I have been a patient for decades. I know what I am talking about.
Physicians have elite knowledge. They know more about our bodies than we do. Theoretically.
But they don’t feel a patient’s body.
They have a statistical approach to patients, just as do public health officials. This means that if a treatment is effective in 99 percent of cases, and in 1 percent, it has bad side effects, they will calculate whether for the society overall, it has a net health benefit.
Too bad if you are the 1 percent.
Even if the risk is just 0.1 percent (as in anesthesia awareness), I avoid it if the consequences are terrible. I will look for an alternative, even if it is much more costly. In such cases, I don’t mind spending money.
I find 0.1 percent a high risk. Would you ride on airplanes if the chance were that 1 in 1000 flights crash? Public health care sees this differently. If a treatment is cheap and beneficial in 99 percent of cases, and if public funds are not available for a much, much more expensive solution that has less risks of side effects, then the decision typically is in favor of the cheaper solution.
This is why children are vaccinated for polio. Read more on the dangers of polio vaccines:
This is not an article about polio, and I do not want to decide anything on polio vaccine disputes. I just want to raise awareness that a complex set of considerations is involved in the decision-making processes of physicians and public health officials, which include the acceptance of side effects that occur in a statistically small number of people.
On the other hand, did you know that in the US alone, almost 200,000 patients die each year from preventable medical errors?
Now, that’s in the US, which has the best physician education in the world. Nobody has yet studied this for countries like Thailand.
I go to considerable length to avoid being a statistical case to feel sorry about.
But apart from their statistical approach, there is one aspect that has me even more worried about physicians. They usually are in the game for the money.
Physicians don’t have an income if they don’t sell treatments, so they have a genuine incentive to turn those who walk through the door into costumers / patients.
Thailand is a country with a very well developed high-end infrastructure for medical services. As a patient (privately insured or not) who pays cash, I can walk into a hospital and ask for a heart bypass, a kidney transplant, or a facelift, and chances are I can have an appointment within a week.
Here, at clinics that target patients that pay charges that allow physicians to become rich citizens, you can find dentists that idle for hours, waiting for somebody to show up. Or you have hair transplant surgeons with nothing to do for two or three days.
Sure, this is a buyers’ market. This means that those who know their way around can get quality at a low price.
It also means that those who do not know their way around find themselves trapped in profit-maximizing schemes of beauty clinics, by surgeons with a shopkeeper mentality..
Almost every woman and man in the world wants better looks.
If only all of this is available in a few painless treatment sessions. That’s what people want to spend money on.
And that’s why young smart people want to become doctors. It is considered a respected avenue to becoming rich..
Cosmetic surgery, more than any other medical field, is a specialty typically chosen by young physicians for whom becoming rich has been a major argument for going to med school. In this respect, there is no difference between the West and countries like Thailand.
I may be above average distrustful of physicians in general, and cosmetic surgeons in particular. But even to me, it happens sometimes that I don’t get the best deal. Because it’s hard to negotiate with physicians on one’s own.
It is difficult to negotiate with physicians face-to-face. Imagine you walk into the office of a heart surgeon, and ask for a bypass. Imagine his schedule is rather full, but he does make space for you next Wednesday. You don’t discuss money with him. But when you make the further arrangements with the administration staff, you learn that the price is 20,000 US dollar. Oops, you though it would only be 15,000.
Do you have the nerve to walk back into the consultation room (you may have to wait half an hour), and then try to hackle over the price?
“Doc, can you make this for 16,000 Or 16,500 How about 17,000 Or could we meet in the middle, let’s say 17,500
Well, the surgeon may just think: you are the pain-in-the-ass type of patient. And how if he may just feel like teaching you a lesson? Save on anesthetics, for example.
Some docs and nurses are known to even have given patients lethal dosages, when they considered them a nuisance.
When I undergo surgery, I want a surgeon to care for me and my condition. I don’t want him to feel annoyed because I ask for discounts. This is why even I exercise constraint in negotiating with physicians.
In general, I would prefer somebody else to negotiate with the surgeon on my behalf. That is one reason that indeed speaks in favor of public health insurance (not private health insurance that pays a physician anything he asks for). The officials of the public health insurance organizations negotiate prices for certain procedures. So patients do not have to be afraid of seeming complicated to their surgeons.
I do not run a health insurance. I am a writer (and a patient). But my secretary handles appointments with cosmetic surgeons in Bangkok (those that I recommend), and based on official pricelists.
Surgeons who run cosmetic clinics may feel not as bound to their pricelists as do chefs who run restaurants. They may decide that a case is more complicated, and that they should charge more (even though they may just think that a patient is rich enough to pay a higher price). Even I can’t avoid this.
But through the appointment service of my secretary, there is at least a standard price known to both sides. And usually, there is no deviation.
And it’s the best price one can get.
I have a lot of experience as a patient. And I make it a point that the physicians whom I let operate on me know that I am a writer. And that I publish on my experience with them.
Maybe this makes them just that little bit more careful, and concerned to avoid mistakes.
Those who make their appointments for cosmetic surgery in Bangkok through my website also benefit from this protection.
“Oh yes, this is one of those patients that have been recommended by that writer.”
I want physicians to be careful, and certain risks, I go a long way to avoid.
The risk of anesthesia awareness, for example.
I think that it’s a scandal. Even in the US, two out of 1000 patients experience anesthesia awareness. this absolute horror scenario. And a very large number of full anesthesia applications are not even needed. They are just convenient for the surgeon (most surgeons prefer the patients they operate on as a lifeless mass of flesh).
Well, I am firmly convinced that practically all cosmetic surgery procedures can be undertaken with local anesthesia. I have had several facelifts, and even a tummy tuck, undertaken under local anesthesia.
Those surgeons in Bangkok that I refer to are aware that I am against full anesthesia for cosmetic procedures, and that I do not allow full anesthesia. And if you follow my opinion in this matter, I am your best bet for arranging a procedure under local anesthesia.
1 Jones, MR Skintight: An Anatomy of Cosmetic Surgery epress UTS Publishing
2 Ramsey Alsarraf, MD, MPH; Wayne F. Larrabee Jr, MD, MPH; Shelia Anderson, RN; Craig S. Murakami, MD; Calvin M. Johnson Jr, MD Measuring Cosmetic Facial Plastic Surgery Outcomes A Pilot Study Arch Facial Plast Surg. 2001;3(3):198,201. doi