Health care as it oughta be (as my dad would have said)

I was awakened around 2 on a Sunday morning by a now-familiar sensation: a stabbing pain in my left elbow, radiating toward my wrist.

This is no way to start a holiday weekend, I thought. But after a fitful nights’ sleep I was eager to put the pain behind me.  I massaged the painful spot in the dark and made up my mind: it’s time to seek treatment.

Three hours and $150 later, I had seen a world-class orthopedic surgeon, received a treatment regimen for both the tendinitis and a wrist injury sustained in a motorbike accident, had paid for the procedures and picked up my prescriptions and was on my way to meet a friend for brunch.

Doesn’t sound like the Kingdom of Wonder, does it?  Nope. It was more like the Land of Oz, in terms of medical care.

For the uninitiated, Oz is actually Bumrungrad International Hospital, a sparkling and sprawling medical complex in the center of Bangkok, where registration is more like a hotel reception and emphasis is on care on the patient’s terms.

Bumrungrad’s slogan: Internationally accredited healthcare. Famous Thai service. No long waits.

They should add this: No fooling.

Here’s how my case unfolded.

Having made the decision to get my issues treated, my wife and I hopped in a cab outside our hotel in Bangkok’s Thong Lor district. Ten minutes later, we walked into Bumrungrad’s main building and asked for directions to the orthopedic department.

A delightful young woman class in soft green silk directed us to the 12th floor in the nearby clinic building.

Emerging from the elevator, signage directed us to orthopedic registration, where another pleasant young woman clad in green asked me if she could help.

I plunked down my Bumrungrad medical card and explained that I was hoping to see a doctor for two problems, taking a long shot and shooting for Monday or Tuesday. We’d figured to book an appointment and then change our flight and hotel reservations to allow for the last-minute decision to seek treatment.

Calling up my patient records on the hospital computer system, she gave me the bad news: “Oh, I’m sorry, but the doctors not start treatment until 9 a.m.”

“That’s OK, I was hoping to see someone tomorrow. Is that possible?” I asked, a pushy American trying his luck for an appointment with short notice.

“Oh, you go downstairs and drink coffee, come back at nine and see doctor.”

“You mean today? Now?”

She nodded. Yes.

So there we were, confronted by a smiling waif of a receptionist in green, bathed in soft lighting that gave the light browns of the room a muted, welcoming tone. An enormous, comfortable waiting area lay before the registration desk. Reading materials lined the walls, and a self-service refrigerator was tucked into the bottom of one of the bookshelves.

For a guy from the US who is accustomed to appointments booked weeks in advance and doctor’s office waits long enough to watch a cricket match, this felt like stepping on foreign turf. More like…dare I say? Health care.

We left, and after a coffee and bagel (at Au Bon Pain, one of many food options in Bumrungrad’s complex) we were back shortly before 9. I was immediately taken aside for vital signs and had barely cracked my book when the nurse came back and advised me that the doctor would see me.

“The doctor” was Dr. Pijaya Nagavajara, an affable man who had received his training in Thailand and Canada. Board certified in orthopedic surgery. Specialist in sports medicine and spinal injuries. Personable. Smart. Confident but not arrogant. My kind of doctor.

He did the usual poking, twisting and prodding while asking questions, and smiled when I told him how impressed I was with Bumrungrad’s approach to health care.

He proudly pointed out that Bumrungrad was the first Thai hospital to earn the Joint Commission International Accreditation (JCIA) approval for excellence in health care standards. Bumrungrad earned the designation in 2002, several years before its competitors (there are now more than 20 accredited hospitals in Thailand).

I checked out the accreditation criteria and process, which is focused on providing patient-centered care. As an expat US citizen who has been living and working in Southeast Asia for three years, a patient-centric, affordable health care system works just fine for me.

Anyway, Dr. Nagavajara diagnosed my “golfer’s elbow” and gave me some choices for treatment (I went with the more aggressive steroid injection, having been down a similar path for my right elbow years prior). He turned to my wrist and diagnosed it as radial styloid tenosynovisitis, then explained in layman’s English the problem and what to do about it.

“We can treat this conservatively with no injections, and I will show you some physical therapy for you to do at home,” he said quietly, his twinkling eyes giving me great confidence that I was in good hands.

Then the weirdest thing happened. We talked.

We spoke about travel, the world, the healthcare crisis in America. He clucked his tongue disapprovingly when I described the long waits and high costs of treatment, though he sat up straight when I told him I was from Boston.

“Oh, Mass. General Hospital…very, very famous…very, very good,” he praised. I asked him if he’d been to Boston. Yes, for pleasure. Did he eat lobster? Again with the twinkling eyes.

“Oh, yes! Delicious!”

He asked me where I lived, and when I told him Cambodia a nurse who had been laboring nearby, making notes and making preparations for my injection spoke to me in Khmer. We chatted for a moment in a language Dr. Nagavajarra didn’t understand but seemed to appreciate the connection.

“She grew up in a town near the Cambodian border so she speaks both Thai and Khmer,” he explained. And English, I pointed out. Both grinned.

Injection completed, paperwork in hand I left the doctor’s office after another grin and a strong handshake. Twenty minutes, tops, but it was a relaxed time in which we had a moment to learn a bit about each other.

I went back to the waiting area to meet up with my wife then was directed first to the cashier and then to pick up my medications. Moments later my meds arrived at the pharmacists’ desk in a vacuum tube, presumably from Bumrungrad’s vast pharmacy on some distant floor.

Another 10 minutes later, we were out the door, less than two hours after I’d initially entered the facility to inquire about an appointment (coffee waiting time included).

Here’s a breakdown of my costs:

Doctor’s fee:   $51.64 (1,550 Thai baht)

Facility:           $7.74 (225 Thai baht)

Medicine:       $83.97 (2,440 Thai baht)

Total:              $149.11 (4,165 Thai baht)

My bill also came with itemized details of the specific costs of everything from the lidocaine spray used to numb my elbow before the shot to the doctor’s and facility’s fees.

And out the door we went.

I left with a ton of questions, not about the quality of care I’d received or whether I was just a lucky guy on a Sunday morning in Bangkok (Not the case at all. We’ve sought treatment at Bumrungrad several times and have been consistently impressed with the cleanliness, low costs and great access to excellent care).

My questions were mostly about a health care system 10,000 miles or so away, in my country of birth. A system so broken, so wrong, so failing that it has become a global icon for waste, inefficiency and, well….inappropriateness.

Thailand has become one of the world’s leaders in medical tourism because the medical profession and government have figured it out. Here, there’s no skimping on quality care, excellent service and state-of-the-art facilities.

It’s well trained doctors, nurses and support staff, working in the air-conditioned comfort of a medical facility where everything is focused on making people well.

      2 comments

      • Megan R

        Skip,
        Great post as always!! I agree completely re: the deficiencies of our system. But I would suggest that this costs so little because you’re thinking in terms of American $$s; to the average Thai, I’d imagine that this facility would be far from affordable…. So it’s a great system for the “wealthy,” but not-so-great for everyone else. (That’s not excusing our own overspending and access issues in the U.S., of course.)

        xo
        meg

      • Grant

        Fabuloust post. Yesterday I went to a Doctor in Mexico for sever allergy/asthma. I’m in San Diego for some fishing and got a version of this recurring problem. I could go to a Minute clinic or emergency room but would spend hours and hundreds of dollars on treatment. I know what prescriptions I need to treat this chronic condition and went to a pharmacy in Mexico. They took a look at me and insisted I see the doctor. I walked across the street and he took me right in to the office. He examined me and prescribed exactly what I need for fast recovery. Doctor visit, $25, prescriptions $50. The anitbiotic Leviquin is $90 alone in the US. I already feel better and am going out tomorrow. Something needs to be done about the cost of US healthcare.

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