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.. INFECTIOUS DISEASE - Diagnosis, Treatment, Costs in Detail


brutox

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Another chapter on life here in Thailand .. ever consider that you might contract an exotic infectious disease? .. read on.

 

I recently attended a buddy admitted to Bumrungrad Hospital (BKK) with scary severe respiratory problems .. all he could muster when he SMS’d me was simply: “Please come”.. pretty disturbing when you get that pre-dawn call.

 

After being undiagnosed for 3 months, the problem had gotten progressively worse.  He was coughing so violently that he was vomiting and even passed-out on a couple of occasions, so we both knew he was in trouble.

 

The two lazy-assed, simple-minded pulmonologists he had seen a total of 3 times at Samitivej and Bumrungrad did virtually no labs (only chest x-rays, which read as ‘clear’), and they simply threw broad spectrum antibiotics and steroids at the symptoms (recall the common Thai adage: “do just enough”) .. they were clueless.

 

Having a need 15 years ago for a virologist, I found here a bright young infectious disease research physician who was surperb .. fast-forward to 2015 .. I am unsurprised that the guy is now the head of Bumrungrad’s Infectious Disease Department, and has quite a reputation in tropical infectious diseases here and abroad.

 

He mostly does the heavy lifting of diagnosis only, and does not generally treat patients, only advising other doctors who do the treatment .. but, he thankfully took my friend on as his primary physician.

 

After quickly screening for and eliminating all the first tier viral, bacterial, and parasitic suspects, he went to work drilling down on the lesser known candidates.  With multiple residencies in infectious disease in the US, this guy was truly impressive and mounted an amazingly disciplined medical investigation .. gathering evidence; eliminating suspects; theorizing compound infections; extensive, detailed interviews on my friend’s lifestyle, environment, routines, activities, travels, dining, medical history .. taking into consideration a dead pigeon carcass outside his bedroom window, feral neighborhood cats, changes in behavior, air-con filter maintenance, and on, and on, and on.

 

After my friend suffered through four days of some scary bad symptoms, the doctor concluded that the infection was a bacteria, Rickettsia typhi, resident in the gut of a parasitic flea living on rats .. the diagnosis is not confirmed until the serology tests are complete, which takes a few more days, but he thinks he has got it.

 

While there are no rats apparent in the space where my friend lives and works, he works out in a park where he does push-ups on the grass.  The park is infested with feral cats, on whom these fleas can be transported to their next rat host .. what a freakin’ mid-field score of a diagnosis that was!

 

The cure is only THB 2,000 for an antibiotic, and in 24-hours, the fever was 100% gone .. however .. the cost for the diagnosis was not so minor.

 

The all-in cost was THB 170,000 .. you have to be working really hard to spend that kind of money in a Thai hospital over four days and not have major organs piled-up in a stainless steel bowl at your bedside.

 

Of that, the physician fees were only THB 21,000 .. the infectious disease specialist prophylactically prescribed some heavy combinations of medications, some of which were quite expensive .. THB 28,000, or 60% of the total medicine cost, was on 2 exotic meds only, administered for 2 days until he could eliminate the infections these treated.

 

The infectious disease specialist said he sees only 4, or 5 cases as tough as this to diagnose each year.  Had he not been able to figure this out, the next stop for my friend would have been the UK .. no way an airline would have allowed him aboard, so it would have been an air ambulance .. even then, I worried if the same expertise in tropical disease medicine would have been available there .. Thailand is a virtual Petri dish for this stuff, and this guy is the top kick.

 

So, guys .. here they are .. the costs for diagnosing and treating an uncommon infectious disease in Thailand .. were this in the US, my buddy would be bankrupted in 4 days (case solved and cured, or not):

 

THB 4,000 – EMERGENCY ROOM (2 hours)

1,000   ER physician

500      Nurses

2,500   Acute care diagnostics

 

THB 25,000 – DIAGNOSTICS

12,500 CT Scan – Chest

7,500   CT Scan – Sinus

1,000   Chest x-ray

4,000   Radiologist

 

THB 36,000 – LABORATORY

27 clinical tests on every possible body fluid, from frontal sinus cavity down to the rectum

Viral, bacterial, parasitic

Ranging from THB 400-5,000/test

 

THB 21,000 – PHYSICIANS

10,000 Infectious disease (5 consults)

8,000   Pulmonologist (4 consults)

3,000   Otolaryngologist (2 consults)

 

THB 27,500 – ROOM (shared room; 4 nights)

10,000 Nurses

11,500 Room

3,500   Food

2,500   Room supplies

 

THB 2,000 – MEDICAL EQUIPMENT

Intravenous pump; 2 days

 

THB 46,500 – MEDICATIONS

16 different meds, many prescribed prophylactically in advance of a diagnosis

THB 28,000 on 2 meds alone, taken only for 2 days

 

THB 8,500 – MEDICAL SUPPLIES

Syringes, intravenous sets, etc.

 

 

THB 170,000  ALL-IN COST

.

 

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Wow!  Glad to hear your friend was sorted out.

 

Getting a rat/cat borne bacterial infection is not high up on my list of medical worries when abroad, its mostly about injuries and gastrointestinal issues. I do not even worry about sunburn!

 

I wonder just how much more expensive it would be in the US or UK (if one had to pay)?

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.. this infectious disease guy was fascinating to watch .. he went through with us all the details and the whys and how's of every step .. a real pro.

 

.. the culprit was actually a flea, that lives on rats, but migrates on cats .. this guy was as much an investigator as a physician.

 

.. the cost .. the emergency room cost about USD 110 .. doing the homework on this, I read some shocking ER costs in the US, none of which seem under USD 10,000 (most quite a bit higher) .. even for minor, minor stuff .. indigestion, whatever.

 

.. the entire physician team (2 of whom did fellowships in US hospitals) cost only USD 580! .. that covered a total of 11 consults.

 

.. the meds and laboratory tests are where the costs were, which makes sense.

 

.. Thai doctors are notorious for over-prescribing meds .. the doctors themselves make very little money .. the meds are where the money is.

 

.. seems a disincentive for Thai physicians to actually practice medicine, when they are rewarded for piling on the meds, and guessing at the diagnosis and treatment .. that is what the first 2 doctors did, and they utterly failed at diagnosing, OR treating him.

.

 

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