Hospitals and health care in Thailand

[KansasCoder]

sawatee dee krup!

I'm curious about the state of medical care in Thailand. Is medical care free there? Is your medical system overwhelmed? I'm asking because my mother in law, 71 years old, is not able to get in to a hospital despite the doctor's being "90% sure it is advanced bone cancer."

A couple of things strike me as very odd. First is that despite xrays, an MRI and a spinal tap the doctors are unable to provide a 100% diagnosis. This was in a hospital in Nonthaburi that I think is public. There is no air conditioning and no private rooms. Is that public? Anyway, they said she would have to go to a university hospital to get a diagnosis. Unfortunately there is a waiting list or something. This poor woman was sent home with morphine to wait. She has been flat on her back for well over a month and is being cared for by my wife and I and her son.

It just strikes me as odd how the doctor can't provide a diagnosis after so many tests. Is that common there?

Is the waiting list so long that there is a constant state of triage going on in the hospitals? I would think someone in need of life saving measures would take precedence no matter what their age. I can't help but think that the hospitals have sent her home to die.

Can anyone help me understand the Thai medical system better?

Thank you

[khonrai]

HI

sounds just like American Medical system.
doctors no where are ever 100% sure of what they are treating.
two doctors given the same symptoms if not a normal illness will have two different opinions of what is wrong.
do you think if your mother was in USA she would be diagnosised and cured any faster.?

but it is common for the children or family to care for the patient once in the hospital.
specially in rural areas do you have the money to send mother to a private hospital.

as in business and Medicene is a business you usually get what you pay for.

talking to my Thai wife it seem the day to day care and doctor visits for minor problems is better in thailand "faster and more availalble" than USA. but major medical problems
it is better to go to private hospital

[Mike]

Private hospitals can give very good care, but of course they're not cheap.

Unfortunately due to being over-worked and under-resourced it's not uncommon under the subsidized government health care that doctors will do pretty little for patients with diseases requiring extensive tests and/or treatment like cancer. Having an MRI and xray is not going to be enough to get a 100% diagnosis for every disease though (doesn't suspected cancer almost always needs a biopsy too?), so I don't think there's anything out of the ordinary or specific to Thailand there. You could get her to private hospital to get the necessary tests for a definite diagnosis, and then get the treatment at a government hospital - Siraraj and Chula are the best government hospitals to go to, much better than you'd get in Nonthaburi.

[KansasCoder]

Thanks for the replies. Not having any government health care here in the states (outside of the VA maybe for military vets) I'm totally unfamiliar with that kind of care. I've always used private healthcare and this is my first experience with anything like this so I'm totally clueless. Both my wife and I are grasping at straws trying to care for her. We are trying to get her into a private hospital but there is a waiting list and its been over a month now. I have never heard of a waiting list here in the states which is why I'm wondering if something is wrong with system there. As you know we just passed major health care reform in the states so when i tell my conservative friends about my mother in laws situation they all say "That's what you get when you have free medical care'.. It kind of saddens me that they would draw these kinds of conclusions from such little knowledge about what really happens there.

Kohrai can you really say that doctors are never 100% sure of what they are treating? I mean maybe at some academic level they can differ over the charge of a proton, the origin or something but I don't see how 2 doctors could possibly disagree on a goiter or a tumor. In the states the doctors can almost always provide you with a diagnosis after 1 or 2 tests unless you have something really, really obscure. Of course sometimes a battery of tests are required to get to it so ... in that regard it's probably the same. Perhaps the 90% was as close as any responsible physician could come to a diagnosis without a biopsy?

Mike I think the biopsy is probably the missing element and this is probably why they want to send her to a private hospital. I'll pass on the information to my wife. Thank you for that.

My wife has been able to obtain chiropractic care for neck and back pain while she has been there for which we are very grateful for. Here the doctor wanted to send her for an MRI which is like 1500US and we weren't insured at the time so it was basically impossible to get any care for her. To make matters worse because the doctor wrote something about the possibility of arthritis on her medical record the insurance companies would not insure us until we got the MRI and saw a specialist.

[Mike]

It sounds like they're trying to send her to a government hospital if there's a waiting list, if it was private one you'd typically be able to register and get the tests done very fast (possibly same day, certainly within a week). You don't need to get referred to a private hospital by the government one, she could just go there herself and register (or someone on her behalf). You may have to wait again if you then want to get treatment at a government hospital, but with a definite diagnosis you might get priority.

Kohrai can you really say that doctors are never 100% sure of what they are treating? I mean maybe at some academic level they can differ over the charge of a proton, the origin or something but I don't see how 2 doctors could possibly disagree on a goiter or a tumor. In the states the doctors can almost always provide you with a diagnosis after 1 or 2 tests unless you have something really, really obscure. Of course sometimes a battery of tests are required to get to it so ... in that regard it's probably the same. Perhaps the 90% was as close as any responsible physician could come to a diagnosis without a biopsy?

Could well be. I think there are plenty of reasons doctors anywhere can disagree on a diagnosis for a patient with complex symptoms though, and I'm sure cancer can be much more difficult to diagnose than just 1 or 2 tests in some patients. Perhaps the tests need to get a definite diagnosis for her disease simply aren't available in that hospital ? I really don't think Thai doctors are different from any others in this regard.

[paul_au]

Well you don't need an MRI to diagnose bone cancer, as MRI's are used for soft tissue diagnosis but the doctors may have been looking for for other courses or another course to her problems or for another cancer, as bone cancer is quite often a secondary cancer that has spread from some where else. A bone tape is for the removal of a small amount of fluids from the hollows of bones, this bone marrow can be tested for cancer in a pathology tests, it seems the test must not be conclusive, A CT scan should in most cases detect bone cancer but in her case the evidence must not be conclusive. I presume since this hospital has the ability of doing an MRI, they also have a nuclear medicine department that can do a bone scan using there specialized equipment. Remember medical science is not an exact science, there is a lot that doctors don't know yet about the human body, I would think there are many cases of cancer diagnosis in western countries where the evidence of cancer is not conclusive at it's earlier stages.

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[Curt]

Most of Thailand's government hospitals would seem similar to a Stateside "urgent care" center, overcrowded, where walkins are handled on a first come, first served basis. And, although doctors are in attendance, much of the work is handled by PA's and students. And, each visit is usually handled by a different caregiver.

If a referral needs to be scheduled, it can take weeks or months.

In contrast, private facilities, like Bumrungrad, BNH, Sametivej, would be all over the case.