Gangjin, my hometown on the south coast, has no ob-gyn clinic in the entire county with a population of 40,000. For years, the county office has unsuccessfully tried to recruit a doctor to open a maternity facility in the main town, offering a decent salary as well as a furnished space for free use. No qualified doctor has applied.

Residents have cars, so they can take their wives to the cities of Gwangju or Mokpo for checkups and delivery. But women fear an emergency, and fatalities from pregnancy toxemia have been reported. The 21st-century Korea has many things distributed unevenly; quality health care is a most vexing example.

In Seoul and other large cities, there is an overabundance of medical services, both in demand and supply. Boasting an early establishment of the universal health insurance system, which is not available even in some wealthier nations, the Republic of Korea is supposed to be a medically advanced nation. But my recent experience with a swollen little finger reveals a complex problem.

For a few years I have had psoriasis, a kind of skin disorder which troubles about 1 percent of the population in Korea and elsewhere. Small round patches of non-contagious inflammation appear on the legs and arms. In a public health lecture at Samsung Medical Center, I learned that psoriasis can cause arthritis in the hands and feet.

One morning, I felt pain at the tip of the little finger in my right hand and the top joint looked swollen a bit. That symptom seemed to worsen as days passed. What I had heard at the health lecture led me to suspect arthritis in the finger. I visited the Gangnam Severance Hospital near my home where I had been treated for psoriasis, getting prescriptions for ointments or taking phototherapy.

After checking my hand, the dermatologist at the hospital referred me to the department of rheumatism. The rheumatism specialist examined my little finger and opined that it could be a simple case of degenerative arthritis. He prescribed anti-inflammatory and pain-relieving drugs, but he said I still needed an assortment of tests to ensure correct diagnosis.

The nurse guided me to places for blood, urine and DNA tests and the X-ray section. I understood blood and urine tests are naturally required for most hospital visitors, but I wondered why the DNA test was necessary. Knowing the patient’s genetic profile may help giving customized treatment for any disease. Still, I was hardly convinced that my genetic predisposition should be determined first to identify the cause of the trouble at the tip of my little finger.

So I asked the nurse if I could skip the DNA test this time. She went back to the doctor who was busy seeing the next patient after me and returned to tell me that he permitted the omission but he would require it when the results of other tests indicated a more complicated case. At the X-ray room they photographed not only my hands but the entire body from the waist up.

The pain in the little finger somehow disappeared and the swell was flattened though not completely after I took the tablets for a few days. When I went to see the doctor at the rheumatism department again two weeks later, he reported to me that the test results were “good.” My case was a “degenerative disorder” as he had initially suspected. The doctor wrote prescriptions for me and made an appointment for some time three months later.

Leaving the hospital, I did not go to the pharmacy to get drugs. I was relieved that it was not a complicated disease that would require a DNA test, but I still felt uncomfortable. Couldn’t the doctor with so much expertise to serve as the specialist in one of Korea’s leading hospitals have determined a simple case of common degenerative symptom when he first checked me? How indispensible were the blood, urine and (skipped) DNA tests and the X-ray photographs of my spine as well as those of my hands?

The tests cost me 140,000 won ($130) and a little less to the National Health Insurance Corp. If I had taken the DNA test, it alone could have cost another 150,000 won or so for me and the NHIC each. I have no sufficient ground to call it a case of excessive treatment and had actually been impressed by the kindness of the doctor and the nurse. And, even if it were a bad practice, I certainly am partially responsible for having gone to the Class-1 general hospital instead of a neighborhood clinic with the ailment in my tiny little finger.

And it may be unfair to extend my experience to wider situations. But hospitals these days are generally suspected of being inclined to require costly tests for their patients after competitively installing expensive machines. Health-sensitive people who can afford the cost would comply and they would not complain if the test results were “good” or any disease was detected early thanks to the machine. Doctors are increasingly dependent on machines rather than their own sense and knowledge, as the former guarantee less professional liability.

We are constantly told of the weak national health insurance finance and the need to increase the individual premiums in order to keep the system afloat. Yet, as hospitals make large investments in mechanical facilities as technologies advance, to introduce CT, MRI and PET systems, for example, patients have to pay more and, eventually, the burden grows to the insurance finance.

Popular belief hardens these days that doctors recommend expensive tests and operations to help their employers make more money or to enrich themselves. The proof may be that 200,000 Koreans undergo spinal surgery each year, the expensive PET-CT is generally used for cancer screening and a DNA test is prescribed for a sore little finger. And, it is so much disheartening to know that when 800,000 Koreans receive plastic surgery each year, the poor women in my hometown have to travel 80 kilometers to ob-gyn clinics in Gwangju when in labor. 

By Kim Myong-sik
 
Kim Myong-sik is a former editorial writer of The Korea Herald. ― Ed.