Choosing Wisely – Part 1“The Importance of the Power to Choose Seen Through U.S.–Japan Medical Culture” No9

<Introduction – Stepping away from “leave-it-to-the-doctor” medicine>

I have worked in healthcare as a nurse for many years in Japan and later experienced studying abroad in the United States in my 50s. Through those years, I encountered many situations in which I deeply felt the differences between Japanese and American medical culture.

In Japan, careful and attentive medical care is considered a symbol of “safety.”In the U.S., on the other hand, a strong emphasis is placed on the attitude of choosing “only the care that is truly necessary.”

Of course, differences in healthcare systems play a major role.However, the mindset of patients themselves also differs significantly.

<In the U.S.: Patients choose their care — Short hospital stays and strong independence>

Recently, a friend living in the U.S. told me about her daughter-in-law who underwent a liver transplant.Her hospital stay was only one week. In Japan, the hospital stay would typically be one to two months.Conversely, I have heard of cases where the donor stays only about a week in Japan.

During my time in the U.S., an 80-year-old acquaintance of mine fractured her leg.Her hospital stay was just one night.

Her home was halfway up a steep hill, with stone steps at the entrance and several levels inside.I visited several times because I was worried.Yet immediately after discharge, she was already moving independently and had resumed her normal daily activities.

I couldn’t help thinking:“This would be unimaginable in Japan…”

<My own experience — A diagnosis without X-rays>

Once, I injured my leg in a skiing accident and visited a clinic.The physician examined me carefully, but decided X-rays were unnecessary. No imaging was taken.In Japan, X-rays would almost certainly have been done.

Falling while skiing!!

At first, I felt uneasy—“Is this really okay?”But I was convinced by the clear diagnosis and explanation and went home reassured.

Another time, I arrived 30 minutes late to a scheduled appointment due to heavy snow.I was simply told:“You are not within your appointment time, so we cannot see you,”and they calmly referred me to a different clinic.

In Japan, exceptions are often made in such circumstances, so I was shocked by the strictness.

<Japan’s medical culture — Skilled care, but also a “leave-it-to-the-doctor” mindset>

After returning to Japan, I was being treated for hypertension.Since my blood pressure did not improve despite medication, I requested a referral to a university hospital myself.The diagnosis turned out to be primary aldosteronism.

Perhaps I recognized the signs because of my professional background.I could not help wondering—What if I had been a typical patient?Would it have been brushed aside as “just aging”?

Japan’s medical system is admired for its kindness and reassurance.But at the same time, we often rely too heavily on healthcare providers.

<Reality in the U.S. — You can’t rely blindly, so you must learn>

In the U.S., the principle of personal responsibility is fundamental. Insurance type determines what care is available.Patients routinely check the effects and side effects of medication on their own before taking it.

I constantly researched and asked:“Is this treatment really necessary?”“Are there alternatives?”

The mindset required is:“Know your own body yourself.”

<Choosing Wisely — What does it mean to choose care wisely?>

During these experiences, I encountered the concept of Choosing Wisely.This is an international movement aimed at identifying “tests and treatments that may not be beneficial” and reducing unnecessary medical care.

Not just to reduce medical costs,but to improve patient safety and quality of life.

And this responsibility does not lie solely with healthcare providers—it also depends greatly on the attitude of patients.

<Conclusion — “Necessary care for those who truly need it.”>

The era of “the more medical care, the better” is coming to an end.

Providing only the necessary care, at the necessary time, and in the necessary amountis the key to maintaining a sustainable healthcare system with limited resources.

In the patient-support services and professional training programs I provide,I place importance on fostering the ability to think independently and choose wisely.

In the next blog post, I will explore more deeply the themes of physician expertise and quality of care.

PS) Both Japan and the U.S. have their own strengths and challenges in healthcare.My intention is to share what I learned through these two different systems, not to judge which is better.