During our weekly content planning meeting, the topic of the medical options available to foreigners came up. At Weekender we try to maintain a positive outlook on life in Japan, and like to present readers with information and resources that will improve their lives here. Presenting the topic of medical services in Japan in a positive way, posed a rather large problem for me, as I have spent the last 18 months battling with numerous doctors here, to get what turned out to be a life-threatening condition, recognized.

It all started in May last year, when I exhibited symptoms resembling those of some sort of brain injury. Two months later I suffered a neurological ‘episode’, and then in April this year, another. Throughout this time, certain cognitive functions disappeared, leaving me unable to perform many tasks I had previously been able to. I have a First Class Honors degree in Mathematics, and I suddenly found myself unable to add up in my head. Something was clearly very wrong.

I visited many doctors throughout this period, starting with my favorite doctor who dismissed my symptoms as being related to stress. I liked her a lot (and still do), and while I didn’t feel her diagnosis was correct, I trusted her—after all, she was the doctor, not me. But as I altered my working hours and made efforts to create a stress-free life, my condition got worse. So I consulted a Japanese neurosurgeon, who diagnosed me with “hysteria”, saying that many Japanese women my age suffered from the same thing. In May this year, I saw another Japanese doctor, who asked to speak to my husband in private about my “mental illness”. Finally I tried a well-known foreign doctor, who gave a diagnosis that caused much hilarity amongst those who know me: “lacking in confidence”. I could not get a diagnosis in Japan, and the reaction I was getting from doctors here, was making everything worse.

So I left the country, where it was quickly discovered that the three neurological episodes were all strokes and the loss of cognitive function was due to brain damage caused by these strokes. The strokes were caused by a heart defect, and heart surgery was immediately performed (I now have a titanium implant and can call myself a bionic woman!). I was told I was very lucky to still be around, and one of my doctors was amazed I was still walking.

All the doctors I saw in Japan work (or worked at the time) at well-known clinics in Tokyo. All of those clinics made it to our ‘most frequented clinics’ list to the right. We all go to them, and we choose them because they say they are international— they have foreign doctors, or doctors who have trained overseas, or lots of other foreigners go there. And we expect them to give us the kind of treatment that we would receive back home—in fact, because of the fees they charge, we probably expect them to give us better treatment than we’d get at home!

Except that the rules that apply back home, don’t apply here: doctors don’t seem to update their medical knowledge; complaints procedures are not straightforward; and patient confidentiality appears to have no place. I’ll be generous to the doctors I saw, and consider myself the only person these doctors have ever misdiagnosed, and that they all enjoy wonderfully successful careers saving countless lives. But it’s difficult to determine just how good they are because they have such a high turnover of patients, and nobody wants to complain because who do we then go to for health care? Doctors who treat foreigners can diagnose you with stress, hysteria, mental illness, or lacking in confidence, because if anything serious is wrong, you’ll probably go back to your home country and get it dealt with there. In a worst case scenario, and you drop dead or become permanently paralyzed (either of which could have happened to me at any time) then your family will be so busy grieving in your home country that nobody will want to go halfway round the world to find out if you received adequate medical care beforehand.

As one of our survey participants commented: “I think people ‘put up’ with healthcare here generally because the expats are only here for a limited period of time”—if we’re all putting up with whatever service we’re receiving, then what incentive is there for a clinic or doctor to give a particularly good service? Perhaps by making our survey an ongoing feature of our website, culminating in a special issue next year, we may at least go some way to encouraging international doctors and clinics to feel accountable to those who pay them.

And in the meantime, my advice is to take control of your own health—the only person you can rely on to get to the bottom of whatever health issue you may be dealing with, is you.

Caroline Pover, Weekender Publisher

The Survey by Marie Teather

For this, the first of our Weekender Medical Services Surveys, we decided to conduct a mini-survey, hoping first and foremost, to compile an all-important medical services league table. At this stage we conducted a qualitative survey in which we were trying not to gain a whole quantity of information, rather, we targeted those people who have been living in Japan for a longer period and sought their more experienced opinion on the medical services here. The survey was sent out online and the respondents were able to name (or shame) their preferred doctors and clinics. We also asked respondents to offer comments on any situations or experiences, good or bad, they have encountered here in Japan.

So, who took part in the first and mini Weekender Medical Services Survey for 2007? Most respondents were in their twenties and thirties, and 60 percent were female. 43 percent of the respondents have been living in Japan for over 10 years, and two thirds have been living here for more than three years, which means most people who took the survey were indeed the ‘longer’ term residents of Japan. 30 percent have children under the age of 18 living in Japan, and half said that their Japanese is good enough to converse with a doctor. Interestingly, Japanese ability perhaps played a bigger part in respondents’ overall opinions of healthcare in Japan than we anticipated, with one participant commenting “If you are comfortable speaking Japanese, there is absolutely no problem in finding first-rate doctors,” and another, “Being a foreigner whose Japanese isn’t good, there isn’t much choice really, and all the international clinics are expensive before you even walk in the door.”

Of the respondents, only 25 percent used Japanese medical services exclusively and the remainder used either international medical services, or a combination of both. 67 percent of respondents have private medical insurance. Just under one quarter of respondents go for routine checkups and most go only when something is wrong. Around half of the survey participants have, or someone in their family has, experienced a serious injury or undergone major surgery in Japan, which included a serious of broken bones, motor cycle or bike accidents, an emergency appendectomy and one family member was treated for leukemia. 64 percent said they would actively wait for, or put off certain procedures, rather than have them done in Japan: such procedures ranged from “anything more than a common cold” and “almost anything” to “any major surgery”, “very serious disease”, and “anything life-threatening”.

What follows to the right is our league table of the most frequented eight clinics or hospitals as determined by the score each participant gave the facility out of ten. Please note, there were 18 other clinics or hospitals mentioned by our participants, but a clinic had to be visited by 10 percent or more in order to make it to our list. This means that the facilities listed are the most visited, and not necessarily the ones that received outstanding comments or recommendations from participants. (Again this could be related to Japanese ability.) This being our qualitative and mini-survey we have ranked this list in alphabetical order until we investigate in more detail and interview a wider range of people.

How Weekender readers rated medical facilities they usually go to…

Aiiku 5/10
Tokyo’s most famous hospital of Obstetrics and Gynecology last year saw birth to the Crown Prince Hisahito—Japan’s only male heir to the throne—and has quite literally been bringing in new life to the country since 1938. Located conveniently in Minato-ku with English speaking staff and an almost hotel-like interior, this private clinic did, despite the royal connections, score only 5/10 with our survey respondents, who commented on the “bad communication, completely inaccurate information at times; foreigners accept it because it has private rooms and is near Hiroo”.
Tel. 03-3473-8321 or see www.aiiku-hos.or.jp.

Hiroo Hospital 5/10
Founded in 1895 this is the oldest of the hospitals to make it to our list of most frequented medical facilities, which provides both inpatient and outpatient health care. The hospital’s mission statement talks of the emergency supply reserves already built-up in the event of a disaster, but yet this hospital didn’t have such a high response rate from our survey participants, scoring just 5/10. Still, comments were fair, including a “good service and nice doctors, no English though, had to bring a friend to help me translate” plus “helpful and what I would expect from a NHS hospital”.
Tel. 03-3444-1181. www.byouin.metro.tokyo.jp/hiroo/e_top.html for more details.

Jikei University Hospital 5/10
Aside from the adjoining Jikei University, there was very little information to be found about this hospital other than to mention it’s close proximity to Kamiyacho station in Minato-ku. Still the hospital fared quite well with our survey respondents who added comments such as “very nice clean and modern”.
Tel. 03-3433-1111. www.jikei.ac.jp/hospital/honin/.

Nisseki (Red Cross) Hospital 4/10
Conveniently based in Hiroo but inconveniently having a Japanese-only website, information was very hard to come by, even when calling the office in Japanese. The location alone is probably the reason why so many people have been there, as it scored extremely badly with our respondents. One person said “I wonder if they have ancient doctors with attitudes to match on normal hours, and trainees for A&E” and another “A&E was filthy dirty”.
Take your chances and call 03-3400-1311.

St. Luke’s International Hospital 7/10
St. Luke’s began in1902 as a small clinic in Tsukiji by missionary doctor Rudolph Bolling Teuslesent, making this, almost (but not quite) the oldest establishment in our survey. Founded as Japan’s first modern hospital, St. Luke’s still strives to equip itself with the best of IT and medicinal technologies, a feat echoed by our respondents who graded the hospital highly and commented on the “care level reasonably high and the facilities/service good.” Another however, added in contrast “new, lovely facilities but out-of-date procedures and doctors that need to renew their skill base”.
St. Luke’s International Hospital is a five-minute walk from Tsukiji Station, for more information call 03-3541-5151 or see www.luke.or.jp.

Tokyo British Clinic 4/10
To quote from the homepage ‘The Tokyo British Clinic was established in 1992 to provide foreign residents and visitors with the highest  standards of medical care in the tradition of British General Practice.’ Founder Dr. Gabriel Symonds, a British GP, has been serving the foreign community since 1984 and offers diagnosis and care in a wide range of medical practice. He did however, cause a very polarized response from our respondents, and only scored a 4/10 overall. “I personally like Dr. Symonds, he has a minimalist intervention policy, and has correctly diagnosed numerous conditions over the years for my family members” whilst another “I may hesitate to go back there if my problem was more ‘personal’ due to the stuffy and ‘old school’ nature of the doctor”.
Consultations are available by appointment Monday–Friday 9am–5.30pm, Saturday 9am–12pm. Call 03-5458-6099 or see www.tokyobritishclinic.com for more details.

Tokyo Medical & Surgical Clinic 7/10
Tokyo Medical & Surgical Clinic was established in co-operation with some foreign embassies in Tokyo and has continued to serve the international community since 1951. 50 percent of the physicians at this private clinic are from overseas, including Germany, France and England, and it has specialty consultants covering a diverse range of medicines (and languages).  Tokyo Medical & Surgical Clinic scored highly with our survey respondents, an overall 7/10 with comments such as “very friendly, helpful, seem to know what they are talking about” but also “too many people in the waiting room”.
Clinic office hours are Monday–Friday, 9am–5.30pm, Saturday 9am–1pm. For more information please call 03-3436-3028 or see www.tmsc.jp/index.html.

Tokyo Midtown Clinic 9/10
Affiliated with the pioneering Johns Hopkins Medicine International, Tokyo Midtown opened in March of this year, boasting the latest examination equipment at its multi-specialty and bilingual outpatient complex. This clinic was voted top of the medical facilities in our survey, scoring 9/10. Respondents were still careful to mention the clinic was “good but expensive” and another “while the care was good, and the clinic is immaculate with amazing facilities, I am a little concerned about patient privacy.”
Tokyo Midtown Clinic is open Monday–Friday, 10:30am–2pm, 3pm–7.30pm, closed weekends and Bank Holidays. Please call or see website more details. Tel. 03-5413-0080. www.tokyomidtown-mc.jp/en.