Earlier this year, England recognized its National Health Service with a 10 minute celebration in the opening ceremonies of the 2012 London Olympics. Japan is no different; the country has had nationalized health care for over 50 years.

With all of the fuss about Obamacare in the US, health care around the world has been a particularly interesting subject for Americans recently. Unlike American healthcare, the Japanese health care system is largely nationalized, tightly regulated, and relatively cheap.

It seems to have paid off pretty well, too; life expectancy is pretty high, infant mortality is low, and most of the important stats are right where they should be.

Blah blah blah. I’m sure policy nerds could break down the numbers for you all day. That’s not really what interests me. What’s kind of incredible to me is that many Japanese have physical proof of their participation in the national health care system. A portion of the Japanese have scarring on their arms from — what? Robots? Aliens? Doraemon?!

The scarring comes from a tuberculosis vaccine that nearly every Japanese person gets at around the age of five or so. It scars, unlike other vaccines, because it’s administered with a horrifying syringe — the kind of syringe that children imagine when they refuse to go to the doctor. You know, the kind with nine needles.

Given in recent years, the size of the syringe has gotten increasingly less terrifying, but from an American standpoint it’s interesting that virtually every Japanese man, woman, and child has received this vaccine even though very, very few Americans have.

Why is this? Even though lots of countries around the world administer this vaccine, it’s not seen as necessary in the US. The US government says that the vaccine “should be considered for only very select people who meet specific criteria and in consultation with a [tuberculosis] expert.”

Instead of vaccinations, the US deals with TB by blowing away the animals that might cause it. Well, kind of. A certain type of deer carry a strain of TB that’s transmittable to humans, and the US permits people to hunt the deer to keep the disease under control.

But I’m getting off track here. These scars interest me so much because they’re very real, physical proof that the Japanese health care system touches nearly every person (often quite literally) in Japan.

Unfortunately though, it’s not all great. We’ve talked before about how frightening Japanese doctors can be, whether it’s not telling you about your cancer or the sometimes strange diagnoses and excessive prescriptions.

There’s unfortunately more though. As the population gets older and older, there are fewer and fewer young people to pay for the higher health care costs of the elderly. Many people think that the current system is completely unsustainable as it stands.

And even the whole thing isn’t working out too great for Japan. Surprisingly according to the World Bank, Japan actually has a higher rate of TB than the US does, once again proving that there’s no problem Americans can’t solve with guns (or something like that).

But this isn’t anything that the Japanese don’t know about already. The aging of the country is the defining demographic issue of our time or, as Joe Biden might say, a big f’in’ deal.

For example, when the man who was revered as a divine being by his people, Emperor Hirohito, was showing deteriorating health and unexplained vomitting, his doctor knew what was causing it, but withheld the diagnostic from him.

“I don’t regret that I didn’t tell him about his cancer”
– Akira Takagi, Emperor’s Chief Doctor

According to a survey conducted in the mid-1990s, only one out of five cancer patients were honestly told of their diagnosis. [1]

A New York Times article cites a cancer diagnostic experience of 50-year-old Kazuku Makino. Her doctor diagnosed her with gallstones and suggested surgery to remove them. Makino, being a former nurse, sniffed out, for the lack of better but no truer words, the bullshit, and opted out of having unnecessary surgery.

Makino’s doctor suspected she had gallbladder cancer. The diagnostic proved to be correct. The cancer spread to her system and Makino died shortly after.

Her family sued the hospital for malpractice, but the courts rejected their claim. What resulted was a 1989 landmark case won by the medical industry in which doctors weren’t obligated to inform their cancer patients their true condition.

Some doctors argue that informing the patient of a terminally ailing disease would cause unhealthy psychological stress to the patient. As far as I know, no reputable journal or study has supported this claim.

Photo Source: pezheadsthemovie

Japanese doctors also have a reputation in prescribing medicine for every symptom or even non-symptom the patient may have. Oftentimes, the medicines are overprescribed. Some prescriptions aren’t even labeled for user readability, but with a hidden code for those only in the medical field can understand. So who knows what kind of medicine you are ingesting (or if you are unlucky, putting medicine into that backdoor of yours).

What is up with all the sketchiness? Doctor’s make a commission off of the medicine.

Why can Japanese doctors get away with this?

How Doctors Are Viewed

Photo Source: cathywagnerblog

To understand why Japanese doctors operate the way they do, one must understand how the Japanese view their relationship between themselves and their doctor.

In the United States, medical care is viewed as a service. The doctors and medical staff provide the skilled services, while the patients are the paying customers. The customers expect to get what they are paying for. The Japanese society on the other hand generally view doctors as their masters and the patients as the subordinates who are indebted to the master for his or her services.

As such, it is extremely rude and looked down upon to question their doctors, in addition to go around consulting other doctors for second opinions. The doctors tend to not go into a detailed explanation of the diagnostic and treatment being administered.

Again, to contrast this to U.S. doctors, the patient is informed of the specifics of the treatment, such as what and why it is being conducted, and the possible outcomes, good and bad, that may result. A big reason behind informing the patient is legal protection for the doctor and the medical practice.

Unfortunately, the Japanese tend to dislike causing drama. If any hint of malpractice was involved, it is very rare for them to take legal action against their doctors. And if no legal action is taken against the doctors, then they are left unchecked to do whatever they want.

What the Japanese expect from their doctors in regards to full disclosure has been changing the past few decades. In a survey conducted in the 1990s, 60% of the people surveyed would want to be told by their doctor if they were diagnosed with cancer. In a research that was conducted in 2004, 86% surveyed wanted full immediate disclosure. [2]

Not all doctors aren’t forthcoming with the results. Those who have studied or done work overseas, especially in Western countries, tend to bring back with them the practice of being forthright. How do your country’s doctors operate? Koichi has also written an similar article on Japanese doctors. Check it out!

[1] Japanese Journal of Clinical Oncology Volume 24, Issue 5, October 1994.

[2] Kai, I., Miyako, T., Miyata, H., Saito, T, Tachimori, H., (2004). Disclosure of cancer diagnosis and prognosis: a survey of the general public’s attitudes toward doctors and family holding discretionary powers. BMC Medical Ethics, 5:7. Retrieved June 17, 2004.

Japanese hospital experiences are known to be a little… wild… but when I saw this chart I thought it had some pretty interesting information in it. The main goal of this chart was to show how ridiculous America’s per person spending on health care is (while still doing pretty mediocre in terms of life), but of course my eyes were immediately drawn to Japan’s data.

If you look at the chart, you’ll see that Japan’s life expectancy is very high (it’s the diet, methinks, though even that seems to be changing with Western influence), and they visit a doctor an average of 12+ times per year! Can you imagine going to the doctor 12 times per year? I can barely imagine going once per year (though I suppose that’s why Americans visit doctors 0 times per year, according to the chart, ouch).

Surprisingly, though, for a country that visits a doctor 12 or more times a year, it isn’t costing people as much. People are spending approximately $2581 a year on health care in Japan, which isn’t chump change, but isn’t all that much either. Still, though, I can’t help but think that with all the horror stories I hear about Japanese doctors (I’ve only had to experience this once, thankfully, and luckily it wasn’t all that bad… unless they were lying about the lack of tumor in my head, which is completely possible) Japanese people are heading to the doctor a little too much. I don’t think the long life expectancy would go down if people went, say, 6 times a year?

Why Japanese Doctors Are Scary

There are plenty of reasons why Japanese doctors are, in general, kind of frightening. Luckily, Japan is an advanced first world country, which makes it less scary than going to a doctor in, say, Canada (just kidding, Canada!), but I’d rather go to a doctor in the U.S. or Canada (love your gravy and fries, Canada!) if I had something serious. If you are in need of a doctor in Japan, it’s generally best to find one that studied outside of Japan. The following list of scary Japanese doctor bullets are a generalization (so don’t take them as 100% true 100% of the time, because that won’t work), but will give you some insight as to why the whole doctor situation can cause a bit of a problem for foreigners in Japan.

• Doctors get a commission for every bit of prescription they give to you. According to several stories, doctors will take your temperature, listen to your heart beat, look at your throat, and then prescribe something somewhat unrelated to how you’re feeling. Stomach pain? What stomach pain? On top of that, you’ll get several different kinds of prescriptions, too much (or too little) of each, and often times something that doesn’t help you at all.
• If you have something bad, doctors might not tell you about it. They might tell your family, but the problem with that is the family might not tell you about it either. Whoops. “6 months to live? Who said that? Nah, you’re fine, just eat your wakame.”
• Japanese medicine comes from German medicine. Nothing wrong with German medicine, but I’d prefer my Japanese doctors learning specifically Japanese medical terms instead of German ones. I’ve also heard about plenty of Japanese doctors who learn medicine in German. Learn your life saving knowledge in your own native language, please!
• You can’t really question your doctor. Even when things don’t seem to make sense, it’s insulting to ask the doctor for an explanation. Though, as mentioned earlier, Japanese doctors who have studied outside of Japan seem to take this better, from various stories and articles I’ve gone through.
• In Japan, if you get almost anything, you go to a doctor. I don’t know how many times my host family tried to get me to see a doctor when I had a regular, not-all-that-bad common cold. That’s not something I really need to see a doctor for, thanks for the concern, though! Of course, there’s no data to back this up, but I imagine seeing common cold after common cold in the doctors office can make a doctor feel a bit too relaxed about how they diagnose something. Anyways, it makes me worried.
• There isn’t really much competition between hospitals. Lots of competition in terms of the folks making the medicine, but not so much in terms of the actual doctors themselves, it seems.
• You are discouraged from getting a second opinion (this goes back to questioning the doctor’s diagnosis). “How dare you question me! Did you go to Toudai? I think not!”

All that being said, there are plenty of people who have great experiences in Japanese hospitals / with Japanese doctors as well. It’s not all horror (though that could explain Japan’s obsession with hospitals + horror games & movies), and if you find yourself sick in Japan it could be so much worse. More likely than not, you’ll probably have an okay to great experience, and then you can come back here and say “damnit Koichi, why you scare me so?”

On the other hand, if you’ve had a terrible hospital / doctor experience in Japan, share it in the comments below! My own personal experience was fine, though if I find out I have a head tumor three years from now I’ll be really upset.

(chart source)

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