Report on doctor visit at St-Louis hospital BKK - dermatology

[smo]

Last week I went to see Dr. Parichart dermatologist at St Louis hospital here in BKK for what turned out to be a case of ezcema. After reading positive reviews of her treatment of several TV members here - some of whom came in from out of town to see her annually , I was in for a surprise. Her attitude to me was not disrespectful but rather brusque, and her demeanor sent the message that there was no two way discussion to be expected. She spoke I listened, any other question was met with a repetition of what she just said. For the record we conversed in English though upon the initial sawatdee greeting she asked me in Thai whether we were going to speak thai or english. The obvious reason for this was because I'm asian american often taken at first sight for a local.

The whole visit lasted no more than 10 min, including disrobing time down to my underwear (and more, read on.) The diagnosis consisted of her giving my whole body a cursory once over - with a magnifying glass in hand, even though in this instance she didn't have to pause and use it.When I first voiced my concern about skin cancer, she said "yellow skinned" people don't get cancer until the age of 70, wheras the "white skinned" ones can get it in their 50s already. Later when I pointed to a BCC (balsa? spelling?) on my fore arm,indicating my wish to have it removed, she simply waved away "it's a sun spot," then repeated the above statement. I wonder whether this had to do with the fact that I am not only a "yellow-skinned" farang - but also a "yellow skinned" older male? At one point I had to, as discreetly as I could, show her the rash on one of my testicles, maybe that could have thrown her off guard? I don't know, I had thought of, actually had wanted to wait for Dr. Prathit, another doctor from the same hospital who is also well regarded on TV forum here. Unfortunately he works part time there, Sunday mornings only, and his first return to work date post songkran is not until this coming Sunday.

Last but not least when I asked dr. Parichart if I could get a prescription from her to buy my medication off site, she again brushed me off with a "No, (you can't) this is the hospital's system!" and that was it. Outside at the cashier I was presented with one bill that included both the doctor's visit and the medication. I paid the bill and was told to go down to first floor to pick up the medicine: one bottle of hypoallergenic non-soap cleanser Physiogel , two small bottles of "hospital formula" milk lotion, plus antibiotics Rulid and anti-itching Lorsedin pills. Except for the " hospital formula" lotion the rest of the stuff look like something easily available at regular pharmacies. The total cost for the medicine was around 850 bt. I remember one post here on TV from one fair skinned blue eyed (by his own admission) member came in for a consultation with dr Paritchart, during which several of his sunspots got removed and the total cost was just a smidgen above 800 bt (not sure whether this included doctor fees or not.)

Now I am wondering whether I should keep my follow up appointment this Thursday with this doctor. Or wait until Sunday and switch to the other one, Dr. Prathit? I am just thinking of the possibilities of her prescribing more "hospital formula" for long term use and the cost would escalate accordingly. On the other hand, the medication seems to be working, the rashes look like they are "drifting" downward and away....whether they stay away for good once the medicine is finished remains to be seen. The bottom line is I seem to have missed the boat with dr. Parichart regarding having a good rapport, and her treatment of me was just oh so by the number. As a patient I don't have a good feeling about this.

[Sheryl]

BCC= basal cell carcinoma. How do you know that is what the spot is?

If any concern or suspicion that the lesion is cancer, should consult Dr. Anna at Bangkok Pattaya Hospital, she is the only doctor in Thailand I am confident of when it comes to skin cancer.

If cancer is not a concern (i.e. you did not actually mean BCC) then you could try asking her to freeze the spot off, or ask another doctor if you prefer.

As regards the rash, it sounds like the treatment is working so if I were you I would stay with her for that, but go elsewhere for the sunspot removal (assuming it is a sunspot and not a BCC or suspected BCC) if she does not respond to your request to freeze it off.

Doctors differ in their personalities and communication styles. Most Thai doctors, this one included, are not much into two way discussions.

Regarding the medicines the thing to do is refuse them at the pharmacy window saying you already have them (having noted what they are). There is no need for a prescription for most drugs, including antibiotics - you just walk into a pharmacy and buy them.

[inbangkok]

If you don't have a good feeling about the Dr, find a new one.... Bottom line. I usually have good luck with Dr's here but recently met with one I found to be pretty incompetent and uninterested. He also charged and absurd consultation fee. I will never go back to him again.

[Greenhill]

BCC= basal cell carcinoma. How do you know that is what the spot is?

If any concern or suspicion that the lesion is cancer, should consult Dr. Anna at Bangkok Pattaya Hospital, she is the only doctor in Thailand I am confident of when it comes to skin cancer.

If cancer is not a concern (i.e. you did not actually mean BCC) then you could try asking her to freeze the spot off, or ask another doctor if you prefer.

As regards the rash, it sounds like the treatment is working so if I were you I would stay with her for that, but go elsewhere for the sunspot removal (assuming it is a sunspot and not a BCC or suspected BCC) if she does not respond to your request to freeze it off.

Doctors differ in their personalities and communication styles. Most Thai doctors, this one included, are not much into two way discussions.

Regarding the medicines the thing to do is refuse them at the pharmacy window saying you already have them (having noted what they are). There is no need for a prescription for most drugs, including antibiotics - you just walk into a pharmacy and buy them.

All agreed - except the last paragraph!! All hospitals that I have visited here make you pay at the cashier BEFORE you pick-up the meds., so refusing them at that stage, serves no purpose!!

[fstarbkk]

BCC= basal cell carcinoma. How do you know that is what the spot is?

If any concern or suspicion that the lesion is cancer, should consult Dr. Anna at Bangkok Pattaya Hospital, she is the only doctor in Thailand I am confident of when it comes to skin cancer.

If cancer is not a concern (i.e. you did not actually mean BCC) then you could try asking her to freeze the spot off, or ask another doctor if you prefer.

As regards the rash, it sounds like the treatment is working so if I were you I would stay with her for that, but go elsewhere for the sunspot removal (assuming it is a sunspot and not a BCC or suspected BCC) if she does not respond to your request to freeze it off.

Doctors differ in their personalities and communication styles. Most Thai doctors, this one included, are not much into two way discussions.

Regarding the medicines the thing to do is refuse them at the pharmacy window saying you already have them (having noted what they are). There is no need for a prescription for most drugs, including antibiotics - you just walk into a pharmacy and buy them.

All agreed - except the last paragraph!! All hospitals that I have visited here make you pay at the cashier BEFORE you pick-up the meds., so refusing them at that stage, serves no purpose!!

I have refused meds in the past after paying the cashier, once I realized what they were giving me. This is not usually a problem, as the pharmacist will then inform the cashier and the bill will be adjusted accordingly.

You also have the right to request an itemized bill, including the meds from the cashier, before you pay. This is what I am always doing nowadays. Never a problem with that either. Hospitals I use/ have used in that way include, Bangkok Hospital, BNH and Bumrungrad.

Edited May 3, 2016 by fstarbkk

[DogNo1]

When I saw a pulmonologist at Bumrungrad a few months ago, he wrote then names of my medicines on a consultation sheet at my request. I had to get the nurse to rewrite them though because i couldn't read his writing. They were pretty cheap at the Pratuu Naam pharmacy that I always patronize. So far as whether you should see the same doctor on your follow-up visit, it's a matter of which would cause you the most hassle. If her treatment is effective and you can accept a short, brusque consultation, that might be easiest for you. It's good to have a doctor that you like and trust though so you might want to avoid her in the future. Good luck.

[Sheryl]

BCC= basal cell carcinoma. How do you know that is what the spot is?

If any concern or suspicion that the lesion is cancer, should consult Dr. Anna at Bangkok Pattaya Hospital, she is the only doctor in Thailand I am confident of when it comes to skin cancer.

If cancer is not a concern (i.e. you did not actually mean BCC) then you could try asking her to freeze the spot off, or ask another doctor if you prefer.

As regards the rash, it sounds like the treatment is working so if I were you I would stay with her for that, but go elsewhere for the sunspot removal (assuming it is a sunspot and not a BCC or suspected BCC) if she does not respond to your request to freeze it off.

Doctors differ in their personalities and communication styles. Most Thai doctors, this one included, are not much into two way discussions.

Regarding the medicines the thing to do is refuse them at the pharmacy window saying you already have them (having noted what they are). There is no need for a prescription for most drugs, including antibiotics - you just walk into a pharmacy and buy them.

All agreed - except the last paragraph!! All hospitals that I have visited here make you pay at the cashier BEFORE you pick-up the meds., so refusing them at that stage, serves no purpose!!

They do, but after you refuse all or some of the meds, they tefund the difference. I do this all the time.

[cardinalblue]

You are not required by law to buy drugs from hospital pharmacy

First impressions are important...she is also stereotyping and seems to lack critical thinking skills....find a doctor you like and trust...

[smo]

BCC= basal cell carcinoma. How do you know that is what the spot is?

You've caught me, yes, it is a sun spot, or something non-cancer related as it has been pointed out to me way back in the States then. But as time goes by I tend to jump (ahead) to the worst outcome. Sorry,

Thank you everybody here for your practical input and oodles of sympathy. The reason I chose this doctor was mainly through the TV forum. Somewhere among the grapevine of recommendation I picked up the impression that she was someone one could "talk" to (and if I remember correctly, the context was in comparison with another dr.W. in the same department who was considered "brisk.") Maybe my evaluation was slightly off the mark, but here we are. I agree with many that I should follow up with the same doc, bear the brunt of her "brusqueness" and hope that all will end well.

Anyway some consolation in the meantime:

From another current thread "where to find a good doctor", comes this enticing recommendation -

"BTW, another Dr. at BNH was I was pretty impressed with, when I happened to end up seeing him for a viral infection, was Dr. Yuthana Budsayavith, who also deals with infectious diseases.

Perfect English, but more than that, very communicative and easy to talk with. And struck me as being very smart, well-considered and not one who goes for needless treatments or excessive prescriptions.

He trained in Germany, and had an accent that reminded me of my high school German teacher, who was a German native. But that's not the reason I'm recommending him..."

I looked into BNH website and found that this doctor is an internal medicine doctor with specialties in allery and immunology. Just my kind of doc! If only I had found him 10 days earlier (fate is cruel sometime...)

[smo]

I would be remiss if I didn't report my follow up visit. Doc was all smile and chatter! for a moment I thought that she must have read my thread about her and was determined to make amends. She voluntarily answered all the questions that had been unasked or unanswered on my initial visit. Why I got this problem? old age. How to treat it? no cure, simply keeping things under control (because your skin has started to break down.) Btw, Doctor, my pharmacy has all the medicine that you have prescribed previously- ok, then I don't have to write a new description for you, etc.

My only caveat is that had her personalities quirk been mentioned in the various members recommendation that I have considered, I would not have chosen to see her. I would have preferred a doc who maintains an accessible disposition towards the patient. I don't want to gauge my luck to come in on his/her good, or bad days.

[Morakot]

^^ Thanks for following up and reporting back! Glad to hear it went well to your excpections.

[JSixpack]

I saw Dr. Parichart more than a year ago, also as a result of recommendation here, and I thought she was great. Personally I liked her no-nonsense approach and gettin' outta there quickly. 'Course if she'd found anything serious then I might've appreciated a bit more warmth, lol. Time proved her right in everything she said. So from what I can tell she's quite competent and I'd see her again.