By the time you’ve read the other articles on this site you’ll have noticed a pattern. Certain things kept happening, across different countries, different hospitals, different doctors, and I kept having to learn the same lessons in new settings. Eventually I stopped being surprised and started treating certain behaviours as diagnostic in their own right. Not of my hip, of the hospital.

These are the red flags I’ve accumulated. Some of them are obvious in retrospect. None of them were obvious at the time.

The doctor who returns your written summary unread.

I started bringing a two-sided sheet to every consultation, my medical history, my concerns, my questions, what I needed from the appointment. At Lim Taing in Phnom Penh, Dr. Meng Sok read it wordlessly and handed it back. The consultation that followed was essentially nothing. If a doctor isn’t interested in what you’ve prepared, they’re not interested in you as a patient. They’re interested in processing you. Those are different things.

The examination that isn’t an examination.

A leg raise and a rotation, fully clothed, lasting thirty seconds, is not a physical examination. A surgeon who doesn’t examine you before recommending surgery hasn’t assessed you, they’ve glanced at an X-ray and assumed the rest. I had this experience more than once. It matters because my specific situation has complications that only show up if someone actually looks: muscle loss, vascular issues, range of movement. If they don’t look, they don’t know. If they don’t know, they can’t plan. That’s your risk, not theirs.

The surgeon who gets irritated by questions.

Questions are not an imposition. They are the entire point of a consultation. A surgeon who raises their voice when you ask about a procedure, or who becomes visibly annoyed when you push on an answer that doesn’t make sense, is telling you something important about how they handle uncertainty and challenge. You want someone who can be questioned. You are about to trust them with major surgery.

The answer that changes between visits.

Dr. Phat at FV told me dual mobility wasn’t possible with SuperPATH because of my anatomy. When I came back and pressed him, the answer changed, it wasn’t the anatomy, it was that they didn’t stock it and didn’t want to import it. Those are completely different things. If a surgeon’s explanation shifts when you push on it, either they didn’t know the first time, or they weren’t being straight with you. Either way, you need to know which.

The quote that doesn’t match the bill.

This happened at Lim Taing, quoted one price, billed another, with a charge added that wasn’t on the bill as a separate line item. It also happened in subtler ways at other places. The solution is simple: get the price in writing before you travel anywhere. If the bill doesn’t match, push back. If they make you feel unreasonable for doing so, that’s another flag.

The hospital that will only give you information if you pay first.

Several hospitals I contacted would not provide pricing, would not confirm implant availability, would not answer any specific question at all without a paid consultation. In some cases that’s a legitimate policy. In most cases it’s a way of trapping you, once you’ve paid and travelled and sat down, the pressure to proceed is enormous. Get as much information as possible before you commit to anything, including the journey.

The email that bounces, the form that doesn’t work, the chatbot that loops.

This sounds petty but it isn’t. If a hospital’s international patient email bounces because it only accepts messages from staff, their mistake, not yours, that tells you something about how carefully they’ve set up for overseas patients. If the online form won’t accept a Cambodian phone number. If the chatbot says it’s online but it’s clearly not. If three weeks pass and nothing comes back. These are not isolated technical glitches. They’re a pattern of institutional indifference to exactly the kind of patient you are. A hospital that can’t manage basic communication before you arrive is not going to be easier to deal with after surgery.

The facilitator who ignores your specific questions.

Medical tourism facilitators exist to match patients with hospitals. In theory this is useful. In practice, many of them treat complex cases as inconveniences. The ones I contacted largely responded to my detailed, specific query with a generic package and a price. Extended recovery support, which I had specifically asked about, was either ignored or answered with “nearby hotels from $25 a night.” If a facilitator can’t engage with what you’ve actually asked, they’re not facilitating anything. They’re just forwarding your details to whoever pays them a commission.

The surgeon who doesn’t look at the imaging you brought.

I specifically asked FV to let me send my MRI in advance so the surgeon could review it before I arrived. I was told to bring it on a USB. I brought it. He said the internet was too slow and looked only at the X-ray. The MRI was the whole point, it was the imaging that showed the muscle situation I needed him to assess. If a surgeon won’t look at the imaging you’ve specifically brought to them, they haven’t done the assessment. The consultation hasn’t happened in any meaningful sense.

The feedback that’s collected under observation.

The nurse at Vinmec held a tablet with smiley faces in front of me and waited while I pressed one. Not privately, she was watching. This matters because it tells you exactly what kind of information reaches management: uniformly positive, collected under social pressure, bearing no relationship to actual patient experience. A hospital that collects feedback this way doesn’t want feedback. It wants compliance. Those are not the same thing, and the difference will show up somewhere in your care.

The surgeon who tells you to go back to your home country.

I had lived in Cambodia for over a decade. I had explained this. He told me to go back to my home country and get treatment there. This is not medical advice. It is a dismissal dressed up as a suggestion. Any doctor who responds to a legitimate and complex clinical situation by telling you to go somewhere else without engaging with why that isn’t possible has abdicated the consultation entirely.

A few more that don’t need their own stories, because you’ll recognise them:

The coordinator who only wants to speak by phone when you’ve specifically asked for written communication. The hospital whose website has large sections under construction. The surgeon whose explanation of your anatomy contradicts basic physiology and who doesn’t notice when you write it down. The reply that arrives six weeks later asking you to please call the hotline. The WhatsApp message in such poor English you can’t tell what it’s saying. The quote that arrives without itemisation, for a round number, with no breakdown of what’s included.

None of these things, on their own, necessarily means the hospital is bad or the surgeon is incompetent. But they are signals. And in a situation where you have no insurance, no advocate, and no easy way to recover from a mistake, signals are what you navigate by.

The positive version of all of this, what good actually looks like, is also worth saying, because I did find it occasionally. CarePlus District 1 in Ho Chi Minh City: every question answered, price matched the quote, the radiologist gave me free time to help me decide whether I needed contrast. Dr. Ho Van Duy An at Tam Anh D7: examined me properly, answered everything, gave me a referral to a colleague with a clear explanation of why. Dr. Gavaskar in Chennai: replied himself, the next day, with a clinical opinion I hadn’t asked for because he thought it was relevant to my decision.

That’s what engagement looks like. When you find it, you’ll know. The contrast with everything else will be obvious.