• 대한한의학원전학회지
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• 제9권
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• pp.555-652
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• 1996

Up to the present the scholastic achievements in the history of the medical system have been rather scare despite its importance in the Korean History. Hence, this dissertation attempts to examine the significance of the institute in the Korean History, covering the period from the ancient times through the early Chosun-Dynasty. In the ancient times, the medical practice relied primarily upon human instincts and experiences at the same time, shaman's incantations were widely believed to cure diseases, the workings of evil spirits supposedly. For the period from the Old Chosun through Samhan(巫堂), Chinese refugees brought a long medical knowledge and skills of the continent. New Chinese medicine, traditional practices and incantations were generally used at this time. Medicine and the medical system were arranged by the period of the Three Countries(三國時代). No definite record concerning Koguryo remains now. As for Paekje, however, history shows that they set up the system under the Chinese influence, assigning medical posts such as Euibaksa(medical doctor), Chaeyaksa(pharmacist), and Jukeumsa(medicine man) within Yakbu(department of medicine). Scientifically advanced, they sent experts to Japan, giving a tremendous influence on the development of the science on ancient Japan. After the unification of the three countries, Shilla had their own system after the model of Dang(唐). This system of the Unified Shilla was continued down to Koryo and became the backbone of the future ones. In the ancient time religion and medicine were closely related. The curative function of the shaman was absolute. Buddhism played a notable part in medical practice, too, producing numerous medical monks. The medical system of Koryo followed the model of Dang with some borrowings from Song(宋). Sangyakkuk(尙藥局) was to deal exclusively with the diseases of the monarch whereas Taeeuigam(太醫監) was the central office to handle the national medical administration and the qualification test and education for doctors. In addition, Dongsodaebiwon(東西大悲院), Jewibo(濟危寶), and Hyeminkuk(惠民局) were public hospitals for the people, and a few aristocrats practiced medicine privately. In 987, the 6th year of Songjong(成宗), local medical operations were installed for curing the sick and educating medical students. Later Hyonjong(顯宗), established Yakjom(clinics, 藥店) throughout the country and officials were sent there to see patients. Foreign experts, mainly from Song, were invited frequently to deliver their advanced technology, and contributed to the great progress of the science in Korea. Medical officials were equipped with better land and salary than others, enjoying appropriate social respect. Koryo exchanged doctors, medicine and books mainly with Song, but also had substantial interrelations with Yuan(元), Ming(明), Kitan(契丹), Yojin(女眞), and Japan. Among them, however, Song was most influential to the development of medicine in Koryo. During Koryo Dynasty Buddhism, the national religion at the time, exercised bigger effect on medicine than in any other period. By conducting national ceremonies and public rituals to cure diseases, Taoism also affected the way people regarded illness. Curative shamanism was still in practice as well. These religious practices, however, were now engaged only when medication was already in use or when medicine could not held not help any more. The advanced medical system of Koryo were handed down to Chosun and served the basis for further progress. Hence, then played well the role to connect the ancient medicine and the modern one. The early Chosun followed and systemized the scientific and technical achievement in medicine during the Koryo Dynasty, and furthermore, founded the basis of the future developments. Especially the 70 years approximately from the reign of Sejong(世宗) to that of Songjong(成宗) withnessed a termendous progress in the field with the reestablishment of the medical system. The functions of the three medical institute Naeeuiwon(內醫院), Joneuigam(典醫監), Hyeminkuk(惠民局) were expanded. The second, particualy, not only systemized all the medical practices of the whole nation, but also grew and distributed domestic medicaments which had been continually developed since the late Koryo period. In addition, Hyeminso(惠民局, Hwarinwon(活人院)) and Jesaenwon(濟生院)(later merged to the first) played certain parts in the curing illness. Despite the active medical education in the capital and the country, the results were not substantial, for the aristocracy avoided the profession due to the social prejudice against technicians including medical docotors. During the early Chosun-Dynasty, the science was divided into Chimgueui (acupuncturist), Naryogeui(specialist in scrofula) and Chijongeui (specialist in boil). For the textbooks, those for the qualification exam were used, including several written by the natives. With the introduction on Neoconfucianism(性理學) which reinforced sexual segregation, female doctors appeared for the female patients who refused to be seen by male doctors. This system first appeared in 1406, the sixth year of Taejong(太宗), but finally set up during the reign of Sejong. As slaves to the offices, the lowest class, female doctors drew no respect. However, this is still significant in the aspect of women's participation in society. They were precedents of midwives. Medical officials were selected through the civil exam and a special test. Those who passed exams were given temporary jobs and took permanent posts later. At that time the test score, the work experience and the performance record of the prospective doctor were all taken into consideration, for it was a specialized office. Most doctors were given posts that changed every six months, and therefore had fewer chances for a goverment office than the aristocracy. At the beginning the social status of those in medicine was not that low, but with the prejudice gradully rising among the aristocracy, it became generally agreed to belong to the upper-middle technician class. Dealing with life, however, they received social respect and courtesy from the public. Sometimes they collected wealth with their skills. They kept improving techniques and finally came to take an important share in modernization process during the late Chosun-Dynasty.

• 의료법학
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• 제22권1호
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• pp.3-23
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• 2021

원격의료는 원격지에서 영상, 통화 등 기기를 사용하여 환자를 진단, 치료하는 의료의 한 분야이다. 환자를 대면하여 진단, 치료, 처방하는 전통적인 방식에서 벗어나, 원격에 있는 환자에게 의료를 제공하기 때문에, 의료 소외 지역, 거동이 불편한 환자에 도움이 될 것이고, 의사들은 공간적 제약을 벗어나 환자를 볼 수 있다는 장점이 있다. 하지만 의사가 환자를 대면 진료하는 것에 비하면, 진료의 질이 떨어지는 문제가 나타날 수 있어서, 허용 여부와 한계를 정하는 것도 필요하다. 원격의료 유형 중에서 의사가 환자를 원격에서 진료하고 처방전을 발행하는 것을 원격진료라고 정의할 수 있는데, 현행 의료법상 허용되는지에 대하여 법 해석이 일관되지 못하고 있다. 의료법 처방전 조항은 의사의 '진찰' 또는 '직접 진찰' 규정에 의하여 처방전을 발급한다고 규정하고 있는데, 이것을 대면 진료를 요구하는 규정이라고 해석하는 헌법재판소 결정과 일정한 제한 하에서 전화 처방을 인정할 수 있다는 대법원 판결이 대립하고 있다. 또한 의료법상 원격의료 규정에 의하여 명백하게 법상 허용되는 원격의료자문 외에 의사 환자 간 원격진료는 불법이라는 대법원 판결이 있다. 본 논문에서는 의료법 개정 연혁, 개정 이유 및 관련 의료법 조항과의 관련성을 통하여 원격진료에 대한 대법원 판례를 해석하고자 한다. 결론적으로 의료법상 처방전 규정에 의한, 의사의 직접 진찰 후, 처방전 발급 조항은 환자를 진찰한 의사가 처방전을 발급해야 한다는 처방전 발급 명의에 관한 의무 조항으로 해석하며, 의료법 원격의료 규정에 의하여 의사-환자 간 원격진료는 허용되지 않은 것으로 판단한다.

• 대한예방한의학회지
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• 제17권3호
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• pp.115-128
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• 2013

Objectives : This study was aimed to investigate burn out degree of K.M.D.s(Korean medicine doctors) who work at convalescent hospitals and to find contributional factors for the result. The relationship between burn out and job performance was also studied. Methods : 77 K.M.D.s(Male 49(63.6%), Female 28(36.4%)) participated in this survey that has 62 main questions about burn out, job performance, job environment and Social demographic characteristics. Survey was conducted from 19th Aug. 2013 to 6th Nov. 2013. Results : Average of burn out degree of K.M.D.s was 2.62 out of 5. Emotional exhaustion was highest (2.80) and depersonalization was lowest(2.20) among subordinate concepts of burn out. Work place location and average income of the subjective which are subordinate concepts of social demographic characteristics showed significant correlation with job performance. Role conflict, relation of co-worker, workload were significant factors for emotional exhaustion and meaning of the job, will of patient, challenge were significant factors for lack of feeling of accomplishment by multiple regression analysis. Relation of co-worker, aggression of patient and meaning of the job were also significant factors for depersonalization. Conclusion : Emotional exhaustion and lack of feeling of accomplishment among subordinate concepts of burn out were high in the subjective who participated this study. Significant factors that contribute to burn out of this study, shows different result compare to the studies that show other factors contribute to burn out who works at convalescent hospital or other place.

• Clinical and Experimental Reproductive Medicine
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• 제44권4호
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• pp.181-186
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• 2017

With advances in the methods of cancer treatment used in modern medicine, the number of breast cancer survivors has been consistently rising. As the number of women who wish to become pregnant after being diagnosed with breast cancer increases, it is necessary to consider fertility preservation in these patients. However, medical doctors may be unaware of the importance of fertility preservation among cancer patients because most patients do not share their concerns about fertility with their doctors. Considering the time spent choosing and undergoing treatment, an early referral to a reproductive specialist is the best way to prevent a delay in cancer treatment. Since it is not easy to make decisions on matters related to cancer diagnosis and fertility, patients should be provided with enough time for decision-making, and to allow for this, an early referral will provide patients with sufficient time to choose an appropriate method of fertility preservation. The currently available options of fertility preservation for patients with breast cancer include cryopreservation of embryos, oocytes, and ovarian tissue and gonadotropin-releasing hormone agonist treatment before and during chemotherapy. An appropriate method of fertility preservation must be selected through consultations between individual patients and health professionals and analyses of the pros and cons of different options.

• 동의생리병리학회지
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• 제24권6호
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• pp.1077-1081
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• 2010

In this work, we report the diagnostic relations among some primary pulse conditions such as the floating/sunken, deficient/forceful, large/fine, and the long/short pulses. For this purpose, we carried out a clinical test, in which 11 Oriental medical doctors had participated to diagnose the pulses for 1566 healthy subjects. The subjects were divided into 11 subgroups and each subgroup was allocated to an individual doctor. It resulted in that, for 847 subjects (54%), two or more than two pulse conditions were felt simultaneously, for which we counted the frequency of the pairs of the pulse conditions. For the statistical analysis, we used a Chi-square test. As a result, at high frequency, the forceful, large, and the long pulses were diagnosed in pairs or in their triplet, and a similar close relation was found between the deficient, fine, and the short pulses. The pairwise diagnoses of the pulse conditions between the forceful, large, and the long pulses, and between the deficient, fine, and the short pulses imply their close relatedness in clinics. This result is supported by the theory of deficiency/excess syndromes. Moreover, we show that the close relatedness among the pulse conditions can be understood in terms of the geometric features of the radial artery near the prominent bone. This is the first work which reports the relatedness between the primary pulses by an objective clinical test.

• 한국의사학회지
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• 제25권2호
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• pp.155-193
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• 2012

From the part "歷代醫學姓氏(Historic Doctors)" in "醫林撮要(Uirimchualyo)", the following has been noticed and concluded. 1. Because acupuncture was originated from stony needle, the word "石(sok)" contains the meaning of needle, and from this point on, words like 石(sok), 砭石(pyumsok), 箴石(Jamsok), 鑱石(Chamsok) had been derived. 2. The word 砭石(pyumsok) used in "Hwangjenaekyong(Yellow Emperor's Canon of Medicine or Hwangdineijing)" should be interpreted as acupuncture in a verb form, not a noun form. 3. 鑱石(Chamsok) or 鑱鍼(Chamchim) was used for surgical treatment for tumor, by cutting open tumors and pressing the pus out. Therefore, 砭石(pyumsok), 鑱石(Chamsok) are the same kind of needles, and 鑱鍼(Chamchim) is the tool improved from 鑱石(Chamsok) used in the Bronze Age. 4. Kwakpak put a note on 鑱石(Chamsok) in "山海經(Sanhaekyong)" that reads "it is defined as 砥鍼(Jichim) and treats tumor." This let us know the shape of 石(sok), 砭石(pyumsok), 鑱(Chamsok), 鑱鍼(Chamchim), and the stone that can be used as a surgical tool with slim & sharp shape is obsidian. 5. Because obsidian is only found around Mt. Baekdu and limited area in South Korea & Japan in Asia, it is closely related with the life & medical environment of the tribe "Mt. Baekdu". 6. The development of 鑱鍼(Chamchim) was influenced by surgical treatment used in early stage of civilization, and its origin is traced upto Gochosun dynasty. Korea's own traditional medical knowledge is derived from this surgical treatment skill. 7. Because the acupuncture is originated from Gochosun dynasty, 鍼(chim) was derived from 箴(Jam) of 箴石(Jamsok), 䥠(Chim) & 䥠(Chim) both were used for a time being, and finally settled into 鍼(Chim). 8. The word 針(Chim) showed up at Myung dynasty, and started to be used in Korea from early Chosun dynasty. 9. In the early Chosun dynasty, 鍼(Chim) was used for medical term, and 針(Chim) for non-medical term. In the mid Chosun dynasty, 針(Chim) was used as a term for tool, and 鍼(Chim) as a term for acupunctural medical treatment. 10. Under the order of King Sunjo, Dr. Yesoo Yang published "醫林撮要(Uirimchualyo)", added "醫林撮要續集(Sequel to Uirimchualyo)", and added "歷代醫學姓氏(Historic Doctors)" again which eventually made totally 13 books of "醫林撮要(Uirimchualyo)". In addition, many parts of "醫林撮要續集(Sequel to Uirimchualyo)" were quoted in "東醫寶鑑(Donguibogam)", and influenced much in publishing "Donguibogam". 11. In "歷代醫學姓氏(Historic Doctors)" of "醫林撮要(Uirimchualyo)", the same way in "Donguibogam", referred to 針(Chim) as a term for a needle, and 鍼(Chim) as a term for Acupuncture. 12. From the usage of 針(Chim) & 鍼(Chim), shown in "鄕藥集成方(Hyangyakjipsungbang)", "醫林撮要(Uirimchualyo)" and "東醫寶鑑(Donguibogam)", we can notice the spirit of doctors who tried to take over the legitimacy of Korean tradition, and their elaboration & historical view that expresses confidence on our own medical technology, through the wording 鍼(Chim).

• 대한예방한의학회지
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• 제17권2호
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• pp.105-127
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• 2013

Objectives : We examined the use of the moxibustion through survey on Korean Medicine Doctors (KMDs) on preparation of universal moxa product standard by fully reflecting opinions of practitioners and the industry. Methods : The questionnaire is composed of 25 questions including use of indirect moxa, side effects, complaints and improvements, general characteristics and so on, and were responded by 1,588 KMDs. For statistics, frequency analysis, chi-square analysis, T-test and ANOVA were conducted using SPSS 12.0 for windows, and the significance level was 0.05. Results : In this research, 91% of the responded KMDs was using moxibustion, and the proportion of using mediate moxibustion was shown as 63.2%. They used mediate moxibustion for side effects of direct moxa method such as risk of burn, ease of use, control of stimulation and so on. And it was mostly being conducted to women and 40 ages. Most respondents gave moxibustion treatments for the purpose of thermal stimulation on acupoint to musculoskeletal diseases. Most respondents were treating 1~2 pieces of moxibustion to patients by moxibustion points to those of 1~2 regions every time within 10 minutes. Regarding the frequency of side effects of mediate moxibustion, within 3% of respondents had experienced side effects, and the types were burn, flare and itchiness, odor and smoke. The dissatisfaction of mediate moxibustion products was moderate(2.00 out of 5 point scale), and went up public health doctors, the younger ages and the shorter clinical experience. Complaints on mediate moxibustion products were serious odor, poor attachment, risk of burn etc. Regarding ways to improve mediate moxibustion, the expansion of moxibustion's insurance cost carne out highest, followed by preparation of manual on efficacy, strengthening of training, acquiring evidence on efficacy, diversification of specifications, safety improvement, quality improvement of mediate moxibustion products. Conclusions: Many KMDs use for ease of use and give moxibustion treatments for thermal stimulation but they complain about safety, efficacy and quality of mediate moxibustion. After this it is considered that we have to elevate therapeutic effect through the improvement of mediate moxibustion products.

• 대한수사과학회지
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• 제1권2호
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• pp.44-56
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• 2006

The reform necessity of medicolegal death investigation system is continuously issued. The problems from the current death investigation system are discussed, specially on the professionalism of the involved personnel such as policemen, doctors, prosecutors. Death investigation exists not only to prosecute the criminals but also primarily to protect the general public's health, safety, and welfare. The reform proposals of death investigation system are followed as below. Statutes require that the prosecutor be notified of certain deaths. All deaths that may reasonably result from anything other than natural disease should be investigated. A death certificate is a legal document which authenticate a death, therefore it is issued by the doctor. The postmortem examination must be rearranged on the university base and performed by the qualified doctors who are trained at least in pathology. The police officer specified in death investigation and forensic identification should be encouraged to keep doing their special work in many ways.

• 한국의료질향상학회지
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• 제10권1호
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• pp.20-27
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• 2003

Background : The doctors' strike was not only a manmade disaster but also a chance to apply a new pattern of emergency medical service for patients. We hope to propose a new pattern of emergency medical service by comparing the patterns of emergency medical service given by resident and staff during the doctors' strike. Methods : We reviewed the medical records of patients who received emergency medical service in the Emergency Department(ED) of Deagu Catholic University Hospital during 3 days a week prior to the residents' strike (July 21-23, 2000) with those of patients receiving emergency medical service during the first 3 days of the residents' strike (July 28-30, 2000). We evaluated the patient's severity, the cause of the ED visit, the performance on the laboratory study, ECG, and radiological study, the disposition, and the length of ED stay. Also, we compared the collected data by presenting doctor and by patient's severity. Results : The staff performed fewer tests admitted fewer emergent and non-emergent patients than the residents. Also, the length of ED stay was shorter in both the emergent (212.76 vs. 321.40 minutes) and the non-emergent groups (117.68 vs. 171.39 minutes) for patients presenting to staff. Conclusion : It is desirable that emergency medical service is given by staff, not by resident.

• 의학교육논단
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• 제15권1호
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• pp.19-24
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• 2013

In medicine, rapid changes in information, technology, socio-economic interests, and globalization affect the medical education focused on the competencies of doctors, and the number of medical schools that are adopting an outcome-based curriculum (OBC) is increasing worldwide. This paper introduces the OBC model of 5 trailblazing medical schools from the UK, US, and Australia, comparing their unique features, followed by brief comment about Canada and the EU as well. On developing an OBC, the process of establishing the top outcomes for graduates is similar and the outcomes comprise knowledge, skills, and attitudes about science, patients, colleagues, society, and themselves. Implementing the outcomes down into the sub-levels of the curriculum is much more complicated and time-consuming. Assessing the achievement of every outcome is essential and requires the use of many tools in addition to the traditional written examination. From the perspective of adult learning theory, self-directed learning, team-learning, and individual and flexible achievement are tested and executed in an OBC. The gradual expansion and further innovation of an OBC is expected so that tomorrow's doctors will be able to meet the challenges of the future.