Warning: This post contains frank discussion of a minor surgery, though the discussion is not terribly graphic. It also contains a picture, hidden by default, which might make some readers squeamish.
When I first went to Thailand back in 2015 for a whole bunch of dental work, I got all the expected responses from friends in the US.
“Aren’t you scared of getting dental work done in a developing country?”
“Are the dentists trained as well as here?”
“Why travel for dental care? Don’t you know we have the best medical care in the world?”
I would always laugh and remind people that medical tourism is just called “going to the doctor” to locals. I further argued that simply because it is drilled into us that the US has the “best” health care system in the world, it probably isn’t the truth. Relative to other developed countries our country is the worst performer, and we have particularly shameful levels of cancer, infant mortality, and low life expectancies. If you live in the right state, have the right insurance, and have access to the right doctors, health care in the US can be excellent. However, even with those things working for you, it can still be financially ruinous. A chronic or severe illness like cancer combined with a job loss could spell bankruptcy, never mind the end of any fancy plans to retire early. On top of that, two years of Republican Congress have whittled away some of the meager but important protections of the Affordable Care Act.
In short? American health care on the whole objectively sucks, compared to other developed nations. However, if you could pick your hospital, doctor, and even country, it stands to reason that you could find excellent health care around the world, provided the costs were manageable.
It was this thought process that led me to having an outpatient surgery, paid for in cash, at Bumrungrad International Hospital in Bangkok on a recent trip to Thailand.
Bumrungrad International Hospital is a JCI-accredited private hospital located in Bangkok. It serves over a million patients annually, many of them foreigners. They have over 30 specialty centers like cosmetic and robotic surgery, cancer treatment, labor and delivery, and others.
I first heard about Bumrungrad on the CNN show Morgan Spurlock: Inside Man. Spurlock visited and had a full physical workup done while profiling the hospital’s generally stellar cleanliness and patient management. Seeing his experience at Bumrungrad was actually a huge part of my decision to seek dental treatment in Thailand. Those visits gave me a huge appreciation for the country, its people, and the vibrant and interesting city of Bangkok. My wife and I both fell in love with the city, one that teems with life and which always seems to be thrumming with the energy.
A Tropical Visit Becomes Something More
Right now in Granada, Spain, it’s cold, fam. Not polar vortex cold, but every-day-it’s-at-or-below-freezing-all-night cold. It wears on you. You start to wonder where the toasty warm country you moved to last year went. So, this January we decided to spend ten days in Thailand to enjoy a little shopping, a little warmth, and a whole lot of spicy food.
As we planned our trip, I started to think about the little lump I found in my chest a few years ago. It started as a little hard knot, under my skin but above my muscle. Over a couple of years, it slowly grew to about the size of a grape. I showed my doctor in the US, who examined it, declared it a lipoma, and told me not to worry about it. Still, every time I would lift a barbell into the “rack” position, the bar would hit my chest and cause a little twinge of pain. Every pullup would squinch it. It had gone from annoying to mildly painful. With a family history of breast cancer (and cancer in general) in the family, and the slow but steady growth of the lump, it began to occur to me that it might be a good idea to have it removed. I thought back to what I knew about Bumrungrad, and decided to try to determine the cost of having it done on our visit.
Full disclosure: I have zero-deductible, full coverage insurance here in Spain. I very likely would have spent less by going through that coverage. It was a variety of things that led me not to do that:
- I haven’t seen a doctor here yet, and it would involve finding one.
- It would involve convincing the doctor that removing the lump was essential and not purely cosmetic.
- I’d need a referral to a surgeon.
- It would potentially run afoul of my insurance as a pre-existing condition and I might end up paying anyway.
Spanish medical care isn’t that expensive on a cash basis (we paid 144 Euros for an unplanned emergency room visit for our baby when we first moved here), but out of equal parts curiosity, sense of adventure, and desire for simplicity, I filled out the web interest form on the Bumrungrad web site.
The first time I reached out, I was contacted by a member of the staff who instructed me on how to make an appointment. I replied and explained that due to the short duration of our trip (10 days), I wondered if a surgeon could weigh in on whether it would be enough time to consult, excise a small growth, and perform all followup. I never heard from that agent again.
After a few days of being annoyed, I decided to simply make the surgical consult appointment through the web site. I reasoned that the consult fee was low enough (ranging from 500-2,000 Thai Baht, or $16-60 USD) that if nothing else, I would have a surgeon’s insight on whether the growth should be removed. This process went much more smoothly and I was confirmed almost immediately for a Sunday appointment with an English-speaking doctor and professor at Mahidol University.
Consult and Surgery
I arrived bright and early on our first full day in Thailand. Bumrungrad is near the Nana Skytrain station in Bangkok, off of Sukhumvit Road. This is a major area of tourism for both the wholesome (huge malls loom over the skyline nearby and there are countless excellent restaurants catering to every taste) and the unsavory (pockets of business devoted to the sex trade exist on some of the nearby streets).
The Bumrungrad hospital building itself resembles a luxury hotel or shopping center as much as it does a hospital. There are fountains and planters lining the driveway that leads up to an expansive roundabout where patients are dropped off and picked up. From there, it’s a short elevator ride to the “sky lobby” on the tenth floor, where you could grab a quick Starbucks before entering the Welcome Center. That’s if you didn’t stop at the McDonald’s on the M level. As I said, this isn’t your average hospital.
I walked into the Welcome center, where I was immediately intercepted by an attendant, who guided me to an open reception desk. I provided my appointment printout, passport, and a release of liability that they had emailed to me, and I was given a Bumrungrad ID card with my name, picture, and patient ID. I was also given a hospital-issue patient wristband that was scanned at every juncture to immediately bring up my file.
I was directed up to the 16th floor, where the surgical consult and procedure rooms are located. This is one place where Bumrungrad might improve a bit. It wasn’t always clear where I should go as I traveled from reception, to consult, to the cashier, back to the consult, etc. Training each person involved to give clear instructions on where to go, why, and what to do afterwards would be a big, big help.
As I waited for my appointment time, I couldn’t help but notice that the demographic here was very different from what I experienced at Bangkok Smile for all my dental procedures. Where Bangkok Smile served a great many Europeans, Australians, Canadians, and Americans, Bumrungrad seems to serve a majority Asian and Middle Eastern clientele. I presume that since most western nations offer universal health care, there is less of a need to seek this kind of care abroad.
Before too long, I was called in to see the surgeon, who spent perhaps five minutes speaking with me and briefly palpating the growth. He pretty immediately concluded that it was not a lipoma, and that it probably ought to be excised to find out what it actually was. Was I interested in having it removed then and there? You bet I was. Was I also kind of alarmed and wishing I had made my wife get up and come to the appointment with me? Also yes.
In another semi-confusing logistical step, I was directed to the cashier, where I put down a deposit on the estimated surgery cost, or about $900 USD. This seemed a little expensive to me, but I also didn’t have a whole lot to compare it to. I was then sent back to the surgical department, where I was taken to a procedure room.
This is probably a good time to reiterate that Bumrungrad is clean and hygienic in a way that puts American hospitals to shame. The procedure room was spotless, and I had an English-speaking nurse with me at all times as I waited for the doctor to arrive. In the end, there were three nurses and a doctor present for the procedure. One nurse assisted with the surgery, one monitored my blood pressure constantly, one took notes, and the doctor, of course, performed the surgery.
The procedure itself was painless. I was injected with a local anaesthetic and the whole surgery took about fifteen minutes. The doctor used dissolvable sutures and dressed the wound with a waterproof bandage. This is another place where I felt a little in the dark. I wasn’t exactly told how to care for it, and I had to ask questions on my own about when I could exercise, swim, etc. The answer, by the way, was 7-10 days in both cases.
Because I asked, the doctor let me check out what he had excised. He declared that it was clearly a tumor, but what type, and whether it was malignant, had to wait on a biopsy. TMI warning, I’m going to tell you about my tumor now. It was basically a totally encased lump of gray rubbery grossness. It was pretty cool looking, and I took pictures. If you really, really want to see a cool tumor, you can click below.
I mean, pretty cool, right?
I was scheduled for a followup three days later, which is when the biopsy results were expected. I was told not to be too alarmed, as the slow growth probably indicated a benign tumor, but who stays 100% calm about the word tumor? I was also given four days worth of antibiotics and Tylenol. I took the antibiotics, but never needed the painkillers. Aside from my toddler bashing me in the chest, I never really felt any pain.
I reported to the cashier one last time, where my deposit was reconciled with the actual cost of all of my care. In the end, i was refunded several hundred dollars. The total cost of the consult, anesthesia, surgery, biopsy, and medication was $554. This seemed pretty fair to me.
Three days later, I was back in the doctor’s office, where I was told that my tumor was a benign Schwannoma, or nerve sheath tumor. It’s just one of those things that some people get, and no further followup was needed.
I don’t know about you, but not having cancer always makes for a good day. There was ice cream.
All told, I really came away with a positive feeling about having my surgery done in Thailand, as well as for Bumrungrad specifically. I would happily go there again for my own care, or have any member of my family treated there. The price seemed fair and was transparent before and after treatment. The doctor was professional and competent. The facility was (again) spotless. Aside from logistical annoyances, I didn’t have anything to complain about.
What about you? Could you ever see yourself seeking surgical treatment abroad? Let me know what you think!