Korean Journal of Medical Ethics
The Korean Society for Medical Ethics
Article

의료 전문직의 자율성과 자율성 확보를 위한 실천 방안*

김도경1,*, 권복규2
Do-Kyong KIM1,*, Ivo KWON2
1동아대학교 의과대학 의료인문학교실
2이화여자대학교 의과대학 의학교육학교실
1Department of Medical Humanities, School of Medicine, Dong-A University
2Department of Medical Education, School of Medicine, Ewha Womans University
*교신저자: 김도경. 동아대학교 의과대학 의료인문학교실. 051-240-2642. dinkum11@dau.ac.kr

ⓒ Copyright 2013 The Korean Society for Medical Ethics. This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: Jun 30, 2013; Revised: Aug 10, 2013; Accepted: Aug 21, 2013

Published Online: Aug 31, 2013

ABSTRACT

Physician autonomy and medical professionalism have been changing ever since the patient-physician medical relationship was changed to patient-physician-third-party payer medical relationships. Until now, physician autonomy has meant that physicians should have complete freedom to provide the best treatments for their patients, without external constraints, but ever since medical insurance was introduced, medical decisions have been controlled by the third-party payers, and many conflicts have emerged in the patient-physician-third-party payer medical relationships. The concept of physician autonomy thus has to be changed. That is, the society should respect the rational and deliberated decisions of the physicians to resolve the conflicts between their patients and the third-party payers beyond the obligation of beneficence towards the patients. To mediate between their patients and the third-party payers, the physicians should carry out two roles - as healer and as manager - and should adjust the different applicable principles, such as patient autonomy, beneficence, and justice. The physicians have to be well acquainted with such principles and should make the appropriate decisions so as to gain social trust. To help resolve the conflicts between the patients and the third-party payers, the physicians should effectively carry out their roles as healer and manager by considering evidence-based practice, the treatment goal, and cost-effectiveness in their clinical practice. These criteria can help the physicians make reasonable and well-deliberated decisions in relation to their just provision of medical care for their individual patients.

Keywords: 의료 전문직의 자율성; 제3지불자; 관리자; 근거바탕의학; 의료의 목표; 의료의 효율성
Keywords: professional autonomy; third party payer; manager; evidence-based practice; care goals; cost effectiveness