Thai doctors selling medicine

[recycler]

Most Thais are disappointed if they visit a doctor with common cold and don't walk away with at least 4 different colored sets of pills with at least one type ofheavy antibiotic.

Some of the bigger government hospitals are quite reliable and have doctors that think like medics in stead of businessmen.

Anyway in some European countries doctors also have their own pharmacy that they benefit from.

[CIHUAHUA]

It is better to have more than enough than not enough. Like the doctor said "Its small money for you".

[h90]

not only Thailand....Everywhere it happens that Docs sell you more than you need.

Even surgeries that aren't necessary, or tell it more friendly, often it is a grey area if something is necessary or not necessary.

So better give some antibiotics on a virus infection, just to be safe that no bacterial infection comes additional on the already weakened immune system, which does happen.

So did he sell you unnecessary antibiotics to make some extra money? Or was he just on the safe side? For both you can find good arguments.

[Suradit69]

It's simply a business, i believe a lot of doctors have/run pharmacies as well, nice sideline,

Most Thais expect to get several medicines - one medicine, doctor no good.

Right. Once again it's Thais who are somehow different from the rest of the world's population.

Misprescribing and Overprescribing of Drugs

• Seven all-too-often-deadly sins of prescribing
• Evidence of Misprescribing and Overprescribing
• The Causes of Misprescribing and Overprescribing

The numbers are staggering: in 2003, an estimated 3.4 billion prescriptions were filled in retail drugstores and by mail order in the United States. That averages out to 11.7 prescriptions filled for each of the 290 million people in this country.¹

http://www.worstpills.org/public/page.cfm?op_id=3

New Research Finds Doctors are Massively Overprescribing Drugs

"Yet many doctors are quick to prescribe a drug, partly because they have limited time to deal with individual patients or because they and their patients have been bombarded with ads from the pharmaceutical industry."

The average annual prescription rate for children and seniors in the United States is now:

• Almost 4 prescriptions per child (age 0-18)
• More than 31 prescriptions per senior, aged 65 and over

http://articles.mercola.com/sites/articles/archive/2011/07/02/new-study-finds-doctors-are-massively-overprescribing-drugs.aspx

Edited January 3, 2014 by Suradit69

[Farma]

Providers selling the drugs they prescribe for a profit, is clearly a conflict of interests.

Their interest is to be in your health and well-being, not their pocketbook.

You could make an argument for a provider selling the medicines at cost, if no other access to the medicines is available locally.

Local pharmacy kickbacks and pharma company junkets also constitute a breach of ethics.

F1

There are a few claims in this thread of kickbacks.

The only businesses getting anything worthwhile are high turnover wholesalers and chain stores. Note high turnover.

Your average doctor and local pharmacy doesn't have the turnover. Fair enough they may get the odd coffee cup, note pad or manicure set as part of advertising but thats all.

[Pii Kate]

I get medical care at RAM in Chiang Mai. Doctor visits are 300 baht or $10 but medicine at that hospital is out of sight, over the top, expensive. So most of my stuff gets filled at a local pharmacy for about 1/3 the price. It's not the doctors, it's the hospital;, but not all hospitals.

[circusman]

My experienced Thai doctor sells pills. The treatment, diagnosis etc. is mostly 0 Bath! So what?

I will trust him more than most European money making doctors.

What a stupid post. Where do you get 0 cost treatment or even a consult ? Just stupid.

[frozin1]

Providers selling the drugs they prescribe for a profit, is clearly a conflict of interests.

Their interest is to be in your health and well-being, not their pocketbook.

You could make an argument for a provider selling the medicines at cost, if no other access to the medicines is available locally.

Local pharmacy kickbacks and pharma company junkets also constitute a breach of ethics.

F1

There are a few claims in this thread of kickbacks.

The only businesses getting anything worthwhile are high turnover wholesalers and chain stores. Note high turnover.

Your average doctor and local pharmacy doesn't have the turnover. Fair enough they may get the odd coffee cup, note pad or manicure set as part of advertising but thats all.

There is no 'value' threshold that needs to be met for it to be unethical.

F1

[nidieunimaitre]

It's simply a business, i believe a lot of doctors have/run pharmacies as well, nice sideline,

Most Thais expect to get several medicines - one medicine, doctor no good.

Right. Once again it's Thais who are somehow different from the rest of the world's population.

Misprescribing and Overprescribing of Drugs

• Seven all-too-often-deadly sins of prescribing
• Evidence of Misprescribing and Overprescribing
• The Causes of Misprescribing and Overprescribing

The numbers are staggering: in 2003, an estimated 3.4 billion prescriptions were filled in retail drugstores and by mail order in the United States. That averages out to 11.7 prescriptions filled for each of the 290 million people in this country.¹

There we go again.

You see thai bashing everywhere, don't you.

The problem described by the OP is not thailand.

The problem is ignorance and wild west capitalism.

Both are more frequent in less developed countries of course, why would thailand be an exception to that?

[GuestHouse]

Right now I'm on my way to an appointment at a private hospital.

I will report my experience later today.

[GuestHouse]

Meanwhile, claiming to love Thailand seems to be the medicine of choice of people who cannot accept others having a different point of view.

[nidieunimaitre]

Most Thais are disappointed if they visit a doctor with common cold and don't walk away with at least 4 different colored sets of pills with at least one type ofheavy antibiotic.

Some of the bigger government hospitals are quite reliable and have doctors that think like medics in stead of businessmen.

Anyway in some European countries doctors also have their own pharmacy that they benefit from.

Which european countries?

Romenia? the UK? Bulgaria? or another borderline "european" state?

[flyingdoc]

Certainly any hospitals I have experienced except a University Hospital in BKK, and indeed Government run hospitals, overcharge on Meds they dish out, which are usually more than required for the condition or accident in question! However, one must weigh this against the convenience of a one stop service!

[txp158]

And this is why I will continue to bring my sons to the children's hospital in Bangkok I just can not trust any of the doctors in the private hospitals for them.

For myself there is one foreign doctor who is very reliable in Bangkok and if I have any issues I will always go to him

I agree. My son is currently in the Queen Sirikit Institute for Children's Health hospital. I'm really impressed by the doctors and medical staff there. The children's hospital he goes for his wheelchair, walkers, and special boots is also really good.

On recommendation, we tried a local private hospital. Expensive, but nice facilities, like a hotel. The senior doctor misdiagnosed him and wanted to operate. Luckily he bottled out of the op and suggested we move him to QSICH. The doctors there were not impressed with the diagnosis nor the lack of adherence to transfer procedure.

One question - I thought only Thai doctors could practice medicine in Thailand?

All doctors in Thailand are required to have a license provided by the medical council of Thailand in order to practice medicine. That license would be given to anyone who passes the licensing examination. The last (oral) part of the exam is given in Thai, so most foreign doctors will have difficulty passing the exam if they speak no Thai at all.

[bkkgooner]

And this is why I will continue to bring my sons to the children's hospital in Bangkok I just can not trust any of the doctors in the private hospitals for them.

For myself there is one foreign doctor who is very reliable in Bangkok and if I have any issues I will always go to him

I agree. My son is currently in the Queen Sirikit Institute for Children's Health hospital. I'm really impressed by the doctors and medical staff there. The children's hospital he goes for his wheelchair, walkers, and special boots is also really good.

On recommendation, we tried a local private hospital. Expensive, but nice facilities, like a hotel. The senior doctor misdiagnosed him and wanted to operate. Luckily he bottled out of the op and suggested we move him to QSICH. The doctors there were not impressed with the diagnosis nor the lack of adherence to transfer procedure.

One question - I thought only Thai doctors could practice medicine in Thailand?

Nice to see other foreigners using that hospital as well as I really think it's a great place. This is a foreign doctor I was referring to http://www.mission-hospital.org/index.php/en/component/sobipro/?pid=149&sid=238:Dr-Nick-Walters

He was spoken about on this thread as well http://www.thaivisa.com/forum/topic/330385-looking-for-a-us-licensed-physician/ in post 8 - I would recommend to use him as your GP if the location is OK as he is an excellent doctor who takes his time and explains things very clearly. He treats both foreign and Thai patients and has an excellent reputation.

[robertson468]

Karen 1 - Scotland 0

Scotland 4 - Karen -1.

[Docno]

I suspect this is the way it is throughout most of Asia, if not the world. It's certainly that way in SE Asia's most advanced nation, Singapore. The doctor prescribes you some meds and sells them to you. Sometimes they are things as simple as a wound disinfectant that you could presumably buy cheaper off the shelf. But it's all provided at the clinic and billed by the doctor (so there is no prescription to be filled out etc). This widespread practice has been criticised for leading to over-medication (since doctors directly profit from dispensing meds), especially as concerns antibiotics (which can lead to resistance to these drugs building up faster).

[stoli]

I came here years ago to Bangkok for open heart surgery. Price was 90% less than the U.S., and the Hospital was nicer than any in the states. Doctors were all trained & worked in the U.S. before coming home. My experience was that when I asked for more medicine, (for pain, for gas related to surgery, etc.) was that it would very hard to get them to give it. They like to have the body heal a lot of the problems by themselves. I do find that living here now, they do prescribe a lot of anti-biotics, but probably only because I see them for infections, colds, cuts. Makes sense.

Edited January 3, 2014 by stoli

[stoli]

I took my wife to a thai doctor for a general checkup.

That included a blood test.

As a result of that blood test, we were advised that my wife has a shortage of calcium, osteoporosis.

The doctor sold us medicine to cure the problem.

Later we went to my doctor in Belgium, and asked for a prescription of a similar medicin, and told him why.

The belgian doctor then informed us that osteoroposis CAN NOT BE ESTABLISHED through a blood test.

Never again will I trust a medecin selling doctor.

About 54% of postmenopausal white women in the United States have osteopenia and 30% have osteoporosis. If your wife is in that age range, he doesn't need a blood test and he'll be half right.

In order to establish the diagnosis of osteoporosis or osteopenia, one would need to undergo bone desitometry aka DEXA. If the general check up includes that test, then your wife is likely to have osteoporosis.

If you are certain that your wife have low blood calcium, then doctor will need to order a whole lot more tests in order to establish the cause of hypocalcemia. Most foreigners will be ask if they want to find the cause at home or in Thailand.

If there is a lot of language barrier, most doctor will say low calcium. Take calcium pill now and do more tests at home.

Indeed, that is what the belgian doctor (the real doctor) told us, only a bone densitometry can establish the osteoporosis - and it was not included in the check up.

Unfortunately, there was a waiting list in belgium, so that will be for our next trip to europe.

And no, I am not certain that the wife has osteoporosis, no bones ever broken, I have only the word of a Kwak (as we call such doctors at home).

Possibly the blood was never analysed too.

Thank you for your answer!

And no, I am not certain that the wife has osteoporosis, no bones ever broken, I have only the word of a Kwak (as we call such doctors at home).

Possibly the blood was never analysed too.

You don't need to have broken bones to get osteoporosis. This is a big problem in Thailand, and is one reason they have stopped installing squat toilets. Planting rice is also a big problem.

Probably your remark about the blood never being analyzed shows a bias that you just don't believe in your doctor, without proof that he has done something wrong. That is only an issue you can deal with. You went to a new doctor, fine, but you still have no basis to slam the first doctor if you don't know he did not check the blood.

[nithisa78]

Thai doctors have no monopoly on anything of this sort. No profession exempts you from what you are about. Nor does it exempt the so called client / patient. We all pretty much receive what we have given, in life. Like it or not. Walk tall, be kind. H.N.Y.

[personchester]

My experienced Thai doctor sells pills. The treatment, diagnosis etc. is mostly 0 Bath! So what?

I will trust him more than most European money making doctors.

Your poster stating "0" costs for your medical treatment and diagnosis here in Thailand does not make sense, and your reply is either meant to be silly, or funny, but certainly not sensible.

The German people of Aachen are not happy reading this, in their view it puts city Aachen down hill.

[Aachen]

My experienced Thai doctor sells pills. The treatment, diagnosis etc. is mostly 0 Bath! So what?

I will trust him more than most European money making doctors.

What a stupid post. Where do you get 0 cost treatment or even a consult ? Just stupid.

I think, you are trying to be rude. In any case you must not address yourself as stupid just because you do not understand that the treatment in included in the medicine sold.

But maybe in a quite moment you can think it over and try to remember your education if any.

[GuestHouse]

OK here's my experience of doctor's in Thailand's private healthcare sector today.

I came away from the hospital with ear drops, for which I was charged ฿210 - I guess I might have bought those cheaper at a pharmacist - but my time's worth a lot more to me than waiting to save ฿50.

My total bill was just over ฿900 (though I did get the ฿800 'international patient charge' taken off when I asked to be treated like the regular patient I am.

So in the end I probably paid ฿750 more than if I had gone to a local pharmacy, for ฿750 I had the medical opinion of arguably the top ENT specialist in Thailand.

฿750 is a pittance for access to such good medical expertise.

All in all I'm very happy with the service, not a hint of over subscribing medicines but sadly the 'foreigner price' was at play.

As a final note, my experience was what it actually turned out to be, I didn't get out of bed expecting only good things to occur, nor did I get out of bed expecting a day of hell.

Such outlooks are the reserve of the lunatic fringe.

I, like most, take my Thai days exactly how I find them.

[BillyBobThai]

Before I take any medicine, be it from a doctor or anyone else, I always Google it first. I do not trust any of these docs.

[harryfrompattaya]

And this is why I will continue to bring my sons to the children's hospital in Bangkok I just can not trust any of the doctors in the private hospitals for them.

For myself there is one foreign doctor who is very reliable in Bangkok and if I have any issues I will always go to him

Amazing everyone on Thai Visa no mater where he lives even in different countries has the only reliable Doctor I being 86 never had a good doctor most of them did not live past 84 think about that

[nidieunimaitre]

I took my wife to a thai doctor for a general checkup.

That included a blood test.

As a result of that blood test, we were advised that my wife has a shortage of calcium, osteoporosis.

The doctor sold us medicine to cure the problem.

Later we went to my doctor in Belgium, and asked for a prescription of a similar medicin, and told him why.

The belgian doctor then informed us that osteoroposis CAN NOT BE ESTABLISHED through a blood test.

Never again will I trust a medecin selling doctor.

About 54% of postmenopausal white women in the United States have osteopenia and 30% have osteoporosis. If your wife is in that age range, he doesn't need a blood test and he'll be half right.

In order to establish the diagnosis of osteoporosis or osteopenia, one would need to undergo bone desitometry aka DEXA. If the general check up includes that test, then your wife is likely to have osteoporosis.

If you are certain that your wife have low blood calcium, then doctor will need to order a whole lot more tests in order to establish the cause of hypocalcemia. Most foreigners will be ask if they want to find the cause at home or in Thailand.

If there is a lot of language barrier, most doctor will say low calcium. Take calcium pill now and do more tests at home.

Indeed, that is what the belgian doctor (the real doctor) told us, only a bone densitometry can establish the osteoporosis - and it was not included in the check up.

Unfortunately, there was a waiting list in belgium, so that will be for our next trip to europe.

And no, I am not certain that the wife has osteoporosis, no bones ever broken, I have only the word of a Kwak (as we call such doctors at home).

Possibly the blood was never analysed too.

Thank you for your answer!

And no, I am not certain that the wife has osteoporosis, no bones ever broken, I have only the word of a Kwak (as we call such doctors at home).

Possibly the blood was never analysed too.

You don't need to have broken bones to get osteoporosis. This is a big problem in Thailand, and is one reason they have stopped installing squat toilets. Planting rice is also a big problem.

Probably your remark about the blood never being analyzed shows a bias that you just don't believe in your doctor, without proof that he has done something wrong. That is only an issue you can deal with. You went to a new doctor, fine, but you still have no basis to slam the first doctor if you don't know he did not check the blood.

Yes, I do have a basis to slam the first doctor, since he lied to me about the osteoporosis.

If a doctor lies about the results of a blood test, so that he can sell his pills, why would he not lie about having the blood tested for real?

[Sheryl]

It's simply a business, i believe a lot of doctors have/run pharmacies as well, nice sideline,

Most Thais expect to get several medicines - one medicine, doctor no good.

Too true. I have never met a Thai yet who was unhappy at a handful of pills. Met some who have been unhappy with few or no pills though.

+1

Thai doctors overprescribe even when the patient is going to buy the meds at an outside pharmacy.

Private hospitals/doctors worse than public in this regard but it happens in the public sector too even though the financial incentives are in the other direction.

it is assumed patients will be dissatisfied -- even outright offended -- if not given several different medications on each visit.

[txp158]

You don't know every Thai doctors. At least you don't know me.

I usually ask my patients if they want my medicine or they wanna go to buy themselves at drug store. And even so, some get offended when I do that because they think that I think they don't have money.

I try to make everyone happy but in the end, you can't do the same thing and expect everyone to be happy and don't complain. It's just impossible.

If you are RN, you should know that.

[uptheos]

It's simply a business, i believe a lot of doctors have/run pharmacies as well, nice sideline,

Most Thais expect to get several medicines - one medicine, doctor no good.

Just give them some chocolate M&M's, tell them they are sublingual so they should let them melt in the mouth and they'll be cured in no time.

[Kangawallafox]

A few years back a friend I was staying with in a local camp wanted steroids,we got them and the first lot were taken in the doctors office.

Is this a doctor you could trust,I will note I have friends who get them of Australian doctors to.