— Two sentences from two different doctors. Both of them missed the point.
“Do not come if you are not in pain.” A Japanese orthopedist actually said that to me. At a different clinic, the internist tells me the same three things every visit: lose weight, exercise, drink water. After 40 years of working with my body, I know my body. Why do Japanese doctors not see the whole patient? Here is what I have learned, at 67, after a lifetime of brief, repetitive medical visits.
“Do not come if you are not in pain”
This was at an orthopedic clinic two or three years ago. My hips and knees had been giving me trouble. My general physician referred me to a specialist.
On the day of the appointment, my pain had eased. I wanted to be seen anyway, before the next flare-up. The orthopedist looked at me briefly and said, more or less: do not come back unless you are in pain.
Lately I hear more and more news about my old classmates. One got cancer. One collapsed from a stroke. One has died. These are people my own age, and they are disappearing. That is why I want to be checked before the pain comes, not after. I only wanted to be seen as prevention.
I understood his point. In the Japanese national health insurance system, doctors are not supposed to bill for visits where nothing is wrong. From his angle, I was an inefficient case.
From my angle, I was a 60-something man who wanted to understand his own body before it gave out. Those two angles do not meet in the same exam room.
The internist says the same three things every visit
I have a regular internist for my mild high blood pressure. Every three months, I go in, get my pressure measured, pick up my medication, and hear the same three sentences:
- Lose some weight.
- Get some light exercise.
- Drink plenty of water.
In the early days, I thought he was tailoring this advice to me. Now I think he says it to every patient who walks in. It is the doctor equivalent of “have a good day.”
I am not angry about it. It is friendly. It is professional. It is also slightly empty, because none of those three sentences have anything to do with what I have actually been doing.
I am already doing what he tells me to do
The truth is, I started before the doctor ever told me anything.
- I walk every day, about 5,000 steps, around 50 minutes.
- I do my own version of Hindu squats, sit-ups, and forward bends, two sets of 20 each. Not pretty. But every day.
- I drink more water than I used to, especially in summer.
The doctor does not know any of this. He has never asked. I have never been given the chance to mention it in the five minutes I get with him each visit. So he tells me to do the things I am already doing, and I nod, and we both move on.
There is no doctor who sees the whole me
The orthopedist sees a joint. The internist sees a blood pressure. The dentist sees a tooth. Each one knows their piece. None of them know me.
The result is that the only person who knows the whole me, is me.
So I have become my own doctor, sort of
I track my own walking. I pay attention to when my back hurts, when my knee hurts, what I ate, how the weather felt. None of this is in any medical record. It exists only in my head.
I am not a doctor. I am 67 and tired. But I have been paying attention to this one body for a long time, and I notice things no specialist would notice in a five-minute visit.
Looking back now, maybe I was the naive one. Walking into that orthopedist in that frame of mind may have been my own mistake. And the doctors surely have it hard too, running a clinic, seeing patient after patient. This is not a problem I can pin on any one of them.
If a Japanese doctor reads this, I do not mean it as an attack. I know the system is set up to push appointments through quickly. I know each of you is doing the job you were trained to do. I am just saying, from the patients side: there is no one looking at the whole me. I have to be that person myself.
FAQ
Why do Japanese doctor visits feel so short?
Japanese national health insurance rewards efficiency. Clinics see many patients per day, and individual visits are often only about five minutes. The system is designed for volume, not for long conversations.
Is there a family doctor system in Japan?
There are general practitioners, but the relationship rarely becomes as deep as a Western primary care physician. Most Japanese patients see specialists directly for specific problems, then move on.
What should I do if my doctor keeps giving generic advice?
What I do now is say out loud what I am already doing. For years I stayed quiet, because speaking up feels rude in Japan. But a doctor cannot tailor advice to a patient he does not actually know. One short sentence about my routine changes the visit.
Can I track my own health between visits?
I do it myself. I keep track of my daily walks, my pain points, and changes in appetite. I end up knowing my body better than any specialist who sees me for five minutes every 3 months.
— Me-me
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