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Background

South Korea (Republic of Korea) is located in East Asia near Japan and China [1]. Its only land border with North Korea, referred to as the demilitarized zone (DMZ), was formed after the Korean Armistice Agreement in 1953. Its official language is Korean.  

 

Previous dynasties have adopted Confucianism as a code of ethical conduct, including loyalty, ancestor worship, and filial piety [1]. Its values still resonate heavily within the Korean population, although the majority of the religious population are Christian or Buddhist [1]. Much of the South Korean culture and beliefs are also shaped by recent historical events, namely the Japanese colonization, the Korean War, and military rulership [2]. These events have contributed to a stronger sense of nationalism, ethnocentrism, and civic duty [3]. 

Health Beliefs

  • Young patients generally do not hold any specific health beliefs. 

  • South Korea has a rich history of health remedies and traditional medicine that is still widely practiced today. 

  • Donguibogam (“Principles and Practices of Eastern Medicine”) published by Dr. Heo Jun in 1613 is still used/studied today as a cornerstone for Korean oriental medicine [4].

  • Korean oriental medicine is largely divided into acupuncture, herbal remedies, moxibustion, and cupping. Together with allopathic medicine, oriental medicine is practiced in a oriental clinic (i.e., “Han-Uiwon”) by a Doctor of Korean Medicine (i.e., “Han-Uisa”) [5]. 

  • Regardless of the clinical effects, the plants used for herbal remedies are widely consumed in Korean culture for general health, such as ginseng and chrysanthemum [6]. 

Social Traits

  • Age hierarchy and Gender roles 

  • Collectivist

  • Ppalli-Ppalli Culture (Hurry, hurry culture) 

  • South Koreans tend to rush over tasks and demand rapid results. 

  • Nunchi: assessing and acting based on others’ emotions, reactions, body language, and voice tone

  • Nationalist

Implications for Health Practitioners/Health Questions

Greeting: As mentioned above, age hierarchy and Confucianism play a significant role in Korean culture. Generally, older people prefer to be treated with respect. This includes receiving/giving things and shaking the other’s hands with two hands [7]. 

  • Physician-Patient Communication: With nunchi being one of the key social traits, South Korean culture heavily relies on the speaker's nonverbal communication cues, such as tone, posture, and expression.

    • Paying close attention to these cues can benefit the physicians on how the information is being received. 

    • It is worth noting that South Koreans would rarely give a definite “no” response for refusal or show drastic facial expression (i.e., smiling). 

    • To ensure clarity, physicians should ask open-ended questions multiple times. 

    • Additionally, it is largely considered a taboo to point at people, specifically towards older people [8]. 

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  • Mental Health: Mental health disorders are widespread across the Korean population driven by competitive, self-conscious culture. Unfortunately, there is often a stigma surrounding mental health, with many afraid to discuss their condition. The majority of mental health issues are thus ignored. Physicians must carefully look for any signs and encourage patients to speak about their concerns [9] 

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  • Diet: A traditional meal typically consists of rice, soup, pickled vegetables (kimchi), and other side dishes (meat and fish). However, fast-food chains, Western cuisine, and instant food have quickly become popular in the South Korean diet [10]. As food and herbal remedies are linked closely, cooking and bringing traditional Korean dishes is viewed as a form of care for loved ones.

Questions/Education

  • Healthcare:

    • Describe the stages and progress of treatment to the patients. 

      • Due to the Ppalli-Ppalli Culture (Hurry, hurry culture), patients may not follow through with the treatment plan without immediate results. It is important to carefully explain how long the treatment will take for patient compliance. 

  • Describe carefully about the treatment plan and medications to see if the patients are comfortable. 

    • For instance Adderall is a highly illegal medication in Korea and might cause repercussions when brought to Korea even if with a legal documents brought from United States [11]. 

  • Aside from Western medicine,  what other medicine do you use?

    • Patients might incorporate home remedies in addition to their current treatment. 

    • It is important to ask what types of herbs and remedies they are using to prevent any unwanted interactions. 

  • Social History

    • What are your thoughts about smoking/drinking?

    • In one day, how often do you smoke? If not, how about the people around you?

    • Have others expressed concern about your smoking/drinking habits?

    • Smoking and drinking are prevalent in South Korean culture. 

      • The two behaviors are considered to be common social practices. 

    • Second-hand smoking is another prevalent issue. 

      • Even if the patient may not smoke, there may be smokers in his/her family that may cause second-hand smoking.

      • Older Koreans may be used to smoking indoors which may put their family members’ at risk also. 

  • Women’s Health: 

    • Women may be extremely cautious and conservative regarding sexual activity and history. 

    • Do you have any chest pain, difficulty sleeping, or breathing difficulty?

    • Have you had any major changes in your life?

      • These questions are used to initially evaluate the cultural syndrome, Hwa-byung, which is described further below.

    • Do you feel safe at home?

      • Observe patients for any signs of domestic abuse.

Health Challenges

  • Drinking is an extremely common practice among the South Korean population. Excessive consumption (possibly from social pressure) is a risk factor for various chronic conditions [12]. 

  • Mental health disorders may be prevalent among Korean adolescents due to the competitive social and academic environment. In review done in 2023, up to 10% of Korean adolescents in Korea report suicidal ideation [13].  

Women's Health

  • Hwa-byung is a cultural syndrome when Korean women tend to internalize their emotions and psychological stress (from family loss or financial struggles). The patients tend to suffer from various somatic and psychological symptoms. Hwa-byung may have a unique diagnosis compared to other DSM disorders; it is important for physicians to keep the condition in mind, specifically for middle-aged Korean women. More information and care strategies can be found in this source [14]. 

  • Domestic violence is prevalent among South Koreans, especially among intimate partners. Physicians should look out for any signs of domestic, emotional, or sexual abuse, as most of the domestic violence cases tend to be silenced within [15]. 

Conclusion

  • Korean oriental medicine will continue to be used as home remedies or alternative forms of treatments. It is important to be aware of this practice to prevent any unwanted interactions with the medications. 

  • The South Korean cultural and societal values may influence physician-patient communication. These cues must be acknowledged and adapted to accordingly. 

  • The cultural and societal norms have made the South Korean population more prone to various mental illnesses. Thus, having a therapeutic alliance and noticing early signs would greatly benefit the patients.

Resources for Patients

  • International Institute of St. Louis

  • Korean American Association of St. Louis

    • To promote cultural education, support the rights of Korean Americans, and strengthen relations with other communities in the area.

    • Phone:314-814-2085

    • Address: 1015 Locust St STE 1036 St. Louis, MO, 63101, US

    • Link: https://www.kaastl.org/

This information was collected and organized by our team. As of this time, we have not yet been able to connect with any individuals in this community that could review this article. If you are interested in reviewing this article, please contact kaitlynn.borik@health.slu.edu

References

(1) South Korea - Summary. (2023, July 24). Retrieved March 16, 2024, from https://www.korea.net/AboutKorea/Society

(2) History.com Editors. (2018, August 21). South Korea. History. Retrieved March 16, 2024, from https://www.history.com/topics/asian-history/south-korea

(3) Hur, A. (2021, June 29). South Korea's Demographic Crisis Is Challenging Its National Story. Carnegie Endowment for International Peace. Retrieved March 16, 2024, from https://carnegieendowment.org/2021/06/29/south-korea-s-demographic-crisis-is-challenging-its-national-story-pub-84820

(4) Song, B. K., Won, J. H., & Kim, S. (2016). Historical Medical Value of Donguibogam. Journal of pharmacopuncture, 19(1), 16–20. https://doi.org/10.3831/KPI.2016.19.002

(5) Jae-hee, C. (2022, August 19). 'Doctor of Korean Medicine': Does this title confuse you?. The Korea Herald. Retrieved March 16, 2024, from https://www.koreaherald.com/view.php?ud=20220819000550

(6) Villines, Z. (2022, June 29). What to know about hanyak. Medical News Today. Retrieved March 16, 2024, from https://www.medicalnewstoday.com/articles/hanyak#what-it-is

(7) Shaheen, S. (2021, January 13). Korean etiquette and manners. Citizen Journalists. Retrieved March 16, 2024, from Embassy of the Republic of Korea to Norway.

(8) Evason, N. (2016). South Korean Culture. Cultural Atlas. Retrieved March 16, 2024, from https://culturalatlas.sbs.com.au/south-korean-culture/south-korean-culture-communication

(9) Nagar, S. (2022, March 11). The Struggle of Mental Health Care Delivery in South Korea and Singapore. Harvard International Review. Retrieved March 16, 2024, from https://hir.harvard.edu/the-struggle-of-mental-health-care-delivery-in-south-korea-and-singapore/

(10) DIET AND EATING HABITS IN SOUTH KOREA: TRADITIONS, NUTRITION AND DELIVERED FOOD. (2021, July). https://factsanddetails.com/korea/South_Korea/Life_2/entry-7249.html

(11)​​Lee, K. (2024, March 7). Adderall in Korea: How US Tourists Escaped Prosecution. Lee & Lee Legal Professional Group. Retrieved March 16, 2024, from https://lawfirmleeandlee.com/adderall-in-korea/#:~:text=In%20other%20words%2C%20even%20though,punishable%20as%20a%20drug%20offense.

(12) Roh, E.H. (2022) Analysis of multiple chronic disease characteristics in South Koreans by age groups using association rules analysis. Health Informatics Journal, 28(1). doi:10.1177/14604582211070208

(13) Kim, S. J., & Lee, J. (2023). Introduction of Child and Adolescent Mental Health Services in Korea and Their Role During the COVID-19 Pandemic: Focusing on the Ministry of Education Policy. Soa--ch'ongsonyon chongsin uihak = Journal of child & adolescent psychiatry, 34(1), 4–14. https://doi.org/10.5765/jkacap.220034

(14) Lee, J., Wachholtz, A., & Choi, K. H. (2014). A Review of the Korean Cultural Syndrome Hwa-Byung: Suggestions for Theory and Intervention. Asia T'aep'yongyang sangdam yon'gu, 4(1), 49. https://doi.org/10.18401/2014.4.1.4

(15) Se-jin, O. (2022, August 29). 46% of cases of violence against women in Korea perpetrated by intimate partner, study finds. HANKYOREH. Retrieved March 16, 2024, from https://english.hani.co.kr/arti/english_edition/e_national/1056632.html

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