人と人がつなぐ医療のかたち　Hands-on Healthcare Service Provider

Introduction

In this first column, we are pleased to introduce Dr. Motoki Fujita, who is an advisory board member for Medi Legato and a dentist of M-Y Clinic in Azabu-jyuban. Dr. Fujita is happily shares his feelings of caring and unique medical treatments for patients including travelers and expatriates from both Japan and overseas through the following column of the interview and “My Life in a Day.”

Sonoko Hirose　President & CEO　Medi Legato

Interview

－Why did you become a dentist?

I felt attracted to the work a dentist does, because the result was directly related to what I did.
‘M’ and ‘Y’ in my M-Y clinic represent the capital letter of Magokoro (sincerity) and Yasashisa (kindness) in Japanese, respectively. I thought I wanted to be a dentist for both treating and caring for patients’ mind and body.

－The number of a dental clinic in total in Japan represents about 68,000 (Health, Labour and Welfare Ministry, Survey of Medical Institutions in 2014). This number shows the high number, more than a convenience stores in Japan. And the clinic is in the center of Tokyo, which is a competitive city. Why did you choose Azabu-jyuban in Tokyo? Why did you focus on this place?

Convenience. At the same time, I aimed to have my dental clinic that patients can feel comfortable and be relied on. For example, I give a detailed explanation of the fee and the safety of the material used in the treatment. As some patients are suffering from metallic allergy due to tooth filling, I explain that I will use a nonmetal for a restoration in my treatment.
The clinic provides a relaxing space for patients. We have a private consultation room made of wood. Aromatherapy is also used in the room. I appreciate that patients from Tohoku (locals) and other prefectures, during their Tokyo sightseeing, come to my clinic. We are actively seeing patients from overseas as well. Azabu-jyuban is close to Ginza and Roppongi. Patients who stay at a five-star hotel, such as Peninsula and Grand Hyatt are able to come to the clinic within 30 minutes. They say that foreign patients feel comfortable because the treatment is given by doctors who can speak English fluently. Therefore, concierges at hotels introduce patients to M-Y clinic.”

－I heard that foreign ambassadors in Japan and patients from overseas come to your clinic. Please tell me how you are making efforts to see foreign patients. Also, do you have any challenges?

I try to put emphasis on “First Impression” in meeting patients. I mean, I try to make patients feel comfortable at the first five minutes when they come in, because usually patients who are first time visitors feel nervous in a clinic. Therefore, we avoid using a consultation room mixed with other patients. The reason why we use a private room is for providing a calm space for patients’ diagnosis and treatment. Moreover, dental diagnosis methods differ from each country. It is essential to consider the patients’ environment, cultures and religion that they grew up. Consequently, this gives patients reliable feelings, and they also feel I can listen to their requests for their treatment.
With the globalization of medical fields today, the need for a medical interpreter is discussed. However, basically I think medical staff should explain treatment plans to patients directly. Regarding medical interpreters, I strongly wish opportunities for lectures, such as cultural and customs differences and effective communication methods, could be provided to doctors, nurses and office workers. As for the challenge of accepting foreign patients, the accounts receivable issue is controversial. In the time of the Lehman Brothers bankruptcy, a patient who worked for a foreign bank needed to return to his hometown due to collapse of his office. Although I knew his address and working place in Japan, I missed hearing of his contact information in his country. An accounts receivable of about several million yen has been left because of the large-scale treatment that he had taken. Therefore, I request foreign patients to pay for the medical care fee when treatment is done.

－What is your dream and goal as a dentist from now on?

Through my knowledge and skills that I have acquired, I would like to contribute to improve people’s health and treatment in Japan, developing countries and in the world as well.

On a Saturday

7.15 am

Arrived at Roppongi Station at the usual time. I past Roppongi Hills and stopped at Azabu-juban, where my clinic is located. On the way to the office, I had a breakfast chatting at a coffee shop on Keyaki-zaka, which is attended by regular members. Usually, through communicating with these people (old and young), I can learn a variety of things. One member closed his company and has been enjoying a laid-back lifestyle. Another one is a Vice President of a well-known big company. At this breakfast meeting, we usually talk about events that we experienced during the week. I can get tips for life from the discussions, which is useful for managing my clinic.

8.00 am

Arrived at the clinic.

I check the emails and documents that I’ve received since yesterday. I made a handout and some PowerPoint slides for a lecture meeting. Then I reconfirmed the day’s appointments. The number of patients for today was 15, which is a lot. It was going to be a long day. The patients were from Hokkaido, Nagoya, Okinawa, Nagano and Hong Kong.

10.00 am

Opened the clinic and started working.

The first patient wanted to have a non-metal treatment. This patient was told that he had a metal allergy by a university hospital. I replaced all the metal crowns with ceramic or hybrid resin ones. If I find additional cavities in the initial diagnosis, I treat them as well.

In case of serious metal allergies, all metal used in oral cavity needs to be removed. However, the truth is that ‘metal base’ of the crown is not removed. Only the top parts are replaced with ceramics.

The Minamata Convention on Mercury is not well-known here in Japan. Despite the danger of amalgam (which was recently recognized at the Convention), the degree of its recognition is low in Japan. There are still a number of people that have been treated with amalgam. In Japan today, the amalgam treatment is not conducted in the major cities; the treatment is still done in some rural areas. Through my work, I have seen patients from other parts of the world, from America or Europe, with amalgam in their mouths as well. It seems that regional / geographical characteristics can be related to the incidence of amalgam in patients.

1.00 pm

An emergency call was received from the concierge at a hotel in Tokyo. The concierge related that the daughter of a hotel guest expressed pain because the wire of her dental brace had come off. The problem was that they could not go back home in to London for a month. They were supposed to stay in Kyoto and Osaka after their one-week stay in Tokyo, and then go back to London via Paris. They called their orthodontist, and the doctor advised them to have a new wire attached to the brace for her in Japan. The concierge had already contacted several dentists refused the treatment.

I contacted Dr S, an orthodontist I know well. I asked her if she could respond to an emergency case. I explained the time required and cost for treatment, and we had discussion. I asked the concierge to bring the patient to my clinic at 5.00 pm to receive some treatment before heading to the orthodontist together.

4.00 pm

In the middle of treating a patient, the clinic’s door opened, and I heard a voice crying ‘It hurts! It hurts!’ A boy in the neighborhood ran in by himself crying with his hand on the cheek. I could finish treating the current patient twenty minutes earlier than estimated. I explained the situation to the next patient and she was kind enough to let me treat the boy. I was relieved that I could treat the boy promptly.

The boy had fallen down on the street. One of his front teeth was quite loose. I also found a cut in his gum, and it was bleeding. Luckily, the tooth was not broken. I fixed the tooth to the gum properly and disinfected the gum. I called his father and asked him to come over and take his son home. I explained the condition to his father and gave the boy some medicine. I asked the boy to come back to the clinic tomorrow as well. The next day was Sunday, so through the boy’s case today, I realized opening a clinic on Sundays could be helpful for patients. After the treatment, the boy was relieved and started to talk about kindergarten.

5.00 pm

The girl from the hotel came to the clinic with her father. The brace’s wire had split, and it was stuck in the gum. I cut the wire off and disinfected the injured gum. I also made sure that there was no other injury or pain. We all went to visit the orthodontist together. In the taxi, I explained the patient’s condition to the orthodontist.

6.00 pm

Arrived at the orthodontist. Before commencing treatment, the orthodontist and I discussed the wire and instrument to be used and the total costs to the patient’s father. The father understood and consented. When I came back to my clinic, I made a medical report with details of the treatment for submitting to the patient’s orthodontist and their insurance company in London.

7.00 pm

I presented the day’s cases at a study group meeting for young doctors.

1.00 am

I looked back over the day and looked ahead at tomorrow’s scheduled surgery and appointments at the clinic.

Finally I went to bed.

・Glossary
Non-metal treatment:
The symptoms of metal allergies are sometimes caused by reaction to the metals used for dental treatment. In this case, all metal needs to be changed to non-metal materials. Regarding palmoplantar pustulosis, some cases show that it is fully cured by removing all the metal in the oral cavity. No significant improvement was observed over a long period of application of steroid, perscribed by dermatologists.

Regarding dental treatment fees for foreign residents in Japan:
In Japan, the government has developed the system of the public health insurance for the whole nation. Either National Health Insurance or social insurance is applicable to Japanese citizens. They are also applicable to foreign residents in Japan as long as they meet certain requirements, and they can receive treatment covered by insurance. However, it is not available to tourists or short-stay visitors to Japan. Therefore, they need to be insured by private insurance companies.

At our clinic, we prepare documents responding to foreign nationals’ private insurance (if patients have time to come back to the clinic, they can receive those documents at the next visit) but not many dental clinics accept it because documentation and the related correspondence are complicated and time consuming.

In Japan, the number of patients from overseas is increasing; this will become an inevitable issue.

Minamata Comvention Mercury:
http://www.mercuryconvention.org/Portals/11/documents/conventionText/Minamata%20Convention%20on%20Mercury_e.pdf