From August 8th to 12th, 2025,Support for sustainable decision-making and arrangements that preserve dignity for everyone during and after life" project, I visited Seoul, Korea to investigate decision-making support for the elderly. The outline of the investigation is as follows:HerePlease see the article.
On August 10th, we interviewed Dr. Yoon Ji-hyun, a family physician (specialist in family medicine), and exchanged opinions on the role of family physicians in Korea and the challenges of medical care for the elderly. In this article, Researcher Ogino reports on the contents of the interview and the exchange of opinions.
(Professor Yoon is on the left)
Dr. Yoon is a family physician specializing in geriatrics and chronic disease care at Korea University Anam Hospital in Seoul. He also provides hospice care within the hospital and provides advice on pain control to patients in other departments.
The hospital has approximately 1,000 beds and is a tertiary medical institution that provides advanced medical care in the region.
The role of family doctors in Korea
First, we asked Dr. Yoon about the role of family physicians in Korea. The most important role of a family physician is to act as the hospital's gatekeeper, providing primary care for a wide range of generations, from children to the elderly. As the name "family physician" suggests, a family physician is also characterized by the perspective of treating not just a single patient, but the entire patient, including their family. The Department of Family Medicine at Korea University Hospital, where Dr. Yoon is affiliated, is particularly interested in geriatric medicine.
Korean family doctors have three main roles in hospitals. The first is that of a gatekeeper, where when a patient comes to a university hospital for the first time, they determine the cause of the illness and assign the patient to the appropriate department.
Secondly, as specialists with a thorough understanding of the characteristics of each age group and a perspective that sees the patient as a whole, we provide advice to ensure better treatment and care for hospitalized patients, including postoperative management and unexplained symptoms in the elderly.When patients are discharged from the hospital, we also support them in returning home so that there are no obstacles to their daily lives.
Thirdly, they are also responsible for outpatient care for patients whose disease condition has stabilized and who have been placed under observation. They monitor patients regularly, and if new symptoms or a worsening condition are observed, they decide whether or not they should be hospitalized. They also provide home visits to patients who find it difficult to come to the outpatient clinic.
Korean family doctors and Japanese general practitioners are similar, but since home medical care is not yet widespread in Korea, I was particularly impressed by their role as gatekeepers within hospitals.
On the other hand, in both Japan and Korea, unlike in the UK and other countries, each household does not have a family doctor (GP), and each patient visits multiple medical institutions depending on their specialty. The way patients choose medical institutions is also similar to Japan, with patients free to access the medical institution they wish to go to, and many people travel far away to visit university hospitals in Seoul in search of more advanced medical care. This makes it difficult for private practitioners, including family doctors, to fulfill the role of family doctor in the local community, and this is an issue.
Medical care for elderly patients and those with dementia
We also asked Dr. Yoon how he deals with elderly patients and those with dementia in his daily practice.
Family physicians have longer consultation hours than other departments, which makes it easier for them to understand the needs of patients with declining cognitive function and to find time to discuss the situation with their families. Furthermore, in Korea, elderly patients tend to make decisions that take into consideration their sons, daughters, or other family members, and are influenced by the opinions of their eldest sons. They also shared cases where the needs of the patient conflicted with the opinions of their family, leaving doctors caught in the middle. While each hospital has developed guidelines for decision-making support when dealing with such cases, they are sometimes difficult to utilize, leaving doctors and medical teams struggling to respond.
Furthermore, South Korea is also experiencing an aging population, and recently "slow aging" among the elderly has been attracting attention. Slow aging refers to extending the period of active life as much as possible and aging slowly. Because family physicians are well-versed in the changes that occur in old age, they also play an important role in assessing fractures in the elderly, providing post-operative care, and understanding and improving the progression of frailty.
Another problem facing the elderly in South Korea is the high poverty rate. In South Korea, the poverty rate for people over 65 is nearly 40%, and some people find it difficult to go to advanced hospitals due to financial circumstances. However, local health centers apparently have the ability to provide medical care at low cost (*1), so even elderly people who are struggling financially can receive medical care by going to a health center.
(*1) Korea's Community Health Act stipulates that public health centers provide medical care in the "matters concerning medical treatment, health checkups and disease management of chronic diseases, etc. for local residents" (Article 11, paragraph 5 (f)). Japan's Community Health Act does not have a corresponding provision, and Japanese public health centers do not provide medical care in principle.
Use of AI for decision support
Finally, Dr. Yoon and I exchanged views on the use of AI to support patient decision-making. While there are still very few examples of AI being used for decision-making support in either Japan or Korea, we discussed the possibility of creating a program that digitizes daily medical records and other data to make it easier to understand the needs of patients and their families.
On the other hand, to create decision-making support AI that can provide more advanced advice, it is necessary to identify an ideal decision-making support process that can be used as learning data. While exemplary decision-making guides have already been established in the United States and other countries, no such guides exist in Japan or Korea. Therefore, the participants shared the idea that it may be necessary to first consider the ideal form of decision-making support that takes into account the characteristics of the East Asian cultural sphere.
Finally, the importance of Japan-Korea cooperation was confirmed, and the fruitful hearing came to a close.
