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Korean/American Medical Systems

July 27, 2009

Observations of Korean medicine in contrast with American medicine:

Ever notice that doctor’s visits in Korea tend to be quick, with little waiting? Sort of an in-and-out experience, unless there are extenuating circumstances? Ever wonder why? I’ve got a friend who is a doctor serving with the Republic of Korea Air Force, and I’ve had the good fortune to be able to bounce questions off of him now and again.

There are a couple reasons for this difference. First and foremost, doctors in Korea aren’t compensated by the hour, like they are in the United States. They are paid per patient. Therefore, volume is key to profitablity. In the USA, a doctor will see you, chat with you a bit sometimes, take some extra time to explain your condition, prognosis for treatment, possible treatment options, etc. He or she is getting $300+ an hour no matter how long it takes. In Korea this is not the case. A secondary reason is because like other experts in Korea, doctors are generally not questioned, and patients trust their advice, so it needs no explanation. For example, it is a common experience for me and friends of mine (both citizens and non-citizens) to visit a doctor and be given medication, but not told what the medication is. I’m always told what it is for (e.g. “Take this for the pain.”), but if I don’t ask specifically what it is, I’m not told. This doesn’t seem to bother Koreans. For me, I’m strongly conditioned not to take anything if I don’t know what it is. God forbid I’m rushed to the emergency room for an unrelated accident and the doctor says “Are you currently taking any prescription medication?” and I have to say “Yeah, a little green pill for back pain.”

Because Americans are socialized to be “informed consumers,” and because American doctors are more than willing to inform us about conditions we may have, Americans tend to have a lot more knowledge about the medical specifics of conditions they may be suffering from. Think about a chronic illness you have or someone close to you has. How much do you know about it? I can tell you an awful lot about astrocytoma, a type of brain cancer that someone very close to me had. I know about prognosis, treatment options, the works. I know even more about asthma, as I suffered from it as a child. A Korean friend of mine with asthma just knows to puff the inhaler, although he doesn’t know what’s in it. In contrast, I used an albuterol “rescue” inhaler, and an Advair diskus later when they came out. if I required a hospital visit, a nebulizer was employed. When I was very young (before the nebulizer), I just got epinephrine shots. Why do we know all this? Because we’re socialized to be critical, and to take responsibility for our own health. We’ve got to make sure the doctor knows what he’s doing. Yes, he knows a lot more than me about my condition, but if he prescribes a course of treatment markedly different than another doctor has in the past, I won’t blindly accept that; I’ll want to know why.

Have you noticed that Koreans tend to go to the doctor for every minor symptom, while Americans often will not see a doctor until they’re sure they’ve got worse than a common cold? My guess is that this is because Americans are socialized to handle little medical issues themselves, due to the high cost of a doctor’s visit. With a $20 co-pay (assuming you have insurance) plus more for medication, the illness must justify the cost of a doctor’s visit. That’s easier to do when you’re paying 5,000 won, medication included, for the same visit in Korea.

The last couple times I’ve been to a clinic for treatment of cold/flu symptoms, I’ve been given very short treatments of antibiotics (e.g. 3 days of penicillin). I usually throw them out, because I know that less than7-10 days will likely just cause the flu to become resistant. I asked my doctor-friend about this, and he said “That’s a big problem in Korea. Patients expect medication, and so doctors do not want to disappoint (else they lose customers to other doctors willing to meet patient expectations). There is a major problem with drug-resistant illnesses in Korea for this reason.

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