Bedside manner
An interesting window on Japan’s group-over-individual culture as it applies to the practice of medicine–I may have mentioned this before in a post related to health care before, but I don’t remember–is that if you’re gravely ill, they don’t tell you what’s wrong. They tell your family. It then becomes the responsibility of the ranking party (such as your eldest son) to tell you and take the lead in deciding what kind of treatment you should get. The Asahi has a new survey with some figures. Of course, surveys have to be swallowed cautiously, but the results here ring true:
The survey was conducted by a Ministry of Health, Labor and Welfare research group in October and November 2004. Questionnaires were sent to 1,000 randomly selected hospitals with between 50 and 300 beds, since many terminal patients die in such hospitals rather than hospices or palliative care units. A total of 145 hospitals responded.
In only 45.9 percent of the reported cases, hospitals said they informed a terminal patient–generally considered someone with less than six months to live–what disease he or she was suffering from.
In contrast, they told the patients’ families 95.8 percent of the time.
Occasionally (and not mentioned in this survey), doctors seem to lurch in the opposite direction and raise the possibility of truly frightening diagnoses without more than iffy information. Several years ago, a friend of mine returned from a trip to Thailand. She was weak and feverish and went in for a blood test. They told her she might have leukemia. She spent a few agonizing days before suddenly returning to her usual hale and hardy outdoorsy self. Must’ve been one of those things you pick up in Thailand. You know, oops.
Okay, so she was a foreigner, and maybe the doctor figured he was supposed to be as frank as possible. But a few months ago, a friend was told that he might have liver cancer. He was–and do you wonder?–seriously spooked. I couldn’t get anything out of him but that his blood sugar level was elevated, according to the doctor. He went into the hospital for more tests. It turned out to be…well, I’m not sure what it is. He didn’t use the word for “diabetes,” but he definitely said it wasn’t cancer. Given his former drinking habits, the shock may have been for the good; he’s been sober since then. Still, his doctor gave him a real freak-out.
It’s probably derived on some clan custom from whatever planet the Japanese originally migrated from
Like anything complicated and confusing, it has multiple roots. The doctor thinks that dealing with a patient’s emotions is beneath him, so he farms it out to the patriarch. There’s a tiny bit of stigma associated with being sick, so the family hides it. And Japanese are not supposed to show emotion in public, so the family often hides the truth from visitors. This is where the “hate” part of my love-hate relationship with Japanese culture comes in.
Well, it’s a little bit more complicated than that. My wife is a Japanese doctor, and she claims that at most hospitals doctors ask patients beforehand if they want to hear a bad diagnosis/prognosis.
Often the answer is “no,” and so doctors tell the families the truth while telling the patient that they have to undergo a routine surgery for a non-malignant tumor when in fact that sucker is about to kill them.
However, the patient still has the choice to know their own condition or not, and they are exercising it when they wish to be kept in the dark. You can make all sorts of conclusions from the number of people who don’t wish to be told the truth, but at least they have the opportunity.
In other words, it’s not nearly as paternalistic as it sounds. (It’s more ostrich-like-head-in-the-sand.)
Zak, that’s not the first time I’ve heard that from a doctor…well, first time from a doctor’s husband, but I trust you’re not misrepresenting your wife. My question is, wouldn’t they factor that into the studies?