Do I really need this operation? Is this medication really good for me? Does my doctor really know what ails me?
Who can you trust? Which of the following leading Japanese businesses, for example: Nissan Motor Co.? Subaru Corp.? Toray Industries Inc.? Kobe Steel Ltd.? Mitsubishi Materials Corp.? KYB Corp., which manufactures earthquake shock absorbers? All, within the past 14 months, have publicly admitted deceiving the public and/or government regulators regarding the quality of their products.
Can you trust the government? Even after the Finance Ministry’s June admission of having falsified documents pertaining to the discounted sale of state-owned land to school operator Moritomo Gakuen? You can if you want to. But would you if your life depended on it?
“Post-trust” joins “post-truth” as a buzzword of the age. Shift the focus from business and politics to medicine, and your life may very well depend on who you trust, if there’s any trust left in you.
There’d better be. An aging society needs medical support. The doctor-patient relationship is crucial to people in their 70s, 80s, 90s and 100s. It’s crucial to anyone who is ill. Illness makes us aware of our bodies in a new way. We’re suddenly face to face with a fact rarely considered in health: Our bodies are total strangers to us. Most of us know nothing of their inner workings. There’s no relying on our own judgment. We turn to doctors as oracles. They “know.”
So it was in the old days, not so very long ago, when questioning a doctor’s diagnosis or treatment was an outrageous breach of manners — or worse. The doctor in whose healing hands your fate reposes is the last person in the world you want mad at you.
Even today, reports Shukan Post magazine, the “second opinion” concept in Japan is shallowly rooted. Patients hesitate to procure one. Only 30.4 percent of those who thought they wanted one actually sought one, a health ministry survey found in 2011.
Deceit is, of course, corrosive to trust, and a growing feeling that deceit is pervasive — which the term “post-trust” expresses — will undermine trust even when, as here, dishonesty is not the issue. Consider, for example, as Shukan Post invites us to, this relatively benign instance.
A 72-year-old man receives from his doctor a prescription for medication to counter his high blood pressure. Something in him recoils — he knows not what. Certainly he does not suspect the doctor, with whom he’s had satisfactory dealings for eight years, of callously playing on his ignorance and gullibility to promote the sale of medicine the patient doesn’t need. On the other hand, is it impossible? Don’t other people do worse things? No doubt they do. Still, one mustn’t let fuzzy and formless suspicions get the better of one. If the medicine is necessary, it must be taken — but is it necessary? Should he get a second opinion? But what would the doctor think — that his honesty and competence were being impugned? That would be unjust.
“I couldn’t bring myself to speak out,” he tells Shukan Post. “But I was worried.”
He filled the prescription, took the medicine and the story ends happily and uneventfully — he feels fine.
Shukan Gendai magazine, pursuing a similar theme, presents a more critical case. A 61-year-old man found himself urinating frequently and painfully. He went to a neighborhood clinic. Bladder infection, said the doctor. He wrote a prescription.
A month passed. No change. If anything, worse. He returned to the clinic. “It’s all right,” the doctor said. “Just keep taking the medicine.”
Another month passed. Still no change. Seriously alarmed now, he went to another clinic — where the diagnosis confirmed his worst fear: “Bladder cancer.”
It’s under control; he’ll survive. If he’d allowed trust to overrule his anxiety, however, he may not have gotten off so lightly.
A 71-year-old man, Shukan Gendai tells us, began suffering headaches. It’s nothing, he told himself. Then his vision became distorted. He’d better have it looked into. An MRI scan revealed a brain tumor. The doctor recommended an operation.
No, said the man. A knife cutting through his skull — he would not have it. The doctor, a young man in his 30s, stood firm. An operation was the only hope. The patient’s wife and son were convinced. The patient himself was not. Let the doctor say what he liked, he would seek a second opinion. He did — as a result of which, under medication and radiation, the tumor is shrinking.
Second opinions are no panacea. As easily as they can set right an initial error, they can strike down an initially correct judgment. Imagine the bladder cancer case reversed. First diagnosis: cancer. “Impossible,” the patient cries. His very terror drives him to seek a second opinion — which is: nothing, a mere infection, take these pills, you’ll be fine. Swooning with relief, the patient fills the prescription. And subsequent events show — either one thing or the other. He recovers and blesses the fates that protected him from superfluous cancer treatment. Or … he dies, cursing himself on his deathbed for not trusting the first doctor.
Shukan Post warns of another potential danger in second opinions. Might it lead to “doctor shopping”? You go to this doctor and to that doctor — why stop at a second opinion? Why not a third, a fourth? Keep “shopping” until you hear what you want to hear — finally, at worst, perhaps, falling for some “folk remedy” that promises to cure cancer painlessly and without debilitation, as per the ad in the paper, on TV or online. And what if the folk remedy works after all? Do skeptical “Western” doctors know everything? The disagreements among them that make second opinions meaningful in the first place prove they do not.
A frequent source of doctor-patient misunderstanding, Shukan Gendai points out, is the respective parties’ different points of view. A “successful operation” is one thing to the doctor; something else entirely to the patient. To the doctor, if the illness is cancer, it’s removal of the cancerous cells. To the patient, it’s a vigorous return to his or her old life.
Is the following case a success, or not? A 77-year-old man, healthy all his life, began suffering back pains. Spinal constriction, doctors declared. They operated. It went well. The pain vanished — but at a cost: The patient can’t walk. He’ll walk after rehabilitation, the doctors promised. He didn’t. “To us,” the man’s son tells Shukan Gendai, “the operation didn’t go well at all!”
Big in Japan is a weekly column that focuses on issues being discussed by domestic media organizations.