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.