The Japanese public, however, is no longer quietly taking their medicine. Kawafuchi’s is but one voice in a growing chorus of outrage at Japan’s insular medical system. Assertive patient-advocacy groups, a wave of malpractice suits and even some damning government studies are exposing professional negligence at some of Japan’s most respected hospitals. And these revelations are being met by a surprising ally: doctors. Physicians, especially the younger set, are demanding an overhaul of how medicine is practiced. Until recently, Japanese doctors abided by a strict code of silence. But doctors know best what an ailing state Japanese medicine is in. “Even Japanese doctors don’t want to be treated in Japan,” says Gen Nomura, spokesman for a Tokyo-based health-care consultancy. “They don’t trust their own system.”
Japan’s socialized health-care system resembles a well-heeled guild. Hospitals keep problems internal. Peer review boards don’t exist. Most of the high-school graduates who fill the coveted slots in medical school are physicians’ sons and daughters; their place is secured by pedigree, not performance. Inside hospitals, status is conferred by age, not achievement. And Japan’s all-powerful medical lobby, the Japan Medical Association, staunchly defends the system. In essence, many Japanese doctors believe they are beyond reproach. While they have the necessary basic skills, many are never trained in newer treatments and lack the medical ethics considered commonplace elsewhere. “Patients are essentially walking into an examination blind,” says Yuko Noma, an analyst with U.S. health-care consultancy Best Doctors Inc. “And doctors expect them to stay quiet and obey orders.”
It’s difficult to even assess Japan’s medical woes because the government doesn’t require hospitals to release data on success rates. But Toshihiko Hasegawa, a director at the National Institute of Health Services Management, announced at a medical conference last March that his research indicates that medical mistakes result in 26,000 deaths in Japan each year. Hasegawa defends the figure even though he’s been censured by his employer for doing so. The government–which, incredibly, has never compiled national statistics on malpractice claims–is beginning to assess the damage. The Health Ministry recently surveyed 82 teaching hospitals and found 15,003 medical mistakes over a one-year period. Of course, these are just the reported errors, and it’s anybody’s guess what’s going on inside Japan’s 9,000 smaller hospitals and more than 80,000 clinics.
Increasingly, malpractice claims are resulting in litigation–especially if the victim is a physician. Dr. Tsuneko Kunou, who lost her teenage daughter to cancer 10 years ago, has sued two surgeons for allegedly performing an unnecessarily invasive procedure. She claims that they mistook a small cluster of cancerous cells for a massive brain tumor. (All doctors and hospitals named in her lawsuit declined NEWSWEEK’s request to be interviewed.) But Kunou opted to sue only two of the three doctors, leaving the chief neurosurgeon out of the claim. “I was too afraid to challenge him because of his status and power,” she said. “We would have lost the case from the beginning.”
The lawsuit has made Kunou a pariah in the community where she runs her clinic. “I committed the ultimate Japanese sin by accusing a doctor of malpractice,” she says. Now she receives threatening letters in the mail. One reads: “You will be powerless against the doctors you are trying to ruin. Watch and see if patients keep coming to your hospital.”
Some physicians are banding together to advocate for patients’ rights. Medio, a Tokyo-based health-care watchdog, recently published a patient’s manual entitled “111 Rules for a Safe Doctor’s Visit.” It advises people get a second opinion and suggests videotaping all medical procedures. And the powerful JMA is under siege from its youngest members. “It won’t do for us to wait with our mouths shut knowing that peoples’ lives are in danger,” says Kazuhiko Kabe, an outspoken young doctor. “If the JMA doesn’t start taking us seriously, it will crumble.” (JMA officials declined to be interviewed by NEWSWEEK.)
Authorities now appear to have a more attentive bedside manner. They’ve just ordered a review of Japan’s 600 biggest hospitals. But they have a long way to go. “The fact is that we’re just now researching how to collect information on hospital and doctor performance,” says Atsushi Miyamoto, a Health Ministry official. They better act fast if Japan is to save a health-care system already in critical condition.
