Changes in Medical Care Delivery Systems and the Relationship of Medical Professionals and Patients

, Gook Jin Moon

Original Article

Korean Journal of Legal Medicine 1988;12(1):1-14.

Department of Legal Medicine, Korea University, College of Medicine, Institute of Legal Medicine, Korea University, Seoul, Korea

Abstract

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 sovereignty 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 there of 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: l . 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 ilIness 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 time 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 instruction. 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 ad-