by Elyse M. Rogers

Emergency Care. The Hospital System

In a medical emergency, after dialing the ambulance (119) and explaining in Japa­nese that you need an am­bulance and giving your address, you will have to direct the ambulance driver or dis­patcher to the proper hospital.

Let’s back up a minute, be­cause there’s a prior step re­garding the hospital that should be accomplished before you call the ambulance. If you have planned in advance for a medical emergency, which is the best system, you have ob­tained a Tokyo doctor, dis­cussed emergency care with him and know what hospital is best for your needs. In that case you should have no prob­lems: your first call would be to him, and he would take care of calling the hospital and perhaps even the ambulance as well.

If you don’t have a doctor, or are not in a situation I where you can I reach him readily, you must I call the hospital yourself to see if they will accept you, and then direct the ambulance dis­patcher or driver to take you to that particular hospital.

If this all sounds complicat­ed, it is. Some more back­ground explanation on the sys­tem may help. First, the rule is that the ambulance must take you to the nearest hospital. If for some reason that hospital cannot accept you, because of lack of staff or facilities, the ambulance dis­patcher will call the next hos­pital until he finds an appro­priate place for you.

However, because of the language problem with gaijin, some Japanese hospitals are reluctant to accept foreigners and, if the system doesn’t work well, an ambulance driver may be forced to drive from hospital to hospital be­fore finding one that will accept his patient. Most am­bulance people recognize this problem and will take foreigners to the hospital they prefer if—and this is the sticky part—the hospital has been notified and has agreed to ac­cept that patient. The ambul­ance staff will not take your word for it, either. They will call the hospital and check to be sure.

Problems arise when a for­eigner who is unaware of the system, calls the ambulance and tells the driver to “drive to such-and-such a hospital,” without knowing that he was supposed to call the hospital first. Usually, what happens is that the driver then calls the hospital and, if that hospital agrees to take the patient, the ambulance drives to that hos­pital, and it all ends happily.

However, if the ambulance staff isn’t quite so accommo­dating and insist that they can only take you to the nearest hospital, you will have to be more patient and persistent. Usually, if you keep insisting on a specific hospital they will eventually take you there.

One woman, when told that she could go only to the nearest Japanese hospital, responded that in that case she wasn’t going anywhere. That’s a bit of a bold move for most of us, particularly if we were in a situation, as she was, where she had injured her back and could not move. Still, her obstinacy proved suc­cessful as they finally drove her to the hospital she re­quested.

You may wonder why there is all this fuss about one hos­pital over the other, anyway. Certainly we have good hos­pitals and competent Japanese physicians in Tokyo, don’t we? And the answer is yes, we certainly do. And, if you have something like a broken leg or a cut that is bleeding, any physician will know what the problem is and fix it. The problem arises when the diag­nosis must be based partially on the medical history and the patient’s description of symp­toms.

In this case, communication plays a big part. Or, if pro­longed hospitalization might result, most gaijin would prefer to be in a hospital that prac­tices a more familiar type of medical and nursing care. Many Japanese hospitals ex­pect family members to do much of the nursing care, including bathing the patient and feeding him, if necessary. In addition, only Japanese food is served at most Japanese hos­pitals, so Western food has to be brought in by the family.

The three hospitals that take care of the bulk of the foreign community needs in Tokyo are The Catholic International Hospital (Seibo Byoiri), St. Luke’s Hospital (Sei Luka Byoin) and Tokyo Sanitorium Hospital (Tokyo Eisei Byoin). They will accept either your own country’s medical insurance plans as a guarantor of your bill, or some kind of company financial backing, which can be shown by your business card. (Although on discharge from the hospital you may have to pay the bill yourself and then get reimbursed by your insurance or company.)

At Japanese hospitals, if you do not have a Japanese na­tional medical card, you may be asked for a deposit of some amount before you are treated. So, be sure to have ¥20,000 or so with you, if possible. That might be one of the things you tuck into an em­ergency envelope and keep on hand.

A final word about hospitals in general; In Tokyo, all the Japanese hospitals work under what we call a “closed system,” which means that the physicians are employed by the hospital and are on their staff. This is very different from in the U.S. where the majority of hospitals are “open” hos­pitals that allow private phys­icians to have “staff” pri­vileges, and care for private patients in that hospital. So when you go to the hospital in the U.S., your own person­al physician directs your care.

In Tokyo, this is not the case. If you go to a Japanese hospital, you will be assigned a staff physician. Your own physician, if you have one, is not allowed to be involved in your care at all. In fact it is often difficult for him to do anything, even such as getting you moved to another hos­pital, if that is your wish.

This “closed” system is practiced in all hospitals with the exception of the Catholic International Hospital (Seibo Byoin), and has led to problems with unknowing foreigners who go to the local hospital assuming that their own doctor will be able to care for them once the emerger situation is over.

Knowing the system and planning what to do before any emergency arises is the best way to make sure there are no big surprises after the fact.