antibiotics and doctors in thailand vs usa

[h90]

As a primary care physician here in Thailand I'd like to chime in and say I think there are truths to all the posts here and several reasons why doctors here prescribe antibiotics over zealously might be because:

1. Don't want to appear incompetent- this is the fault of the ignorance of the thai population which doctors are also to blame.

It is a misconception that the more meds the better the diagnosis and treatment. We are often too lazy to explain the difference between viral and bacterial infections and why antibiotics need or not need to be used.

2. Don't want to get the stink eye- This occurs in the national healthcare system which is highly distrusted by the general public as offering substandard service to save on costs. Doctors often don't want to offend, get reprimanded by the patient for being stingy and unethical, so they prescribe to get it over with. This is for the same reason as no. 1. GP's in the system on average see over 100 patients a day and are just too tired to explain. It is wrong but human nature tends to find the easy way out instead of having to take another 5 minutes explaining viruses and bacteria and end up with a distrusted face from the patient.

3. For private hospitals its about boosting income: Some doctors performance is based on the amount of income they generate.

I would blame the policy of those private hospitals and the doctors who willingly do it.

4. Borderline diagnosis between viral and bacterial infections. High fever, inflamed throat and signs of lower respiratory tract involvement, though all possibly due to viral causes concern for doctors and unless everybody is willing to pay 2500 baht to have their throat cultured for influenza and do CBC's to differentiate viral vs bacterial, doctors often opt for antibiotics to stay on the safe side as often there are both types of infections superimposing at the same time. Cases of rheumatic heart disease, though rare are due to failure to administer antibiotics in upper respiratory infections. If extensive lab results are not available sometimes the risk of developing resistance is outweighed by the benefits.

I myself advocate spending a little more time asking about the onset, detailed history with a thorough physical examination instead of just "aahhh" open your mouth, and use your best judgement. Take the time to explain the difference of a bacterial versus viral infection and let the patient decide.

Just to add from Europe....my mother knows some elderly women (in Europe) and:

They are upset if they don't get a lot tablets from the doctor...They fell not taken serious (as actually no one is taken them serious for good reason).

And they are upset if the doctor is asking too much about other things than the direct problem (like eating habits). As they feel it is not his business.....

And of course elderly women are the main business....they are bored at home and medical care is free, so they go to the doctor for every small problem and find their friends in the waiting room for a chat.

So often young doctors are better/dedicated to what they have learned. But as older they get as more they are bent by their customs demands....

That might be less of an issue in Thailand, but also I doubt that the doctor can tell: "You have a normal flu, beside you don't feel well it isn't a problem. So don't be a pussy. I could give you some Aspirin, but I don't because of the risk with Dengue Fever. So I don't give you anything. Please pay 1000 Baht for nothing and come back if it isn't good in 2 weeks.----->Next one!"

Giving a lot tablets signals that the problem and the person is taken seriously....

[TallGuyJohninBKK]

As a primary care physician here in Thailand I'd like to chime in and say I think there are truths to all the posts here and several reasons why doctors here prescribe antibiotics over zealously might be because:

1. Don't want to appear incompetent- this is the fault of the ignorance of the thai population which doctors are also to blame.

It is a misconception that the more meds the better the diagnosis and treatment. We are often too lazy to explain the difference between viral and bacterial infections and why antibiotics need or not need to be used.

2. Don't want to get the stink eye- This occurs in the national healthcare system which is highly distrusted by the general public as offering substandard service to save on costs. Doctors often don't want to offend, get reprimanded by the patient for being stingy and unethical, so they prescribe to get it over with. This is for the same reason as no. 1. GP's in the system on average see over 100 patients a day and are just too tired to explain. It is wrong but human nature tends to find the easy way out instead of having to take another 5 minutes explaining viruses and bacteria and end up with a distrusted face from the patient.

3. For private hospitals its about boosting income: Some doctors performance is based on the amount of income they generate.

I would blame the policy of those private hospitals and the doctors who willingly do it.

4. Borderline diagnosis between viral and bacterial infections. High fever, inflamed throat and signs of lower respiratory tract involvement, though all possibly due to viral causes concern for doctors and unless everybody is willing to pay 2500 baht to have their throat cultured for influenza and do CBC's to differentiate viral vs bacterial, doctors often opt for antibiotics to stay on the safe side as often there are both types of infections superimposing at the same time. Cases of rheumatic heart disease, though rare are due to failure to administer antibiotics in upper respiratory infections. If extensive lab results are not available sometimes the risk of developing resistance is outweighed by the benefits.

I myself advocate spending a little more time asking about the onset, detailed history with a thorough physical examination instead of just "aahhh" open your mouth, and use your best judgement. Take the time to explain the difference of a bacterial versus viral infection and let the patient decide.

I think those are all reasonable and factual explanations.

Unfortunately, patients deserve better professional behavior from their doctors than the details you describe, performance that too many doctors aren't meeting.

And, unfortunately, many many Thais (and even some farang) are acculturated to not question their treating doctors. Why do I need this medicine? What are the potential side effects? What makes you think I have a bacterial infection treatable by antibiotics vs. a viral infections that isnt. Etc etc etc.

The doctors are to blame for letting economic and business issues influence their medical treatment decisions. But patients are to blame too for having stupid expectations (like the more pills, the better) and for not exercising some personal responsibility over their health care decisions.

Overall, here in Thailand, in my experience, it's proper evaluation and diagnosis that is the most lacking element among local doctors.

I think Chiang Mai put it correctly above, when he wrote:

Most doctors/hospitals here are OK with straight forward events, broken bones. lacerations. flu, etc. But add the inconvenience of complexity and the situation changes, what to do when the scans or blood tests don't give an easy answer, capable resources on that front are seriously hard to come by.

[smileydude]

As a primary care physician here in Thailand I'd like to chime in and say I think there are truths to all the posts here and several reasons why doctors here prescribe antibiotics over zealously might be because:

1. Don't want to appear incompetent- this is the fault of the ignorance of the thai population which doctors are also to blame.

It is a misconception that the more meds the better the diagnosis and treatment. We are often too lazy to explain the difference between viral and bacterial infections and why antibiotics need or not need to be used.

2. Don't want to get the stink eye- This occurs in the national healthcare system which is highly distrusted by the general public as offering substandard service to save on costs. Doctors often don't want to offend, get reprimanded by the patient for being stingy and unethical, so they prescribe to get it over with. This is for the same reason as no. 1. GP's in the system on average see over 100 patients a day and are just too tired to explain. It is wrong but human nature tends to find the easy way out instead of having to take another 5 minutes explaining viruses and bacteria and end up with a distrusted face from the patient.

3. For private hospitals its about boosting income: Some doctors performance is based on the amount of income they generate.

I would blame the policy of those private hospitals and the doctors who willingly do it.

4. Borderline diagnosis between viral and bacterial infections. High fever, inflamed throat and signs of lower respiratory tract involvement, though all possibly due to viral causes concern for doctors and unless everybody is willing to pay 2500 baht to have their throat cultured for influenza and do CBC's to differentiate viral vs bacterial, doctors often opt for antibiotics to stay on the safe side as often there are both types of infections superimposing at the same time. Cases of rheumatic heart disease, though rare are due to failure to administer antibiotics in upper respiratory infections. If extensive lab results are not available sometimes the risk of developing resistance is outweighed by the benefits.

I myself advocate spending a little more time asking about the onset, detailed history with a thorough physical examination instead of just "aahhh" open your mouth, and use your best judgement. Take the time to explain the difference of a bacterial versus viral infection and let the patient decide.

Happy to see you here, can you please supply the forum with details of your primary care qualifications here in Thailand, bodies, boards, locals, etc?

I completed my pre-med in the US.

Medical training at Chulalongkorn University.

Board certified in Family Medicine/General Practice by the Medical Council of Thailand

Diploma in Acupuncture and Alternative medicine.

I've noticed a lot of comments questioning the competency of Thai medical training and would like to answer that in general the standard of medical training here is not inferior to that in the US or UK as Thai doctors who complete their medical training and pass the USMLE are readily accepted into US residency training and have garnered a reputation as hardworking and possessing skills. The thai system is similar to that in the UK, you enter after finishing secondary school. 6 years then 3 years interning then an additional 3-5 years of speciality training.

In the UK its complete IB/A levels then 5 years of medical school, 2 years foundation training and an additional 3-5 years of speciality training.

In the US as most probably know its 4 years undergraduate, take the MCATS, 4 years medical school and then 3-5 years speciality training.

The average US medical student is about 28 years old so they have an advantage in maturity and focus as the path to medical school is longer then in the UK or Thailand.

Thai medical students would probably have an advantage in terms of skills proficiencies as they do more procedures per student then in the US/UK. I performed numerous venous cutdowns, over 10 appendectomies and 30 deliveries by the time I graduated from med school. You don't have that chance in the UK/US. The US med students are known for having a solid background in the basic sciences because of the 4 years of pre-med. Some say residency/speciality training in the US has an edge over the UK because of the technology which I agree in general but the doctors in the US are also heavily reliant on technological diagnostics so their bedside skills might not be as well polished as their counterparts in the UK.

Having studied in the US and my daughter is currently a 2nd year med student in the UK I do have some first hand knowledge but these are only generalizations and proficiency/competency depends much on the individual student. I have found in general Thai doctors have a weakness in history taking and being thorough with what they write down as they are less exposed to the paperwork requirement from insurers as in the US. I'm not sure but what alot of expats here have experienced may also be attributed to language and cultural barriers. There is a different kind of modus operandi here in Thailand but universally a caring doctor who see's his/her patient as a person and not as a case will always be a better doctor.

[olddoc]

The only observation I would make is that a professional person would have no need to brag about the number of "cutdowns", "appendectomies " (sic) or deliveries that were (allegedly) undertaken as a student !

[thailiketoo]

The only observation I would make is that a professional person would have no need to brag about the number of "cutdowns", "appendectomies " (sic) or deliveries that were (allegedly) undertaken as a student !

The Doctor mentioned them to point out that Thai doctors had more experience as a student than students from the UK or US. If you read his post that is obvious.

He wrote, " Thai medical students would probably have an advantage in terms of skills proficiencies as they do more procedures per student then in the US/UK."

[Sheryl]

Since medical care is the third leading cause of death in the USA I think Thailand is doing OK.

http://chriskresser.com/medical-care-is-the-3rd-leading-cause-of-death-in-the-us

The most shocking revelation of her report is that iatrogentic damage (defined as a state of ill health or adverse effect resulting from medical treatment) is the third leading cause of death in the U.S., after heart disease and cancer.

This seems to me to be nonsense, the link to the study that Kresser refers to is not found, I also have some serious doubts about Kressers mission in life but hey, that's just me.

It is complete nonsense.

Iatrogenic illness/injury is a problem but not remotely on the magnitde suggested. Most iatrogenic illnesses do not lead to death. There is NO reputable source that lists it as a "third leading cause of death".

(It is also difficult in many cases to ascribe a death solely to iatrogenic factors, given that by definition the patient had another illness(es) or injury as well.)

[uptheos]

In my experience Thai doctors are more thorough and will only prescribe when required and often tell you , you dont need pills and some medications you may already have from the west are in fact not required as its old outdated practice/thinking.

I would suggest the doctors in the west are more likely to be pressured by medical reps/companies than any doctor in Thailand would be.

I see with my staff frequently:

a normal light cold....feeling not so good, no fever or very low one.....

They go to the doctor and come back with a bucket full of tablets.

often 5-8 different medications (non of them vitamins). And they are 20-40 year old healthy men who would be OK by themself within 1 week.

The next day or two when the cold is subsiding the antibiotics get thrown away.

No wonder so many strains are developing resistance.

[MAJIC]

Antibiotics misuse: from the Mayo Clinic

http://www.mayoclinic.org/antibiotics/art-20045720

Edited February 13, 2014 by MAJIC

[Sheryl]

Some provocative/borderline flaming posts and replies to them have been deleted.

[thailiketoo]

It is complete nonsense.

Iatrogenic illness/injury is a problem but not remotely on the magnitde suggested. Most iatrogenic illnesses do not lead to death. There is NO reputable source that lists it as a "third leading cause of death".

(It is also difficult in many cases to ascribe a death solely to iatrogenic factors, given that by definition the patient had another illness(es) or injury as well.)

http://www.scientificamerican.com/article/how-many-die-from-medical-mistakes-in-us-hospitals/

An updated estimate says it could be at least 210,000 patients a year, more than twice the number in a frequently quoted Institute of Medicine report.

In 2010, the Office of Inspector General for Health and Human Services said that bad hospital care contributed to the deaths of 180,000 patients in Medicare alone in a given year.

Now comes a study in the current issue of the Journal of Patient Safety that says the numbers may be much higher 2014 between 210,000 and 440,000 patients each year who go to the hospital for care suffer some type of preventable harm that contributes to their death, the study says.

Sep 20, 2013 |By Marshall Allen and ProPublica

Edited February 13, 2014 by thailiketoo

[smileydude]

Perhaps Sheryl or others who are equally/better knowledgeably can help clarify all of this, my take is that the poster is NOT a medical doctor, but hey ho?

I failed to detect the insincerity in your mock questions but thats fine as I was answering to the topic and need not justify anything else.

[Sheryl]

As a primary care physician here in Thailand I'd like to chime in and say I think there are truths to all the posts here and several reasons why doctors here prescribe antibiotics over zealously might be because:

1. Don't want to appear incompetent- this is the fault of the ignorance of the thai population which doctors are also to blame.

It is a misconception that the more meds the better the diagnosis and treatment. We are often too lazy to explain the difference between viral and bacterial infections and why antibiotics need or not need to be used.

2. Don't want to get the stink eye- This occurs in the national healthcare system which is highly distrusted by the general public as offering substandard service to save on costs. Doctors often don't want to offend, get reprimanded by the patient for being stingy and unethical, so they prescribe to get it over with. This is for the same reason as no. 1. GP's in the system on average see over 100 patients a day and are just too tired to explain. It is wrong but human nature tends to find the easy way out instead of having to take another 5 minutes explaining viruses and bacteria and end up with a distrusted face from the patient.

3. For private hospitals its about boosting income: Some doctors performance is based on the amount of income they generate.

I would blame the policy of those private hospitals and the doctors who willingly do it.

4. Borderline diagnosis between viral and bacterial infections. High fever, inflamed throat and signs of lower respiratory tract involvement, though all possibly due to viral causes concern for doctors and unless everybody is willing to pay 2500 baht to have their throat cultured for influenza and do CBC's to differentiate viral vs bacterial, doctors often opt for antibiotics to stay on the safe side as often there are both types of infections superimposing at the same time. Cases of rheumatic heart disease, though rare are due to failure to administer antibiotics in upper respiratory infections. If extensive lab results are not available sometimes the risk of developing resistance is outweighed by the benefits.....

Well said.

Antibiotic overuse is a problem world wide, but Thai doctors do do it more than those in the west for exactly the reasons outlined above.

Another factor in some western countries is "managed care" health financing systems which, though they have many disadvantages, do effectively curb this practice.

[olddoc]

As a primary care physician here in Thailand I'd like to chime in and say I think there are truths to all the posts here and several reasons why doctors here prescribe antibiotics over zealously might be because:

1. Don't want to appear incompetent- this is the fault of the ignorance of the thai population which doctors are also to blame.

It is a misconception that the more meds the better the diagnosis and treatment. We are often too lazy to explain the difference between viral and bacterial infections and why antibiotics need or not need to be used.

2. Don't want to get the stink eye- This occurs in the national healthcare system which is highly distrusted by the general public as offering substandard service to save on costs. Doctors often don't want to offend, get reprimanded by the patient for being stingy and unethical, so they prescribe to get it over with. This is for the same reason as no. 1. GP's in the system on average see over 100 patients a day and are just too tired to explain. It is wrong but human nature tends to find the easy way out instead of having to take another 5 minutes explaining viruses and bacteria and end up with a distrusted face from the patient.

3. For private hospitals its about boosting income: Some doctors performance is based on the amount of income they generate.

I would blame the policy of those private hospitals and the doctors who willingly do it.

4. Borderline diagnosis between viral and bacterial infections. High fever, inflamed throat and signs of lower respiratory tract involvement, though all possibly due to viral causes concern for doctors and unless everybody is willing to pay 2500 baht to have their throat cultured for influenza and do CBC's to differentiate viral vs bacterial, doctors often opt for antibiotics to stay on the safe side as often there are both types of infections superimposing at the same time. Cases of rheumatic heart disease, though rare are due to failure to administer antibiotics in upper respiratory infections. If extensive lab results are not available sometimes the risk of developing resistance is outweighed by the benefits.....

Well said.

Antibiotic overuse is a problem world wide, but Thai doctors do do it more than those in the west for exactly the reasons outlined above.

Another factor in some western countries is "managed care" health financing systems which, though they have many disadvantages, do effectively curb this practice.

I would be less enthusiastic!

Whilst agreeing with point 4 "High fever, inflamed throat and signs of lower respiratory tract involvement" is an indication for antibiotic treatment in young children swabs and a CBC should be undertaken prior to antibiotic therapy being commenced only in those areas where lab facilities are not available could such an omission be excused.

The Western world has awoken to the potentially very serious issues of reduced antibiotic effectiveness.

The WHO are active in spreading awareness of the risks not only of unwise prescribing but the rampant unrestricted sale of antibiotics, particularly within the so called third world.

I would urge "smileydude" to refrain from finding excuses for poor practice and instead focus attention on improving education about the very real risks antibiotic resistance is presenting and to campaign for antibiotics to be designated as prescription only medications in Thailand.

[Sheryl]

Bear in mind that lab facilities fir culture, and sometimes even CBC, are not available in many rural practice settings in Thailand.

I did not take his post as "finding excuses" bit rather as explaining factors/reasons without condoning them.

[olddoc]

Bear in mind that lab facilities fir culture, and sometimes even CBC, are not available in many rural practice settings in Thailand.

I did not take his post as "finding excuses" bit rather as explaining factors/reasons without condoning them.

I accept that in rural settings different standards of practice may, of necessity, have to be accepted.

You may be right in saying the post did not "condone" bad practice but neither did the post "condemn" such practice which within an urban situation is unacceptable!

[kriswillems]

I think it all comes down to money.

Viral and bacterial infections are often difficult to distinguish. Checking if an infection was a result of a dangerous bacteria or a virus may require a lab-test. This lab-test is more expensive than 35 B of antibiotics.

The problem in Thailand is not only the amount of antibiotics taken, but also the kind. In 99% of all cases, you'll get amoxicillin - the cheapest broad spectrum antibioticum available. In the West doctors prescribe more narrow spectrum antibiotics.

[h90]

In my experience Thai doctors are more thorough and will only prescribe when required and often tell you , you dont need pills and some medications you may already have from the west are in fact not required as its old outdated practice/thinking.

I would suggest the doctors in the west are more likely to be pressured by medical reps/companies than any doctor in Thailand would be.

I see with my staff frequently:

a normal light cold....feeling not so good, no fever or very low one.....

They go to the doctor and come back with a bucket full of tablets.

often 5-8 different medications (non of them vitamins). And they are 20-40 year old healthy men who would be OK by themself within 1 week.

The next day or two when the cold is subsiding the antibiotics get thrown away.

No wonder so many strains are developing resistance.

yes of course......one of our freelance sales guys had an infection in the frontal sinus. They gave him some heavy antibiotics and wanted to make a surgery..........

But he, an old drunk who is all the time financially broke didn't had the money....so he ate the antibiotics only.....for 1 year and in average something like 2 weeks than 1 week off than 1 week again etc etc. how he had pain and/or money....

No worry about resistance....No worry about long time effects on the liver....

Only good thing is he didn't drink when eating antibiotics and before I only knew him a bit drunk or heavy drunk. Now he is 99% of the time sober.....

[h90]

I think it all comes down to money.

Viral and bacterial infections are often difficult to distinguish. Checking if an infection was a result of a dangerous bacteria or a virus may require a lab-test. This lab-test is more expensive than 35 B of antibiotics.

The problem in Thailand is not only the amount of antibiotics taken, but also the kind. In 99% of all cases, you'll get amoxicillin - the cheapest broad spectrum antibioticum available. In the West doctors prescribe more narrow spectrum antibiotics.

Also to add: if you have a bacterial infection, the lab test also needs time. You loose time waiting for it.

[smileydude]

As a primary care physician here in Thailand I'd like to chime in and say I think there are truths to all the posts here and several reasons why doctors here prescribe antibiotics over zealously might be because:

1. Don't want to appear incompetent- this is the fault of the ignorance of the thai population which doctors are also to blame.

It is a misconception that the more meds the better the diagnosis and treatment. We are often too lazy to explain the difference between viral and bacterial infections and why antibiotics need or not need to be used.

2. Don't want to get the stink eye- This occurs in the national healthcare system which is highly distrusted by the general public as offering substandard service to save on costs. Doctors often don't want to offend, get reprimanded by the patient for being stingy and unethical, so they prescribe to get it over with. This is for the same reason as no. 1. GP's in the system on average see over 100 patients a day and are just too tired to explain. It is wrong but human nature tends to find the easy way out instead of having to take another 5 minutes explaining viruses and bacteria and end up with a distrusted face from the patient.

3. For private hospitals its about boosting income: Some doctors performance is based on the amount of income they generate.

I would blame the policy of those private hospitals and the doctors who willingly do it.

4. Borderline diagnosis between viral and bacterial infections. High fever, inflamed throat and signs of lower respiratory tract involvement, though all possibly due to viral causes concern for doctors and unless everybody is willing to pay 2500 baht to have their throat cultured for influenza and do CBC's to differentiate viral vs bacterial, doctors often opt for antibiotics to stay on the safe side as often there are both types of infections superimposing at the same time. Cases of rheumatic heart disease, though rare are due to failure to administer antibiotics in upper respiratory infections. If extensive lab results are not available sometimes the risk of developing resistance is outweighed by the benefits.....

Well said.

Antibiotic overuse is a problem world wide, but Thai doctors do do it more than those in the west for exactly the reasons outlined above.

Another factor in some western countries is "managed care" health financing systems which, though they have many disadvantages, do effectively curb this practice.

I agree. I also worked as a medical auditor for health insurance companies and they are coming down harder on all forms of over treatment. AIA does internal audits on participating hospitals commenting on for example: above industry average days of admission (IPD) for specified procedures, medication charged but never prescribed, and incomplete patient charts. I think its a good thing as doctors and hospitals need to be accountable and ethical about their practice. The fact that many hospitals now have JCI accreditation also helps keep tabs on the quality of healthcare though that is limited to the top tier hospitals. Much still needs to be improved in the Universal Healthcare and the Social Security program though. Edited February 13, 2014 by smileydude

[smileydude]

Bear in mind that lab facilities fir culture, and sometimes even CBC, are not available in many rural practice settings in Thailand.

I did not take his post as "finding excuses" bit rather as explaining factors/reasons without condoning them.

I accept that in rural settings different standards of practice may, of necessity, have to be accepted.

You may be right in saying the post did not "condone" bad practice but neither did the post "condemn" such practice which within an urban situation is unacceptable!

Actually I did condemn the practice in the form of the words "lazy" and "wrong". Please re-read.

Its not in my character to be overly critical or judgmental as I feel that is unprofessional so maybe I did not get the message across as strongly as you thought it should have been.

I do agree with you in principle. Antibiotic resistance is a big problem. MRSA is a big problem in ICU settings and one of the most irresponsible examples of malpractice I see is the use of 2nd or 3rd-line antibiotics such as imipenem as first line treatment for bacterial infections instead of starting with ampicillin IV and then doing drug resistant testing if unresponsive. But Mother Nature can also be very adaptive. Look at the emerging resistance to chloroquine in Malaria.

Edited February 13, 2014 by smileydude

[olddoc]

Bear in mind that lab facilities fir culture, and sometimes even CBC, are not available in many rural practice settings in Thailand.

I did not take his post as "finding excuses" bit rather as explaining factors/reasons without condoning them.

I accept that in rural settings different standards of practice may, of necessity, have to be accepted.

You may be right in saying the post did not "condone" bad practice but neither did the post "condemn" such practice which within an urban situation is unacceptable!

Actually I did condemn the practice in the form of the words "lazy" and "wrong". Please re-read.

Its not in my character to be overly critical or judgmental as I feel that is unprofessional so maybe I did not get the message across as strongly as you thought it should have been.

I do agree with you in principle. Antibiotic resistance is a big problem. MRSA is a big problem in ICU settings and one of the most irresponsible examples of malpractice I see is the use of 2nd or 3rd-line antibiotics such as imipenem as first line treatment for bacterial infections instead of starting with ampicillin IV and then doing drug resistant testing if unresponsive. But Mother Nature can also be very adaptive. Look at the emerging resistance to chloroquine in Malaria.

In the case of malaria I would be more worried about the increasing resistance to Artemisinin .

As always (not in the case of Thailand) bought about by unrestricted sale of anti-malarials, fake medications and poor medical practice.

[farang000999]

So has anyone here ever requested a doctor do blood work when the doctor wanted to prescribe an antibiotic from the get go and how did the doctor react?

[chiang mai]

Can't disagree with that.

One wonders how they achieve "God-like' status afterwards as well?

I had a nurse with me. I was having a cardiac event. Upon arrival at the hospital the nurse pointed to my chest and the doctor met us while they were getting me in a wheelchair. They all ran with the wheel chair to the ICU where they hooked me up to an ultrasound and cardiogram machines. They found the problem and operated immediately.

It's been a few years and I still see the same doctor once a quarter. I don't think he is a god but I really like the guy. He also did all the paperwork for my insurance claim in the States.

Is the medical education crap? No, of course not. They used high tech state of the art equipment quickly accurately and economically. I was involved with the Thai education system for a number of years and is it total crap? No.

Could it get better? Sure. Is it better than the education systems in Detroit or Washington DC? Yes.

Hmmm, I lived in Detroit for many years so I do know the answer to that one, Cottage Hospital (St Clair Shores) or St Johns Hospital (Detroit) doctors would beat the pants off most of what's seen here .

But more to the point. Most doctors/hospitals here are OK with straight forward events, broken bones. lacerations. flu, etc. But add the inconvenience of complexity and the situation changes, what to do when the scans or blood tests don't give an easy answer, capable resources on that front are seriously hard to come by.

Sorry but I did not make a comment about medical care in Detroit. I wrote, "Could it get better? Sure. Is it better than the education systems in Detroit or Washington DC? Yes."

The above is a comment about education systems in Detroit. BTW St Clair Shores is not Detroit and St Johns Hospital is right across the street from Grosse Pte (one of the wealthiest suburbs in the US) if memory serves me correctly.

But If you know that most hospitals don't have serious resources here just how many Thai hospitals have you been in?

I spent about two and a half years in and out of about a dozen hospitals in Phuket, Bangkok and Chiang Mai trying to get a diagnosis on a swelling on the side of my face and neck, I was scanned, zapped, tested and probed without any explanation whatsoever and the cost was probably around 100k in total I would guess.

In parallel with the above I did my own research and attempted to self diagnose, whenever I put forward my preferred diagnosis it was ignored. Eventually I went to NUH in Singapore where a Head and Neck surgeon agreed with me during the first thirty seconds, a short test later confirmed the answer.

The problem was/is a blocked salivary duct, probably caused by a stone in the Parotid gland and not any of the obviously silly things suggested by doctors here - one even suggested it was due to using a computer too much.

The problem went quiet for a couple of years but has since flared up and once again I'm faced with the prospect of trying to find treatment, in doing so I find myself reaching for the airline flight schedules to Singapore.

[thailiketoo]

I spent about two and a half years in and out of about a dozen hospitals in Phuket, Bangkok and Chiang Mai trying to get a diagnosis on a swelling on the side of my face and neck, I was scanned, zapped, tested and probed without any explanation whatsoever and the cost was probably around 100k in total I would guess.

In parallel with the above I did my own research and attempted to self diagnose, whenever I put forward my preferred diagnosis it was ignored. Eventually I went to NUH in Singapore where a Head and Neck surgeon agreed with me during the first thirty seconds, a short test later confirmed the answer.

The problem was/is a blocked salivary duct, probably caused by a stone in the Parotid gland and not any of the obviously silly things suggested by doctors here - one even suggested it was due to using a computer too much.

The problem went quiet for a couple of years but has since flared up and once again I'm faced with the prospect of trying to find treatment, in doing so I find myself reaching for the airline flight schedules to Singapore.

Did you visit Bumrungrad or Chaing Mai Ram and if so did they not have the facilities to test your diagnosis?

[chiang mai]

I spent about two and a half years in and out of about a dozen hospitals in Phuket, Bangkok and Chiang Mai trying to get a diagnosis on a swelling on the side of my face and neck, I was scanned, zapped, tested and probed without any explanation whatsoever and the cost was probably around 100k in total I would guess.

In parallel with the above I did my own research and attempted to self diagnose, whenever I put forward my preferred diagnosis it was ignored. Eventually I went to NUH in Singapore where a Head and Neck surgeon agreed with me during the first thirty seconds, a short test later confirmed the answer.

The problem was/is a blocked salivary duct, probably caused by a stone in the Parotid gland and not any of the obviously silly things suggested by doctors here - one even suggested it was due to using a computer too much.

The problem went quiet for a couple of years but has since flared up and once again I'm faced with the prospect of trying to find treatment, in doing so I find myself reaching for the airline flight schedules to Singapore.

Did you visit Bumrungrad or Chaing Mai Ram and if so did they not have the facilities to test your diagnosis?

Yes I did and no they didn't, neither did they have the expertise or equipment to do a sialogram. One very charming lady doctor at Sriphat attempted to do the lemon test, this is where they insert a catheter into the salivary duct in the cheek and then ask you to bite into a lemon to record the path of the salivary secretion. Poor lady had obviously drawn the short straw and had clearly never done this before and couldn't even get the catheter into the duct. After thirty minutes she gave up and suggested we do a an ultrasound of the duct instead, why I asked, that wont show what we need to see!

At Bumrungrad I met three specialists on three separate occasions - ENT failed completely to understand the problem but declared my throat and sinus as fine, orthopedics consulted from his side of the desk and told me I'd been using the computer too much and this was why my neck and face were swollen, a common problem in Thailand! Endocrinology declared my thyroid as fine and was interested in looking at any part of my body that was not directly related to her area of specialty - interestingly, none of the specialists I met were willing to refer me to another specialist in a different discipline.

I could go on and on with stories such as these but what's the point. The only other one that's worth recanting, just to make the point, is the assistant professor and GI specialist who thought that the cure for my poor motility and distended gut was to take laxatives every night for three months and to have x-rays of the gut taken weekly to see how much gas was present - this was a course of action not mentioned anywhere and one that had never been heard of during subsequent visits to other GI specialists, a vitamin deficiency would later be identified.

Finally, as part of the work involved in building the pinned list of medical specialists in the Chiang Mai forum, I got to visit all the hospitals in CM and to talk with a range of medical and support staff, some of the comments from those interviews made my hair curl. Doctors asking not to have non-Thai patients referred to them because their English was so poor plus farangs had a reputation for "knowing too much"! The comments from international support staff were also illuminating, one in particular actually sat with me and told me which doctors were OK and which ones to avoid at all costs, scary.

[thailiketoo]

Yes I did and no they didn't, neither did they have the expertise or equipment to do a sialogram. One very charming lady doctor at Sriphat attempted to do the lemon test, this is where they insert a catheter into the salivary duct in the cheek and then ask you to bite into a lemon to record the path of the salivary secretion. Poor lady had obviously drawn the short straw and had clearly never done this before and couldn't even get the catheter into the duct. After thirty minutes she gave up and suggested we do a an ultrasound of the duct instead, why I asked, that wont show what we need to see!

At Bumrungrad I met three specialists on three separate occasions - ENT failed completely to understand the problem but declared my throat and sinus as fine, orthopedics consulted from his side of the desk and told me I'd been using the computer too much and this was why my neck and face were swollen, a common problem in Thailand! Endocrinology declared my thyroid as fine and was interested in looking at any part of my body that was not directly related to her area of specialty - interestingly, none of the specialists I met were willing to refer me to another specialist in a different discipline.

I could go on and on with stories such as these but what's the point. The only other one that's worth recanting, just to make the point, is the assistant professor and GI specialist who thought that the cure for my poor motility and distended gut was to take laxatives every night for three months and to have x-rays of the gut taken weekly to see how much gas was present - this was a course of action not mentioned anywhere and one that had never been heard of during subsequent visits to other GI specialists, a vitamin deficiency would later be identified.

Finally, as part of the work involved in building the pinned list of medical specialists in the Chiang Mai forum, I got to visit all the hospitals in CM and to talk with a range of medical and support staff, some of the comments from those interviews made my hair curl. Doctors asking not to have non-Thai patients referred to them because their English was so poor plus farangs had a reputation for "knowing too much"! The comments from international support staff were also illuminating, one in particular actually sat with me and told me which doctors were OK and which ones to avoid at all costs, scary.

Well you did what I would do. If I could not get adequate treatment in Thailand I would go to Singapore too.

[AngelsLariat]

I spent about two and a half years in and out of about a dozen hospitals in Phuket, Bangkok and Chiang Mai trying to get a diagnosis on a swelling on the side of my face and neck, I was scanned, zapped, tested and probed without any explanation whatsoever and the cost was probably around 100k in total I would guess.

In parallel with the above I did my own research and attempted to self diagnose, whenever I put forward my preferred diagnosis it was ignored. Eventually I went to NUH in Singapore where a Head and Neck surgeon agreed with me during the first thirty seconds, a short test later confirmed the answer.

The problem was/is a blocked salivary duct, probably caused by a stone in the Parotid gland and not any of the obviously silly things suggested by doctors here - one even suggested it was due to using a computer too much.

The problem went quiet for a couple of years but has since flared up and once again I'm faced with the prospect of trying to find treatment, in doing so I find myself reaching for the airline flight schedules to Singapore.

Did you visit Bumrungrad or Chaing Mai Ram and if so did they not have the facilities to test your diagnosis?

Yes I did and no they didn't, neither did they have the expertise or equipment to do a sialogram. One very charming lady doctor at Sriphat attempted to do the lemon test, this is where they insert a catheter into the salivary duct in the cheek and then ask you to bite into a lemon to record the path of the salivary secretion. Poor lady had obviously drawn the short straw and had clearly never done this before and couldn't even get the catheter into the duct. After thirty minutes she gave up and suggested we do a an ultrasound of the duct instead, why I asked, that wont show what we need to see!

At Bumrungrad I met three specialists on three separate occasions - ENT failed completely to understand the problem but declared my throat and sinus as fine, orthopedics consulted from his side of the desk and told me I'd been using the computer too much and this was why my neck and face were swollen, a common problem in Thailand! Endocrinology declared my thyroid as fine and was interested in looking at any part of my body that was not directly related to her area of specialty - interestingly, none of the specialists I met were willing to refer me to another specialist in a different discipline.

I could go on and on with stories such as these but what's the point. The only other one that's worth recanting, just to make the point, is the assistant professor and GI specialist who thought that the cure for my poor motility and distended gut was to take laxatives every night for three months and to have x-rays of the gut taken weekly to see how much gas was present - this was a course of action not mentioned anywhere and one that had never been heard of during subsequent visits to other GI specialists, a vitamin deficiency would later be identified.

Finally, as part of the work involved in building the pinned list of medical specialists in the Chiang Mai forum, I got to visit all the hospitals in CM and to talk with a range of medical and support staff, some of the comments from those interviews made my hair curl. Doctors asking not to have non-Thai patients referred to them because their English was so poor plus farangs had a reputation for "knowing too much"! The comments from international support staff were also illuminating, one in particular actually sat with me and told me which doctors were OK and which ones to avoid at all costs, scary.

I guess that I've been lucky. Though I've been very dissatisfied with medical treatment in Chiang Mai, I've had good luck at BNH and Bumrungrad in BKK. Not simple cases at BNH and Bumrungrad either, though as anywhere I'm sure that it makes a big difference which doctor is assigned to your case.

[atyclb]

I'm just trying to help but you could google, "

This seems to me to be nonsense, the link to the study that Kresser refers to is not found, I also have some serious doubts about Kressers mission in life but hey, that's just me.

http://chriskresser.com/medical-care-is-the-3rd-leading-cause-of-death-in-the-us

The link works for me. But I understand your point. Better to attack the messenger than the message.

Well no, not at all, if the message can be reviewed and assessed independently then anyone can form a view, it's just that the message he's talking about doesn't seem to exist any more (for me, Firefoc under 3BBB). I really do have an open mind on these things but I do need verifiable proof.

Medical care is 3rd leading cause of death in U.S.

I can see the Kresser page but the link to the study is what I want to read and that's simply not there, for me at least.

"Using a weighted average of the 4 studies, a lower limit of 210,000 deaths per year was associated with preventable harm in hospitals. Given limitations in the search capability of the Global Trigger Tool and the incompleteness of medical records on which the Tool depends, the true number of premature deaths associated with preventable harm to patients was estimated at more than 400,000 per year. Serious harm seems to be 10- to 20-fold more common than lethal harm"

http://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Harms.2.aspx