ブログ
Blog
Blog
In this edition of Doctors’ Insight, a series that explores the true faces and convictions of physicians working on the front lines of medicine, we spoke with Dr. Yamato Kikuchi, Chairman of the Medical Corporation ONE Kikuchi General Practice Clinic in Ayase City, Kanagawa.
In today’s increasingly specialized healthcare system, it has become common for patients to visit multiple medical institutions and receive medications separately from different specialists.
If they have back pain, they go to orthopedics.
If they have headaches, they visit neurosurgery.
This style of medical care has become the norm for many people.
Of course, specialized medicine is an essential pillar supporting Japanese healthcare.
However, as people age, physical problems can no longer be explained by a single organ alone. Multiple illnesses, medications, living conditions, family circumstances, and anxieties intertwine and appear as a person’s overall condition.
What Dr. Kikuchi advocates as a “general practice family physician” is a doctor who continuously understands a patient’s illnesses, medications, test results, lifestyle background, and anxieties, while connecting them to specialized care when necessary. In other words, such a physician serves as the “starting point” overseeing the patient’s entire medical care.
Rather than choosing hospitals according to symptoms,
patients first consult “the doctor who truly understands them.”
What Dr. Kikuchi is trying to convey is a form of healthcare that may seem entirely new for the future of Japan, yet is actually something very natural at its core.
Dr. Kikuchi:
When I talk about a “general practice family physician,” I do not simply mean “a place for people who don’t know which department to visit.”
Of course, it is important to support patients when they are unsure where to go. But ideally, one physician should continuously oversee the patient’s overall condition.
Today, many patients regularly visit different specialists at university hospitals and general hospitals—neurosurgery, cardiology, orthopedics, and more. Many also receive separate medications from each department.
But ideally, I believe one physician should comprehensively understand all of those medications and conditions together.
If patients see the same general practice family physician every month or every few months, they begin to feel:
“This doctor truly understands me.”
Once that relationship exists, patients no longer have to hesitate when problems arise.
“Which hospital should I go to?”
“I don’t know if I should ask my usual doctor.”
“Could this symptom be related to my medication?”
When such anxieties arise, there should be a doctor they can consult first.
That is my ideal image of a general practice family physician.
Especially in elderly patients, poor health cannot be explained by a single organ alone.
There are multiple illnesses, medications, living circumstances, and anxieties, all intertwined in complex ways.
That is why I believe it is essential to have one physician who understands the patient as a whole.
Dr. Kikuchi:
Modern medicine has become highly specialized. Patients visit orthopedics for back pain, neurosurgery for headaches, and each specialist thoroughly examines their own field.
However, even when no abnormalities are found, patients may still continue suffering from symptoms. As a result, patients are left behind without answers.
For example, one patient had been told by an orthopedic clinic that there was “nothing wrong” with their back pain. But after we conducted a detailed examination at our clinic, we discovered a large abdominal aortic aneurysm and kidney cancer. In other words, the back pain had actually been caused by entirely different diseases.
Of course, specialists are not wrong.
But I strongly feel that there are illnesses and anxieties that cannot be fully addressed by medicine focused only on one specialty.
That is why I try not to stop at “the symptom currently visible.”
Another important aspect is staying close to the patient’s anxiety.
For instance, if a patient appears worried, I always tell them:
“If it doesn’t get better, please come back again.”
For some patients, simply searching for another hospital can already be a tremendous burden.
Through this process of continuing to support patients, we sometimes discover illnesses that were invisible at first glance.
As long as patients are struggling, I want to continue standing beside them.
That belief became the foundation of our philosophy:
“Treat the disease, treat the person, and provide medical care that gently embraces as many lives as possible.”
Dr. Kikuchi:
Today, it has become normal for patients to divide their care among different hospitals according to symptoms.
If they have back pain, they go to orthopedics.
If they have headaches, they go to neurosurgery.
If they catch a cold, they visit another clinic.
Perhaps that system worked in the past for healthy, active people.
But Japan’s elderly population will continue increasing, while the number of physicians and medical institutions cannot grow infinitely.
Under such circumstances, a system in which patients continue visiting separate institutions for each symptom has limits. There simply will not be enough physicians, and it becomes an enormous burden for patients as well.
Elderly medicine is never simple.
Behind one symptom, there may be multiple illnesses, medications, or lifestyle issues.
For example, what appears to be an orthopedic issue may actually be an internal disease.
A headache may stem from sleep deprivation or caregiving exhaustion.
That is why we must first look at the whole person rather than narrowing our focus immediately to one organ.
If a general practice family physician already understands the patient’s overall condition, patients no longer need to feel lost.
They first consult that physician, who then connects them to specialists if necessary.
That flow prevents medical care from becoming fragmented.
I do not want to deny the importance of specialized medicine.
Specialists are absolutely essential.
But to properly connect patients to specialists, we first need physicians who see the patient as a whole.
Dr. Kikuchi:
I believe such a physician is someone “to whom patients can entrust their lives.”
When something feels wrong physically, simply knowing:
“I can talk to that doctor first”
gives people enormous peace of mind.
Of course, discovering serious illness is important.
But equally important is reassuring patients properly when tests show that things are okay.
Especially elderly patients often live with deep anxieties.
“Is this symptom serious?”
“Could this be another terrible illness?”
“I don’t know which hospital I should go to.”
I want to be someone they can easily consult in those moments.
Over time, as we continue caring for patients, we naturally come to understand their personalities, families, medical histories, and anxieties.
Sometimes we notice:
“This person is usually like this, but today something feels different.”
Those changes can only be recognized by a physician who has been closely involved with the patient for years.
Dr. Kikuchi:
First, I ask:
“What is troubling you the most right now?”
Elderly patients often live with multiple illnesses and take many medications. Their symptoms are rarely limited to one issue.
Even when something is not medically severe, problems such as:
“I can’t sleep at night”
or
“I’m afraid to go outside because of pain”
may be the greatest suffering for that person.
That is why I prioritize carefully listening to patients.
For elderly people, simply having a place where they can safely seek advice provides enormous reassurance in life itself.
Patients whose symptoms appear complicated often reveal the true core problem once each issue is carefully organized one by one.
Rather than merely seeing “many diseases,” I try to understand:
“What state is this patient truly in right now?”
Dr. Kikuchi:
As medicine has become more specialized, physicians have gained deeper expertise in their individual fields.
At the same time, however, I feel we are gradually losing the perspective of viewing patients holistically.
What especially concerns me is the growing distance between doctors and patients.
Medicine increasingly relies on objective data such as imaging and test results, while less attention is given to patients’ anxieties and life backgrounds.
The most important thing for a general practice family physician is making patients feel comfortable enough to come see us anytime.
That requires not only knowledge and technical skill, but also the attitude of truly listening to patients and accepting their entire situation.
Otherwise, patients stop coming.
And if they stop coming, illnesses may become irreversible before they are discovered.
I strongly believe this problem must be addressed starting from medical education itself.
The physicians who will support regional healthcare 10 or 20 years from now are the young doctors of today.
Dr. Kikuchi:
It comes down to one principle:
“Anyone, anytime, with any symptom — we see them first.”
Symptoms in elderly patients are extremely vague.
Even among 100 patients with the same heart attack, all 100 may describe it differently.
Patients themselves often cannot determine which department they should visit.
If they can first come to their family physician regardless of the symptom, we can evaluate them and connect them to specialists if necessary.
Creating that flow is essential.
Rather than narrowing our view from the start, we should first look broadly, then gradually narrow down possibilities.
A physician who knows the patient best can also say:
“Perhaps we should have you evaluated at a larger hospital.”
I believe general practice family physicians must become the starting point that prevents healthcare from becoming fragmented.
Dr. Kikuchi:
As Japan’s aging population continues to grow, having someone you can consult first when illness arises will become more important than ever.
Especially for those whose parents live far away, I hope they will think about whether their parents have a doctor they can comfortably consult.
Elderly people often hesitate, thinking:
“Is this really serious enough to visit a hospital?”
Or they simply do not know which department to visit.
That is why we need general practice family physicians who serve as the entry point for any concern.
“I think this symptom can safely be observed.”
“Let’s have a larger hospital examine this.”
“I don’t think you need to worry too much right now.”
Helping patients and families organize their anxieties and think through the next steps together is also an important role.
Because medicine has become more specialized and information has become overwhelming, many people feel even more uncertain about whom they should consult.
That is why I want to be someone patients can think of first when they are troubled.
And as long as patients are suffering, I want to continue standing beside them.
Yamato Kikuchi
Chairman, Medical Corporation ONE
Kikuchi General Practice Clinic