RIGHTS-JAPAN: Once Taboo, Patients’ Rights Come into the Open

By Suvendrini Kakuchi Reprint | | Print |

Suvendrini Kakuchi

TOKYO, Sep 6 2002 (IPS) - Whenever Masako Nohara, 46, plans to visit her doctor at the local municipal hospital, she wakes up at the crack of dawn to finish her household chores and gets into the hospital by 8 am.

“The place is so crowded and the wait so long that I very often pack a lunch to keep waiting till afternoon,” explains the homemaker, who has had a hysterectomy at the hospital this year.

Like Nohara, many other Japanese patients say they are resigned to long waiting hours at their doctors’ offices – a wait that is made even worse by the fact they only have an extremely short time to spend with their physicians.

“At the most I am out of the doctor’s office in ten minutes, and much of that time is spent with the nurse rather than consultation time with my doctor,” explains Nohara.

Riddled with complaints about poor hospital care, callous treatment, and negligence that at times results in death, Japan’s once-touted medical system – more than 90 percent of the country’s 128 million people own health insurance — is ailing from a lack of public confidence.

“Japan may be the world’s second richest economy,” complains 63-year-old Atsuko Yamamoto, who blames her doctor a for botched eye operation that left her left eye blind. “But it is worse than some developing countries when it comes to social issues such as providing the proper care for patients and the elderly.”

Analysts agree. They point out that while Japanese hospitals boast some of the best medical technology in the world, when it comes to patients rights the national health system lags far behind its counterparts in the industrialised world.

“The issue of patients’ rights has only just dawned in Japan. This is also because of revelations of severe mistakes in well-reputed hospitals that have jolted public confidence,” says Dr Makoto Kondo, one of the leading advocates of the practice of “informed consent” for patients.

Indeed, the Health and Welfare Ministry released a survey this year that shows there were more than 15,000 medical errors within a two-year period that ended in February 2002 at 82 of the nation’s hospitals recognised as technically advanced.

Most of the errors, it says, caused serious harm to patients and some were fatal.

This is the first time such a survey has been conducted — at the request of an opposition politician who was concerned about the increase in reports of hospital mishaps.

One of the latest mishaps was the July arrest of two doctors for professional negligence after the death of a 12-year-old girl following a botched heart operation in March last year.

The Tokyo Metropolitan Police reported that one doctor has since been accused of professional negligence. The other has been charged with destroying evidence by altering medical records.

The case — while the first in Japan of the arrest of a doctor suspected of malpractice — follows a host of recent lawsuits against doctors for mistakes that they acknowledged only after investigation by the police.

One of the major landmarks for patients’ rights, albeit after a long and tenuous battle, was a court decision in 2001 to hand down a prison sentence on Takeshi Abe, an expert on haemophilia responsible for contaminating hundreds of patients through the use of HIV-infected blood products in 1985.

The case was closely watched across the nation because Abe was a senior doctor and had close relations with the Ministry of Health and Welfare.

The scandal erupted in 1989 when patients took the unprecedented step of suing the doctor and two presidents of pharmaceutical companies responsible for importing the controversial blood products.

A spokesman for Medio, a four-year-old grassroots organisation and a pioneer in the patients’ rights movement in Japan, says the group’s research indicates that medical mishaps have been occurring for years but have risen rapidly in recent years.

Part of the reason for this trend lies in the rapid development of difficult and experimental treatments that require doctors to use complicated machinery that often poses risks on patients.

“The government does not view these developments from the perspective of patient’s rights,” explains the spokesman, who preferred not to be identified by name.

Medio, which comprises victims, lawyers, doctors and advocates, aims to educate the Japanese on how to demand that doctors provide the necessary information to enable them to make their own medical decisions or seek a second opinion in their treatment.

“Historically, the Japanese have not developed a sense of disclosure or accountability, which is why doctors have got away with mistakes that are actually crimes. Culturally, people in authority are rarely questioned by the ordinary people, and this must change,” argues the Medio spokesman.

But despite the gloomy picture, some activists see the latest revelations of medical malpractices and errors as a sign of important changes in Japan.

For example, the government has in recent years started to conduct surveys — such as one in 2000 — that showed that 66 percent of patients wanted to see their own medical charts.

This indicates that the once-taboo concept of patients rights, though not often discussed openly, is indeed a priority for most people.

The poll was conducted after the Japan Medical Association had argued for allowing doctors the option of disclosing medical charts, a proposal that was in the end adopted by the government.