Dara Rathana (not his real name), my faithful Cambodian patient who travels frequently to Thailand, once asked me provocatively, “Do you know that 1,500 Cambodians are queuing up at a particular hospital in Thailand every day?”
One thousand five hundred is a big number. If each of them spend only $200, it means $300,000 is draining out of Cambodia each day, or about $100 million every year for that hospital alone. There are many more similar hospitals. Many Cambodians also flock to Vietnam and Singapore for their healthcare. Let’s explore the implications of such a phenomenon.
About a year ago, I saw somebody who had her gallstone removed with an endoscope at the same hospital. She ended up having E. coli bacterial septicaemia (overwhelming bacteria infection of her blood) that lead her to septic shock which is potentially fatal. Fortunately, she pulled through the septic shock. However, on her return to Cambodia, she suffered recurrent weakness, dizziness and fever due to recurrent E. coli bacterial infection. Sadly, the infection and the accompanying treatment were noted to threaten the function of her single transplanted kidney. Nonetheless, she was lucky to survive the ordeal.
Her near-death ordeal and large amount of money spent could have been avoided if she had consulted an experienced ethical doctor who would certainly advise against the endoscopic surgery to remove her gallstone. Statistics have conclusively shown that many patients with gallstones do not suffer any symptoms and actually live through their whole lifespan with the stones in their gallbladder without encountering any problem.
What most people need when they fall sick is really the first level care, also known as primary healthcare. The primary healthcare doctors are often known as the family physicians or general practitioners. The real good ones are those who have completed their post-graduate training in Family Medicine, General Practice or Primary Healthcare. They are sometimes known as the specialist generalists. However, some others may be as good in their clinical acumen that is acquired through their years of self-training and clinical exposure, if they are passionately learning to improve themselves.
These doctors have sufficient knowledge of most diseases, the causes and risk factors leading to the diseases, and the ways to avert them. They are also the best person to diagnose most diseases and refer those in need, to the appropriate specialist(s). Nonetheless, most of the medical problems can be solved at their level with minimal cost from the savings of avoiding the unnecessary sophisticated and expensive tests or surgeries.
The over sub-specialisation of various medical disciplines of care lead to fragmentation of holistic medical care. Together with the increasing commercialisation of medical care, it had led to escalating cost and lesser value-for-money care as a result of over-investigation with high-tech equipment, involvement of multiple specialists instead of a single specialist generalist, and the missing of diagnosis due to increasing alienation of super-specialist in the systems outside their specialty.
People should learn that consulting their family physician first, for any of their medical problems is the smartest, and most cost effective approach, instead of going through several specialists, doing multiple expansive high-tech investigations to finally arrive at a straightforward diagnosis.
A specialist generalist may be able to quench the diagnosis by skillfully putting together selected relevant aspects of clinical history and findings, with or without minimal blood tests, urine tests or simple imaging such as ultrasonography and x-ray.
For example, a person with chest pain presenting to a cardiologist may have an expensive CT heart scan and echo of his heart done with no positive findings. The cardiologist may then refer him to a gastroenterologist who does an unpleasant gastroscopy of his stomach, again with no positive findings. Finally, he may be referred to a psychiatrist who then makes a diagnosis of depression with symptoms of lower chest pain.
If such patients had consulted a specialist generalist, his diagnosis could have been made without consulting so many specialists of different disciplines and doing so many expensive tests apart from saving him lots of time and thousands of dollars.
The smartest approach for Cambodians to care for their health is to consult a good family physician annually for a preventive health check. Most of their illnesses can be solved by the family physician, if the diseases are diagnosed early. They do not need to consult the specialists of isolated disciplines or do wasteful and often unpleasant high-tech investigations unless their family physician feels the need to do so.
Such family physicians including some expats are available in Phnom Penh, and perhaps in other big towns of different provinces. They can do a good job.
If the 1,500 Cambodians queuing up at that particular hospital adopted the smart approach to their healthcare, perhaps only 10 percent would need to be referred overseas for further investigations and consultation with the appropriate specialists. Billions of dollars could be saved annually from being siphoned overseas to Thailand, Vietnam and Singapore if the people of Cambodia can change their mindset. Such change of mindset will invariably help to strengthen the national economy and its currency.
At any moment, there are millions of people lying on their sickbed, some wondering what disease they are having, some recuperating from a bypass surgery, some undergoing chemotherapy for cancer, some battling with bacteria and viruses and many overwhelmed by multiple degenerative diseases of ageing with multiple organ failure.
On the sickbed, the most common thought crisscrossing their mind is the wish to get well as soon as possible. A sickbed is a good teacher of the philosophy of life. Many were taught many times, yet they fail to grasp the accent of the highest wisdom of the sickbed – health is the greatest wealth, the greatest gift of life.
Life is a journey to a destiny. The flavour of life is in the journey itself. And the best flavour is savoured at each moment to the fullest, in the best of health. Thus, the journey of life should be travelled with sustenance of good health in mind, while pursuing for the ideal and legacy of our mind and the materials of our fleeting wishes that tantalise the senses of our body.
Dr. Victor Ti, MD, MFAM (Malaysia), FRACGP (Australia), Dip P Dermatology (UK), Dip STDs/AIDS (Thailand), Dip. AARAM (USA), LCP of Aesthetic Med. (Malaysia) is an experienced specialist generalist (Family Physician) of BH Clinic, Phnom Penh. As a specialist generalist, he is skillful at diagnosing all general diseases and excluding the sinister ones. Apart from the general diseases, Dr. Victor is also known for his skill in skin diseases, sexually transmitted diseases, minor surgery and aesthetic medicine. He can be contacted via messenger m.me/bhclinic1 or Tel: 023900446