Dear incoming minister of health,
Japanese travel guides advise visitors that there is seldom any reason to tip in Japan. Luckily, tourists rarely have any reason to visit Japanese hospitals, or they might be in for a rude awakening.
A Japanese relative of mine’s long battle with Parkinson’s disease has slowly been coming to its inevitable conclusion. Being minister of health, I’m sure you’re aware that Parkinson’s is a degenerative disease that attacks the central nervous system, impairing motor skills and speech, and that there is no cure. As my aunt gradually lost the ability to walk and feed herself, she began requiring increasingly long periods of hospitalization.
During her time admitted to a private hospital in Tokyo I’ve learned something new about tipping in Japan. While it may not be standard practice in most of Japan’s service industries, it seems to be common in at least one hospital. I’ve heard that handing over cash-stuffed envelopes to doctors is officially illegal, but it would appear some of them need a friendly reminder from your ministry.
Initially, the hospital would only admit my aunt for periods of a few months at a time then discharge her back to my family’s care. To ensure future admission to a very busy hospital she felt compelled to hand over envelopes containing several tens of thousands of yen to the head doctor with each admission and discharge from the hospital.
Making matters worse, hospital staff took their lead from the doctors, so the culture of tipping in this hospital extends down to most of the nurses, rehabilitation staff, and even student volunteers. While a few individuals refused to accept tips, most staff seemed to expect payment for even the most basic and necessary tasks.
For example, assistance to reach the toilet or the pay phone down the hall meant a ¥1,000 gratuity. Until my aunt became completely bedridden and reliant on feeding tubes, she typically spent ¥30,000 a week in tips to nurses and other staff. Other patients who wouldn’t or couldn’t pay found staff slow to respond to their call buzzers, or they never came to help at all.
Making matters worse, some hospital employees confuse this culture of tipping with a sense of entitlement. Imagine our anger when we learned that one of the caregivers on the night shift would take advantage of our aunt and other sedated patients by eating our gifts of mandarins and watching TV using the pre-paid cards we bought. Our complaints eventually led to the staff member’s transfer to another floor of the hospital. Unfortunately for the other patients, the hospital failed to fire the employee.
I find it impossible to believe that this problem is limited to this one hospital, so I urge you as minister of health to take strong action immediately to stamp out this practice of tipping hospital staff. As Japan’s population continues to age and children are no longer able or willing to care for their elderly parents and other relatives, the standards in the nation’s hospitals and extended care facilities will continue to rise in importance. The future electoral health of the Democratic Party of Japan may depend on addressing this problem now.
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