Why family physicians are desired?

Current Medical Care in Japan

Advancement in medical care support human’s high quality of life. It brings smiles of children, young people, adults, and elderly to home. Therefore, all of us wish for medical progress. If you go to countries where medical treatment is not advanced, you will feel terrible, regrettable, and grateful for the advancement of medical care. Actually, I realized it in some developing countries. Even with some issues remain for medical care in Japan, I appreciate that Japanese medical care is progressing.

Advancement in medical care differentiates medical care. For example, in response to medical progress, it is impossible to say, “All doctors can perform cardiac catheterization or all doctors should be able to perform brain surgeries.”

Therefore, the scope covered by one doctor narrows, and the depth in that field increases. By narrowing the subject in this manner, it became possible to provide finer and effective diagnoses and cares. Although it is an extreme example, there are countries where only two CT scans are available in the country. To receive differentiated medical treatment (*), patients are to go to other countries or, in many cases, they even do not know the availability of those medical treatment and they lose their lives. We would like to thank for the fact that there are many doctors targeting such differentiated medical treatment in Japan and there are many facilities available in Japan.

(* Dr. Igarashi calls doctors targeting differentiated medical care as a differentiated physician not a specialist because a family physician is an expert in family medicine. I would also like to call a doctor who is targeting such differentiated medical treatment “a differentiated doctor”.)

In addition, even in countries where medical care has progressed, people may not be able to access the advanced medical care. For example, there is actually a country where people cannot take advantage of advanced medical care unless they are economically wealthy. A young man who is confident in health, hence he does not purchase an insurance policy, will regret once he gets sick. Indeed, even in a developed country where I joined training in Family Medicine, such a situation was found. In this regard too, I would like to thank the Japanese medical system that adheres to the nationwide health insurance system.

Japan has the highest average life expectancy in the world and a high standard of health standard of health care. We must thank for this as well. There are many elderly people around us, but not every country has such an environment. Indeed, even in economically advanced countries, there are countries with low average life expectancy. This cannot be explained only by the superiority of medical treatment in Japan. Seemingly, the unique eating habits of the Japanese, the diligence of the people, and the adequate supply of water are deeply involved.

Many developing countries and advanced countries are also interested in Japan to learn from Japan that is blessed with good health. 


Currently lying issues in Japan

Today’s medical treatment of Japan is not inferior as mentioned above. Nevertheless, it is said that Japanese citizens are not satisfied with the current medical treatment in Japan. Even in some reports, we think we are the unhealthiest people in the world.

In the community the shortage of doctors is getting worse. Patients are refused in emergency outpatient, chronically it is difficult to secure beds, and there is no place for elderly who need medical treatment. There is a huge line waiting when patients go to a hospital. Tired doctors are sitting in the front of the line. Time which a doctor can spend for one patient gets shorter and shorter. Moreover, the further away from the city, the number of doctors are extremely decreasing. Despite the fact that access to medical care in Japan is secured, why the condition of Japan is like this? In reality, why does such a thing occur when the number of doctors in Japan increases year by year?

Why do Japanese people go to hospitals so frequently? Why are examinations and images ordered so frequently? Why are people taking so many medicines? It is natural that Japanese believe they are the unhealthiest people.

As mentioned earlier, medical advances have brought many benefits to people. On the other hand, differentiating medical care is making doctors view to patients too narrow. Even if the eyeball is located next to the nose, even if the kidneys are in contact with the gastrointestinal tract, the differentiating surgeon who is targeting each organ is less likely to think that the abnormality of the adjacent organ is the not their own subject of diagnosis or treatment . Or, the differentiating doctor refers to doctors in other departments as if they think that symptoms which are not familiar with are their own subjects. Patients make the most of the benefits of free access and visit doctors in the clinical department that patients believe it is appropriate. Sometimes they visit different doctors for each disease. The department of medical treatment selected by the patient may not be suitable for examining the symptoms.

Yes, patients often recognize symptoms and medical problems with quite different knowledge from doctors. Therefore, patients who come to receive medical treatment sometimes wish to solve problems in a difficult way for doctors to understand. Even though it seems to be beneficial to the patient clearly in the medical world, it is not necessarily convinced for the patient. Not all the diagnostic methods presented by doctors, which doctors think them the best, are to be accepted by the patient. There are many cases where doctors do not like popular appeals and attitudes of such patients. This can happen for both the differentiating and regular doctors. Rather speaking, differentiating doctors often has an interest in the diagnosis and treatment of the disease rather than whether the patient understands, and cannot fulfill the expectation of the patient, or have negative emotions to such patient. They probably say that “I do not quite understand the condition, but it seems not to be my specialty, so would you please go to other doctors?”

In addition, as patients have more information, the information may be further distorted, causing anxiety. Health-related information provided through mass media is not always correct. Sometimes it is a very rare case, but some information is reported as happening anywhere. There is a possibility that some unnecessary anxiety is caused among these patients by this. In addition, information on “good medical institutions” and “good doctors” is flowed by the Internet and publications, but how is the reliability of these evaluation standards?  The patient may visit the differentiating physician introduced as a “good doctor” despite common symptoms, by getting these information. In addition, there are reports such as “Doctors without mistakes, there are super doctors who always achieve good results.” It is clear that these patients’ expectations will collapse in any way. Thus, many patients may be distrustful and dissatisfied with medical care. 

To make matters worse, it is impossible to know who is responsible for collecting all the information about the patients because many different doctors are involved in. Cooperation among doctors is still better compare to the relation between doctors and other healthcare workers.  The most prominent case is in the home medical care. We can only hear from the patients saying “The nurse told me so.” “The pharmacist said so.” “The care manager told me like this.” These are not enough; we do not know the reality. This shows the lack of interprofessional collaboration.


What Family Physicians Do Now?

I believe that family medicine is one of the ways to solve above mentioned problems.

Family physicians who are responsible for medicine comprehensively may able to response many of the patients’ problems. They can also provide advices for preventive medicine. If needed, they can efficiently refer to a differentiated physician to the patient. They can collaborate with related interprofessional healthcare workers. Family physicians are to provide medical treatment considering mental and social background of the patients; therefore, the patients accept doctors’ advices. If such family physicians are working everywhere in community, how will the medicine change in the future? Patients must first visit the family physicians that will satisfy their needs.

I think that patients first will visit to doctors who can cope with common diseases, work in cooperation with various people, and solve their problems; even they have problems in their own world.

When such doctors point out the errors in distorted medical information, it may be persuasive for patients. If patients become familiar with the face, unnecessary and defensive hospitalization may decrease. If family physicians first examine the patients, emergency room visit may decrease. Shifting from hospitalization to home care will be smooth. If family physicians put efforts into preventive medicine, the effect may improve. Then, if the doctor introduce an appropriate differentiated physician to the patient when necessary, the patient will be willing to “visit the family physician first” with peace of mind. Then, appropriate flow of the patients to the differentiated physicians can be made, and gives more time for them to provide good medical treatment.

Accessing freely to family physicians must give patients peace of mind. Thus, I think the number of better family physicians will increase. In the advanced countries of family medicine, this situation is actually being realized due to the existence of family physicians. I think what family physicians are required now is to offer family medicine to the people all over Japan. To achieve this, doctors who engage in primary care should come as close to family physicians as possible and as many doctors as possible should be trained as family physicians. 

 (Yousuke C. Takemura, A Suggestion: Why family physicians are desired?

In The Japanese Academy of Family Medicine, Modified from the Introduction to Primary Care 2010)