Background
: More energetic activities of family physicians have been required as the role and contents of medical care in department of Family Medicine have been enlarged since the establishment of new health care delivery system, which came into effect on July 1, 1989. Accordingly, it is expected that family physicians will care for more patients, at the same time, suggested that it is very important for family physicians to manage their inpatients in the aspect of continuing care. We analyzed the hospitalized patients to help in establishing the training contents of family medicine residency.
Methods : We examined the medical records of the patients who had hospitalized in department of Family Medicine of Asan Medical Center from July, 1, 1989 to June, 30, 1991.
Results : A total of 266 patients were hospitalized during study periods. They were hospitalized during study periods. They were composed of 134 males(50.4%) and 132 females(49.6%). The patients were relatively evenly distributed among all ages. The majority of them were 4th decades in male and 6th decades in female, respectively. The most common symptom, which the patients complained at the time of admission, was abdominal pain(57 cases). The next common symptoms were as follows; headache(12.0%), fatigue(10.9%), medical examination(9.8%), and fever(9.4%). A total of 133 kinds of diseases were diagnosed, and the number of diseases of the patients was 1.6 per capita. The most common diagnosis at discharge was gastritis of 65 cases(24.4%). The next common diagnoses were as follows ; DM(13.2%), hypertension(10.2%), fatty liver(6.4%), and anemia(6.4%). 185 patients were consulted with more than one department; a total of 347 cases in 18 departments. The departments in the order of frequency of consultations were Ophthalmology of 66 cases(35.7%), Internal medicine(29.2%), OB & GY(20.0%), ENT(20.0%), and Rehabilitation medicine(18.4%). 56 patients were transferred to the other departments. Internal medicine held a majority of 35 patients, and General Surgery(8), Psychiatry(3), Orthopedic surgery(2), ENT(2), and Neurology(2) followed it. At transfer, each 5 cases of lung cancer and acute cholecystitis was most common diagnosis, and hepatoma(4), stomach cancer(3), DM(3), pneumonia(3), and acute viral hepatitis(3) followed it. Interview with patients and their families of 10 patients were carried out including one time of consultation with a social worker and one time of home visit.
Conclusion : In the management of hospitalized patients in family medicine, it is essential to train about managing the chronic disease and diagnosing malignant disease differentially, and family-oriented approach must be emphasized.
연구배경 : 가정의학은 1989년 새로운 의료전달체계 도입 이후 더울 많은 환자에 대하여 더욱 많은 역할이 기대되고 있다. 따라서 입원환자에 대한 이해는 진료의 연속성 면에서 매우 중요하다. 이에 저자들은 3차 병원 가정의학과 전공의의 입원 환자에 대한 수련 지침을 세우고자 가정의학과 입원 환자에 대한 기초 자료를 분석하였다.
방법 : 1989년 7월 1일부터 1991년 6월 3일까지 2년간 서울 중앙병원 가정의학과 입원한 환자들에 대하여 입원 당시 의무기록을 검토하였다.
결과 : 이 기간 동안 총 입원환자수는 266명으로 이중 남자는 134명(50.4%), 여자는 132(49.6%)이었다. 연령은 전 연령층에 걸친 분포를 나타냈고 이중 30대 남자와 50대 여자가 가장 많았다. 입원 당시 가장 흔한 증상은 복통으로 57명이었고 다음은 두통(12.1%), 피로(10.9%), 건강검진(9.8%), 발열(9.4%)순이었다. 총 질병수는 133종류였고 일인당 1.6가지 수를 보였으며 그 빈도는 위염(24.4%), 당뇨병(13.2%), 고혈압(10.2%), 지방간(6.4%), 빈혈(6.4%)순이었다. 자문을 의뢰한 환자수는 185명으로 18과에 걸친 347건이었고 자문과는 안과(35.7%), 내과(29.2%), 산부인과(20.2%), 이비인후과(20.2%) 재활의학과(18.4%)순이었다. 56명의 활자가 타과로 전과되었는데 내과가 35명으로 대부분을 차지했고 일반외과(8), 정신과(3), 정형외과(2), 이비인후과(2), 신경과(2)순이었다. 전과시 폐암과 급성 담낭염이 각 5건씩 이었고 간암(4), 위암(3), 당뇨병(3), 폐렴(3), 급성간염(3) 순이었다. 환자와 그 가족들에 대하여 상담을 한 경우는 10명이었으며 사회사업가의 자문과 가정방문을 병행하였다.
결론 : 가정의학과 입원환자 질료를 위하여서는 만성질환의 관리능력 배양과 악성 종양의 감별 진단에 관한 수련이 필수적이며, 아울러 가족지향적인 접근이 더욱 강화되어야 하겠다.
