[Reporter’s Notebook] Risk of Overlooking 'Hidden Critical Patients' in Tertiary Hospital Structural Transition

Mr. A, a man in his late 50s working in Seoul, suddenly experienced slurred speech and narrowed vision during work several years ago. He immediately went to the emergency room of the nearest university hospital and fully recovered after receiving emergency treatment for an initial cerebral infarction. Shortly after, he developed bruises on his leg without any impact. At first, he thought it was minor, but after hearing that post-stroke sequelae blood clots might have blocked his deep veins, he returned to the hospital. The doctor said it was a great relief that the clot came before it could travel upward to block cerebral or cardiovascular vessels.

As government resident doctors showed no signs of returning, preparations began for a 'New Normal' pilot project at tertiary hospitals. More than half of the residents’ resignations have been processed, and the government will launch the tertiary hospital structural transition pilot project starting this September. The pilot project focuses on tertiary hospitals concentrating on severe, emergency, and rare patient care led by specialists, while mild cases are referred to primary and secondary hospitals.

The Korean Stroke Society recently pointed out that unless the current patient classification system is changed, most stroke patients will not receive treatment at tertiary hospitals undergoing structural transition under the government’s plan. According to the current classification system, about 80% of stroke patients are categorized as general medical disease groups treated at primary and secondary hospitals.

The plan to reform the referral system through a medical cooperation system is also expected to increase patient inconvenience. A university hospital official in Seoul said, "It is not as easy as it sounds to refer patients upward from primary and secondary hospitals to tertiary hospitals or to transfer them downward." The process requires thorough prior discussion among attending physicians and sharing of medical records, which cannot be completed quickly. The official added, "Already insufficient medical staff will have to handle unnecessary additional tasks, and patients may fail to receive timely treatment."

Patients who fall on the borderline between severe and mild conditions are called 'gray zone patients.' There are concerns that the safety net protecting gray zone patients will disappear under the New Normal medical system. Many stroke or myocardial infarction patients, like Mr. A, experience prodromal symptoms and visit hospitals on their own. When patients come this way, not by ambulance but on foot, it is called a 'walk-in.' If walk-ins to tertiary hospitals are blocked because they appear mild, patients with prodromal symptoms of stroke or myocardial infarction may become more at risk or lose their lives after wandering through smaller hospitals. This raises concerns about a different kind of 'emergency room merry-go-round' harm.

The government’s New Normal pilot project seems to be pushed forward without sufficient consideration of the various risks patients face. In the direction for tertiary hospital structural transition announced by the Medical Reform Special Committee on the 11th, the only preparation for gray zone patients is to "revise severity classification in two stages."

In a public opinion poll last March, 9 out of 10 people supported increasing medical school admissions, but recent surveys show this has dropped to about 6 out of 10. This reflects that the government’s medical reform efforts have not fully satisfied the public. The victims of poorly prepared medical reform are the public and patients. The government must devise reform plans that do not overlook any single patient.

This content was produced with the assistance of AI translation services.