An elective report from Tokyo

I chose to do my elective in Tokyo. In many respects it is similar to medicine in England, which would make an interesting comparison. The Japanese are renowned for their unique social structure so I regarded my elective as an ideal way to gain further insight into their lives.
 
I chose Jikei University Hospital as it was closely based on Guys, Kings and Thomas’ Medical Schools in London and during their first year the medical students are taught English. They also have an established elective programme.
 
I divided my time between Obstetrics and Gynaecology and Paediatrics, as these are my areas of special interest.

On a typical day we would begin at 8 am with a team meeting. We would discuss house-keeping matters (such as relevant meetings or seminars currently being attended and recent publications or changes in practice).
 
Every Wednesday and Friday morning there was a Professorial Ward Round. There were two professors and impressively they would conduct the whole ward round in English while I was there.
 
The doctors and even the medical students would present their patient to the Professor who would question them to assess their understanding of the condition. The paediatric department was extremely large so there were a number of subspecialties - cardiovascular, neonatal, neurological, obstetrics. The ward round would take about 4-5 hrs. In addition to this, each department would have an individual ward round for that particular specialty each morning. However the neonatology department would also have a hand-over ward round in the evening, which was specifically for the doctor who was working that night.
 
The doctors at the hospital told me that in Japan there is not such a strong role for family doctors, the primary care is minimal. Generally the patients present at the hospital rather than going to their general practitioner. There is no specific career pathway for doctors who want to work as family doctors. Family doctors have usually done between 5 and 10 yrs of specialty training in a large hospital before becoming a family doctor. I was told that it is only recently that some hospitals have begun to develop a general medical department.
 
As I was based in Tokyo most people would be admitted directly to hospital without referral from a general practitioner. There is competition between the hospitals in a particular area for patients. Patients who require specialist treatment would often research which hospitals specialised in that particular condition and admit themselves for treatment. Each department had a specialist subject. Paediatrics specialised in metabolic disorders, therefore I saw many rare conditions such as Fabrys disease, which I’m unlikely to see in the UK. I did question whether the learning experiences were too specialised for the general education required in medical school. During paediatrics I certainly felt that I was learning about many interesting conditions, which I was unlikely to see at home. Personally I found this useful but I also felt that I was not coming into contact with the common disorders, which are important to learn about.
 
I noticed that patients would stay for longer than would be expected in the UK. In the neonatal unit, there was a ‘growing centre’ for the babies, although premature, they were admitted without any medical problems.
 
The doctors seemed to do much of the work themselves rather than referring their patients to different departments. It seemed much more hands-on than in the UK. During the obstetrics clinic, the doctor running the clinic would perform the transvaginal and transabdominal ultrasound scans, artificial insemination, seminal fluid analysis and even ICSI (intracytoplasmic sperm injection) during his usual clinic. ICSI is a procedure which is only offered in specialised centres in the UK, therefore it was extremely interesting for me to see. They had a television screen which visualised what the doctor was doing under the microscope.
 
Investigations and treatments were conducted most efficiently in Japan.
The funding of their health service is partly private and partly state funded. I was advised that some patients do have private health insurance, however most doctors often treat both private patients and non-private patients. In the Jikei University Hospital there was a private ward, which had views of the Tokyo Tower and the surroundings were generally more comfortable. The service that the private patients received appeared to be similar to that of the normal patients. In the hospital where I worked I was told that almost all of the doctors at Registrar level did one or two days per week in a private hospital. The pay of the doctors varies dramatically according to the hospital where they worked, not just their specialty and their grade.
 
Dermatology is the most popular specialty whereas Paediatrics is considered less attractive. The doctors also explained to me that the jobs with longer hours are less popular. The doctors who I worked with would start their day at 8am, and would not finish before 8pm.
 
The doctors would eat lunch with their team each day. They would wait until everyone was available, however this would occasionally mean 5 people waiting for one doctor. There was a definite hierarchy within the medical profession; the senior doctors would always pay for the junior doctors’ lunch. The fact that they socialise together meant there was more cohesion within the teams.

Many of the doctors could speak fluent English, in particular in the paediatric team. This was regarded as an essential skill for the doctors to learn, as most of the conferences were presented in English. It was felt that if a doctor’s English was not adequate, they could not compete internationally which was regarded as extremely important. The paediatric professors conduct the whole ward round in English and the junior doctors would present their patients in English to the professor. Even the medical students presented cases in English. They all improved dramatically while I was there. There was a direct correlation between the level of English spoken and the grade of the doctor. The professors spoke perfect English and were keen for the junior doctors to improve.

The Japanese are renowned for their respect and this transferred to how their patients were treated. The obstetric department specialised in fertility. They would perform IVF and ICSI. They were quite conscious that clinics for patients with fertility problems and those having routine check-ups during their pregnancies would be occurring concurrently. The obstetric department was designed accordingly, as they had two separate waiting rooms which would keep the patients who were seeking fertility treatment separate from those who were pregnant.

My experience as a medical student in Japan has changed the way I view the working team. The Japanese place great importance in working together and socialising in their team. They are under immense pressure and often doctors would tell me that it was part of the Japanese philosophy on life to work hard.

I found my experiences during my time in Tokyo changed my perspective on both the treatment of patients, and how they work together. There is much that we can learn from the effectiveness and productivity of the Japanese, I found them to be extremely organised in every aspect of their lives and this transferred to the healthcare system.



This guidance was correct at publication 01/07/2007. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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