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

[Bruce Mangosteen]

21 minutes ago, forcebwithu said:

...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?

I had this same thought.  

https://www.cancer.org/cancer/types/prostate-cancer/about/key-statistics.html

"Prostate cancer can be a serious disease, but most men diagnosed with prostate cancer do not die from it. In fact, more than 3.3 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today."

[Encora]

1 hour ago, forcebwithu said:

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?

Thank you, an interesting question to put to my two doctors.
One thing I didn't mention is that the oncologist said that asa back up for the radiation, they would recommend some hormone injections, I think to reduce the testosterone. I think I was already low on that to start with, so that would probably kill off my libido altogether .

[Bruce Mangosteen]

1 hour ago, Encora said:

One thing I didn't mention is that the oncologist said that asa back up for the radiation, they would recommend some hormone injections, I think to reduce the testosterone. I think I was already low on that to start with, so that would probably kill off my libido altogether .

I wouldn't suggest being so cavalier about your T level.  It has many effects on quality of life for men other than libido, including (from link):

Hot flashes, which may get better or go away with time
Breast tenderness and growth of breast tissue (gynecomastia)
Osteoporosis (bone thinning), which can lead to broken bones
Anemia (low red blood cell counts)
Decreased mental sharpness
Loss of muscle mass
Weight gain
Fatigue
Increased cholesterol levels
Depression or mood swings

In other words, you become a depressed old lady.

As last resorts go, this sounds last-er than most to me. 

I suggest that you get another opinion that includes asking if the cancer is aggressive enough to do more than monitor , at least for the time being.

Disclaimer:  I'm no more a doctor than I am a lawyer.  

Edited May 5 by Bruce Mangosteen

[Encora]

4 hours ago, Bruce Mangosteen said:

I had this same thought.  

https://www.cancer.org/cancer/types/prostate-cancer/about/key-statistics.html

"Prostate cancer can be a serious disease, but most men diagnosed with prostate cancer do not die from it. In fact, more than 3.3 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today."

Thank you Bruce, useful reading.

[Bruce Mangosteen]

42 minutes ago, Encora said:

Thank you Bruce, useful reading.

Cheers, and good luck.

[freedom42]

23 hours ago, Encora said:

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..

My father was diagnosed with prostate cancer at age 68. He had this procedure that wiped the cancer out without requiring chemo of external radiation. He was still cancer free at 80 when he passed due to a vehicle collision. 
https://www.mayoclinic.org/tests-procedures/prostate-brachytherapy/about/pac-20384949

[Phoenix Dave]

@Encora, with no current prostate function symptoms (urinary or sexual), I highly recommend discussing with your docs the option of waiting/monitoring, as well as partial ablation via HIFU. And do some research on the side effects of the three options you discussed (Prostatectomy, radiation, hormone). Be as well informed as you can be when you make life altering decisions like this.

[hormone]

@brutox  Congrats on a great thread of importance for anyone who spends any length of time in Thailand, as an expat or frequent visitor, and who either suffers an accident or falls prey to an illness...
I think you dissected the topic very well and used a very rational approach. 
I am sorry but anyone who replies "I can totally recommend this hospital"  based on a personal experience if you are a lay person in the medical field, I think it is what we refer to scientifically as a n = 1 (number of observed cases = 1 so it is not useful to derive much scientific observation), or as a case report.  But I am thoroughly happy for you if all went well.

When we talk about quality medical practice, we indeed have to separate the run of the mill benign issues which without any care would 95-100% auto-resolve from the more serious things were intervention is warranted.   This includes all small twists, sprains, minuscule fractures which would not warrant a cast or surgery, most viral infections (most ... not all). 

I agree with the need to search for a good diagnostician.  From teaching at university level in Thailand, I can say that even at this level, most of their learning is based on memorizing and regurgitating.  Not so much on true thinking.  We could call this knee-jerk reflex...  Obviously the better and most curious students will evolve into better and more curious doctors.  Some (a minority) will then go do training outside of Thailand, some won't.   Rarely will they do a real residency (specialty) training outside of Thailand.  Most will do either 1- sometimes 2- rarely 3 years of post specialty training or some will do some "special certificate" such as using ultrasound machines for example...

The reasons few Thai doctors train outside of Thailand are multi-fold.   One of the main reasons is that Thai medical degrees are not recognized as equivalent by most western countries such as USA, UK, AU, Canada.  The medical councils of these countries will not allow the trainees to (pardon the pun) practice medicine for a full residency.  In general for example to do residency (specialty) in the US, you need to have passed medical school level examinations recognized in the US, such as USMLE.  Some states will accept Canadian medical school level examinations, not all. 
This explains why more Singapore doctors have completed residency training outside of SG, as their med school training is more widely recognized as equivalent  in "western world". 
Another reason is the limited proficiency in English that a lot of Thai doctors show.  Insufficient to be able to work clinically with patients...

You also hit the nail on the head on the "save/ lose face" issue.  If you or a loved one is sick, you need to keep on pushing and as Brutox wrote: he lost face, I don't care...  Usually competent and thorough physicians will not reject your questions.  They will be happy to explain, to weigh the pros and cons with you. 

 

[hormone]

On 05/05/2024 at 18:40, Bruce Mangosteen said:

I had this same thought.  

https://www.cancer.org/cancer/types/prostate-cancer/about/key-statistics.html

"Prostate cancer can be a serious disease, but most men diagnosed with prostate cancer do not die from it. In fact, more than 3.3 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today."

You are right and the main reason is that USUALLY prostate cancer is a slowly progressive disease which manifests in older men.  So basically if you are diagnosed with prostate cancer at 70 yo... it might take 10-15 years for the cancer to kill you.  You have lots of other "opportunities" to die from something else before (a heart attack, another cancer... ). 

The notable exception is prostate cancer diagnosed in younger men (for example in their 40's and 50's which is usually much more aggressive and will evolve quicker...

[hormone]

On 04/05/2024 at 14:49, brutox said:

V.  OVERVIEW – THAI MEDICAL CARE
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.

I love your image of hardware vs software.  I think it is appropriate. 
Indeed the Thai medical system is a lot about the user experience, the front end.  Nice smiling ladies kaaaa, rapidity of service, air conditioned comfortable waiting rooms, free small drinks and lots of nice cushy private rooms.  They also do a lot of little useless tests for routine benign conditions which falsely reassures you that "they checked and everything is fine" ...
When one comes from a universal access public health care system like NHS, Canada or Australia (to name a few), the rapidity of service/ low waiting times and politeness make you feel great from the start. 

[hormone]

On 04/05/2024 at 14:49, brutox said:

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 ..

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).

(...)

• “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

 

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.

Some thoughts on MISDIAGNOSIS:

It is indeed frequent... But we need to dissect into various categories...

#1 - the symptoms and signs are there and clear but no one asked or made the appropriate correlation
--> your example of your daughter's appendicitis is clearly one of these.  Menstrual cramps would never give fever, so from the start, there was a diagnostic reasoning mistake...
This is usually associated with anchoring bias, where the clinician will too rapidly think of a diagnosis (a teenager with painful periods... ) and hold on to that diagnosis to the point of neglecting other important possibilities. 

#2 - the symptoms are still too vague initially and could be easily confused with tens of other disease
--> vague non localized abdominal pain of short duration... It could be anything.  So if the thorough questionnaire and examination does not reveal anything else... a wait and see approach will be common.  We tend to associate this error with spectrum bias, meaning the disease is/ is not at a point of its evolution where is will not be easy to recognize and differentiate from other disease.  Another example would be fever and headache.  One might think meningitis immediately, but the overwhelming majority of cases are a simple cold or flu...

#3 - the disease is so rare ...or under-recognized... or rarely fatal... or the presentation lacks a usual key feature...  that it is reasonable to expect some confusion initially in the diagnosis
--> murine typhus is a good example of this (and I am not trying to defend the pulmonologists who saw your friend initially!)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7515178/

Probably the reason why ER/ ED is the #1 place for misdiagnosis is sadly since the Thai medical system is based on speed (come in to ER, be seen by a doctor in 5 minutes, get your diagnosis in as much), this anchoring bias is all to frequent.  We can also call it pattern recognition, which has its obvious downsides.  Other reasons are because it is often a first consultation, tens of questions have yet to be asked, ERs in Thailand are still staffed by junior doctors (residents or attendings... ) who can dispose of patients without discussing/ reviewing with senior ones. 

 

[brutox]

Good stuff hormone, good stuff .. your detailed knowledge appears as pretty deep stuff .. very helpful.

[hormone]

3 hours ago, brutox said:

Good stuff hormone, good stuff .. your detailed knowledge appears as pretty deep stuff .. very helpful.

I am an academic by nature and nurture...
This is an interesting thread you started and I hope it remains on track as a guide for members...

[hormone]

On 04/05/2024 at 14:49, brutox said:

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.

I could not agree with you more here also!
For local Thais, for farang... the Thai hospital medical visit usually results in a nice little bag with the hospital logo (free publicity!) full of at least 4-5 medications. 
For anyone who has run of the mill cold or flu symptoms, you get paracetamol (tylenol) + antibiotics as you said.  You usually also get an antihistamine for decongestion, some vitamins for... (for their taste??) and maybe some losenges for throat pain or something akin.  Obviously the majority of these meds apart from paracetamol are useless in cold + flu ... But the doc will throw in "in case you get pneumonia" to which everyone will heed and gulp down said pills...
For "gastro" symptoms, you usually get paracetamol, some antibiotic in case it is a bacteria, some antihistamine for vomiting and many times a 2nd antihistamine called "antispasmodic" for stomach cramps, plus you can add some loperamide (imodium) if you have diarrhea.  They will also stuff you with "reydration salts" for whatever reason...
Then you get side effects of all this and wonder why while some symptoms have improved (maybe on their own) while new ones appeared (dry mouth, blurry vision, sleepiness... )

As in the "West",  a lot of this kind of practice in Thailand is caught in a vicious circle of catering to patient expectations. It is a trap...  If you go see a doctor and they give you "something" you almost automatically feel they have "done something" for you -- which is not true.  If they gave you nothing and told you "it's just a cold, it will pass... take tylenol and hydrate lots..." you feel you have wasted your time + your money.  This has been slowly changing in "the West" for the past 10-15 years (less useless antibiotics), but this evidence based medicine vs "patient satisfaction" has not reached SEA yet.  Obviously if your medical knowledge is more limited, you will fall more prey to this patient satisfaction trap. 

And as @brutox points out so well, this over prescribing gives a nice opportunity for the private medicine sector to pad the bill very ... very cushingly!  For most benign ailments, all the meds you need can be bought at 7-11 or Max Value for a fraction of the cost the hospital will charge you...

INPATIENT care:  sometimes you really need to be admitted to an inpatient ward.  But...  Thai hospitals (actually most SEA hospitals, the same can be said of Cambodia, Vietnam, etc) have the strange habit of admitting people to hospital for things that you would never even come close to an admission in western countries.  Sometimes the patient could have the procedure done in a day surgery/ outpatient.  Sometimes no admission at all...  When the patient DOES need to be admitted, the duration of hospital stay in usually invariably longer in SEA/ Thailand as compared to Western world. 

One of the main reasons this continues here is related to medical insurance coverage in Thailand.  Most insurers will cover fully any investigation/ visit that leads to an admission within 30 days of the initial diagnostic testing... The insurers will also cover fully anything that is done during a hospital admission... but will not cover diagnostic test/ procedures/ treatments that are not related to a hospital admission!   So Thai medicine continues to admit all the patients so that the insurers cover the costs!  It is completely stupid, because the admission costs are invariably higher than if things were done via the outpatient route. 
A simple example would be an uncomplicated leg fracture that needs casting.  If you consult in the ER and you get the cast put on, you are sent home with crutches, it is possible/ likely (depending on your type of coverage) that you will NOT be covered for ER treatment and for follow ups!  But if you get admitted for 36 hours "just to make sure no complications arise... " and "to make sure you can use crutches" at 43 years old without previous mobility issues... Then insurance covers everything!  
 

[Encora]

Another anecdote about dicy diagnosis:

About 6 years ago, I had an unexpected strange experience.
I was showing a few faring friends around a market on the darkside, they were interested in markets and Thai ingredients. I had the benefit of having a S.O. who knows a lot about Thai food, and some of it rubbed off on me. she wasn't available that day, so I took these two women market shopping. Someway, in the middle of me explaining what yo use a certain vegetable for, and in which dish, suddenly I found that the words I was trying to say didn't actually come out of my mouth anymore. I knew what I was trying to say, but was unable to say it. First reaction, puzzled, but trying to hide it. They must have been a bit confused, but I tried with hand signals to explain that we needed to go eat something. I think my suspicion was that I forgot to eat breakfast, my stomach was telling me I needed food, so maybe my problem was hypo (Hyper?) glycemia needs to food to start up my brain again. 
Whatever, I managed to get my guests back into the truck and I drove us into Pattaya to Central, parked, took them down to the ground floor food market. Still not able to talk, I showed them where to buy lunch, went and bought my own and quickly shot into M&S to buy some sweet biscuits (Quick sugar).  Ten minutes into the meal, my speech came back. I explained what I thought happened, told them I was fine and we eventually made it back home. never mentioned it to my S.O., bit sheepish,
Next day, she came with me back into Pattaya, when I stood in front of an ATM, trying to get some cash out, realised all of a sudden I'd forgotten how to do that. Sttod there, just mystified how to work that machine in front of me, after maybe 20 years of using ATMs.
Walked with her arousn th supermarket, she paid, then back in the car, I explained my ATM problem and also my previous day's speech problem. then I drove us home. Arriving home, I felt sleepy, so I went to my room, and had a nap. My S.O. (a very smart cooky, went online and googled my symptoms. came back to me when I woke up and showed  me her findings, which suggested I probably had a T.I.A.  ( transient ischemic attack)
 

[Encora]

New chapter because I couldn't fix my formatting.
The google article said that if a TIA ("mini stroke") was suspected, it was important to get medical attention ASAP, to see if there was reason to fear a more serious stroke.
So we got back into the truck and I drove us (S.O. doesn't drive) another 20 km back into town to go to a highly reputed hospital. In retrospect, driving when suspected of a ministroke may not have been wise, but I wasn't thinking...
A&E, on mentioning my symptoms I had quick action, doc sent me for a scan and a few other tests, no immediate clear explanation, so they decided to keep me overnight. Next day multiple other tests.

I was feeling fine, but while being in a private room, with my S.O. and a friend, I suddenly had some problems eating, not able to decide how to use my knife and fork.

Went back to bed, watched some TV in four languages, no problem understanding all of them. Then a psychologist arrived, to do a psych test. My speech froze again, I failed the test 2/10. During the test, I was given a simple mathematical task to fulfill. I understood the question, formulated the correct response in my head, but was unable to say it.


At that stage, since I had been perfectly OK until lunch, then suddenly not OK, someone should have picked up at the time of that psych test that something was happening and maybe wheels me back to the scan to see if they could monitor what was going on.

But by the end of that day, nothing had changed. ten minutes after the psych guy left, my speech was back and the entire afternoon I was absolutely fine, having interesting talks with my friends. Around 6.00 PM, I got bored with no action and discharged myself, went home and had a nice dinner out with my friends, all OK.
I had a follow up appointment a week later with a neurologist. 

Before I went in to see him, I was given a similar test as the week before and passed almost 10/10. The mathematical question from the week before, I remembered and gave them the answer almost before they finished the question.

Went in to see the neurologist, who told me I had a TIA (which we already worked out), none of the many tests they did (CT scan, Ultrasound of my carotid artery, Xray, EKG, blood and urine analysis and a few more) gave any unusual results.

Then he said "But my conclusion is that you suffer from premature dementia!"

THUNK!

I was I think 69 at the time.  
I asked him to explain how, when all test showed absolutely nothing abnormal, he could explain his conclusion, what path did he follow to get here.
He mumbled about the absence of any physical abnormality in my tests combined with my presented symptoms was pointing him to only one likely conclusion.
I replied "I don't accept your explanation, I want a second opinion"

He looked at me like I slapped his face.

In the end he did what I asked, but suggested it would be best if I would have that consultation (With a neurological specialist in dementia at a major Bangkok Hospital) a month from that day, to allow for any changes to be monitored and recorded. I foolishly agreed.

Went home, convinced he was wrong, but feeling seriously spooked. Visions of me sitting in a chair, drooling, unable to talk or communicate or think, slowly becoming more vegetable, were haunting me. I started researching various methods of self euthanasia, decided which one I'd use. I'd prefer to leave before getting trapped in a dead brain/live body stage.

Then I remembered a farang friend who lived in Chiang Mai, who was retired prof in clinical psychology from my country. I called him and invited him for a visit to us, all expenses paid for him and his family. He was happy to help and they flew down here.
We spent an hour talking, his conclusion was that he could see nothing wrong with me but from my account of the hospital events and conclusion, he could see no grounds for their conclusion/diagnosis.
The week after that, I went to see the dementia specialist in BKK. She took her time, reading the files passed of by the Pattaya neurologist, then interviewing me and making me do a few simple tests.

In the end, she almost threw her hands up and said "I have no idea why that Pattaya doc is suggesting premature dementia, there is nothing I can see that points at that, you are perfectly "normal"!
My reply, "Please tell him that, and his departmental head"

I had to date no repeats of these symptoms. 
And not demented yet, ( I think, but who am I to judge....)

[hormone]

8 hours ago, Encora said:

New chapter because I couldn't fix my formatting.
The google article said that if a TIA ("mini stroke") was suspected, it was important to get medical attention ASAP, to see if there was reason to fear a more serious stroke.
 

Hmmm with all your obvious formatting /editing issues, maybe ... just maybe you are starting dementia??  (obvious joke!)

[hormone]

@Encora wow indeed this is a typical story of the thai doctors  where one starts off ok, then when it gets more complicated they simply do not know and instead of saying: hey I am not sure maybe it's A or B or C.. they have to anchor to a diagnosis and many times the wrong one. 

Dementia is a slow progressive disease, multiple causes, some of the causes are repeated small strokes which often go un-noticed actually.   You don't suddenly forget how to speak or how to use something...  But yes you could forget your glasses in the refrigerator, become progressivley incapable of adding numbers... over months and years.

Your neuro symptoms were very precise to one kind of function.  It clearly points to one part of the brain being affected. 

I am happy that you did not have any reccurrence.
Since diabetes and high blood pressure and cholesterol and smoking are  major risk factors for cerbro-vascular disease, I hope these have all been looked into and addressed if need be. 

Cheers!

[Encora]

1 hour ago, hormone said:

Since diabetes and high blood pressure and cholesterol and smoking are  major risk factors for cerbro-vascular disease, I hope these have all been looked into and addressed if need be. 

Cheers!

Sugar checked and OK, BP meds are working fine, smoking stopped over 40 years ago...

[Harry Brown]

@kingofsurf that topic is not for this board, 

[hormone]

On 04/05/2024 at 14:49, brutox said:

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)

Here is where I would be a little more cautious although basically I agree with @brutox on pretty much everything-- especially the GOD syndrome! 
-----
By the way: what is the difference between God and a cardiac surgeon? 
...

God knows HE is not a cardiac surgeon...

-----

OK back to serious: I am 100% in favor of wider public education on body functions and health issues.  But when one searches for "what's wrong with me?"...  this is where Dr Google can be detrimental if not used properly.  Here's why.

Herein lies the major difficulty for (allow me to say it like that) lay people or people with insufficient medical knowledge:
All the references shown here (and they are quite good for lay people!) go from the medical diagnosis --> explain the symptoms/ signs/ testing and treatment ...
It is the same problem with most (not all) medical textbooks.  You read on stroke for example and you learn what causes it, how it manifests, what the clinician will find on examining the patient, the tests to diagnose a stroke and the treatments. 

To the opposite: In clinical medicine, the doctor will be facing a bunch or more or less coherently explained symptoms related by patient or family and then must make sense of all this and come to a working diagnosis, refine it and prove it (or disprove the serious ones, at the least). 

So if you are searching for what is your diagnosis, search engine queries can be frustrating, panicking or worse just plain wrong out in left field.  Obviously with advances in AI things will improve!  But you need to be as complete as possible.  For example, Brutox' daughter's case (appendicitis) could very well also sound like menstrual cramps if only a few symptoms are put in, until you enter fever and maybe for example that she is 2 weeks from her previous period...
Another eloquent example would be: muscle pains, chills, sore throat, runny nose, mild headache and fever.  To most of us this sounds (and in the appropriate context would likely be) a flu-like illness... covid... Until you put in that you went to Central Africa and returned a week ago... and then we have malaria as no 1 diagnosis!  

I do totally agree though is that if you are given a diagnosis by a physician, by all means do research it on APPROPRIATE medical sites.  And there you can find a good description of symptoms and diagnostic findings as well as recognized / recommended treatments. 
 

[brutox]

44 minutes ago, hormone said:

... by all means do research it on APPROPRIATE medical sites ... 

Living much of my life relying upon questionable health care systems, the arrival of the Internet was a godsend .. I cite just above a few of my go-to sources to help me be sufficiently informed about my and m y family's healthcare .. enough to sense when something doesn't smell just right and an intervention is warranted.

I've Googled into world class specialist hospitals MD Anderson, Memorial Sloan Kettering, Mass General, Johns Hopkins, Mt. Sinai, others when doing a deep dive on specific medical issues .. but, are there other/better/different websites you might add to that list that we laymen will find useful sources for readable medical knowledge?

Of the above, I am least impressed by WebMD (although I find their pharmaceutical references pretty helpful).. way jazzed by Cleveland Clinic.

[hormone]

2 hours ago, brutox said:

I've Googled into world class specialist hospitals MD Anderson, Memorial Sloan Kettering, Mass General, Johns Hopkins, Mt. Sinai, others when doing a deep dive on specific medical issues .. but, are there other/better/different websites you might add to that list that we laymen will find useful sources for readable medical knowledge?

#1 - I was in no way inferring that the websites you cited as reliable sources of info are NOT good! 
 

#2 - I am not exactly the best person to say "this site is easy to read for the non initiated" ...  BUT let me share a super interesting article/ website from the National Institutes of Health's (NIH) National Institute on Aging which explains I think pretty thoroughly how to make sure you get the best info possible on line:

https://www.nia.nih.gov/health/healthy-aging/how-find-reliable-health-information-online

It is a quick and easy read and I would recommend to everyone...

#3 - Personnaly I would list as top sites, which will always be up-to-date and reliable :
- NIH https://www.nih.gov/

- Center for Diseases Control and Prevention (CDC) https://www.cdc.gov/.
** Of note, some other countries have similar sites of equivalent quality, but I don't want to start listing them all. 

- Scientific/ medical organizations' sites are usually of equivalent quality, though the information is not always as easy to find or access.  Examples would be
American Cancer Society        https://www.cancer.org/
American Heart Association.   https://www.heart.org/en/

- I would also include some physician specialty associations which might at times post publicly some position papers or consensus statements about disease XYZ or situation ABC.  It is deeper diving into topics, but it can be a good guide for futher information gathering/ reading... Two examples would be
a) the American College of Emergency Physicians (ACEP) :  has publicly available clinical policies for various situations, which could be more useful in undifferentiated situations. 
https://www.acep.org/patient-care/clinical-policies

b) the Infectious Diseases Society of America (IDSA) which also has a lot of practice guidelines that anyone can read. 
https://www.idsociety.org/practice-guideline/alphabetical-guidelines/

#4- Finally if you are really into it and want to learn more about diseases XYZ for knowledge (or looking oblivious to the scene, while sipping your drink on Soi 6...) there are some condensed textbooks available online.  While they may not always have the utmost latest studies included, the basic description of diseases is always correct and reliable.
- Merck Manual : https://www.merckmanuals.com/home

[Encora]

10 hours ago, Harry Brown said:

@kingofsurf that topic is not for this board, 

Harry, I had a PM discussion with him about this, I personally don't have any inhibitions about talking about this, we all have to die one day. I believe in freedom of choice. having seen a few peopel close to me die in unpleasant circumstances that would  have been much better if voluntary euthanasia was available, I am firm believer in freedom of choice.
 
I don't want to challenge you, I strongly trust your judgement as a Mod, but are you able to enlighten me why this subject is taboo? If not here, then in PM?
If it is a legal (Thai) issue, no problem, I understand.

I am only raising it because I do think there maybe quite a few BM here who would be interested in a serious discussion about this. If that is contravening rules, could we initiate a group PM discussion about it?

[palmtree]

6 hours ago, Encora said:

Harry, I had a PM discussion with him about this, I personally don't have any inhibitions about talking about this, we all have to die one day. I believe in freedom of choice. having seen a few peopel close to me die in unpleasant circumstances that would  have been much better if voluntary euthanasia was available, I am firm believer in freedom of choice.
 
I don't want to challenge you, I strongly trust your judgement as a Mod, but are you able to enlighten me why this subject is taboo? If not here, then in PM?
If it is a legal (Thai) issue, no problem, I understand.

I am only raising it because I do think there maybe quite a few BM here who would be interested in a serious discussion about this. If that is contravening rules, could we initiate a group PM discussion about it?

Without knowing what the discussion was about, but inferring from what you’ve written here, perhaps it is worth a separate thread?