FUKUSHIMA Lives on the Line

215chap.IVPatient Relief Activity Records [Essays and Research Publications]FUKUSHIMA: Lives on the Linethe same corporation.I had been trained in family medicine while in Canada, but I had no experience creating training programs. Therefore, at first, it was a bit of trial and error. Thankfully, however, my colleagues from around the world showed me their curricula and encouraged me, and their support truly helped. Therefore, I recommend young students who come to train that they go out and observe the practice of family medicine in other countries. I want them to see firsthand what exactly world-class family medicine is.When I transferred to Fukushima Medical University in 2006, President Shin-ichi Kikuchi understood my desire to train the next generation of physicians that would graduate from the university hospital and practice in the community. We have bases all over the prefecture, from which senior residents can practice, with residence facilities as well. The family doctor that I wanted to be is the type that understands and can implement Dr. McWhinney’s “patient-centered medicine” methods not just at the level of listening to what the patient says—it is more than that and requires specialized training.Listening to the patient, examining the patient, ordering tests, diagnosing conditions, prescribing medicine.... For all of this, we must understand and master evidence-based medicine (EBM). However, to understand the patient’s pain and where he or she is coming from, we must also practice narrative-based medicine (NBM). It is important to not just think about the patient but also his or her family and entire community. We must adeptly change our examinations, role, and functions to meet the needs of the individual, family, and community. That is what a family doctor should do.Fifteen years have passed since I began to train family doctors in Hokkaido, and five years have passed since I began working in Fukushima. I think that all those who studied with me and are since practicing as family doctors are able to implement the methods of patient-centered medicine. Family doctors, who come to Japan from all over the world, are impressed by the vision and practice levels of those doctors who have studied with me. I am very pleased about this.With the Great East Japan Earthquake, Fukushima Prefecture Fell Victim to an Earthquake, a Tsunami, and a Nuclear Accident. The Prefecture is Still Busy with Reconstruction Efforts.Emergency medicine is clearly necessary in times of disaster. However, few people overall need high-level medical care, and most only need primary care. But with the Great East Japan Earthquake, many of the primary care practitioners in the area around the nuclear power plant left their communities. Thus, everybody in need of medical care crowded tertiary medical facilities, causing confusion and exhausting medical staff at the hospitals.I was requested by the prefecture and university’s Disaster Response Headquarters to assume the task of finding non-ambulatory people within the zone 20–30 km from the nuclear power plant. Teaming up with the Self-Defense Forces, government officials, fire fighters, and community nurses, we travelled around in a Self-Defense Force vehicle. Starting on April 4, we went around the entire half-donut shaped area we were assigned in one month, searching for those needing medical or nursing care. Because we did not know the health conditions of all community residents, we relied on information from long-term care insurance and national health insurance records or neighbors telling us things such as “there is an elderly lady with dementia in Residency at the University of Western Ontario, Canada. On the far left is Dr. Ian McWhinney, Professor of Family Medicine. Dr. Kassai is second from the right.The Hokkaido Center for Family Medicine 15th Anniversary Alumni Meeting was held this past July. Dr. Kassai is in the middle of the front row. To his right is Dr. Thomas Freeman, Professor of Family Medicine at the University of Western Ontario.