Q. Can you use chopsticks?

A. Yes, I have been using them since I was a child. ☺️

Q. Do you like Japan?

A. Yes. The length of time I have lived in Japan reflects on how much I like being here. I have lived over 1/3 of my life in Japan!

Q. Why did you come to Japan?

A. As a child, teenager and young adult, I had interest in what is termed the 'Far East.' This includes Japan, China and surrounding countries. I was influenced by the Japanese TV show 'Monkey' which for the first time showed me that there were different looking and sounding intriguing people from other lands afar. I was also influenced by the many films on Shogun, ninja, karate and kung fu. Bruce Lee, who was from Hong Kong, was another major influence. Admittedly, there are major differences between Japan and China, and even between mainland China and Hong Kong with its prior British infleunces. Nevertheless, the Far East was the place I chose to come and visit as a medical student. It was one of the best choices I made in my life and it has led to some life changing experiences.

I met some Japanese people in England as a teenager. It was the first time to meet and try to communicate with people from Japan for me. I then decided to try and learn Japanese from books written in Romaji. Of course, it was standard Japanese and totally different from daily spoken Japanese I hear every day. But it was a start!

Learning that Japan had such a long and ancient culture, but yet that they embraced technology and created the Shinkansen, it was the place to come and visit!

Q. What are your favourite sites to see in Japan?

A. I have been to many famous places in Japan during my time living here. However, most notable places include 1) Kyoto and Nara 2) Sendai, and 3) Okinawa. There are many wonderful places in Japan to visit. The aforementioed three places are listed because of their respective culture and architecture, cuisine and friendliness, respectively. ⛩️🇯🇵🏯🗼🗾

Q. Do you find it difficult living in Japan?

A. It depends to what you are referring. I did find it difficult adjusting to the culture. It took about five years or longer to acclimatise myself to daily living matters, work environment, social expectations and requirements, and so on. These I found stressful. Language has been an ongoing challenge, but it is a bit easier over the years. Sometimes, I have experienced xenophobia and mistrust because I come from a foreign country. However, with effective communication and a warm demenour, it is often possible to challenge such fears and to make new friends. 👘⚔️🥷

Japan has a brilliant and punctual train system. This makes getting from one location to another very helpful. As a consequence, it is much easier to live in Japan. The locomative system is one of the best in the world. 🚄

Q. Are there any major differences between Japanese doctors and doctors from other countries?

A. Yes, there are some differences, but many things are the same. The differences are related to several areas including:

1) Different focus on training e.g. U.K. focuses on history and physical examination much more than in Japan. Japan focuses heavily on laboratory data and imaging studies. 🇬🇧 🇯🇵

2) Differences of how the medical system is funded e.g. Japan is an insurance based system that covers the majority of the population. In many cases, the insurance contributions are paid by employers (for full-time workers) or directly by self-employed persons. Nevertheless, for people of working age, they must still pay 30% of the cost of medical bills despite paying insurance through their contributions. The elderly still frequently pay for medical expenses, which is around 10-20%.  This is frequently a burden for poorer patients. In many instances, family members are asked to pay medical bills for those who cannot afford to pay for themselves. 

The U.K. healthcare system is funded by taxation at source from all salaried persons. No U.K. citizen accessing a hospital has to pay any fee when seeing a doctor, or when being admitted to or being discharged from the hospital. It is 'free' to use when required.  No family members are burdened with massive medical bills. There is no percentage of the bill to pay for the patient or the family. There is no bill! However, there is little or no choice. Usually there is the local hospital at which an appointment can be made by the family medicine doctor (general practitioner) to see a specialist. The wait to see a specialist can be many weeks or months. There is no ability to turn up, pay a fee, and see a specialist. That means that there is a potential limiting factor slowing down the U.K. medical system for its patients. Resources are limited!

These differences have shaped each respective healthcare system. In Japan, hospitals are funded by fees accrued from patient visits when utilising their insurance, and by the doctors ordering respective tests and treatments for them. Hence, there is an incentive to review patients for short consultations so that more patients can be seen overall. There is an incentive to bring back stable and well patients on a reguar basis, which albeit reassures patients, it also provides regular income to the hospitals. The ordering of expensive tests also provides economic reward for hospitals. This may be a reason why Japan has the most CT and MRI scanners in the world. Notwhithstanding this, there is major competition between facilities. Hence, the need for the latest and greatest technology and the most popular national and international accreditations for patient safety and provision of care. Many hospitals pride themselves on their technology with pictures being shown of their latest scanner. There is little mention of the quality of their care.

U.K. hospitals receive a lump sum of money annually, and from that they must pay for their healthcare services. U.K. hospitals may be underfunded and as a result, they may not be able to employ sufficient staff. Sometimes, wards are closed because of underfunding and understaffing. Not all hospitals have all medical and surgical subspecialties and they must refer to tertiary centers. For example, percutaneous intervention is not available in some hospitals.

 Hence, the two systems are diametrically opposite in a sense. Generally speaking, Japanese hospitals must make as much profit as they can to maintain their existence; U.K. hospitals must reduce their spending as much as possible in order to exist and provide services to as many of their patient population as possible. One is therefore trying to 'spend' money to make money and the other is trying to 'save' money to save 'many.'

The difference in the two systems likely contributes to the different emphases on training to a greater or lesser extent.

Q. Why did you decide to become a doctor?

A. There were several reasons. 

1) When I was a youngster, my mother suffered with Wolff-Parkinson-White syndrome. Her palpitation episodes landed her in the hospital too many times. Only amiodarone helped keep things under control until she later elected to have ablative therapy. Almost losing her to a heart condition was a strong subconscious reason to become a doctor. I still can see the heart monitor showing tachycardia in my mind when she was having an 'attack' and the doctors looking stressed trying to save her. The images I experienced in the hospital as a child left a neverending mark. 🫀

2) I wanted to help fellow humans in need of medical care. I grew up in the era of famine in Africa, and HIV-AIDS in the 1980's and 90's. These serious human problems left their indellible mark on me. I can still remember Live-AID concert which raised $9 million for Africa, which is worth equivalent to about $25 million in todays money (2023).🌍

3) I am a science fiction fan of sorts. I was highly influenced by the doctors from Star Trek such as Dr. 'Bones' McCoy, Dr. Crusher (Next Generation), and The 'Doctor' from Voyager. Being a doctor in the future racing through space and meeting all kinds of alien species was appealing. Even today, I try to utilise modern technology in my medical teaching. I think I was also influenced by other TV programmes including Dr. Killdare, Casualty (U.K.) and Quincy M.E. 🌌👨‍🚀🚀

4) At school I realised I had an aptitude for biology and chemistry. I enjoyed human biology in particular. In the end, when it came to making a choice of my future career, medicine was the natural choice for me. I did not have any family role model as a doctor or other medical personnel. I was even disuaded by others not to become a doctor because of the long hours of studying and long and hard work ethics. None of that affected my decision to enter medicine. 🔬👨‍🔬⚛️