Are annual check ups just money making for the hospitals

[al007]

I am at the moment quite focused on medical matters, over the last nine yrs in Thailand I have had 5/6 Hospital check ups, normally choosing the most expensive, I have believed this should show problems early, FALSE assumption !

 

I am not medically qualified, and have always relied on the doctor patient meeting post the check up, generally I have only scanned the results to see no items are outside the recommended parameters, I have ignored the items not checked, again MISTAKE

 

Recently I have needed to go back to these reports and I see the same things are not necessarily checked each year, i.e. PSA was not done a couple of years, Thyroid has sometimes been done then not done, Colonoscopies have been done with no follow up biopsies

 

At the moment I have two cancers, prostate, and colon/rectum, and possible Thyroid problems, these were not flagged at the annual medicals and additional tests, they should have been

 

I write this so others can be aware we need in Thailand to double check the doctors and hospitals, and NOT to rely soley on the hospitals and their doctors

 

At my last annual medical prior to finding all my problems,(and the medical showed none of them), I enquired prior to the medical surely the doctor should mark what tests need to be done, I asked but did not push, my wife said it was not nice in Thailand to be pushy, some tests were missed

 

I believe at the hospitals I have been to, and hopefully not all hospitals, these medicals are seen by the hospitals as primarily being money making opportunities with patient care being second, BEWARE AND CHECK, your own well being is at risk

[1FinickyOne]

Double 0  - - sorry about your problems... the biggest difference between my medical care here and back home was not having a GP here who oversaw everything. I have very much felt that nobody looked back at past check-ups as often it is not the same doctor. It seems most important to be your own advocate and do your own research. A heart doctor seems to not care at all about your prostate.. 

 

What I have seen with family and Thai friends is that the doctors barely even talk with them. They do their job but do not discuss things so much with the patient. When I get involved, politely of course, there has never been resistance and the doctors always seem glad to take a few moments and tell me what is going on and answer any questions. 

 

Be your own advocate, plenty of info on the net and best wishes for a speedy recovery... 

 

ps - if you go to a private for profit hospital, they are there to make money. I have always been concerned about the conflict of interest inherent in the situation... but, I can also look around and see a big building and plenty of employees and understand that it is not cheap to run a good facility.... 

[Anon999]

Seems like luck of the draw the same as anywhere else.  I've been having an annual medical at the same private hospital for over 10 years and have seen the same doctor after my visit to various departments, this is in Isaan. The doctor always goes through all the items and discusses them with me. However, I could have more checks done but  where do you stop?

[timewilltell]

4 hours ago, al007 said:

At my last annual medical prior to finding all my problems,(and the medical showed none of them), I enquired prior to the medical surely the doctor should mark what tests need to be done, I asked but did not push, my wife said it was not nice in Thailand to be pushy, some tests were missed

 

I think this is the heart of many problems in Thailand. It matters not the situation, even when justice or your health are at stake, it is not 'nice' to ask questions, not nice to accuse anyone of wrongdoing (indeed the wrongdoing is much less hideous than not being nice). Here you have to smile while being screwed up the rear.

[lopburi3]

Probably best to make a (good) doctor choice as primary provider (know GP is almost unknown here but most in various internal medicine specialties will accept that role) and then have them set the tests you need - it may be annual plan type test but for most of us suspect we have issues that might need more frequent visits and many of the annual test not indicated.

 

For OP PSA is often not considered as required yearly anymore if not elevated so that might explain why it was not tested some years.  As for biopsy you need something to have been removed - often people have nothing that requires removal/testing.   Annual TSH seems to only be recommended for males over 70 if no issues.

[fittobethaied]

For the past 6 years I have been going to the Army Hospital in Udon Thani, and they have an excellent department that does only physical check-ups.  They have a standard menu of prices depending up what you want checked, but then I can add on any test that I feel is necessary.  As has been said already, one must be his own advocate and look out after his own health concerns and know in advance what exams you think are necessary.  My results are always given to me in print with all the parameters for healthy readings, and if something is not normal then it is highlighted for all to see.  I always ask for a film of my chest x-rays and ultrasounds along with a full formal report written by the radiologist. I also get a copy of my EKG, and each year I keep all of these in a separate document compartment in my important papers file. 

After my exams I have a consultation with a doctor who is generally just a general practitioner who has just graduated med school, so I never truly rely on their observations.  In this day and age of the internet there's no reason in the world why I can't educate myself, and in most cases I know as much or more than the doctor who is advising me. Most of them seem to be pleased that I am concerned about my own health and take such a keen interest in educating myself.  On occasion I have met with a few older doctors who seem to take offense with all of the knowledge with which I have armed myself, but I don't really care.  Just remember one thing....if a doctor doesn't have the answer to your question, he's no different than a sales clerk at Big-C in that he will sometimes lie to you or make up an answer if he doesn't know the correct one in order to "save his face", and this to the detriment of your own health.  Saving face is paramount, and your life is of little concern compared to that in some cases.....so buyer beware! 

[little mary sunshine]

Makes money for the hospital and SAVES

LIVES TOO. ..Win...Win..

[balo]

Most of these checkups are unecessary.  I visit a blood lab yearly and do some tests and check them myself online if they are within the normal range. If not I visit the hospital . 

[Sheryl]

It is necessary to do your own homework to find out what tests you need...cannnot relt on the hospital for this (and in most places will not even see a doctor until after all the tests are  done).

 

The various packages are often not well designed and will both omit important things and include unnecessary ones.

[bberrythailand]

So how to know what we should test if we cannot trust doctors and hospitals ?

 

 

[dddave]

It's pretty clear that most "One size fit's all"  check-up packages have a lot of holes and leave a lot to be desired, especially it seems, with competent and comprehensive follow-up interpretation of test results. It doesn't seem to matter if the facilities selling these packages are 5 Star such as Bumrungrad & BNH or less expensive venues such a St. Louis or Bangkok Christian, expectations of accurate and insightful results seem to be rarely met.

 

So many times, Sheryl has emphasized the importance of shopping the Doctor, not the hospital and maybe that would be the better approach in preemptive check-ups.  Rather than seeking out the "all around" check-up, maybe we would be better off spreading the testing out between specialties:  one year, finding a well regarded GI specialist and arranging a GI work-up.  Next year, perhaps a specific cardiac work-up, again with a well regarded physician, then the following year perhaps pulmonary or colo-rectal.  Properly planned, one could cover all the major systems every 5 years and the cost probably would not be that much more than doing annual "One size fits all" check ups.

I would imagine the follow up consultations with the specific physician would be a lot more informative and useful than 15 minutes with a bored resident assigned that work because nobody else wants to do it. 

[Shaunduhpostman]

The doctors at the big expensive hospitals in Bangkok are mostly pretty awful. Most seem to be pretty out to lunch, either so indifferent they don't even seem to be paying any attention to what they are doing. Its well known many of them only get work because they speak English and that is about the extent of their expertise.  The upper classes hatred of foreigners really can end up in your ending up maimed, seriously neglected or I suppose even dead when it comes to Thai doctors. A few I have seen were outright out of their minds, one guy snickered and chortled into his sleeve that they would be amputating my foot for an ingrown toenail. Another doctor, when I went to see him for problems with a minor Plantar's fascia problem told me that nearly all of the bones in my foot were broken  to pieces. He told me he had never seen such extraordinary case, that a person could actually walk around without feeling any pain when all the bones were broken in thousands of pieces. He told me that I needed to go home immediately, stay off of my feet and that he would be calling me shortly after he reported my case to his colleagues. He never called or emailed as promised and didn't return my calls, completely disappearing, I never saw or heard from him again. My wife said he appeared to be completely insane in her opinion. A country eye doctor seeing me for a mild eye infection asked me what I thought about letting him just jab a needle into my eye and removing my eye altogether that way, that I may have serious infection that could spread to my brain. A neice was having chronic headaches and the doctor said he thought they probably just ought to get her to surgery pronto and remove the top of her skull and have a look. She told him no thanks, saw another doctor who gave her some pills for headaches and the headaches disappeared never to return. Another doctor suggested that I stay at the hospital for a week so they could monitor a 1/4 inch abrasion on my knee that had started to get infected. i said, "How about if I just stay home and come back if the anti-biotics don't work?" Without hesitation she said, "Oh sure, if you'd rather just stay at home, that's fine," as though I knew better than she did, no explanation as to why she had at first suggested I stay there. Another otherwise good dermatologist, an older lady, who was treating me regularly for minor skin cancer for some reason would say incredibly rude things such as "You seem like the kind of person who bathes about once a week." I bathe twice a day and have never been told by anyone in my life that I smelled or seemed filthy dirty. Another time she told me, "That shirt looks terrible. Where do buy such badly designed  clothing, in your home country?" In response to my attempt to be friendly and chatty, she said with this angry look, "You really think you are cute and clever don't you?" If you aren't in seriously bad shape, they seem to not want to see you, is what I have concluded. The way most doctors I have seen seem to operate in Thailand is that they  would prefer you wait till it was too late.

[Ulic]

Figure out what tests you need based on your own history. At home you have a GP that co-ordinates

the tests with specialists and should be a central repository of your records. Over time he/she

sees the broad picture of your health and any issues. Walk in clinics may be convenient but make

for poor outcomes with things missed over time. Here your use of various hospitals, doctors, and clinics

will make for poor health care if you don't take responsibility for your records. If you are planning on being

here for years, see the same doctor on an ongoing basis. Don't expect to show up to see a new doctor

every time you have an issue with 5-10 years of records and expect him to go through them.

The special test packages offered by hospitals here are quiet cheap, but the doctor you see will only have

a snapshot on your health at that moment based on those results. You need to understand those

results (somewhat) and take responsibility for yourself. I have compared them with test results

from Canada and they have all been the same/similar so accuracy was not an issue.

[akentryan]

I get a physical two times a year because of heart problems. I get an INR every two months because I take Warfarin (blood thinner rat poison) I get my Pacemaker read every 3 months and see my cardio doctor. For the INR test I use a lab in Naklua at a cost of 350 baht. For my physicals I use Phayathai Hospital in  Sriracha and the special they run every month. The November special costs just under 2,000 baht and includes a medical report and  a meet with a GP after. The Pacemaker read has to be done at Bangkok Hospital Pattaya because that's the only place the Medtronic Tech comes to in Pattaya. Mandatory that you see a cardio doctor as part of the deal. I have insurance but still try to hold costs down.

[impulse]

1 hour ago, akentryan said:

I get a physical two times a year because of heart problems.

 

I did the same, at one of the big name hospitals in BKK.  EKG 2-4x a year and stress test each year for 3 years running.  Went in on a Friday because I knew something wasn't right.  Doc said no change on the EKG, so we'll see you in 3 months.  I insisted something was wrong and asked for the next level of tests.  

 

As a result, that Monday I had a triple bypass after they found one artery blocked 95% and another blocked 100% (I didn't think that was even possible- apparently it is).  This after the cardio guy gave me a clean bill of health.  Had I gotten reasonable care 3 years earlier, I suspect I would have gotten stents instead of a bypass.

 

Annual checkups are great if you can trust the results.  If they give you a warm fuzzy while something is eating you up from the inside, they're worse than useless.  They're criminal.

 

This is one case where Thai defamation laws cost lives.  We should be able to name and shame doctors (and hospitals) who give sub-standard care, just so others don't have to learn the hard way.  Like the guy at my office who died of a stroke the week after he was given a clean report on a "comprehensive" annual checkup.

[lungnorm]

I would not trust any doctor or hospital in Thailand. Several years ago 2003-3 I was taken ill and went to a hospital in Phayao. Ferang hospital my wife told me. I was in excruciating pain in my rectum. They told me they could fix it with an operation. However I declined and took painkillers which worked for the rest of my holiday. On my return to Australia I visited a specialist and was told there was no operation they could do to fix it. Time would heal it as long as I took care not to get constipated. Over the years I have self educated myself on health matters and found that even in Australia your GP will request a lot of unnecessary annual tests and omit some tests that should be done. You can find out online  the best selection of tests for yourself. Also there is a new breed of medical doctors, they are called Functional Medical Practitioners. It is wise to locate one of these doctors you can search online to locate one near you, they may be listed as Holistic Medical Practitioners.Also do not have M.R.I,s or C.T Scans unless absolutely necessary and females should not have Mammograms any more as they actually can cause breast cancer. Good Luck 

[little mary sunshine]

16 minutes ago, lungnorm said:

I would not trust any doctor or hospital in Thailand. Several years ago 2003-3 I was taken ill and went to a hospital in Phayao. Ferang hospital my wife told me. I was in excruciating pain in my rectum. They told me they could fix it with an operation. However I declined and took painkillers which worked for the rest of my holiday. On my return to Australia I visited a specialist and was told there was no operation they could do to fix it. Time would heal it as long as I took care not to get constipated. Over the years I have self educated myself on health matters and found that even in Australia your GP will request a lot of unnecessary annual tests and omit some tests that should be done. You can find out online  the best selection of tests for yourself. Also there is a new breed of medical doctors, they are called Functional Medical Practitioners. It is wise to locate one of these doctors you can search online to locate one near you, they may be listed as Holistic Medical Practitioners.Also do not have M.R.I,s or C.T Scans unless absolutely necessary and females should not have Mammograms any more as they actually can cause breast cancer. Good Luck 

 

 

One person's opinion.....Also test for early detection of cancer 

saves thousands of lives each year.  Annual physical, UA, Chem 20,

 PSA for male should be done.  Another opinion!!

[lungnorm]

1 minute ago, little mary sunshine said:

 

 

One person's opinion.....Also test for early detection of cancer 

saves thousands of lives each year.  Annual physical, UA, Chem 20,

 PSA for male should be done.  Another opinion!!

Not just one persons opinion. Its quick mouths like you that should get up to speed with the latest medical news. Its so easy with the internet so I suggest you get up to speed on everything before opening your big mouth.

[little mary sunshine]

4 minutes ago, lungnorm said:

Not just one persons opinion. Its quick mouths like you that should get up to speed with the latest medical news. Its so easy with the internet so I suggest you get up to speed on everything before opening your big mouth.

 

 

People,that believe everything on the internet, opinions

count as zero!!

[lungnorm]

18 minutes ago, little mary sunshine said:

 

 

People,that believe everything on the internet, opinions

count as zero!!

I never believe anything on the net without checking as many reference points as possible. Seem you need skills in that department too.

[Sheryl]

7 hours ago, bberrythailand said:

So how to know what we should test if we cannot trust doctors and hospitals ?

 

 

 

It is not a matter of trusting "doctors", the check-up packages are put together by hospital marketing depts.

 

Regarding doctors, blindly trusted all of them just because they are doctors is very misguided but so is deciding not to trust any (or any Thai ones) because of a bad experience with one or a few of them. Doctors are individuals and vary in their competency.  If one car mechanic screws up your car, do you decide that 100% of them are incompetent? No, you just don't use that mechanic again, and also take more care in selecting the next one.

 

There are competent and conscientious doctors to be found in Thailand,. There are also incompetent ones, careless ones etc.  No hospital has a monopoly on this. One has to carefully select one's doctor...and also use common sense/trust your gut, if what you are told doesn't feel right to you, get another opinion. Even the best of doctors is not infallible and will occasionally get it wrong.

 

In terms of knowing what test to have on a general check-up here are some very good resources. Note though that you may need to add to this if you have a history of a specific disease or are suffering particular symptoms.

 

https://my.clevelandclinic.org/ccf/media/files/Health/health_maintenance_guidelines.pdf

 

https://medlineplus.gov/ency/article/002125.htm 

(scroll down and click on relevant age and sex)

 

The above are generic anda ssume no special problems or prior abnormal result, obviously need to adjust for these.

 

 

 

[al007]

18 hours ago, Sheryl said:

It is necessary to do your own homework to find out what tests you need...cannnot relt on the hospital for this (and in most places will not even see a doctor until after all the tests are  done).

 

The various packages are often not well designed and will both omit important things and include unnecessary ones.

 

Spot on ! ! !    I did not do what Sheryl says, why because I forgot there is not a GP in the system, and here in Thailand you need to be your own GP, and when picking the tests need qualified medical advice

At one of my local hospitals it costs 300batt to see a doctor, so the answer with hindsight is see the doctor before choosing the tests and discuss with him what is required, small extra cost

 

At the moment I am getting some excellent care, Well I hope so ! !, from a radiologist and a chemo therapist, I have identified I might have a thyroid problem, and last evening when I asked the Chemotherapist to add Thyroid tests to my next blood test he was questioning it, saying I was only just over the limit on TSH (thyroid), I explained there were several different thyroid tests and I wanted them all, (and this week not in January when I return for more tests) he happily agreed; but I had to push hard

 

My point is whilst specialists are often good on their own sphere, they may be distinctly limited else where, and again we have to be our own GP, if in doubt check

 

Else where in this thread I have seen a comment specialists are expensive, not so in my experience, even at top notch Bumrungrad I have had consultations and come out under 1000batt including the hospitals add ons, I doubt if one can get private consultation in UK for much under 10,000batt, yes free on the NHS but wait for ever 

[lopburi3]

You might want to have that thyroid issue checked by a qualified endocrinologist as they should not be any more expensive and should have better knowledge for pre cancer testing.  If cancer is suspected there is a fine needle test that requires a great deal of skill to be effective in collecting various cells for testing so you need someone very experienced.  In my case not all four types of cells were collected so was inconclusive and proceeded with removal - later testing did not indicate cancer in the solid mass but was not working in any case.  Now a pill a day takes care of that missing organ.  Hope you do not have such issues in addition to what you already know about.

[lungnorm]

2 hours ago, al007 said:

 

Spot on ! ! !    I did not do what Sheryl says, why because I forgot there is not a GP in the system, and here in Thailand you need to be your own GP, and when picking the tests need qualified medical advice

At one of my local hospitals it costs 300batt to see a doctor, so the answer with hindsight is see the doctor before choosing the tests and discuss with him what is required, small extra cost

 

At the moment I am getting some excellent care, Well I hope so ! !, from a radiologist and a chemo therapist, I have identified I might have a thyroid problem, and last evening when I asked the Chemotherapist to add Thyroid tests to my next blood test he was questioning it, saying I was only just over the limit on TSH (thyroid), I explained there were several different thyroid tests and I wanted them all, (and this week not in January when I return for more tests) he happily agreed; but I had to push hard

 

My point is whilst specialists are often good on their own sphere, they may be distinctly limited else where, and again we have to be our own GP, if in doubt check

 

Else where in this thread I have seen a comment specialists are expensive, not so in my experience, even at top notch Bumrungrad I have had consultations and come out under 1000batt including the hospitals add ons, I doubt if one can get private consultation in UK for much under 10,000batt, yes free on the NHS but wait for ever 

Very difficult area. Even most western doctors either send you for the wrong tests or cannot read the tests correctly. You need to see a Thyroid specialist or they will tell you that your thyroid needs to be removed and you have to be on meds for the rest of your life. Thyroid diagnosis is difficult and way beyond the average doctor especially in Thailand. 

[Sheryl]

There are several excellent, US trained and US board certified thyroid specialists at Bumrungrad. Feedback I have gotten on them has been very positive.

 

In my years on this board, I have come across many reports of shall we saw sub-standard or questionable medical advice/treatment but I can't say I have ever heard of someone with mild hypothyroidims being told they needed to have their thyroid gland removed. Never.

[IMA_FARANG]

That's a very loaded question and depends a lot on the patients age, sex, and life experience.

There is no 'one size fits all" medical check-up.in my Thai gilfriend;s family there is for example, a known history of Vaginal cancer in the females in the family.

for a woman to ignore that family history would be foolish.

 

[Sheryl]

Yes, of course individual and family history should be taken into account.  (Vaginal cancer though requires only the same pelvic exam that every woman should have regardless).

 

It is also important to educate yourself as to what the various tests check for so that you do not develop a false sense of confidence. A clean bill of health at most excludes the specific conditions tested for, it does not guarantee that you have no health problems brewing. Many conditions lack a good screening test. Other tests may have been left out for one reason or another.

 

 

[al007]

6 hours ago, lopburi3 said:

You might want to have that thyroid issue checked by a qualified endocrinologist as they should not be any more expensive and should have better knowledge for pre cancer testing.  If cancer is suspected there is a fine needle test that requires a great deal of skill to be effective in collecting various cells for testing so you need someone very experienced.  In my case not all four types of cells were collected so was inconclusive and proceeded with removal - later testing did not indicate cancer in the solid mass but was not working in any case.  Now a pill a day takes care of that missing organ.  Hope you do not have such issues in addition to what you already know about.

 

Thank you,absolutely correct, I will be going to an endocrinologist once I have some results in my hand , unless they are all very in the middle results, I am sort of hoping to jump start the process, if I go with no results I expect I would be sent to get some, by doing this way I might just save costs of extra appointment, I am self insured

 

I continue to be very grateful for so much quality advice

[al007]

4 hours ago, Sheryl said:

There are several excellent, US trained and US board certified thyroid specialists at Bumrungrad. Feedback I have gotten on them has been very positive.

 

In my years on this board, I have come across many reports of shall we saw sub-standard or questionable medical advice/treatment but I can't say I have ever heard of someone with mild hypothyroidims being told they needed to have their thyroid gland removed. Never.

 

I am appreciative of input however just for the record I have no intention of allowing any surgery on my thyroid, to put the thing in perspective, my THC is just outside the recommended level, and while in BKK and living in and out of hospitals every day, I consider it only prudent to investigate further, and yes I will probably be going for consultation at Bumrungrad

 

And even if any of the below average doctors (not many of whom I have met fortunately) want to cut off anything else, I will not allow it, I am only 71 and still despite everything pretty fit, hopefully with a brain still working

 

I may have to have surgery in February and have a colostomy bag fitted, and even this I am not just going to agree to without some detailed thoughts, on the alternatives, including maybe a shorter life, the thought of this appals me, but I keep an open mind

[NanLaew]

On 11/15/2016 at 10:43 AM, al007 said:

... At the moment I have two cancers, prostate, and colon/rectum, and possible Thyroid problems, these were not flagged at the annual medicals and additional tests, they should have been. ...

"...they should have been"? Not if they weren't evidenced so questionable at the time of the medical exam.

 

There's no way a private hospital will pass up the opportunity of emptying your wallet further by dismissing even the slightest indication that something is not quite right.