Visiting the doctor is never fun, and in a foreign country the stress is increased by unfamiliar locations, unknown opening hours, and differences in language, culture and medical practice. Stories related by foreigners who have had the misfortune to be taken sick in Japan range from comical to horrifying, the only common thread being the difficulty of the process.

As any good doctor will tell you, prevention is better than a cure, and preparation is key to ensuring you receive the care you need should you become ill. Finding a doctor competent in spoken English will require some research or asking around, and of course it�fs better to do this before you get sick rather than panicking when you do. If you have concerns about communicating with a doctor, take a friend who can speak Japanese, or at least a dictionary.

 

When you fall ill or are involved in an accident, friends, colleagues, or family will hopefully provide support, but access to accurate information can help to limit pain and stress, and also save time and money. With this in mind, Yale Medical School-trained Joe Kurosu M.D., formerly Medical Director of the Nakagaki Clinic in Nagoya, offers the following advice: �gMost routine medical problems can be dealt with initially by a local internist or pediatrician, and referrals for specialized care can be made if necessary. Life-threatening emergencies require a call to the fire department for an ambulance.�h

To call an ambulance, which are available free of charge 24-hours a day, dial 119, or press the red button on a public phone for a free connection. Your call will reach the fire department (shoubou / ���h), and you will need to ask for an ambulance (kyuukyuusha / �~�}��). It may be possible to speak in English, but it is advisable for those not proficient in Japanese to learn the following phrase: �gKyuukyuusha o onegai shimasu. Basho wa �c desu.�h (�gI need an ambulance, please. I�fm at/in �c�h)

Dr. Kurosu continues: �gIn most cases you will be taken to the most appropriate emergency facility based on your condition and locale. Less urgent problems are a bit more difficult. Many of the larger private or university-affiliated hospitals will have 24-hour emergency rooms. Staffing, however, may be variable, with no guarantee of in-house specialist availability.�h

�gPrivate doctors often do not have an answering service or cover each others�f practices, so it may be hard to contact them outside regular office hours. If you can contact them and they live close to their clinic they may be willing to see you at any time. Some cities have urgent care clinics run by local medical societies which are open on weekends and evenings/nights.�h

 

 

Many doctors in Japan are specialists (see the Glossary), with a basic delineation between internists (naika-i / ���Ȉ�), who practice internal medicine, and surgeons (geka-i / �O�Ȉ�). Internists are similar to what English speakers would call a General Practitioner (GP). If you are unsure what your problem is then it is best to visit an internist in the first instance. Should they be unable to provide immediate assistance they will refer you to a relevant specialist. If you have some idea about the location or cause of your ailment then you can go directly to a specialist in that area without needing a referral.

Doctors who have studied or practiced overseas, or who regularly deal with non-Japanese patients, may take the time to put you at ease and explain their diagnosis and recommended course of action. But, as people with experience of Japanese medical practice will know, such doctors remain the exception. Most rarely discuss medical conditions with patients, although they sometimes inform relatives of serious conditions, and it is considered disrespectful for a patient to question the doctor�fs judgment. If you persist in questioning the doctor they may eventually come to understand your motives - or lose patience - and provide more information.

Dr. Kurosu is bilingual, licensed to practice in both the Japan and the U.S., and has 20 years�f experience, including more than four in Nagoya. He says foreign residents of Japan should consider the �gdifficulty of finding specialists that speak English or other languages, and the gap in expectations between Japanese doctors and foreign patients.�h Also, based on his experience, �gthere seems to be a relatively high incidence of psychological and social issues in the foreign resident community.�h These can �gaffect physical well-being, and there may be difficulty finding appropriate healthcare providers to deal with these issues.�h

He adds: �gAny illness can be stressful, and being in a foreign country can compound this immensely. Differences in language and culture can be serious obstacles to receiving what one perceives as appropriate care, and this seems to be one of the reasons for the generally low marks that foreign residents give to healthcare in Japan. Many of the complaints stem from cultural and social expectations based on country of origin that often lead to disappointment or mistrust. It helps to remain flexible and shop around, especially if you have National Health Insurance, to try to find an acceptable balance in your healthcare.�h

 

A visit to the dentist is even more nerve-wracking than usual when the person sticking metal objects in your mouth is mumbling through their mask in a foreign language. And that�fs if you�fre lucky enough to find one who will explain what they are doing.

Word of mouth on dental clinics is often reliable, so asking friends is a good first step to finding a dentist you will be happy with. The good news is that, once you find a dentist, the cost of treatment is considerably lower than in most western countries.

 

Doctors and clinics in Japan often have their own dispensary (yakkyoku / ���). Occasionally you may receive a prescription (shohousen / �����) that you need to take elsewhere, usually to a nearby pharmacy (kusuri-ya / ��). In most cases you will be prescribed a maximum of one weeks�f medication and be expected to return to the doctor if your symptoms persist. Pills and tablets are often supplemented by medicines that come in liquid or powder form.

Japanese National Health Insurance rules regarding prescriptions are very complex. Dr. Kurosu says: �gUpper limits on many medications are lower than that of other countries, which may lead to denial of payment or require some creative billing by the physician. Only medications on the official list may be used for insurance purposes. Use of �eunapproved�f medication requires that the entire visit be considered outside of the system, meaning the patient must pay 100% of the fee.�h

�gThere are no restrictions on consultations with specialists. One may go directly to a specialist, or any doctor, without referral at any time (although some hospitals may charge a fee if there is no referral). CT scans and MRIs are relatively easy to obtain - no pre-authorization is required. But most preventative services, pregnancy related fees, and contraceptives are not covered�h by National Insurance.

	Glossary
	Some hospitals will offer a variety of medical services, but in Japan it is common for doctors, clinics and hospitals to specialize in narrow areas. If you have a general complaint then a public hospital may be as good a place as any to go, but should your needs be specific then the following keywords may come in handy. Acupuncturist / hari-i / �I�� Dentist / haisha / ����� Dermatologist / hifuka-i / �畆�Ȉ� Doctor / isha / ��� Ear, Nose & Throat (ENT) / jibiinkoka-i / ���@��A�Ȉ� Gastroenterologist / ichoukika-i / �ݒ���Ȉ� Gynecologist / fujinka-i / �w�l�Ȉ� Internist or Physician / naika-i / ���Ȉ� Neurologist / shinkeika-i / �_�o�Ȉ� Nutritionist / eiyoushi / �h�{�m Obstetrician / sanka-i / �Y�Ȉ� Ophthalmologist / ganka-i / ��Ȉ� Orthopedist / seikeigeka-i / ���`�O�Ȉ� Pediatrician / shounika-i / �����Ȉ� Psychiatrist / seishinka-i / ���_�Ȉ� Psychologist / shinrigakusha / �S���w�� Sexually Transmitted Diseases / seibyouka / �a�� Specialist / senmon-i / ���� Surgeon / geka-i / �O�Ȉ� Urologist / hinyoukika-i / ��A��Ȉ�