A focus on family care

One doctor’s quest to revamp the Japanese family medicine model

More than 30 years ago, Michael Fetters was a high school exchange student from Hilliard, Ohio, studying and living with a local family in Kikugawa City in the Shizuoka Prefecture of Japan.

Last fall Fetters, an associate professor of family medicine at the University of Michigan and director of U-M’s Japanese Family Heath Program, hosted a delegation of mayors and hospital executives from Shizuoka in a visit that marks a partnership at the heart of his life’s work.

The Japanese Family Health Program was recently awarded a $1.4 million grant from the Shizuoka Prefectural Government to establish a family medicine residency training program and help Japanese doctors revamp the way family medicine is practiced in Japan.

“The partnership is really a culmination for me of almost 20 years of working to promote family medicine in Japan along with my colleagues who share a similar vision,” says Fetters. “After years of making the sales pitch for family medicine in Japan, we found three mayors and three hospital CEOs who were willing to support it.”

The residency program has already hosted four doctors from Shizuoka Prefecture in its inaugural class.  The second class of the Shizuoka Family Medicine Program begins April 1.

U-M is lending its expertise to a country that finds its medical system in crisis, Fetters says, and the four-year grant is part of a larger $8 million effort undertaken by the Japanese government to improve medical care in rural areas. Like in the United States, Japanese physicians tend to practice in metropolitan centers at the expense of rural areas.

One of the main problems, Fetters notes, is that young physicians are driven from hospitals into private practice by extremely long hours and low pay. Many of these doctors have trained for five to 15 years as specialists in a particular area of medicine, such as cardiology, but find the majority of their work is general care. They aren’t adequately prepared to be community physicians dealing with anything and everything — expectant mothers, sick children, troubled teens, adults with chronic illness or elderly patients with dementia.

The 10-person delegation – which includes the mayors of Kikugawa City and Morimachi Town and the directors of the Iwata City, Kikugawa General and Morimachi Public hospitals – visited University Hospital, the Japanese family clinic at Domino’s Farms and Chelsea Community Hospital to get a firsthand view of how family medicine is practiced and how it’s integrated into academic and community hospitals. They also met with the mayors of Ann Arbor and Chelsea.

“That one of collaborating cities is where I lived 30 years ago amazes me,” says Fetters.

Family medicine is just getting a foothold in Japan and the delegation will observe various aspects of patient care while exploring how family physicians might be better integrated into their health care system.

At the Japanese Family Health Program clinic, which specializes in culturally competent care, the delegates were able to “see with their own eyes what the breadth of care by a family physician can look like for Japanese patients,” Fetters says.

About 80 percent of the Japanese population the clinic serves relocated to Southeast Michigan to work in the auto industry; most of the other 20 percent are affiliated with the University, Fetters said.

Now in its 16th year, the program has seen more than 60,600 visits, 580 deliveries, 7,000 executive physicals and had 1,000 attend prenatal classes. The program seeks innovative approaches to transcending cultural barriers. One faculty member, Dr. Masahito Jimbo, an associate professor of family medicine and urology at U-M, develops podcasts about health topics in Japanese. And under the leadership of Dr. Sahoko Little, the program recently started a group prenatal care class for expecting mothers and fathers.

Providing culturally competent care is more than just overcoming linguistic differences, Fetters notes. There are significant cultural differences, too – for example, some Japanese patients tend to worry that medicine prescribed by American doctors will be too strong for them because their bodies are generally smaller than Americans’ bodies. Understanding those concerns and proactively telling patients that their medicines are right for their body size means the patients will be more likely to stick to a regimen.

Health care providers also need to be attuned to subtle social cues. For example, a Japanese woman who comes to a doctor with a complaint of a “stiff shoulder” may be trying to communicate that she feels depressed, Fetters says.

“We call it ‘anticipatory guidance,’ ” Fetters says. “Given our understanding of cultural differences, we anticipate patients’ fears and are able to deliverer a higher quality of care.”

Ian Demsky is a public relations representative in the U-M Health System’s Public Relations and Marketing Communications department. This story originally appeared in the UMHS newsroom.