FUKUSHIMA Lives on the Line

96The Vulnerability of the Community Medical System in JapanToday, most local clinical physicians in Japan run private practices, and a majority of them have been specialists at hospitals prior to starting a private medical practice. Thus, they are not the type of doctor you could go see for any type of condition, as is the case of a family physician. Patients can see the clinician’s specialty just by looking at the clinic name or sign, such as “X Gastroenterology Office” or “Y Neurosurgery Clinic,” and choose the clinic they want to visit based on their symptoms and purposes. This has been perceived as a strong point of the Japanese medical system because anybody can freely see a specialist; on the other hand, it also has the shortcoming that patients as medical laymen must themselves decide the specialist they want to see.The division of labor at clinics that support community medicine is not based on the community, but instead on the medical specialty. Thus, there is no tacit understanding that “That doctor in this community will see us,” or “The clinics in our area were all damaged in the disaster, so the doctor in the neighboring community will surely see us.” The responsibility that clinicians have toward the community is yet to be clearly delineated. This disaster, and being confronted with the need to provide comprehensive and effective care to people with various health issues, made me keenly aware that the present community medical system in Japan was vulnerable and inefficient in times of disaster. However, is it only a disaster that can expose the flaws in a country’s medical care system? In Japan, the scene of masses rushing to the hospitals and exasperating hospital staff is not unique to times of disaster. It is a serious social problem that occurs every day. With most clinical physicians now in private practice, it is unrealistic for a single physician to provide 24-hour care, 365 days a year, even if we consider only his or her existing patients. There are instances of physicians sacrificing their private lives so that they are accessible to their patients at all times, and efforts by the local medical association or government to create holiday or night-time clinics or on-duty physicians. However, there appears to be more than a few cases of patients with medical problems outside of the physician’s specialty visiting the clinic beyond regular hours. Therefore, proper healthcare becomes difficult. Hence, it becomes easy for patients to overwhelm hospitals at night and on holidays.The Efforts of One Person Start a Movement throughout Fukushima and JapanNumerous people spent worrisome days at the evacuation centers. One particular doctor, even though his own clinic was damaged, would visit a few of the evacuation centers around his clinic every day. This doctor, who would say “When you don’t have medicine, you can cure with kind words and a smile,” is one of the people I admire the most, and the reason I wanted to become a family physician. It goes without saying that in the midst of a crisis, the words of a familiar, local private doctor saying “It’s okay, don’t worry,” can really spur you. That doctor has supported the local medical care in his small fishing village in Iwaki City for over 50 years. Facing all types of medical issues head-on, regardless of age or disease, he carried on a practice rooted in his community, similar to a family physician. This position did not change even in the slightly, even in during this unprecedented disaster.There are doctors, even those without specialized training experience in family medicine, who can admirably perform the role of the community’s local doctor through their own efforts, which is truly commendable. However, I cannot help in saying that the Japanese medical system, supported by these types of individual efforts, is vulnerable. Moreover, in the present medical education system of Japan, it is exceedingly difficult to gain the skills necessary to be a family physician through single-handed efforts, and the number of family physicians is unequivocally low. With advances in medicine, specialized areas of medicine are rapidly becoming segmentalized, and a stronger trend exists now wherein patients are demanding treatment from specialists. Medical education is now centered on a specialization training system that is vertically structured, resulting in an environment in which it is difficult to train family physicians who can treat all types of conditions. However, as noted in “People Cannot Live Alone” this workshop has already been conducted throughout the prefecture, training family physicians to revitalize community medicine. Training is showing favorable progress throughout the prefecture. We have already trained young family physicians and are opening community family medical centers required for the successful running of family medical training facilities throughout the prefecture.But in Fukushima, where even now many are still forced to live as evacuees, we need to accelerate the project implementation, since there are still insufficient family physicians. Now, in particular, we are pressed Messages from Fukushima Family Physicians