Warning: This post will describe a real, personal health issue. I will be using language that may be offensive for some. If you’re offended by terminology involving the male body, you may not want to read this post. Also, I apologize for some of the pictures being blurry.
Some real talk is about to follow, folks.
Life isn’t always sunshine and rainbows, even when you’re financially independent at 35 years old, living the life of your dreams halfway across the world.
When I wrote about my reasoning behind not wanting or having health insurance here in Thailand, I wasn’t expecting to put my theories to the test so quickly.
But that’s the way life works.
When life hands me lemons, I make lemonade. It’s just who I am. I have a positive attitude, always.
Developing what I thought might be a serious physical problem recently was a great test of my resolve, but I kept right on smiling and going about my life.
But I also thought that having something that required visiting the hospital was a great opportunity to share the process with you readers.
The bad news (the lemon) is that I have a health issue that will probably be moderately bothersome for the rest of my life.
The good news (the lemonade) is that the process of interacting with the health system here in Chiang Mai in a rather direct and serious way only served to further cement my belief that I’m making the right choices in not only living here indefinitely as a dividend expat, but also in living here without health insurance.
I developed an uncomfortable ache in my groin area somewhat recently.
Specifically, the pain was originating from the left side.
While disconcerting in and of itself, this pain rather quickly spread up to my lower left abdomen, turning discomfort into a fairly noticeable ache across the left side of my body. This ache could be reduced by laying down, but it was prominent when walking or exercising.
Being the analytical, pragmatic, and research-minded person I am, I decided it was time to practically get a degree in the male reproductive system.
I’m not a huge fan of visiting doctors in general. Whereas some people see a doctor as a first line of defense (making a doctor appointment as soon as they develop a sneeze), I see a doctor as a last line of defense. Outside of a medical emergency (in which case doctors are necessary and wonderful), I see doctors generally (but not always) as well-paid, educated guessers who hand out antibiotics.
And so I instead live a fairly healthy lifestyle that should reduce the wear and tear on my body and mind, which in turn should limit the need to see doctors.
To each their own on that. But that’s where I’m at with it.
And so far, so good.
Until this ache developed…
So I did some research on my symptoms, leading to a diagnosis on myself as I was trying to figure out what this was.
It didn’t appear to be cancer, which was great. However, I wasn’t prepared to totally rule that out due to the serious consequences of being wrong.
After some analyzing the issue and research, it came down to two likely issues:
The first was epididymitis.
The second was varicoceles.
Of course, testicular cancer was also a remote third possibility that I kept in the back of my mind.
The first issue could possibly require antibiotics that are given via a shot, which would necessiate a doctor visit.
The second issue would call for a bit more expertise than I have in terms of what to feel for.
And the third issue, while unlikely, was something I’d feel much better about if I had it professionally ruled out.
Seeing A Urologist
So I took some time on a Sunday afternoon to casually stroll down to Chiang Mai Ram Hospital, which is only one kilometer or so away from where I live.
I didn’t make an appointment.
I walked right into the hospital, where a very sweet nurse greeted me right away.
She asked me what symptoms I had and who I needed to see.
I told her what was going on. And I told her that I thought it’d be a good idea to see a urologist, due to the nature of the issue.
In the United States, seeing a urologist would almost always require an initial visit to your GP, upon which time you’d get a referral. This is extra time, cost, and rigmarole. And it’s another example of why I don’t like the healthcare system in the US.
I was quickly shown to a desk in front of the urology area.
They took down my information, gave me a patient card, and walked me over to the waiting area.
I waited for about 15 minutes.
Then a nurse called my name. I was shown into a vitals room. Height. Weight. Blood pressure. Temperature.
Everything was great.
I was told to take a seat again.
After another 15 minutes, the same nurse called my name.
I was shown into the doctor’s office.
There I met a urologist who spoke great English and was very professional.
He asked me what was going on. I shared my symptoms and ideas on what’s going on.
There was definitely groin pain originating from the left side. And this ache seemed to quickly spread up into my left abdominal area. The abdominal ache could largely be eliminated by laying down.
I told him I already ruled out something dietary relating to my intestines, as I had changed the foods I was eating temporarily to just make sure I wasn’t chasing the wrong problem(s). He agreed with me that the pain in the abdomen area was likely at least partly related to the groin pain (although I also found out that mild dehydration was causing me some issues).
The urologist then showed me to an examination area in his office.
He proceeded to physically examine my groin. This examination lasted for about 30 seconds.
The diagnosis was decided and swift:
An enlargement of the veins within the scrotum. It occurs in ~15% of all men. And it’s almost always on the left side.
I won’t delve too deeply into the issue, but there’s plenty of information out there regarding what it is.
Unfortunately, there isn’t much I can do about this, outside of pain/swelling management (via ibuprofen). I was advised there was nothing I did (or didn’t do) to cause this.
Because of shared nerves/veins, any groin pain/ache can radiate up into the abdomen area.
Surgery is an option, but the doctor said this is usually reserved for people who want to maintain fertility. Since this isn’t a concern of mine, surgery apparently is not recommended.
I then left the doctor’s office and had a seat back in the waiting room.
A minute passed by. The same nurse then called my name and had me follow her over to the cashier area, which is on the other end of the main atrium of the hospital.
I walked by numerous “stations” that fronted related doctor’s offices.
The nurse had me take a seat in front of a cashier window. She gave the cashier my paperwork.
I figured it might take a few minutes to process my paperwork.
Only 15 seconds or so passed. The cashier then called the number on my patient card.
I walked up to her window. She gave me my receipt.
The total bill came out to 620 baht.
The urologist fee was 500 baht. The hospital then has surcharges that add up to 120 baht.
620 baht (at the current conversion rate) comes out to $19.89.
The entire process took under an hour. And you’ll remember I didn’t have an appointment.
Notably, a GP costs 300 baht at this same hospital. A specialist (rightly so) has a higher fee.
It’s $20 I wish I didn’t have to spend. Even more than that, I wish I didn’t have varicoceles.
But I like to see the glass half full.
I don’t have testicular cancer. I don’t have a life-threatening condition.
(I’d say I’m not dying, but my good friend here in Chiang Mai, Andrew, reminded me “we’re all dying”. Touche! That’s a major reason behind my whole drive to achieve financial independence, reclaim my time/life, and live on my terms.)
Furthermore, this $20 is significantly less than I would have had to pay in the States, especially after factoring in the health insurance I would have had to carry between the time I left the US and today. We’re talking thousands of dollars here. Instead, I’m out $20. Not too bad. I’m already greatly ahead on my long-term bet against living in the US and carrying health insurance there.
Perhaps most importantly, though, I saved a ton of time. The process that’s involved anytime one has to interact with the US healthcare system is one thing that turned me off from it in a major way.
Although I don’t have anything serious, I probably would have been even more unlikely to visit a doctor (or at least delayed things longer) in the States for this same issue simply to avoid the headaches. And that’s a real shame that I think impacts many, many people.
Avoiding the headaches is fantastic. Avoiding almost all of the costs, too, is very tasty icing on the cake.
I wish I didn’t have to share this story.
But I’ve always attempted to be as transparent as reasonably possible with things.
And since many people who decide to retire abroad and live off of passive income are likely going to do so at an older age, the process and cost of interacting with the local health system is an interesting (but unfortunate) topic that should be broached.
If I have to interact with the health system again in any major way – I hope this doesn’t happen for many years, if ever – I’ll be sure to share that, too.
Seeing as this was the most potentially serious health concern I’ve had in many, many years, and seeing as how it happened in a foreign country where I lack health insurance, this was a great time to share the experience.
This process only served to reinforce my belief that the benefits (in both financial and non-financial terms) of geographic arbitrage are rather significant, especially when it comes to healthcare. This process would have been far more confusing, time consuming, and expensive in the States.
What do you think? Did this process surprise you in any way? How would this process compare to your local experience?
Thanks for reading.
P.S. If you’re interested in becoming financially independent, which could allow you to live abroad and take advantage of geographic arbitrage, check out these resources that I personally used on my way to achieving financial independence in my early 30s.