"Please put the explanation of the examination you've just given me in writing and email it to me, alright?"
Akihiro Nabuchi, a heart surgeon and instructor at the Yokohama Northern Branch of Showa University Hospital, was not at all pleased with the above request from his female patient. He had informed her that a valve in her heart was in a precarious condition and prompt surgery was warranted. But from her aggressive reaction to the news that she needed an operation, it was clear she was somehow blaming her doctor for her condition.
"We doctors try to work with patients in a frank manner," Nabuchi told Shukan Asahi (June 17). "But some patients see themselves as victims, and take it for granted that the doctor will treat them. No doctor wants to have to deal with such patients."
Nabuchi complied with her request, but ended his email to her by terminating the relationship. "I'd like to request that you please use another hospital," he wrote her.
"Proceeding with coronary surgery involves a big decision on the part of a patient," reflected Nabuchi, who has authored several books. People come from all over Japan to consult with him.
"When they come for a diagnosis, and we try to be upbeat about promoting their treatment. But some patients are just uncooperative. If a cardiac patient misses the opportunity for treatment, it's not only bad for the heart, but the liver and kidneys as well," Nabuchi noted, adding that the pulse can also become irregular (arrhythmia). "When that happens, the risks to surgery are multiplied."
Among the various things one can do to become regarded as a first-rate patient is understand that as doctors' time with each patient is limited, patients be also be willing to discuss their fears, concerns and pains with other professionals, including nurses, pharmacists, clinical psychologists and the social workers at cancer patients' support centers.
Another piece of advice the article offers is for patients to avoid the Jekyll-and-Hyde syndrome when dealing with doctors and nurses. Showing an obsequious attitude toward the former while being abrupt and demanding toward the latter will not win any friends.
Knowing how, and when, to convey one's appreciation to a physician is a tricky process, even for Japanese who are supposed to be knowledgeable about such things. Along with a list of advisories is a sidebar essay titled "Communication is more important than gifts."
Among the points the article notes are:
- Monetary gifts at public hospitals are to be avoided.
- A gift should only be presented after surgery/treatment is completed.
- More than money, a sincere thank-you letter will please him or her.
Arranging for a second opinion also requires diplomacy and tact. In 2000, Shinsuke Amano underwent chemotherapy for malignant lymphoma. When a recurrence was diagnosed, his doctor warned him, "The treatment is rigorous, and in some cases can result in a patient's death."
"At that point, I decided to overrule my primary care physician and get a second opinion," Amano relates. That doctor concurred that there was indeed a high risk, and Amano told his doctor he'd decided to forego another round of chemotherapy.
"I don't know if that was the right choice or not, but it helped to get my feelings in order," Amano says. A decade and a half later, he continues to beat the odds. And what's more, he's the co-founder and current executive director of the Tokyo, Setagaya-based Japan Federation of Cancer Patient Groups（Zenganren), a national advocacy group for cancer patients.© Japan Today