“How Medical Specialization is Being Eroded by the System — Choosing Wisely, Part 2” No10

Introduction: Has Health Insurance Changed How Physicians Work?

After publishing Part 1 of “Choosing Wisely,” I received many insightful comments.Some readers wrote:

“In Japan, physicians provide care assuming treatment is always necessary.But without imagination or dialogue, can we truly provide care that protects a patient’s quality of life?”

“When I was a young nurse, I never questioned Japanese medical culture.Now I see many issues that must be discussed by society as a whole.”

These voices made me feel that we need to look deeper into how medical care is delivered.

In Japan, short appointments, routine tests, and high patient volume are part of daily practice.But we must ask:

Are these truly the best choices for patients?Or have physicians been pushed away from their essential roles, limiting their own professional value?

I believe the cause is not only physicians themselves, but also how the medical insurance system works.

For example, in the United States, physicians earn more than 2.5 times their counterparts in Japan,and the average reimbursement per outpatient visit is nearly four times higher.

Based on my own experiences, I want to explore how the pursuit of “efficiency” may be eroding medical professionalism.

The Era of “Three-Minute Visits” — and What Slipped Away

There was a time in Japan when everyone spoke of “three-minute consultations.”Overwhelming patient volume forced clinicians to prioritize productivity over presence.

As this trend accelerated, the physician’s role shifted:

From diagnosing and treatingto judging and prescribing

Fundamental hands-on assessment skills—interviewing, inspection, palpation, auscultation, percussion—were gradually delegated to others:

• Lab tests → medical technologists

• X-ray imaging → radiology technologists

• Medication explanation → pharmacists

• Lately even initial interviews → nurses

Team-based care can be efficient.However, as dependency on others increases,face-to-face time between patients and physicians decreases.

And with that, the presence of “doctors who truly examine patients” seems to fade.

The Cost of Efficiency: Over-testing and Declining Physician Value

This division of labor has raised personnel costs for support staff,while the relative value of physicians’ time appears to be shrinking.

Efficiency—seeing as many patients as possible—has consequences:

• Personalized care gets pushed aside

• Explanations become rushed

• Patients leave with questions unanswered

Against this backdrop, the global movement “Choosing Wisely” emphasizesavoiding unnecessary tests and treatments.

Yet in Japan, public awareness remains limited.

Choosing wisely expresses a delicate balance.

My Own Experience: When “Routine Testing” Felt Wrong

When I lived in the U.S., I once injured my leg in a skiing accident.The physician took time to interview and examine me carefully.Despite my expectation as a Japanese patient, no X-ray was taken.

I was surprised—almost uneasy.But because the doctor thoroughly looked, touched, and evaluated my legeven across a language barrier,I felt confident in his diagnosis and went home reassured.

Now in Japan, I receive regular follow-up carefor chronic conditions (hypothyroidism and primary aldosteronism).Every visit includes blood tests, chest X-ray, and ECG—regardless of symptoms.

As a patient, I understand the fear of not testing.I once switched clinics because I wasn’t getting checked frequently enough.

And yet, that is exactly why we must ask:

“Why am I taking this test?” “How will this result change my care?”

We owe ourselves that question.

Closing: It’s Time for Both Physicians and Patients to Re-examine the Basics

Japan’s aging society and expensive new treatmentsare pushing medical insurance into difficult terrain.Discussions on cost-sharing reforms have already begun.

In the midst of all this, the principle of Choosing Wiselyis becoming increasingly important.

As efficiency takes center stage,are physicians losing sight of their professional value?And have patients become accustomed to over-servicing,forgetting what “truly necessary care” looks like?

I believe we must return to the foundations of medicine:

Physicians:

Reclaim your ability to observe, evaluate, and make sound judgments.

Patients:

Strengthen your ability to choose medical care based ontrust and genuine understanding.

Because in the end—the heart of healthcare lies not in the number of tests performed,but in the relationship between those who careand those who are cared for.