Japan Today

What to expect when undergoing a medical check-up in Japan

By Dr Tom Lomax for BCCJ ACUMEN

Only the youngest of my daughters, now six years old, has any interest in becoming a doctor. She is already preparing for her future career; her toy stethoscope is getting plenty of use.

Returning from work one evening, I found her at play with a long line of soft toys acting as patients. When asked what was wrong with them, she looked at me blankly and replied: “Nothing. They are having a check to make sure they stay healthy”.

A few days later, my daughter’s nursery sent us the report on her check-up — the basis for the play session I’d previously seen.

When undergoing a full medical check-up in Japan, a British employee will probably look — and feel — considerably less comfortable than his Japanese co-workers.

This could be because his colleagues have had annual medical check-ups since nursery school, while a surprisingly large number of UK nationals living here have never had a medical before moving to Japan.

As a consequence, the process involved and the ensuing report can cause confusion and consternation.

For anyone who is about to have their first medical here, it is important to recognize the difference in the underlying philosophy between Japan and the UK.

An employee in the UK may be offered, or required to have, a medical (paid for by the firm) at regular intervals. However, the employer’s involvement ends there; the process and final report are left to the individual.

An employer would only expect to see a report under specific circumstances—for example, when an employee is being assessed for fitness to work as a pilot.

Japan stands in stark contrast to this; regulations fall short of making it compulsory for employees to have an annual medical. However, government incentives are in place in larger firms to ensure that a high percentage of staff complete their check-up and file the report with their firm. This can lead to staff being pursued to have a medical even if they don’t want one.

In addition, doctors employed by firms will check staff medical reports and may even contact individuals to find out what they are doing about a particular problem.

Perhaps this helps keep the workforce in good shape, but non-Japanese might feel that their employer is being intrusive and paternalistic when they are contacted and asked, for example, to take steps to lower their cholesterol.

What should you expect when you step into a clinic in Japan for a check-up? In many ways, it is similar to visiting a medical center in the UK and, as there, the doctor’s time is golden.

You should expect to spend half a day in the facility with the most time spent undergoing various tests. At larger clinics, you may be given a menu of additional investigations from which to choose.

Face-to-face time spent discussing concerns is brief and, for those who do not speak Japanese, often unproductive.

There may not be much discussion as to why certain tests are being performed, thus foreigners could end up with investigations that don’t work as well for them as they do for Japanese — for whom they were designed.

An example is the barium meal and stomach X-ray that many readers might have had and vowed never to undergo again.

Japan has one of the highest rates of stomach cancer in the world, due to the Japanese diet: low in fat but high in salt and nitrates from traditionally preserved fish and vegetables.

Westerners have much lower rates of stomach cancer and so almost no medical back home would include a stomach screening by X-ray. Sadly, few Japanese doctors performing medicals will take the time to discuss this, and Western clients are discouraged from skipping the stomach checks.

Meanwhile, the situation is reversed for colon cancers. These are much more common in the West due to the meat- and fat-rich diet favored there. When past a certain age, anyone eating a Western diet should have some form of colon cancer screening.

This is offered by the UK’s National Health Service to those who are over 60 years of age, while U.S. gastroenterologists recommend that patients aged over 50 have regular colonoscopies. Even an elaborate medical check in Japan may neglect this area.

My view on medicals here is that, although sometimes inconvenient and uncomfortable, overall the good points outweigh the negative ones.

Early detection of high blood pressure, cholesterol and diabetes can limit the damage caused by these silent conditions. However, for a foreigner who is a novice to the Japanese system, some extra homework is necessary to make sense of the results and, most important, to figure out what wasn’t considered.

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As an expat, I get mine done in Thailand and once even in Vietnam. The tests there are tailored for your background, unlike the en-mass approach in Japan, are cheaper, the technology more modern and the results come out quicker. Language, of course, is another big factor.

2 ( +4 / -2 )

I've had a work health check for the last decade+. It is pretty painless, though they add to it as you age, and a lot of the bigger checks are optional, like the poop check and the barium ride, which I actually enjoy, as I have no trouble keeping the chalky liquid down while others vomit in a corner.

Other optional exams are a pap smear, but you have to pay for that, of course, and whatever the male equivalent is (I wonder if they have to pay for that?).

Height, weight, hearing, eyes, cardiogram (I think that's what it's called?- they attach pads to different points of your body and check your heart rate for a minute), 3 blood samples taken, hand over a urine sample, 'metabo', where they measure your waistline, and chest/lung X-rays...

There is also a questionnaire which is mostly about eating habits (how often, how much, at what pace), exercise (ditto), smoking and drinking.

There is a box at the bottom of the questionnaire which asks you if you'll consider any advice given by the doctor during the brief consultation you get with one. A couple of years I actually had specific questions to ask, and the young doc's answers were so useless, that I have checked the "not interested" box ever since.

This conveyor belt system takes an hour, if you time it right, and you end up with a results form that grades your health from A to E. I only ever had a B twice, instead of straight As, despite being overweight and until 18 months ago a frequent smoker and drinker.

It's a bit Mickey Mouse, then, but better than nothing.

1 ( +2 / -1 )

JeffLee, I would agree with you about Thailand, which seems to have a wonderful medical service and excellent doctors. I have found doctors there excellent even outside the medical tourist hospitals and right down to local doctors. I am surprised that you mentioned Vietnam. I never thought they were medically advanced.

In fact, I have found an excellent doctor in Japan and his English is good. I think it is important for a doctor's English to be good. If it is not, he will not be able to keep up-to-date with advances in medicine.

2 ( +2 / -0 )

I don't mind the health checks here at all. However, I still haven't had to do the barium challenge which may change my opinion. Also, my city doesn't have any English speaking doctors on hand which prompted my company to offer someone to go with me. I told them that I can do it on my own and was so happy I did! The doctor asked me if I have ever been or was thinking of becoming pregnant...although a little intrusive, the doctor just wanted to give me advice. If my company heard about my answers though, I would have felt very uneasy.

2 ( +2 / -0 )

If disease is found during the check up and the worker has to leave, health insurance cooperative (kenko hoken kumiai) must pay 60% of previous wage, tax exempt, during the length of the leave. Is there similar benefit in the UK or elsewhere?

2 ( +3 / -1 )

In the health checks in Japan, the standards are those of Japanese (Asian); so if you are Caucasian, your BMI and Waste circumference will be judged based on Japanese standards and reported as too high. Also the annual X-ray checks are too frequent; it is better to avoid them and only accept them once every 3-4 years.

0 ( +1 / -1 )

I am surprised that you mentioned Vietnam. I never thought they were medically advanced.

Well, they're not that medically advanced. But a number of international hospitals have sprouted up recently. My physical seemed OK, with little waiting, especially for the price. Included an ultrasound of my leathery old organs.

At an international dental clinic, I had a teeth cleaning for 20 bucks. No complaints. A good thorough job.

1 ( +1 / -0 )

That's why I suffered here ulcerative colitis coz this country were the most high stomach problems and they gave benefits free medecine and hospitalization

0 ( +0 / -0 )

If these medical check-ups were optional, or even if they were once every five years or so, they'd be wonderful, but as they are, I find them disruptive to one's mental health.

If you have any physical impairments (vision or hearing, for example), you may have been able to go for years without ever thinking about them, but under this system, you're forcibly reminded, every single year, that you were born with a handicap, and after getting yet another "C" or "D" or whatever letter grade it is, you get the thoroughly pointless admonishment to go see a specialist. Hello? I was born with these problems and they're not going away until my next dharmic incarnation.

They also seem to think that the average person is continuously monitoring their health. One of the questionnaires asked me if my weight had fluctuated by more than 3 kilograms in the past year and, not having weighed myself since the last check, I had to leave it blank. Of course the receptionist assumed that my lack fo an answer was because I couldn't read Japanese, and was surprised when I told her that we'd find out the answer to the question today, since I hadn't stepped on a scale in the past year. (When my weight came back as the exact same number as last year, to the nearest 100 grams, she was not amused.)

3 ( +3 / -0 )

I'm with JeffLee. I save up and go to Thailand once in a while for a REAL doctor's assessment. I like the Bumrungrad in Bangkok. Japan is still stuck in a feudal mentality with lots of hangover from the Mad Men days. It's a system that stemmed from Mad Men trained Japanese doctors after the war, and with the training came all the misogynistic, white male worship that made up the lives of the Mad Men back before Martin Luther King marched in Birmingham. Now it's the Japanese male and female doctors who were trained by the Mad Men trained Japanese male doctors, and as there weren't any civil rights marches over here it's a right kerfuffle. I seriously doubt this woman's daughter in the article above really got a decent assessment. A doctor or clinician gets a certificate to practice ONCE in Japan and is never evaluated, questioned or checked afterwards. Women get fed all manner of old wives' tales and 200 year old advice while being expected to pay from their salaries into an insurance system that covers everything for men including viagara but leaves them to pay for their own gyne and breast exams. 'Free' clinics offer substandard checkups with inexperienced clinicians who have no idea what they're checking half the time. The woman in this article should not confuse the excellent options offered by the NHS of the UK with the system here in Japan. The differences are not just cultural, there really are mental and legal limitations on the care here that denies girls and women professional care, and denies everyone access to the latest treatments available.

-1 ( +2 / -3 )

Basically, you can expect a third-world level of medical care.

-2 ( +1 / -3 )

Useful article. Thanks.

No-one mentioned that this is a cash cow for the medical esatablishment.

1 ( +1 / -0 )

Diagnosis is generally good, treatment and follow up are poor. Agree with others on the Thai hospitals. Bumrungrad run a good healthcare check programme, tailored to your needs, and provide good feedback on what measures, if any, you should take in the future. Their acute facilities are also good, I was in their for cardiac complications following Economy Class Syndrome (DVT); prompt diagnosis and treatment.

Nearest equivalent in Japan is Kameda hospital in Chiba, their admin is run by an ex-US Navy lieutenant, and has some US accreditation.

0 ( +0 / -0 )

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