Doctor - patient relationship in Japan vs. USA - comparison of attitudes to second opinion (7)

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Professor Dr. Tsuyoshi Kaneko MD, cardiac surgeon and expert in minimally invasive and transcatheter aortic valve and mitral valve replacement implantation, and aortic dissection treatment, and Dr. Anton Titov MD / Exclusive interview

- You were initially trained in Japan, and did your first surgical residency in Japan. Doctors in every country have certain different approaches to both interaction with patients and to selecting an appropriate treatment. What are some of the differences between Japan and the United States in terms of how medicine and surgery is done? Perhaps you could discuss some differences in communications between doctors and patients in both of these countries and cultures. So I can start with the doctor-patient relationship. In Japan doctor-patient relationship is very paternal. So the patients seek opinion from the doctors, but they often follow what they're being told, because they're "the father". So the relationship is very very paternal. The Japanese physicians tend to tell their opinion and the patients tend to accept them relatively easily. On the other hand, I see the patient-doctor relationship in the United States being more of a consultant. So a lot of the patient population, especially in Northeast [ Boston, New York] are very well-educated and they actually study very well prior to seeing their own physician. So the patient-doctor relationship here are more of a consultant. We get asked a lot of questions, we give recommendations, and it is up to patients whether they follow the recommendation or they can seek a second opinion if they don't like it. So the concept of second opinion is trying to infiltrate in Japan, but because of that paternal culture, I think it's not really infiltrating [as fast] as people thought. And a lot of patients over there tend to go to the doctor, and just follow their recommendations. I think that has pros and cons. For the doctors, you can freely recommend what you think is right, but it really puts the doctors in tough spot, because they sort of have to take the responsibility for all of this. The cons [of paternalistic patient-doctor relationship] are that, if the doctors are not really thinking about patient's interest, then it can really harm the patient. So I think it does have pros and cons, and it's very hard for me to say, which one is better. As far as the structure of surgeons and the training goes, Japanese surgeons are very very hierarchical, much like the Europeans. So they have one professor, who is the "big boss", and the rest really has to follow the boss's lead. Here we do have Division Chiefs, we have Department Chairs, but we are all individual [surgeons] under the Division Chiefs, so we're all treated equally, and we have the voice to speak up to our Chiefs. That usually does not happen in Japan. It is much much more hierarchical. However, I did hear that recently that hierarchy has been changing a little bit, trying to be more like United States format. But it's still ongoing process, and I think Japan remains to be very very hierarchical community.

- If we talk about the patient's seeking a second opinion, it's not necessarily that they disagree with their physician, but they just want to make sure that what doctors are recommending [is correct], and they try to learn as well [-Absolutely!] through alternative expert opinion, not necessarily contradicting the treatment course that they are having, but being more proactive, learning and having more confidence, and therefore following the recommended treatments in a better way.

- Right. But in a paternal world, I think that is viewed as a rebel against the recommendation. So you're going against "your father". So I think that is a reason why it is not viewed as smart or intelligent [as getting second opinion] is viewed in the United States. In Japan it's it's sort of considered as rude rather than a smart move.

- Thank you for illuminating the differences, they are clearly important in making medical decisions with the cultural standpoint in mind.

Doctor - patient relationship in Japan vs. USA - comparison of attitudes to second opinion (7) best treatment for damaged hair
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