The willingness of patients to pay for intravenous patient-controlled analgesia in Korea

임형선,이덕형,한영진,최훈,손지선 대한마취통증의학회 2012 Korean Journal of Anesthesiology Vol.62 No.6

Background: The use of intravenous patient-controlled analgesia (IV-PCA) has been increasing because it has advantages such as improved pain relief, greater patient satisfaction, and fewer postoperative complications. However, current research has not considered the patients’ thoughts about IV-PCA’s cost-effectiveness. The purpose of this study was to investigate the willingness to pay (WTP) for IV-PCA and the relationship between patients’ characteristics and WTP in Korea. Methods: We enrolled 400 adult patients who were scheduled for elective surgery. The patient was requested to indicate a series of predefined amounts of money (Korean won; 30,000/50,000/100,000/150,000/200,000/300,000/500,000). We also recorded patient characteristics, such as age, sex, type of surgery, IV-PCA history, education level, the person responsible for medical expenses, type of insurance, net annual income, and residential area. Three days after surgery, we asked about the degree of satisfaction and the WTP for IV-PCA. Results: For IV-PCA, the median WTP was 100,000 won (25-75%; 50,000-200,000 won: US$1 = W1078.04; July 19, 2011) before surgery. All patients’ characteristics were not related to preoperative WTP for IV-PCA, whereas the increase in WTP after surgery showed a tendency correlated to higher IV-PCA satisfaction. Conclusions: The median WTP was 100,000 won. The satisfaction of IV-PCA increased patients’ WTP after surgery, but the WTP may be independent of patient characteristics in Korea. Background: The use of intravenous patient-controlled analgesia (IV-PCA) has been increasing because it has advantages such as improved pain relief, greater patient satisfaction, and fewer postoperative complications. However, current research has not considered the patients’ thoughts about IV-PCA’s cost-effectiveness. The purpose of this study was to investigate the willingness to pay (WTP) for IV-PCA and the relationship between patients’ characteristics and WTP in Korea. Methods: We enrolled 400 adult patients who were scheduled for elective surgery. The patient was requested to indicate a series of predefined amounts of money (Korean won; 30,000/50,000/100,000/150,000/200,000/300,000/500,000). We also recorded patient characteristics, such as age, sex, type of surgery, IV-PCA history, education level, the person responsible for medical expenses, type of insurance, net annual income, and residential area. Three days after surgery, we asked about the degree of satisfaction and the WTP for IV-PCA. Results: For IV-PCA, the median WTP was 100,000 won (25-75%; 50,000-200,000 won: US$1 = W1078.04; July 19, 2011) before surgery. All patients’ characteristics were not related to preoperative WTP for IV-PCA, whereas the increase in WTP after surgery showed a tendency correlated to higher IV-PCA satisfaction. Conclusions: The median WTP was 100,000 won. The satisfaction of IV-PCA increased patients’ WTP after surgery, but the WTP may be independent of patient characteristics in Korea.

의과대학생의 진료 참여에 대한 환자들의 견해

이영미,김지훈,안덕선,김병수,유세화 한국의학교육학회 2004 Korean journal of medical education Vol.16 No.1

Purpose: There is a negative assumption that patients are reluctant to have medical students be involved in their care. In response, students refrain from revealing to the patients that they are students in order that they may participate in patient-care. The purpose of this study is to determine whether patients' attitudes towards medical students is negative or positive, and to explore the level acceptable by patients of students' involvement in their care. Methods: The study subjects were 90 inpatients in two university hospitals. The questionnaire consisted of 12 items covering patient's attitude toward student involvement in their care, acceptable patient-care activities in which students could be involved, and preference for being told if caregiver is a medical student. Results: Patients' attitudes towards students' participation in their care were relatively more favorable than expected. 46.8% of patients reported that they would permit students to be involved up to and including simple non-invasive techniques. 76.2% of patients stated that they would allow students to participate in their future in-hospital care. Most patients preferred knowing that the caregiver was a medical student. Conclusion: The results of this study are reassuring. A higher than expected percentage of patients surveyed disclosed that they would accept medical students being involved in their care. Medical educators should provide a safe environment for medical students to be able to tell the patients, “I am a student doctor”.

물리치료 내원환자의 만족도에 영향을 미치는 요인 분석

손애리,김미원,Sohn, Ae-Ree,Kim, Mi-Won 대한물리치료과학회 2002 대한물리치료과학회지 Vol.9 No.4

Patient satisfaction is an important factor in evaluating the quality of care. Patient satisfaction may be used to evaluate provider services and facilities, and used to predict the patient returns to a facility. The patients d whether the patient returns to a facility or whether the patient recommends the facility to other people may be affected by a variety of factors of patient satisfaction. Low satisfaction may result in poor compliance with the potential of waste of resources and suboptimal clinical outcome. This study is to identify factors of patient satisfaction that will affect patients decision whether the patient returns or not. A self-administered questionnaire survey was conducted in Seoul, Chung-Joo and Bu-Cheon cities, Survey data was obtained from 743 patients who visited the physical therapy practice at university hospitals, general hospitals and clinics. Response rate was 94.4%. The instrument developed by Goldstein et al. (2000) was used and translated into Korean. Several items were added to the instrument. Patient's opinions of service in each domain measured using 5-point Likert-type scales that ranged from strongly disagree to strongly agree. A multiple-regression analytic approach was used to predict overall satisfaction of physical therapy. Age, kindness, scheduling, convenience of parking, privacy, and waiting time predicted the overall satisfaction of physical therapy. The older patients had higher level of satisfaction with physical therapy compared with the younger patients. Patient satisfaction were more affected by access (scheduling and waiting time), administrative technical management (convenience of parking), and interpersonal management (kindness of physical therapists and other staffs) than clinical technical management (physical therapists' skills).

의과대학 학생의 실제 환자 진료와 표준화 환자 진료 간의 환자 중심 면담 특성 비교

이향미,박훈기,황환식,전민영 한국의학교육학회 2013 Korean journal of medical education Vol.25 No.2

Purpose: Patient-centered care is one of the most important factors of high-quality medical care. Medical educators have been increasingly interested in education for patient–centered care. This study was conducted to guide such education by assessing the patient-centeredness of medical students in a real patient encounter and a standardized patient encounter on the clinical performance examination (CPX). Methods: During the first semester of 2010 and 2011, fourth-year medical students in a clinical clerkship interviewed outpatients who visited the Department of Family Medicine. The interviews were videotaped, 25 of which were selected for study. We searched the 25 students’ CPX videotapes that were recorded in the same year for comparison. The patient-centeredness of the students was assessed by measure of patient-centered communication (MPCC). Results: The inter-rater reliability of the MPCC was 0.89 when measuring real patient encounters. MPCC scores of 25 students were very low for both real patients (mean, 28.8; range, 8.2~53.1) and for standardized patients (mean, 27.5; range, 8.2~52.7),and there was no significant difference between two groups. The component 1 MPCC scores were significantly higher for real patient encounters compared with those of CPX encounters (0.28 vs 0.18, p=0.0001). The component 2, 3 MPCC scores of two groups were not different each other. Conclusion: Medical educators must emphasize the importance of exploring a patient’s illness and social background and involving them in making a diagnosis and treatment plan for patient-centered care. They should give students more opportunities to interview real patients and diversify scenarios for standardized patients.

외래 의료서비스 이용 환자의 환자참여 경험이 환자만족에 미치는 영향

안신애 간호행정학회 2022 간호행정학회지 Vol.28 No.2

Purpose: This study examined outpatients’ experiences of patient participation, their level of patient satisfaction, and the factors that influence their patient satisfaction with outpatient care. Methods: This cross-sectional descriptive study utilized secondary data from the 2018 Survey on the Experience with Healthcare Service conducted in South Korea. Data from 6,684 outpatients over the age of 20 years who had visited hospitals were analyzed. Patient characteristics, health-related characteristics, and their experiences of patient participation were assessed as factors related to patient satisfaction. Factors that influenced patient satisfaction with outpatient care were identified using logistic regression analysis. Results: Overall, 84.9% of the participants were satisfied with the received outpatient care. Higher patient satisfaction with outpatient care was significantly associated with middle (40-59 years) and old age (≥60 years), good self-rated health status, and experience of patient participation in patient safety activities. Conclusion: Multiple factors were related to patient satisfaction with outpatient care. These factors need to be considered when evaluating patients’ satisfaction levels. To improve satisfaction with health care use, it is essential to provide more experiences and expand their opportunities for patient participation during the care process and establish healthcare policies and strategies to enhance patient participation in patient safety. 연구목적: 본 연구의 목적은 환자가 경험한 외래 의료서비스 이용 과정에서의 환자참여 경험 정도와 환자만족 현황을 파악하고 환자만족에 영향을 미치는 요인을 파악하기 위함이다. 연구방법: 본 연구는 ‘2018년 의료서비스경험조사’ 데이터를 사용하여 의원급과 병원급 의료기관의 외래 의료서비스 이용 경험이 있는 20세 이상의 성인 6,684명의 자료를 분석하였다. 환자만족에 영향을 미치는 요인은 환자 특성, 건강관련 특성, 환자참여 경험으로 분류하였으며 로지스틱 회귀분석을 통해 분석하였다. 연구결과: 대상자의 84.9%가 외래 의료서비스에 만족하는 것으로 나타났다. 외래 의료서비스를 이용하는 환자의 환자만족에는 연령, 주관적 건강수준, 환자참여 경험이 유의한 영향을 미치는 것으로 확인되었다. 결론: 환자만족에는 다양한 요인이 관련되어 있으며 이러한 요인을 고려하여 환자만족을 평가할 필요가 있다. 외래 의료서비스를 이용하는 환자의 만족을 높이려면 환자참여를 증진시키기 위한 의료정책 및 전략 수립을 통해 치료과정에서 환자가 참여할 수 있는 기회를 확대해 주는 것이 필요하다.

Characteristics of Patients With More Than 90% Adherence to Automatic Positive Airway Pressure

Kim Min Su,Kang Jae-yoon,Park Soo-Kyoung,Kim Yong Min 대한수면학회 2022 sleep medicine research Vol.13 No.3

Background and Objective Among patients suffering from obstructive sleep apnea, there is a group with surprisingly high adherence (≥ 90%) to automatic positive airway pressure (APAP) treatment. This study aims to evaluate the characteristics of these patients.Methods Medical records of 4757 patients, who received APAP prescriptions between July 2018 and December 2019, were reviewed retrospectively. After the exclusion of patients not meeting the study criteria, a total of 103 patients were included in the study, and patients were divided into a very good adherence (VGA; adherence ≥ 90%) group and a poor adherence (PA; adherence < 70%) group, based on nine months of APAP adherence. Patient demographics, medical history, body mass index, and pretreatment polysomnography (PSG) results, as well as APAP therapy adherence-related variables (percentage of total days of APAP usage, and the mean time of APAP usage), the 90th percentile pressure (P90), residual apnea-hypopnea index (AHI), and the type of devices or company managers were compared between the two groups.Results Median age was significantly higher in the VGA group than in the PA group (p = 0.032). The Beck Depression Inventory (BDI) also differed significantly (p = 0.017) between the two groups. There were significant differences in the total sleep time (p = 0.003): 309.04 ± 64.96 min in the VGA group and 345.47 ± 53.06 min in the PA group. Patient sleep efficiency was observed and differed significantly (p = 0.003) 74.46 ± 13.73% in the VGA group and 82.09 ± 10.82% in the PA group. Other parameters, such as a pretreatment PSG and sleep-related questionnaires, did not show significant differences between the two groups. The device-related data at 1, 3, and 9 months were similar, and there were significant differences in the mean usage time (p < 0.001) and the number of days on which the device was used for more than 4 hours a day (p < 0.001) between the two groups. However, the two groups had no significant differences in mean pressure, residual AHI, and the P90.Conclusions The total sleep time, sleep efficiency, and BDI were the main determinants of adherence in patients in the VGA group. To find additional fac Background and Objective Among patients suffering from obstructive sleep apnea, there is a group with surprisingly high adherence (≥ 90%) to automatic positive airway pressure (APAP) treatment. This study aims to evaluate the characteristics of these patients.Methods Medical records of 4757 patients, who received APAP prescriptions between July 2018 and December 2019, were reviewed retrospectively. After the exclusion of patients not meeting the study criteria, a total of 103 patients were included in the study, and patients were divided into a very good adherence (VGA; adherence ≥ 90%) group and a poor adherence (PA; adherence < 70%) group, based on nine months of APAP adherence. Patient demographics, medical history, body mass index, and pretreatment polysomnography (PSG) results, as well as APAP therapy adherence-related variables (percentage of total days of APAP usage, and the mean time of APAP usage), the 90th percentile pressure (P90), residual apnea-hypopnea index (AHI), and the type of devices or company managers were compared between the two groups.Results Median age was significantly higher in the VGA group than in the PA group (p = 0.032). The Beck Depression Inventory (BDI) also differed significantly (p = 0.017) between the two groups. There were significant differences in the total sleep time (p = 0.003): 309.04 ± 64.96 min in the VGA group and 345.47 ± 53.06 min in the PA group. Patient sleep efficiency was observed and differed significantly (p = 0.003) 74.46 ± 13.73% in the VGA group and 82.09 ± 10.82% in the PA group. Other parameters, such as a pretreatment PSG and sleep-related questionnaires, did not show significant differences between the two groups. The device-related data at 1, 3, and 9 months were similar, and there were significant differences in the mean usage time (p < 0.001) and the number of days on which the device was used for more than 4 hours a day (p < 0.001) between the two groups. However, the two groups had no significant differences in mean pressure, residual AHI, and the P90.Conclusions The total sleep time, sleep efficiency, and BDI were the main determinants of adherence in patients in the VGA group. To find additional factors which affect adherence, further studies will be needed.

Management and educational status of adult anaphylaxis patients at emergency department

( Mi-yeong Kim ),( Chan Sun Park ),( Jae-won Jeong ) 대한내과학회 2018 The Korean Journal of Internal Medicine Vol.33 No.5

Background/Aims: We evaluated the management and educational status of adult anaphylaxis patients at emergency departments (EDs). Methods: Anaphylaxis patients who visited ED from 2011 to 2013 were enrolled from three hospitals. We analyzed clinical features, prior history of anaphylaxis, management and provided education for etiology and/or prevention. For analyzing associated factors with epinephrine injection, Pearson chi-square test was used by SPSS version 21 (IBM Co.). Results: A total of 194 anaphylaxis patients were enrolled. Ninety-nine patients (51%) visited ED by themselves. Time interval from symptom onset to ED visit was 62 ± 70.5 minutes. Drug (56.2%) was the most frequent cause of anaphylaxis. Forty-seven patients (24.2%) had prior history of anaphylaxis and 33 patients had same suspicious cause with current anaphylaxis. Cutaneous (88.7%) and respiratory (72.7%) symptoms were frequent. Hypotension was presented in 114 patients (58.8%). Mean observation time in ED was 12 ± 25.7 hours and epinephrine was injected in 114 patients (62%). In 68 patients, epinephrine was injected intramuscularly with mean dose of 0.3 ± 0.10 mg. Associated factor with epinephrine injection was hypotension (p = 0.000). Twenty-three patients (13%) were educated about avoidance of suspicious agent. Epinephrine auto-injectors were prescribed only in five patients. Only 34 (19%) and 72 (40%) patients were consulted to allergist at ED and outpatient allergy department respectively. Conclusions: We suggested that management and education of anaphylaxis were not fully carried out in ED. An education and promotion program on anaphylaxis is needed for medical staff.

연명의료결정법상 환자의 동의에 대한 고찰 - 미국의 연명의료결정법을 중심으로 -

성경숙 숭실대학교 법학연구소 2019 法學論叢 Vol.44 No.-

Patients generally possess the right to refuse unwanted medical treatment even if it will result in their death. Unwanted medical procedures make the patient keep alive against his will and subject him to invasive treatment. According to the act for Withdrawing Life-Sustaining Treatment, the patient and his family seek to terminate life-sustaining treatment. In America, The Patient Self-Determination Act is designed to increase the role that advance directives- both living wills and durable powers of attorney- play in medical decision-making. Futhermore, the Uniform Health Care Decision Act(UHCDA) substantially alters the form and utility of living wills and durable powers, and it provides a method of making health care decisions for incompetent patients who do not have advance directives. The UHCDA has explicitly determined that the decision maker should make a decision based on the principle of substituted judgment rather than the best interest principle. If it is impossible to apply the substituted judgment principle, the statute would apply the best interest principle. In patients without decisional capacity, one way to serve the underlying goal of autonomy is through the application of the doctrine of substituted judgment. Under this doctrine, a person attempts to determine what the patient would do if the patient had decisional capacity. It may be possible to review the values of a formerly competent proposed medical care. This can be done through a thoughtful analysis of the patient`s values during life, or more precisely, through review of formal statements made by the patient when the patient had capacity. Some have argued that the doctrine of substituted judgment is too speculative to be applied reliably and that there is simply no way to protect the autonomy of a patient without decisional capacity. In these circumstances, the doctrine of substituted judgment is serving beneficence, and the alternative to the doctrine of substituted judgment is the doctrine of “best interest” of patient. The more difficult it becomes to decide what the patient would do if that patient had decisional capacity, the more likely it is that the court will apply the principle of beneficence rather than the principle of autonomy. Life-sustaining treatment may be withheld or with drawn from an incompetent patient when it is clear that the particular patient would have refused the treatment under the circumstances involved. To decide refusing the life-sustaining treatment for the patient, the “subjective test”, “limited-objective test”, and “pure-objective test” should be satisfied. Through these tests, the patient without decisional capacity make their lives more honorable. 연명의료결정법은 환자의 최선의 이익 보장과 자기결정권의 존중을 통한 인간으로서의 존엄과 가치의 보호를 목적으로 하고 있다. 연명의료결정법에 따라 환자가 임종과정에 있는지의 여부를 판단한 이후에 환자의 의사를 확인할 수 있는 경우와 환자의 의사를 확인할 수 없는 경우로 나누어 중단여부를 결정하고 있다. 연명의료결정법에 있어서 환자의 의사를 확인한 경우에는 별다른 문제가 발생하지 않는다. 즉, 연명의료결정법은 사전연명의료의향서와 연명의료계획서를 도입하여 환자의 의사를 확인하고 있으며, 이와 같은 환자의 의사를 명확하게 확인할 수 있는 문서가 없는 경우에도 가족의 일치하는 진술에 의한 의사추정을 인정하고 있다. 뿐만 아니라 연명의료결정에 대한 환자의 자기결정권을 기대하기 어려운 경우에 연명의료결정법은 매우 제한적으로 자기결정이 아닌 타인결정에 의한 연명의료 결정에 대하여도 허용하고 있다. 따라서 환자의 의사를 확인할 수 없고 환자가 의사표현을 할 수 없는 의학적 상태에 있는 환자가 미성년자인 경우 법정대리인인 친권자의 의사에 근거하여 연명의료결정이 허용될 수 있도록 규정하고 있고, 성년인 경우에는 환자가족 전원의 합의가 있는 경우에도 이를 근거하여 연명의료결정을 허용하고 있다. 하지만 환자의 의식회복의 가능성이 없는 경우에 추정적 의사를 확인하기는 쉽지 않으며, 환자가 그 상황에서 그와 같은 선택을 했다는 것을 확신할 방법이 없다. 또한 환자의 의사를 확인할 수 없고 의사표시를 할 수 없는 의학적 상태에 있는 환자의 경우에 환자의 의사가 아닌 보호자 의사나 가족의 의사에 의한 연명의료결정은 환자 자신의 의사결정이 아닌 타인의 의사결정으로 경제적 이해관계 등에 따른 환자의 친권자 또는 가족에 의한 남용의 우려도 제기될 수 있다. 따라서 연명의료결정에 관하여 환자의 의사를 확인할 수 없는 경우에는 그 의사를 추정해야 하고 환자의 의사를 추정할 수 없는 경우에 환자 가족에 의한 대리결정을 내려야 하는 문제에 있어서, 연명의료결정에 대한 환자의 자기결정권을 기대하기 어려운 경우에는 최선의 이익 판단으로 환자의 연명의료결정을 이행할 수 있다. 미국법원에서 제시한 주관적 판단방법, 제한적 객관적 판단방법 그리고 순수 객관적 판단방법의 3단계 방식은 사전의사표시도 없고 의사결정능력이 없는 환자의 연명의료결정에 있어서 자기결정이 아닌 타인결정에 의한 연명의료결정을 이행하는데 유효한 판단방법일 것이다.

Patients’ Perceptions and Expectations of Family Participation in the Informed Consent Process of Elective Surgery in Taiwan

Mei-Ling Lin,Wai-Ming Kan,Ching-Huey Chen 한국간호과학회 2012 Asian Nursing Research Vol.6 No.2

Purpose: This study investigated patients’ perceptions and expectations of their families’ participation in the informed consent process of elective surgery. Methods: This is a survey study. Anonymous questionnaires that were mailed to potential participants included a demographic data sheet and a scale, measuring patients’ perceptions of themselves and their families’ participation level in the informed consent process. A convenience sample of patients who had undergone surgery and had been discharged within 4 months from a medical center in southern Taiwan (n ¼ 1,737) were recruited. Results: One hundred and forty-five recipients replied, gaining a response rate of 10.0%, and 120 provided complete data. The mean age of the participants was 56.0 years (range 20e85, SD ¼ 14.98), and more than half were female (54.2%). Twenty-one participants (17.5%) perceived having less family participation than their own participation in the surgery informed consent process, and 40% expected more family participation in the process. The mean scores of the self-rated participation level was significantly higher than that of the families (p < .001). Patients' expectations of family participation were significantly higher than their perceptions of family participation (p < .001). Eleven patients (9.2%) reported having more family participation than they expected. Participants received the most information about the disease during the informed consent process and the least information about alternatives to surgery. Age,gender, number of previous surgeries and admissions influenced the study participants' perceived level of participation in the informed consent process. Conclusion: This preliminary study demonstrates that patients’ perceptions and expectations for family participation in the surgical informed consent process vary. Healthcare providers should be aware of patients’ expectation to appropriately invite their family into the informed consent process. Purpose: This study investigated patients’ perceptions and expectations of their families’ participation in the informed consent process of elective surgery. Methods: This is a survey study. Anonymous questionnaires that were mailed to potential participants included a demographic data sheet and a scale, measuring patients’ perceptions of themselves and their families’ participation level in the informed consent process. A convenience sample of patients who had undergone surgery and had been discharged within 4 months from a medical center in southern Taiwan (n ¼ 1,737) were recruited. Results: One hundred and forty-five recipients replied, gaining a response rate of 10.0%, and 120 provided complete data. The mean age of the participants was 56.0 years (range 20e85, SD ¼ 14.98), and more than half were female (54.2%). Twenty-one participants (17.5%) perceived having less family participation than their own participation in the surgery informed consent process, and 40% expected more family participation in the process. The mean scores of the self-rated participation level was significantly higher than that of the families (p < .001). Patients' expectations of family participation were significantly higher than their perceptions of family participation (p < .001). Eleven patients (9.2%) reported having more family participation than they expected. Participants received the most information about the disease during the informed consent process and the least information about alternatives to surgery. Age,gender, number of previous surgeries and admissions influenced the study participants' perceived level of participation in the informed consent process. Conclusion: This preliminary study demonstrates that patients’ perceptions and expectations for family participation in the surgical informed consent process vary. Healthcare providers should be aware of patients’ expectation to appropriately invite their family into the informed consent process.

이야기 접근을 통한 환자중심적 병력청취 대화

박일환 대한가정의학회 2010 Korean Journal of Family Medicine Vol.31 No.1

Patient-centered interviewing is to understand and respond to patient's needs and prefers at the level of patient. For practicing the patient-centered interview, the way of communication should be changed in history taking, explanation,and patient education. Story telling (illness narrative) which composes of 5 dimensions such as abstract, orientation,development (complication), evaluation, and coda is the unique and key way to approach the area of patient's illness experience, values, history of life, social environment (occupation, family relationship), and emotion. Narrative gives information about how a story teller views and expresses the event that he/she experienced before, and information about how a story teller positions the self, the subjects of story, and listener's identities. Narrative competence to listen to a patient's story requires several kind of interview skills at the moment of patient's expression of disease history, including skill for composing story, skill for listening, skill for empathizing, and skill for effective questioning. Collecting patient's illness story is not refi ned to the individual patient. If we listen to the various patients' illness stories, who have the similar disease, and arrange the stories systematically, the patients' illness database can help many patients by the facts in the database and the therapeutic power of the other patients' illness stories. 환자중심적 병력청취 대화는 환자가 진정으로 원하고 필요로하는 것, 환자가 선호하는 것을 환자 수준에서 이해해 주고, 적절히 반응해주기 위한 대화이다. 이를 실천하기 위해서는 문진이나 환자교육, 상담을 위한 의료면담에서 의사소통 행위의 변화가 필요하다. 개요, 배경설정, 사건전개, 평가, 종결부의 구조를 가지고 전개되는 이야기는 한 개인의 질병경험과가치관, 삶의 내력과 사회적 환경(직업, 가족관계 등), 감정적영역에 접근할 수 있는 유일하며 핵심적인 통로이다. 이야기는 이야기하는 사람이 과거의 사건을 어떻게 바라보고 표현하는지를 알게 해주며, 화자가 자기 자신과 이야기의 대상 및이야기 상대자(청자)의 정체성을 어떻게 자리매김하는 지를알게 해준다. 환자의 병력 이야기를 들을 수 있는 능력은 이야기 구성 기술, 경청 기법, 공감기법, 효과적인 질문 기법 등의질병 표현단계의 몇몇 의사소통 기술을 요구한다. 환자의 질병경험의 수집은 일개 환자에게만 국한되는 것은 아니며, 유사한 질병을 앓고 있는 환자들의 질병경험을 폭넓게 듣고 체계적으로 정리해 볼 때에 질병경험 데이터베이스가 갖고 있는 유용한 사실적 정보와 질병경험의 이야기가 갖고 있는 치료적 효과에 의하여 많은 이들에게 도움을 줄 수 있을 것이다.