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How to avoid being a 'third-rate patient'

33 Comments

"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

©2019 GPlusMedia Inc.

33 Comments
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Please put the explanation of the examination you’ve just given me in writing and email it to me, alright?”

Fair enough, the patient probably wants a second opinion, so?

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.

There has to be more than just this, BUT if it is just this request and the doctor thinks she is blaming him, he comes across as one arrogant man. She has the RIGHT to the information and the right to have anyone else check her out, it's her body that will be operated on.

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.

More proof that he is an arrogant arse.

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.

What article?

13 ( +17 / -4 )

“When they come for a diagnosis, and we try to be upbeat about promoting their treatment. But some patients are just uncooperative.

Yeah, I mean, he just told her that her heart doesn't work and she needs serious surgery just to live. Why can't she be upbeat like her totally healthy, wealthy, and respected doctor? He doesn't need someone who is grappling with existential fears bringing down the mellow vibe in his office. Good on him for dumping her, even if it was in a critical time when she urgently needed health care. Life is a beautiful thing and you can't just let your life get filled up with people who only think about their own problems all the time. It throws off your golf game.

14 ( +17 / -3 )

Why can't she be upbeat like her totally healthy, wealthy, and respected doctor? He doesn't need someone who is grappling with existential fears bringing down the mellow vibe in his office.

I just noticed, this guy works at a teaching hospital and does research there, so it is rather easy to assume he is unaccustomed to having people question him about anything. Doctors and surgeons especially are like gods to the interns, residents and students.

Dude needs to retake bedside manner 101

13 ( +15 / -2 )

@Yubaru:

What article?

It's not obvious info, but:

Nabuchi told Shukan Asahi (June 17). ]

Otherwise I agree with both the above posters. A patient who has received such serious news doesn't want upbeat, she wants to process the information fully, with more time than a ten-minute meet with a doctor using technical language and talking quickly while she is in shock.

What a mensch of a doctor, kicking her out...

9 ( +10 / -1 )

That seems to be the very same hospital I now avoid like the pest... I had a different problem (so different doctor) but luckily we tried - and found - a MUCH better place. I now avoid all "University hospitals"...

10 ( +11 / -1 )

This should be "How to be a third rate doctor"

15 ( +18 / -3 )

Well as a cancer patient here in Japan, I fully agree with the doctor. He told me straight up it was cancer, a kick in the guts but then we talked about treatments and he said I was welcome to get a second opinion. Dr Nabuchi is a doctor with very limited time to care for a vast number of people demanding and grateful for his expertise. Maybe he was tired but I saw it in the chemo and radiation ward more than once; people looking pissed off and bringing their attitude to the professionals doing their best to treat them. There are counseling and support services well advertised in the hospital and those are the places to download and vent your opinions. The nurses are also a great source of extra information and support. I think you all are missing the context of upbeat and thinking of a sing a long with ukuleles. I infer he means he is positive and forward looking, projecting positive outcomes which will help keep a patients morale high. That is a good thing when you consider the other alternative. "Hi lady, tough break, it's lethal heart disease, I'll email you the results, okay?" "next". Good on the Dr for not pandering to the "monster patients". This is a good reminder to the general public of the scene in hospitals.

If any of you ever end up with a child needing heart surgery to repair Kawasaki Disease damage and are given a choice of open heart surgery or a less invasive technique you better choose the open heart method as this "third rate doctor" is a pioneer in the latter. Wouldn't want anything associated with him treating you child right?

1 ( +5 / -4 )

My heart doctor found it rather amusing that I might one day have to have a pacemaker. Ok, not the worse thing to have to happen but his tact left a lot to be desired. Perhaps there is something about heart specialists. Meanwhile the guy shoving a camera down my throat was telling me about how foreigners get this or that stomach issue because they eat a lot of meat and how he was expecting that to be the case with me. He was surprised then that I don't eat any. I thought it might have all been to do with some kind of prejudice about foreigners. The latter concerning meat and the former to do with them liking directness (or them having a lack of feelings). That almost seems a charitable explanation because it is better than the alternative raised by this article; that some of these experts have no tact at all with anyone.

7 ( +7 / -0 )

This should be "How to be a third rate doctor"

Or how to avoid third rate doctors, which is quite difficult.

7 ( +8 / -1 )

Well as a cancer patient here in Japan, I fully agree with the doctor. He told me straight up it was cancer, a kick in the guts but then we talked about treatments and he said I was welcome to get a second opinion.

Sounds like you have a great Doc.I hope everything is fine. The Doc in this article could learn a few things from yours.

9 ( +9 / -0 )

My doctor tell me stuff which goes over my head so I just ask him to tell my daughter (his Nurse)

2 ( +3 / -1 )

Doctors in Japan and generally 90% of physicians are third rate at best... Its mostly a family business here and they are all under qualified, and generally just bad at what they do, anyone good enough works in a different country. If you have any actual serious disease, you really should be seeking help in another country.

4 ( +7 / -3 )

The way people in Japan respond or comment on other humans is actually a mean streak, but it is unintentional and cultural. Shrug it off.

Be polite and go for direct answers if you are a gaijin. Just ask them to politely tell it as it is.

Ms. Delicious Of Course

-3 ( +2 / -5 )

Oh boy. The stories I can share!

Let me first state that the care that I've received in Japan has been incredibly efficient, if not exactly sympathetic. However, some of these "doctors" really need to brush up on their people skills.

The doctor who performed my emergency appendectomy (brilliantly, by the way) actually told me just before the op that I was the first gaijin he had ever operated on, so he was a bit nervous about the outcome. Imagine how I felt.

The doctor who diagnosed my gallstones told me that he'd never encountered such a young patient before (I was 33 at the time) and that it was obviously caused by my decadent foreign lifestyle and eating habits.

The doctor who diagnosed my mumps - which I caught from a Japanese student, btw - felt the urge to inform me that foreigners have superior salivary glands, which explains our supposedly superior linguistic abilities. He wasn't joking.

The doctor who wrongly diagnosed my friend as having breast cancer (how can such a thing happen in this day and age?) advised her to start making care plans for her children. Fortunately she got a second opinion. It turned out to be a mere cyst!

A doctor I met in a nightclub passed around a huge photo album of medical photos of women's genitalia, possibly taken by him or a colleague.

Another doctor showed up in one of my English classes, wanting to improve his communication skills. He had been sued for medical malpractice by a patient. He seemed like a nice guy, but frankly his bedside manner was appalling, and I wasn't surprised there were misunderstandings.

By the way, almost every single one of the above doctors was a second or third generation one. Avoid those guys like the plague!

5 ( +8 / -3 )

After several months of a painful knee problem, I asked my doctor if I could have my MRI scans as I wished to get a second opinion. He initially refused and ranted, berating a foreigner for doubting his opinion. I eventually got hold of the scans through another channel, and found a new doctor who immediately scheduled a knee op for 1 week later. 12 years later and I'm still playing football weekly. Respect & humility works both ways.

3 ( +4 / -1 )

Doctors in Japan and generally 90% of physicians are third rate at best..

ON this I will argue with you to no end. I have spent over 6 months laid up in a Japanese hospital and had surgery that lasted over 8 hours, that put me in ICU for over 10 days.

I also worked in a Japanese hospital group for nearly 10 years as well, and your comments are WAY off the mark.

5 ( +6 / -2 )

“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.”

This is really sad. A physician's first duty is to his /her patient, regardless of whether they want to treat them or not.

3 ( +5 / -2 )

I see nothing wrong with asking a doctor to explain a treatment in writing so that it can bee fully comprehended by the patient; after all the scalpel is going to be into the patient and not vice versa....

5 ( +5 / -0 )

The doctor who diagnosed my gallstones told me that he'd never encountered such a young patient before (I was 33 at the time) and that it was obviously caused by my decadent foreign lifestyle and eating habits.

Exactly the same thing was told to my Canadian friend, who was about 35 at the time. She is 5'2" and about 105lbs, the Japanese doctor who said those exact same words to her was about 5'9" and over 200lbs! She just started laughing and said "Have you taken a look at yourself recently?!" He had the grace to laugh too and said yes, you are right!

4 ( +5 / -1 )

The best way to make your Dr happy is to have an excellent outcome. Reducing refined sugars, alcohol and refined carbohydrates to near zero will reduce inflammation and infection. Soups cooked with bone added (bone broth etc) will work wonders rebuilding bone, tendon and cartilage.

-6 ( +1 / -7 )

The best way to make your Dr happy is to have an excellent outcome. Reducing refined sugars, alcohol and refined carbohydrates to near zero will reduce inflammation and infection. Soups cooked with bone added (bone broth etc) will work wonders rebuilding bone, tendon and cartilage.

Huh? The best way to keep your doctor happy.....bs. You doctor wants to see you as much as possible, how else is he or she going to make money!

0 ( +3 / -3 )

Huh? The best way to keep your doctor happy.....bs. You doctor wants to see you as much as possible, how else is he or she going to make money!

If you are not healthy - you will not be able to play tennis or golf with your Dr. -If your Dr is too busy he will not be able to play tennis or golf with you either. There is a balance there and many Dr's are paid by insurance -if your care "goes over expected set costs" they are not making money from you, but you are costing them money and time

-4 ( +1 / -5 )

badsey3JUN. 19, 2016 - 04:10AM JST The best way to make your Dr happy is to have an excellent outcome.

Why on Earth would I want to make my Dr. happy? They aren't paying me. I go to them because I want to be healthy, and anything they aren't doing that isn't working with me to get me to that goal is a pointless distraction. They want to be happy, they should join a club and make some friends.

But you do a good job of revealing the sort of entitlement that so many doctors have. There are of course good doctors, but like teachers, politicians, and other people with high-status jobs, there are far too many arrogant doctors who think the world revolves around them. Though unfortunately I've encountered incompetent doctors in both the US and Japan, at least in the US my doctors' incompetency could be blamed on their greed and the commercial incentives in the system which a sensible Congress could regulate. But in Japan my incompetent doctors just seem to have suffered from a sort of bumbling paternalism that no amount of oversight could ever fix.

2 ( +4 / -2 )

Patients have a right to the examination notes. Just request a copy as you're leaving.

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.

No tips for doing your job.

doctor I met in a nightclub passed around a huge photo album of medical photos of women's genitalia, possibly taken by him or a colleague.

Doctors, especially anesthesiologists, have access to mood altering drugs. The ones who get hooked on the drugs are known to tell off-color jokes or engage in the above behavior.

I met a gynecologist from Saga. He asked my wife about my penis. We left the party and I actually dropped the saga doctor's friend as a student. The student had been disgusting too. always touching his balls in class.

0 ( +1 / -1 )

It's a shame that Dr Nabuchi, though something in his field, cannot find it in himself to be someone to all his patients.

0 ( +1 / -1 )

From a family of doctors, doctors should welcome questions from patients and 2nd even 3rd opinions. Because doctors are not infallible, and getting it correct for the patients is paramount over any ego.

Another doctor showed up in one of my English classes, wanting to improve his communication skills. He had been sued for medical malpractice by a patient. He seemed like a nice guy, but frankly his bedside manner was appalling, and I wasn't surprised there were misunderstandings.

Wonder what communication skills he learned bedside

I met a gynecologist from Saga. He asked my wife about my penis. We left the party and I actually dropped the saga doctor's friend as a student. The student had been disgusting too. always touching his balls in class.

Maybe there's more pediatric gynecologists in Japan

1 ( +1 / -0 )

It´s not easy to be a Physician...dealing everyday with people´s illnesses (although they are trained for it)...I believe patients should work and cooperate with the doctors in trying to resolve the problem.Also,it´s nothing wrong with a second and even a third opinion...but within respect and consideration...to the first opinion...(False-positive test results are more common than we think) perhaps a lab limitation at times.

0 ( +1 / -1 )

Wow, who paid how much to get this printed? What, billboards are good enough? But the cat is out of the bag. People are wary of aggressive surgery, and rightfully so.

0 ( +1 / -1 )

Shoot, what the heck is wrong with wanting a copy of your records? I worked at an orthopedic clinic in America and "I want a copy of my records" didn't always equal "I want a second opinion." Shoot, "I want a second opinion" didn't always mean "I hate you and your clinic please go die in a fire."

If someone wanted their records, we sent them to the records department because they were their records. Sometimes you gotta think and plan things. I also ran across patients who wanted a second opinion (and a glance in the appointment notes showed that the doctor actually gave their blessing for a different doctor they knew to make sure that treatment was the right call.) And a lot of these doctors were primadonnas! SMH.

2 ( +2 / -0 )

True story: I have a female Canadian friend who went to the doctor to discuss a female-related problem. The doctor (female btw) who had had lived in the USA said, "So, I hear you have a problem with your kunt". Same friend went to a different doctor and on the examination table the doctor said "oooh fish and chips!".

1 ( +1 / -0 )

I avoid doctors here unless I have no other option:

I went to the emergency room for a kidney infection (which I'm prone to). I recognized the symptoms right away and waited in the "international" hospital near Tsuki. The doctor had no idea what was wrong (after repeatedly telling him the issue) and had me take a bunch of tests before declaring that he wasn't sure and just gave me some antibiotics...though the dosage and amount wasn't enough to fix the problem and I had to return to another clinic.

I went to a gynecologist for the first time and the lady was in her late sixties (at least). She performed a sonogram (though I wasn't pregnant) and declared I had a serious disease in my ovaries. Freaking out I contact my doctor back home who assured me everything was fine and at my next appointment the gyno declared "Your ovaries are beautiful and healthy--forgetting she had given me a grave diagnosis the visit before...oh and telling the two friends I recommended they were afflicted with the same disease.

The same gyno informed me not to bother getting HIV test because Japanese people don't get HIV....that was the last time at that place.
1 ( +1 / -0 )

I have only run into two bad doctors here in many years. Most have been very kind and helpful.

Maybe the gaijin attitude when meeting a doctor needs changing?

-5 ( +2 / -7 )

Been in twice now, to local hospitals, not big university or teaching hospitals.

First for elective orthopaedic/neurosurgery, and the second time as an emergency admission at night for pulmonary emboli, uncoupled heart rhythm, heart failure and circulatory collapse; pretty close to terminal. Both times received excellent care, and whilst the doctors, nurses and other staff spoke virtually no English, my medical Japanese is pretty good; and they were more than happy to explain treatment options, anaesthetic procedures, show me before/after ECGs and scans, and for a small cost, gave me a couple of CDs of my ultrasound and CT scans. When my IVs extravasated, they promptly called a plastics/dermatologist to deal with the skin ulcers and cavities that developed, rather than manage it themselves.

Must note that none of the surgeons/ cardiologists and ER physicians were more than 45~50 years old, and were certainly very conversant with modern treatment techniques.

If you are going in for treatment, it pays to prepare, and learn some of the words for the treatment that you will be receiving. There are number of small medical dictionaries that fit in your pocket with basic vocabulary, as well as some 'apps' that have good medical sections.

1 ( +1 / -0 )

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