Doctor brings U.S. training home to Japanese patients

By Miwa Murphy

HOUSTON —

When patients see a doctor for a common cold or a regular checkup, or to get prescriptions, few would be able to give the generic name of a medicine or explain why they are taking it.

That’s because most patients see their doctors as their ‘‘taxi drivers’’ who magically take them to their destinations while they passively sit, but such paternalistic doctor-patient relations must change, especially in Japan, says Naoto T Ueno, a medical oncologist at The University of Texas M. D. Anderson Cancer Center in Houston, Texas.

Ueno has trained over 400 Japanese medical professionals since 2001 at a variety of educational programs hosted by medical institutions in both Japan and the United States, including St Luke’s International Hospital in Tokyo.

He has focused on a collaborative or multidisciplinary approach, in which doctors, nurses, pharmacists and other specialists work closely together and exchange views and opinions freely at a conference to come up with the best possible treatment for their patients. The patients are also involved—they are fully informed of the decision-making process and their questions are examined and answered.

The Kyoto-born Ueno went to the United States in 1990 to continue his medical studies after being inspired by his mentor at the U.S. Naval Hospital in Yokosuka.

Ueno, 44, said that he was motivated to bring this patient-centered multidisciplinary approach—originally developed in the United States in the 1960s—to Japan after visiting the country in 2000 and seeing how over-tasked his Japanese colleagues were and thus how little time they had to interact with their patients.

He says Japan does not differ much from the United States in terms of medical technology available. But communication between doctors and patients lags far behind and has much room for improvement against the backdrop of the fast-changing situation surrounding cancer treatment in Japan.

In the past, cancer was not a very common cause of death in Japan—a distant third in the 1950s after tuberculosis and stroke. As with other infectious diseases plaguing Japanese at the time, some of the most common types of cancer—stomach, liver and cervix cancers—were often caused by bacteria or viruses.

But in 1981, cancer replaced stroke as the No. 1 killer, with one out of three people dying of cancer in Japan today. Many experts blame a Westernized diet and lifestyle in recent decades. In particular, breast, colon and prostate cancers, which are often associated with a high-fat and meat-rich diet, have increased substantially.

In the past, cancer treatment involved only the removal of a tumor with surgeons overseeing drug therapy as well as the surgery. But now treatment options are diversified and sophisticated, ranging from a combination of radiation and drug therapies to proton therapy. Among drug therapies is one targeting molecular characteristics of specific cancers.

But specialists who can oversee the ever increasing treatment options are short in Japan. As of June 2008, there were about 200 medical oncologists in all of Japan. Japan is also lacking certified medical physicists, radiologists and nurses who can care for specific cancer conditions.

Another problem is a significant time lapse for new drugs approved in other industrial countries to reach Japan—the so-called drug lag—due largely to the government’s slow approval process.

A survey released in February by the Office of Pharmaceutical Industry Research showed that, between 2000 and 2006, it took about four years before a majority of drugs approved in Europe and the United States made their way to Japan.

It takes years for the situation to change in Japan, but there are many simple steps patients can take to improve their communication with doctors, such as keeping their own medical files and enlisting friends and families to practice verbally explaining their own basic medical history, Ueno says.

However, many Japanese families are still reluctant to let patients know about their cancer diagnosis. This culture evolved from the past when the disease almost always had deadly implications, but now it poses a significant hurdle to the patient-centered approach.

Ueno acknowledges there is no easy answer to this question. American doctors are somewhat similar. They are ‘‘weak’’ at talking honestly about related issues, such as bringing up the topic of when to remove life support. ‘‘Ultimately, the answer to these issues comes down to whether the doctors have themselves thought hard and seriously about how they wish to die,’’ he said.

However, as cancer has become a treatable or controllable disease, allowing many to maintain a near-normal life, Ueno often likens cancer patients to marathon runners and doctors to their pace-setters, not ‘‘taxi drivers.’’

‘‘It’s difficult to do what I preach,’’ Ueno says of his experience of being a cancer patient, having lived through a diagnosis himself.

After feeling a mass in his right thigh in December 2007, Ueno was subsequently diagnosed with stage-2 sarcoma, which is a relatively uncommon cancer that affects connective tissues. As he struggled to regain his peace of mind, his colleague told him a story that helped him survive the uncertainty of not knowing what was next.

Likening the diagnosis to riding in a boat as an ominous storm approaches, his friend told him that no one knows if the storm will hit the boat or not. However, if the boat has a hole in it, there will be a greater chance of sinking. But if the boat doesn’t have a hole, there is a chance of survival, although there is no guarantee.

‘‘What you have to focus on is to make sure that the boat is in good shape...You have to focus on things you can control,’’ he told Ueno.

Ueno still remembers the valuable words his friend instilled in him and draws from the wisdom of the experience when he tries to help others through their medical journey.

‘‘I decided to disclose my experience completely and tell everybody because I want to use myself as motivation to do my research and to inspire patients as I talk to them,’’ Ueno said.

Latest 15 of 25 Total Comments Show All

helloklitty at 07:04 AM JST - 18th August

My personal experience has shown me that, although Japan has superb medical research as shown by the reports I read,

In Alex Kerr's book Dogs and Demons, he refers to Japanese medical research as the laughingstock of the world and not to be taken seriously.

Aren't you aware of the longstanding stereotype that Japan is a nation of copycats and incapable of original ideas?
wanderlust at 08:20 AM JST - 18th August

They call it "concordance", and it was promulgated by Barbara Hulka back in 1972, the move from the traditional paternalistic, authoritative physician-patient relationship towards a more egalitarian, explanation-heavy partnership, where both agree on the management plan, even if the patient does not want to submit to all of the physician's suggestions.

An idealistic world though; many patients prefer to defer to the physician, do not understand the inner workings of their bodies, and there is just not enough time to go through the process.

However, it is a good goal to aim for.
motytrah at 08:58 AM JST - 18th August

The $1600 you pay for an MRI in the states included the analysis by a highly-trained specialist; not someone who worked part-time jobs while going through medical school as is the case here in Japan.

Maybe, maybe not. A lot of MRI and CAT analysis is outsourced to India and Singapore. The bigger the health system/HMO is the more of a chance that a good chunk of your chart is shipped overseas.
Rich107728 at 09:15 AM JST - 18th August

I don’t know too much about the J-medical system but after my wife having a child in the US and then having one in Japan I would have to go with the US system for sure. The prenatal OBGYN care was FAR superior in the US, I can even stress this enough. Japan as been like living in the dark ages in comparison. The cost difference in negligible, the US was $15 a visit with no additional cost until the delivery. In Japan the cost has been 1,000yen – 12,000yen per visit but the visits are less frequent here. The only up side in Japan is you get an ultrasound at every visit but I almost think this is used as a distraction to keep you from thinking how bad the care is.

The delivery and hospital stay was cheaper in the US after insurance. US delivery + epidural + 4 days hospital stay = $8800 - $8100 insurance = $700 , Japan delivery + 6 days stay = 440,000yen – 300,000 reimbursement = 140,000

The quality of care was again far superior in the US. Also the US hospital provides you with nearly everything you need including diapers and clothes for your new baby.

I could go on and on but the fact is if you have insurance the US is not that much different in cost to Japan but the quality is far better. Don’t even ask me about pediatric care here.
LIBERTAS at 09:17 AM JST - 18th August

I have the habit of tracking down what ails me here: http://www.mayoclinic.com/ and printing out the results if I am reasonably sure that I'm sure of what I've got. Entering the doctor's clinic and talking to her face-to-face as an equal, all be it with different areas of specialty, I have yet to get a negative response. Especially if I refuse un-named lotions and potions and ask for a specific medicine they usually comply, ask to keep the printout for my file, the Doc seems almost relieved to have someone who approaches the whole process a little more rationally. A friend who works desk at a hospital internal medicine department regales me with stories of elderly patients with their pills, loose in ziploc bags, swapping blue ones for pink ones etc. etc. among the fellow visitors in the waiting room! For many of them hospital is a social event where they get to try out different pills for free!
Badsey at 09:19 AM JST - 18th August

H?K:

It's not just research, but results and medicine lags the other sciences. Look at Helicobacter Pylori (stomach ulcers), for many years Australian Drs were saying and treating these ulcers while it took the U.S. At least 10yrs to finally change their opinion.

Anyway a true pioneer and rebel died today. Masanobu Fukuoka --> went totally against most of his peers, but he is correct.
helloklitty at 09:23 AM JST - 18th August

From today's JT story on Child Mortality: The research Yomiuri Weekly cites is by Osaka pediatrician Masatetsu Fujimura—who, the magazine says, had considerable difficulty obtaining records from the Health, Labor and Welfare Ministry to undertake the sort of study that is commonplace in the West.

This is another example of Japan's poor performance in medical research.

Why would the Health Ministry make life difficult for the researcher? Could it be he'll expose their poor performance in infant mortality results?

Another longstanding stereotype of Japan: they are very secretive.

Alex Kerr's book also discusses this and compares secretive Japanese industry with Silicon Valley where much cooperation exists between high tech firms.

From this article: However, many Japanese families are still reluctant to let patients know about their cancer diagnosis. This culture evolved from the past when the disease almost always had deadly implications, but now it poses a significant hurdle to the patient-centered approach.

Has anyone seen Prof. Randy Pausch's last lecture? www.youtube.com/watch?v=ji5_MqicxSo He became an inspiration to millions after being diagnosed with pancreatic cancer. He knew he was going to die but he was upbeat and humorous. Medical professionals owe it to their patients to reveal their diagnoses completely.
ExPrinceska at 10:36 AM JST - 18th August

I think Japan has to sudy from the best medicine in the world - in Cuba.
fds at 11:20 AM JST - 18th August

an anesthesiologist will run you a few thousand in the U.S., but they are specialists and very important for a good surgical outcome. Almost as important as the surgeon.

i think this is more of an insurance/liability issue in the U.S. in japan doctors aren't really held accountable.
8iamhappy8 at 01:06 PM JST - 18th August

Speaking from first hand experience, the US medical education system ain't all that great. Heck, I've met some U.S. medical students, who can't even tell you the difference between PTH and calcitonin. Very dangerous stuff to become a medical doctor without this kind of base-line knowledge.
TheNewZen at 01:09 PM JST - 18th August

IMO & IME, having lived in a few countries your medical cover/support is more due to the doc you know and the right hospital/medical cover.

Ok, here starts the personal talk.

When my wife got pregnant in japan we had a choice of 4 birthing clinics, 3 we didn't even walk into(don't ask), the 4th was great and gave good service(including a hamper of goods that lasted us for the first 3 weeks) after the birth).

Said that I had good and bad experiences at the same hospital, my wife got diagnosed with breast-cancer and I nearly floored the doc when he told her to prepare for her funeral(we got a referal to the National Cancer Clinic 3yrs ago and she is still going strong today). She had to endure 6-month chemo, breast-reduction and radiation treatment, etc.

About a year later I had some serious probs(bout 1 week from dying) and got admitted to the same hospital and had great care during my 6-weeks stay. Hate to say it was a "Red-Cross" Hospital that treated both me and my wife.

It all depends on the Doc, etc I seen the good and the bad here.

There are good and bad docs out there (same as everywhere else) you just got to ask around to find the good ones. And, IME, many english speaking docs are in it for the bucks.

With my wifes cancer due to medical aid and top-up schemes we actually ended up $2000 in the black. Same with my hospital visit out of a $8000(includes multiple MRI/CT's/etc) bill we paid $200.

It is all relative and you got to　play the system and know the right contacts, same as in the rest of the world.
Ah_so at 04:38 PM JST - 18th August

I think Japan has to sudy from the best medicine in the world - in Cuba.

Why would the country with the highest life expectancy in the world study from the country with the 63rd?
usaexpat at 11:56 PM JST - 18th August

Of all the posts concerning the comparison between US and Japanese healthcare Badsey's comes closest to the problem with the American system. That said, America in my oppinion does have more advanced healthcare and research medicine. The problem really lies in the astronomical cost of both healthcare and private insurance. The US may have the technology and skill edge in the world but fails in preventive care and simple things due to the huge amount of profit taking by major hospital and insurance companies. If the US really covered everyone in a functioning socialized medical system they would have the best of all worlds.
Nessie at 01:47 AM JST - 19th August

But in 1981, cancer replaced stroke as the No. 1 killer, with one out of three people dying of cancer in Japan today. Many experts blame a Westernized diet and lifestyle in recent decades.

Um, it's also largely because people are living longer, which gives cancer more time to emerge (Rachel Carson's boneheaded oversight). Rising cancer rates are in part a testament to advances in longevity realized through Western medicine.
KitsuneYoukai at 11:29 PM JST - 19th August

Socialized system???? Give me a break! The grass is not greener on the other side as one Canadian put it. Heck if I am willing to agree to socialized medicine. I agree that there needs to be control over hospital costs and insurance but socilaized medicine does not allow people with much needed care to see doctors when needed. Time lines for people who could potentially have a serious medical issue have to wait to even be seen not to mention the lengh of time to get an MRI ot CTScan. Also, the burden on the middle class to pay for those that cannot. Theres a lot kmore to it. On the surface it may sound like a better system but it isn't.