Medical care: Are you prepared?

Every New Yorker knows how to find the best medical care.  Each year New York Magazine publishes the de facto list of “best” doctors.  Reputation and status are as American as apple-pie.  How then does a foreigner living in Japan find a good doctor or hospital?  How does one prepare for a potential medical emergency?  We put these questions to Dr. Keong, Director of Garden Clinic Hiroo.

If you experience a life-threatening medical emergency, you already know to dial 119 for an ambulance.  Upon arrival you can direct the ambulance crew, conditions permitting, to the hospital of your choice.  In the event of an emergency the ambulance crew will normally radio ahead to the nearest hospital with emergency services to say that they’ve got somebody, for instance, having a heart attack. They will ask if the hospital has capacity to attend to the patient.  “It really depends on how busy the hospital is as to whether they will accept you”, said Dr. Keong.  The ambulance will continue to call different hospitals until they can find one that will take you.  Therefore, Dr. Keong suggests that foreigners should identify a few hospitals they would prefer to be taken to in case one is not available.

Be prepared by identifying one or two hospitals in your neighborhood that offer emergency services whenever you first move into a new area.  Doing so, however, will not guarantee you will be taken to the hospital of your choice. Distance may be an issue, or the receiving hospital may not have the capacity for the day, or there may not be a specialist available to treat your medical condition.  But it raises the probability that you will be taken to the facility of your choice.  For the Tokyo region, Himawari offers a free on-line search engine that will help you find local hospitals and clinics offering emergency services.  Search criteria include the facility’s distance from the subway station, medical specialization, and language spoken by staff.

If you are having a life-threatening medical emergency, getting to the hospital quickly is paramount. For ambulatory services to be able to find you without delay, learn how to say in Japanese your address, telephone number, and be able to describe local landmarks.  Remember, even for the Japanese, finding an address can be tricky as the numbering system dates back to feudal times.  Ambulances can otherwise be going around in circles before finding you.  Dr. Keong suggests that you prepare a little note at home in advance in case of such an event.  Be prepared!  Attach the note to your refrigerator door.  That way, you won’t find yourself brushing up on your Japanese when your life is hanging on the line.

Generally speaking the level of care offered by emergency services in Japan is quite high.   However, a lot comes down to luck.  “If you are having a heart attack and there is a cardiac surgeon on duty for the day, you’re lucky.  But if you happen to have broken a bone and you’ve got a cardiac surgeon on duty, it may not be such a perfect match. That can be a problem”, said Dr. Keong.

If your emergency is life-threatening, most hospitals will take care of you as soon as possible.  However, if your emergency is determined not to be life-threatening you may be asked to wait your turn so that those with greater medical need can be attended to first.  If you walked into the emergency room, say for a minor burn on your arm or flu-like symptoms during the New Year holidays, you could end up having to wait for several hours before being treated.

Here are some useful resources for non life-threatening emergencies.  Use Himawari to search on-line for a specialist located close to home for treatment during normal working hours.  If it’s a Sunday or holiday and you don’t have a big emergency, the Japan Medical Association offers information on where to obtain treatment during off-hours.  Each ku (ward) operates its own branch of the Medical Association differently, but they all have the same ultimate responsibility to ensure the public has access to doctors and dentists during Sundays and holidays.  Some run their own emergency private clinics.  Others arrange for local internists, pediatricians, and surgeons from private clinics to be on duty during off-hours. You can obtain the dates, times and locations where Sunday and holiday medical care is provided by your ku from the Medical Association Network.  From that website you can drill down to find your local ku’s Medical Association’s web address.  For instance, the Minato-ku Medical Association publishes its Sunday and holiday schedule here.

Also note that emergency services have a mandate to treat you only for a 24-hour period until you can see an ordinary doctor. They’re there to see you through for one day until the next assessment.  So if you show up as an “emergency” patient at night or on a weekend and the doctor has assessed you and found that you can be sent home, you may just be given medication to tie you over till you can see a doctor the next working day. The emergency room is not expected to give you medication or treatment to completely cure your condition.  Neither should you expect them to schedule a series of tests for you.  Their focus is to contain “emergencies” and move on to the next patient.  So be certain to seek further medical support after the event.

Most treatments will be covered under the public health insurance.  However, the Japanese health insurance does not cover everything. If a medication is not indicated for a given diagnosis under the public health system your doctor cannot normally prescribe that medication.  “It’s a very tricky thing”, said Dr. Keong.  “For a specific form of lung cancer, for instance, some chemotherapy drugs that are known to be effective in treating the cancer may be in use in your home country.  That drug may even be available in Japan, but if it is not medically indicated and approved for use in Japan to treat lung cancer, then your national health insurance policy will not cover the treatment. Your doctor may even refuse to treat you with that particular drug.  If you opt for the treatment, then you will have to pay the medical bills on your own.  That is when having private insurance can be useful.  Other times expatriates may choose to return to their home country for treatment, for example, if the disease is chronic or if the patient needs long-term care or if they opt for certain treatments or for surgeries not available in Japan.  In such cases private insurance may cover repatriation and medical expenses in their home country.  These cases are rare, but they do happen.  If you have held a private medical insurance policy for a long time, then you might not want to give it up because you’ll lose any coverage for pre-existing conditions.  This could be important to you if you plan to return to your home country.  On the other hand, if you live in Japan all your life you probably don’t need private health insurance.

Which hospitals have a good reputation?  According to Dr. Keong, there are many good University Hospitals.  Most, but not all, have emergency rooms.  So you have to check.  Tokyo University Hospital (known as Todai Byoin in Bunkyo-ku), Keio University Hospital (Shinjuku-ku), and The Jikei University Hospital (Minato-ku) are also on her recommendation list.  The Red Cross has a series of good hospitals.  If you are giving birth prematurely and are nearby, the Japanese Red Cross Medical Center (Hiroo) has a good pediatrics department to deal with the situation.  For heart problems, the Zaidanhoujin Shinzoukekkankenkyujo FuzokuByoin (Minato-ku) has an excellent reputation for administering cardiac treatment.  Other recommended hospitals include St. Luke’s Hospital (Chuo-ku).  It is popular among foreigners as the staff speak some English.  The National Children’s Hospital (Setagaya-ku) and Tokyo Metropolitan Hiroo Hospital (Hiroo) are also good.

How do you find the best doctor in their specialty?  Like New York Magazine there are annual publications, but printed only in Japanese, that list the “best” doctors.  However, these may not be quite as informative because, unlike New York Magazine, the Japanese publications seek advertising revenue from the doctors.  Dr. Keong offers the following advice: “Within your own specialization you know by reputation who are the good subspecialists. You need a doctor that you can consult with and talk to and have him or her refer you to somebody. That’s the best way to find a good doctor.”

Lastly, Dr. Keong opined, “The thing to understand about Japan is that you can’t buy your way to see the best doctor as you might be able to in other countries.  In Japan it doesn’t matter where you go to see a doctor. The cost is all standardized under the public health insurance system.  One good point is that you can get to see, for instance, a good orthopedic surgeon that lives locally to you. In other countries you may have to travel a long distance to see a good specialist.  Japan offers the ultimate equality.”

Dr. Chin-Huai Keong, MD., Ph.D., Director / Certified dermatologist, GARDEN CLINIC HIROO, 2F, 7-14-7, Minami-Aoyama, Minato-ku, Tokyo 107-0062. www.gardenclinic-hiroo.com

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