After a week with business colleagues and doctors in Japan, I leave with three major impressions.
First, no matter how a country’s medical system is organized, there are troubling problems with the rising cost of health care. Second, even in Japan, a culture in which patients are especially respectful of doctors, patients are increasingly questioning decisions of their doctors. And third, the best doctors, all over the world, are deeply dedicated to the science of medicine and the care of their patients.
I’ve lined up the pictures of some of the doctors I saw below and share some of their stories, too.
If you have the chance to meet Dr. Amano, a renowned cardiac surgeon in Tokyo, you will meet a man who is remarkably present. He is there with you, even during a rushed meeting between patient visits. He gives the impression of a man who is fascinated by his work. Dr. Amano told me about a clinical trial he is leading to treat aortic valve stenosis without a valve replacement. It’s an innovative approach for an illness that is an increasing problem in Japan’s aging population.
Dr. Amano believes that, if effective, it may make treatment for aortic stenosis possible for patients who otherwise may not be treatable. In this sense, it is one of many examples of how medical advances make it possible to treat more people than would otherwise be the case. I think that’s a good thing. But it likely will also add new costs into the system. Is that a bad thing?
One of the ways Japan has tried to control health care costs is to keep doctors on a salary-based compensation formula. It’s one of the approaches American reformers favor. Does it work? It may. Still, the doctors I spoke with universally complained about it. It seems the government-established salary levels are seen as too low. It means that younger doctors are avoiding specialties in which they feel that the balance between lifestyle and pay are the worst.
The government is considering adjustments to the pay formula for doctors. Some, like Dr. Nakai, an orthopedic surgeon, worry that these changes will come too late. With demand for new doctors is growing, there is increasing urgency to train new doctors, especially as the older generation of doctors begins to retire. There may end up being a gap in the availability of doctors just at the time when patients need them most.
Other doctors, like Dr. Fukui, a noted urologist, told me about other problems, like changes to the mix of illness in Japan. He says rates of prostate cancer have increased markedly in recent years. He ascribes it to changes in Japanese diet, but also to increasing lifespans and improvements in cancer detection. Dr. Muto, seen here with my colleague Shunichi Higashijima, President of Houken Corporation, made a similar observation about other types of cancer. Dr. Muto, now Chairman Emeritus of Tokyo’s largest cancer center, says rising cancer rates and increasing availability of new previously unimaginable treatments are reflected in the tremendous expansion of his hospital and rising pressures on the Japanese health care system.
Speaking of expanding hospitals, you should see the work being done by Dr. Moriyama at Jikei University Hospital. Dr. Moriyama is a renowned ENT surgeon who has taken on responsibility for the administration of this major hospital. One of his priorities has been the construction of a new building and modernizing the existing one. With six major university hospitals within only a few miles of each other in Tokyo, competition is fierce and patient expectations are high. It is easy for patients to seek second opinions for their illness, and they increasingly do so.
It’s a similar story at Mitsui Memorial Hospital, where I spoke with Dr. Atsushi Fukuuchi. Dr. Fukuuchi treats breast and endocrine cancers. His busy schedule is split between an old building with creaking and cramped elevators and a brand new one that looks more like a boutique hotel than a hospital. In the picture I took with him on one of the patient floors, patients can enjoy panoramic views of Tokyo, and a relaxed and luxurious environment in which to recover from their illness. It’s a standard floor, but it looks more like what I have seen in VIP floors in major American hospitals.
Perhaps my favorite visit was with Dr. Ikeda, a noted liver expert. I arrived for my meeting with him but he was still with a patient. No problem, it was late afternoon and I know how doctors’ schedules get backed up. After about a half hour of waiting, his secretary politely took me to another part of the hospital and just outside of a sterile operating room. Moments later, Dr. Ikeda emerged, in scrubs, with a mask and gloves on. Come in, he said, I am about to start working on a resection and you can watch. I begged off – I had a dinner to go to, you see. So Dr. Ikeda went back in, took off his mask and gloves, and came out to take a picture with me instead.
I’m always impressed, no matter where I go, at how doctors work within complicated health care systems that they did not create. Whatever the problems they face, they continue to persist with their work and try to figure out ways to do the best things for their patients. More than one said that while they felt aspects of their system were not fair, they derived terrific satisfaction from the honor of helping patients with their problems. Maybe it’s something they learned from their patients, who carry on through problems more difficult from the ones they face. Or maybe it’s just one of the personality types that makes for great doctors. Either way, it’s an inspiration, and a privilege for me to meet them and to share their stories.
Evan Falchuk, Dr. Amano
Evan Falchuk, Dr. Osamu Nakai
Dr. Iwao Fukui, Evan Falchuk
Evan Falchuk, Dr. Muto, Shunichi Higashijima
Dr. Atsushi Fukuuchi, Evan Falchuk
Dr. Horishi Moriyama, Evan Falchuk
Dr. Ikeda, Evan Falchuk
