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    You’re giving me a heart attack

    There’s been another mix-up of patient records at a hospital, with tragic results:

    A 70-year-old man died in March following a misdiagnosis brought about when his CAT scan results were accidentally switched with those of another patient at a hospital in Numazu, Shizuoka Prefecture, The Yomiuri Shimbun learned Tuesday. Hospital authorities have denied responsibility for the man’s death.

    The man, from Numazu, died of a cerebral hemorrhage two days after being taken to the hospital and given the CAT scan following complaints of difficulty swallowing. The results of his scan were accidentally switched with those of another patient who underwent the scan the previous day.

    According to hospital officials, the cranial CAT scan was performed on the man immediately after he arrived at the hospital. The technician, however, accidentally gave the wrong scan results to the man’s attending physician, leading to a misdiagnosis that the man had suffered a stroke.

    This sort of thing is not at all uncommon–a famous mix-up at a Yokohama hospital led to heart and lung surgeries being performed on the wrong patients–and I wonder whether its roots lie in more than just the way health care, specifically, is run.

    Everyone in Japan who works for a decent-sized company has found life somewhat reordered by the new laws, which went into effect this month, governing the handling of personal information. Because Japan is famous for order, carefulness, and semi-conductors, people often make the easy assumption that the handling of information here must be first-rate; but in many ways it’s not. Japanese offices are full of clutter–folders and vertical files and post-it notes piled everywhere are a common sight. True, any office anywhere in the world that hasn’t been prepped for a magazine shoot is going to look worked-in, and because space is at a premium here, separate rooms or closets to keep unattractive piles of paper hidden away are less easy to manage. It’s still true, though, that most Japanese prefer the traditional use of paper documentation and name-stamp approvals to computerized MIS. Most documents go through many hands on their way to being approved or filed, and Japan has had relatively little crime since the war, so it’s not uncommon for documents that contain personal information to be lying about all over the place because there aren’t any policies to prevent it.

    Oddly, while information tends to go through many people vertically up and down chains of command, it often isn’t shared horizontally. The in-group consciousness can mean that marketing departments don’t always know what their own R&D people are creating, or how to communicate to them what the customers would like it to do.

    Of course, computers aren’t perfect either, and territoriality is not a trait the Japanese invented, as we all know. But so many of the problems you hear about in Japanese health care seem to result not from garden-variety incompetence or questionable judgment but from a specific mishandling of documents: mixing up patients’ charts, not reading warnings about an employee’s conduct, not having received the crucial information in report A. Apparently, the hospitals are run less like the rest of the domestic economy.

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