[Omnipotent medicine] I heard this interesting fact about my former colleague who has recently left Japan to his new home, USA, to join an academic hospital there: He has been a long-term patient of nephrology (kidney disease). One day, he received a new prescription for his blood pressure medication. But he forgot to take it, and later on he met with an accident. For several days, he was in critical condition. But the doctor from Tokyo’s famous Ryojun Hospital, said that there was nothing we could do. He said that his condition was caused by lack of the blood pressure medication, and the doctors in his department agreed that there was nothing to do about it. It turned out that, in fact, he had been taking the medication. What he had been told by the previous hospital, however, was different. They thought he did not take it, as they thought he was not taking any medication. At that time, his blood pressure was out of control and he was in critical condition. A week later, he was OK. What was the problem? The hospital that he used to be under was not very good in communication. They did not inform the new hospital about his condition, and the new hospital assumed that he had been non-compliant, and sent him back to the old hospital. From this one incident, he knew that the previous hospital must have made a serious mistake in medical treatment. The Japanese are known to be “superior” when it comes to “human relations”, not so much medical ones… (laugh) In the past, we received a telephone call at about noon from the hospital administration. The hospital was located in a remote mountain area. We were told that a patient was in critical condition. He must be transferred to the hospital right away, as he was not expected to live without treatment. We went there as fast as we could. As we arrived, they told us that the patient was in the intensive care unit (ICU). After about half an hour, the patient was moved to a regular room. Even so, his condition was very critical. He was not expected to live until the following morning. When we left the hospital, he told us that he wanted to be discharged. He had not eaten any food for two days, and felt bad all over his body, especially in his legs and arms. We had to think twice about what to do. On the one hand, we wanted to keep him there for the further treatment, but on the other hand, if we did not release him immediately, he might die during the night. What shall we do? He must have a right to know, as he would not have been there if it was not for his critical condition. We should let him decide himself. We called the family and tried to reach him. Finally, his wife answered and informed us that he was still asleep. She asked us to tell him that his condition is critical and he should decide himself, but she would not be in a position to decide on his behalf. So she would let us know what she decided. We continued to call him and finally he woke up. We explained to him his condition and asked him to let us know what he thinks about whether he wants to be discharged or not. He answered that he was fed up with being in the hospital. We thought that he would leave, but what he did was just the opposite. He said: “Please let me stay here.” Then we said: “If you want to stay, I will do my best, but I cannot promise that you will not die during the night.” In fact, it was a life-and-death situation. His medical condition was critical, and he could be transferred to the ICU again. He stayed in the hospital overnight, and we had to take good care of him all the time, including putting in extra resources such as doctors, nurses and the like. Finally, we succeeded, and he survived. He used to be very fit, but he had been hospitalised five times in the past ten years. Maybe that is why he decided to stay in the hospital now. However, after being so ill, he must have regained his health. (laugh) A lot of times, we had to decide whether to continue the treatment or release the patient. Even so, when patients became weak or were in critical condition, we had to keep them in the hospital. In one case, the patient had been put on a life-support machine when he became brain dead. That is also one of the reasons why we should keep in good condition and continue to learn medicine. If you want to keep in good condition, there is no way out. Medicine must be kept in its proper place. If you want to succeed, you have to practise hard, day after day. He was very thankful and said that he wants to come back for more treatments. If you are aware of such cases, please let us know if any of the hospitals did not follow the rules and standards. And of course, if you need any medical treatment or medical help, let us know. We will always do our best to take care of you. (laugh) How do you rate a particular hospital? The reason why the story above was published is that two years ago, when the hospital was under new administration, I received a special phone call from them about the hospital. One day, one of the physicians from the hospital called me, asking for the permission to publish the story on the hospital website. “If we do so, how do you think this would affect the hospital?” I asked. He replied: “We would like to have such a good reputation. It would be a great contribution if we succeed in achieving high quality medical care.” I agreed, of course, and we asked them to send the story, which the editor-in-chief then approved. When I asked him about it, he replied that there was no problem to publish this story. “That’s good,” I replied. “But why do you ask?” “We would like to have the story for our website,” he said. “It will be very helpful if you can help us out.” “Ah, I see,” I replied. “I thought you had come here because you wanted to publish this story. I am very glad you wanted to use it for your hospital.” (laugh) When the writer called me back, he also said: “The editor-in-chief was very happy with this story, too, and he is very glad that I called you. He wants to use it for the hospital’s website, too.” We agreed that the story could be included in the hospital website, and then we sent him all the information and photos that were needed. When it was posted on the hospital website, one of the physicians from the ward called me, saying: “We are very grateful for your help. I am the first one to read the article today. I do not know why they call me, but I would like to thank you.” It is a pity that the hospital has already changed its administration and the new leader wants to retire (laugh). The previous administrator was a very well-known doctor from the university hospital. He was very good at treating patients, but he was not good in dealing with his own people, including the staffs of the hospital. My previous colleague was under his supervision at that time. Since he was still young, he had to deal with a lot of things on his own. He could not do it all. Some people said: “I do not have the time to do so. I have to work harder, even though I am sick. I wish I had the time, but it is not possible.” That is one reason why many people cannot reach the same level as well-known hospitals in other countries. They do not have a chance to see things from different angles.