National

Mie doctor finds niche in after-hours clinic

Kyodo

A 31-year-old doctor is endeavoring to alleviate the problem of emergency room overcrowding in Matsusaka, Mie Prefecture, by running a night and holiday first-aid clinic.

Masashi Ryosetsu opened Ioji Okyu Clinic in November 2015, hoping to stop people from treating hospitals like “a convenience store” for minor ailments and unnecessarily using already-stretched ambulance services.

“If emergency rooms become too busy, doctors cannot find enough time for patients really in need of treatment for serious injuries or diseases,” Ryosetsu said.

“A senior doctor I respect has quit (an emergency room job) because he was so exhausted.”

Ryosetsu described a case last year in which a man came to his clinic on a Saturday night with his 4-year-old daughter who was complaining of a sore finger — a situation that may normally require a trip to the emergency room if no other option is available.

Using a toy to help with his diagnosis, Ryosetsu told the father, “There should be no problem,” before sterilizing the reddish spot and prescribing an ointment.

On that Nov. 5 evening, 40 people, in addition to the young girl, visited Ryosetsu’s Ioji Okyu Clinic in Matsusaka. They included a farmer who had sliced his knee with a tea leaf cutter, a man complaining of throat soreness and a woman suffering from diarrhea and vomiting.

Matsusaka is a municipality where the number of ambulance dispatches is relatively high.

Even though the city already has a first-aid clinic serving people with minor injuries and ailments on holidays and at night, it only opens for 2½ hours in the evening. Patients who cannot wait until the morning often resort to calling an ambulance.

Ryosetsu said the situation needed to be rectified in order to maintain reliable and sufficient levels of emergency medical care.

But running a clinic open mainly at night and on Sundays and holidays was financially difficult, he said.

Even clinics offering limited first-aid needed a large initial investment in order to purchase equipment for blood examinations and other basic diagnoses. The clinic also had to employ nurses and other workers just like ordinary, larger hospitals.

Patients at such clinics, meanwhile, are irregular and relatively few, and there are no inpatients.

Ryosetsu borrowed ¥50 million to open the clinic and cover initial expenses. He hired four full- and part-time nurses and two clerical staffers.

Initially, the clinic operated in the red, but it has now reached a break-even point after the municipal government agreed to make contributions in recognition of the clinic’s role in cutting ambulance dispatch costs. In fiscal 2016 through March, the clinic received ¥30 million in local government payments.

It is open both day and night on Thursdays, when local hospitals are closed, as well as on Sundays, holidays, and Friday and Saturday nights.

The clinic accepts patients brought by ambulances when medics judge them to not need emergency treatment. But when a person has serious symptoms, the patient is transferred to the emergency room at a local hospital.

“You cannot relax here because any kind of patient can come in,” Ryosetsu said.

He recalled a case in which a patient complaining of chest pain was discovered to be having a heart attack and was immediately taken to a general hospital.

Ryosetsu treated 5,200 patients in the first year of his clinic’s operations, 2,200 more than he had predicted.

In 2016, the number of ambulance dispatches in Matsusaka dropped 3 percent from the previous year to 11,782, the first decline in two years.

The city attributed the drop to the launch of Ryosetsu’s clinic, in addition to other factors such as the local government’s campaign urging citizens to call an ambulance only in a serious emergency, and the popularization of a telephone service providing emergency medical advice.

Last spring, however, the city began to look at ending payments to Ryosetsu’s clinic after a new mayor took office.

But a citizens’ campaign forced the city to back down and it instead committed to continuing its support in fiscal 2017.

Masahiro Tanaka, 60, head of the campaign, said he wanted to support Ryosetsu and his clinic. The group collected about 8,000 signatures and presented them to the mayor in November.

This month Ryosetsu was able to quit his part-time position at a hospital in order to focus on the clinic.

But despite modifying its hours in reaction to changes at the city-run first-aid hospital, it is not known whether the city will maintain its support past this year, he said.

Seeing an opportunity to serve his area’s rapidly aging population, Ryosetsu now plans to hire another doctor to provide in-home medical care to patients during the day.

House calls “should help stabilize (the clinic) and enable me to contribute more to local medical services,” he said.

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