DISCLAIMER: this blog post is long, but it’s the most important one I’ve written to date because it says more about Japanese society and culture than any other post so far.
A couple weeks ago I started feeling very weak and lightheaded. I put off going to the doctor for a while because I never had before and dreaded the first visit. After finally doing it, I learned just how different the whole doctor’s office experience is in Japan.
In the US, if I wanted to go to the doctor, I had to make an appointment. Unless it was something urgent, my doctor was so busy I had to schedule it a month in advance. Once at the doctor’s office, I’d sign my name on a chart, which they’d use to check me in and quickly black it out for my own privacy. Then I’d sit in the waiting area, which was made to feel kind of like a living room, for about 45 minutes before finally being called back by my doctor’s nurse to one of three patient rooms. The nurse always checked my weight, blood pressure, and pulse. Then she’d disappear and 15 minutes later finally the doctor would come in. That appointment usually lasted only 15 minutes and then I’d leave and not see the doctor for again very long time. Everything felt so normal and standard.
Point by point, everything is different in Japan. If you don’t already know, everyone in Japan who is not only here on a 3 month tourist visa is required to enroll in the national insurance plan. That plan covers 70% of everything. The remaining 30% is still considerably less than what you would pay for the same procedure in the US because prices are set by the government. Because everything is so cheap, according to Frontline’s Sick Around The World people go to the doctor 3x as often as they do in the US, and doctors are more inclined to prescribe more drugs, particularly those that treat symptoms. There’s also no “gatekeeper” system in place. That is, if you want to see a specialist like a cardiologist or neurologist, you don’t need a referral from your primary care physician. Between me and Kenny, our insurance costs us less than about $30 USD every month. Finally, according to that same episode of Frontline, Japan has the highest life expectancy in the world, BUT, that could also be attributed to lifestyle.
I got that out of the way, so here’s how the actual doctor experience went. First, no appointment was needed. Appointments are typically only made hospitals; the rest of the time you just show up and say you want to see the doctor. Also, doctor’s offices stay open until 6 or 7pm in Japan, so you can go right after work. I walked in with Kenny, my translator, gave the woman at the front desk my insurance card, she had me fill out a half piece of paper, and then I sat down. The waiting area does not look like a living room, but felt more like a train station. To make space, benches are lined up in rows. I was nervous about the doctor right away because there were only a couple other people in the waiting room with me. While waiting, they had me take my temperature, which I’m told is pretty much the only thing they check. It was high, but only because every building in Japan in my opinion is crazy hot in the winter.
A nurse called me back, had me sit in the hallway and asked what was wrong. Kenny, always prepared, had written down my symptoms translated into Japanese. We also mentioned we thought my blood pressure might be low because a lot of the women in my family have that problem. The nurse disappeared to talk to the doctor, then brought me in to see him. Instead of having multiple patient rooms, there’s just one. I sat on a small chair about a foot from the doctor himself. The doctor came off as very rude; very annoyed that we are foreigners. That happens a lot. He checked my blood pressure three times, said it was a little low, wrote me a prescription, and told me to come back in a week. Also, instead of the doctor having one nurse, he had seven, and apparently having a lot of nurses is the norm. One did all the work, the other six just stared. It wasn’t weird because I’m a foreigner and people stare at me all the time. We paid the balance, a little over $10 (which was higher than normal because it was my first appointment).
I wasn’t satisfied with that appointment at all. He never told me what my blood pressure was and the machine was facing away from us so we couldn’t tell. A little low means nothing to me because it’s always “a little low.” Nonetheless, I decided maybe I would take the medicine for a week and see if I felt better.
We went across the parking lot to a pharmacy and got the drugs filed. The pharmacist was a whole lot nicer to both of us. He gave me three drugs. I was shocked, three seemed like a lot, but I asked a student I tutor and he told me even leaving the pharmacy with 4-5 drugs is normal in Japan. What was even crazier to me is that they all needed to be taken multiple times a day. One of the drugs had a texture I’ve never even heard of. It was about the size of kosher salt. You’re supposed to just pour it in your mouth and swallow it with water. Well, whatever, I took medical sociology in college, I figured they wouldn’t be prescribing drugs if they aren’t supposed to help. I went home and took all of them.
The next day I pretty much threw a tantrum. I felt even worse that day than the day before, I demanded to Kenny that he take me to another doctor who will run more tests because that’s what my doctor in the US would do. Kenny really wanted me to keep taking the drugs for a week, but I was extremely insistent. We went to another doctor in the neighborhood that same day.
We told the second doctor we weren’t happy with how things went the day before and I wanted lab work done to rule out issues like diabetes or anemia. First, he checked my blood pressure, and once I finally saw just how incredibly low it was, I started to feel the lab work was unnecessary, but, we already asked for it, so I did it anyway. That appointment, because of the lab work, was about $22, which is still less than my copay was in the US. I had to wait four days for the results. Instead of calling me like my doctor in the US would, this meant a third trip to the doctor.
In the meantime, the second doctor told me to keep taking the drugs the first one gave me, and even added a fourth. We were also surprised to find out that the first three drugs were merely to treat symptoms. I hate symptom-treating drugs. I think they’re useless. My medical philosophy says to treat the problem, not the symptoms it’s producing. But, the doctor told me to do it, so I did for another day and half, then we looked up what that fourth was. It was Xanax. Now, I know drugs in Japan can be prescribed for different uses than the ones in the US. For example, Benadryl is illegal as an antihistamine in Japan, but legal as a sleep aid drug. So, it’s possible he was prescribing it for something else than what we all know people in the US take Xanax for. Still, Kenny and I were shocked, broke out into laughter, and I threw out all four drugs. They all made me feel worse, so I’m not really sure why I was taking any of them.
Anyway, I went back to the doctor for a third time, and all the lab work as I suspected came back negative. I literally walked in, the doctor said in English “normal range” and we left. All of the appointments were extremely short, but that one was under a minute. Very impressive. My problem is merely low blood pressure. It’s always been a little bit of an issue, but I’m eating so healthy now that I’m not getting much sodium. It’s an easy problem to fix, but I’m so reluctant to do it. Every time I have a meal with a lot of salt it shows on the scale the next morning because it makes me retain water. Obviously, I’m doing it anyway. I feel a whole lot better.
PS I still can’t believe he gave me a week’s worth of Xanax. I mean, Xanax! In the future, I probably won’t take too many of the drugs they prescribe, unless it’s like an antibiotic or something actually necessary.
Traveling with Dana 