… THAI DOCTORS AND HOSPITALS – Finding and Managing Quality Medical Care

[brutox]

Okay, men .. here is what I got.

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I.    FOR WHOM THIS THREAD MIGHT INTEREST – "THE LAST STOP, THAILAND!"

II.   CASE STUDY – “THE JOKER” (DON) .. GASTRIC ULCERS > GASTRIC CANCER

III.  MISDIAGNOSIS – FREQUENCY FOR WHICH IS ABSOLUTELY ESSENTIAL KNOWLEDGE

IV.  MY EXPERIENCE IN FINDING QUALITY MEDICAL CARE

V.   OVERVIEW – THAI MEDICAL CARE

VI.  THE CONSEQUENCES OF GETTING IT WRONG – MISDIAGNOSIS

VII.  PHYSICIAN VETTING – CHECKLIST

VIII. HOW TO FIND PHYSICIANS CREDENTIALS

IX.   SELF EDUCATION

X. MISDIAGNOSIS CASE STUDIES – THAILAND:

        a. CASE STUDY – MY DAUGHTER .. ACUTE APPENDICITIS > PERITONITUS, SEPSIS

        b. CASE STUDY – CLOSE FRIEND .. MURINE TYPHUS > PULMONARY EDEMA, CARDIAC ARREST

XI. A SIDE NOTE – HOSPITAL PRESCRIBED MEDICATIONS

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I.   FOR WHOM THIS THREAD MIGHT INTEREST – “THE LAST STOP, THAILAND!”

This is lengthy and will certainly bore the buh-jee-sus out of healthy young bucks whose meticulously planned medical care is simply “live forever” .. for others to whom that great idea never occurred, the need for smart medical care is alas a reality .. and let’s be honest, Thailand is the last stop for many of us, so this is important.

Lots of experiences to share, but I will confine my comments to Thailand and be specifically relevant to resident farang.

Proofreading this, it is not short, men .. anyone who reads my posts knows that my love of words prevents me from writing a short anything.. so, for those whose frontal lobes are now trained to overload on anything more than social media’s 15-second knowledge-deficient flashes .. umm .. better pass on this thread.

If you read through this is a single sitting, you really need to find a hobby.

 

II.   CASE STUDY – “THE JOKER” (DON) .. GASTRIC ULCERS > GASTRIC CANCER

The unexpected recent passing here of a popular forum member exposed an often misplaced trust too many farang innocently place in the quality of care they expect from the Thai medical sector .. Don was misdiagnosed at an unnamed Pattaya area hospital (name withheld to avoid threat of a defamation claim) in approximately March 2023 with gastric ulcers and sent home with acid suppressants and antibiotics .. the problem persisted .. he then sought treatment at a different hospital (Bangkok Pattaya Hospital) approximately three months later, where he was diagnosed with Stage 4 gastric cancer and started chemotherapy immediately .. he passed away in April 2024, not living long enough to even complete the chemo.

https://forum.pattaya-addicts.com/topic/354569-the-tears-of-a-clown-a-life-report-the-jokers-next-adventure/?do=findComment&comment=5724341&_rid=71254

In most western countries, this misdiagnosis would clearly be medical malpractice .. protocols for diagnosing severe, persistent stomach ailments (including stomach cancer) are widely available and performed in Thailand – simple upper endoscopy .. while Don’s misdiagnosis made no difference in his survival (a 20% 1-year survival rate), it could have been a misdiagnosis of any number of ailments for which early detection could make the difference between life and death.

Don's story drew a good measure of reactions by forum members, and requests for a follow-up .. perhaps the cautionary observations below might be helpful to some of you somewhere along the way.

 

III.  MISDIAGNOSIS – THE FREQUENCY OF WHICH IS ABSOLUTELY ESSENTIAL KNOWLEDGE (emphasis added)

Understand this essential knowledge .. medical misdiagnosis is far more common a problem than I ever imagined .. a knowledgeable American friend and physician schooled me up on how to get quality medical care (see Section VII) .. surprisingly, his focus was avoiding misdiagnosis – first and foremost, get the diagnostics right.

Citations by the peer-reviewed Journal of American Medical Association are pretty stunning .. 75% of misdiagnoses with serious consequences occur within three major categories – vascular events, infections, and cancers .. so, knowing within which group you are having problems can draw your attention to a higher level of due diligence.

Some ailments can be diagnosed with high accuracy – 1.2% misdiagnosis rate for heart attacks (vascular event).. others with high levels of uncertainty have a higher rate of misdiagnosis – up to 15% misdiagnosis in children and 24% misdiagnosis in adults for appendicitis (infections), and 23% misdiagnosis for lung carcinoma (cancer).

• “About 795 000 people die or are permanently disabled each year due to diagnostic errors and related harms …” ..  https://jamanetwork.com/journals/jama/article-abstract/2807896?resultClick=24 
• “The [Emergency Room] is a high-risk setting for diagnostic errors. With approximately 80% of errors potentially preventable and approximately 50% of all diagnostic errors having the potential for patient harm…”  https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2762391#:~:text=Appendicitis%20is%20one%20of%20the,emergency%20department%20(ED)%20visits.
• “On average, the researchers estimated that 11% of [all] medical problems result in a misdiagnosis, although the error rate varies widely depending on the disease.” .. https://www.webmd.com/a-to-z-guides/news/20230719/misdiagnosis-seriously-harms-people-annually-study

This in the US .. little imagination is necessary to think about the incidence of misdiagnosis in lesser developed countries .. that I could find no authoritative documentation on misdiagnosis rates in Thailand is unsurprising .. there are individual local news reports on misdiagnosis, but no one has compiled the figures to draw any conclusions on the overall incidence of misdiagnosis .. not good for Thailand's medical tourism business .. umm, definitely .. no.

But be certain, misdiagnosis in Thailand must be worse than in the US, where best medical practices are applied and hordes of insurance companies and preying medical malpractice lawyers skulk over physicians shoulders just waiting for a misstep .. here in Thailand, not so much.

 

IV.   MY EXPERIENCE IN FINDING QUALITY MEDICAL CARE

For the majority of my life, I have lived outside my native America – 11 countries .. developed, emerging, and Jungle economies .. US, Europe, MENA, Sub-Saharan Africa, and 6 Asian countries .. 24 years here in Thailand.. I learned many adaptations to live happily in most all of them.

Acquiring quality medical care in less-developed countries has been particularly important, especially here in Thailand where I have aged (now 70), and no longer have the exceptional medical care privileges afforded to me by the major international companies for which I served in senior executive roles.

A big part of that is educating myself sufficiently to recognize areas where diagnostic uncertainty is likely, know the alternatives, ask the right questions, and understand the replies .. Thai doctors generally resent questions, so being an active participant in critical medical decisions is a delicate patient-doctor fandango.

I do not profess to be medically proficient, but am medically very aware .. I have also learned through my professional experiences and involvement with medical care in still-developing countries that judgement and common sense can compensate for lacking medical skills of some physicians with limited knowledge, training, and experience, and who are often culturally handicapped from making good decisions.

 

V.  OVERVIEW – THAI MEDICAL CARE

Thailand is popularly promoted in media as a world-class center for medical tourism, which in my experience is overly misrepresented by marketers and leads to a misperception of the reality .. high quality medical care is available here .. selectively, but not universally.. relying on slick marketing campaigns and unqualified opinion surveys is in my view risky .. you have to work at finding quality medical care on your own.

Medical practice in underfunded upcountry hospitals is vastly different than in Bangkok, where the money is and where physicians probably prefer living .. I guess the resort trade areas are presumably somewhere in between – Phuket, Pattaya, Chiang Mai, Hua Hin .. in those sub-markets, Bangkok’s international hospitals have planted their flags, ostensibly offering Bangkok-quality medical care .. ummmaybe.

Thailand medical industry has done a great job of creating the image of high quality medical care, which belies a reality that can be quite different (very typically Thai – appearance over substance) .. two images:

• One is the ‘hardware’ – hospitals and advanced medical equipment .. lobbies like 5-star resort hotels, with comfortable lounges, high speed Internet, Starbucks, Au bon Pain, and wonderfully warm, welcoming staff for which Thais are well-known .. I once checked on a radiology machine that a physician friend in the US assessed as only a few years behind the most advanced equipment in the US’s best hospitals and clinics .. for it’s use (radiating an encapsulated liposarcoma), he said perfectly sufficient; however,
• Far, far more important is the ‘software’ – the physicians, and how they utilize the hardware.

The hardware bears no relationship to the quality of the medical care patients should expect.

 

VI.  THE CONSEQUENCES OF GETTING IT WRONG – MISDIAGNOSIS

Run of the mill runny noses, or itchy skin, or a minor fracture are not so much a concern for me, but I laser focus on severe ailments (especially internal) and their higher potential for misdiagnoses .. I have personal experiences with bad medicine where I expected better – one of my children and a close friend .. only by intervening directly in their care were severe consequences of misdiagnoses avoided (ruptured appendix for my daughter; and, pulmonary edema for my buddy).

I favor Bumrungrad International, Sukhumvit Hospital, and Bangkok Hospital, all highly regarded international hospitals .. (https://www.newsweek.com/worlds-best-hospitals-2022/thailand) .. most Thai physicians hate my intervening into their lane, into which I have on occasion been compelled to impose myself .. I find western experienced physicians here are used to this patient-physician relationship and accommodate a two-way discussion quite well .. when needed, I have insisted on calling in my selected physicians (for a ‘second opinion’), who handled the whole loss of face issue in their Thai way .. I even replaced a less experienced surgeon slated to perform an emergency appendectomy, for a more experienced one .. not a happy camper there.

 

VII.  PHYSICIAN VETTING – CHECKLIST

I have physicians and nurses in my family, but the absolute best advice I received is from a friend who is a Harvard-trained research cardiologist at the National Institute of Health (NIH) in the US, who worked with physicians from all over the world .. a major talent.

The core of his advice that guides me — medical misdiagnosis is far more common than physicians admit .. in any new country to which I move, he advised that I shop for a diagnostician, first and foremost .. not a hospital.. a great clinician in a great hospital treating you for the wrong ailment isn't actually that great a doctor.

He emphasized that diagnostics is where the very highest skill in clinical medicine is practiced.. he explained that most competent doctors can treat an ailment once the problem is correctly diagnosed – it is almost cookbook, especially in this information age.. so his checklist is quite nuanced and focusses on identifying physicians with probable diagnostic competence:

• Foreign educated and experienced in 1^st world, highly-rated medical schools, teaching hospitals, and clinics .. of course, he favors American medicine, where some of the best in the world is found .. I am sure other countries have very good medical schools, but this is the standard I choose .. arguably some of the best medicine in the world (until the damage of woke-ism taking precedent over exceptionalism starts taking its toll).

          https://www.newsweek.com/rankings/worlds-best-hospitals-2024

          https://www.newsweek.com/rankings/worlds-best-specialized-hospitals-2024

          https://www.usnews.com/education/best-global-universities/clinical-medicine

• He favors American Medical Association (AMA) Board Certified in their field of specialization .. once certified, the AMA requires physicians to maintain their qualifications through ongoing education .. few AMA Board certified physicians I have found out here maintain their certification after they first pass the boards, so an ‘AMA Board Certification’ is no guarantee that their certification is current .. still, even earning it once is high commendation .. best in class prospects.
• He excludes ‘certificates’ awarded for short-term training programs on the use of machines and devices, which are sponsored by the manufacturers, or clinics on the use of their own techniques .. he refers to them a golfing holidays.
• In order .. graduates of highly-rated US medical schools .. or, foreign medical school graduates who win placement in US residencies at highly-rated teaching hospitals or clinics.
• Age and experience matter.. ideally, a minimum of 10-12 years of experience in their field of specialization, up to about 25-30 years of experience .. dinosaurs tend to get lazy and fail to stay current .. exceptions are older researchers and medical school professors (see next) .. for run of the mill ailments, dinosaurs extensive experience can be valuable.
• He favors physicians who have practiced clinical medicine in the US, worked in research (especially in international collaborations, and have published peer-reviewed papers), or instructed at teaching hospitals .. these guys by nature are curious, stay current with medical technology, and are less likely to age-out .. best in class prospects.

A word on common Thai hospital practices .. walk-in patients are assigned a physician based on which physician is available next .. luck of the draw .. umm, no .. not good .. for runny nose, okay .. but, no way for any critical medical issue .. if you have the time, do the homework and make an appointment with the physician you select .. in an emergency room admission, be prepared to call in your own selected doctor for a ‘second opinion’.. keep in mind that the overwhelming preponderance of misdiagnoses happen in ERs.

Checking all of these boxes is unlikely .. still, by using this vetting I have found some of the best medical treatment here in Thailand than anywhere I have lived .. checking the big boxes above will serve patients far better than taking a number in the queue where innocent farang often have false confidence.

 

VIII.   HOW TO FIND PHYSICIANS CREDENTIALS

It is difficult here .. few hospitals here publish any more than just bare minimum information on their physicians medical credentials .. a cultural thing .. the exceptions are Bumrungrad International and Bangkok Hospital, which provide useful information .. other hospitals are slowly catching on.

Desktop research on physicians by name sometimes reveals valuable intel .. the hospitals typically list their physicians by name, which is often searchable.

Physicians move around and sometimes practice in other locations .. when you find one, get their personal contact coordinates if at all possible.

 

IX.  SELF EDUCATION

A reasonable skepticism for medical practitioners is healthy .. doctors are notorious for falling prey to the self-delusional “God Syndrome”, common all over the world I suppose .. that is compounded here by cultural practices in which highly hierarchical Thai society places physicians above the unwashed masses, who must of course know our place as .. lessers.. “your input is uninvited” .. and .. “who are you to question me? .. I am a physician” .. immediately terminate the services of these people the very second you get a whiff of it .. nothing good will come of it.

Protect yourself by gaining medical knowledge .. enough to know what conditions are critical, what areas are prone to misdiagnoses, the right questions to ask, and when to intervene .. my go-to online learning sites are:

• https://www.mayoclinic.org/ (diagnostics and treatments)
• https://my.clevelandclinic.org/health (diagnostics and treatments)
• https://stanfordhealthcare.org/directory/guided-search.html (diagnostics and treatments)
• https://www.webmd.com/ (commercial, but very useful for pharmaceuticals)
• https://jamanetwork.com/ (deep, deep dive if you are on to something specific)

 

X.  MISDIAGNOSIS CASE STUDIES

I offer here examples of potentially very bad outcomes I avoided by necessarily intervening into the decision-making process where I was uninvited by Thai physicians .. raising 4 kids here, starting from age 1, I’ve had scores of hospital experiences in Bangkok – Bumrungrad, Samitivej, Sukhumvit hospitals .. more limited experiences at Bangkok Hospital and Bangkok Pattaya Hospital which friends selected .. by carefully selecting physicians .. my kids, friends, and I have received some of the best medical care I have had anywhere in the world, including the US .. but, not without vetting the physicians and intervening when necessary.

Others here might have firsthand experiences to share as case studies .. useful, so please share how and when (advise you to edit out proper nouns to avoid the risk of defamation claims . .probably unlikely on this little-known forum, but you just never know) .. there are plenty of anecdotal stories we hear, but I’d rather that contributors not turn this into a trash on Thai medical care thread based on rumors.

Do not get me wrong, I have far, far more very positive medical care experiences here in Thailand that I won’t cite, than these few bad ones .. but, this is a cautionary thread.

 

a.  CASE STUDY – MY DAUGHTER .. ACUTE APPENDICITIS > PERITONITIS, SEPSIS

At 2.00 in the morning, one of my teenage daughters woke me up in tears, doubled over in sharp abdominal pain, unable to walk .. I carried her to the car, called the hospital ahead of our arrival, and Bumrungrad’s Emergency Room prepped to receive her .. a weekend, as I recall .. looking back on it, wee hours on a weekend, a junior grade ER attending should have been no surprise.

The attending ER physician was a young woman who took her medical history, poked and prodded, and queried .. no imaging and no blood work which would have been protocol for appendicitis .. she diagnosed that my daughter was suffering from severe menstrual cramps (she has a history of severe menstruation) .. wanted to give her meds and discharge her.

Ummm, no .. I am no physician, but come on .. high fever, constant sharp crippling pain, lower right abdominal cavity .. are you kidding me? .. I know my daughter’s menstrual pain and tolerance .. this was not that .. I pushed and the attending poo-pooed my urging for a deeper look at her appendix.

This is when I intervened .. I called my go-to internist at Bumrungrad, who came in a couple of hours later .. he called for imaging, diagnosed appendicitis, and scheduled immediate surgery.. the ER attending physician suffers major loss of face .. too bad.

I interviewed the on-call surgeon in the queue, who was relatively young .. he had performed a number of key-hole appendectomies, which I understand is fairly straight forward, but not to my satisfaction in terms of whole numbers, frequency, and last performed .. here again, I intervened .. I quietly pressed the internist to recommend more experienced surgeons, one of whom was performing appendectomies regularly each week.

My daughter was in the operating theater at about daybreak .. rotten appendix on the verge of rupturing, the consequences for which are peritonitis (widespread infection throughout abdominal cavity) .. then, possibly sepsis (blood-borne systemic infection) with a 1:20 chance of death .. umm, no .. not for my kid.

 

b.  CASE STUDY – CLOSE FRIEND .. MURINE TYPHUS > PULMONARY EDEMA, CARDIAC ARREST

A very close friend, very fit and a pretty tough old school Mancunian, was suffering from breathing difficulties for some months .. he had seen 3 different pulmonologists at Samitivej and Bumrungrad hospitals over 2-3 months, who were unable to diagnose the problem .. they prescribed antibiotics, which temporarily eased the problem but none of which were the cure, and the symptoms roared back worse than before.

He called me in the early morning hours, weak and barely capable of speaking, asking that I get him to a hospital immediately .. the guy could barely make it to his front door, looked like he was near death, and I very nearly had to fireman’s carry him to the car .. again .. Bumrungrad ER .. he was seen by ER, suffering from pulmonary edema, admitted, and placed on oxygen.

One of the two Bumrungrad pulmonologists who was previously unable to correctly treat him was assigned his case .. bullshit on that, I intervened .. I blew right past that guy and called in my go-to infectious disease guy, a very competent diagnostician and a published research virologist who treated me for HepB years ago.. as before, the pulmonologist who last treated him (or failed, actually) was not a happy camper .. and, as in my daughter's case, too bad.

Honestly, my buddy was looking alarmingly bad .. if he was sufficiently ambulatory and an airline would accept him onboard, and this was not sorted in the next day or so, I was prepared to haul him aboard and fly him to the UK or US.

The cost of getting this wrong was pulmonary edema, potentially causing heart failure .. life threatening.

My infectious disease diagnostician went through an unbelievable history on my buddy, personal and family.. literally hundreds of the most arcane questions .. what and where he ate in the last weeks, does he eat bush meat, do pigeons roost on his window sills, what kind of soap and shampoo he uses, recent change in household cleaning agents, does he own pets, did he ever contract any of a list of diseases, history of surgeries and blood transfusions, has he ever left his shoes out on the balcony at night.. on and on and on .. oral and written .. it took my buddy half a day to complete.

Along with bloodwork and imaging tests, the virologist keyed on my friend’s workouts in the park .. doing press-ups in the grass, where there is a particular type of flea native to Thailand that lives on rats.. in the stomach of that particular type of flea lives a particular bacteria (Rickettsia typhi) that is a vector for murine typhus in humans .. fleas whose hosts die wait in the grass for the next host to come by – that would be my buddy.. when fleas bite and feed, they crap at the same time, and the bacteria is introduced into the host through the bite wound .. the physician suspected that my buddy contracted murine typhus, a rare disease in Thailand, which had spread throughout his lungs.

The lab work would take a week to conclude a test for murine typhus .. not waiting for the lab, he prescribed a single pill (one dose) that cost like some crazy-assed USD 400-500, and explained that if he was suffering from murine typhus, this pill would kill it stone cold dead and my buddy would feel better in 24 hours .. and son of a bitch, that is exactly what happened.. the lab later confirmed his diagnosis .. I thought it pretty remarkable medicine, where two pulmonology specialists at the best hospital in Thailand failed.
 

XI.  A SIDE NOTE –  HOSPITAL PRESCRIBED MEDICATIONS

Over the years, I have broken down many medical bills .. a pattern emerges.

For most any outpatient treatments the percentage of the total bill for meds is quite high – generally 25-30% .. no one leaves Thai hospitals without a goody bag filled with meds, which are priced up just a bit over street pharmacies and many of which are quite unnecessary.

This almost always includes paracetamol and commonly includes an antibiotic for the ever so remote possibility that your broken toe might develop into a bacterial infection (just as a precaution, you see).. I keep a well-stocked medicine box at home, so I politely tell the pharmacist to remove all but the truly necessary meds.

[If an antibiotic-resistant bacteria evolves from unneeded overuse, it might well emerge in Thailand .. physicians here are getting better about it.]

For in-patient care, a saline IV drip is often ordered, on the ever so remote possibility patients might be dehydrated (so hot here .. just a precaution, you see), even though they are pissing like a double-dick quarter horse on a flat rock.. unless you really do need hydration or expect to be medicated on a drip IV, thank them, but decline.

This is a business in which local hospitals know Thais will not deny the physicians orders.

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So .. there it is, men .. that’s all I got .. good health to you all.

Edited May 4 by brutox

[FROST MEDIC999]

Thanks 

 

I actually found your post well written and informative.

Gives food for thought,and should we have doubts about ourselves or loved one ( after all we know our bodies n loved one better than a on call HCP ) then do not put blind faith in them and push further or ask if concerned.

Only time loss of faith does not matter is our Health and if we upset somebody so be it

[Bobmoore]

Quote

even though they are pissing like a double-dick quarter horse on a flat rock.

Bravo. 

[palmtree]

Brutus, thanks for this.

one thing I wonder about is whether expats - particularly those who have recently moved there - could be extra susceptible to bugs that locals have developed immunity to.   Your friend’s case made me think of that - although the added risk there was probably more due to not knowing to not do push-ups in the grass.

What do you think?  And do you think physicians would think about this?

[Bobmoore]

Had surgery two days ago at Pattaya Memorial Hospital. I can recommend the hospital no problem , but I wish I'd read this post first. Especially IX, that's exactly what happened, a drip that maybe wasn't needed and antibiotics pain killers and sleeping pills in my goodie bag. All itemised on the bill, which said the anaesthetist got 6k and the surgeon 18k out of a 120k bill. 

 

 

 

 

 

[Joeleg]

Thanks @brutox.  Medical tourism is big in Thailand. People talk about it. I know that their main selling points are prices, packaging into easy to read / understand categories and listing in details all the test and procedures to be done 

But I have always wondered the basis of their medical history and practice. They were never colonised. Examples are Malaysia and Singapore. The foundations were laid by the British including the exams. In Singapore, it done all in English and for their specialisation they head to the UK, OZ and US. 

Compare the qualifications of Glenegales Hospital in Singapore and Bumrungrad International Hospitals. The latter, all their qualifications I checked at random are local Thai universities. Their training education and training all in Thai. 

The second concern is refusal for long time expats to head home for second opinion and or treatment. Acknowledge that it will be question of cost. Aussie are lucky in this respect as it is much closer. 

 

Edited May 4 by Joeleg

[palmtree]

46 minutes ago, palmtree said:

Brutus, thanks for this.

one thing I wonder about is whether expats - particularly those who have recently moved there - could be extra susceptible to bugs that locals have developed immunity to.   Your friend’s case made me think of that - although the added risk there was probably more due to not knowing to not do push-ups in the grass.

What do you think?  And do you think physicians would think about this?

And sorry I butchered your name.   Don't know how my fingers decided to type Brutus instead of Brutox   😄

[palmtree]

27 minutes ago, Joeleg said:

Thanks @brutox.  Medical tourism is big in Thailand. People talk about it. I know that their main selling points are prices, packaging into easy to read / understand categories and listing in details all the test and procedures to be done 

But I have always wondered the basis of their medical history and practice. They were never colonised. Examples are Malaysia and Singapore. The foundations were laid by the British including the exams. In Singapore, it done all in English and for their specialisation they head to the UK, OZ and US. 

Compare the qualifications of Glenegales Hospital in Singapore and Bumrungrad International Hospitals. The latter, all their qualifications I checked at random are local Thai universities. Their training education and training all in Thai. 

The second concern is refusal for long time expats to head home for second opinion and or treatment. Acknowledge that it will be question of cost. Aussie are lucky in this respect as it is much closer. 

 

@Joeleg, you bring up a good point about traveling home. Not just cost, but also ability to.  If one is in a bad situation, making the trip itself may not be feasible - especially the 24 hours if you live in the US.

More reason to get accurate diagnoses early and to stay on top of things.   If you let things go too long, your options become really limited.

 

[Dave1986]

@brutox  Thanks for the write up!  Can tell a lot of time and effort went into it.   As a first year expat,  plenty of food for thought!

[Bobmoore]

I've never been there but while researching I heard from a few places that Bangkok Pattaya Hospital is pretty expensive, the rooms are like four star. Suites, so the family can stay. 

[brutox]

1 hour ago, Joeleg said:

Thanks @brutox.  Medical tourism is big in Thailand. People talk about it. I know that their main selling points are prices, packaging into easy to read / understand categories and listing in details all the test and procedures to be done 

But I have always wondered the basis of their medical history and practice. They were never colonised. Examples are Malaysia and Singapore. The foundations were laid by the British including the exams. In Singapore, it done all in English and for their specialisation they head to the UK, OZ and US. 

Compare the qualifications of Glenegales Hospital in Singapore and Bumrungrad International Hospitals. The latter, all their qualifications I checked at random are local Thai universities. Their training education and training all in Thai. 

The second concern is refusal for long time expats to head home for second opinion and or treatment. Acknowledge that it will be question of cost. Aussie are lucky in this respect as it is much closer. 

 

I think you might be over-thinking the colonized/non-colonized basis for Thai medical system .. countries all over the world are adopting best medical practices .. some faster than others.

And yes, I have found very few Thai doctors who did medical school overseas .. to practice medicine here, medical students must pass Thai medical board examination, which is given only in Thai .. I know of only two foreigners to pass the Thai medical board exam .. a Brit and a Swiss.

If you look deeper in Bumrungrad's "Find a Doctor" option, you can find Thai licensed physicians who did their residencies and fellowships at some of the world's best teaching hospitals and clinics .. those are the guys for whom you are looking .. Johns Hopkins, Cleveland Clinic, MD Anderson, Stanford, Harvard, Mayo Clinic,etc. .. they are there .. but unless you are willing to take your place in a queue, you have to do the work to dig them out.

And you will find these guys are overwhelming proficient in English and sometimes Japanese, Chinese, and Teo Chew.

[brutox]

2 hours ago, palmtree said:

Brutus, thanks for this.

one thing I wonder about is whether expats - particularly those who have recently moved there - could be extra susceptible to bugs that locals have developed immunity to.   Your friend’s case made me think of that - although the added risk there was probably more due to not knowing to not do push-ups in the grass.

What do you think?  And do you think physicians would think about this?

You are correct about a farang's immunology being vulnerable to an unfamiliar environment .. our immune systems are a product of the environments in which they develop .. but some bacteria and viruses are going to nail us, no matter how strong our immunities.

I did not look it up, but I suspect murine typhus is not a bacteria for which a natural immunity is common .. it beat my buddy up pretty good .. locals who are exposed to similar bacteria for which  they have built a natural resistance might have handled it better, I suppose.

But, yeah .. some guys can eat stuff that would make a pig puke and not get sick .. locally sensitized immune system.

Raised throughout Asia and having lived in 11 countries exposed me to lots and lots of bugs along the way .. but, I've gotten food poisoning only twice in 24 years here (both times in nice sit down restaurants - Mexican and Indian) .. I eat tons of street food, but I do avoid street carts serving any seafoods or steamed chicken after about mid-day.

My immune system also completely expunged HepB after 20 years .. I have a family history of an overly active autoimmune disease, so I think my immune system is really tuned for my lifestyle out here .. 555.

[brutox]

41 minutes ago, Bobmoore said:

I've never been there but while researching I heard from a few places that Bangkok Pattaya Hospital is pretty expensive, the rooms are like four star. Suites, so the family can stay. 

Yeah, well, so nice 'hardware', eh? .. but, that is what can make the quality of medical care delivered by the 'software' so deceptive .. it is all about the doctors Bobmoore.

Being treated in the lap of luxury for viral pneumonia when you are suffering from bacterial murine typhus (my buddy's situation) is just not quality medical care.

Edited May 4 by brutox

[Joeleg]

27 minutes ago, brutox said:

f you look deeper in Bumrungrad's "Find a Doctor" option, you can find Thai licensed physicians who did their residencies and fellowships at some of the world's best teaching hospitals and clinics .. those are the guys for whom you are looking .. Johns Hopkins, Cleveland Clinic, MD Anderson, Stanford, Harvard, Mayo Clinic,etc. .. they are there

To be fair, I did. Hence I chose as comparison Gleneagles in Singapore well known by the expat community. Singapore local doctors have their education in English, and for their speciality  are admitted to the various colleges such as Royal College of Physicians of Edinburg, Royal Australian and New Zealand College of Obstetricians and Gynaecologists etc. There are many such prestiges schools for specialists. 

These are not short term attachments to Mayo Clinics etc . You have to spend time sometimes up 6 years and sit for exams and this is after you qualify as a young doctor. None of the Bumrunguard doctors that I looked at had that. And I looked at many of their profiles. All of them had local Thai and some did short term attachments overseas but not sit for Specialist exams for admission to such 1st world colleges. One chap graduated from a medical school in Delhi. 

In Singapore, not just Glenageles, it’s the norm in public and private hospital as well. 

Here is a link to Singapore largest public hospital and I did a search for general surgeons and 5 came out. Look at their qualifications

https://www.sgh.com.sg/patient-care/find-a-doctor?SpID=17be2c92-14d9-462f-8393-2c16946d6c5a&InstID=8e9834e6-3ccb-4ee2-bdb9-45837e8602f8#abdomen

Out of 5, 1 got his basic medical degree - MBBS in London, another in Australia and a third in Ireland. All 5 were admitted to colleges for their speciality to the Royal College of Surgeons in Edinburg. 

Edited May 4 by Joeleg

[Bruce Mangosteen]

Related well to this thread as I got two hip replacements in Phyathai 2 by this doctor:  https://phyathai2international.com/doctor.php?pid=60&lang=en

Smashing success, back in the gym working legs after a bit more than a year.

Edited May 4 by Bruce Mangosteen

[manni2011]

12 hours ago, brutox said:

• I once checked on a radiology machine that a physician friend in the US assessed as only a few years behind the most advanced equipment in the US’s best hospitals and clinics .. for it’s use (radiating an encapsulated liposarcoma), he said perfectly sufficient; however,
• Far, far more important is the ‘software’ – the physicians, and how they utilize the hardware.

This immediately made me think of the radiological event in Samut Prakan in 2000.  Hopefully the people operating the hospital equipment aren’t products of the same educational system as the people who try to scrap the hospital equipment. 😄

[ZRHuser]

13 hours ago, Joeleg said:

Compare the qualifications of Glenegales Hospital in Singapore and Bumrungrad International Hospitals. The latter, all their qualifications I checked at random are local Thai universities. Their training education and training all in Thai.

If you look where the best Thai University stands in the International Ranking, that will give you your answer. This Hospitals targeting the International Markets are all nice to look at with nice looking nurses, short waiting times and so on. Big show but then the problems may start. Most of brutox examples have been from the best Hospital in this country. They still screwed up. That should tell you something. 

Thank you brutox for taking the time to analize this all and to point it out to us. 

[brutox]

11 hours ago, Joeleg said:

To be fair, I did. Hence I chose as comparison Gleneagles in Singapore well known by the expat community. Singapore local doctors have their education in English, and for their speciality  are admitted to the various colleges such as Royal College of Physicians of Edinburg, Royal Australian and New Zealand College of Obstetricians and Gynaecologists etc. There are many such prestiges schools for specialists. 

These are not short term attachments to Mayo Clinics etc . You have to spend time sometimes up 6 years and sit for exams and this is after you qualify as a young doctor. None of the Bumrunguard doctors that I looked at had that. And I looked at many of their profiles. All of them had local Thai and some did short term attachments overseas but not sit for Specialist exams for admission to such 1st world colleges. One chap graduated from a medical school in Delhi. 

In Singapore, not just Glenageles, it’s the norm in public and private hospital as well. 

Here is a link to Singapore largest public hospital and I did a search for general surgeons and 5 came out. Look at their qualifications

https://www.sgh.com.sg/patient-care/find-a-doctor?SpID=17be2c92-14d9-462f-8393-2c16946d6c5a&InstID=8e9834e6-3ccb-4ee2-bdb9-45837e8602f8#abdomen

Out of 5, 1 got his basic medical degree - MBBS in London, another in Australia and a third in Ireland. All 5 were admitted to colleges for their speciality to the Royal College of Surgeons in Edinburg. 

Clarifications to my original post ...

Hey, Joeleg .. I have no reason to doubt Singapore's Gleneagles Hospital (a developed-world medical system) has more internationally trained and credentialed physicians than Bumrungrad (a still developing-world medical system).

This thread is not about comparing Thai hospitals to Singaporean or any other country's hospitals .. it is not even about comparing a Thai hospital to other Thai hospitals .. it is about finding quality medical care in Thailand by comparing Thai physicians to other Thai physicians.

[To restate my physician friend's emphasis to me .. 'shop for a diagnostician, first and foremost .. not a hospital.']

Someone in Thailand with the resources to seek treatment in Singapore should go there .. this .. is not that thread.

As I qualified in the original post, I vet for US standards of practice.. I am unsure how the British-based medical training you cite differs from the US's .. I am sure the British-based system produces competent physicians.

For reference, the US system is:

• 4 years medical school; then,
• 1 year internship; then,
• 3-7 year residency in their chosen specialized field; then,
• after residency, physicians take the government-administered examination (each US state has their own examination) and become licensed to practice; then,
• also after residency, physicians can test for the highest US medical credential — American Medical Association's (AMA's) Board Certification in their area of specialized medicine; then,
• optional 1-3 years fellowships in advanced medicine.

My experience here is that the overwhelming majority of Thai physicians choose post-medical school and advanced medical training in the US over the British or EU systems .. for me, Thai doctors completing US residencies, fellowships, or AMA Board Certification are the go-to guys .. search again using those credentials.

Using the British-based medical system I think you refernced, you found none of the 1,200+ physicians practicing at Bumrungrad meeting their standards.. lots and lots of physicians to cover there, so I will assume by 'none', you don't literally mean 'none' .. 555 .. change your search criteria .. some very competent physicians are there, as well as at other Thai hospitals .. US credentialed in the full range of specializations all the way up to neurosurgery.

Hope that clarifies the basis for my original post above.

Edited May 5 by brutox

[brutox]

6 hours ago, ZRHuser said:

If you look where the best Thai University stands in the International Ranking, that will give you your answer. This Hospitals targeting the International Markets are all nice to look at with nice looking nurses, short waiting times and so on. Big show but then the problems may start. Most of brutox examples have been from the best Hospital in this country. They still screwed up. That should tell you something. 

Thank you brutox for taking the time to analize this all and to point it out to us. 

To emphasize .. this is not a hospital comparative .. I recommend blowing past the tricked-out hospital lobbies and pretty nurses and go more granular .. the .. physicians.

[Joeleg]

1 hour ago, brutox said:

Clarifications to my original post ...

Hey, Joeleg .. I have no reason to doubt Singapore's Gleneagles Hospital (a developed-world medical system) has more internationally trained and credentialed physicians than Bumrungrad (a still developing-world medical system).

This thread is not about comparing Thai hospitals to Singaporean or any other country's hospitals .. it is not even about comparing a Thai hospital to other Thai hospitals .. it is about finding quality medical care in Thailand by comparing Thai physicians to other Thai physicians.

[To restate my physician friend's emphasis to me .. 'shop for a diagnostician, first and foremost .. not a hospital.']

Someone in Thailand with the resources to seek treatment in Singapore should go there .. this .. is not that thread.

As I qualified in the original post, I vet for US standards of practice.. I am unsure how the British-based medical training you cite differs from the US's .. I am sure the British-based system produces competent physicians.

For reference, the US system is:

• 4 years medical school; then,
• 1 year internship; then,
• 3-7 year residency in their chosen specialized field; then,
• after residency, physicians take the government-administered examination (each US state has their own examination) and become licensed to practice; then,
• also after residency, physicians can test for the highest US medical credential — American Medical Association's (AMA's) Board Certification in their area of specialized medicine; then,
• optional 1-3 years fellowships in advanced medicine.

My experience here is that the overwhelming majority of Thai physicians choose post-medical school and advanced medical training in the US over the British or EU systems .. for me, Thai doctors completing US residencies, fellowships, or AMA Board Certification are the go-to guys .. search again using those credentials.

Using the British-based medical system I think you refernced, you found none of the 1,200+ physicians practicing at Bumrungrad meeting their standards.. lots and lots of physicians to cover there, so I will assume by 'none', you don't literally mean 'none' .. 555 .. change your search criteria .. some very competent physicians are there, as well as at other Thai hospitals .. US credentialed in the full range of specializations all the way up to neurosurgery.

Hope that clarifies the basis for my original post above.

This thread is about Thai medical practice and nothing in this World can amount to much unless there is a close peer comparison made. 

I acknowledge that Thais prefer US medical for post grad. Would be happy for anyone to show a sampling of US post grad that Bumrungrad doctors have done that follows the same regime as UK college system of admissions and examinations.

Out of respect to OP, I would not do any more comparisons. 

But appreciate the content made as it indeed informative and educational. 

 

 

 

Edited May 5 by Joeleg

[Billy Shears]

I was misdiagnosed and treated by 1 GP and 2 specialist here in Thailand about 10 or 15 years ago. Went back to the US and the American Dr diagnosed me correctly immediately. I no longer trust Thai doctors unless it's something minor.

The problem in what the OP suggest is how can a total lay person know which Thai doctor is the better diagnostician and which is not?  

My plan is that unless I need emergency treatment, to fly back to the US for anything major.  

[brutox]

1 hour ago, Billy Shears said:

I was misdiagnosed and treated by 1 GP and 2 specialist here in Thailand about 10 or 15 years ago. Went back to the US and the American Dr diagnosed me correctly immediately. I no longer trust Thai doctors unless it's something minor.

The problem in what the OP suggest is how can a total lay person know which Thai doctor is the better diagnostician and which is not?  

My plan is that unless I need emergency treatment, to fly back to the US for anything major.  

That, @Billy Shears is the dilemma for which the solution is found in your own deep due diligence and judgement, and by manipulating the odds in your favor.

Developed in his many years as a research cardiologist working with diagnosticians in one of the preeminent medical research facilities in the world (I'll ignore the NIH's ignominious role in the Covid-19 debacle), my friend's checklist characterizes physicians with traits that identify best prospects to be good diagnosticians .. but, no guarantees .. with none of them, the odds seem to me pretty long:

• The advanced, specialized training in western medicine is part of his checklist .. simple recognition and deep knowledge of the individual pieces of a medical condition;
• The other part is experience and judgement — intuition .. when it comes to making difficult diagnoses, not too few years, and not too many years (as I described in the original post).. for simple diagnoses, many years is an advantage; and,
• Another part about which my life in Asia informs me is the critical thinking process characteristic of western education and training.. as with most Asians, the preponderance of Thais are still products of a rote learning and training culture.. to that, add Thailand's strict social hierarchy that avoids making socially privileged Thais vulnerable to social discomfort, by discouraging questions, debate, and open discussions.. sure, rote learning trains people to deal with the more obvious individual variables of a data set that all fit together nicely .. no problem .. but throw at them an unexpected, disparate variable that doesn't fit the memorized pattern, and rote thinkers are challenged to integrate it into an innovative solution, as critical thinkers do —such as, say .. a complex set of medical data.

So, yeah .. finding these guys is hard work and a bit of a gamble, but the deck can be stacked in your favor .. I've found some great medical care here.

Edited May 5 by brutox

[Encora]

Brutox wrote about doctor's attitudes "trust me, I am the doctor, I know best, who are you to question me"

Yes, I have encountered that, it was a well known eye specialist in one of the better hospitals, who acted like that, when I consulted him (ten years ago) about cataract surgery. He was reluctant to take my questions seriously. He omitted telling me that the variable lenses he recommended would cause a light reduction of 80%, which resulted in me now needing a torch to read the menu in most restaurants. Same hospital different surgeon, did the cataract in one of my wife's eyes, outcome less then satisfactory. A second opinion, after the fact, by a surgeon in Rutnin eye hospital confirmed that , considering her complex history of eye surgery, he should have chosen a different type of lens.

Both these docs were male. I have noticed that as a whole, the attitude of doctor's arrogance is far more an issue with male doctors than female, and especially older male doctors. But, going back of my 23 years of experiences in Thai hospitals, my sense is that over time this is slowly changing. I have had numerous male doctors over the past 8 or so years that did not have that attitude, but, instead, went out of their way to ensure that I understood the issue we were dealing with and patiently and carefully replied to all my questions and concerns. Mind you, I may have become more selective in choosing my doctors over that time.
But bottom line, I will almost always choose a female doctor if I have the option. My eye doc in Rutnin is a woman aged around 40, trained in the US, excellent (American) English, taking great care to ensure I know and understand everything that is relevant to my issues. The Rutnin cataract specialist who investigated my wife problem happened to be her mother...

Just very recently, I was diagnosed with prostate cancer. I am 77, so no great surprise. I had an operation at Bumrungrad 7 years ago, using a laser, to widen the urethra going through my prostate, since I had Benign Prostate hyperplasia (BPH). The specialist who treated me (over an 18 months period, prior to this procedure, was an older man. When he described the procedure, which involved sticking a laser instrument up your urethra and using it to burn off tissue, I was a bit nervous. An added factor was that when we talked about infection, he seems to want to tell me that infection meant the same as inflammation, which I disputed.
So I decided to get a second opinion on this procedure, and went to consult a specialist at a Pattaya hospital. He listened to my story, probed my prostate (Delicately, this time), then asked "Who is that specialist who is suggesting the laser procedure?"
I mentioned his name, my consultant smiled and said "This is the doctor (I think professor) who introduced this relatively new procedure into Thailand and is responsible to training probably every specialist in Thailand in this procedure, you are in very safe hands".

And, although it was a rather scary experience, since the whole procedure was done with only local anesthetic, so I was fully awake all the time, It didn't hurt and I recovered quite rapidly. The one thing I remember was that after he finished, the old doc bent over close to me and said "Don't you agree we have some very sexy  nurses working here?", with a big smile on his face. (a remark that might have gotten him in trouble in some western hospitals) My reply "Doc, while you were doing your thing I was trying hard not to look at the nurses, to stop myself from causing complications for your operation!"
My concern would have been that a possible erection at the time of being lasered might be both disturbing the procedure as well as been rather embarrassing. But I'm sure they would have thought of that and taken precautions to prevent this from happening. (I do remember the issue of erections being a source of embarrassment in my massages early in my time in Thailand, before I learnt that this is all part and parcel of the experience).

Brings me to anal probes of my prostate. I believe that all urologists should as part of their training be made to do a session with an experienced sex worker, preferably one trained in prostate massage. I have had numerous sessions with ladies who inserted a finger in my arse and virtually each and every one used plenty of KY and were painless, while more then half the doctors (all male) who did a digital exam of my prostate were rough, fast and didn't use KY, causing considerable pain. One, my NZ general practitioner, was so rough and caused such unnecessary pain that I changed doctor, never went back to him.

Back to my recent diagnosis of prostate cancer:
I had an all over medical check up about four years ago, a package where for fixed price they test a wide range of things, blood, stool, urine, Ultrasound, Xray of chest, ECG etc, about 4 years ago. Early this year, I found the old report, realised it was four years old, so decided to do another one.

Only two things found, slightly high cholesterol (Doc's advice "Go back on Statins"). and elevated PSA (Doc's advice "Go do check up with urology"). everything else was fine!

Went to Urology, accepted the random Urologist on duty, who interviewed me, looked at my records, ordered another PSA test. He said the procedure on my prostate of 7 years ago had a usual result of losing its effect over about 6-8 years, so nothing unexpected. He ordered (I think, if I remember correctly ) an ultrasound. Then based on that and the PSA still high after two or three weeks of medication to bring it down, he suggested an MRI. The MRI indicated medium risk of cancer, but no signs of it spreading, so he ordered a biopsy. Biopsy confirmed cancer in the prostate, so he recommended a CT scan of lower abdomen to check further for metastasis. Plus a Bone scan, same reason.

Now in every step we took over the past six weeks, he was meticulous in explaining the details and meaning  of each result and how the values measured in the testing indicated the percentage chance of certain outcomes. These were based on longterm statistical records of similar tests in different people. On the whole, I found his approach appeared scientifically sound, his patience in explaining and willingness to answer my questions was commendable. So, to date, I haven't checked his background.
A couple of days ago, the result of the CT scan and the bone scan came out. He showed that all the previous tests including the CT scan supported the same conclusion, prostate cancer, but no other signs of cancer spreading. 
The bone scan hinted at three or four small indications that they're maybe a cancer elsewhere, One near my pelvis, and two in my vertebrae, one high up, one low down. But the last two were 'possible indications, contradicted by the other tests, and even the third was dubious. Also no signs of other problems in those location, no pain. His conclusion was that they probably represented false positives in the bone scan.

His advice was getting a second opinion, from an oncologist that specialised in radiation therapy. We saw him the next day, a man in his late '40s, with a very pleasant attitude and way of communicating. He went over the material presented to him, agreed that it was highly likely that the contradictory results of the bone scan was a false positive. But he also said he would run this stuff past a colleague for a third opinion.
That was a relief.
The urologist explained two options of dealing with the prostate cancer, radiation therapy or surgery. He went through the pros and cons of each and his opinion was that both of these options had about similar risks of adverse outcomes, and the choice was really mine. When I reminded him that I was a layperson in terms of medical knowledge and would like to know his own personal choice, what would he do if he were in my shoes. He thought about it, and replied he'd go through the operation rather than the radiation. he is a urologist and a surgeon.
Next day, I asked the radiation oncologist the same question, he thought about it and replied he's go for radiation therapy.....
Each to their own.
We haven't decided yet, no rush.
One small discrepancy:
The Urologist suggested radiation therapy would take place in the Rayong Cancer treatment centre, the nearest to Pattaya (and in fact, half an hour closer to my home than to BPH in Pattaya. But the estimate was it would take between 30 and 40 daily visits for radiation.
That alone made me reluctant to chose this option.
However, the oncologist recommended a different radiation method, done in Bangkok, where they have different (better? More modern?) equipment and more options. He suggested that I'd have some markers implanted in my prostate to guide the radiation and it would take only six sessions to kill the cancer. the newer method was more precise and less likely to cause secondary damage, making it less likely to damage the closing muscle to my urethra (damage could cause incontinence) and less risk of damage to my sphincter. He also mentioned using a gel to build a insulation layer between my probate and my rectum, protecting the latter from radiation damage.
That new option would make the Bangkok radiation option much more attractive. Added to that, the likelihood that the Bangkok option would have a much higher patient throughput, meaning its doctors would probably have more experience.

Altogether, although the whole process from PSA test to where we got now was a rather nerve-racking one and some of the tests downright unpleasant, my overall opinion was positive. It came across as professional, based on science and statistics and it inspired confidence in the final outcome. Nothing is certain yet, but it could have been a lot worse.

All this came during the same period as I was personally involved with TheJoker's last weeks and his cremation, which made it all a bit more doomladen. It is highly likely that this the end of my mongering career, bu at 77, I had "good innings", I had 25 years of enjoyable mongering, I was running rather low on libido anyway and I think I can leave it behind me without too many regrets.

I'd be interested to hear from others who have had prostate cancer and what their experiences were.

My last case history is about my ankle, not sure if I have already told it here.

In 1976 I had a motorbike accident, (farangland) broke both tib and fib on my left leg. Leg set by the ambulance staff on the spot, taken to hospital, Xray, Doctor ruled it was set well, and slapped plaster on. Some months later, plaster came off, leg OK.
20 years later, while traveling in Canada, I developed an acute pain in my ankle, getting rapidly worse, making it impossible to walk. Hospital, Xray, Docter said you have arthritis in your ankle. I said "Nonsense, I am too young for arthritis."

"Wrong", he said. "You had a leg break long time ago, set slightly out of line (out of kilter?), which caused pressure on your joint, the 20 years of pressure wore down your cartilage, very little left now."

He prescribed anti inflammatories and recommended I see a podiatrist to get orthotics, which may relive the stress on the ankle joint.
That worked, until 4 years ago. Then these two remedies were not enough and I started having great pain while walking.
So I went to an orthopedic surgeon in a Pattaya hospital. He did an Xray, identified  the ankle's complete loss of cartilage. He said "we can fix it, two bolts through the ankle bones, basically locking them together." That would remove some movement up and down of my foot, maybe cause a limp, but get me walking again. But he added that I'd better do it soon, waiting too long it might get too damaged to be fixed again.

The solution worried me, I went to a different hospital for a second opinion. Youngish doctor Samitivej Sri Racha. He gave me a similar story, two titanium bolts to permanently fuse the bones, but said he's use a different operation method (Open Vs closed). Two docs, two different views.  But he added "Or maybe, we could do better, replace the whole joint with an artificial joint (again Titanium) That way, no immobility, no limp".
"Would you do that here?"
"Oh, no, I wouldn't , I'd take you to my teacher in Bangkok, he specializes in it."
"What's his name ?"
"Dr Chamnani"
I am a longstanding patient at Bumrungrad, I looked up their website and he is a consultant there. So I called Bumrungrad and made an appointment. looked him up on internet, lots of positive feedback, no negatives.
Saw him, he said "X-rays are interesting, but not enough, need a CT scan".
I had the scan, went back to see him. "You have some complications, you have some cysts in the bone of you lower leg, if you want an ankle replacement , I need to look at this a bit more, consult with some of my colleagues and the people who trained my overseas, to see if I can do that in one go, or need two separate operations."
He was very thorough, both in his explanations as well as his research, he tried not to influence our decisions by giving pros and cons of the options and ended up saying that he could do the joint replacement in one operation, 70% chance only one, 30% chance he'd have to follow up with a second one. He got back to us two weeks later, consultations completed. 
We went ahead, 8 months into Covid, since we couldn't go out anyway, just as well spend a few months in a chair or wheelchair.
Everything went OK, walking a bit after two months, walking pretty good after 4 months, still fine 3 years after that. Very happy with the outcome. he predicts a lifespan of the joint of about ten years, so if I get old enough, I may need another one, or not....
So a success story. My insurance paid about ¾, I paid the rest, total cost about 700K.

In my country, even with insurance (which would have had annual premium three times higher than here, I would have had a waiting time, six months to two years. here, almost instantly operated.
In my country, a simple scan for a suspected prostate cancer can be six month wait, an operation maybe a couple of years.

I am thankful for living in Thailand and having the means to pay for limited insurance as well as the money to pay the non insured parts.

Sorry, I got even more longwinded then Brutox..

[Harry Brown]

@Encora

My friend here in OZ is going through prostate treatment. It sounds very much like what you describe. It is called "Cyberknife" the place what he calls gold seeds in the prostrate and he had six radiation sessions. Finished his last one on Thursday last week. He had no il effects and his doctor said that there was a 95% success rate with this treatment. My friend mentioned that with this treatment its does not affect erections  none of the other complications with any of the other treatments.

I am starting to have inflated prostate counts so if I need to I think I will go this route.

Hope this helps you.

[forcebwithu]

40 minutes ago, Encora said:

...
It is highly likely that this the end of my mongering career, bu at 77, I had "good innings", I had 25 years of enjoyable mongering, I was running rather low on libido anyway and I think I can leave it behind me without too many regrets.
...

Was there any mention of closely monitoring of the prostate cancer as an option? From your description it sounds like the cancer detected isn't an aggressive one, so my question to the Dr's would be, given an age of 77 would I have a better chance of dying with cancer rather than from it?

Edited May 5 by forcebwithu