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[Column] Establish a "50,000 Won for a 15-Minute Initial Visit" SystemPark Jaeyoung's Monotasking
  • By Park Jae-young Executive editor
  • Published 2016.12.22 09:56
  • Updated 2017.02.20 16:50
  • comments 0

The current fee for the first visit to the doctor’s office is 14,000 won and for ensuing visits is 10,000 won at local clinics. The fee increases according to the grade of the hospital, and for the tertiary general hospital, the fees are 17,910 won and 13,880 won respectively. In other words, the initial consultation price is about 29~40% higher than the subsequent treatments. Is that difference adequate?

Obviously, the first visit is more difficult than the second. It also takes more time. If we ignore the difference in difficulty and consider that the price of a second visit is the compensation for a three-minute consultation, the time for the first visit recommended (?) by the government turns out to be about four minutes. A second visit lasting three minutes is ridiculously short, but a four-minute first visit is just unreasonable.

Four minutes is too short to see where and how the patient feels discomfort, check her past medical history and family history, conduct a brief examination, make a diagnosis, carry out necessary tests and prescribe necessary medication, even when done super fast. What if the patient prepared a list of questions? Or perhaps the patient or guardian was exceptionally concerned? Or perhaps the patient had a complicated medical history? It's either one or the other: the doctor suffers losses or the patient is dissatisfied. Naturally, there is no time for a doctor and a patient who meet for the first time to share what feelings they can and build a basic relationship.

In the case of tertiary general hospitals, there are people who come to see the doctor because of a more serious disease, who came a long way, spending more time and money, who are more worried and nervous. If a patient diagnosed with cancer takes four hours to see a famous doctor at a major hospital in Seoul and ends up being pushed out of the doctor's office after a four-minute consultation, does this make sense? There is no way that a rapport can be established between the doctor and patient in this situation. Since they lack dialogue, the number of tests is bound to increase.

Some so-called "successful" doctors of Korean medicine spend 30~45 minutes with a patient on her first visit. That is enough to establish rapport. That time is enough to make someone believe a lie, if one put his mind to it. The patient can say everything and listen to everything. And most importantly, she experiences empathy. Even if the treatment is not effective, the patient does not think that her money was wasted, and even if things go awry, she doesn't think of filing a lawsuit.

It is difficult to eliminate the evils of the 3-minute treatment, which has already established itself as common practice, at once. But couldn't we at least guarantee 15 minutes for the first visit? If the consultation lasts longer than fifteen minutes, then just for the initial visit, couldn't we compensate the doctors with a fee that is about five times that of the second visit? If it is difficult to implement such changes at all hospitals, then how about setting the fee at around 50,000 won for a fifteen-minute first visit, at least for tertiary general hospitals, perhaps just for patients who want such consultations? If it is difficult to implement such measures immediately, then maybe we can try it as one of those common pilot projects.

The average treatment time of doctors in the United States is also growing shorter and shorter. Doctors complain that they don't have enough time to faithfully tend to a patient, but the "not enough time" that they are complaining about is a surprising fifteen minutes. For South Korean doctors fifteen minutes is an enormously long time. It may not be enough to change the world, but perhaps it is enough to provide the basis for a sound doctor-patient relationship.

This may be another story, but to use the short consultation time more efficiently, we should consider ways to take advantage of IT. As technology develops, doctors tend to spend more time looking at the monitor than their patients, and it is interesting that new technology overturning such a trend is being developed.

The venture startup "Augmedix", one of the official partners of Google Glass, recently conducted a clinical study at a hospital in California. They had doctors enter data in the EMR system through Google Glass and a related app while they examined their patients. The result was surprising. The time that the doctor spent struggling with the computer plunged from 50% to 15% of his total working hours, and instead his time spent communicating with the patient soared from 35% to 70%. Such technology can be particularly useful to physicians in South Korea, who have to finish everything in 3-4 minutes.

The 3-minute treatment is the fundamental cause and key result of all distortion in South Korea's medical treatment. We need to find a way to improve the situation even if we have to resort to drastic measures.

editor@docdocdoc.co.kr

<© Korea Biomedical Review, All rights reserved.>

Park Jae-young is Executive Editor of 〈The Korean Doctors‘ Weekly〉. Author, Novelist, MD PhD (health law & medical ethics)

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