[Corona Behind] Who should do the Corona 'Expert Test'?

Enlarging an image

※ 'Corona Behind' is a report by Park Soo-jin, a reporter from the Life and Culture Department of SBS Press Headquarters, who is running at the forefront of COVID-19 coverage.

Once a week, reporters Park's articles and thoughts that were not included in the article are released to readers.

[Editor's Note]

At the end of last year, an acquaintance who was diagnosed with Corona contacted me.

At that time, the public health center was sending medicines to home-treated patients, but contact was often delayed due to a large number of patients.

He said he couldn't contact the public health center until two days after the diagnosis, so he said he saw a review saying 'Mt. Eunkyo is good for a sore throat' while searching the internet.

On this day, he first learned about the existence of 'Eungyo Mountain'.

It was not an exclusive treatment for Corona, but a 'Oriental medicine for sore throat'.

Later, I heard that an acquaintance said that they had cooked galgeuntang at the oriental medicine clinic along with Mt. Eungyo.

He said it is a herbal medicine that he prescribes if he has a fever, cold or chills.

Fortunately, the acquaintance did not get worse with Corona and finished home treatment, but he said, "I don't know" because of the herbal medicine.

At the time, I thought of this situation as 'a phenomenon that occurred when the work of the public health center was paralyzed due to an explosion of home treatment patients'.

It was my understanding that there are patients who do not receive health care kits on time and that non-face-to-face treatment is not working well, so there are patients who are in a hurry to find herbal medicines.

But four months later, I changed my mind.

The 'conflict between doctors and oriental doctors' arose as the government dedicated the rapid antigen testing for corona experts and face-to-face treatment to confirmed patients to local hospitals.

I started to investigate because I thought the problem was more complicated than it looked.

Enlarging an image

The 'conflict' that started when the rapid antigen test was entrusted to the hospital

This conflict is

.

It was not revealed when the corona diagnosis test was a PCR test system centered on public health centers, but the government, which could not withstand the surge in test demand after the outbreak of Omicron, allowed the dual PCR and rapid antigen test system → Specialized rapid antigen test to hospitals and clinics. It came to the surface as it expanded → recognized the positive result of the rapid antigen test for experts as confirmed.

The starting point was the back briefing of the Central Disaster Response Headquarters on March 21st.

Reporter: Why is there no oriental clinic for Corona Rapid Antigen Test?

It is also said that it is possible to have an oriental medicine clinic and a medical clinic (oriental medicine hospital). What is the legal basis?

Sohn Young-rae, Head of Social Strategy Division: This issue is a matter of professional work between medicine and oriental medicine, and since there is a part that is linked to treatment, I am considering various complexities.

The Health and Medical Policy Office is reviewing it, and if there is anything to be sorted out, we will let you know at a later date.

Immediately after the briefing, articles poured in, 'The government is reviewing oriental medicine clinics to perform rapid antigen testing for experts', and the Korean Medical Association gave a 'welcome' and medical groups including the Korean Medical Association gave a 'opposite' position, causing great confusion. lost

After three hours, the government changes its stance.

“Under the current circumstances, we are not considering whether or not to conduct rapid antigen testing for COVID-19 experts at oriental medical institutions.”

(In the middle version of the press release)

The quarantine authorities have since taken a consistent stance on media inquiries regarding the authority to test.

.

The director of the Ministry of Health and Welfare told reporters on the phone at the time,

He said, "Currently, there is no plan to acknowledge the results of the rapid antigen test by oriental doctors."

However, it did not quell the controversy.

Even the Korean Dental Association jumped in, asking, "I want dentists to be able to perform rapid antigen testing for professionals."

The 'claim of authority' of oriental doctors and dentists

is based on evidence.

However, the Korean Medical Association and other medical groups believe that oriental medical doctors or dentists conduct professional rapid antigen tests on the

basis of

It is argued that the rapid antigen test for professionals by medical personnel is

.

Since then, the Korean Dental Association has taken a 'Jung Jung-dong' position, saying, "The position on the examination authority has not changed, but there is no legal response or group action plan" (on the 21st, during a call with an association official).

However, the Korean Medical Association filed an administrative lawsuit against the quarantine authorities on the 12th and is responding hard.

It seems to be spreading into a direct translation conflict between doctors and oriental doctors.

Enlarging an image

Controversy over 'expert qualification' that went to court

The administrative lawsuit filed by the Korean Medical Association is a

.

The Korea Centers for Disease Control and Prevention (KCDC) has blocked the use of the system for registering corona confirmed patients by oriental doctors.

The reason this lawsuit was raised is that 'the patient was registered at the oriental clinic and then failed'.

It is said that the government has never approved oriental medicine rapid antigen testing.

In March, in the process of expanding the scope of the government to allow local hospitals to perform rapid antigen testing for experts, some oriental clinics also received approval.

According to the Ministry of Health and Welfare and the Korea Centers for Disease Control and Prevention, it was more like some oriental clinics were mixed in in the process of receiving an application from a local hospital rather than recognizing the authority of the oriental clinic.

The Ministry of Health and Welfare and the Korea Centers for Disease Control and Prevention were unaware of this fact until it was reported in the media.

I personally interviewed an oriental medicine clinic in Gangseo-gu, Seoul, where the rapid antigen test and registration of confirmed patients were conducted. The next day, we registered two confirmed cases for the first time.”

The Korean Medical Association asserts that when it became known that such an oriental clinic existed through media reports, the Korea Centers for Disease Control and Prevention blocked access to the system and demanded that the confirmed patients registered at some oriental clinics cancel their confirmation history and undergo a retest.

Enlarging an image

Enlarging an image

The Korea Centers for Disease Control and Prevention (KCDC) filed an administrative lawsuit, claiming that this action was unreasonable.

is presented as a legal basis.

Oriental medicine doctors are one of the subjects of diagnosis and reporting of infectious disease patients recognized by the government legally, and they follow the reporting obligations stipulated by the law.

What appeared on the surface was, 'Please cancel the measures of the Korea Centers for Disease Control and Prevention', but the underlying argument is to acknowledge the authority and expertise of oriental medical doctors to diagnose Corona.

At a press conference on the 12th, President Hong Joo of the Korean Medical Association said, "Oriental doctors are also performing nasogastric intubation, which is inserted about 50 cm from the nasopharynx and esophagus to the stomach. A sample collection tool is inserted. More difficult behaviors are recognized, but it is the quarantine authorities' observation of the yanggi system that the rapid antigen test is not possible."

There is still no precedent that can determine the qualifications of experts in corona diagnosis and testing. It is presented based on the Constitutional Court's decision (2021 Heonma 551) that canceled the suspension of prosecution given to him.

Briefly, the prosecution judged that it was 'medical practice other than licensed' to prescribing herbal medicines to patients after eye and hearing examinations using medical devices such as tonometry and hearing tester at an oriental clinic in Seoul. It was a case in which the prosecution was suspended by applying the charge of violation, but the Constitutional Court nullified it.

At that time, the Constitutional Court presented this rationale.

"Whether or not it falls under Article 27 of the Medical Act, 'medical practice other than licensed' is escalating into a conflict between doctors and oriental medicine doctors. The interpretation of the latter part of the main text of Article 27, Paragraph 1 should also be interpreted with a focus on protecting and promoting the health of the public. If this can be done, it should be construed in a way that grants the right to use it to qualified medical personnel."

Based on this decision, Lee said, "I found that it is in line with the purpose of the Medical Law to interpret the Medical Law in a way that medical personnel can use if there is no health and sanitation risk due to the development of medical technology. I think there is,” he said.

However, since the tonometer and hearing tester, which were the issues in the 2013 case, were also used for examination at opticians and hearing aid stores, and the results of the examination for intraocular pressure and hearing were automatically extracted, a sample collection tool was inserted into the nasopharynx. Opinions may differ as to whether it can be compared with the rapid antigen test for diagnostic use on the same line.

Another variable is the fact that the current medical law does not provide specific definitions related to medical practice, leaving much room for interpretation.

Although the rapid antigen test kit for professionals is classified as a medical device, the scope of use for medical purposes is also not stipulated by the Medical Device Act.

(※ 'Medical practice' is experience and function based on medical expertise, and prevention or treatment of diseases performed by examination, optometry, prescription, medication, or surgical procedure, and other health and sanitation if not performed by medical personnel Refers to an act that is likely to cause harm (Supreme Court sentenced on August 19, 2005, judgment of 2005, 4102 / Supreme Court, sentenced on October 28, 2004 of 2004, judgment of 3405).

Enlarging an image

Is it a 'rice bowl fight' or a 'pride fight'?

The 2013 Constitutional Court decision also made this expression.

Medical technology has advanced a lot in the past nine years, while the laws remain the same.

It is perhaps natural that the conflict intensifies.

Regarding the controversy over the qualifications of rapid antigen testing experts, there are also interpretations of it as a 'rice bowl fight'.

It's not wrong.

Until the beginning of this month, the health insurance fee of 55,920 won per case has been applied to the rapid antigen test for experts at hospitals and clinics.

This amount consisted of a consultation fee of 16,970 won (patient pays 5,000 won), an examination fee of 17,260 won, and an infection prevention and management fee of 21,690 won (31,680 won for less than 10 visits).

It is said that if 100 people were inspected a day, they made more than 5 million won in profit.

It was also a new source of revenue for local hospitals, where the number of hospitalized patients decreased significantly due to the corona virus.

However, since the 11th, the infection prevention and control fee, which had the largest proportion, was abolished.

The total of the examination fee and the examination fee per rapid antigen test was 34,230 won, which was reduced by nearly half.

At local hospitals and hospitals, 'If Sue is not compensated enough, why are they risking infection for corona testing and treatment?'

As the government is gradually reducing the scope of reimbursement in line with the transition to the daily medical system, it seems unlikely that 'revenue' is the only absolute reason.

The honest feeling I got while covering this case was more like a fight for pride between literal translations.

When I was interviewing doctors, I said, 'I still rely on Donguibogam.

There is a lack of scientific evidence,' and when covering oriental doctors, 'Doctors are trying to monopolize medical care.

This is because I could hear blunt statements such as 'the government supports the self-righteousness of the doctors group'.

I also think that the government's vague, case-by-case application of different standards only fuels confusion.

This controversy itself started with unfamiliar remarks from a government official, and while not acknowledging the authority for rapid antigen testing, both oriental clinics and dentists were included in the medical institutions that could provide face-to-face treatment for corona patients.

This contradicts the government's initial position that 'The rapid antigen test for corona experts is implemented to manage everything from diagnosis to treatment' (March 21).

(Reporter: Park Soo-jin, PD: Kim Do-kyun, Illustration: Kim Jeong-yeon, Producer: D Content Planning Department)