One Day in Bangkok

[zenman]

My wife, Karen had scheduled a Saturday appointment with a plastic surgeon at Bumrungrad Hospital in Bangkok to have a look at a cyst on her left index finger. I had already sent him digitals photos and he thought it was a mucous cyst and could be done under a local.

Sure enough, it was a mucous cyst and his assistant picked up the phone, called the Medical/Surgical clinic and we walked over and he took the cyst out. Total cost almost $300, broken down by facility fee ($3.53), nursing ($16.17), medical supplies, anesthesia supplies and medicine ($42) and a whopping $235 for the plastic surgeon. The doctor asked us to meet him two days later outside the OR doors for a sidewalk consultation to see how Karen's finger looked. He had an 8pm case scheduled and I would not be surprised if Bumrungrad scheduled elective cases around the clock. I wished I'd thought to ask.

After Karen's finger work, we went to the Cashiers Counter and presented our insurance card. The pharmacy is right behind the Cashier Desk so while you're waiting on insurance verification, the pharmacy is getting your medicine ready-really convenient.

I injured my back 18 months ago so thought I would see if the ortho clinic had any openings. They did if I could be so kind as to wait on two patients. No problem, and a few minutes later, I see the doctor about my back and also throw in an old thumb injury that hurts all the time.

I'm off to X-ray for back and thumb films and return to find I have a little osteoarthritis in my lower back as well as a bone spur and to top it off, traumatic osteoarthritis in my thumb. I get some exercises and medication. My fees for the ortho visit were $20.59 for the physician, $3.53 for the facility and $25 for the medicine.

Now, I remember that the dermatologist back home in Dhaka has not been very successful in clearing up a rash on my back so off to the derm clinic I go. I get right in and see the doctor. Fees here were $20.59 for the physician, $3.53 for the facility and $25 for the meds, which are working great by the way.

Lately, I've noticed changes in my vision so off to the eye clinic my wife and I go. We get in and the doctor compliments my wife's doctor on an excellent laser surgery done two and a half years ago. Me, I'm tired of glasses in order to read so I come away with mono contacts to see if I might tolerate surgery later. For the both of us, the fees were $47 for the doctor, $11.76 for the exam and only one facility fee of $3.53.

There are several things of interest here. One is that nursing generated a fee. Nurses by the way, wore white uniforms and caps and I hate to say it, really stood out and looked professional. Nursing assistants wore green uniforms and clerical staff wore another uniform. There was no trouble identifying who did what.

Second, all the clinics were packed out yet ran like a well-oiled machine. It was also Saturday. I think the clinics ran full bore every day of the week.

Third, I got into every clinic just by walking up to the front desk and signing in. If I had tried to get an appointment in the states it would probably take months before I got in.

Fourth, you can't beat the costs.

Overall, not a bad way to spend a few hours on a Saturday!

[ebear, BSN, RN]

Zenman!

WOW!!!!

[Elvish, BSN, DNP, RN, NP]

Very interesting, zenman. Especially interesting is that nursing generates a fee.

Wishing health to you both. :balloons:

Arwen

[czyja, MSN, RN]

Medical care in the developed Asian countries is quite fascinating. They have a two-tiered system: state operated clinics and hospitals providing a modicum of services at a regional level of quality for all who wish to use them, and private clinics/hospitals like Bumrungrad that provide fee for service care like we had in the 1950's here (but with 2007 technology and quality) to those that can afford it. Upper middle class asians use places like Bumrungrad in addition to Americans and Euros. Asians are bewildered by our "health care system." A friend from India explained - "when we get sick we go to our doctor and pay the bill - no big deal - I cannot tolerate this insurance business." I told that I cannot tolerate either most days.

And its not like the nurses and docs are working for free over there either. Many trained here and/or could easily work here do to favorable immigrations practices. Clearly they must enjoy a decent living in their country of origin otherwise there would be a great incentive to immigrate.

And of course they have clinics 7 days a week at Bumrungrad, probably 18 hours a day too. They have a an expensive building with a lot of expensive equipment (all of from the US/Europe/Japan, so you know it cost mega-baht) that they need a return on. So what did they do? They took a patient centered approach and set things up for quality and convenience. Go figure.

And yes, this extends to the uniforms. I'll bet even the doctors are required to dress like ladies and gentlemen, with dress clothes and pressed white coats - not a stained frayed pair of chinos a wrinkled scrub top, a two day beard and a pair of clogs badly in need of some tlc. They'd probably loose privileges if they dressed like most American doc. I know some would argue that dress is not important. I would suggest that it is, because it speaks to a culture of caring, mission, and organization. This is why the military places such an emphasis on dress. They don't send their uniforms for professional cleaning because it will help them shoot better as individual - they do so because it will help them win wars as a team.

I know they have a favorable labor (at least for the non-professional staff) and regulatory climate and this helps to keep costs low. But it doesn't take an MBA with a concentration in healthcare to figure out why these places are busy.

Might we not learn something from these institutions?

[zenman]

Asians are bewildered by our "health care system." A friend from India explained - "when we get sick we go to our doctor and pay the bill - no big deal - I cannot tolerate this insurance business." I told that I cannot tolerate either most days.

We have expat insurance and they have "connections" with Bumrungrad. Everywhere else though you just pull out the old VISA card and pay up. And most people here in Bangladesh have no ideal of the concept of insurance...of any kind.

[RN007]

Wow. Thanks for sharing. I was born in Japan to a Japanese war-bride mom and American GI dad, and spent my first 11 years going to a Japanese hospital, so your narrative really interests me. At work the other day (occupational health for a Japanese company in Tennessee), one of the American employees in Japan right now called his wife here to have his doc send antibiotics for a sinus infection he's gotten! Needless to say, the clinic there has a doc who most certainly will give him more than he would get here.

My question to you: Do you feel the medical care/knowledge in Bangkok or the rest of Asia is any less than what you would receive stateside?

Keep your stories coming!

[czyja, MSN, RN]

At work the other day (occupational health for a Japanese company in Tennessee), one of the American employees in Japan right now called his wife here to have his doc send antibiotics for a sinus infection he's gotten! Needless to say, the clinic there has a doc who most certainly will give him more than he would get here.

This is an interesting phenomenon, not limited to Americans, and I wonder if it has ever been studied. I know a woman from Ukraine that travels back to Kiev for dental care because she does not "trust" American dentists. Similarly, my Indian friend thinks the care in India is better than the care here. Of course Americans are brought up to think that we are the only place on earth that has quality medical care.

Medical care is so personal and intimate. Perhaps many people only feel comfortable getting care in their own country. Do Japanese expats in the US prefer to go home to Japan for non-emergent care?

I grew up as an American expat in Singapore. Our family was always treated by Singaporean doctors - some of them trained there, others in the UK or Ireland. All were excellent. I have read quite a bit about medicine in Thailand - they have worked very hard to develop a very high standard of care in order to attract international patients - primarily from Asia and the Middle East, but also from Europe and the US.

[zenman]

My question to you: Do you feel the medical care/knowledge in Bangkok or the rest of Asia is any less than what you would receive stateside?

Keep your stories coming!

I think it depends on where you are at. Out in the smaller cities you might find hospitals lacking in the latest equipment. For example, in Hawaii I oriented a Thai nurse and she was used to IV cutdowns (I haven't seen one of those since the 70's) and no experience with IV or tube feeding pumps. But I would not hesitate to have anything done in Bangkok. India is also becoming a spot for medical tourism, but I'd stay in the major cities.

Here in Dhaka, at Apollo Hospital (a major chain in Asia), you will find cardiac surgery and the latest in imaging equipment. But you might never see a Bangladeshi nurse as very few meet the criteria to even go to India for further training. So the hospital is staffed by Indian nurses. It's most likely a cultural thing but many of the expats I've been in contact with feel the Indian nurses are "mean," especially in comparison to Thai nurses. Might make a good study for a nurse in grad school! On an outpatient basis (never been an inpatient), I've never had any problems.