Health Care

Do not have even faintest idea that I belong to the medical profession. My interest in medicine evaporated on the day  when I choose engineering in IIT Kharagpur over medicine after my high school graduation. Despite such low-key file storage in my head’s hard disk on medical matters, I can neither avoid visiting doctors nor having medicines.  So it is all about my medical treatment experiences in all those world-standard hospitals including Makati Medical Center  (Manila, Philippines), Shifa International (Islamabad, Pakistan), United Family Hospital (Beijing, China), Pyathai 2 Hospital (Bangkok, Thailand) and Bumrungrad International (Bangkok, Thailand). I am not that sickly a person visiting all these hospitals regularly enabling me to write this. Most of my visits were for annual medical check-ups, and few for treatments. I have my own impression either way of each hospital which I consider beyond my moral principle to disclose here.

For all patients medical treatment means full recovery from illness. It can only happen if the disease is diagnosed properly, treatment and post-treatment advice/care are given appropriately.  Generally patients have no idea of proper diagnosis, appropriate treatment and post-treatment advice/care. Also patients normally cannot differentiate if the treatment is for symptoms or problems. For doctors, it varies I guess. While I think most of the government hospital doctors (typically with doing-you-favor attitude) diagnosed, treat and advise patients on their illness considering also patients’ identity, personality, behavior, attitude, outfit etc., my experience in private hospitals is the following.

During one of my annual medical check-ups, doctor discovered that I was suffering from hernia and needed to be operated.  All justifications that operation being minor involving only local anesthesia, doctor having experience in operation etc.... were explained to me. I was also reminded that since I was with the Asian Development Bank and had insurance coverage, it would be good if I decided to do the operation.  There it was, the financial aspect of the diagnosis. First, slicing and stitching my body scared me to death. Second, the doctor did not even mention non-surgical treatment. And, why was he advising operation which should, in fact, be the last option? Was the recommendation for operation more associated with cost rather than diagnosis and appropriate treatment? I had to consult few more doctors and decide on appropriate treatment. Thereafter I have had several cases where doctors asked if I had insurance coverage for treatment. Even if it was not intended to associate with the type and level of treatment, I had already learnt to do basic research on my illness and discount appropriately  the impact of market forces in medical treatment through critical dialogue with doctors on diagnosis, treatment and post-treatment services. This I find is very important. It’s my life! It is not intended to be derogatory to medical profession but give a perspective on impact of privatization.

Bangkok  occupies more and more prominent place as being medical destination for the people all over the world in addition to being tourist and shopping paradise. The reasons quite simply are Thai hospitality and care, world-class equipment and facilities, and well trained professionals in addition to its tropical climate, location and cost effectiveness compared with medical care in developed countries (MRI: $350 in Bangkok, against $1,080 in the US). The right strategy calls for focusing on what you are good at and excelling in it, and  Thais are good at it. The reasons,  in addition to being a prestige issue for some, why more and more Bhutanese are heading to Bangkok for treatment . While it is so, illusion that Bangkok treatment being always perfect ensuring full recovery from illness is bit far fetched. For that matter anywhere in the world, I guess.

More recently I went to Bangkok for treatment of my back pain. The diagnosis included X-ray, MRI (magnetic resonance imaging) and evaluation by spine surgeon.  The problem was identified and I was given the choice: non-surgical treatment (medicine plus physiotherapy) or surgery, Lumbar Laminectomy (LL).

The human back comprises of many interlocking bones, discs, ligaments, tendons, nerves and more I suppose. The LL surgery involving two inches cut including lamina (bone) from one or more vertebrae is bound to have higher risk of destabilizing the spinal cord. I opted for non-surgical despite surgeon's recommendation for appropriateness of LL for full cure. The non-surgical treatment for about a month had no impact on my back pain what-so-ever. What do I do? I was back researching how best to treat my back. I came across new spine surgery procedure using endoscope, least invasive to date I read, called Endoscopic Lumbar Disectomy (ELD). Since ELD was done with very small incision (less than 2 cm) and on an out-patient basis (in west), I opted for ELD in another Bangkok hospital.  I asked the surgeon there regarding appropriateness of ELD vis-à-vis LL.  He told me they did not do LL anymore because ELD was least invasive, patients got back to  normal situation after about three months and more or less had no possibility of back destabilization. Why was LL appropriate on me earlier? Good question!

After my ELD I was back in Thimphu. Unfortunately, Thimphu weather deteriorated - snows at hilltops and severe cold wind sweeping through all afternoons. This adversely affected my fresh surgery. I had nerve inflammation. I wrote back to the surgeon for anti-inflammatory drugs. The Thai surgeon could not have given me cold weather post-surgery advice when he had only experienced tropical climate. The environment in Bhutan is different from the one  in Thailand. Then there were other issues: different drug brand names, lack of post-surgery physical examination and others with regard to difficulty in giving post-treatment care/advice.  I am fortunately now on my regular golfing days.

While I point out my real life experience for the readers to understand briefly pros and cons of overseas medical treatment along with impact of privatization on medical services, I see the other extreme that the loose free-medical-care-for-all policy on standstill from its sectoral inception flawed with never-ending issues relating to purchase and shortage drugs; counterfeit drugs; dilapidated hospitals/basic health units; shortage of doctors; non-operational medical equipment and you name it.  For balanced and sustainable development;  social, political and economic progress have to move ahead hand-in-hand. The economic reform makes no sense if a sector is on standstill. Isn’t it time to reform health care accounting the cost of mismanagement and overseas treatment (Nu 50-60 lakhs for couple of weeks in Bangkok hospital seems normal),  and allowing careful private sector participation including for health insurance for effective health coverage? I think it is, keeping in mind also that a pure free market model simply cannot work in providing health care!