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Queen’s Park Women’s Hospital Director Choi Jinseok Says You Cannot Run Ob/Gyn Hospital without ‘Sense of Duty and Responsibility’… and Medical Fee Needs to Be Improved Urgently

by Lee Sang Chul | Report entered on 11 Nov. 2020 [09:17 a.m.]

【Whosaeng Shinbo】 The obstetrics and gynecology (ob/gyn) used to be the most popular department of medicine, and only the best students in medical schools could apply for it. However, the past has gone with its all glory now, with the area ‘avoided’ by students, and it is getting harder to find any applicant. Medical school students do not want to apply for the area because of the excessively low medical fee and especially the high risk of medical accidents. The Korean government is supporting the ob/gyn area very well, but the situation is not good at the moment. The Republic of Korea has become the country with the least new babies in the world, and in particular, overseas studies are being released saying the nation of the Republic of Korea could not even exist in some hundreds of years from now. Under such circumstances, we met with Queen’s Park Women’s Hospital Director Choi Jinseok who is running the ob/gyn hospital based on his sense of duty and responsibility as a doctor in Busan. We exchanged opinions with him about the current status of his hospital and its management, the goals of the hospital and himself, and plans for institutional improvements necessary for the women’s hospitals. Especially, Director Choi has in earnest introduced the ‘Revo-i’ of meerecompany developed only by pure Korean technology in the area of robotic surgical system which is currently represented by the Da Vinci. Let’s listen to what he has to say about the background for introducing the ‘Revo-i’ and the possibility to develop from here on.

Q. Please introduce Queen’s Park Women’s Hospital.

A. Queen’s Park Women’s Hospital is acknowledged as the most advanced hospital in obstetrics in Busan.

Because of the lowered birth rate, the market of obstetrics is shrinking, but obstetrics is unavoidable to an ob/gyn.

I think now is the time that needs diversified treatment areas in the whole scope of medicine. As a specialist in the obstetrics and gynecology, I have taken charge of many laparoscopic surgeries so far, with excellent treatment performance.

Especially, gynecologists are considerably interested in robotic laparoscopic surgery, and they are also trying it. Based on that, I am making endeavor to devise a specialized treatment area.

Q. Does your hospital also have the same goal?

A. In fact, the hospital has been oriented to a somewhat different point. An ob/gyn hospital does not have a high profitability because of excessively low medical fee and the like, so if you think of marketability, it is not reasonable to maintain an ob/gyn hospital.

However, obstetrics is an essential area of an ob/gyn and the local community. As a doctor, I have a considerable sense of responsibility on that point. When I opened this hospital, my goal was to make it a hospital loved by local residents.

I also tell my employees that we are not only earning money but also performing medical treatment doing the right thing and being generous to the local residents. The hospital is also a business in itself, so we also need to make money, but I am in fact putting a higher priority on this aspect.

Q. Nevertheless, the management of an ob/gyn hospital demands much sacrifice and responsibility. Don’t you have some difficulties in that respect?

A. You feel tired when you do something that you don’t want to do. If you manage a women’s hospital, it is hard for you to take care of your own personal life and things like that.

That is, if you put the highest priority on your private life, it is hard to run an ob/gyn hospital, but if you enjoy the job and feel its worth, then you can do it. We need younger ob/gyn doctors who have both sense of social responsibility and sense of duty.

▶ Ob/gyn hospitals have many difficulties in management because of an excessively low medical fee

Q. But, the reality is very, very tough. The management of women’s hospitals is so hard because of the low medical fee compared with the hard work and efforts for the treatment in the ob/gyn area. Even the risk is high for medical accidents. When an accident occurs in an ob/gyn hospital, the penalty reaches over a hundred million won, which is almost the same level in the U.S. that has a remarkably higher medical fee.

A. A similar accident has occurred in Busan also, making the local society considerably noisy. I personally know the doctor in that case very well, and if you look into the case, you feel very pitiful.

When doctors treat patients, they don’t have any malice whatsoever. Of course, when an accident occurs, the doctor should be responsible for ethical reasons, but I think we should not deal with such doctors as if they are some kind of murderer.

When a medical accident occurs, the doctor comes to be socially criticized very much, and his/her contributions to the society based on his/her hard work as an ob/gyn doctor all come to nothing. However, the doctor in that case also must have helped many patients before the accident.

Q. It feels very pitiful that you come to be evaluated based on just one mistake even if you have had done a hundred good deeds as a doctor. Do you have any area that your hospital focuses on strategically?

A. Considering the future distribution of population or the like, we focus on the area of tumor in the gynecology field. I mean I think benign tumors, which are not cancer, such as fibroids and endometriosis, have marketability in terms of business.

Such diseases are somewhat neglected in university hospitals and the like, and private hospitals have difficulties in treatment of those diseases.

University hospitals tend to perform laparotomy, which is easier, but recently, the aspect of beauty is considered so important, so in that respect, laparoscopic surgery is more favorable.

Patients have much greater satisfaction with laparoscopic surgery. University hospitals focus only on treatment of diseases, but in fact, diseases in your mind are as important as those in your body.

The same goes for the corona blue which is a recent issue. Satisfaction of patients is also a very important indicator. If you are a woman and has a big scar because of a laparotomy, you may be very depressed as a woman. I wanted to find a way to settle this issue. In other words, we need to become a ‘special hospital’ which considers even the satisfaction of patients.

Q. There are some university hospitals that operate a fibroid center. Do you have active exchange with them in relation to treatment?

A. In reality, it is not easy for a private hospital to have exchanges with university hospitals. In the past, I actively participated in academic society activities, but recently, I couldn’t do so. However, I want to found and run a center for the gynecology area.

Q. If you make a center, you can have more active exchange with those centers of university hospitals, right?

A. For mutual exchanges, our center must be improved also. At first, there may be differences between our center with those other centers, but during exchanges, both will have some improvements. However, I put a greater importance on my position as a doctor.

Q. Don’t you need to exchange the latest knowledge and opinions through exchanges between centers in terms of providing service and the latest information for those patients who cannot visit your hospital, not in terms of some commercial purposes?

A. That’s why I perform the robotic laparoscopic surgery. Since the medical specialist courses have changed, younger doctors have more difficulties in learning about surgery in great depth than our generation.

You need a considerable effort and time to perform the laparoscopic surgery very well. However, you can do the surgery much easier by using a robotic laparoscope if only you have some background knowledge.

Such a robotic system is expensive, but by using it, you can make a better prognosis on average.

So I think it may be great if I first try the robotic laparoscopic surgery based on my own ability for such a surgery, establish the basis for the surgery, and then nurture new doctors’ abilities for the surgery based on that.

In addition, I have a personal goal. So far, I have never turned to laparotomy while performing a laparoscopic surgery. 

I have completed all such surgeries by using a laparoscope even if some patients had a very big lump. You need to be somewhat tenacious. Nevertheless, there are some imperfections definitely after surgery.

During a laparoscopic surgery, you cannot completely look at the parts around the tumor or the like with bare eyes, so sometimes you fail to find some small lump of 1 cm or smaller in size. It is very hard to find such a small one, but I want to solve this problem also as a doctor for my patients.

So my personal goal is to combine the robotic laparoscope or other technology, and to completely cure a myoma or benign tumor. I am looking for ways to definitely remove benign tumor in various aspects even if the solution is not any kind of surgery. 

Q. Have you ever invested in the research area such as academic or surgical advancement other than treatment?

A. I don’t have done such efforts clearly yet, but I am planning to make such endeavor from here on. I think various ways can be found if I discuss with professors and my peers around me.

Such exchanges are not formal yet, but I think we can find points where our personal ideas can be studied along with university hospitals through diverse exchanges from now on.

Q. There must be some aspects you experience with your patients at your private hospital that you cannot go through if you are in a university hospital, right?

A. That is sufficiently true. It seems we can get very good results in such respect if we cooperate with each other. For instance, even if you completely cure some disease up to 90 percent by using a medicine, the rest 10 percent remains to be cured. That’s a very hard part. As a doctor, I can’t help doing my best to completely cure even the rest 10 percent.

Q. I think you have decided to introduce the ‘Revo-i’ to completely cure the patients of the rest 10 percent. Have you been introduced to the Revo-i?

A. No. Those doctors who prefer surgery by hand thanks to their excellent skills don’t like a robotic laparoscopic surgery. That was the case for me, too. I did not need a robotic laparoscopic surgery. However, considering that you should be prepared for the future development and that there are only very insufficient ob/gyn doctors, you need a way to more efficiently and easily train doctors for the surgery.

I think that’s the only way to secure a sufficient base for the ob/gyn area in South Korea even in 10 to 20 years from now.

From this background, I came to be interested in the robotic laparoscopic surgery, and then I learned there was the ‘Revo-i’ which was a robotic surgical system developed by only Korean technology. So I in person called the company and inquired about the product, and then I introduced it to my hospital.

▶ The ‘Revo-i’ is able to replace other systems for the laparoscopic surgery…and meerecompany is expected to share ideas with doctors

Q. You have a plenty of experiences in laparoscopic surgery, and how would you use the ‘Revo-i’ for your purpose?

A. I want to replace the laparoscopic surgery I’ve done with the ‘Revo-i,’ a robotic surgical system. Some point out that there are limitations also in the laparoscopic surgery, but I had no limitations in performing the surgery since I also used surgical tools I have made on my own.

Q. If you develop such tools, you should share them with other doctors.

A. Yes, I should share them. But there are differences between people in skills, so others may feel difficult to use such tools I made. Now is the time for the robotic laparoscopic surgery to emerge in South Korea, and you need to identify what doctors who meet patients in person need in the field.

However, researchers may not know this point very well. So, doctors in the field of medical practices may be able to give proper ideas while operating surgical tools and help make a more convenient instrument by using the ideas. On top of that, I also hope South Korean products can be better than overseas ones.

Q. They say they have studied for around 11 years to develop the Revo-i. But, doctors tend to use those tools they have been used to in most cases. Those who have used the Da Vinci want to continue to use it however great the Revo-i may be.

A. To overcome such limitations, you need a completely different technology which is able to completely, innovatively go beyond the interface of the Da Vinci. You need to find what it is.

I have tried to use the Revo-i a few times, and I got a few ideas. It would be great if I can share my personal ideas with other doctors who have tried to use the Revo-i and have some brain-storming session with them to discuss about the product.

Q. It would be great for the company to have a relation with you and other doctors to discuss about the Revo-i and share ideas about how to supplement and improve the product, with the introduction of the system as an opportunity to have such relation. However, some doctors tend to use imported products however great the Korean technology and products may be. I think we need to change such recognition and thoughts about Korean products.

A. Doctors tend to be conservative and continue to use the instruments they are used to and have been using without any mistake so far.

Therefore, it is not easy for them to accept some new technology. The same goes for myself. I have developed a laparoscopic suture technique among others.

This is a new method which is not included in the textbook, and it’s very easy. If you are a doctor who has done a surgery, you can apply it to your practices just by learning for one to two days.

When I presented about the technique, many doctors showed interest in it, but they did not used it, because they needed to learn about it as a new technique.

I released a paper about it on an academic journal about laparoscopic surgery in 2015, and over 10 doctors poured questions about it. There were many doctors who said they wanted to learn about it, saying it was so innovative, but there has been no doctor who actually came to me to learn about it.

Q. Could you pick just one to two wishes you want to demand to the government about running an ob/gyn hospital?

A. I think it would be great if the government operates the area of obstetrics. It would be better if the government takes all the responsibility on giving birth to babies. For the nation to develop, you continuously need new babies to be born. Giving birth is directly related to the national power.

I don’t understand why this issue is left to the private sector. Even if the private sector operates the area, the national government should totally support the manpower and facilities and other things necessary.

Giving birth is an industry based on the nation. I started to work when I obtained the qualification for a specialist in 2003, and I have not seen even a single accident in the area of obstetrics at the hospitals I have worked for. How many doctors do you think have taken the responsibility sleeping fitfully for such a long time?

Q. It is hard to do the job without any sense of duty.

A. You have to go to the hospital even at 2:00 or 3:00 a.m. if there is any mother in danger. Each and every ob/gyn doctor is working like that even now. Therefore, the national government should support many things for those doctors.

▶ We need to separate obstetrics from gynecology…and to improve the DRG

Q. What do you want on top of that?

A. I want the system related to ob/gyn to be reformed. The ob/gyn doctors are enduring sacrifice to some degree by recognizing that the area of obstetrics is some kind of public goods. However, the area of gynecology is surgery.

The surgery in gynecology is not different from the spine surgery or other surgical operations. Obstetrics and gynecology should be separated, I think. Obstetrics may have the DRG, that is, the diagnosis-related group.

 However, the area of surgery has differences in accordance with the skills of the operating doctors. The medical fee is rationalized to some degree in those areas such as orthopedics, neurosurgery, and ophthalmology.

However, the ob/gyn area is handled differently by being bound with obstetrics.

The area of gynecology is not different from surgical operations for treating other diseases. It does not make sense to bind it with obstetrics by using the DRG.

A few days ago, I performed the fibroid surgery for a young lady. She had too many fibroids, but I could not remove the womb since she was a young woman, and could not perform laparotomy either, so I had to perform the laparoscopic surgery anyway.

I removed a total of 31 fibroids from her womb by performing the laparoscopic surgery for three hours. I also gave her blood transfusion of two packs. However, the surgery has the same medical fee as a surgery to remove only one fibroid of 5 cm in size. If I repeat performing such difficult surgery only, I cannot help suffering a loss in fact.

Q. What do you think about your job as a doctor?

A. A doctor is a job of service. A doctor’s eyes should not aim at himself/herself but at the general public including his/her patients. You need to give up yourself to become a qualified doctor. If you don’t have such a will, only an increase in the number of college of medicine does not help very well. South Korea has a much smaller number of doctors than that of foreign countries, but in fact, the number of doctors is considerably great if you look at the number of working doctors per hour. You should not compare Korean doctors with their counterparts in the U.K. who work only from 10:00 a.m. to 3:00 p.m. South Korean doctors work for a considerably long time.

Article: http://www.whosaeng.com/122387