Is Healthcare Deteriorating in Japan?
<My post>
I introduce a recent healthcare episode in Japan. What do you think of it?
A healthcare activist, whom I have known for more than a decade, was staying in a business hotel in the downtown of Tokyo. Early in the morning of Monday, around 4:00 am, he woke to find that his visual field had been narrowed to about half (nothing visible in one half and only dimly visible in the remaining half). He called ambulance with his cell phone because he thought something serious had developed in his eyes. The ambulance came to the hotel soon, but the rescue crew took much time to find a hospital accepting this patient for critical care at that time (before dawn on Monday or Sunday midnight). It was slightly before 5:00 am that the ambulance carryign this critical patient arrived at a university hospital which the crew had found after contact with many hospitals. The physician on duty at that hospital was, however, a part-time young physician who did not seem to be sufficiently familiar with the devices installed for testing and treatment at the outpatient opthalmology clinic of the hospital. The physician applied mydriatic drops to the patient's eyes and, 20 minutes later, checked the fundus. He told the patient: "There is no sign of bleeding or retinal detachment. But the fundus is totally white, suggesting artery occlusion. You need to be admitted but please wait until the full-time physicians come." The patient was forced to wait in the lobby until 9:00 am (start of regular care on Monday). Then, he received CT scan, drip infusion and, later, HBO (hyperbaric oxygen therapy) based on the diagnosis of central retinal artery occlusion (HBO was applied on the 3rd hospital day in response to the request of the patient who investigated the nature of his disease by himself). But, these means of treatment were ineffective, leaving the patient almost blind.
This episode arouses several questions in me:
(1) Why does it take so much time (about 1 hour) for the rescue crew to find a hospital accepting a patient requiring critical care in a big city like Tokyo? Is this a very rare case attributable to an accidental combination of several rare factors delaying smooth care? Or, does it reflect an overall trend of deterioration in the healthcare system in Japan? There are several university hospitals and other general hospitals in the vicinity of the hotel where this patient was staying. Why were these hospitals unable to accept this patient immediately? In Japan (probably also in the USA), both public hospitals and private hospitals are receiving huge amounts of subsidies from the government(tax) under various forms or titles. If these hospitals cannot serve citizens (taxpayers) upon emergency, these subsidies may be "wasted money."
(2) Why didn't the physician on night duty at the university hospital provide treatment immediately (instead of waiting for arrival of regular physicians)? Was he not experienced enough to do so or did he give up treatment because the prognosis after any treatment would be poor in this case of retinal artery occlusion having arrived too late after disease onset?
(3) If an individual staying in a hotel in the downtown of New York develops retinal artery occlusion under a similar setting (midnight or early in the morning), can he/she receive appropriate care immediately? (This may vary depending on whether the individual is staying in a luxury hotel or low-cost hotel and it may be also affected by the complicated health insurance system in the USA, I imagine).
Your comments will be appreciated.
<Post from list member>
Hello Ichiro:
I, of course, know practically nothing of the Japanese health care system, and even for the U.S., I can only speak of my own experience with such problems. Perhaps others here have more extensive knowledge.
ERs here generally refuse ambulance patients only when they are full, as on Saturday nights in the more violent sections of town. When I worked in the ER at L.A. County, on Saturday nights it was usually full of gunshot, knife, and traffic victims, so a patient in no obvious distress might have quite a wait. However, Japan is a much less violent society, so I wouldn't expect that much of a problem.
However early Monday morning is generally quiet, and there would ordinarily be little problem getting into an ER. Do you know what reasons the ERs gave the ambulance driver for their refusal to accept the patient?
We have a Federal law, EMTALA, which requires ERs to accept all patients and at least "stabilize" them. That presumably just means stopping bleeding and making sure they can breathe - not necessarily definitive treatment.
Even though all ERs have a doctor in attendance, most specialists are on call. In private hospitals it may be hard to get a specialist to come in, especially since there is no guarantee that he'll be paid.
University hospitals usually have a senior resident on call in all major specialties, and a faculty member to at least take phone calls, so I'm surprised that nothing was done right away to protect his vision.
I don't know if this case was an individual breakdown in the system, or whether this IS the system.
<My post>
Thanks for your comments.
I hear that medical facilities in Japan registered as critical care facilities (providing critical care in addition to ordinary healthcare) occasionally refuse accepting critical patients for a reason of transient unavailability of manpower, saying for example: gAt present, there is no physician who can take care of a new patient.h This may be a significant problem with our healthcare system which we must address from now on so that no further patient will have an unfortunate outcome like the one experienced by this healthcare activist.
<Post by list member>
With the aging population of Japan, this will probably be an accelerating problem, with fewer people of working age and more older people needing help. I think I read that by 2030 there would be a centenarian for every newborn.
This may be the trigger that will force Japan to liberalize its immigration policy.
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