필수의료의 위기와 의학전문직업성
Critical Care Crisis and Medical Professionalism
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한국의료에 대한 우려가 깊다. 응급실에, 수술실에, 중환자실에, 지방병원에 사람 살릴 의사들이 사라지고 있다. 소위 ‘필수의료’가 뿌리채 흔들리고 있는 것이다. 그 와중에 의료 전문직업성은 실종 위기에 있다. 문제의 원인을 의사 개인에게 돌리는 것은 적절치 않아 보인다. 의사 이전에 사람인 개개인이사명감보다 삶의 질을 선택하는 것만 탓할 수는 없다. 현장의 의료진뿐 아니라 환자, 시민단체, 언론과정치권도 문제의 심각성을 인식하기 시작하였다. 본 고는 중병이 든 한국의료를 증상과 증후, 병태생리와 진단, 그리고 치료의 단계로 나누어 고찰해 보았다. 한국 의료의 위기는 철학 없는 보건의료정책의불합리성, 사명감보다는 삶의 질을 택한 의사들, 대형병원의 확장으로 인한 의료전달체계의 붕괴, 실손보험으로 인한 환자와 의사들의 도덕적 해이 때문이라는 진단을 내려 보았다. 한국의료를 살릴 처방으로는 수가냐 정원이냐의 근시안적 논의에서 벗어나, 환자-의사 간 믿음의 회복, 전문직업성의 고양, 규범윤리를 넘어 긍정윤리로의 전환을 고려한 시스템 구축을 제안하였다.
Abstract
There are deep concerns about Korean medical care. It is becoming difficult to find doctor who save life inemergency rooms, operating rooms, intensive care units, and rural hospitals. The so-called ‘critical care’ is shakingin its roots. In the meantime, medical professionalism has lost its way. It does not seem appropriate to attribute thecause of the problem to individual doctors. It is not reprehensible for individuals, who are people before doctors,to choose quality of life over a sense of duty. Not only medical staff on site, but also patients, civic groups, media,and politicians began to recognize the seriousness of the problem. This article examines Korean medical care forserious illnesses by dividing them into ‘symptom and sign’, ‘pathophysiology and diagnosis’, and treatment stages. It was diagnosed that the crisis in Korean medical care was due to the irrationality of philosophyless health carepolicies, doctors choosing work-life balance over a sense of duty, the collapse of the medical delivery system due tothe expansion of large hospitals, and the moral hazard of patients and doctors due to private medical insurance. Asa prescription to save Korean medicine, it was proposed to break away from the short-sighted discussion of ‘costvs capacity’ and build a system that takes into account the restoration of trust between patients and doctors, theenhancement of professionalism, and the transition from normative ethics to positive ethics.
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