Strategies for Development of Hospice Reimbursement

In the last few moments of life before death, a more adequate health care system must be established in order for suffering patients to have their dignity respected. To this point, Korea's health care system does not possess additional health insurance reimbursement covering hospice care. Until recently, the existing fee for service system consists of an informal hospice care service that has been developed and supplied. Due to society's increasing expectation of hospice reimbursement in regard to development and in reality, progression is currently being undertaken which we have welcomed. However, there has been a tendency for over expectation in financial reduction by hospice reimbursement introduction in which there were evidence from cases in other nations. In practice, supplementation of per diem type of hospice coverage will be the mainstream and fee for service in some areas must be explored in order to compensate for the negative aspects of per diem type of hospice coverage.

PAP Smear-screening in Primary Care Women Physicians and Its Influence on Patients

BACKGROUND: PAP smear has been highly appraised for screening cervical cancer. Generally regarded is that women physicians regularly screen for PAP would promote patients' early detection and treatment rate by their strong recommendation. Hereby we investigated PAP-screening in primary care women physicians, recommending proportion and associated factors. METHODS: Questionnaires were sent to 981 members of the Korean Academy of Family Medicine, Korean Association of Family Practitioners, Korean Medical Women's Association, and Songpa-gu and Kangdong-gu family practitioners. a total of 193 respondents was analyzed. RESULTS: Among the total 55.4% of the respondents screened for PAP smear regularly, either annually (23.9%), or from their treating gynecologists (61.6%) or through routine check-up (81.1%). Common reasons for not screening were lack of time (40.7%) and forgetfulness (38.4%). Recommending proportion for PAP to patients was 49.2%. Reasons for not recommending were lack of equipment, forgetfulness (18.8% each). Confidence of PAP as a screening test was very high (71.5%); significantly related to PAP-screening and to recommending proportion (P=0.033, P=0.005, respectively). Many of the respondents thought physician's own PAP-screening affected its recommendation (45.3%), whereas significant relation to their actual PAP-screening was not found (P=0.845). PAP-screening in physicians showed no significant relationship with recommending proportion (P=0.053). Internal disease history had meaningful relation only with recommending proportion (P=0.001). CONCLUSION: Though physicians show strong confidence in PAP and undergo more than the general public, most do not screen for it regularly and the recommending proportion was low. To improve physician's PAP-screening and recommending proportion, re-education of physicians and provision of proper clinical equipment are required.

The Development of a Pre-medical Curriculum for a Service Learning Program and the Post-implementation Evaluation / 한국의학교육

PURPOSE: This paper reports on the development a program to foster 'good doctors' who care for their patients with humanism and self-directed learning ability. METHODS: In order to develop the program, Korea University College of Medicine established educational committees. In collaboration, these committees discussed the direction for curriculum reorganization, performed a needs analysis of specified programs, and built realistic strategies for program management. Based upon the needs analyses, through literature review and survey studies, committee discussions and benchmarking of other medical schools, three programs were developed for rearing humanism and self-directed learning ability in medical students were developed: Service learning by experiential learning; Doctoring by small group activities; and Communication skills program by various small group activities. RESULTS: The evaluation by the pre-medical students who participated in the service learning program for one week reveals that through service learning, pre-medical students had an opportunity to obtain the attitudes that encompass the sanctity and dignity of human life and an understanding of cultural, social and religious customs and beliefs that differ from his or her own. In addition, the pre-medical students came to realize that patients' most difficult problems might be caused by non-medical factors as well as medical factors. CONCLUSION: It is needed to grope for the way that leads the active participation of students in the continuous linkage of substantial post-work evaluation and next learning of volunteering in order to make the program of educating the public spirit more than self-learning of experience.

Teaching 'Breaking Bad News' Based on SPIKES Protocol during Family Medicine Clerkship / 한국의학교육

PURPOSE: We taught medical students how to break bad news to medical students using the SPIKES protocol and investigated its efficacy. METHODS: After developing the program, we taught the 16 medical students doing their family medicine rotation. We surveyed their self-reported performance prior to the teaching and their satisfaction and change in confidence level after the teaching. Using standardized patients(SP), we also analyzed the difference in clinical performance between educated and non-educated groups. RESULTS: Students were satisfied with the education program and 12 students showed increased confidence levels. However, there was no difference in clinical performance between eduated and non-educated group, even after categorization of the exam. CONCLUSION: Self-confidence for delivering bad news increased but there was no evidence of improvement in clinical performance. Communication skills training should be repeatedly performed in each medical educational curriculum.

Family Physician's Knowledge of and Attitude towards Spouse Abuse in Korea

BACKGROUND: The primary physician may be the first or the only professional who may come in contact with victims of spouse abuse. But little is known about family physician's knowledge of and attitude towards spouse abuse in Korea. Therefore, this study was conducted. METHODS: We selected 191 doctors from the participants of the 2003 annual meeting of the Korean Academy of Family Medicine (KAFM). We distributed a 5 paged questionnaire them to fillout and analyzed 125 cases among them. The questionnaire included social demographic characteristics, individual knowledge of and attitudes toword spouse abuse, individual practice experience, education and training experience, and others. RESULTS: We found a significant relationship between doctor's knowledge of spouse abuse and intervention after coming in contact with the victim. Also, this study showed that 31.8% of doctors intervened and traced the spouse abuse cases actively after physical treatment of victims, but none of the cases were reported to the police. Among the total 64.7% of the doctors explained that they did not want to intervene because they were afraid of getting involved in a legal situation. Some of the doctors who had prior educational experience concerning spouse abuse showed very significant high rate of actual intervention (P=0.0112). CONCLUSION: The more educational experience on spouse violence the doctors had, the more active intervention they showed. Therefore, we need to intensify the practical educational program along with the training medical program targeting medical practitioners. Of course we need to reguest sacrifice from doctors based on moral principles, but we also need systemic aid and reform to legal system to minimize burden to doctors.