A Tale of Two Surgeons
Thailand is the reigning king of the lucrative “medical tourism” industry
Becoming an old geezer who sits around with other old geezers exchanging ailment complaints and hospital stories is one of my greatest fears. But, if you live long enough to start breaking down a little, I guess it just comes with the territory. When the maintenance begins, my adopted home in Thailand is a great place to be. With a plethora of highly acclaimed mega-medical facilities chockfull of superstar surgeons, Thailand is the reigning king of the lucrative “medical tourism” industry. From pearly white dental implants to “gender reassignment” your procedure of choice is “tuk lai dee”. That’s Thai for “good and cheap”.
Other than a quickie physical to get a work permit, my first encounter with the Thai healthcare system was a few years ago and involved a rather complicated combination of oral surgery and a pretty serious 3 step root canal. I was referred by a friend to Dr. Chutima, an endodontics expert in Bangkok. After initial examinations, Dr. Chutima called me into her office for consultation. Having never undergone any type of surgery, and being intolerant of searing dental pain, I was mortified. Dr. Chutima carefully explained the procedure to me in flawless reassuring English. My fears began to subside. Perhaps it was the walls of her office full of certificates and awards from her peers at UCLA Medical School where she was a Professor of Endodontics.
The oral surgeon Dr. Chutima recommended was a magician. And, her deft hand performing the complicated root canal saved me 2 teeth, about $3,000 and a world of pain. To say I was impressed by my first encounter with the Thai medical system would be a significant understatement. I felt like the care I received was equal or better than in the US, and certainly less expensive.
Last week I pulled out my to do list and focused on the ominous “Thing To Do #4” “GET A COMPRIHENSIVE PHYSICAL CHECK UP”. I considered continuing my 2 year procrastination on this one, but in recent weeks I had been feeling not quite right some how. In general medical terms I was experiencing a malaise, or “general feeling of unwellness”. In a flurry of uncharacteristic motivation, I drove to my local international hospital and made an appointment.
Since I live in Ban Amphur, on Thailand’s eastern seaboard, the closest mega-medical complex is in Pattaya City, about a 20 minute drive. The Bangkok Hospital Pattaya (BHP) towers shiny and new on the main road into town from Bangkok. Upon entering, the reception concourse looks more like a busy five-star hotel than a place with bedpans. Even though it was bristling with medical tourists, and full blown Starbucks, it still maintained a serene atmosphere. Smart design, Asian-modern décor and white noise pumped through the speakers dampening the din gave the place a very Zen feel.
When I arrived at the registration counter, I was promptly drained of all my pertinent information including a copy of my passport, insurance card and one form to fill out. While the system digested me, I entertained myself by watching three burka-clad Muslim women yammer on in Arabic while scouring a brochure touting the modern marvel of liposuction. A counter in the main registration lobby had been set up with all the major elective plastic surgeries detailed in brochures written in Arabic. Two Arabic speaking Thais answered questions and made appointments. They actually had a sign proclaiming “Lipo-Promotion”.
Within 10 minutes I had an ID card with my picture and barcode and a menu of services available from “The Wellness Center”. The Wellness Center packages groups of diagnostic procedures together and offers them in varying degrees of comprehensiveness and price. Men have 4 options and women have 3. I chose the “VIP Package” for 26,900 THB ($868 USD). From the description on the menu, it was quite thorough, targeted my age group and included the abdominal CT scan and ultrasound I wanted. I got an appointment for the next day and my fasting instructions. On the way out, I made a Dentist appointment for cleaning and a check up. I was on a health maintenance roll!
The next day I was escorted to the Wellness Center, weighed, measured and vital signed. Again I had the feeling of being in a lobby of some chic new hotel. Diagnostic rooms surround “the lobby” and smartly dressed English speaking Physician Assistants quietly transport patients through the various procedures. I didn’t feel hurried nor was I kept waiting. Several times I remember marveling at the efficiency and thoroughness. My only previous experience with medical care was in the US. As you might imagine, humane efficiency in a hospital was a new experience.
What started promptly at 0830 ended about 1430 with a free lunch at one of the deli shops on the mezzanine level. Afterwards, I returned to the Wellness Center for a counseling session with a doctor to interpret my results.
I was given a bound 40 page report detailing the results and physicians’ comments on each and every diagnostic procedure I had endured. Included was a CD with the entire report, X-Rays, CT scans and any other pictures they took. My consulting doctor looked like a Chinese Jerry Lewis character. He wore ridiculously thick eyeglasses and his trousers pulled up comically high above his waist. His demeanor was equally silly.
“I’ve got good news and I’ve got bad news”, he pronounced. Normally, I like my physicians humorless and to the point, but I figured it was his way of breaking the ice. Before I could play along, he said “The good news is you have eyes like a hawk, the heart of a 20 year old and the bones of a 30 year old. Your whole system is running better than it should for your age.”
When I was sure he was finished with the good news, I sheepishly queried, “And the bad news?” Very matter-of-factly he replied, “You have a cyst the size of a cantaloupe near your left kidney”. The jocularity left the room as fast as the blood from my face. Dr. Jerry went from comedian to Angel of Death, staring at me unblinkingly through jelly-jar glasses. Next he fielded an avalanche of nervous and nearly hysterical questions from me with short and evasive answers. In the end, he looked at his watch, pointed at my belly and concluded our counseling session with “Maybe take out … maybe not. You see surgeon tomorrow.”
I was escorted to the cashier, handed a follow-up appointment slip and given more fasting instructions. The drive home seemed endless as visions of scalpels and catheters danced in my head.
One sleepless night later I was back at BHP to meet with a surgeon for counsel on my condition. Upon entering the examination room, the surgeon, sour-faced and serious, asked me to lie down on the table. He spoke English like a guy who hates to speak English. He tapped me with two fingers in two places on my belly, and once on each ankle and with a dramatic flourish of a hand gesture instructed me to get up. I didn’t feel examined, I felt like I was the volunteer assistant in some kind of magic trick.
He shuffled the printed pages of my physical report and squinted at the pictures of the ultrasound on his computer screen. “Big cyst” he announced. “Take out”. I switched the language to Thai so we could use more than one syllable words. I asked him to describe the procedure he had in mind. Instead of talking, he poked his finger into my chest just below my sternum and made a line south about 10 inches. Then he shaped his hand into a hook and made a scooping motion and repeated “take out”. When he signaled for the PA who had been hovering mute in the corner of the room, I knew the counseling session was over.
Numbly I followed the PA to the next stop in the carousel, Administration. The language switched back to English with the young lady who would be getting me a price quote and coordinating with my insurance company. She must have seen the shellshock on my face and let me take some time to gather myself. She told me the operation would include at least 5 nights stay, one in ICU. The total estimated cost of the procedure and stay was 550,000 THB ($17,742 USD). For some reason she couldn’t contain a prideful smile when she said it. My insurance company would be contacted to pre-certify payment for the procedure. I was to wait for their call to schedule the operation.
next stop in the carousel, Administration
That evening I felt an overwhelming desire to commiserate with some one else who had been suffering a similar fate. I remembered that my friend Joe Beaver, a fifteen year expatriate from Northern California, had recently undergone a simple hernia operation at BHP. I called and asked how he was feeling. What I heard next was a 30 minute tirade about his treatment. He had been admitted for a simple procedure and told he would be in one day and out the next. Complications arose after the initial operation and Joe ended up spending 5 days in the hospital and the hernia operated on 3 different times. He was still virtually bedridden at home a full 12 days after walking in the door of BHP. What stunned me most was that I hadn’t even mentioned my condition. He had volunteered the information and was obviously in the middle of learning a serious and painful lesson.
The next day, I ran into another friend of mine, a sixty-something healthy-as-a-horse Englishman named Michael. When I told him about my predicament he also gave me an earful about his recent experience with a different international hospital. He had gotten into a heated argument with his surgeon about the severity of his condition and the necessity of a particular operation. In the end, Michael was right and the doctor was wrong. Had Michael not stood his ground, daily life would be significantly different right now. “Don’t be intimidated by a guy with letters after his name” he confided. “In the end, he’s just a bloke like me and you … only with 5 more years of school. Nobody’s perfect. Remember mate … you’re the boss.” I thought about that statement for the rest of the day. That evening I took action.
I soon discovered the concept of “second opinion” … the patient’s best friend. I dug into my fat folder of insurance information. All I could tell you about my health insurance coverage before this incident was how much it cost. After an hour of diligent reading, I discovered that not only was a second opinion covered, but with an operation of this magnitude, it was required. I picked up the phone and called the toll-free number for the Holy Grail of mega-medical facilities, Bumrungrad International Hospital in Bangkok.
Bumrungrad is synonymous with high profile, high volume, and high degree of difficulty medical procedures. Medi-vac patients from all over Asia are flown there to see one-of-a-kind specialists performing miracles on a daily basis. When SARS broke out in Vietnam several years ago, the first patients were flown to Bumrungrad to identify and isolate the disease. Last year, nearly 400,000 foreigners alone visited Bumrungrad for one procedure or another. I had heard it was expensive. I had heard it was an impersonal production line. But, I had never heard anyone complain about the quality of care they received.
I spoke with a woman who kept me on the phone for 20 minutes and questioned me more thoroughly than an FBI agent. She also made me fax two documents and e-mail the files of scans and x-rays from my original exam at BHP. In two hours she had scheduled me to see a Urologist since the problem was located near my kidney. Again I got fasting instructions.
Bumrungrad International Hospital sits right in the middle of the concrete beehive that is the Bangkok Central Business District. The main reception area resembled a combination of 5-star hotel and the busiest airport I’ve ever seen. Registration agents greet and direct visitors to clinics, wellness centers, restaurants and an on-site hotel. Long escalators carry patients and visitors from every corner of the globe up to the mezzanine level where they can continue to various clinics including surgical, orthopedic and an entire wing devoted to women’s wellness. Or, they can dine at a number of fast food outlets, cafes and several international restaurants.
Since the hospital sent me an SMS message that fasting wasn’t necessary for this appointment, I plopped down at the only vacant table at the in-house Starbucks and plowed through a low fat triple-berry muffin and a latte. I was soon joined by a friendly old fella wearing a Dallas Cowboys T-shirt and a US Marine Corps baseball cap. I hoped I didn’t look as American as he did, but somehow he sniffed me out. Naturally, he wanted to know what I was in for with all the gory details. I evaded his questions and it wasn’t hard to turn the attention on him. “Oh, I’m in for a couple of ball joints and some new head lights”, he lamented. After several minutes of gruesome detail, I learned that Mort, a retired US Marine Officer from Brownsville, Texas, had already received arthroscopic surgery to remove some “junk” from his shoulder and had corneal implants to correct his failing vision. He was enjoying a coffee after his last meal and before his hip replacement the next afternoon. “Two ball joints and new head lights!” he kept saying over and over. Mercifully, it was time to meet my second opinion savior.
The surgical center was arranged like a smaller airport, with 12 nurse stations that look like departure gates, hustling 20 to 30 patients at a time to see various specialists appearing and disappearing behind sliding doors. Bumrungrad is much older than Bangkok Hospital Pattaya and doesn’t have the slick veneer of a new facility, but it sure makes up for it in volume and variety. I saw Russians, Americans, Europeans of every ilk, and Arabs of every flavor. The process was a controlled chaos, but in short order I entered a counseling room with a urologist, Dr. Apichat. I already knew about Dr. Apichat from the Bumrungrad website. He is a urologist and a surgeon, trained in Japan, and speaks Thai, English and Japanese. He is a Diplomate American Board of Urology. He is also a Professor at Chulalongkorn University in Bangkok, easily the most prestigious school in Thailand and possibility all of Southeast Asia. When Dr. Apichat appeared from the elevator, all the doctors and nurses clasped their hands in a Thai “wai” as he approached and politely greeted him as “Ajarn”, a highly respectful Thai word meaning “teacher”.
Dr. Apichat is a distinguished looking 60-something Thai gentleman that certainly has the demeanor of Professor. He greeted me with a warm smile and perfect English. He studied the CT Scans on his computer screen for a moment, stared at my face for a second and asked me, “How do you feel?” I described the half dozen or so nagging symptoms that added up to my general malaise. He listened attentively and asked “what did they want to do in Pattaya?” I told him the first surgeon I saw wanted to cut me open like a watermelon. His expression was flawless poker face. He responded with, “Well, certainly this would take care of your problem, but I recommend we try something less invasive. This thing isn’t life threatening, but it is more than likely the source of most of your complaints.”
I liked this guy already. He explained to me a procedure that didn’t involve major surgery, only one or two days in the hospital and at less than a third of the cost. And, most importantly, no long drawn out recovery time. Dr. Apichat then pulled out his cell phone and called his associate that could perform the recommended procedure. He made an appointment to see his old friend and former student to discuss my case. I could come back tomorrow and know the results of that corroboration, then hopefully schedule whatever I needed done right then. I felt light as a feather, smiling for the first time in a week. As I gathered up my paperwork and various belongings, I told him, “Dr. Apichat, I can tell you are a great doctor”. “How do you know?” he asked. I haven’t even done anything for you yet.” “Yes”, I said with a genuine grin. “But I feel better already!”
The next day Dr. Apichat gave me the good news. His colleague agreed to perform the procedure while Dr. Apichat supervised. Groping for all the good luck possible, I scheduled the appointment for the next Monday, St. Patrick’s Day. I was taken to Admissions Administration and processed for insurance payment, and a surprisingly small amount of forms signing. I paid for the two consultations with Dr. Apichat. It cost me 1100 THB, or about $35 USD. I went away from Bumrungrad International Hospital actually looking forward to surgery. I had total confidence that I was going to feel better soon.
On the morning of St. Patrick’s Day, that’s exactly what I kept chanting to myself on the way to Bumrungrad. “You’re going to feel better … you’re going to feel better”. The admission procedure was predictably efficient and 20 minutes after my early morning arrival, I was wearing a patient ID bracelet and being shown my private room. Without a doubt, I have stayed in hotels that were smaller and less (pardon the pun) “hospitable”. The nurse on duty showed me every bell, whistle and gadget the room employed and briefly reviewed the projected recovery schedule.
At 10:00 AM, I was escorted to the Surgery Center and prepped. As they wheeled me into the “staging area”, I no longer had the feeling of being in an airport. I was actually on the runway. I counted fifteen other ailing souls waiting in different stages of preparation, lined up behind privacy curtains waiting for clearance from a team of surgery nurses and anesthesiologists. One by one, I watched them roll by and disappear into what I assumed were operating rooms. An ancient Arab woman chanting and praying, escorted by here team of attendants in Muslim attire; a middle-aged English woman chattering about her impending triumph over the scourge of gravity; another 40-something like me who appeared to have stolen my mantra, “you’re going to feel better, you’re going to feel better”, only in Italian. The anesthesiologist arrived, introduced herself and promptly turned out my lights with a swift and adroit application of the needle. I woke up back in my room at 1PM with my girlfriend watching Thai soap operas on the TV.
For the next two and a half days I was visited by Dr. Apichat twice a day and attended to by a constantly rotating cadre of Registered Nurses and Physician Assistants. The RN’s, were easily identified by their crisp white uniforms and old-school nurse hats. They were all ridiculously professional and proficiently English speaking. The PA’s scurried around in teal green pant suits and ensured I was as comfortable as possible.
The PA’s always worked in teams of two. I surmised that they had to work in tandem because not one of them was over 4 foot 8 inches tall. When charged with the task of giving me a shower, they could easily lose sight of each other simply by standing on opposite sides of me. When I mentioned the diminutive stature of the nursing staff to Kaneung, the head floor nurse, she raised her eyebrows and responded, “Perhaps you’ve been hanging out in places where the ladies are all wearing high-heels or are up on a stage.” I knew right then, in this particular war of wits, I was ill-equipped for combat. The mini-nurses were deceptively strong and quite well versed at handling a big old injured teddy bear like me. At night they even retracted the blinds so I could get a picture-window view of the glittering skyline of my beloved Bangkok.
Recovery was predictably fast and on the final day Dr. Apichat began our conversation with his tried-and-true opening, “How do you feel?” Gleefully I responded, “A whole helluva lot better than when I came in Doc! Everything feels new and I’ve lost five kilos!” In short order, Dr. Apichat gave me home-recovery instructions and told the nurse to begin discharge proceedings. Within the hour I was joyfully paying my insurance deductible and saying goodbye to my on-duty team of nurses, and mini-nurses. The total charges (including my deductible) was just shy of $7,000 USD. The next morning I woke up in my own bed, gazing out at the Coke-bottle green Gulf of Siam.
While enjoying my first cup of decent coffee in 3 days, I felt like a contestant on Jeopardy, a venerable old American game show where you are given answers and have to provide the questions. I pondered what questions this experience had given me the answers to.
I now have the answer to the question “Is it really good and safe health care over there?” First and foremost, the Doctors, nurses, technicians and Physicians Assistants at both hospitals were extremely qualified and trained. I never felt like I was in the hands of a “quack” no matter what their demeanor or bedside manner. The facilities were unlike any I had seen in the US or during the several years I lived in Europe. In my opinion their approach is something we should have converted to in the US a long time ago. The management and efficiency of both facilities astounded me, especially in Thailand, a country known for a relaxed approach to almost everything.
It also occurred to me I answered the question of “Is it really cheaper?” I should qualify my remarks by saying that I had not previously even considered the cost of health care for myself, as I had never been diagnosed with a serious illness or condition. However, after some post hoc research and comparisons with US mega-medical centers, the same procedures and services I purchased in Thailand cost between 3 and 8 times more back home.
It should also be noted that currency is a factor. I’ve lived in Thailand for nearly 6 years, so my currency of choice is the local Thai Baht. Since the THB is on the rise and the USD is taking a dive, my purchasing power has improved 27% since I moved here. For me it’s great. For all those paying in greenbacks, its still a good deal, but getting more expensive every day.
My insurance company stunned and amazed me. I had no idea what to expect from my annual premium of $1100 USD per year. What I got was prompt, friendly and generous service. They coordinated with the staff of both hospitals and kept me informed every step of the way. When the first surgeon recommended an invasive procedure and extended hospital stay, my insurance company responded by saying they would pay for a second opinion and/or less invasive exploratory procedure. In a backhanded way, I feel like they were looking out for me.
If I had to describe my reaction to the whole experience in a single word it would be “surprised”. I was surprised at the humanity of their approach. I had braced myself for an assembly line. I couldn’t imagine how one place could provide quality healthcare to that many people, from that many nations for that price and not treat you like cattle. With the exception of a slightly knife-happy surgeon at the first hospital, every individual I encountered treated me with courtesy and respect. The same service in my home country, if it is available at all, would be considered VIP treatment.
The efficiency of their systems is an organizational manager’s wet-dream. From the welcome center to the operating table, it was technologically and managerially impressive. The patient-to-professional ratio was nothing like I had seen anywhere. In Bumrungrad, every hour of the day, we had 12 RN’s servicing a wing with only 20 rooms, not to mention an army of ubiquitous mini-nurses.
What surprised me the most was my overall change of attitude towards all medical care facilities. I had masked my own fear with assertions that the whole system was impersonal, greed driven snake oil sales. I considered the entire medical community ghoulish charlatans, harvesting bodies for profit. Once the necessity of real big-boy medical care was apparent, I had no choice but to see for myself. Perhaps I should change the one word to describe my experience as “demystified”.
I still do not cherish the thought of going to any hospital, either visiting family, friends or as a patient. My friend Joe is still suffering from a bad experience. My friend Michael is fully recovered, but deservedly takes most of the credit for taking control of his own situation. His sage advice was invaluable; “Remember mate, it’s your body.” It is unwise to blindly handover your fate to a health care system no matter how many expert technicians and superstar surgeons they’ve got on the roster. It is important to understand what’s going on and what your options are.
Ultimately, I had a positive experience, but I’m not going to drop by Bumrungrad just to hang out. Catching my condition earlier wouldn’t have made any difference in the treatment, but it did wake me up to the necessity of routine check-ups. Besides the ultra-quality care from upper-echelon medical professionals, the demystification of the whole process impacted me the most. We all have a natural fear of the unknown. What I now know is the medical care in Thailand is extremely user-friendly and disarming. This, in my case, is just what the patient ordered.
So, even though it’s no fun, this aging warrior has pledged to make a trip to the nearest mega-medical complex for a comprehensive check-up next St. Patrick’s Day, and all those to follow.
About the Author: Bart Walters is a retired advertising executive from Orlando, Florida. He is now a part-time real estate developer celebrating his 10th year in Thailand. Bart lived several years in Bangkok, spent 3 years on the island of Phuket and now resides in Ban Amphur on Thailand’s eastern seaboard.
Slightly embellished report when it came to Bumrungrad but fairly accurate of it keen position in the medical hospitals in BKK. And I live in Thailand (Nongbulamphu) and would not think of going to any other medical hospital in Thailand.