Japanese Women Now

Women and Medical Care

By YAMAGUCHI, Ikuko
Executive Director, Consumer Organization for Medicine & Law (COML)

Telephone consultation is one of the most important activities of the Consumer Organization for Medicine & Law (COML). The total number of consultations over past 11 years has exceeded 20,000, with monthly consultations numbering around 300 to 400. In contrast to when the center first began operating, the number of consultations for men has increased, while approximately 70 to 80% of consultation are received by women each month. Among women requesting consultation, the ratio of patient and the family member of a patient is almost 50:50.

Rather than simply a difference in gender, symptoms, character, thinking, lifestyle, and conditions at the time show a marked difference in how illness is accepted, and there is little difference in consultation based on gender.

The system to provide medical examinations by public organizations is widespread today in Japan, and the number of housewives seeking consultation claiming that "the discovery of my illness was delayed by the lack of opportunity to receive a medical examination" has decreased. In addition, the public today is more knowledgeable about the symptoms of disease, such as breast cancer and ulcers. However, when disease is discovered or suspicions arise, the question of "which medical institution to chose" becomes a serious problem. The amount of information available to the public has grown due to the availability of numerous books and magazines, and the widespread use of the Internet, but the number of consultations has also increased due to the difficulty in discerning and selecting the best information available.

Strict advertising restrictions still apply to the Japanese medical field, and essential information to assist patients in selecting the most appropriate medical institution is not publicized. For example, the expertise and treatment results of doctors are not disclosed. We often hear that patients visit a doctor after seeing a name in a book, or perhaps hearing a name through word of mouth; but upon doing so they often find the doctor to be oppressive or unresponsive. Thus, problems surrounding the personality or compatibility of doctors also exit, and these problems become obvious to patients only after their visiting a doctor.

Patients should be actively involved in their own medical care

COML proposes that patients should carefully consider the kind of medical care they want to receive and use this as the standard to judge whether a medical institution can satisfy their medical needs. Of course, patients select their own medical institutions. If a patient wants to look for "a doctor who will willingly explain when asked questions," the patient should ask these questions and judge how the doctor responds. After selecting a medical institution, it is important for patients to seek consultation on the kind of medical care they wish to receive and orally convey this to their doctor; and in order to do so, patients also require effective communication skills.

Eleven years has passed since the term "informed consent" introduced in Japan. This term now established in Japan, but there are still many medical care workers who interpret informed consent as a one-sided explanation. COML interprets "informed consent" as "explanation and agreement, as well as understanding and selection," and proposes "medical care where doctors and patients work together." Obtaining consent after providing explanation is the responsibility of medical caregivers, while "understanding" through asking questions and "selecting" the desired treatment method from multiple options are the responsibilities of patients.

Participation in patient groups

In order to realize medical care emphasizing "respect for the individuality" of patients and caring for the "character" of each patient, it is essential to change the level of current awareness so that patients themselves can become actively involved in medical care in cooperation with medical caregivers. However, a system to listen to the worries and problems of patients or to support the decisions taken by patients is not fully developed in Japan.

In the consultations by COML many people claim there is "no place to voice my true feelings," or "even family members will not listen to my problems." This means it is essential to establish "consultation corners" at medical institutions, or to hire coordinators who are not medical caregivers, to listen to the concerns of patient from a neutral position.

There are few such corners at which overall medical care consultation is provided as a third party. Patient groups for women's diseases, such as breast cancer, uterine cancer, uterus myomatous, and endometriosis, are actively working at such corners and providing support functions as self-help groups. Different patient groups and physically disabled groups exist throughout Japan, and COML recognizes 1,266 such groups ("National Patient Group and Physically Disabled Group Guide," 2nd ed., issued by Pre-Med in cooperation with COML). For people who "want to listen to others suffering from the same disease" and "want to know what kind of special measures are undertaken in everyday life," COML introduces patient groups.

Patient groups can facilitate the exchange of information and mutual support among people suffering from the same disease, while it can also become an important opportunity to "not suffer alone." On the other hand, groups seem to have difficulty in establishing a sense of unity, as patients compare the symptoms and progress of their disease, and different feelings arise depending on the length of suffering.

The meaning of patient groups will be established only when the members of these groups can clarify and share their objectives.

View as family members

The number of consultations on child rearing for young mothers has rapidly increased and currently represents approximately 10% of all telephone consultations. Mothers often express vague anxieties, such as worries about their child's symptoms after reading about a serious disease in childcare books, nervousness over slight changes as mothers spend all day with their children, worries because their child is not growing as described in childcare books. These mothers tend to seek "judgements," such as "is this a disease?" or "is it better to see a doctor?" These questions reveal the need to develop a social system for the younger generation habituated to following manuals.

In Japan, when a child becomes ill, it is the mother who is forced to run here and there taking care of her child. For families with more than one child, few facilities exist where mothers can leave their children without worry. A support system for mothers who are worn out by domestic work and yet caring for a sick child is essential. Some pediatric faculties have established support groups for mothers within hospitals, but only few independent groups exist where mothers can maintain equality with medical caregivers.

On the other hand, when a husband or parent becomes the patient, wives or daughters tend to worry alone, as they feel "I have to do something," and they sometimes fail to respect the patient's involvement in their own medical care. In order to respect the feelings of patients, COML advises that patients and families should communicate, and that family members should devote themselves to supporting the feelings of the patient.

In Japan, women often participate in the medical field, and women are expected to play a central role in changing Japanese medical care by encouraging the active involvement of patients in their own medical care.

Consumer Organization for Medicine & Law (COML): COML is an NPO that looks at medical care from the viewpoint of consumers. Consisting mainly of citizens, COML began activities in 1990 to achieve the independence of patients and to encourage patient to take a leading role in their own medical care. COML advocates that each person should be aware that "this is your own life," "you have responsibility for your own health," and "you should become a smart patient." Through repeated dialogue with medical caregivers, the goal of COML is to establish better patient-doctor relations through repeated dialogue and mutual understanding.

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Consumer Organization for Medicine & Law (COML)
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WOM has been working on the initiative Japanese Women Now in order to provide information about contemporary legal/social environment surrounding Japanese women. It is our hope that information on this page help readers gain further understandings on gender issues in Japan.

Authors of articles contributed to this initiative are active and knowledgeable members of the respective fields of selected topics. The contents are based on the fact available as of late 2001, when these articles were written. The original Japanese articles are also available on our Japanese Home Page.

Topics selected in this initiative are: Domestic Violence, Compulsory Selection of a Family Name for a Married Couple, Elderly Care and Women, Women and Work, Sexual Harassment in Working Place, Sexual Harassment on Campus, Equal Employment Opportunity Law, Single Mothering, Child Abuse, Women and Medical Care, and Reproductive Health/Rights. ===＞GO to Index

This initiative was made possible by the grant from Asian Women's Fund.