KEEP CALM AND READ BETWEEN THE LINES-a doctor at the beginning of May and what I have found in my first experience of telemedicine with patients.

Daily routine for patients with cold has been changed.

My previous routine when I had a patient was that nurses check the temperature and blood pressure and that I will see him with checking with his face color, throat, neck, eye and chest sound... then diagnose him. 

Now, this has been changed...
When I see the patients with slight cough or fever...any type of fever, I ask the nurse to take X-ray as screening, checking O2 saturation and body temperature. 

PCR center didn't work even though the internet said it worked.

The area the clinic is located at has PCR checking center. The news was astonished and gave us hope because it can release our life from COVID19. Without it, we should treat all the patients with either cough, fever or sore throat as COVIT19 suspects, which means the clinic needs to prepare PPE (Personal Protective Equipment). 

The clinic

The clinic I sometimes work at is a very small and incredibly old style clinic located in a suburban area in Tokyo because the location was never convenient and the only with small X-ray equipment and a couple of staff. Of course, there is nor rapid blood CBC testing and chemistry testing. But it inspires my sense of clinical practice. 

Prescribing drugs for 2 months, and seeing patients through phone.

A couple of patients who have come to the clinic called on the clinic to ask the prescriptions without seeing the doctor. In Japan, there are no rules how long we can prescribe the daily medication but generally, doctors can prescribe drugs for patients for 2 months at maximum.

Another couple of patients asked the doctor to talk through the phone. When I talk through the patients, we had some time to think about what topic we should talk about. I talked to two patients with high blood pressure and both of them have no preparation for the call.

"Good morning ○○-san, how are you?"
"Hello doctor, there's no change."
"Great, how much was your blood pressure today?"
"Well, I haven't measured it yet, but it was 130/75 last night, almost every day the blood pressures are same."
"Okay. How do you spend your life under the COVID19 situation?"
"Not that great change but my weight seems to increase."
"How much is your weight now?"
"Well, sorry I don't measure it."
"Please weigh once in a week. You need to control your life by yourself. But do not feel pressured. Just tracking the date leads you in the right direction. Please tell me the next time."
"Okay."
"So, I will prescribe your daily medication for 60 days. The length is long just for this special period."
"Understood."
"Please keep safe and healthy. See you next time!"

What I felt was we could share the patient's info beforehand like the first-visit patients. Sometimes patients don't have any equipment to measure their necessary physical data. 

Moreover, I couldn't see the face color and mental status through phone calls. In my opinion, seeing patients only with the phone should be applied on the limited cases because I can't see their face. 

Most of the clinic in Japan has no phone inside the outpatient rooms because Japanese love to see doctors. 

If you are interested in other interesting features, you can visit this blog:
https://www.tofugu.com/japan/medical-system/

"A friend of mine who speaks excellent Japanese went to a gynecologist. She was led to a room where one wall was just a curtain. A disembodied voice told her to take the clothes off her bottom half and sit in a chair. Since her feet were cold she kept her socks on. They were cute socks with mameshiba's face on them. Mameshiba is a half-dog, half bean who loves trivia. My friend sat down in the chair stripped to the waist apart from her cute socks and waited. The voice asked her if she was ready. She said yes, but she certainly wasn't ready for what happened next. The voice said, "ugokimasu !" which is usually said when buses depart. Suddenly the chair lifted up, spread her legs apart, and swiveled around. Her feet swept the lower portion of the curtain aside, but the upper curtain still hung down, separating her from the doctors and nurses on the other side. One of the nurses exclaimed, "Ah! Mameshiba!" in great surprise, when she saw my friend's socks."


As mentioned here, there are actually communication gaps sometimes (I would say not often) even among Japanese because Japanese culture has the habit of reading between the lines on human communication. Moreover, I just felt the lines are getting somewhat bigger when communicating through phone because we have to get the emotional factors only from patients' voice tones and pitches.


So, all you have to do is...
"Alternatively, if you are simply visiting Japan, all you have to do is get travel insurance. It is usually pretty affordable. With it you can enjoy your trip without worrying about what will happen if you fall down some shrine steps or have a bad plate of fugu."

Because...

"Around the world, Japan's healthcare system is admired for providing good service at a low price. "

And both doctors and patients must KEEP CALM and READ BETWEEN THE LINES.

*The conversation and the story introduced here are fictional.