Inside the Japanese Medical System: A personal account of one person's experience receiving treatment in the Japanese medical system for appendicitis, bladder cancer, Castleman's disease (a rare lymph system cancer) and clinical depression

Bruce Holcombe

18 February 2004

Speaking in English to a packed audience for over an hour, the noted professional Japanese-English interpreter Bruce Holcombe described with great wit and candor his trials and tribulations as a patient in Japan's medical system. While praising the overall quality of Japanese medical care and the commitment of its practitioners, he focused attention on several of the salient weaknesses of the Japanese health care system. Based on firsthand experience, he stressed the importance of patients' assuming responsibility for their own health, demonstrating with examples how his own decisions influenced the course and outcome of his own care.

Mr. Holcombe has received treatment in Japan for basal skin cancer, undergone an appendectomy and surgery for bladder cancer, received chemotherapy and radiotherapy for multicentric Castleman's disease (a rare lymph cancer, diagnosed in Mr. Holcombe's case as also exhibiting symptoms of the even rarer Rosai-Dorfman disease), and medicinal treatment for clinical depression. He described the dangers of misdiagnosis of skin cancer in Japan, the indignities of bladder cancer diagnosis, the side effects of chemotherapy for Castleman's, and the extreme difficulties in understanding and overcoming the neuro-chemical changes that occur with depression. He told us in direct terms how mortality in Castleman's, Rosai-Dorfman, and multiple myeloma differs, what blood indices (e.g. Interleukin, histocytes) clinicians monitor as the patient undergoes successive rounds of chemotherapy, and the differences between taking Paxil, Lithium, and Epilim [sodium valproate] to treat bipolar disorder.

The weaknesses in the Japanese health care system he pointed out were over-medication, poor care on weekends, dismissive attitudes by some doctors toward the patient's pain and reluctance to administer analgesics and general anesthesia, lack of understanding by doctors of the need for informed consent, and insensitivity towards the need for privacy (open consultation cubicles and little or no draping during tests). Mr. Holcombe also underlined characteristic failings of doctor-patient communication, warning of the need for patients to educate and inform themselves through access to the Internet and, for English speakers especially, to beware of taking the doctor's words at face value when such gairaigo terms as "biopsy" and "informed consent" are used by Japanese physicians.

Bottom line:
Frequently at MITA meetings, we discuss medical terms out of context and with little grasp of the environment in which they are used. Mr Holcombe's use of drug names and medical terms in context brought home to MITA member listeners some of the harsh realities behind the bland terminology.

The meeting was followed by a well attended dinner and vivid conversation at a nearby Chinese restaurant, lasting until past 22:00. The only regrets were that no one recorded the proceedings.

(Report submitted by Christopher Holmes, Office of International Academic Affairs, University of Tokyo Faculty of Medicine)

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