Thursday, March 12, 2009

The French system is better than the Japanese

Friends --

This is painful, but I feel I should contribute to the discussion of the health-care issue. My story is that of the sudden and unexpected death of my late wife, Hatsue, last May 5th.

My wife was of Japanese origin, but she had lived in the US for some 36 years, was an American citizen, and a proud and active Democrat.

We retired to Chiba city in mid-2006, and built a new home on a plot of family land. The objective was to take care of Hatsue's elderly mother, whom she felt she had neglected by staying so long abroad. She wrote in the wet concrete outside the front door, "For my mother---with love."

I should note that Hatsue was an independent-minded person who paid close attention to her health. She had a trim figure, ate well, and exercised.

We are only a few hundred meters from the Chiba Medical Center, formerly a "national" hospital that has been privatized. It is a major facility, with all the usual services.

My wife complained to an internist in June of 2007 of stomach pains. She was given an endoscopy, which proved negative. Later in the year, she complained of violent shoulder pain. She was given scans of her neck and shoulders, all of which were negative. She was transferred to a female psychologist, on the theory that the stress of moving back to a by now unfamiliar environment and building a house had caused stress that was responsible for her pain. I accepted this diagnosis, because there had indeed been a great deal of stress.

Hatsue received permission to go to a "pain clinic," where she received shots of what must have been very powerful palliatives. She was finishing a month's series of these shots and felt that she had made enough progress that she was about to schedule "rehabilitation," when she collapsed in late April.

We took here to the Medical Center, where we were told that she could not be hospitalized because of a lack of beds. I insisted on a blood test, and the results--a total lack of sodium in her system was one-- led to her hospitalization on a Sunday afternoon. Sh was given extensive tests and we were informed on Tuesday that she metastasized cancer in "at least" eight organs, including a large growth in her brain, and we were shown the x-ray pictures. She was placed on morphine (we had always agreed between us that we would not authorize desperate measures if our partner was to be in just this sort of situation).

Hatsue passed away peacefully the next Monday (Children's Day), seven days after entering the hospital. The death certificate read "lung cancer."

The cancer specialist at the Medical Center told us that a simple chest x-ray would have revealed the cancer at any point in the previous year.

I hasten to say, however, that Hatsue never evinced any of the symptoms of lung cancer. She was able to move around more or less normally, walking to her pain clinic visits for a round trip of two kilometers even during her final month.

I have consulted with American specialists and talked to academic experts on Japanese health care to try to make sense of this tragedy. The Americans refuse to speculate on failures in diagnosis, but point out that Hatsue probably had the most vicious form of cancer: small cell. If you Google "small cell cancer," you will see that the only suggestion is to try to get yourself into a trial of some new treatment. The academic experts on Japanese medicine defend the Japanese health-care system as making only the average number of diagnostic errors and note that there are no limits to test ordering that restrict Japanese physicians from testing broadly.

But those of us who live in Japan know that there are serious problems with the Japanese health-care system. I am told that a Japanese doctor see more than 6000 patients each year on average, versus an average for an American doctor of just over 2000. I

f you have gone to a Japanese doctor, you know what this means. You are granted no more than two or three minutes with an obviously impatient physician who gives you an extremely compressed "bottom line" diagnosis and treatment in a peremptory tone that brooks no questions. The ignorant patient is granted no role in his or her own health-care. To use the famous analogy, the patient is presumed to be too dumb to help to determine if the hoof beats are those of a horse or a zebra.

I am told there is no system for ongoing education for medical professionals in Japan, and that there are no specialty groups (the "academies" and the "boards" in America) that set standards and qualifications for practice in specialized fields.

This overloading of the average Japanese doctor must trace back to restrictions on entry that probably mirror the cartel-like practices that infect so many other professions in Japan.

My own conclusion after some forty years of involvement with the Japanese health-care industry is that the Japanese people owe their high longevity figures to a diet that is steadily being corrupted by American (or is it Western?) influences and to the exercise that even middle class persons get by use of the public transportation system, with its walks to the stations and the stairs that they must climb and descend on a daily basis. (The latter, of course, are being replaced by elevators and escalators.)

I understand that the French system is much more promising as a source for ideas for American health-care reform than the Japanese. The French exercise a great deal of control over medical education, and I am told that unless their model is followed, there is not much hope for American success.

Rod Armstrong
Japan
Virginia

1 comment:

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