the Present Situation on Medical Care System in Japan

There is a popular TV drama series starring Ryoko Yonekura, "Doctor X".
She is an expert surgeon who always says "I never fail (in the operation)."
She is really a heroine who cut ill regions off at a stroke.

When we are troubled in certain sickness,
the suffering people definitely need a rescuer;
a skilled doctor.

Some viewers might also compare themselves to the heroine with admirations and admonitions,
as they wish to be a topflight worker who never fail in their jobs as she is !

Anyone has some jobs to do in his/her daily lives.
Why should we work ?
To earn one's living for tomorrow's life.
To find something to live, a reason for living.

All jobs are for money and for people.
Which weigh bigger, the former or the latter ?
As to a doctor, the latter should be more,
because it is a job to help others, named patients.

Medical services system differs from country to country.
In U.S.A., it costs high due to nongovernmental health insurance system.
In UK, I heard once it severely lacked as to wait 1 month long before gaining admittance into a hospital.

Medical services are really important because
everybody can be caught by some illness which requires immediate treatments.
It always must be of good quality just like in U.S.A.
and it should never lack for nothing unlike UK at one time.

Then, I think our Japan has a rather good functioning medical system.
All Japanese nation belongs to the national medical insurances
which enables any patient can take needed medical care with moderate charge,
including patients' own free choice of medical facilities.
Isn't it a fairly rare system throughout the world ?

I am involved in both medical services in Japan covered (dermatology)
and not covered (chiropractics & NAET) by national health insurance plans.
I think it's quite logical generally certified treatments are covered by insurance
and other new experimental ones are not.
As to the latter treatments, patients should accept their own responsibilities more.

However, recently Japanese government plans as a medical cost-controlling measure
along with great expenses of increasing old population and advancing medical technology,
to restrict free-access of patients to medical facilities.
I oppose to it because it'll be a revision for the worse.

Though people in the province have less doctors nearby,
there are lots of doctors to choose in urban areas in Japan.
Everybody usually choose where to go by themselves,
sometimes even to a distant specialist found via internet.
Japanese people won't accept the restriction to be allowed
to see the only gate-controlling family doctor in whatever condition.
They directly want to go to the skilled professional for their conditions.

It's in the nature of things anybody wish to see an able doctor
who can bring more suitable cure to their sickness.
The original intention should be very reasonable.
If they directly go to the doctor who make a specialty of their exact diseases,
they can take the shortest course to relief or cure.

As a dermatologist, I have an example.
A man with thick toe nails was treated by his family physician.
He was diagnosed as nail invasion of athlete foot and took oral and topical antifungal medications for over six months, with no improvement.
On dermatological examination, his nail thickening was revealed to be made up by physical pressure disturbing nail growth, containing no tinea fungus.
The whole medical expense of six months' treatment was all in vain.

Therefore, I think when patients are treated long by doctors who are not familiar to their diseases, it tend to bear waste medical expanses.
The diagnosis and treatments might not necessarily be correct,
the patients will be frustrated with delayed recovery
and disbursements from health insurance will be expanded.

Recently in Japan, general practitioners are made much of
as ultimate doctors who can diagnose and treat any disease.
However, today's medicine requires too rich standard for one single doctor to grasp.
Any doctor can be familiar not all but in some limited medical area.
A general practitioner should originally mean a family doctor,
who make a specialty of primary care.
Even a "Japanese general practitioner" of somewhat changed meaning
has its own limit to be good at general differential diagnosis.

It's just a illusion general people like to dream -
a perfect doctor who can diagnose and cure any disease from head to foot.

If general people, as well as Japanese government, force the illusion to real doctors,
even if they just anticipate better doctors innocently,
it'll be a driving force to smash up physicians, clinics and hospitals
so as to destroy medical system in Japan.

Let me think
if patients are not allowed to go only a single provided doctor,
as Japanese government now plans.

Then the gate-controlling general practitioner will always be a introducer to other specialists,
as far as he/she keeps up his/her territory.
One of his/her main duty will be to write numerous introducing letter daily.
He/she is a doctor to treat patients, not to write letters.
He/she will definitely be less motivated.

If the general practitioner wish to treat more by themselves instead of writing letters,
then he/she will have to diagnose and treat beyond his/her knowledge and ability,
which surely would be a heavy mental stress.
He/she may also not willing to lose his/her clients in a financial view.

When they treat diseases they know little, it's no good for patients
but also for themselves deeply defeated by their own incompetency.

Therefore, it is unreasonable for family doctors
who run their clinics and hospitals on their own responsibility
to push off another official responsibility classifying all patients first
like emergent triage.

In fact, Japanese medical system already has some restrictive measures about access.
Patents have to pay additional fees at some larger hospitals on their first visit.
Advanced treatment hospitals are open to patients who have introduction letter only.
I think it is enough to control proper distribution of patients.

Every doctors introduces patients from the beginning to other medical facilities
when it is thought to be more suitable for the patients.
Patients or doctors should have rights to decide where to entrust their lives.
Governmental overbearing disturbs their natural course.

Social factors must also be considered at choosing hospitals and clinics in charge.
For example, age of the patient, job and earning, residential place, conditions of family members...
Even if a family doctor introduce a good medical facility in the therapeutic view,
they may have some social reasons they can not go there.
Patients' own choice will be reasonable for not choosing where they can not go.

The affinity problem between a doctor and a patient might also rise.
If a patient can not help disliking his/her family doctor instinctively,
he/she should be allowed another choice.

In conclusion, this Japanese governmental plan to limit nation's primary doctor
will frustrate patients and annoy doctors, wasting money and work.

Nowadays, this brilliant Japanese medical system has facing to crisis.

Clinical medicine is insecure by nature,
Originally, human body is respectively an ultimate complex, often difficult to fix.
Treatments and examinations are inevitable to contain certain risk to hurt human body,
especially on their way of progress.

Unfortunately, it seems most general people including police forces are not able to discriminate between an inevitable sad medical course and some malicious crimes.
Since patients require too much medical services, some hospital doctors really could not endure the burden, concluding mass resignation.
Education to new doctors become more and more difficult as modern medicine progress.

To protect Japanese medical system,
it's not wise to obey the systems of other nations blindly.
The important thing is to maintain this fairly good present Japanese system
adjusted to diligent Japanese people.

For that purpose, the whole society, including
patients, mass media, the government and the judiciary
should believe the good faith of doctors.

The medical care is an art for relief.
It surely is a job to help others who are in trouble with sickness.
Every doctor never intend to worsen the condition of patients.

It's wrong to blame a well-meant acts of a doctor
because of a conclusion of medical uncertainty.
Please don't dampen the good intentions of doctors to relieve people.
The intention is the very motivation which lead the doctor to learn continuously
to be more qualified, making less mistakes.
Motivated goodwill doctors can reform medical treatments better.

There should be a good place for doctors to devote themselves to help others
without annoyed with surplus chores, pressures or controls.

Doctors are fighting everyday aiming pleasant cure for suffering patients.
Despite of critical doubtfulness,
reliable relations between doctors and patients, or the society,
are sure to be desirable in daily medical scenes.

And may doctors not shrink while treating patients
to bring them more ease.

2014.2. (translated 2016.1.)@@

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