Experiences with overseas medical testing

#1

Thought a discussion on Medical screening might be of interest. As we all know, these are available in the US at very high prices and are widely available in destinations like Thailand, Turkey, India, Costa Rica, etc. The lure is attractive, often customizable package pricing and the ability to get a lot of tests done efficiently at one time.

I’m curious about the experience others have had with overseas testing and whether follow-up in the US has yielded the same results or diverged, as has been my experience.

Prior to my recent experience, I was even looking into getting a full body PET Scan overseas- weighing that the radiation and cost was worth the potential early detection, coupled with peace of mind. Now, I’m not so sure. I was a big fan of this medical tourism approach until last year when a variable got thrown into the equation that I hadn’t previously contemplated: Accuracy.

My experience with medical tests/exam packages in Thailand is mixed, and I don’t really trust my results like I did before. In fact, I’m going to pay to get my CAC redone here in the US just to be sure (having to pay for it because I’m treated like a hypochondriac when I bring it up to a Dr).

Thailand has very good (and VERY efficient) health care. That said, the medical exam side is an assembly line of check-up packages for tourists where quality, well… isn’t. It’s the most junior/least competent doctors (if you think about it, this makes sense- top doctors aren’t doing physicals all day, every day). The exams are rushed and far from thorough and the tests are… suspect, at best. Examples:

  1. My “exam” was clothed until I had a talk with the doctor about what I had paid for. My body loves to make random tumors now and again (usually lipo), so when I had another bulge, that was my first thought. I showed it to the Dr- he said he had no idea what it was and referred me to an oncologist. Didn’t have time for that so saw a Dr when I got back to the US. It’s a textbook sports hernia requiring 20 seconds to diagnose! Wow, great doctor…

  2. As part of my package, I had an ankle brachial index done. It flagged me as advanced peripheral artery disease. Alarming. I do have edema issue, so I was very concerned, but also puzzled combined with a CAC of zero. I paid a different hospital to do another ABI and the results were also bad, but not as bad as the first (moderate).

I returned to the US and told the same doctor who diagnosed the hernia about my ABI results. Given my heart issues in the past (Afib and a fluke minor heart attack at 35!- when I was ripped with 7% body fat, btw. I digress…), she relented and ordered the test. The tech who did the ABI test in the US hospital saw the Thai results in my chart, my heart attack, etc. When the test finished I asked the verdict. He said, “The verdict is- don’t get tests done in Thailand!”. My ABI was perfect. He said they have no idea what they’re doing.

  1. As part of the same package, I had a scan of my Thyroid. Radiologist came back with several large nodules of concern and I was referred to a specialist. You guessed it- same test in the US showed inconsequential small nodules. Measurements by the Thai radiologist were off by a factor of 5.

I have had excellent medical care in Thailand (I’ve lived there for a total of about 2 1/2 years). Bumrungrad is a great hospital, but it’s getting very pricey to the point that you’re just paying tourist prices. It’s was much more reasonably priced and twice as good 20 years ago. All the English speaking/advertising hospitals are similar. As you see from your link above, their CAC test is 50% more expensive than you can find in the US.

So, I can’t recommend the Thai physical exam factory. I imagine all the blood work was correct and I hope everything else was- but the thing is, based on the above, I have no idea. The whole idea behind paying for this level of physical exam is to catch thing early and, also, to provide peace of mind. Neither box gets checked when you can’t trust the aptitude of both the technician (or pretend “tech”) doing the test, nor the radiologist reading the results. I had 2 false positives and a missed diagnosis that any competent doctor (or nurse) would know. Of course, my concern is any false negatives…

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#2

PET scan is a lot of radiation though. I might have gone for an ultra-low dose PET scan + machine learning in specific situations if it was offered but unfortunately, overseas it’s even harder to find high-tech for cheap and reliably done. I’m not saying don’t go for medical tourism - ie preventative doses of botox are pretty cheap in South Korea and the quality can be decent. But it’s actually even cheaper to get it done in the US at a research facility and getting paid for the clinical trial

I’ll also note you need the right type of scan for the right part when you’re looking for the right stuff. There can be so many false positives in some non-approved tests that end up being pretty useless.

Not to mention, incidentalomas are a real problem. I look forward to liquid biopsy instead to save myself the grief, higher costs, and potential harms of “inappropriate overtesting”. You need to really know in-depth why you’re doing these tests and the subsequent tests. Otherwise one could harm oneself more than one thinks.

For example, at age 30 for say my hypothetical pretest probability of 1% any cancer - if such a hypothetical test is not 80% sensitivity and 99%+ specificity the test is mostly useless to me and I might just end up using it as a baseline if I even get it done.

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