After three years of being a fellow in the U.S., I’ve been working as an attending for more than two years. I think I can compare it to some extent, so I write about the stories of doctors

I’ve worked at a university in Korea, and I’ve worked locally. Things I didn’t understand. And things I couldn’t understand even more after working in the United States. It was ‘Why send a patient who has undergone surgery to a (so-called) local hospital for disinfection?’ And who are you going to blame if there’s a problem while managing the wound like that? And knowing clearly how much dressing costs in Korea’s so-called beggar system. And knowing clearly how long it takes. I didn’t really understand why he actually passed on his annoyance to others.

1. Almost all orthopedic procedures are performed in Day surgery. In the case of our children’s hospital, which has more than 20 operating rooms, there are 30-40 small private rooms right next to the operating rooms in the area. Usually, the procedure must be carried out by arriving at the hospital two hours before the scheduled operation time. The first case starts at 7 a.m., so children who decide to use the first case must arrive at the hospital by 5 a.m. (Families living 80 miles from the hospital? or more can stay at a hostel next to the hospital provided by the charity for free.) After the surgery, they stay in the recovery room for an hour and in the room for two or three hours, check the pain, physical therapy, and leave the hospital on the same day.
2. What about the surgery and disinfection of the wound? I usually don’t do additional dressing because I dress cleanly and cover well in the operating room. I usually do trauma surgery such as pelvis/hip/spine surgery + fractures that come through the emergency room when I’m on duty… Even the incision window of the scoliosis surgery that is close to 40-50 cm is not dressed until the outpatient clinic after the surgery. (I usually check the progress by phone at 3 weeks after the surgery, and the in-person visit is the first outpatient clinic at 6 weeks after the surgery.) Gauze and band-aid are usually removed around 1-2 days after the surgery. They allow showers 4-5 days after the surgery unless it’s special.
3. Surgery requiring hospitalization? If you need hospitalization after surgery…In the case of pelvic osteotomy, it is usually 1-2 days. In the case of idiopathic scoliosis, it is usually 2-3 days. In the case of neuromuscular scoliosis, it is usually hospitalized for 4-5 days. Therefore, there are about 1-2 patients who have to go around the rounds in the morning. Almost all of them are discharged on weekends, so there is no need to go around the rounds.
4. What about physical therapy? In this place, where everyone is operating in a private room, physical therapists visit the patient’s room and perform rehabilitation treatments, usually two sessions a day. Since physical therapists have considerable expertise, they actively communicate with medical staff and ask for prescriptions if necessary, such as assistive devices. For patients with difficulty walking after surgery, permission from physical therapists is required to be discharged from the hospital due to the risk of falling.
5. No, it’s going to hurt a lot after a big surgery, so how can I be discharged in 2-3 days? I heard you put a lot of narcotic painkillers in it. It seems that they are trying to control the pain more actively than in Korea, but as I’m concerned, if I use a lot of narcotic painkillers, it’s not like that. Additional anesthetic drugs are injected into the surgical incision window that have a long-lasting effect, or drugs with ingredients such as Tylenol and ibuprofen are combined as best as possible and administered at appropriate time intervals to control pain. Therefore, the total dose of narcotic analgesics is less than in Korea. Instead, drugs are actively used for acute pain such as fractures.
6. Still, what if there is a problem with the wound or there is a concern about infection? There are various channels for patients/guardians and medical staff to communicate… They call directly (call center – nurse in charge of orthopedic surgery), send pictures of the wound directly through a smartphone app, and communicate in that way. If you think it is necessary to disinfect the wound, a visiting nurse visits the house and sends you dressing items directly by courier. If you are concerned, you should let them visit the outpatient clinic.
7. Of course, what makes all of this possible is the appropriate medical expenses. I’ve been working hard on my medical report, and I didn’t know about the cost of the surgery… Case 1. The cost of the surgery I found out recently after the kid had surgery. Hospitalized after examination through emergency room – discharged after surgery the next day. The total cost of endoscopic appendectomy through hospitalization for 1 night and 2 days. A total of $59,000 (W85 million) was charged. Ouch. The cost I have to pay among the people is $2,000. Case 2. I found out while exchanging e-mails with social workers / financial management teams / staff teams through donations from charitable organizations. For general scoliosis surgery, the estimated total bill is approximately 260,000 (W370 million).