught up in a minor bun fight whereby the people who handle the hospital bookings couldn't agree with the two departments, ENT and Dentistry, which one was more appropriate to take care of a potentially blocked salivary gland. It was almost humerous for a short while until I was eventually booked in to see ENT but told to be prepared to be referred back to Dentistry to see a different specialist - I regret to say I declined all bookings with anyone until they could agree and I 've since heard nothing.

But moving on: Singapore does appear to be a very real option for me, so whilst I think about that, let me ask you one final question. Given what you know about the subject matter, if you had a choice and if the cost of treatment was not a part of the equation and you were solely focussed on good quality diagnostics/treatment/care, where would you elect to be treated for a non-emergency but potentially life threatening condition, Thailand, Singapore or the UK - if it's not too much to ask, knowing the reasons why would also be helpful?

[Sheryl]

Given what you know about the subject matter, if you had a choice and if the cost of treatment was not a part of the equation and you were solely focussed on good quality diagnostics/treatment/care, where would you elect to be treated for a non-emergency but potentially life threatening condition, Thailand, Singapore or the UK - if it's not too much to ask, knowing the reasons why would also be helpful?

Well it would depend on many factors, including the type of problem. And also on exactly what my options in the UK would be, i.e. luck of the draw through the NHS or the were withal to select my own doctor.

Malignant melanoma (or any skin cancer) = UK of course, as rare in Asian populations.

For anything where patient controlled analgesia was important, also the UK, western style pain management and palliative care hasn't arrived in Asia yet.

Malaria = Thailand. Ditto a number of other tropical diseases no longer common in Singapore and certainly not in the UK.

etc.

But I think what you are really asking is how does the quality of care in Singapore stack up, and in general, I would say above that in Thailand, and generally on par with UK/US except where certain things come into play. Like the aforementioned pain management issue. And I'm not sure how good Singapore would be for collaborative involvement of the patient in decision making in situations like a potentially terminal diagnosis. That is an area where the West is usually far ahead. But the medical quality of what would be available for cancer treatment in Singapore would be excellent.

In your particular case, if a trip to Singapore doesn't pose any sort of hardship, I think it might serve you well.

[chiang mai]

I'm grateful for your views Sheryl, many thanks.

[chiang mai]

It's been a while since I started this thread but since I've now got the answers that I started to seek back in September, I'll post the outcome for the sake of completeness.

So the story was that several doctors at a range of Thai private hospitals all said that my two complaints, a painful neck and a hard ridge inside my mouth were not really anything at all and that I should "be happy"! I finally got tired of hearing the same words so I went to Bangkok/Phuket and demanded an MRI, the results of which showed disc problems at C4/5 and C5/6, there's one half of the answer. Unfortunately the MRI didn't cover the correct area to provide any information on the problem inside my mouth.

Undeterred I booked an appointment at National University Hospital in Singapore where an ENT head and neck surgeon immediately identified the problem as a blocked salivary gland and ordered a CAT scan to confirm, there's the second half of the answer.

Exactly why three separate doctors at one of Bangkok's most prestigious private hospitals were unable to give a correct diagnosis, order tests/investigation or make a referral to another specialist will remain a mystery. Similarly, why three separate doctors at one of a private chain of hospitals here in Phuket were unable or unwilling to pursue a diagnosis is also a mystery. What is apparent however is that if you go into one of these places and order your own tests they are usually quite willing to sell that work to you, doing them properly and interpreting the results accurately is another story however. The other thing that's apparent from all of this is that NUH in Singapore is clearly a very very professional organization and the costs are less than at my encounters with Thai hospitals, most importantly it's possible there to get the right answer the first time around. Despite my previous endorsements of some Thai hospitals in the past, I can now safely confirm that I will never ever allow myself to be treated in one again for anything remotely bordering on serious, sorry guys but your performance over the past five months has destroyed all trust.

[Sheryl]

Thanks for the update.

Between the rise in cost of private medical care in Thailand and availability of low cost flights to Singapore, the latter is increasingly tempting especially in a case like yours where the problem was important & complex, but not an emergency.

May I ask what the costs were for the CT and consultation?

[chiang mai]

Thanks for the update.

Between the rise in cost of private medical care in Thailand and availability of low cost flights to Singapore, the latter is increasingly tempting especially in a case like yours where the problem was important & complex, but not an emergency.

May I ask what the costs were for the CT and consultation?

The CT scan cost SGD 570 and the consultation SGD 110, so figure THB 13.700 and THB 2,600, by way of comparison a CT scan at BPH two years ago cost me THB 24k. The best part though is that the consultation and exam were real ones and in-depth and there was no sense of being rushed, the doctor I saw clearly wanted to arrive at the correct answer through investigation rather than to arrive at one that seemed most likely! (flight costs were THB 5,300 round trip for two people and hotel costs were SGD 134 a night).

Just as an aside, there's an excellent fact sheet on salivary gland issues put out by Cedars-Sinai and I read that some months ago. There are five different problems likely with salivary gland malfunction and two of them can lead to blindness since the gland feeds tears to the eyes as well as to the mouth, when the gland becomes infected through blockage the infected residue feeds into the eyes and it's very dangerous. It was for that reason I suspect that one of the first thing the doctor did was to prescribe a long course of antibiotics to combat the problem. So yes, important and, not to overdramatise, I would suggest an emergency condition that needed treatment much sooner rather much later.

Thanks again for all your kind help with this one Sheryl, I owe you.

[Sheryl]

BPH's prices tend to be higher than Bangkok hospital's Bkk branch and the other big "internationals" in Bkk. From what you report it sounds like the total costs inclusive of airfare, hotel, treatment were a bit higher than it would have been in one of those but not by much. And of course that's not factoring in the immense savings of getting a diagnosis correct in terms of avoiding additional visits, tests and so on.

It occurs to me that aside from the info on costs of medical care at NUH in Singapore, what is important in this story is that the OP's own assessment was correct and that of several different doctors wrong. He stuck to his guns and kept at it until he got appropriate care. We had another story not long back won this forum here doctors told a TV member's wife her headaches were due to stress. He and she believed otherwise, perservered and indeed, she proved to a have a brain tumor.

Moral of these stories: trust your instincts. Nobody but you lives in your body.It is easy for a doctor to dismiss a complaint as stress-related, or minor, or just a patient being fussy about discomforts due to a known condition -- and in many cases this may indeed be so -- but only you know what you are experiencing and really only you can gauge its severity. Do your homework, be an informed consumer, and seek additional opinions if your gut sense (or common sense!) tells you that a diagnosis or treatment was incorrect.

[SiamRose]

And now that we have the internet there is a wealth of valuable information available to everyone regarding any imaginable health problem.

Maybe a list of useful health related web sites as a "sticky" might be a good idea.