Disclaimer: this is a record of some of my interactions with Japanese medical professionals and doctors, and expresses my personal opinion
I used to snort when people spoke about cross-cultural challenges in medically treating patients. It sounded to me like a way to “other” the foreigner’s body and turn something universal (the basic human anatomy) into an aberration of nature.
Then I crashed against these very differences myself, when what should have been a 2-minute blood drawing in the clinic of a (supposedly) English-speaking doctor in Tokyo turned into a 10 minute scene from The Exorcist. The simple reason? My doctors, having spent a lifetime working with fair complexioned patients, were not able to find a usable vein through my dark skin. In my home country of India, this is a common situation to deal with and many phlebotomists are armed with an infrared light that helps illuminate the veins of darker skinned patients. In this particular Japanese clinic, however, it was an unthinkable first-time situation. Hello, cultural differences.
Once the vein was procured (I lightly slapped my arms some 40-50 times to contribute), the puncture took place. I completely depend on a doctor’s calm instructions during blood tests but in this case, the procedure was done in total silence. The doctor did not tell me to relax my hand as she withdrew the needle, assuming that I would do so, but I was waiting for her command. Thanks to how tense I was and the physics of liquid pressure, my blood sprayed over the desk and her glasses as all of us screamed. When I finally left, still unsteady on my feet, the waiting patients were looking rather nervous.
By Joshua Coleman for Unsplash
Japanese medical infrastructure is doubtless one of the best in the world. The standards of hospital hygiene are stellar, the tools and instruments used are cutting-edge, the premises are gorgeous, and procedures that are considered high-risk or stressful (such as the MRI) are administered in a calming and professional manner in Japan. I found that venipunctures (blood tests) and fluid collections are done in an almost assembly-line setting that can handle huge numbers of patients in a timely manner with minimum delay and embarrassment. Thanks to the Japanese National Health Insurance’s 70% coverage, I don’t hesitate too long before going to a clinic to get my complaints sorted.
Sadly, I feel Japanese medical institutions are failing in communication and sensitivity.
I recently escorted a friend who was in severe pain for unknown reasons to an international hospital’s emergency room. Rather than assessing her or even helping out, the nurses made my companion fill out a long form by hand, take her own temperature, check her own blood-pressure, and wait 20 minutes. Even after a doctor came to see her, the administrative details were slowly reviewed yet again despite her agony. Though the hospital advertised itself as an international English speaking institution, the doctor we met confided that this only applied to 1-2 professionals who worked on an appointment-basis. It was a culture shock for me; I once had an emergency in India and was in a bed 2 minutes after I announced I needed help. My information was recorded orally and paperwork came after I was stable, which I naively assumed was the human standard.
In the end, my friend was advised to take some rest and come back if the pain hadn’t receded. She was charged 8,000 JPY, uncovered by insurance.
The story gets even worse: an American woman rushed into the same ER soon after us, crying that she was having a miscarriage. The administrators explained they couldn’t do anything for her since she was a tourist, unregistered under a Japanese insurance plan. After begging them, she phoned her own insurance company and a three-way international negotiation took place even as she stopped every few seconds to groan in pain. The woman was finally accepted for treatment but had to first fill out a form, take her temperature, record her own blood pressure, and wait for 15 minutes (despite the waiting room being almost empty). She was crying and rocking herself due to cramps, but was ignored by the supervising nurses on duty until it was her turn to be examined.
By Piron Guillaume for Unsplash
Even in non-emergency scenarios, I found the manner of Japanese doctors (especially those who are male and elderly) to be careless at best and condescending at worst, a view shared by many others. Upon seeing an endocrinologist at a noted hospital in order to discuss my irregular menstrual periods, I found him dismissive of my symptoms. The doctor sent me to do an MRI to check for a brain tumor after the very first appointment. He was upset by my asking the reason for this decision, responding “well, if you think you know better…”
I took the MRI but was shocked to find that I would not receive the original scan sheets. They would remain the hospital’s digital property (to avoid patient transfers) and after a lot of argument, I was given a grainy print-out 2-3 weeks later. The doctor and I spoke in Japanese while discussing the result but I stopped him once or twice to check the meanings of certain words he used, since my linguistic ability didn’t exactly cover highly specialized surgical terms. I was using a dictionary app but even this aggravated him. He brusquely diagnosed me with a brain tumor (which turned out to be an error). After the appointment he told me, “I’m moving you to an English speaking doctor because I think you’ll get along with her better.” That he thought a patient asking him a simple doubt meant their professional relationship was unsalvageable, was a frightening prospect.
I decided to stay with small clinics after that. While going to an all-ladies’ gynecological clinic for my first ever pelvic exam four years ago, I found the doctor’s attitude rude and disrespectful. She was irritated that I was tensing up, making the exam difficult for her. But I challenge anyone to relax when they’re half naked on a recliner in mid-winter with their legs stuck through metal grips, a doctor sitting between their thighs and wielding a huge speculum (again, freezing cold), its metal claws prying open perhaps the most intimate part of the body, to scrape out vaginal samples like it’s some sort of archeological dig.
In addition, all of this was taking place in a foreign country where I was completely alone and with an elementary student’s understanding of Japanese. The place was advertised as an English-speaking clinic, but again this was dangerous optimism.
Finally, the doctor had enough. “There are middle-school girls who can take this well,” she told me casually in Japanese. I meekly apologized (she was still holding the speculum), but was furious inside. Her utter lack of patience for what is an extremely common situation in her field disgusted me—imagine if she said the same thing to a patient who had survived rape or sexual abuse.
Talking to other Japanese medical experts, I found that awareness of PCOS (a hormonal/reproductive disorder affecting 1 out of 10 women) was poor, and contraceptives are prescribed as a cure-all medication to save time, rather than delving into a patient’s personal history, their lifestyle, psychology, family history, diet, etc. to figure out a solution tailored to them personally.
My lived experiences over the course of 4 years and the anecdotes I’ve heard from other patients remind me again and again that while infrastructure is of paramount importance in providing excellent healthcare, a medical practitioner’s communication skills, their sensitivity, courtesy, open-mindedness, empathy, and respect for differing opinions are all indispensable parts of their expertise and must be cultivated with just as much rigor as their technical knowledge.