Staff writer

OSAKA — Yoshiko Tsujimoto, 51, is not joking when she says she’d be happy if the last thing she did in life was to offer one more patient counseling over the telephone.

It was in fact her life goal to help ordinary people exert greater control over their health care that prompted her to set up the nonprofit group Consumer Organization for Medicine & Law almost a decade ago.

Unlike other citizens’ groups in this field, COML’s primary goal is not to challenge doctors and medical institutions over their arrogance and secrecy, but to encourage ordinary people to take them on themselves.

COML hopes to help create better patient-doctor relations by encouraging the former to get actively involved in their own treatment.

Before starting the group, Tsujimoto worked for a Nagoya-based citizens’ group providing support for plaintiffs in medical lawsuits.

“Listening to (their) many complaints … I wondered why they remained so passive and fully reliant on doctors,” Tsujimoto said. “(It’s only) when something they don’t like happens, (that) they start complaining.”

She also realized that the people who dared to take legal action represent only a fraction of those experiencing problems with doctors and hospitals, and that lawsuits alone cannot change the medical world.

Believing the problem to be urgent and doctors unlikely to change their attitude toward patients in the near future, Tsujimoto reached the “obvious” conclusion that patients themselves must play the leading role in their own health care.

If people ended their passivity and educated themselves about their own health and began questioning their doctors, she said, “they would become a more powerful force to bring change.”

When she launched COML in September 1990, people expected little from the activities of a housewife with no medical expertise, Tsujimoto said. But she saw this as no great disadvantage, because it made COML accessible to everyone — as demonstrated in the diversity of its members’ ages, professions and backgrounds.

The group’s neutral position between patients and doctors, she added, allows it to say what it needs to both sides.

But just how much can nonexpert telephone counseling help?

According to Tsujimoto, the most important function of the group is to listen and help callers understand that they are in the best position to solve their own problems.

For example, when a 67-year-old woman with high blood pressure said she was confused about the seven types of medicine prescribed by her doctor, a COML counselor helped her get details on the purposes of each. Then, so equipped, she could question her doctor on the drugs’ advisability.

A 30-year-old woman diagnosed with uterine cancer who was advised to undergo surgery that would make her infertile was encouraged to get a second opinion — a virtual taboo in Japan.

“They seem to feel relieved after we (talk with them), then they are able to recover themselves,” she said. “We let them know that they are not alone, and sometimes give them advice. That’s about all we do.”

That the counseling is offered over the phone is an advantage in itself, according to Tsujimoto, because people feel more at ease and talk more freely than they might do face to face.

Expanding from its counseling and monthly newsletter, COML’s activities now include hospital tours and monthly gatherings to discuss a variety of medical issues.

Of course, many medical professionals are involved, but Tsujimoto still insists that ordinary citizens must be at the core of her activities.

The group gradually gained the attention of the Health and Welfare Ministry, which asked COML to help it draw up a 10-point list of principles for patient-doctor relations. The document was issued in July 1998.

Among other things, the list recommends that patients prepare memos on what they would like to tell their doctors, assume responsibility for creating a better relationship with medical professionals and be candid in asking questions if dissatisfied with the explanations they are provided.

Tsujimoto says she has seen some changes in the field. For one thing, she said, patients are increasingly aware of their right to be informed of their condition and are becoming more knowledgeable about medical issues in general.

Doctors and medical institutions, for their part, are becoming more conscious of their need to better serve patients to survive in a competitive market, though many admittedly do not yet know how to accomplish this, she said.

To create a better relationship with patients, she said, doctors and hospitals must become more accessible and disclose more information about their patients’ medical conditions.

She specifically recommends that institutions provide counseling for patients to explain everything from medical fees to issues of health.

Tsujimoto would also like to create an environment in which patients feel free to seek second opinions.

In a step to further expand its activities, COML launched a new study group in August on policy proposals for the government.

Pointing out that medical treatment in Japan is coming to a crossroads with private businesses entering the market and patients gradually increasing their demands, Tsujimoto said she is not afraid to undertake the number of projects that groups like COML must.

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