My knee has been bothering me for weeks. I’m pretty sure I overexerted it during a tougher-than-expected boot camp-style workout class at my local gym. It was an hour of non-stop activity, with round after round of lunges and squats, high-knees running and stepping up onto things. The class itself was painful, obviously (it should be, right?), but it wasn’t until the next day that I realized how much I had overdone it. My knees berated me for weeks afterward the only way they know how, with popping, pain and inflammation. They eventually got the better of me, and I decided it was time to have the more painful of them looked at.
I plug “orthopedic doctor” into my handy online E-J dictionary and learn that this is 整形外科 in Japanese. I start googling and then google-mapping. I can see there are a few clinics within limping distance of nearby Shibuya station. From there I peruse reviews and the websites of the best-located options until finally settling on this clinic which specializes in knee problems such as 変形性関節症 (osteoarthritis). According to the calendar on the website they are open for walk-ins from 2 to 4 on Tuesday afternoons. Perfect!
I head over right after lunch. It’s an unpleasant 15-minute walk. Once I locate the building I walk inside and am greeted by the familiar drab, no-frills interior design aesthetic typical of doctor’s offices and clinics here. I hand over my blue medical ID card and am given a clipboard and pen and asked to complete the attached single-page questionnaire. All the usual fields are in there: name and address, birthdate, basic medical history, why I’m here today, etc. I fill it out and hand back the clipboard. The nurse-receptionist asks me to take a seat.
No one else is waiting so I’m called right away. Getting called in always feels more like being summoned here in Japan, since it’s always you going to wherever the doctor is (and in some cases having to also wait in some “in-between” space such as a hallway just off the waiting room) rather than the doctor coming to meet you. At any rate, I was glad to be granted an audience so quickly.
The doctor (Seki-sensei) looks to be in his 60s and carries the extra weight of a man who enjoys a good tonkotsu ramen. He indicates the standard-issue, 18 inch-high stool next to him with a friendly smile. I sit (knee complaining), and tell him what ails me.
He asks if he can take a look, and has me roll up my left-side pant leg and lay down on the examination table. He prods and squeezes my knee.
“Oh, your knee is quite swollen! Bet that hurts, eh?”
“Yes, it’s been painful lately,” I reply.
“Your knee is full of fluid. That’s why you can’t bend it. Let’s get you some x-rays,” he says.
He jots something down and hands it to the nurse who has been standing quietly nearby. She disappears with it in the direction of the reception area. I am excused for the moment.
I return to the reception area and wait a couple of minutes before being called again.
“Take this with you down to B1 and give it to the person there,” the nurse says, handing me a light-green folder.
I get in the elevator and head down, noting en route that the inside of the elevator smells a lot like weed. I’m 100% certain that weed is not, in fact, the cause of the odor, but curious because I know of nothing else that smells that way. The doors open and I’m standing in the entrance area. The raised floor three feet in front of me and slipper rack mark the way forward as a no-shoes area. The walls are light-green walls and adorned with posters explaining the magic of MRI. (They have an MRI machine here as well, which is another reason why I chose this place.) A thin man in a lab coat emerges and invites me into the x-ray room. Shoes off, slippers on, I follow him back.
We take two shots in quick succession, one from the front and another from the side. It’s over as soon as it started, really. I am given back the folder and told to return to the doctor’s office upstairs. The smell of weed in the elevator is undiminished, as is my interest in the source.
I bide a few minutes in the waiting room and am then called back in. X-Ray images of my knee hang from a backlit panel above Seki-sensei’s desk.
“Not too bad, overall. See that? That’s where the cartilage has worn down a bit. It’s not uncommon, and is most likely the reason why your knee has been painful recently.”
Like most doctors I’ve met here, he occasionally drops English words into long, otherwise Japanese sentences, and usually for difficult or obscure medical terms, perhaps assuming that I won’t know them (true about half the time) or just demonstrating his command of the English vocabulary of his profession.
“The main thing we need to deal with now is that fluid. We can draw that out with a syringe and then pump a bit of lubricant back in there to help smooth things out,” he explains.
Thinking I’m only here for a few weeks I ask how soon I’ll be able to book an appointment to come back for that.
“We can do it now if you want,” he says. “Most people say they feel better right away.”
I don’t normally rush into activities involving the word “syringe,” but the timing was right and my knee could certainly use some love, so… “Let’s do it!” I say.
“Number 18 syringe, nurse, and a <unknown Japanese term>,” he instructs. “Please roll up your pants leg and lay down on the table there, Michael-san.”
I roll up my pants leg and lay back, at which point things move very quickly. I was expecting the doctor to prepare me for the light sting of an anesthetic injection, but no warning (or anasthetic) comes. Instead he, without a word, thrusts what feels like an ice pick into the side of my knee. “nGHAAAA, HURTS IT HURTS!”
“This will only take a second,” he reassures me, as if addressing a 6th-grader. Over his shoulder he says to the nurse, “See what I mean? Japanese people know how to deal with pain.” (Unlike this wuss, follows the unspoken implication.) The nurse makes no comment, but I think she might be smiling beneath her mask.
It goes on for longer than I want it to. Ten seconds, then twenty, thirty. As is typically the case, I have’t been looking in the direction of the procedure. I raise my head a bit and look now, and can see the doctor moving the tip of the syringe around under my kneecap, and kneading the surrounding area to push fluid toward the needle. It feels about like you might expect it would.
“Aaaaalmost there,” he says, and then… ahhh. Relief. I had been taking deep, loud breaths in through my nose and exhaling through my mouth to take my attention off the pain, and now the room was suddenly very quiet. Seki-sensei was looking as me with a smile. “That wasn’t so bad, was it?” he says. Now that it’s over I’m able to agree.
And with that we’re done. He asks me to come back in a week to do it again, and also prescribes some medicine to prevent the fluid buildup and swelling. I return to the waiting room while they prepare the bill and prescription. The three people in the waiting area steal glances at me to put a face to the person who was moments earlier screaming like a schoolgirl in the examination room. I imagine this will make for good conversational fodder that evening around the dinner table.
In a few minutes I’m called and presented with the bill. The visit, x-rays, treatment, and prescription together total around eighteen dollars. When you consider that the $18 is my 30% portion (standard co-pay here) you can see that the entire socialized medicine experience cost sixty bucks. In the US the x-rays alone would cost 10 times that.
Are we in Japan getting all of this for free, with the government subsidizing it all at massive taxpayer expense? Certainly not. I pay health care insurance dues just like everyone else, and for my family of four the cost is around $400 per month. In return I get excellent health care, access to skilled providers and modern technology, abundant choices, and reasonable pricing. (You can read more about the Japanese health care system on Wikipedia.)
But the best part? That would be having access to a public health care system that is designed from the ground up to serve the public, rather than a profit-driven HMO, PPO, or other private system. This excerpt from the Wikipedia page above covers the broad strokes:
Patients are free to select physicians or facilities of their choice and cannot be denied coverage. Hospitals, by law, must be run as non-profit and be managed by physicians. For-profit corporations are not allowed to own or operate hospitals. Clinics must be owned and operated by physicians.
I don’t know about you, but, when it comes to health care, doing it this way seems like a no-brainer. While a free market-based system might offer some assumed benefits such as reduced operational waste or increased efficiency, when you choose it you also have to agree to the rest of the capitalist package. The result? Intense shareholder pressure to continually increase revenue and profits, business health over patient health, information protection over information sharing, and an adversarial relationship between providers and insurers.
As a business owner I’m a fan of the free market system and aware of the benefits it can offer, but does that mean it is the best choice for health care? I don’t think so. Even in a free market system we choose to put many of our most important social services in the capable hands of the public sector. Would you rather have the police handling law enforcement or give that responsibility to a profit-driven “protective security services” firm? What about the fire department? Water treatment and quality? Law-making? Should Blackwater be in charge of enforcing US diplomatic policy?
We don’t rely on the free market in these areas because of the simple fact that a.) serving the needs of the citizenry and b.) the factors that drive the success of a private enterprise are fundamentally misaligned. And health care is a perfect example. The patient-centric ideal of optimal health, minimal need for doctor visits, low incidence of chronic health issues, and avoiding unnecessary reliance on long-term prescriptions or treatments is completely at odds with what would be best for a “health maintenance organization” accountable to shareholders and obligated to produce ever-higher quarterly earnings reports.
I often wonder why this simple fact was so often absent when Obama worked to sell the US public on the idea of universal health care. Equally perplexing to me is how so little mention was made of the fact that “Obamacare” was not and is not a means for providing free healthcare to large swaths of the population at taxpayer expense. People are expected to pay into the system (and do) just as they have always done, but, thanks to Fox News and a curious reticence on the part of the Obama administration to spell out these basic facts, many of us were left with the impression that universal health care is welfare writ large, with all of its beneficiaries new additions to the dole or something. Not true.
So anyway, my horror story? I wish I could tell you it was socialized medicine, but I can’t. I would take the Japanese system over the broken, dysfunctional, overpriced mess that is the US health care system any day. My knee and I are just glad I have access to something so much better. Maybe someday people in the US will as well.