Emergency Care ---Thai Style

[jrtmedic]

Until very recently I was very supportive of Thai hospitals and medical staff. Then I was involved in an accident which resulted in a severe and very painfull injury to my shoulder. I was scraped up by a sympathetic ambulance crew who could do little to relieve my pain (no entonox or IV analgesia).

On arrival at a private hospital I was "seen" by a "Doctor" who enquired what my problem was but did not offer any analgesia.. Dispite the fact that I had been involved in a violent acciident he did not attempt to examin me (primary survey) despit my suffering what is known as a "distraction" injury. Neither did he attempt to assure himself that my arm was intact from a vascular or neurological point of view.

I did get X-rayed! The films were poor and inadequate technically. They did. however. demonstrate a severe injury to my upper humorus which could only be treated by implanting a prosthetic shoulder joint.

Following the x-ray the "Doctor" came to "see" me again! Once more no attempt was made to examin me but I was toldI had "A big problem" and he left with no further explanation.

I was then confronted by a woman clutching a clipboard!. She told me I needed an operation! and that she needed 250,000 Bht as a deposite against the eventual cost. I asked what operation she thought I needed. She said that that was "up to the Doctor". Now I am in severe pain and I am not amused. I asked to talk to the ""Doctor" and was told there was no need and anyway he was busy!

It was at this point my wife arrived. She of course was shocked and worried. She was told by a nurse that I was a "difficult" patient who asked to many questions! Having discussed my situation with my wife I decided to discharge myself from this hospital. I refused to pay the bill apart from what was stated to be the cost of x-ray. I still have the bill which sets out in detail all the care and treatnent I did NOT recieve.

When I arrived home I had my wife make me a makeshift sling from a scarf. I then asked her to go to the pharmacey to buy me some Tramadol (an analgesic). I swallowed a large dose of the Tramadol followed by a large Scotch!

I then telephoned a collegue in Australia who arranged a flight for me leaving at 10.30 pm. I Arrived in Australia the next day. Within an hour I was in hospital being properly examined! More x-rays were taken and my shoulder CAT scanned. Two hours later i was undergoing joint replacement surgery.

Thai Emergency Care ? Caveat Emptor!

I am now back home and slowly regaining some function in my shoulder.

NB all typos and spelling errors are mine and the result of typing with one hand (the wrong one!)

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Edited December 18, 2012 by jrtmedic

[uhuh]

which hospital was that?

[Satcommlee]

All the more reason to buy premium healthcare insurance, and one that offers propoer 24 hour support and is well know like BUPA international. (except BUPA Thailand, who won't get managers out of bed to authorise treatment)

Sound's like you had a rough time, how can they expect people to produce 250K at the drop of hat? Many Credit Cards don't have that sort of limit, Debit cards are limited on daily withdrawals..

Which reminds me of this cartoon..

[samuibeachcomber]

am sure some herbal remedies would have fixed up

[Mobi]

Yes the 64,000 dollar question is what hospital?

Obviously there are bad and good hospitals everywhere, and it has been my experience that the 'lesser' hospitals here in Pattaya are ill equipped to handle anything but the most basic, straight forward emergencies, and even then very few -if any -specialists are on duty during the night.

Bangkok Pattaya is a much better bet, but of course you may pay through the nose.

It seems difficult to believe that the likes of Bumrungrad or BNH would have given you such appalling care, so I'm assuming that if it was Bangkok, then it must have been one of the lesser known establishment.

If you can't tell us the hospital, can you tell us the town you were in?

[samuibeachcomber]

you get good care and bad care everywhere.I went to bangkok pattaya hospital with a serious problem,their answer was to open me up.I went for a second opinion,phoned a hospital in australia and they were horrified at the thai diagnosis.So i also flew back to australia for a day procedure.after the op. i talked to my naturopath who laughed and said she coud have fixed my problem up with mineral tablets that would have done the healing.Yes i know dam_n alternative medicine what do they know jrtmedic!

Edited December 19, 2012 by samuibeachcomber

[lopburi3]

No hospitals here, that I am aware of, have specialists on duty at night (unless it just happened they had duty that night) so would require calling in and they would have to make decision on what to be done in above case so nurse was likely right in the "what doctor says" as doctor had not seen him yet. The money is often an issue with private hospitals (anywhere in the world actually) and often done in less than casual manner (very unlike Thailand); the first thing we were asked for after ER exam at Bumrungrad was credit card and it was taken and charged prior to testing/admittance (and had full insurance if they had cared to ask).

[cheeryble]

Out of interest why did they give you a CAT scan in Oz if the operation was obviously necessary so when you are opened up everything can be inspected anyway. Nerve and vascular function would be easily ascertained.

Not criticising, just asking in the light of recognised overuse of CATs and MRIs for inappropriate things like early backache especially in America. Given the ridiculous charges for procedures there, avoiding overdiagnosis like that is seen as one way to reduce overspending.

Edited December 19, 2012 by cheeryble

[maturebrit]

well what the OP says does not surprise me but you wont believe this but true nonetheless

my thai wife was pregnant and we arranged with the obstetrition to get a package deal for 42kTHB for her pending delivery.....everything went perfect but as we were checking out the admin called us back and said the price was actually 37k and refunded the balance.

We have had several dealings but never did we get ripped off with the Bangkok Hospitals

Sent from my GT-N7000 using Thaivisa Connect App

[maturebrit]

btw the 42k included a C section plus 4 days post delivery care

Sent from my GT-N7000 using Thaivisa Connect App

[NancyL]

Yes, it does seem that the private hospitals won't do much unless you make a deposit. I once assisted an elderly western lady who had been hit by a motorcycle right outside the hospital (she was trying to cross the street for an appointment -- why don't they put proper crosswalks near hospitals?) Anyway, they scooped her up and "stablized" her in the emergency room, giving her a phone to start calling all her friends. Despite having a broken hip and other problems, they didn't start the morphine drip for over six hours. Amazing how that drip was started as soon as her friends deposited 60,000 baht in her name at the hospital. I asked why so long and was told (by their English-language "social worker") that they wanted her to be alert enough to make phone calls and get her friends mobilized to pay the deposit. At least she was honest about their reason.

I asked what would have happened if she couldn't come up with the deposit. They said the patient had claimed she had friends with money and she just needed to contact them. If she hadn't been able to make contact, they would have transferred her to Suan Dok, the large regional public hospital that has a "human rights" obligation to provide urgent care, regardless of ability to pay. The private hospitals have no such obligation.

Edited December 19, 2012 by NancyL

[Sheryl]

Be aware that "ambulances" in Thailand are private businesses that often (in fact usually) get a kickback from certain hospitals to bring you there. Needless to say those are usually NOT the hospitals where you will get the best care, they are the hospitals that are hard up for clientele and resort to thsi type of thing.

The only way around this is to call an ambulance affiliated with the specific hospital of your choice yourself and refuse to go in any other (or, if you are reasonably ambulatory, get a taxi). . Not so easy to do if you are shaken up and in pain and of course impossible to do if you are unconscious.

The ambulance services of the better hospitals do offer a more comprehensive level of care than what you report. Sounds like this was one of those roving services that relies on kickbacks from third rate private hospitals. In addition to taking you to a place were care is likely to be substandard, they will fail to do what they should to stabilize you and may even cause harm.

Unfortunately there is no public ambulance system with EMTs as there is in the West.

[NancyL]

I've noticed that here in Chiang Mai the traffic makes no effort to get out of the way of an ambulance that's flashing its lights, etc. Often it's quicker to get someone to the hospital of their choice using a tuk-tuk -- those guys can really move, know all the shortcuts, have no qualms about going the wrong way on a one-way street and can go up sois impassable to larger vehicles. Plus, they almost always seem to be readily available.

[jrtmedic]

cheeryble

In answer to your question re the CAT scan. Normal A/P and Lateral x-ray views only provide a limited amount of information. Whilst both I and my good friend and surgeon were convinced that my shoulder could only be repaired by utilizing what is known as a "reverse" shoulder prosthesis the surgeon wished to be 100% certain that this was the only option prior to undertaking a major surgery. Hence the CAT scan.

Determining vascular/nerve integrity as soon after an accident as possible is a vital and necessary procedure as any Western ER Physician will tell you. In my case the "Doctor" failed to appreciate that my median nerve was damaged. This nerve supplies some important muscles in the arm/hand and is responsible for sensation in the thumb and index finger. (We are hoping the nerve is just "bruised" and will recover without further intervention.)

Sheryl

You are correct in warning about the nature of some ambulance services! In my case the ambulance came from a nearby well known private hospital. I have absolutely no criticism of the ambulance guys who tried their best to assist me.

I was interested to read the comments of others (stupid, crass remarks about "herbs" and "minerals apart)

In response I will try to address some of the issues raised.

Clearly if a private hospital is to survive it requires some reassurance that fees will be paid. From a professional view that does not absolve the hospital from requiring Doctors to undertake a full examination and ensuring that pain relief is given together with any other treatment necessary to protect life.

I do not believe that sending an admin person to hassle someone in pain for huge amounts of money is appropriate. For those without insurance or those with limited personal resource a transfer to a Government hospital can be arranged in a sensitive manner. ( Yes I do have insurance but dont always carry the card and I certainly don't carry 250,000 Baht on my person! My credit and debit cards all carry a limit which requires either me or my wife to override by contacting the bank and saying the magic password(s)

Of course one does not expect surgical/medical specialists to be available 24/7 on site in a relatively small private facility. What is reasonable is to expect the ER specialist to conduct competent clinical examinations and to admit when he/she needs specialist advise and to keep the patient/relatives informed.

I do not wish, yet, to name/shame this hospital which is not a tinpot place. I am meeting with the hospitals director next week and will be requiring some answers/action from him in relation to at least one of his ER doctors and the nurse who described me as a "difficult" patient. (She has yet to discover just how difficult I can be!) If a reasonable response is made I will probably never mention the name.

Unfortunately for this hospital I have a number of Thai friends who are extremely angry about the "care" I received and whilst they have agreed to be patient I fear that their patience will not last long!

[samuibeachcomber]

dont take yourself and life too seriously jrtmedic,we are but here for a short while and i am sure your shoulder will heal just fine.i did offer a smiley,you have no sense of humour.

[jrtmedic]

I might have known you would take the bait and swallow the hook, line + sinker!

Another well known saying goes along the lines of "If the cap fits you are welcome to wear it"

Clearly my remark about "stupid and crass" comments was well directed and struck home with full force!!

[jeepguy]

This isn't so much about emergency care, but does anyone know if a spouse can be covered under the Thai Govt. insurance that is offered through employers in Thailand? She would not work, however accompany me if I choose to become an expat and maybe teach English and thus establish eligibility that way. It has been stated on a forum here that a person needed to have 1 year min. of legal employment to continue with premiums and meet eligibility.

[Sheryl]

This isn't so much about emergency care, but does anyone know if a spouse can be covered under the Thai Govt. insurance that is offered through employers in Thailand? She would not work, however accompany me if I choose to become an expat and maybe teach English and thus establish eligibility that way. It has been stated on a forum here that a person needed to have 1 year min. of legal employment to continue with premiums and meet eligibility.

see this thread

In short, no. Best idea would be for her to get herself legally employed for a year and thus qualify.