Kyoto trip with Lin

Lin and I went to Kyoto on my second weekend here in Japan. I’ve been to Kyoto 2 years ago, but I pretty much know all the good spots. It was just for a day but the trip was lots of fun. Here are some pictures:

Lin and I in front of Kinkakuji (Golden Temple)

Geisha!

Kiyomizu Temple (Clear Water Temple)

Outside of Kiyomizu Temple

Nagoya touristy spots

In my first free weekend in Nagoya, I went to check out some of the tourist spots in the city. Nagoya is not a big tourist destination, so a few days of traveling should suffice.

During the second weekend, when Lin (my friend and classmate) came, we checked out Nagoya castle. Here are some pictures:

Some very interesting graffiti on the outside wall of a building in Osu

Osu Kannon - it's basically a temple

The first weekend was right before the Chinese New Year, and I caught this Chinese New Year celebration in downtown Nagoya. Lots of great food (and authentic Mainland Chinese food!)

Oasis 21 - some UFO-like structure in downtown Nagoya/Sakae

TV Tower - it seems like every big Japanese city has one of these

Difference between the US and Japan – Lifestye

It is fair to say that it is not easy to be a doctor wherever you are in the world. We often work long hours, have great responsibility in improving patient’s health, and struggle to balance life in and out of the hospital. Japan and the US have the above similarities, but it is undoubtedly harder to be a doctor in Japan because of its lifestyle.

First of all, let’s talk about compensation, since that’s the most objective parameter. Pretty much everyone that I talk to give me the same figure. Japanese doctors, regardless of disciplines, make anywhere from $100,000 - $150,000 USD a year. Unlike the US where some procedures are not covered by insurance, in Japan everything goes through insurance and thus there cannot be too big of discrepancy in salary amongst doctors. It seems the slightly variable salary described above does not stem from disciplines, unlike the way it is in the US where orthopedic and plastic surgeons make much more so that it is very competitive to get in. In Japan, doctors with lighter schedule (i.e. dermatologists) often run a clinic on their own outside of hospital practice in order to make more money to reach that $150,000 figure above.

But do they work less because they make less money compared to the States? NO! During my month here, I saw how hard the doctors work here. A regular schedule for a surgeon is from 7:30am to 10-11pm, and this is the schedule for attendings! One of my surg onc friends, Kazu, told me that he’s coming to work EVERY DAY. It’s just that on the weekends he can work half-days. I asked why he can’t just let other surgeons take care of his patients on weekend, and he told me that there is no such “team” system in Japan. Each attending cares for his/her own patient. I think this phenomenon echoes my prior entry on how the system here can be very inefficient and “hopeless”.

It is very interesting to compare and contrast the two different systems in Japan and US. In US, we b@#%h all the time on doing scutwork and working long hours “as a resident”, but we don’t realize in other parts of the world, even the attendings are treated more poorly than the residents in the States. All in all, it makes me realize how fortunate I am to be a medical student and soon-to-be doctor in the US.

Leaving for the US tomorrow!

What a great month I had in Japan. I wrapped my visit today with a good friend Kazu and his family to tour around Nagoya. He brought us to a very nice restaurant for lunch; we had shabu shabu (Japanese hot pot) and blowfish sashimi! I will post photos when they're uploaded later.

I have to say I feel very bittersweet that I am leaving. Although I'm eager to go back to NOLA, I feel so indebted to these great friends in Japan because they have been incredibly nice to me. I hope these friendships can last for a long time and I will get to be a host for them someday.

Last Day at work!

Today marks the last day at work in Nagoya! I know I have been lazy updating my blog but it doesn't mean I did not have a great time. The friendships I made here are incredible and I am sure I will get to keep in touch with them for a long time to come. Here are some photos I took on my last day at work:

The cardiac department staff. They're all super nice to me and took care of me during my stay there.

Aki and I. She is the secretary of the int'l exchange program. We went out one night and had lots of fun at a Japanese bar (Izakaya)!

Dr Kasuya and I. Dr Kasuya is the director of the int'l student exchange program. Also took care of me very well.

Like my Uganda traveling blog, a lot of my entries from now on will be not real-time, meaning I will type it up in work document and post here.

Difference in Education continued – Hierarchy

As I alluded in the previous entry, there seems to be a lot of defined roles in the Japanese medical system and there is very little fluidity. I understand hierarchy in medical system is often necessary to ensure efficiency and patient safety, but I feel that the Japanese hierarchy is often time-wasting, un-educational, and hopeless. For example, we US students and residents often complain about the scutwork (blood draws, transport, etc) being un-educational and decrease the work efficiency. In Japan, scutwork is all they do, with the exception of professors. From what I have heard, the internship and residency training in Japan is pretty much all scutwork. There is very little emphasis on education. Interns/residents learn important management skills by watching, and there is very little time for organized lectures and teaching because it is so busy in the hospital.

In terms of surgical cases, the attendings cannot operate on their own; they must wait for the professors to arrive to begin the vital part of the operation. For a CABG, attendings can cut open the chest and start harvesting internal mammary artery, but the actual CABG must be done by the professors in most cases. Therefore, I often see some attendings hold retractors and suctioning for a few hours in a case (just like what med students do in the US) until the professors finished the vital part of the case. It is therefore not difficult to understand that Japanese doctors often have lots of gripes about their work condition and want the autonomy that they think they deserve.

Differences between the US and Japan - Education system:

I will attempt to do a brief analysis from the top down: “professors” à attendings à residents à medical students. The first day that I started working in the cardiac surgery department, I noticed a big difference from the US: there was no resident! The cardiac surgery department has about 10 staff surgeons, but only 3 of these 10 have the “professor” ranks. The professors usually are much older (at least 50) and have more experiences in operations. The other 7 are just attendings. How this works is that the “professors” are the real first operator in the OR, and the other attendings were merely assisting them during the case. Occasionally, the attendings will get to be the first operator, and the professors will assist, but these are only in straight-forward cases. Therefore, the attending surgeons actually act like the residents in the US in my opinion.

So where are all the residents? Apparently, most residents work in community/county hospitals where the standard of care and complexity of cases are lower than an academic hospital like Nagoya. It is interesting to note that in Japan, medical students graduating from med school will go do a 2-year internship year (very similar to the transitional year in the US, where they do rotations in all disciplines), and then go into specific residency of their choice. To specialize in some disciplines like CT surgery, there’s technically no “fellowship” like in the US; the residents that are finished with their residency will get hired by the specific department and start their training there (it’s more like an apprentice, in my opinion.)

Finally, onto med students. The medical education in Japan is like everywhere else in the world (except for the US). High school graduates enter medical school at the age of 18 years old. It takes 6 years to get an M.D. degree. Therefore, most med students earn their MD at 24 years old, which is A LOT younger than their counterparts in the US (around 28 years old, I think.) When the Japanese med students do their clinical clerkships, they are mainly just observing. In the OR, med students really just stand around and can’t touch anything. They are allowed to scrub in, however. But scrubbing in usually makes things a lot worse for med students, because they cannot really move much to get a better view of the surgical field.

In summary, I feel that the med students in the US are really acting like interns in Japan in terms of what we can do (writing notes, assisting in surgeries, etc). The Japanese system seems to be more fixed and it definitely takes longer to gain autonomy amongst doctors.