A few people have asked me about the medical system here in Japan. Luckily, I haven’t had a serious illness, but I do have a couple of experiences that I can share. Note that I’m not trying to be particularly positive or negative about the system, just talk about it.
My Experience
So my fingernails haven’t been particularly great for a while. I always suspected that they had a fungus but when I brought it up to my doctor in Canada he told me to just wait and see if they got better on their own. Well, I was waiting, but one of them got significantly worse, so I bit the bullet and went down to my local hospital to see what was up.
The visit brought to light a few issues:
- You don’t need to see a GP before you see a specialist. I knew that I needed to see a dermatologist. In Canada, I would have needed to see my GP first and then get a referral to a dermatologist. In Japan, I just went to the hospital and the triage nurse sent me straight up to dermatology; I was talking to a specialist within 10 minutes of my arrival at the hospital.
- Specialists do a lot of their own diagnosis rather than sending samples to the lab. The doctor took some samples from my fingernails for analysis. In Canada, he would have sent them off to a lab and I would have had the answers within a few days. In Japan, he took the samples over to a microscope and I had my diagnosis within 2 minutes.
- Prescription medicine here is weak. The standard dosage of the medicine they gave me is 250mg/day in North America; it’s only 125mg/day in Japan. Many of my students are working for pharmaceutical companies; it’s a common lament that the Japanese government only allows fairly weak medicine.
- Health care is quite expensive. Until a recent event (see later in this post) scared me into it, I had no insurance. My fee was something like $100 for a doctor’s visit, $75 for a blood test, and $80 for each month’s worth of medicine. I guess maybe this won’t surprise anyone from a country without socialized health care, but I come from a place where hospitals don’t have cash registers, so it was a bit of a shock.
- Blood samples are analyzed quickly. Due to the nature of the medicine that I’m taking, I have to have my liver checked each month before the doctor will give me more. So, I come to the hospital one hour before my appointment and go to the bloodwork department. They already know what tests to run because it’s in the computer. Typically, while I’m still there holding a cotton swab over my arm, someone is already taking my blood over to the analysis machines. By the time that I go up for the appointment, the results are already on my doctor’s computer screen.
- Hospitals have pharmacies on-site, even for outpatients. At home if you need medicine, the doctor will write you a prescription for you to bring to your local pharmacy. Here, you don’t get a prescription; the doctor just puts it into the computer and when you go downstairs to pay they just hand you a bag with your medicine in it.
My Friend’s Experience
A friend of mine recently had a much worse health scare than just some wonky fingernails. I picked up the phone one Wednesday morning to my friend’s voice: “I’m gonna lose my eyesight!” She was on her way to a specialist to confirm the grim diagnosis given to her by an opthamologist. Since I was closest to where she was, she called me in to reinforce her understanding of what the Japanese doctor would say, but since this was more important than just a fingernail, I called my Japanese teacher who graciously agreed to accompany us to this hospital, so the three of us trekked up to the university hospital to see the retina specialist. In the end, everything worked out well (after some surgery and a week’s stay in the hospital) but I have a few more observations about the medical system as the result of this experience:
- Not all doctors have great bedside manner. My friend was told by the original opthamologist that she was going to lose her eyesight (a diagnosis that proved incorrect), and was basically dumped back onto the street with no more information than a map to a specialist’s office in another part of town, and the warning “they don’t speak any English there.” I guess I’m not sure what would have happened in Canada, but my guess would be that there was a little more care given than that.
- Some specialists are few and far between. The specialist who operated on my friend’s eye was one of only five in Japan who do that surgery. He gets something like 4 days per year off and often sleeps at the hospital. There’s no question that this guy knew his stuff medically and that my friend had great treatment, but I wonder whether it’s good for the patients to have doctors who get so little rest.
- Blind adherence to procedure can make it difficult for patients. My friend, having just had her eye cut open with a knife and sewn shut, understandably had some head pain. Because the hospital beds in Japan don’t sit themselves up, she couldn’t support herself to sit up and eat — it was too painful on her head. And yet the nurses got mad at her because the only foods that she ate were the ones that could easily be eaten flat on her back. The nurses got so cranky, in fact, that it stressed out my friend, making healing even more difficult.
- In spite of the mean nurses, the good doctors make it worthwhile. As I explained this retina surgeon was really really busy. But he still took the time to sit my friend down and explain in English as well as he could during her initial appointment and all of the follow-up care. All indications are that he did a great job fixing up her eye as well.
- Health insurance can be the next thing to useless if you’re not careful. My friend’s surgery cost something like $12,000. And although her insurance company sure sells a lot of insurance in Japan, they didn’t seem prepared to deal with the realities of operating in Japan. When I called to file a claim (while my friend was in her initial diagnosis appointments), they told me, “don’t worry, we’ll take care of everything.” An hour later when I called for a status report, I was told that there was a roadblock because they’d tried to call the hospital, but — surprise of all surprises — everyone at the hospital spoke Japanese. They suggested that she pay for the surgery (out of the $12,000 that she was no doubt carrying in her wallet that day) and file for reimbursement. It finally turned out that her insurance paid for everything directly to the hospital, but that’s only because her day job has a full-time staff person whose only job is to interface between the stupid insurance company and Japanese hospitals.
Well, if nothing else, that insurance shocked me into getting myself some health insurance. And it also made me realize that while a Japanese hospital may be a dismal and bleak place to have to stay, at least I would be getting decent medical treatment out of it….
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