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KMID : 0377619900550040270
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Korean Jungang Medical Journal
1990 Volume.55 No. 4 p.270 ~ p.283
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Changes in Medical Care Delivery Systems and the Relationship of Medical Professionals and Patients
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Abstract
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This work dealt the highly sensitive area of the relationship between the medical care providers and patients as an ever changing entity to be considered in the overall practices of medicine. Also discussed was the publication in the United States, `Making Health Care Decision´. The result of the study indicated that allowing the patients to actively participate in the decision making process regarding the selection of physician has now become the accepted mode throughout the world today.
In the past, we were dominated by the so-called concept of medical paternalism where the decisions made by doctors were considered `in accord with the expert opinions of the medical professionals and most helpful to the patient´. But in today´s society where the human rights are actively enhanced and promoted we are now observing the changes taking place wherein the concept of patient sovereignt; is more and more accepted, allowing the patients themselves to make all the decisions in medically related activities. In legal point of view, medical practice is a kind of contract interrelationship between the medical care providers and patients. Particularly in the conduct of medical practices in the high risk cases, the responsibility of doctors to give explanations and obtain consent of the patients becomes so crucial in relation to the issue of so-called unauthorized medical care on the part of physicians. In other words, explanations and consents are considered the utmost in rendering justifiable medical care.
Today in Korea we already are observing all around us increasingly the instances where the concept is playing crucial roles. It appears unlikely that the trend will be stemmed.
We are no longer relying on such high-flung expressions as `the special position of medical practice, benevolent act of medicine, and ethical aspect of medicine´ to ignore all the other aspects.
No medical endeavor can be contemplated unless there are patients to be critical part thereof and participation of medical practitioners who are motivated and willing to help.
To accomplish the goal of the conduct of justifiable medical practices, there must be established a viable system of joint ventures of the patients and doctors founded on mutual respect. In Korea, however, we are still hampered by the solid wall of the predominance of the decision making power of doctors over the patients´ participation therein. This work has been contemplated in the effort to foster the more in-depth understanding of the realities existing and to suggest some innovations in these critical areas:
1. The patients are not to be left blind-folded in the medical decision making. First, before he can make informed decisions, he must be well informed of the status of his illness. The decision must be founded on the principle of providing the care beneficial to the patient. We note quite regrettably that accomplishing this seemingly simple objective is not so easily done in Korea.
Medical practice today is increasingly becoming sophisticated. Uncertainties are prevailing in the practice. Ever increasing technical complexities make it virtually impossible to provide patients with understandable medical information.
At this point, we pause for a moment to ponder upon the realities in Korea in this respect. First we are neither ready nor patient enough to give sufficient time and attention in the hospital for informing and helping patients understand the state of his illness and other related information. This leads patients to become nervous and anxious, meaning that we have failed to perform our inherent duty as medical practitioners. We must, therefore, place our first priority in this area to help patients understand the circumstances he is in.
To assign excessive amount of t me and efforts may give rise to the care of other patients next in line even though we fully realize that this is no excuse for expediency. In this area, we can be well served by the utilization of such high technology assistance as video tapes, slides, and audio tapes. We may also establish the effective system of assigning specialists soley for the purpose of such information services.
2. The active and effective participation of patients in the medical decision making is rather new, revolutionary concept in medical practice. This means that our medical, nursing and other related educational systems must be reshuffled to incorporate these subjects in the curriculum. More emphases should be placed in instructing medical and nursing students on the subjects of legal aspects of medicine and action-oriented in struction. The results of these efforts must be evaluated in the conduct of national certification examinations.
3. Upholding the rights of the patients is not the only key to the solution of all the problems in this area. We must endeavor to seek more realistic and effective means to cope with the issue. It is, therefore, proper to observe a case in the area of foreign country, the United States in this instance. The United States is known to be most advanced in the area of the patients´ rights. In the United States, the proclamation of the patients´ civil and human rights took place in 1972. In ten years, there was established a special Presidential Commission to study the issue, resulting in eastablishing the concept of Making Health Care Decision on the part of the patients. But there also increased the incidences of disputes between the patients and physicians. The informed consents have now become extremely confusing so that a separate commission had to be appointed to settle the controversy.
Under our system in Korea, we are first faced with the overall lack of awareness on the part of doctors due to the much lesser emphases placed on the medical school instructions on the legal aspects of medicine. Therefore, the rights of the patients are often confused.
Accordingly, the first and foremost order of business at this juncture is to sincerely promote the concept of the human rights of the patients in medical school curriculum as well as the information services to disseminate the concept among the general populace, that is, all these prior to the promulgation of the patients´ rights.
Another crucial area to look into for the overall approaches if we are to handle this issue successfully is the issue of medical bureaucracy aside from the other issues between doctors and patients. The bureaucrats in the health field have long taken the attitude of wait and see or hands-off. It no longer is ignored and the health officials in the government must be motivated to fully participate in the movement if it is to be successful.
It is the sincere recommendation of this author that the society as a whole must take up the issue to be its own first priority task rather than taking the secondary role to the effort of simply the doctors and patients.
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