My Korean Medical Adventure

There's a lot to be said for socialized medicine and a national healthcare system. Certainly there's a lot of agreement that everyone should have access to such care. I found out today that this system has its downsides as well. Of course, I'm sure it isn't this way everywhere. It could easily just be Korea...

The story starts on Saturday, when my hockey team ended up at Bone Hospital for x-rays on our defenseman's leg. We'd played a three-game inline tournament in Gwangju, about an hour and a half away, and at the end of our last game a PP situation had gotten a little ugly and led to a fight. Our d-man had someone fall on his leg in the chaos and it was swelling up pretty badly. We didn't want to search for a hospital in Gwangju, so we brought him home to Jeonju. Sure enough, he had a broken fibula. He was x-rayed, diagnosed and casted in under half an hour. I was shocked -- that would take hours at home, especially on a Saturday night! As we were heading to the van, I noticed he had started hopping, keeping his casted leg (just a soft cast, for a couple days because they hadn't determined yet if he needed surgery with all the swelling) above the ground. I inquired about the whereabouts of his crutches. "Oh," said our club president -- a medical student -- matter-of-factly, "the store with the crutches is closed."

So yes, it only takes 30 minutes for your x-rays and the cast on your broken leg, but...come back Monday for the crutches!

So today I reluctantly informed the director at my hagwon that I probably needed to the see the doctor. My knee hadn't shown any improvement in the week I'd had pain (yes, playing three hockey games probably wasn't helpful) and I was afraid that if it got any worse I wouldn't be able to see a doctor over the holiday this week. My director took me to the same hospital - Bone - at around noon. I presented my resident alien card and she told the receptionsist I needed to see the orthopedist. We were told the wait was two or three hours, so I, used to the American referral system, suggested I just see the internist, the general MD, to see if this even warranted an orthopedist. They said no, I should go straight to the specialist. So I went home, and she brought me back later in the afternoon. We were told the wait was 20 or 30 minutes, so while I sat in the reception area, she went back to the hagwon, promising to return (to translate!). Naturally, I was called in 15 minutes later and...no director. (interesting sidenote: Korean names are three syllables. My first name is three syallables. At the hospital, they disregarded my family name entirely and just called me by my first name, Korean-style)

I entered the office and was directed to sit by a nurse. I call her a nurse, but they didn't seem to do any nurse-like things that I'd get at home. I observed other patients while I was waiting, too, and I saw no nurses taking vitals or history. The doctors seemed to do everything. Apparently they aren't quite as qualified here, though of course I don't know what their jobs are up for those who are admitted. The doctor came in, and luckily spoke some English, so we didn't have to wait on my director. Again, no history, no vitals. He did a routine ortho exam on my knee and found no pain except for some tenderness medially and started to tell me it was an MCL sprain, but I gave him history unsolicited and said there'd been no improvement in a week and a half and that it was sharp, medial and anterior pain and that it was acute up and down steps and standing up and sitting down. I have no idea if he understood, but he nodded and sent me to x-ray.

X-ray was also pretty interesting. Now, it's been a couple years since I last had an x-ray, but I don't remember it being quite like this. First of all, the tech stayed in the room and held the machine for two or three shots. Also, I didn't get the lead jacket thingy, which I'm pretty sure I got even for ankle x-rays. But they were very efficient.

I waited another 15 minutes or so and an orthopedic surgeon called me in. My director was back, so I had a sort-of translator, though naturally she doesn't know any remotely medical English words. Again, no history. Another ortho exam where he didn't produce pain, so I had to show him afterwards that it was flexion and extension with resistance that was the problem, and yes there was clicking. But my x-rays were clear, so he said I needed to "strengthen my anterior muscles". This is undoubtedly true, but I told him I'd been diagnosed with patellofemoral syndrome several years ago. I know my knees, they hurt a lot. This is different pain, in a different place, for a longer period of time, and I thought it was a meniscus issue. I was kind of brushed off and told that it was in the patellofemoral joint and "articular cartilage". He also threw the word "lesions" in there, said he'd write a prescription and did I have any questions? ...I didn't. I had no idea what to say at this point.

Now remember, without a history or asking about drug allergies (I don't have any), he gave me a prescription and sent me on my way. This cost 35,000 won -- less than $40. The five-day, three-pill regiment was 7,000 won. Of course, I'm doing my best to look up the pills now and here's what I've found:

MUSKEL: chlorphensin carbamate 250mg - used as a skeletal muscle relaxant. So I guess he did think it was a ligament and was just humoring me? Why else would I get something for strains and sprains?
PRONAGEN: pronase 133mg - anti-inflammatory, although the Google translation of the Korean druginfo page seemed to indicate that it's mainly used for bronchitis, asthma and tuberculosis.
GATT F: aluminum hydroxide 250mg, magnesium carbonate 160mg - this...seems to be an antacid. I am decidedly not a doctor, just an undergraduate human performance major, but reading the Korean druginfo page coupled with another page about the active ingredients really leads me to wonder why I'm on this for a knee problem.

So. Quick and efficient, cheap as hell. No nurse-like people in the ER. Little concern for x-ray radiation. No history, no questions about drug allergies or current conditions. And no explanation of the medication, since he told me he was putting me on only anti-inflammatories. It's true, I'm not a doctor. Maybe it's stupid for me to try to tell the real orthopedist that I think it's a cartilage issue, but then again, it's my knee.

All-in-all, the most frustrating thing about the whole affair, and what gives me a lot more sympathy for American immigrants, is the communication problem. I couldn't tell him exactly was wrong because he didn't understand. I didn't understand what he thought was wrong. So all I really got out of the whole affair was knowledge that my x-rays were clear. Which...for $40 is, I guess, something.

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