Clinical Exchange in Japan

Departments: Medicine, Gastroenterology, Obstetrics & Gynecology
Period: January 2014 – February 2014

A twelve-hour flight goaded me to think that surely things would be different. This was, of course, the other side of the world. A new culture, a new continent, a new hemisphere. Perhaps the difference would be drastic. Perhaps I was about to be blindsided. Yet, in the back of my mind I found it hard to conceptualize that a fellow first world country, the third largest economy on the planet, would have a radically different medical blueprint than that of my own. Perhaps it was hubris that led me to such a deep-seated conclusion. Having been brought up in the United States, it is hard not for me to take pride in my country and the medical field to which I have devoted seemingly so much of my adult life. Despite the well-documented decline in U.S. health measures, to me America still holds a preconceived position of medical superiority. What Japan would unveil in daily life was a little of both, unexpected surprise mixed with a backdrop of American relatability.

The first apparent difference I found was to be foretelling of many of the unique aspects I would come to notice in Nagoya; that it happened nowhere near the hospital is far more telling. As I collected my luggage from the airport carrousel and made the slow trudge toward the train that would take me to my residence I was struck by the orderly lines being formed. With a train nowhere in sight, the locals were already in single file lines where train doors would soon appear, ready to methodically board as soon as possible. A happy jingle announced the train’s arrival and inside the colors of the car were bright enough to rouse me, even at that point, from a deep 12-hour-flight exhaustion. I amusedly thought of how New Yorker’s, renowned for their brusque, cold demeanor, would handle this explosion of order, sound, and color on their subway.

Having finally made it to my stop, I lugged my bags up the escalators and elevators to street level, only to find myself without direction. A cheerful cab driver and few phone calls later, a student came to my rescue to lead me to my new home. It was late, and I was on fumes, but yet I was wide-awake processing all that had happened. I still hadn’t come close to approaching the hospital, but already the cultural changes were leaping out at me like the pictures in a pop-up book. In the following weeks, I would find that several of those new norms would cement themselves as cornerstones of this mystic Eastern culture. I think the biggest differences I have noticed between our medical communities stems from the inherent differences in our cultures. In my first night, I took note of the order, the playfulness, the helpfulness and friendliness on a short ride from the airport. These motifs would continue to be seen in patients, nurses and doctors throughout my first month in the hospital.

After eight weeks in the hospital, other differences became apparent. I have had the chance to see far more unique disease in a short time here than I have seen in a year and a half rotating in American hospitals. While I feel like New Orleans has made me an expert on diabetes and hypertension, diseases like Churg-Strauss, pyoderma gangrenosum, anisakiasis and thanatophoric dysplasia were things I had only ever read about. While in the U.S., a large majority of the hospitalized population seems to invariably be seeking care for chronic disease management, here in my first few days I found true disease and with it, a craving to know and learn more.

Overall, I feel that in my short time in Japan I have already realized many important differences and similarities between our medical practices. I think that many of the differences stem from cultural norms that in my opinion provide for a more efficient and productive working environment than the U.S. has to offer. However, I think that by and large our medical system structures are derived from the same model and it is only in execution that I find key differences. I feel so lucky, to have been given the chance to visit such an amazing nation, and make so many strong friendships. I look forward telling my American colleagues about my time in Japan and all of my Japanese friends and mentors.

In the OR on my Obstetrics & Gynecology Rotation at Nagoya University Hospital

At dinner with medical student friends in Tokyo!

Seeing the snow monkeys in the Onsen at Nagano