Pattaya Memorial Hospital – too quick to operate!

[VBF]

My lady is in Pattaya, I’m in England. On some of her recent calls, she’d been complaining of a painful stomach - a problem that she’s suffered in the past. So, one day she went, with a friend, to Pattaya Memorial Hospital.

Next I know, she was on the phone, in tears because the Thai “doctor” she saw had brusquely said that they need to cut her open! No X-Ray, no scan, just a brief feel of her abdomen. Oh, and by the way, this will cost at least 100,000 Baht!

Naturally, I was more than a little upset at this, and speaking to a couple of friends, I was told that another lady was misdiagnosed in a very similar way at Pattaya Memorial Hospital.

So, my lady went to see a European doctor in Pattaya who has treated me and several of my friends in the past. I shall not name him but he’s totally professional and his surgery manner is superb and very caring.

This doctor prescribed my lady some medicine for her stomach, advised her gently on dietary matters and all this in the Thai language.

This doctor also wrote a letter to the Bangkok Hospital, Pattaya so that my lady could have an Abdominal Ultrasound Scan performed. He wrote for me that he was concerned about the possibly of an Aortic Aneurism – a potentially serious condition, but that he NEEDED to see the result of the scan to be sure.

In considerable trepidation, she went to Bangkok Hospital, got her scan done, apparently by a very caring team, and took the results to said European doctor. This gentleman assured her that the scan shows NOTHING of any importance is amiss and gently reassured her that the medicine and some dietary advice will sort things out.

Based on my past experience with him – they will!

On Skype, my lady showed me the scans and they were very comprehensive – I’ve had similar in UK in the past so I am aware of what’s needed, if only in an amateur way!

And the cost to set minds at rest? 8750 Baht including the doctor and the scan and a supply of the above-mentioned medicine.

So my questions to Pattaya Memorial Hospital (were I to bother), would be “Why after a few minutes cursory examination did they suggest surgery? Why no X-Ray, or any sort of scan? Why no particular care offered?

Now, a good friend of mine has frequently opined that in Thailand “they don’t operate on the patient, they operate on the wallet”!

You be the judge but please always get at least a second opinion if seeing a doctor in Thailand.

Mods: I’m posting this in the Health, Body and Medicine Forum, as although it occurred in Pattaya, I rather feel it may apply in other parts of Thailand – dare I say “especially areas where Farang congregate”?

Edited August 10, 2013 by VBF

[Sheryl]

One should aleays get a second opinion before having surgery. And also use one's own judgement as to the thoroughness of a doctor's diagnostic procedures.

That said, this was not done by "Pattaya Memorial Hospital". This was done by a specific individual doctor there. A different doctor at the same institution might have proceeded quite differently.

[VBF]

One should aleays get a second opinion before having surgery. And also use one's own judgement as to the thoroughness of a doctor's diagnostic procedures.

That said, this was not done by "Pattaya Memorial Hospital". This was done by a specific individual doctor there. A different doctor at the same institution might have proceeded quite differently.

Possibly Sheryl but as I said, to my personal knowledge doctors at PMH have in the past made snap diagnoses and not explained the "whats" and "whys" to the patient before recommending drastic and expensive procedures.

Surgery should be a last resort not the first thing suggested, especially when there are so many modern, non-invasive techniques for diagnosis

If they've treated the few people I know in that cavalier fashion, it's reasonable to assume that there may be others and that policy might be getting in the way of diagnosis.

In any event, the hospital is responsible for monitoring its staff, wouldn't you say?

[Sheryl]

Private hospitals in Thailand do not "monitor" the physicians who have privileges there. The physicians are not employed by the hospital (whereas they are in government hospitals). Rather, there is a contractual arrangement whereby the physician has the use of hospital facilities and privileges to admit patients there. The physicians set their own fees as they see fit, and the hospital tacks on a small charge for outpatients and then larger fee for room/nursing for inpatient. The hospital also benefits from use of its support services (lab, imaging etc).

It is important to understand this dynamic in private hospitals. The nursing and administrative staff (and lab etc) are hospital employees and the hospital will have policies governing their work. Not the case for the physicians who are in essence working privately .

A hospital can suspend a physician's admitting privileges and right to use their OPD infrastructure should they feel the physician was a serious liability for some reason but that very, very rarely happens and there is certainly no looking over their shoulders to see how they practice medicine.

For this reason you will find a very vast range of practices according to the physician in private hospitals.

Government hospitals on the other hand exert much more control and physicians have to adhere to established protocols.

[VBF]

Private hospitals in Thailand do not "monitor" the physicians who have privileges there. The physicians are not employed by the hospital (whereas they are in government hospitals). Rather, there is a contractual arrangement whereby the physician has the use of hospital facilities and privileges to admit patients there. The physicians set their own fees as they see fit, and the hospital tacks on a small charge for outpatients and then larger fee for room/nursing for inpatient. The hospital also benefits from use of its support services (lab, imaging etc).

It is important to understand this dynamic in private hospitals. The nursing and administrative staff (and lab etc) are hospital employees and the hospital will have policies governing their work. Not the case for the physicians who are in essence working privately .

A hospital can suspend a physician's admitting privileges and right to use their OPD infrastructure should they feel the physician was a serious liability for some reason but that very, very rarely happens and there is certainly no looking over their shoulders to see how they practice medicine.

For this reason you will find a very vast range of practices according to the physician in private hospitals.

Government hospitals on the other hand exert much more control and physicians have to adhere to established protocols.

With my "Farang hat" on, I find the concept of a physician effectively freelancing within a hospital quite alarming - I know it wouldn't be allowed in the UK but then our main hospitals are Government-run. However in the UK private sector there are more "checks and balances" as I suspect there are in the US (though I don't know)

I also suspect that many Farang are unaware of how it works in Thailand. It certainly puts more emphasis on earning money than one might like. It is indeed a business first.

Sheryl I appreciate your explanation, but as much as it helps me understand WHY things are done as they are, it still doesn't change the fact that the doctor made an incorrect snap diagnosis, wanted to put the patient into surgery without proper tests and would have achieved nothing more than the benign and caring European doctor achieved with far less stress, discomfort and cost.

When a Thai person is scared to go to a Thai doctor but content to go to a European doctor and trusts them more, something is wrong with the Thai system!

I have to stand by my original warning to others - knowing why it occurs is useful but doesn't change things a jot.

[jrtmedic]

VBF

"A hospital can suspend a physician's admitting privileges and right to use their OPD infrastructure should they feel the physician was a serious liability for some reason but that very, very rarely happens and there is certainly no looking over their shoulders to see how they practice medicine."

Even with your "Farang hat" on the above is an exact statement about private hospitals ------anywhere !

Your "warning" is also without merit ! Lacking, as it does, any substantive clinical detail.

You, however, seem to believe that some story fed to to by your "g/f" is sufficient to justify making what could amount to a defamatory statement.

Second opinions are a good idea when elective surgery is being considered --- in emergency situations maybe you will just be happy for someone to save your life !

Edited August 11, 2013 by jrtmedic

[VBF]

VBF

"A hospital can suspend a physician's admitting privileges and right to use their OPD infrastructure should they feel the physician was a serious liability for some reason but that very, very rarely happens and there is certainly no looking over their shoulders to see how they practice medicine."

Even with your "Farang hat" on the above is an exact statement about private hospitals ------anywhere !

Your "warning" is also without merit ! Lacking, as it does, any substantive clinical detail.

You, however, seem to believe that some story fed to to by your "g/f" is sufficient to justify making what could amount to a defamatory statement.

Second opinions are a good idea when elective surgery is being considered --- in emergency situations maybe you will just be happy for someone to save your life !

JRTmedic

You were doing OK until you mentioned the "some story.....etc" If you bothered to READ my OP you would see that the same issue has occurred before, to other people.

So

1 - As far as defamatory statements go, I would appreciate NOT being called a liar.

2- My warning could be construed as "caveat emptor" (let the buyer beware) and was and is intended to alert people to POSSIBLE issues. Kindly read it again especially my rhetorical questions - IMO these are the things that prospective patients need to ask - certainly when elective surgery is involved.

Might I ask - considering your board name "Are you a medical professional perchance?"

[jrtmedic]

As a matter of fact yes ! And in over 30 years of experience I have never seen an Aortic Aneurysm occurring or even being suspected in a woman under 60 years old ! ( It can occur but in conjunction with very rare disease processes such as Marfans syndrome !)

In younger women recurring abdominal pain (painful "stomach" in lay terms) is much more likely to be associated with gynaecological problems, appendicitis, biliary colic or simple constipation.

Some rarer causes occur such as ulcerative colitis .

More common causes are associated with unwise lifestyle choices associated with alcohol, smoking and a poor diet.

I would suggest if you want to issue "Warnings" that such are specific, clinically detailed and not based on unspecified anecdote.

Anecdotes told to me include G/Fs telling absent B/fs of the need for expensive medical procedures either for themselves or a member of family. I have also heard of the urgent need to replace expensive buffalo's !

Anyone considering elective surgery would be wise to secure a second opinion.

Are you sure the Doctor told the G/F she would need to be "cut open " ?

Re reading my original post I fail utterly to detect my calling anyone a liar

Edited August 11, 2013 by jrtmedic

[infinity11]

This kind of reminds me of when I bring my computer to get fixed, or just about any other endeavor.

Thanks for posting your story.

[Sheryl]

The incipient flamefest stops NOW>

Keep it civil.

Obviously there are many aspects of the story we do not know. But in my experience, while it is not very common, it does sometimes happen that unnecessarily surgery is quickly recommended. It is also possible that the patient honestly misubnderstood some of what was said....but if so the doctor's communication skills may not have been the best (which in my experience is extermely common here).

VBF, the point of my post was to explain why you cannot generalize from the actions of an individual doctor to an entire "hospital".

It is very important to always carefully choose one's doctor..the doctor, not the hospital. A very wide range of experiences can and will be had in the exact same institution. For the reasons I outlined.

Over the years I have seen botgh good and bad reports of care at the hospital in question...as at most hospitals.

Always, always research the qualifications of the doctor and make a specific selection when using private hospitals. Do not just show up and think that there is some hospital-wide standard of care which ensures you will get referred to soemone who will provide good care. (In faqct you may not even be referred to the right sort of specialist, if you rely ion the reception desk to decide for you whom to see...)

The ability to do this is iMO the biggest advantage to private hospitals. You can't do this at a government hospital. While this does lead to variabilities in the quality of care at them, that fact is at least partially offset by strict hospital-wide protocols and the like. Certainly surgery is not going to be recommended without adequate reason at a government hospital. Like govt hospitals pretty much everywhere, they are more prone to errors of omission than commission.

[Sheryl]

P.S. While we have insufficient information about the details of the woman's problem, one possibility is that it was a pattern and type of pain consist with endometriosis, in which case the surgical procedure may have been a laparoscopy which is necessary for diagnosis and , while surgery, not exactly "cutting someone open" nor something that need be a last resort...it is in fact the gold standard for diagnosis of this condition. 100K sounds about right for that.

And if -- IF -- she dopes have endometriosis, the more treatment given instead may in the long run not work.

Just a possibility. The phrase "painful stomach" can cover a wide range of symptoms especially when said by a non-native English speaker.

[VBF]

P.S. While we have insufficient information about the details of the woman's problem, one possibility is that it was a pattern and type of pain consist with endometriosis, in which case the surgical procedure may have been a laparoscopy which is necessary for diagnosis and , while surgery, not exactly "cutting someone open" nor something that need be a last resort...it is in fact the gold standard for diagnosis of this condition. 100K sounds about right for that.

And if -- IF -- she dopes have endometriosis, the more treatment given instead may in the long run not work.

Just a possibility. The phrase "painful stomach" can cover a wide range of symptoms especially when said by a non-native English speaker.

I was about to reply to Jtrmedic but Sheryl beat me to it. In no way am I flaming - just objecting to one or two comments, however having read your comment, here is the (modified) reply I was preparing:

Jrtmedic

The Aortic Aneurysm was a SUSPICION, not a diagnosis – I actually said POSSIBILITY in my OP hence the need for a scan – the scan showed that nothing serious is amiss. I presume you approve of that? I didn’t mention before that the doctor put that in an email to me: his exact phrase was “Aortic Aneurysm? Suggestion Abdominal Ultrasound”

Simple constipation is indeed a symptom – that’s what the medicine is for – I’m told its working thank you.

I repeat that my warning was to suggest people get a second opinion and don’t automatically trust that “the doctor always knows best” - many people think that’s the case – I’m not so trusting! My aim is to alert other people to make INFORMED DECISIONS. I think there is a flaw in the hospital system if patients need to choose their specialist - how do they know?

My warning couldn’t be specific as I’m not medically qualified – THAT is the point – I need to trust the doctor as do other future patients!

Yes - The original doctor told the lady that he would have to cut her. He told her in Thai.

As for your comments on unspecified anecdotes which I believed IMPLIED a lie – I have seen the container of medicine, I have seen the scans on Skype – please read my OP. I have also exchanged emails with the doctor whom I know personally – please read my OP.

So your saying that “You, however, seem to believe that some story fed to you by your "g/f" is sufficient.........” rather implies that you think she is lying – indeed a possibility, but the evidence above refutes that.

As I said above “I have to stand by my original warning to others” I posted it in good faith because I thought it would help.

VBF

Edited August 11, 2013 by VBF

[Sheryl]

Again, absolutely no flaming.

I am sure no one disagrees with the warning to always get a second opinion nor that people should use their own judgement and not automatically assume "doctor knows best". Doctors come in all shapes and sizes and degrees of competency....and even the best ones can make honest mistakes.

As to the need to choose your own specialist -- that is how it is in private medical care, pretty much everywhere in the world. People not prepared to do that would be well advised to stick with government hospitals.

That the doctor said "cut" in Thai does not, BTW, rule out the possibility that he meant a small incision for the insertion of a laparascope. Would help top know what the doc in question's specialty was.

[VBF]

Again, absolutely no flaming.

I am sure no one disagrees with the warning to always get a second opinion nor that people should use their own judgement and not automatically assume "doctor knows best". Doctors come in all shapes and sizes and degrees of competency....and even the best ones can make honest mistakes.

As to the need to choose your own specialist -- that is how it is in private medical care, pretty much everywhere in the world. People not prepared to do that would be well advised to stick with government hospitals.

That the doctor said "cut" in Thai does not, BTW, rule out the possibility that he meant a small incision for the insertion of a laparascope. Would help top know what the doc in question's specialty was.

Sheryl,

I'm glad you understand my intentions - as the lady seems quite better now, we shall never know.

I hope Jrtmedic realises why I took some small offence - and yes I am very familiar with the propensity for buffaloes to become "mai sabai" - no further comment!

One thing Sheryl - do you (or does anyone else) believe that the government hospitals in Thailand are likely to be as good as the private ones? Despite all I've said above, the old adage "You get what you pay for" seems to apply.

Maybe the subject for a new thread - meanwhile....any opinions?

Edited August 11, 2013 by VBF

[jrtmedic]

"The Aortic Aneurysm was a SUSPICION, not a diagnosis – I actually said POSSIBILITY in my OP hence the need for a scan "

In over thirty years of practise I have never "suspected" a woman under 60 years of age to have a "possible" AA! and have never requested a "scan" on the basis of "stomach pain"!

Maybe I have missed hundreds of young women with AA's !

(But I have never been "sued" for my "failures"! Maybe that is just good luck ?)

Search the internet and come up with the evidence that an AA has to be excluded as a priority in the case of a Young(ish) woman complaining of "stomach pain"

I will be interested to learn about your findings ! ( and my obvious failure over many years if you discover the evidence )

The list of differential diagnoses for a young(ish) woman suffering " stomach pain" is indeed long but AA would be the last on the list !

I am not attempting to argue this issue but rather trying to secure some sort of sensibility

"Hospitals" and Doctor/s should not be condemned on the basis of ill informed anecdotal evidence !

Edited August 11, 2013 by jrtmedic

[VBF]

"The Aortic Aneurysm was a SUSPICION, not a diagnosis – I actually said POSSIBILITY in my OP hence the need for a scan "

In over thirty years of practise I have never "suspected" a woman under 60 years of age to have a "possible" AA! and have never requested a "scan" on the basis of "stomach pain"!

Maybe I have missed hundreds of young women with AA's !

(But I have never been "sued" for my "failures"! Maybe that is just good luck ?)

Search the internet and come up with the evidence that an AA has to be excluded as a priority in the case of a Young(ish) woman complaining of "stomach pain"

I will be interested to learn about your findings ! ( and my obvious failure over many years if you discover the evidence )

The list of differential diagnoses for a young(ish) woman suffering " stomach pain" is indeed long but AA would be the last on the list !

I am not attempting to argue this issue but rather trying to secure some sort of sensibility

"Hospitals" and Doctor/s should not be condemned on the basis of ill informed anecdotal evidence !

You say "Hospitals" and Doctor/s should not be condemned on the basis of ill informed anecdotal evidence !

Indeed not but they should certainly be criticised for hasty decisions to engage in invasive surgery made without proper consideration and after all other avenues explored. Surgery is a last resort, not a first one.

Clearly as the lady is now feeling quite well WITHOUT any such surgery, the correct decisions were made by the European doctor.

I'm rather glad HE was the chosen physician and feel that the case is proven by the recovery of the patient - and THAT is all that's important.

I started this thread to assist and warn other laypersons like myself, not to engage in pointless debate with someone who isn't willing to concede that they could ever be wrong - I trusted a known expert, he was right - we have the proof.

Sorry to be abrupt Sheryl but the patient is well and my patience is being sorely tried - as far as I'm concerned there's nothing more to be said

I bid you goodbye..

Edited August 11, 2013 by VBF

[sustento]

"The Aortic Aneurysm was a SUSPICION, not a diagnosis – I actually said POSSIBILITY in my OP hence the need for a scan "

In over thirty years of practise I have never "suspected" a woman under 60 years of age to have a "possible" AA! and have never requested a "scan" on the basis of "stomach pain"!

Maybe I have missed hundreds of young women with AA's !

(But I have never been "sued" for my "failures"! Maybe that is just good luck ?)

Search the internet and come up with the evidence that an AA has to be excluded as a priority in the case of a Young(ish) woman complaining of "stomach pain"

I will be interested to learn about your findings ! ( and my obvious failure over many years if you discover the evidence )

The list of differential diagnoses for a young(ish) woman suffering " stomach pain" is indeed long but AA would be the last on the list !

I am not attempting to argue this issue but rather trying to secure some sort of sensibility

"Hospitals" and Doctor/s should not be condemned on the basis of ill informed anecdotal evidence !

You say "Hospitals" and Doctor/s should not be condemned on the basis of ill informed anecdotal evidence !

Indeed not but they should certainly be criticised for hasty decisions to engage in invasive surgery made without proper thought. Surgery is a last resort, not a first one.

Clearly as the lady is now feeling quite well WITHOUT any such surgery, the correct decisions were made by the European doctor.

I'm rather glad HE was the chosen physician and feel that the case is proven by the recovery of the patient - and THAT is all that's important.

I started this thread to assist and warn other laypersons like myself, not to engage in pointless debate with someone who isn't willing to concede that they could ever be wrong - I trusted a known expert, he was right - we have the proof.

Sorry to be abrupt Sheryl but the patient is well and my patience is being sorely tried - as far as I'm concerned there's nothing more to be said

I bid you goodbye..

Didn't you know? Doctors are NEVER wrong

[Sheryl]

Again, absolutely no flaming.

I am sure no one disagrees with the warning to always get a second opinion nor that people should use their own judgement and not automatically assume "doctor knows best". Doctors come in all shapes and sizes and degrees of competency....and even the best ones can make honest mistakes.

As to the need to choose your own specialist -- that is how it is in private medical care, pretty much everywhere in the world. People not prepared to do that would be well advised to stick with government hospitals.

That the doctor said "cut" in Thai does not, BTW, rule out the possibility that he meant a small incision for the insertion of a laparascope. Would help top know what the doc in question's specialty was.

Sheryl,

I'm glad you understand my intentions - as the lady seems quite better now, we shall never know.

I hope Jrtmedic realises why I took some small offence - and yes I am very familiar with the propensity for buffaloes to become "mai sabai" - no further comment!

One thing Sheryl - do you (or does anyone else) believe that the government hospitals in Thailand are likely to be as good as the private ones? Despite all I've said above, the old adage "You get what you pay for" seems to apply.

Maybe the subject for a new thread - meanwhile....any opinions?

The quality oif care in government hospitals is usually quite good provided one goes to an appropriate level hospital. There is a pinned thread that explains how the Thai public health system is organized.

In addition, most care is free for Thai citizens. (Though they have to use the government hospital they are registered at, and -- if higher level care needed -- get referred up the chain in order for care to be free).