Hospital Treatment?

[gc777]

Hi All,

I have just managed to slice the palm of my hand open while preparing dinner and think that I may need to go to hospital and get it stitched up. My insurance policy will only pay out for treatment at a state hospital and has a 5000 Baht excess.

With this in mind rather than sitting in the ER of a state hospital would I be better of going private? Does anyone know if there is much of a difference in costs or if the treatment required would be particularly expensive if I went private?

I am on Suthip Road Soi 1 so the University hospital is very near, is there also a private hospital near by that anyone knows of?

Thanks

[uptheos]

Hasn't affected your typing.

Go to Maharaj (Suan Dok) or Ram

[northernjohn]

Seems to me if it was serious they would take you rite away. I doubt that it will cost any where near 5,000 baht considering you have the time and ability to type a message and wait for a reply.

I would just walk into the nearest clinic. Can't swear to it but I do believe all doctors are capable of stitching you up Or stapling you up. My old age is showing with the stitching.

[uptheos]

Seems to me if it was serious they would take you rite away. I doubt that it will cost any where near 5,000 baht considering you have the time and ability to type a message and wait for a reply.

I would just walk into the nearest clinic. Can't swear to it but I do believe all doctors are capable of stitching you up Or stapling you up. My old age is showing with the stitching.

Probably able, but something they don't want to do with a room full of patients.

Dr Tawachai on Loi Kroh, did a biopsy on me and I was quite impressed with his local anaesthetic, cutting and neat stitching. But I had to wait until his clinic was almost finished. Total cost including lab fee was about 1,200 baht.

I'm presuming the OP's hand is now stitched up and maybe he'd be good enough to share his experience, place, cost etc?

Edited April 1, 2014 by uptheos

[gc777]

Thanks all for the responses, it's been bandaged up by my wife at the moment, if it is still not showing any sign of healing tomorrow morning I will follow one of the suggestions above and report back re costs etc.

Thanks again, the advice is much appreciated.

[northernjohn]

I sliced the palm of my hand once real bad. I went into the Pharmacy a few doors down inside the old city from Tha Pai Gate the two sisters bandaged it up and told me tio walk around with my hand held up. It worked. I do have a scar but that is OK no other damage. All though I will admit I looked ridicules walking around with my hand over my chest like Napoleon. Had not much of a chopice was waiting for my glasses to be made down by the UN Irish pup.

I should have known to hold it up from a first aid course I had taken.

[edwinchester]

Seems to me if it was serious they would take you rite away. I doubt that it will cost any where near 5,000 baht considering you have the time and ability to type a message and wait for a reply.

I would just walk into the nearest clinic. Can't swear to it but I do believe all doctors are capable of stitching you up Or stapling you up. My old age is showing with the stitching.

I did exactly that when I managed to stab a 6 inch nail through my ankle. First went to the local clinic where they gave me a tetanus and bandage. An hour later the pain was so severe I went to the nearest Govt hospital where they xrayed and then gave me a pain killing injection.

I went to pay but they waved me away with a mai bpen rai.

A friend did similar and was charged 300bht so maybe they like my face :-)

[Thighlander]

I agree with letting the Pharmacist look at it. They will tell you if you really need to go to the ER, and they will also have some anti-septic/numbing agent that will be all you need.

I let this sweet/young pharmacist treat my poison ivy last Summer in Phayao. 30 THB and 3 days later; it was completely gone. I gave a tube to my brother, who gets it hiking his 300 rai, and he said it was "miraculous."

[BarnicaleBob]

My American neighbor sliced open his hand and it was a deep cut. I drove him to the local government hospital and they sewed it up, total cost 150 baht.

[Bpuumike]

Thanks all for the responses, it's been bandaged up by my wife at the moment, if it is still not showing any sign of healing tomorrow morning I will follow one of the suggestions above and report back re costs etc.

Thanks again, the advice is much appreciated.

Tomorrow morning will be too late to have it stitched.

In fact judging from the time of your original post it's probably too late already.

Good luck.

[MrBrad]

Here's some good advice on treating wounds:

A STITCH IN TIME CAN USUALLY IMPROVE WOUND HEALING

Question: Recently I cut myself while out hunting. The following day, the cut was looking bad so I went to the ER for stitches. They said I should have come in sooner, and it was too late to sew it up. Is this right or was the doctor just being lazy? What are the guidelines for getting stitches?

Answer: Most wounds will heal without stitches, which doctors also sometimes call “sutures.” However, except for small cuts that aren’t very deep, wounds usually heal better when they are closed up with sutures. This is because sutures help to stop the bleeding and promote healing by bringing the ends of the torn tissue together. In most cases, this makes for less scarring and a nicer looking skin surface once healing is complete.

There are some types of wounds we don’t usually sew up. Sometimes this is because a wound has been left open for too long a period of time, giving bacteria a chance to multiply. Even more problematic are wounds that have already become infected or inflamed. Crush injuries where the skin and tissues have been shredded are also often best left “open.”

Additionally, human and animal bites are usually not sutured since these are considered “dirty” wounds. Of course there are exceptions to this rule and the others I’ve mentioned. The number of wounds sustained and their severity can be make suturing of otherwise problematic wounds advisable. Also, if animal or human bites are on the face, your doctor may decide to suture your wound to minimize disfigurement.

As for a timetable for getting a wound sutured, this does vary a good deal depending on the physician and the circumstances. And, in the vast majority of cases, laziness has nothing to do with it. Many physicians believe it’s generally not a good idea to suture any wound over six hours old, because the bacterial count can double within three hours of a cut. On the other hand, some physicians believe that wounds on the body can usually be sutured if under 18 hours old, and they give facial lacerations up to a 24-hour window.

Prompt treatment for any cut should include washing it out, preferably with saline, but water alone is better than not cleaning at all. Placing a clean, dry bandage over the wound will prevent further contamination to the wound. If it is small, and the bleeding stops easily, it may not need sutures.

Even these smaller wounds, however, still need to be watched closely for infections. Cuts and injuries that you get outdoors may be more prone to infection than a cut in a clean house with a clean household item. For instance, a piece of broken glass in the woods can by much more hazardous than a piece of broken glass in your kitchen.

Another reason to have your wound checked early is to evaluate the need for a tetanus shot. The general guideline is to update this shot every 10 years in adults. However, an obviously contaminated wound, a puncture wound, or a severe burn, requires another shot after just five years.

At this juncture, I’d suggest that you go to a family physician to have your wound evaluated. He or she can assess if additional intervention such as antibiotics, a tetanus shot, or a re-opening and late suture of your wound would be appropriate in your case.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to [email protected]. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.

[gc777]

Thanks again all for the very helpful advice. As a couple of people have pointed out I have now probably left it too late to get stitches due to the risk of sealing bacteria in to the wound. With that in mind I went to a pharmacy who recommended I use a type of plaster called 'Flexigrid'. It seems to be holding the wound together nicely and I have maintained good use of my hand.

[NancyL]

I'm very clumsy in the kitchen and with the pruning shears in the garden, so I and have a history of self-inflected wounds from clean, sharp instruments. I've learned it's best to go get sutures immediately, even if it's just two or three sutures. Sutured wounds heal so much more quickly.

One of the great things about living in Chiang Mai is that you can walk into a hospital emergency room and get stitched up immediately. In the U.S., you're triaged to the back of the pack and can forget about getting home in time to finish cooking whatever you were preparing in the kitchen at a reasonable hour.

[hml367]

I don't know where everyone referring to the US experienced medical care, but in my experience, whenever I or someone I know needed urgent medical care, I/we got it. I don't recall ever using urgent medical care in a big city like SFO, but then it still comes back to where and when.

[NancyL]

In the U.S. if you go into a busy emergency room with a wound similar to what the OP described, you're likely to be triaged as a less-urgent case and will have to wait for treatment. At least that's been my experience with a cut hand. At best a nurse would clean the wound with saline, wrap it and tell you to hold your hand over your head while you wait for a doctor to come to stitch it. You might wait several hours.

Meanwhile, if you came into that same emergency room with a stroke or cardiac condition you'd be treated right away -- that's what triage is all about.

I found it easier to go to one of those Doc-in-a-Box places and just pay out-of-pocket to have my many hand cuts stitched up rather than going to the hospital emergency room where my insurance would cover treatment.

[hml367]

Triage and emergency rooms here do not work the same? I mean, if someone went in with a cut as the OP describes, which obviously was not life threatening, and other people were there because of something more serious, the more serious would be seen first.

If there were no cases more serious, wouldn't the cut hand be seen?

I am not being facetious. Fortunately I have never needed emergency medical aid here... it would be nice to know how emergency rooms here operate.

[NancyL]

Well, the few times I've been in or near the emergency room at CM Ram, they aren't busy and people are seen right away. Sure, CM Ram is the most expensive hospital in CM, but how expensive can it be to stitch up a knife wound? We're not talking open heart surgery.

Sure, if you went to the emergency room at University Hospital, you're likely to encounter the same busy, busy triage wait, wait situation that seems to be the norm at every emergency room in the U.S. Then you'd wait for a simple kitchen wound to be stitched.

For something like this, it's worth forking over the few hundred baht extra to be seen quickly at a private hospital just to get home to finish cooking dinner while it's still dinnertime.

[northernjohn]

Had a couple of experiences in Canada

Wife number 1 was triaged and after two hours we just left. She had funny feelings in the stomach.

Wife number 2 I had to take to the emergency room. She passed out in the bathroom with a nurse there. They got her in the bed and the patient in the next bed said some thing and they said they didn't have time at the moment. She had been triaged. The lab report came back on the wife and the Doctor started to ask who I was and then just said doesn't matter she has a pregnancy in the tubes and will die. They rushed her to the emergency room rite away. On the way they had to stop and wait a half hour because she had told them she was allergic to latex.

I number them because they are both named Gail. I wasn't taking chances.

Was in the Ram the other day. Went into the Emergency room and it didn't look busy at all. I was just trying to get my blood pressure tested. Didn't see any machine to do it.

I occasionally go in the Emergency at the hospital in the Worrorot market they get a lot of people there. I just sit for a bit and then when I see no one having there blood pressure taken I take mine. Some times they even push the start button for me.

The big problem with them is they alwasys measure my heart as high. No other place does.

[kjhbigv]

Had a few stitches for a deep cut a few years ago at CM Ram, cost was round 5000bht (they DO like to sell every after care add-on) BUT very very neat job.

Don't think I would do the same again though if I was paying again!

If it was quite deep you should have gone and had a few stitches at any Hospital.

northernjohn...RAM do have blood pressure machines just near reception....but they are fully automated and take ages...don't like them! Lol

[kjhbigv]

Triage and emergency rooms here do not work the same? I mean, if someone went in with a cut as the OP describes, which obviously was not life threatening, and other people were there because of something more serious, the more serious would be seen first.

If there were no cases more serious, wouldn't the cut hand be seen?

I am not being facetious. Fortunately I have never needed emergency medical aid here... it would be nice to know how emergency rooms here operate.

RAM is quite quick, remember you are paying good money, so you get good service generally, in theory. I turned up at 2am once and had a few stitches done in half hour or so.

Luckily, we have a lot of choice in CM.