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I recently started practicing on a military base in Japan and refer US patients to Japanese clinicians. Additionally, I myself now have a primary care doctor in Japan and anecdotally experience it through my Japanese family here.
Based on these findings, these results are not very surprising that Japan scores are low. The idea of primary care or a 'primary medical home' seems early here. Subspecialty referrals for things that can be handled in primary care (ie: hypertension to cardiology, asthma to pulmonology, endocrinology for uncomplicated diabetes) are common and expected. The onus is on the patient to track lab results/imaging and return to clinic for those results, track referrals and often wait 4-5 hours to see physician. This is no small feat given much less consolidation and integration in Japan. The independent practitioner is very much alive and well in Japan. Systems are not very integrated so paper is king.
Furthermore, medical litigation / malpractice claims are not at all common. No expectation that a patient should be able to reach their PCP 24/7. Many primary care doctors were former internal medicine or pediatric subspecialists who worked in hospitals and then transitioned to clinic-based medicine after they had saved enough money to open their own clinic or wanted better working hours. This means they did 1-2 years of internship (many years ago) and don't necessary have training the specialty of primary care.
That bei...
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