47
course, my respect for the Japanese
medical system grew in many ways
as I witnessed the incredible preven-
tative efforts, the patient-centered
health care, the people’s discipline,
and the absolute generosity of a cul-
ture that spares no expense for the
health of its population.
Contrary to my expectations, I re-
ceived amazingly frank assessments
from my Japanese hosts. In particu-
lar, I was amused by the overtures of
young doctors sent by their hospitals
on the mainland to
stand-in
for a day
or two every week or at the island
private clinics. After looking both
ways to ensure their elders were
not present, they asked me if they
could answer any of my questions
and sometimes would offer unsolic-
ited information about differences
in rural versus mainland care. None
of them believed the government
assessment of the radiation damage,
and public outcry has now forced the
closing of about 50 nuclear facilities.
My respect for this system not-
withstanding, I saw jaw-dropping
disparities in individual physicians’
choice of treatment modality. I
asked younger physicians and hos-
pital administrators about this. One
administrator, not a physician him-
self, pointed out that upon receipt
of their board certification, physi-
cians have no requirement to pursue
continuing education. He added
that compliance with a set standard,
such as the various quality-assur-
ance programs one sees in most
developed countries, is voluntary
and up to each hospital, though he
added most do try to comply.
The litigious nature of the Ameri-
can ego that focuses on
self
and
blame
is not a good thing in any capacity,
but it does ensure the majority of phy-
sicians know the current standard of
care, albeit for the wrong reasons. The
Japanese system, with its tremendous
respect of hierarchy and age, leads to
physicians that dole out orders to pa-
tients that say, “Yes, doctor.” No one
asks if a treatment is the most modern
or best one to do. It is taken as a given
that the doctor knows best.
For all of that, I’d still rather be
treated in Japan. Anyone needing
and unable to get a same-day ap-
pointment in the United States will
understand why. I don’t need an
appointment to see my doctor in
Japan. Physicians go to their office
in the morning, usually about 8:00,
and stay there until 6:00 or 8:00 p.m.
depending on the day. I never saw
a patient wait very long to see a
physician, although I did see many
a doctor sitting at his desk, patiently
waiting for patients.
All physicians in the United
States at some point or another have
encountered some regulation or
reimbursement issue that stopped
them from using a simple tool to
arrive at a straightforward diagnosis
and treatment. For example, even
though a microscope is a relatively
inexpensive and unregulated off-the-
shelf purchase that anyone can have
and use in his or her home, getting
the certification required to use them
in the office is often problematic and
cost-prohibitive. Japan has no such
issues. In the absence of costly and
problematic regulations and complex
reimbursement procedures, X-ray
machines are common in most fam-
ily practice/internal medicine-type
offices, blood work is often done in-
house, and patients get their diagno-
sis and treatment faster.
In 2011, I said the Japanese system
was not perfect, just close. A slightly
better grasp of the language and
slightly closer look at the system
reveals it is not as close to perfect as
I wanted to believe. It is, however,
still closer than most systems. And
in every way I know how to assess, it
remains one of the best in the world.
That said, Japan is guaranteed
to see more natural and manmade
disasters. The country is situated on
geological fault lines, has more than
a few active volcanoes, has upward
of tens of millions of people living
along coastlines of island chains that
will be hard-hit by global warming,
and are at a nexus of international
politics simply because they are off
the coast of China, friends of Taiwan,
off the coast of North Korea, and
close friends with South Korea.
Whatever happens in the Pacific,
Japan is in the middle of it, and its
medical system will have to answer
the call. If and when something
catastrophic occurs, I will be there to
assist in any way possible.
“...with Geiger counter in hand, we entered the restricted area around the nuclear reactor, followed
by a car trip up and down the coast through the areas hardest hit by the tidal wave. We saw eerie
ghost towns and pulled up to peer into a vacant 7-Eleven store, noting that the shelves were fully
stocked while a relatively new car remained parked in a driveway.”
COM Outlook . Winter 2015
