Hospitals That Really Care About You.

[sunholidaysun1]

Living in Chiang Rai we have a selection of hospitals , one for the local poor people , one for Christians , one for the more wealthy and one for the Military . There is a new hospital also but one minute its open and the next its closed , no one seems to know if it is just waiting for the population to increase more before it opens or to be used incase of a natural disaster .

What I have found since living here in Chiang Rai is that if you use the most basic of hospitals here , the Chiang Rai Hospital , you normally get good service at a reasonable price , the down side is the waiting as its normally packed out and even if you are admitted for anything , you can end up out in a corridor due to lack of bed spaces . The Doctors seem to run from one hospital to the next , doing so many hours in each hospital with the odd stalwart holding the fort in most while the others do the running about .

The cleanlyness in the Chiang Rai hospital needs a rethink on how to keep the place clean . Last year I had an operation on my thumb and while waiting in the operating room , I noticed that the place wasnt very clean . The theatre doors were wide open for all bugs and flys as well as any dirt particules in the air to come and go as they wished . I spotted several Mozzies flying about while laying there . Surely in all medical practice hygiene is or should be number one . I find that even being in northern Thailand it is just unacceptable for sloppy management resulting in too many infections because of poor health and hygiene standards.

The Overbrook Hospital , the so called Christian hospital is another where money seems to make the wheels go round , and that they are very happy to see paying customers and from my own experiences here tend to add anything they can to the bill even though maybe its not really needed. If any of these hospitals want to take me to issue on my views please do , but I suggest you get your hospitals in order before you do.

The Kasemrad SriBurin Hospital used to be the No1 Hospital in Chiang Rai a few years ago . Most foreigners living here would tend to go there because they had the better facilities for operations and medical equipment along with a more senior experienced team of doctors .

However on my recent trip here I have noticed the lack of care by the nurses and the doctors not really willing to listen to the patients concerns .

I found them too interested in trying to sell me a presidential suite for my hospital stay , trying to sell me insurance , umpteen offers of a massage and very expensive food. I was impressed with the cleanlyness of my 3500 bht a night room , I had more time with the cleaners in my hospital room than I did with actual medical care from the nurses who seemed to keep as far away as possible . The room had a Tv (no English channels only thai ) and breakfast not included . There was also aircon in the room and my own private bathroom , (bring your own towels ). It would have been cheaper for me to stay in a 5* Resort in the city and commute there daily for treatment if I could have . Requesting more Meds when the pain got so severe I was screaming in bloody agony went on deaf ears . The nurses said I couldnt have any more than the Dr had prescribed and I had had my limit . With me threatening all sorts to the nurses on what I would do if they didnt get a <deleted> Dr on the phone and get me more pain killers , eventually some one did make a call and after 30 agonising minutes more pain releif was given . This is very poor medical care. In the end I was so peeeeeed off with the nurses , the Dr's, the over charging and lack of any care whatsoever , I discharged myself , without any assistance from any nurses or even a heartless goodbye , I was just left to stagger out on my own after major surgery to my abdomen .

Money is all these places seem to worry about , if you have got it , spend it on them , then there is a good chance you will be taken care of . If however I did have enough money I would not be or stay in ANY of the poor standard hospitals in Chiang Rai , get to somewhere other than here .I paid cash for my treatment and I am sure they didnt like that method of payment as if by insurance I expect the bill would have been alot higher , but my bill was nearly 3 times more than what I was told when I asked how much my treatment would cost . When I disputed this bill , the senior nurse of the hospital told me I was only informed of the amount of deposit I needed and not the overall cost , TOTAL LIES .

What I would like to know is if there is any real hospital care anymore or is it all about money money money . I am sure many of you who have had top end insurance with stays in the best Thailand has to offer will no doubt be full of praise . Pay out of your own pocket for the service you are getting , is it really worth what you are paying for ? Where are the good , non expensive hospitals that pride themselves in the health and care of the patient and warrent being called true medical proffessionals ??

[Sheryl]

First of all, you will find some caring individuals in all hospitals, as well as (unfortunately) some callous ones in all hospitals. Some (but certainly not all) of what you complain of may be more reflective of the individual providers than the institution. You should always choose the doctor, not the hospital.

That said, the profit motive certainly does make itself felt in private institutions, more blatantly so in some than in others. If a private hospital has the right doctor for your needs it can be worth weathering this. Be firm re selection of rooms and any "extras" offered by the various administrative personnel.

Government hospitals (which includes military) will not be affected by monetary concerns but will, like public facilities the world round, involve many inconveniences - long waits red tape etc. The government provincial hospital in CR it is not only for the poor -- it is also where most middle class Thais go. They pay extra for a private or semi-private room ("hong piset") and so can you. In addition to more creature comforts and probably more cleanliness, the private floors will have a better nurse:patient ratio.

One problem specific to Chiang Rai is that the provincial hospital is a secondary level hospital and there is a tertiary level one, affiliated with a major medical school, in Chiang Mai. Many people will opt to travel a few hours to go to CMU Hospital, especially since there is a semi-private arrangement through which you can choose your doctor and be seen on appointment (Sri Pat, or "Suan Doc", AKA "Special Medical Service Center"). For any major problem and/or for specialist care, this would be the best choice for medical care in your area and certainly the one with the broadest range of specialists and highest level of facilities.

Military hospitals, like government hospitals, are non-profit and generally offer a good standard of care. In the case of Chiang Rai that would probably be my second choice, after traveling to CM. A Military Hospital will also have private and semi-private room options at very reasonable cost.

[sunholidaysun1]

Thanks Sheryl for your view , I agree .

[NancyL]

Sheryl, one minor correction to your description of the CMU hospitals in Chiang Mai. The government hospital is commonly called "Suan Dok", while the affiliated private hospital next door is called "Sripat" (correctly pronounced C-pat, the "R" in the name is silent).

Yes, there are many people who come down from CR to use these facilities and more difficult cases are sent to Chiang Mai by the hospitals in CR. I've seen foreigners arrive from CR with raging, uncontrolled infections, some of which were hospital-acquired. Suan Dok does a great job treating infections, but be advised that many of the newer high-powered antibiotics aren't covered by the "30 baht" program and all patients -- Thai and foreign alike -- are required to pay in advance for medicines that aren't on the 30-baht list. This can sometimes be a problem for destitute foreigners or even those having delays in getting ahold of funds they have overseas.

[Sheryl]

Thanks for that, Nancy.

[wpcoe]

As to the OP's ordeal with inadequate painkillers being prescribed, that has been discussed on this forum before. It seems that for whatever reason, we farang require higher dosage than what is ordinarily prescribed for Thais. I don't know why that is, but it appears to be true.

While the nurses were correct that they couldn't dispense more than the doctor prescribed, it does seem they were a bit callous in not calling the doctor earlier.

Edited June 3, 2013 by wpcoe

[Sheryl]

As to the OP's ordeal with inadequate painkillers being prescribed, that has been discussed on this forum before. It seems that for whatever reason, we farang require higher dosage than what is ordinarily prescribed for Thais. I don't know why that is, but it appears to be true.

While the nurses were correct that they couldn't dispense more than the doctor prescribed, it does seem they were a bit callous in not calling the doctor earlier.

It's not just farangs. Other Asian groups have the same problem. And not just pain meds...sedatives (including anesthetics) also. What we all require is the internationally recommended dosages. It's the Thais that are unusual. They are extremely susceptible to any sort of depressive agent, and the dosages of pain meds and sedatives normally used by Thai physicians and in Thai hospitals is what would otherwise be considered low or even sub-therapeutic.

My personal theory is that it is their neurochemistry tends towards passivity-cum-mild depression to begin with. There's a reason most drug abuse here is of "uppers". While anxiety is more predominant in Western cultures. Even when Westerners are depressed it is usually mixed with a certain amount of anxiety. Thais are just by nature calm and easily sedated. Witness everyone falling asleep sitting bolt upright on inter-provincial buses...

[Sceptict11]

The problem is mainly associated with Americans who are addicted to narcotic analgesia.

No analgesic will provide !00% pain relief unless taken in dangerous and life threatening dosages.

A more realistic expectation of pain being reduced to a tolerable level would benefit many.

Prescription analgesic abuse in the USA has reached monumental levels and is the cause of many deaths.

[Sheryl]

No, it is not just a problem with Americans.

The recommended dosages for pain killers are the dosages most people need to get the therapuetic effect. For some reason, Thais need much less. Hence Thai medical practice normal prescribes in sub-therapeutic dosage or at the lowest end of the dosage range. Does not work for farangs - or Cambodians - or Filipinos - or Chinese - etc etc. But does work in Thais. And creates a problem for foreigners getting care here.

I have seen this in patients who were completely opiate naive. Not due to prior tolerance. Due to simply needing the standard dosage rather than a fraction thereof.

[jrtmedic]

An interesting "take" on prescription medication abuse from the US Office of National Drug Control Policy

http://www.whitehouse.gov/ondcp/prescription-drug-abuse