What makes a good or bad medical professional?

From school medical checks to hospital visits, the average ALT has several medical encounters throughout their year(s) in Japan.  Intrigued by my own experiences within the Japanese medical world, I interviewed 49 foreign English teachers in Japan about their healthcare experiences, and here’s what they said (in a much more condensed format):

Bad providers violate patients’ cultural expectations 

ALTs perceived providers that “violated,” and/or did not perform culturally expected practices as “bad” providers.  In other words, if a Japanese medical profession didn’t act as expected, the ALT perceived the experience and the medical provider as negative, or “bad.”  As an example, one English teacher characterized the difference between a “good” and “bad” doctor.  The following is an excerpt that distinguished between two physicians this English teacher encountered while seeking treatment for bronchitis.

“I walk into his [the doctor’s] office and he’s like, ‘Yeah, you’re not healthy I can hear you from outside.  This isn’t just a cold is it?’ ‘No.’  Just from hearing me cough he knew that I wasn’t well.  He says to me, ‘You either have bronchitis or pneumonia.  We’re going to take an x-ray and blood tests to find out.’  Difference in doctor right there! One of them [the bad one] just hands out a diagnosis and is like I think you might need antibiotics and the other [the good one] is like I want to do a blood test and do an x-ray to make sure you need the antibiotics and if they’re the right kind.  So that doctor, the good doctor, figures out all the information I needed.  The bad doctor, is like, ‘I’m going to give you medicine now.  Goodbye.  Give me ¥600.’”

This ALT’s experience with an array of Japanese medical professionals within Japan allowed the ALT to construct a comparison and contrast of “good” and “bad” doctors.  According to this ALT, good doctors either knew quickly what was wrong with a patient or took immediate action to determine what was causing the patient illness or discomfort as well as how to alleviate it.  The “good” doctor sought to understand the patient’s perspective and the illness versus simply handing out an antibiotic which may not treat the illness for a fee.

Throughout interviews with ALTs, “bad” providers were described as:

• Ignited fear within the patient(s) by thinking out-loud and muttering possible diagnoses.
• Provided no verbal or nonverbal cues, especially on invasive exams like pap smears.
• Did not provide an “appropriate/adequate” diagnosis.

Good providers attend to the patients’ cultural expectations

ALTs believed that “good” providers should attend to their cultural expectations (i.e., all of those standards and norms for practice in one’s home culture).  In other words, “good doctors” should behave and act like one might expect in their home country.  For instance, when discussing a positive time with a doctor, one English teacher said:
“People here don’t always smile when they meet you and things like that.  As a westerner you think, ‘Oh you don’t like me,’ but no it’s just because Japanese don’t smile.  When he [the doctor] first met me, he smiled at me, he introduced himself [in English], and so far it’s all been working out.”
Overall, “good” providers were described in interviews as:

• “Very nice and understanding.”
• “Similar to what I’d experience back home.”
• Had “appropriate” body language.
• Exceeded expectations on providing medical education, understanding, and comprehension to patients.

What next?

This study raises the importance of intercultural health communication training.  More programs need it.  English teachers are placed throughout Japan by numerous organizations and boards of education and are expected to live well.  However, that “living well” can be complicated when foreigners expect intercultural interactions to progress flawlessly and as according to their own culture.  Some ALTs even chose to not re-contract due to their health care experiences in Japan (and not necessarily because they are in poor health).  Scholars argue about “who should adapt to whom,” but that doesn’t really help us in the day-to-day life of a foreigner navigating a medical system (in Japan).
Here are some suggestions, what others do you have?

1. Expect difference.
2. Do your homework.
   1. Research the Japanese medical system.
      1. What similarities, if any, exist between Japan and your home country?
      2. What differences, if any, exist between Japan and your home country?
   2. Google Japanese words for common symptoms and your current prescriptions.
   3. Ask questions to a friend, other English teachers, and co-workers (if you feel comfortable).
      1. What should I expect when I go to the doctor/dentist/hospital?
      2. What surprised you about the Japanese medical world? (to other foreigners).
      3. What over the counter medicine do you find works best for _____?
3. Laughter helps.
4. Remember that Japanese medical professionals are trained professionals.
5. Insert your tips here ______________!

This blog post is an adaptation of the scholarly article:
Simmons, N. (2016). (De-)legitimizing medical professional discourses: Evaluations from foreign English teachers in Japan. Language & Intercultural Communication, 16(2), 1-18. doi:10.1080/14708477.2015.1113984
Available at: http://www.tandfonline.com/doi/abs/10.1080/14708477.2015.1113984?journalCode=rmli20 

This blog post was originally published at: ​http://jetwit.com/wordpress/2016/10/05/good-doc-bad-doc/

What is private in Japan?

If I tell my co-workers I have hemorrhoids, diarrhea, or need to go to the OBGYN will they tell everyone else?
These may not be questions JETs think about when they first go to Japan. It also may not be something JETs consider when they are ill and trying to gain medical care or just discussing information (i.e., relationship status) about themselves with their co-workers.

The reality is Japanese cultural conceptions of privacy might be different than many JETs’ expectations. Depending upon how individualist or collectivist your home country is will influence how privacy is interpreted, expected, and maintained. The concept of “what is private” or “privacy” differs cross-culturally, as do the ways in which privacy values are expressed.
Japan is no exception.

Japan has been largely classified as a collectivistic culture. As you know from your own experiences in Japan, the group matters more than the individual. In other words, in Japan the “we” wants and goals come before the “I” or “me” wants and goals. For collectivists, the very notion of privacy might be viewed as selfish due to an individual’s wants and goals taking precedent over the group’s desires.

Ever notice that privacy is in katakana, the Japanese syllabary used for foreign words? Puraibashi, or プライバシー, is taken directly from the English word for “privacy.” Since traditional Japanese language has no word for privacy, a unique cultural conception of privacy emerged. For example, the idea that one has “the right to be left alone” might signal a lack of cooperativeness with the group and an inability to work well with others. Additionally, controlling one’s privacy information might be perceived as an excess of mistrust. Even Japanese scholars have commented that gaijin might perceive the group interdependence of Japanese people as “suffocating.”

Japanese language use two distinct, yet interrelated meanings of Japanese privacy: shakai ( 社会), or “public,” and seken (世間), or “world/society.” Such terms stress the importance of relationships, interdependence, and group harmony. Shakai contributes to negative aspects of crimes being withheld from the media in order to protect victims and their families. If one was to “break shakai” it would involve speaking publically about private matters which might harm another’s reputation. Seken emphasizes human relations and allows Japanese people the ability to “understand” or at least “explain” what went wrong in a given situation. To the foreign eye, this might look intrusive, or like “gossip,” as one tries to understand one’s home life or culture to explain a tragic event.

As JETs operate on differing values of privacy, this might result in individuals feeling “violated” or “exposed.” Perceived privacy violations can lead to relationship withdrawal, isolation, and negative assumptions/stereotypes about one’s co-worker or Japan in general. Throughout my research, gaijinEnglish teachers reported feeling that their co-workers invaded/violated their privacy expectations. In other words, if they told someone something, it was then told to someone else, who then told someone else…etc. You get the point. In my research, gaijin felt victimized when people knew things about them that they didn’t disclose (i.e., So and so sensei told me you went to the doctor and are on X medication), even if it was something positive (i.e., I heard your dental checkup went well!). My participants felt like “celebrities” because “everyone (i.e., Japanese people)” in their communities knew “everything” about them.

Critics of my participants’ stories have said “Well, they should know it will be different from their home country.” It is easy to say “expect things to be different.” To what extent should this responsibility be shared? No recruiting organizations discuss privacy in their trainings. Perhaps privacy is something so engrained in one’s culture that it is perceived to be “common sense?” Perhaps that “common sense” is where the most difficulties exist when what one “commonly” thinks doesn’t work.

Regardless, this is a collective issue that requires further dialogue and research to better understand how to cultivate meaningful relationships. Several of my participants chose to cut their contracts short or to not renew because of their interpersonal privacy experiences.

That’s costly – it costs financially and personally.
​
This blog post is an adaptation of the scholarly article: Simmons, N. (2012). The tales of gaijin: Health privacy perspectives of foreign English teachers in Japan. Kaleidoscope: A Graduate Journal of Qualitative Communication Research, 11, 17-38. Retrieved from http://opensiuc.lib.siu.edu/kaleidoscope/vol11/iss1/3/

This blog post was originally published on: http://jetwit.com/wordpress/2016/01/16/jets-in-academia-understanding-privacy-in-japan/​ 

“Something of and in Japan, [is that] it doesn’t matter about who you are. Your health is never private.  They [Japanese] don’t see health as a privacy thing.  So you know, if you want to keep it private, don’t talk to anyone about it.” – Alice

After having my own interesting health experiences in Japan, I remained curious as to what other Assistant Language Teachers (ALTs) experienced.  Therefore, I went back to Japan and interviewed 10 ALTs (5 women and 5 men) about their medical encounters.  I quickly learned that it wasn’t “just me.”  I heard a lot of strong comments such as Alice’s.  In fact, everyone managed their medical privacy to some extent.  I share one story below:

“There were no barriers. Every person in the village, every school, you know everyone in the Board of Education, the whole school knew that I broke my leg and what days I was going to the hospital, and medication I’ve been given.  There’s no quiet, patient confidentiality.”

Meet “Jamie.”

An ALT in rural Japan like most of the ALTs employed by ALT organizations.  She loved her job, teachers, and students.  She worked hard and was enthusiastic about English education.

After breaking her leg, everyone knew.  But how?  She explained:

“It starts off with the supervisor who tells the Board of Education, they then informed the schools, and well, the schools tell the teachers, and the students ask, they tell the students, the students tell the parents, the parents go to the restaurant down the road and tell them, and the whole village knows.”

For Jamie, living in rural Japan meant that she wasn’t able to obtain her desired privacy levels.  Suddenly, she was not just the “foreigner,” but the “foreigner with the broken leg.”  She was the talk of the town.  Even her prescribed medication wasn’t a secret.  At the same time, Jamie was a “good sport.”  She laughed about the spectacle of her situation.  However, this somewhat uncomfortable experience influenced later health encounters.

After having appendicitis, Jamie didn’t want to go to the hospital as her doctor suggested.  She told her Board of Education (BOE) that she just needed to go home and “sleep it off.”  However, her tale doesn’t end there.

“I got a phone call from my Board of Education! [The] Doctor called the hospital when I didn’t turn up.  So, the doctor then called the Board of Education and told them everything, what he thought, and that I needed to go to the hospital.  The Board of Education called me and I said “No, I just want to sleep,” and they are like, “It’s too late. Your supervisor is coming to your house to pick you up, to take you to the hospital.” Although somewhat comical to Jamie, she saw this as a privacy violation.  After-all, this isn’t a situation Jamie would have experienced in her home country.  People now knew information she didn’t want them to know.  She attempted to not have her school involved, but things didn’t go the way she planned.  In reality, the doctor’s decision potentially saved her life, but, at the same time, Jamie perceived her privacy to be violated.

This sentiment was echoed throughout stories of ALTs’ health experiences.  Someone told someone, who told someone else…and before they knew it, everyone knew information about them and, yet, they didn’t know much about anyone else.

How did ALTs manage their privacy in this study?

Withdrawing from workplace relationships (i.e., not talking to co-workers), lying, intentionally or through omission, and relying on the help of a non-workplace related friend (i.e., another ALT, Japanese friend, etc.) were the three most common strategies shared.  For example, if an ALT was on medication that they didn’t want their co-workers to know about, they might say it was an “allergy” pill.  If any ALT felt their privacy was violated, they stopped talking to co-workers…sometimes about everything.

Questions for you:

• To what extent was privacy a concern for you?  Why/why not?
• How did you protect your secrets?  (It doesn’t just have to be health!)
• What do you recommend to current ALTs regarding their private health information?  Future ALTs?  Do you agree with Alice?

This blog post is an adaptation of the scholarly article: Simmons, N. (2012). The tales of gaijin: Health privacy perspectives of foreign English teachers in Japan. Kaleidoscope: A Graduate Journal of Qualitative Communication Research, 11, 17-38. Retrieved from http://opensiuc.lib.siu.edu/kaleidoscope/vol11/iss1/3/

This blog post was originally posted at: http://jetwit.com/wordpress/2015/08/14/jets-in-academia-health-privacy-in-japan/

I admit it.

I was “one of those” JETs who lucked out and ended up as an ALT knowing next to nothing about Japan.

No language skills.  Very little cultural knowledge.

Yes, I did my homework once I knew I was going to Japan, but even that was “too little, too late.”  The cultural books I read a month prior to departure ended up lying to me, as once I arrived everything I read was thrown out the window.  Nothing quite captured or described the nuanced life I was about to live in rural Nara-ken.

So how did someone like me survive for two years in rural Japan?  I hurriedly found a tutor who quickly became “my Japanese grandfather.”  Every Sunday morning we drank tea (once he learned I absolutely despise coffee and was making myself drink it as not to be rude) and ate mochi (yes, sweet delicious mochi!).  It was a great life outside of work.  But in work?

It was challenging.

I didn’t speak Japanese and my JTE’s English conversational ability was quite low.  In a town of roughly 8,000 people where I was the only foreigner, I lived in survival mode and I absolutely loved it.  However, because I didn’t speak Japanese, I was reliant on my coworkers (mainly my JTEs) for everything, including my access to health care.

I still remember that day quite vividly.  My JTE’s eyes widened as he looked at a piece of mail that I brought him because I didn’t understand the contents.  The only thing I could understand within the kanji-litterred, bright blue turquoise-esque envelope was the yen (円) sign.  “What bill do  I have to pay now?” I wondered.

“Shimonzu (my Japanified last name), did you use your insurance in Osaka?” he asked after showing the envelope and its contents to various workers in the staff room.

I froze.  I did.  I didn’t want them to know – that’s why I traveled 2.5 hours one way to Osaka without them.

You see, I learned that it was “better” to take my health into my own hands rather than risk my co-workers knowing more about me than I wanted them to know.  Everyone already knew I once had a cold and chilblains (AKA first-level frostbite), but this was different.  To me, my health information should be private.  In other words, my co-workers, as wonderful as they were, need not know my body’s inner workings.  At the same time, I realized I was in a different culture – that was very caring.  I realized my co-workers weren’t “out to get me,” but I did feel embarrassed.

Embarrassed that my private health information was now very much public.  I received numerous stares the remainder of the day and heard my coworkers say my name as they shared the envelope’s contents with others.

I tried my best to pretend that they didn’t now know what I knew they did.

What was the big deal you ask?  Well, it’s private. ;)

Looking back now, I laugh about it, but at the time it made me more aware as to what I did share and did not share at work.  I definitely saw myself being “quieter” at work, which influenced my coworker relationships.

This experience, and others, encouraged me to further pursue my experience in communication.  One thing that I loved about Japan is that I felt as if I was walking the pages of my intercultural textbook.  I finally was able to put my education into practice.  With an interest in culture and health, I went back to grad school to pursue a Ph.D.  I wanted to learn more.  I wanted to make a difference.

Now, equipped with research skills I have interviewed about 50 foreign English teachers and 40 of their Japanese co-workers regarding how they manage privacy at work.  Now that I have completed my dissertation, graduated, and obtained a position as an Assistant Professor, I am seeking outlets, such as JETwit and others, to share my findings both within and outside of academia with hopes that they will create change for those who were in similar situations as me.  It’s my hope that my experiences as a JET and my presence in academia will help improve the ALT-JTE relationship.  This wasn’t my goal pre- or even during JET, but I cannot deny the ways in which my participation within the JET Programme shaped who I am now as a teacher and researcher.  I’m very thankful for it.

 This blog post is an adaptation of the scholarly article: Simmons, N. (2014). My “big” blue health secret: My experience with privacy, or lack thereof, in Japan. Health Communication, 29(6), 634-636. Retrieved from http://www.tandfonline.com/doi/abs/10.1080/10410236.2013.786013?journalCode=hhth20#.VJX0LyMLC5A

This post blog was originally published at: http://jetwit.com/wordpress/2014/12/20/lifeafterjet-from-japan-to-academia-researching-privacy-for-change/