Studying In Japan

Masakazu Yamazaki / Special to The Yomiuri Shimbun

The country is increasingly feeling the pain of an acute shortage of medical doctors. In an effort to perform first aid, the Education, Science and Technology Ministry recently decided to expand the annual quota for medical students accepted by universities.

This is a bold about-face on the part of the government, which has been capping the overall number of doctors in the country. In other words, the sudden decision to offer a structural remedy to ease the situation denotes how bad it has become.

From the point of view of patients, the ministry's decision is a welcome one. But this reminds me of an idea I have cherished for many years: The medical care crisis is an unprecedented opportunity for us to redefine the qualifications of future doctors. I don't mean that the existing criteria to become a qualified doctor are wrong, but my long-cherished idea is that medical students should be chosen from a more diverse talent pool.

Under the current university entrance examination criteria, schools of medicine are seen as the zenith of science studies. Cram schools offer special teaching programs for students aiming to enter medical schools, providing extensive studies in mathematics and physics, which constitute the basics of science. I hear that talented students taking medical school exams tend to feel a particular satisfaction in passing the two most difficult tests--math and physics. However, once they enter medical schools, math and physics expertise is not required so much as in the cases of students at science, technology and pharmaceutical faculties. What they have to learn, instead, are the complex physical and mental aspects of people.

In a sign that the emphasis on math and physics for medical students is shifting, at least one school of medicine no longer includes the two subjects in its exams. Instead, it places importance on Japanese ability and the interview portion of the screening. Similarly, another school of medicine has been keen to accept applications from university students studying in other departments. This school also does not place priority on math and physics, instead focusing on the applicants' breadth of general academic knowledge.

I have not asked those universities about the basic medical philosophy that lies behind their entrance examination policies. Once again, I want to make it clear that I do not have the slightest doubt that science is the very foundation of medicine. However, from a layman's point of view, the ideas of the two schools in regard to medical education is quite understandable, considering that medical treatment requires extraordinary expertise in science.

Put simply, whereas all science studies pursue universal truth, medicine represents knowledge that has to apply to individual patients. Of course, humans are nothing but matter, in a sense, simply following the mathematical and physical arrangement of proteins and fat. But the individual patients doctors treat are not so simple. Patients have physical constitutions and symptoms specific to each of them. Even if general treatment methods are used, it is indispensable for doctors to tailor such treatment to meet each patient's unique conditions.

In addition, personal histories and living environments differ from person to person. Medicine, therefore, is defined as not only part of science but also part of integrated human studies.

Seeing and feeling the problem

To understand each patient's conditions, it is not enough to apply analytical methods based purely on math and physics. Such analyses are fit for something that can be broken down into its constituent parts and then reassembled and restored to its original state. A mechanical approach such as this cannot be applied to human beings. What is necessary for treating people is a method that enables a doctor to immediately gauge a patient's entire condition and intuitively determine the nature of the problem--which is often intangible. This is similar to physiognomy in the human sciences.

In fact, doctors diagnose cases by seeing and touching the affected parts of patients or by wading through the results of X-rays and other tests. In essence, they apply a comprehensive and intuitive diagnostic approach. Advanced technologies, such as the magnetic resonance imaging system that produces highly analytical images of affected parts, can be used, but the intuition of a doctor fostered through experience is indispensable to accurately and quickly read that MRI data.

I am not sure whether a talent for physiognomy is a natural gift or the fruit of experience. However, such an intuition obviously has nothing to do with the talent required to pass required math and physics exams. It is regrettable that the existing medical school entrance exam system ignores from the very start a key indicator of the great potential in students aspiring to be doctors.

Another point we should keep in mind with regard to medicine is that people are different from the objects of pure science--human beings speak and express themselves. Patients tell doctors of their symptoms because they want doctors to understand their problems. Also, patients want doctors to learn of their mental state--which can be the root or result of their diseases--on top of diagnoses of their ailments.

Bedside manner important

As clinical philosopher and Osaka University President Kiyokazu Washida emphasizes in his book "Kiku Koto no Chikara" (The Power to Listen), listening to patients itself can be perceived as part of the cure from a patient's point of view. A situation in which patients feel that their problems are understood and shared by doctors can be as much a source of relief for them as medicine. This was the situation commonly seen a long time ago, before the development of modern medicine, and practitioners were not as busy as today's doctors. In those days, many of those who were renowned as excellent doctors earned that reputation thanks to their willingness to listen to patients.

Doctors need to have excellent speaking skills. Human beings are so sensitive that they readily sense who is truly willing to understand them and tend to speak only to such people. To be a good listener, a doctor has to be a good speaker. In this regard, it makes sense to add Japanese lessons to medical education to help students develop a good bedside manner.

While the lack of doctors is an acute issue that must be redressed urgently, medical education does take time. One emergency step to cope with the matter is to raise the quota of medical students accepted from other university departments. If this were to happen, the gap between science students and liberal arts students would be narrowed--and the door for the latter should be opened as widely as possible.

Another remedy is to take advantage of the presence of so many clinical psychologists to reshape the existing system, with the aim of strengthening cooperation between them and doctors. Clinical psychologists are qualified as specialists for listening to patients--they have a scientific education tailored to that particular goal.

Everyone knows that a major problem facing modern civilization is psychological disorder, which is seriously affecting various spheres of society, including education, crime, nursing care and the medical services. Stress makes people more susceptible to depression and psychosomatic diseases. It also can trigger many other types of maladies that require the involvement of all clinical departments in one way or another. Stress-related diseases are primarily dealt with by psychiatry. Influential theories in the field of psychiatry--from those of Sigmund Freud (1856-1939) to U.S. psychologist Carl Rogers (1902-1987)--are similar to those found in clinical psychology. In fact, there are some academic societies in which specialists in the two fields sit together.

Early detection and counseling is effective in dealing with any disease. However, given the current number of doctors, such time-consuming approaches can hardly be provided sufficiently. To rectify the situation as much as possible, the government should recognize the qualification of clinical psychologists with a state-sanctioned license and cover treatments by clinical psychologists under the public health insurance system. These steps should be urgently implemented to prevent diseases.

Yamazaki, a playwright and critic, chairs the Central Council for Education, an advisory body to the education, science and technology minister.