RichardInSF

Based on my one trip to a Japanese emergency room, I'd agree with those comments. And the "strong medicine" (as it was described to me) that I was given as I left? Roughly equivalent to Advil and a stomach acid reducer -- for a knee problem that ultimately required orthoscopic surgery.

But what about that private clinic in Roppongi Hills, which I assume you'd know a bit about? I somehow had the impression that they worked to a higher standard.

mjm

The clinics in Japan regardless where they are are staffed by people who study in the same system and whose peers and their expectations are similar. Individual doctors do shine, but until there is a general change in mentality the issues which give rise to my opinions will persist.

People go to the hospital (and high end clinics) for a cold, even today. Indicative of the basic level of expectations much?

joejones

The other reason to consider is the lack of meaningful tort liability in Japan. If a doctor makes even a minor mistake in the US, the patient can win a substantial amount of damages in court, and this hits the doctor's insurance bill fairly hard and flushes bad doctors out of the system. In Japan, the amounts are much less, in part because of the lack of civil juries and in part because court filing fees are based on the amount the plaintiff claims, so it's easier for bad doctors to keep practicing. Those of you in the States who want liability caps on doctors need to come roll the dice with medical treatment in Japan.

That said, there are good doctors here -- it just takes trial and error to find them.

mjm

Interesting point. Legal systems filtering bad out and leaving good. I can see that in the US. Here I see perhaps a much simpler reason for the lack of good doctors. Lack of good teachers. We all learn a bit in school, but then we learn a great deal more from our colleagues. So called OJT. Here the blind leading the blind and the general tendency to avoid change with the rationale that something should be done a certain way because things are always done that way seem to be major contributors to the poor level of care possible. I often tell colleagues that if the fellow who invented the car had used that logic we would still all be on horseback.

Sure there are good doctors here. The problem with them being so few and far between is that their influence does not serve to positively dilute the poor quality pool. Trial and error as the right way to get a key in the lock is fine,but as a way to treat a sick or injured patient.... well..........

joejones

To continue my last point:

I was in a car accident in the US the night before the Fourth of July a few years ago. A kid turned left right in front of us while we were heading through a green light at 40 mph or so. Both cars were seriously damaged, but the people in our car were not obviously injured, so we got a ride home and went to bed.

The next day, the driver and I were feeling very sore all over our ribcage area, so we went to the local ER to get checked out (all local doctors' offices being closed for the holiday). We had to wait for a while as trauma victims got processed, but eventually got in to see a doc, who poked us gently in a few places and told us we were only suffering from muscle tightening. We asked if we could get x-rayed to check for broken ribs, to which the doc responded "We don't do that unless we think it's medically necessary -- too much potential liability from unnecessary radiation." He gave us a prescription for relaxants and painkillers, we paid the hospital something like $400 a head (reimbursed by the other kid's insurance company later) and left.

I moved to Japan later that year, and have since gotten a chest X-ray every year as part of my physical...

mjm

Ditto on the chest x-ray. I waive the barium belly scan though. That is whole body x-ray and last a lot longer. Done largely due to the higher incidence of digestive tract cancer here possibly due to the longer small intestine.

Calcifer

I used to tell my Japanese friends that's why I was leaving Japan when I did--had to get out before 40 so I wouldn't have to swallow the barium.

acregal

I was once told that getting an annual physical with a chest x-ray (to test for TB) was a legal requirement for anyone working in a school.

I've refused the chest x-ray for the last few years. I actually refuse most of the tests.

Japanese doctors know a lot about side effects, at least those that they can prescribe something for. Japanese doctors are good for small things (and I have no experience anywhere for something big) and the wait times for clinics are quite short. Nothing like the US where you need an appointment only to wait for 20 or 30 minutes to be called into a room to wait again.

jib71

With all the prescriptions, a visit to a Japanese doctor can leave you feeling like the proverbial old lady who swallowed a fly.

(There was an old lady who swallowed a cat.
Imagine that, she swallowed a cat.
She swallowed the cat to catch the bird ...
She swallowed the bird to catch the spider
That wiggled and wiggled and tickled inside her.
She swallowed the spider to catch the fly.
But I dunno why she swallowed that fly
Perhaps she'll die).

mjm

The Xray and nay other component are up to you. I choose to do the Chest Xray as an ex-smoker who is paranoid, but I blow off the Barium milkshake and bloated belly scan on the rack. I chuckle at the eye tests and ear tests, but the blood work is always good. It is the results that make me chuckle. The ranges they have for waist size and BMI are geared for the local frame. A 36 inch waist is considered very large here and a cause for a warning note on the report. They really should step into the computer age and add data to their databases so as to be able to correctly judge various ethnicities.

I have not been led to believe they know much about side effects or that they are very good at all. They often treat a tiny fraction of what is treatable and schedule check-ups about once a month. Not exactly demonstrative of being problem solving oriented. Kind makes one suspect a lack of ability.

Wait times are a pet peeve here too. They are not short at all. That is terribly misleading. They schedule appointment for blocks of an hour and you wait until your turn is up. You might for example get a 3pm appointment which in fact means sometime between 3 and 4 depending on when you get there and check in at the desk. A wait of most of an hour is very common here. In the US on the other hand, at least in the San Francisco Bay Area, one makes an appointment and goes a few minutes prior and gets in very close to the time. The weird thing in the US these days is the PA concept. People that could not quite stick it out to become a real doctor but can still do most of the stuff a real doctor does. I guess each place as its shortcomings but the US is a far better place to find a quality doctor who can treat you on time and who knows what they are doing.

Ever have a baby here? That will make anyone crazy.

joejones

I got a very detailed summary of the different international standards for "metabolic syndrome" last time I went for a checkup. Interestingly, the waist circumference cutoff for women is higher in Japan: 88 cm in the US vs 90 cm in Japan.

The International Diabetes Foundation has apparently been working on ethnic-specific standards, but they are much harsher than the US standards: 94 cm for white men, 90 cm for Asian men and 80 cm for both white and Asian women.

Based on talking to friends who have done it recently, it seems largely dependent on where you go. Some clinics/hospitals have incredible facilities and will take care of the mother for days before and after delivery. Other clinics/hospitals have shared delivery spaces (i.e. a stranger screaming on the other side of a curtain) and kick you out after a few hours. Doctors are tyrannical about immaterial issues like weight control, but then again you don't have to listen to them...

mjm

Actually those numbers are not accurate, or I should say not the standard for doctors to use in the US. The NIH suggests 88.9cm for women and 101.6 for men. i.e. 35 inches and 40 inches respectively.

The experience when having a baby here is definitely related to where you do it. The clinics in general are far preferable with up to a week in the clinic afterwards which is ideal for new young moms to learn things such as nursing and basic care. A god bridge to being home a lone with an infant. That aspect I really like.

As an example try having a jaundiced baby though and they will not allow the father to touch it for a week while it undergoes ultraviolet treatment to stimulate the production of billirubin in the baby's own system. Jaundice is generally because the baby is not producing its own having been tied to the mom's system until then. Ultraviolet light stimulates the production of billirubin. I asked about this when my son was born and I was handed a Japanese textbook and told to read it for myself. Oh, and I was not allowed to hold my son either. That doctor and I had words afterwards I assure you.
Just one example and I have story after story of clinics, hospitals, regular checkups etc. HAving a baby and watching it grow here is far less medically satisfying than in the US. Most Japanese parents have not got a clue so doctors just get to be the way they are with no reasonable expectation in elevation of care.

KIXman

I've been in Japan for quite some time now and in general don't like the medicine and doctors here. As mentioned earlier the medicine seems to be very weak, so I usually take back some when I go abroad.
As for doctors I started to doubt how much they know when I got chickenpox; it took three doctors in three different hospitals to diagnose it correctly, while a doctor friend of mine was able to come to the right conclusion after only a short check of symptoms over the phone.
For the OP, if your friend is going to be in Japan over a year, I think its better to bring a stock of what he/she's used to. Other cold and cough stuff can be found over the counter but for cases that a visit to the doctor is needed, yes after the doctor gives out the prescription you go next door to get the pills / powders that were prescribed.

RichardInSF

But yet life expectancy is longer for Japanese than for Americans. I am curious how that can be if the standard of medical care is so much lower as most here believe.

Not challenging anyone -- as I noted, my experience at a Japanese emergency room tends to support this belief -- just wondering if anyone has a good explanation.

joejones

Diet (fish) and exercise (little driving) compensates for it, I think.