Clinical Exchange in Japan

Emergency medicine offers ample opportunities to deal with the initial undifferentiated presentations, and the acute episodes of a variety of diseases. It is where you can bring tremendous impact to the patients in a fast-paced, multi-disciplinary manner. This is the reason for which I’ve been drawn into emergency and critical care, with which I’ve been satisfied in Nagoya University Hospital.While still a relatively new and evolving medical specialty, the system is well organized here, which is led by Professor Matsuda, who gives off a cheerful temperament, always uses lively illustrations in a lecture.

My very first impression was the clear working spaces equipped with modern touchscreen where you can follow the progress of the patients in ER and EM-ICU. To minimize medical errors, there are several flowcharts and checklists posted on the wall. In addition to diagnostic work-ups and bedside procedures, I also observed how they manage consultations and the admission process. The ER outpatient load was reasonably controlled, which was roughly around 10 per shift, a schedule suitable for students to enjoy several comprehensive case discussion with the attending physicians.

EM-ICU is operated in a team-oriented way. At the morning conference, physicians from different specialties share their insights in a series of roundtable sessions. The medical charts were arranged in paragraphs based on organ systems, so that we can clearly understand the know-how in treatment plans. The physician/staff member-to-patient ratio in the ICU was estimated to be high, ensuring high-quality healthcare to be provided. My most unforgettable patient was a 22-year-old female diagnosed with bronchiolitis obliterans (BO) due to graft-versus-host disease (GvHD), complicated by possible fungal infections. Even with intensive respiratory control, however, the condition went critically downhill. An emergency case conference attended by all the team members was held, during which the feasibility of lung transplant was discussed. This real experience reminded me of how fast the patient condition would potentially change, and how close we would be faced with a matter between life and death.

I would like to express my gratitude toward Prof. Matsuda and all the staff members in his team, all of whom have been kind and supportive. During the great time I enjoyed, I had my skills consolidated and the motivation toward a career in ER/critical care more strengthened.