A Prescription for Oversight

Features - October 19th, 2007
Medical records

by Benjamin Freeland

Japan’s medical system receives a great deal of flak these days. Deservedly praised as it is for its remarkable egalitarianism and widespread reach, Japan’s medical sector has nonetheless gained a reputation for being an unfriendly, authoritarian world known for its interminable waiting periods and frustratingly short consultations (derisively known in Japan as “the three-hour wait followed by the three-minute consultation”) and autocratic doctors with little bedside manner and a penchant for over-prescription of expensive medications. Moreover, the past decade or so has seen the system develop a regrettable track record for gross negligence on the part of medical personnel accompanied by buck-passing and blatant dishonesty on the part of hospital administrators. Horror stories about botched surgical procedures, fatal clerical errors and violations of patient confidentiality have become regular fare in Japan’s dailies, with Japanese citizens and foreign residents alike increasingly wary of a system that appears to embody the worst characteristics of Japan’s traditional hierarchical social structure. The crux of the problem, most analysts agree, is not a lack of facilities or expertise, but rather a disturbing lack of oversight and a medical culture wherein doctors (who, like teachers, are accorded the honorific title ‘sensei’) are considered beyond reproach and seldom held accountable for their actions.

Fortunately, popular dissatisfaction and anxiety surrounding the country’s medical system have not gone unnoticed by public officials, and the Tokyo metropolitan government, for one, has been taking concrete steps aimed at making the city’s hospitals and clinics more accountable to the public. One such step has been the establishment by the city’s Bureau of Health and Social Welfare of a medical ombudsman service known as the Kanja-no-koe Sodan Madoguchi (Patient’s Voice Consultation Help Desk). Established in 2001 under the banner of the metropolitan government’s much-vaunted Tokyo Medical Reform campaign (Tokyo-hatsu Iryo Kaikaku), this service is now provided at six locations in Tokyo Metropolitan Prefecture: at the metropolitan government offices in Shinjuku, serving the downtown 23-ku area and at branch offices in West Tama, South Tama, Tachikawa, Fuchu and Kodaira, which serve the outlying areas. According to its mission statement, the main objective of this new service is to help build a trusting relationship between patients and the medical system by way of soliciting patients’ concerns and offering them advice on how to proceed. While this service is not a legal organ and it is not within its purview to assign blame in cases of medical misconduct or serve as an intermediary in patient-doctor disputes, it clearly performs an important function, namely the provision of a much-needed independent support system for patients who find themselves underserved by the medical system or simply baffled by explanations they have received by their doctor. It is, in effect, intended as a port of second resort for patients who have already approached the medical institution in question with their concerns and come away with their issues unaddressed, as well as for those who are unsure as to how best to address  their concerns to the institution in question. Patient complaints or concerns can be fielded either by phone or in person at any of the health centers that offer the service.

In its six-year history, this medical help desk has shown itself to be a popular service, with the Shinjuku center alone fielding as many as 17,000 patient concerns a year (up from 11,000 in its inaugural year). Some 60 percent of the consultations it fields constitute patient complaints—as opposed to simple inquiries—of which the three most common are complaints over medical treatment received (34.2 percent), complaints about the conduct of medical personnel (24.6 percent) and complaints about medical bills (11.3 percent). Not surprisingly, this service has proven to be particularly popular among the city’s most vulnerable demographic group, its elderly citizens, with some 34 percent of its users over the age of 60, and female users have thus far outnumbered male, accounting for 62.5 percent of the total. While the service has thus far shown itself to be very user-friendly and transparent in its modus operandi, it still has far to go in terms of making itself available to non-Japanese speakers. The help desk website is only available in Japanese, and while the Shinjuku office employs several English-speaking staff members, it does not as of yet offer any services explicitly geared towards the foreign community. Nevertheless, as help desk spokesman Masaru Tanaka explains, non-Japanese-speaking foreigners are able to use the system by way of the Health and Welfare Department’s Medical Information Service for Foreigners (Gaikokujin Iryo Joho Teikyo), which offers services in five languages (English, Chinese, Korean, Thai and Spanish) and is able to act as an intermediary between foreign residents and the help desk. “Foreigners are not being overlooked in our policymaking,” assures Tanaka. “We are making allowances for non-Japanese speakers.”

While stories of medical malpractice and on the part of Japan’s medical personnel continue to appear in the news on an all-too-frequent basis, it now appears that policy- makers in Japan are taking important steps towards addressing the public’s growing mistrust of the country’s notoriously conservative medical system, a concern all the more pressing considering Japan’s rapidly aging society. And while Tanaka concedes that it’s still too early to tell what effect the medical complaints help desk has had on the overall quality of medical services in the capital, he notes that use of the help desk has in the past year shown its first ever decline, after a steady increase since its inception, suggesting perhaps that some change is underway.

Contact Information:

Patients’ Voice Consultation Help Desk (Kanja-no-koe Sodan Madoguchi)
Medical Safety Support Center (Iryo Anzen Shien Sentaa)
Tokyo Bureau of Health and Social Welfare,
Medical Policy Division, Office of Medical Safety
Tokyo Metropolitan Government Bldg. 23rd Floor
2-8-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 163-8001
Tel. 03-5320-4435 (Japanese only)
Office Hours: Weekdays 9am–12pm and 1pm–5pm

West Tama Branch: 042-820-2113
South Tama Branch: 042-310-1844
Tachikawa Branch: 042-362-4691
Fuchu Branch: 042-362-4691
Kodaira Branch: 042-450-3222
Medical Information Service for Foreigners (Gaikokujin Iryo Joho Teikyo)
Tel. 03-5285-8181
(English, Chinese, Korean, Thai, Spanish)