Thursday, February 20, 2014

Japanese Medical Education

Different countries have different standards for medical training.  Take Japan: it's a very healthy society.  They have lower healthcare costs than the United States thanks, in part, to near-universal healthcare insurance coverage.  The progression for becoming a doctor is a little different from the United States.  The biggest difference is duration of education, but when you speed things up, something else gives.
            In Japan, the first step is toward becoming a physician is to enroll in medical school.  But that process is not just like in the US.  In Japan, a student may enroll in medical school straight from High School, but there is no Japanese equivalent of “pre-med.”  Going straight into med school from High School is not a requirement, but a possibility.  Of course, they have the option of enrolling in medical school after a four-year undergrad course, but it is not so common in Japan to do this, whereas it is usually a requirement in the US.  After medical school, the aspiring Japanese doctors get a residency, similar to the US, or they go into clinical training at a small medical practice.  There is no set time period for this stage, but it can take anywhere from two to six more years.  Specialists have additional training in their chosen discipline, and of course, after residency come the licensing exams.  It is common for Japanese doctors to come from families with a history in the profession, and take over the family practice when they receive their license.
The long and short of it is that relative to the USA, Japanese medical education can take less time.  Japanese would-be doctors face a long time too, but they have the option of starting earlier.  One advantage the Japanese schedule has is that it may cost less.  Most of Japan’s medical schools and teaching hospitals are publicly funded and have lower tuition than American medical school.  Another advantage, the shorter schedule produces doctors more quickly.  If it sounds like I’m suggesting the Japanese approach is superior to ours, I'm not.  It is faster, but does that really produce better doctors?  Here I must admit my ignorance.  I simply do not know the answer to that question.  One thing that may be an advantage for the United States is that by requiring all aspiring doctors to attend college first they gain a well-rounded education in non-medical subjects.  It is theorized that well-rounded students develop better problem solving skills.
In 2008, three Japanese doctors, Yasuharu Tokuda, Shigeaki Hinohara and Tsuguya Fukui argued that the lack of a humanities requirement is a deficiency of Japanese medical education.  Their concern is that doctors without a humanities education have difficulties with professionalism, ethics and “Medical Humanism,” which they take to mean an holistic concern for the patient.  Tokuda and company’s concerns for the ethical foundation of Japan’s MDs reminds me of a common complaint from fellow expats about Japanese doctors: poor bedside manner.  These complaints tend to be the same: the doctor lacks attentiveness, is impersonal and unfriendly, and does not ask enough questions.  I never experienced that problem personally, but I encounter this complaint from other people often enough.  Then again, I have heard it voiced about American doctors as well.  So, maybe yes Tokuda et. al. are right, but I do not see enough evidence to be sure.  Perhaps for doctors, humanities education would not affect their bedside manner as much as medical training itself.

Tokuda et. al.
Introducing a New Medical System to Japan

No comments:

Post a Comment