The collapse of trust: South Korea’s true health care crisis


The South Korean government is seeking to have its first talks with doctors who have walked off the job in protest of a plan to increase slots of medical schools, as a deadline looms for them to return to work or face punishment. — Bloomberg

“DOCTOR, are you going on a strike too? Then how should I receive treatment from now on? I have respected doctors all this time, but I was so surprised and disappointed to see doctors leaving their patients behind to strike,” a patient receiving treatment for panic disorder asked me.

Up until now, the patient and I have had a solid mutual trust relationship. If the task were merely about fixing machines, knowledge and skills would suffice. However, the subject of medical art is not a machine but a person. To treat the human body and mind, mutual trust is more important than knowledge and skills. Such trust is called rapport.

Good rapport leads to better treatment outcomes, while poor rapport slows down treatment and causes unnecessary misunderstandings and disputes. Doctors, who know this all too well, are leaving their patients behind, resigning and leaving hospitals in South Korea.

This tragic situation has been caused by the government’s unilateral announcement of plans to increase medical school enrolment. Korea operates a universal health insurance system, known as the National Health Insurance Service, which allows anyone to receive quality medical services. However, recent struggles – such as regional imbalances in the number of doctors and their avoidance of high-risk areas due to unreasonable medical accident lawsuits and extremely low medical fees – have emerged.

On Feb 6, 2024, the government suddenly announced an increase in medical school admissions from the current 3,058 to 5,058 starting next year.

The government pushed through policies forcefully without sufficient consultation with the medical community, detailed preliminary investigations or concrete plans, causing doctors to be engulfed in shock and anger and take to the streets to condemn the government.

In the media, government and medical community representatives engage in heated debates about whether there is a shortage of doctors or not. However, what is truly important is not the conclusion but the process.

The government, in announcing policies that will determine the health and life of the nation, has ignored the democratic process of respecting diverse opinions, listening and reaching consensus through discussion, instead pushing forward with authoritarian commands. A coercive policy without mutual trust cannot be persuasive.

Whenever a crisis has hit the nation, medical professionals have dedicated themselves to the people. Even during the coronavirus pandemic, doctors who put aside their own safety and benefits, sacrificing themselves to serve, allowed South Korea to be praised worldwide as a leading nation in Covid-19 prevention. The government, which has closed its ears to the voices of doctors who have built up public trust, fails in forming a rapport, receiving a failing mark.

The strong commands of national leaders, which ignore the painstaking process of persuasion, may seem at first glance like swift and efficient solutions. However, what remains afterwards is the retreat of human rights and democracy, mutual distrust and social conflict.

If improvement is desired, building trust is the priority. Destroying trust is easy, but restoring it is difficult. No matter how much health policy is improved, the doctor-patient trust relationship damaged this time will not easily recover.

Without trust, complete treatment cannot be achieved. The trust relationship between doctors and the government is in a more deplorable state, with no visible way to mend it.

Both the doctor treating patients and the government enacting policies need to prioritise listening ears over commanding mouths. Listening, understanding and empathy are the most important fundamentals in both medical treatment and democratic governance. — The Korea Herald/ANN

Chung Chan-seung, a psychiatrist, serves as director of the social responsibility committee of the Korean Neuropsychiatric Association. The views expressed here are his own.

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