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Sonoma County. A diverse county of over one million acres. It's famed for its agriculture, industry and recreation, boasting a booming economy and unique lifestyle for its citizens. Described by the same Luther Burbank as the chosen spot of all the Earth, Sonoma County is the place to

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live, work and play as we move into the 21st century. Led by the forward looking philosophy of its governing bodies, Cinema counties, 340,000 residents are, Ah, harmonious, successful blend of ethnic and economic backgrounds. We invite you to take a closer look at Sonoma County in the

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nineties with your host, Rich McGlinchy. Hi, everybody. Welcome to this edition of Sonoma County in the nineties. We're gonna be talking to a good friend and a gentleman who has been traveling of late. Our guest is Dr James K. Good. He's the Internet here in San

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Rosa heats. Ah, a lot more things than that what you will learn as we go along. But Dr Goude, with whom I've been acquainted for about 20 years, has just come back from Japan and he's going to tell us about medicine in Japan on what happened

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during that trip jam. It's really nice to see right. It's been a couple of years since we visited. Right? When did you go to Japan? Went from July of 91 until July of 90 to 1 year. Right? For a solid year. Yeah. Yeah, we missed you.

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Missed. Didn't have anybody to get on the program with Jim Price and say, Stop smoking. That's right. Okay, I think that's pretty interesting. You went on a kind of what? A special project It was a sabbatical. A Zeno. The community hospital is associate with the University

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of California in San Francisco and the Department of General Medicine there was seeking a teacher to go to Japan for one year. Uber's California been contacted to find someone to go for one year. I was asked by San Francisco to go for a year, and it

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was an offer I couldn't refuse. So Sally and I went over my wife, Sally, and I and had a one year salt experience in Saga Japan, which is about 600 miles south of Tokyo on the island of Kyushu. Saga, saga soccer. Okay, well, all right. Let's

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get right into it then. You know, I know you've been connected with community husband for many years. You've been teaching position up there. You've been in practice here in Santa Rosa for a long time. How is general medicine in Japan compared to America? And by that

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I mean compared to Santa Rosa McGlinchey's on which could be Destiny E ds, No, that was coming back A little Japanese. I want to see what you do, but let me answer away from that. I just looked right. You asked if I could say something so

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I said something to you. But the state of general medicine in Japan is is interesting and in contrast, are general medicine. I went over in a department of gentle internal medicine and I really compared their practice of medicine with our practice of medicine. And I'd give

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you, Ah, a couple comments on it. One is that, um, medicine. Japan is more specialized. They don't really have a family practice program like we have here. There over waited to have too many specialists and not enough generalists. So we have a problem in this country.

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They have more of a problem in terms of having no good generalist training programs. So that they're skewed toward the specialist. That's one comment. I enjoyed Japanese medicine, and I give these comments in terms of the general medicine. One is that it's delivery is very fair

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and equally distributed to all Japanese. It's an instinct system in terms of having a national health service that has universal access. So all individuals can be seen under that system. And that was in contrast to our system that has, for example, 36 million people without health

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insurance without access. So I had a chance to see a system that has nationalized healthcare. Everybody covered and compare that with our system. And I saw pros and cons. I'm sure you did. Did you say that when we go there, there is no family practice in

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Japan? That's correct. They they have. The closest they come to the generalist is general internal medicine. In fact, where was at the University of Saga? I was with the Professor Fukui, who is the only professor of general medicine in Japan, and I went to see that

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program to compare how they are training the generalised compared to how we are training and to help them, and to learn from them most. It was very interesting. The personal side, Sally, my wife and I were treated very, very well, and it's nice to experience really

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Oriental hospitality. They were very good to us. And we had a good year and we were the only Americans in the apartment house where we stayed. And at the university, Um, it was a sea of Japanese and Sally and I Let me ask you this gym,

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I know you've been such a strong supporter and a teacher for family practiced medicine here in Sonoma County. Uh, did you feel that the turn of the year you spent there you persuaded them to think along those lines? We'll give you an example. Beginning in September,

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we're gonna have a rotation of Japanese residents starting at the community hospital so they'll come here to have an experience in general family practice. It's the six week rotation. We've open it up to the University of Saga medical students. They have 600 medical students there and

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faculty, um, and we have a rotation that will be for four weeks in Santa Rosa at the community hospital and two weeks at the San Francisco General Hospital, and it'll be a rotation in American General Medicine for Japanese residents from the University of Saga. Where was

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that? And we have next year four schedule residents beginning in September. So there's going to be in exchange. And it's not just one way. We've had our residents from the community hospital go to Japan. This last year we had three residents who came over for rotations

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with me at University of Saga. So we're really trying to set up an exchange of personnel and ideas, and I think we can learn from them and they can learn from us right now. Um, you said Japanese doctors are more specialised or and not as many

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generalists Witcher in controlling the specialists. I guess Specialist are in control and there's a movement afoot in Japan like there is in this country toe. Have more generalists. For example, the Clinton administration terms of managed care is espousing the idea of having generalists, family physicians, general

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internists see you at the Gate of Medicine and they act as gatekeepers in terms of referring your own to specialists. The concept is that medicines like a pyramid, you need generalists at the bottom and the more highly specialized individuals less and less of those. So it's

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a system that is run by the generalised, both for economy and by thoroughness. And Japan has a problem, as we have of not enough generalists. So they're incident, how they can train more generalists, and they're willing to look at our training programs. The way in which

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we looked at theirs is Japanese medicine, expensive as compared to the USA. That surprised me. It's cheaper to give other reasons why. Um, first of all of the gross national product, the Japanese health system spends 6% of its gross national product on health. We spend 12%.

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We spend twice as much in terms of gross national product. American each American for healthcare per year pays $2000 in general, and the Japanese pay $1000. So they have a system that is less expensive, and I try to figure out why. And I think the reasons

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are these. First of all, Japan, back in 18 68 made a commitment in the major era to give universal health care, and they decided to do it as cheaply as they could. The ways in which I see they do that? Are these first of all, they

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emphasize frequent outpatient visits in Japan. The normal person sees a doctor every month in the United States that the average person sees a physician every 2 to 3 months. They have MAWR visits that emphasize preventive care, and by doing that, they're able tohave half the hospital

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missions we have. And I think that this concept of many outpatient visits trying to solve problems before they reach a point of hospitalization has borne some ah, success in Japan. The second way in which I think they keep their price down is is they have an

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amazingly controlled system from Tokyo, the Ministry of Health and OH, on welfare controls, all physician fees and hospital costs across the country, for example, all hospitals charge the same to have an appendectomy or have a chest X ray. There's no variation, and this is a tightly

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controlled system in a central manner that we lack here. Japan is a very close knit country in terms of central controls, and those controls help to control costs. I think I now our Japanese patients, different from American page. Yes, how so? Culturally different ones. Japanese want

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American. I'll give you something, give you some differences. That was a joke. I got you thinking. But the there different in terms off different religions, different cultural backgrounds. Different, um, concerns in terms of the health, for example, the Americans concerned about the heart they come in

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complaining about heart problems. Where is usually the Japanese come in, concerned about the abdomen, the stomach? And where is an American clinic? We see lots of chest pain and the Japanese clinic I work in the mornings that came in complaining of abdominal pain is part of

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the reason for that. The Japanese word for stomach is harder, which has to do with seat of the soul. So for them, their target organ for complaints is the G I system or the stomach, where ours is the heart, and part of that has to do

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with their number. One cause of death is gastrointestinal. Cancer is there where our is our number. One cause of death is hard things with different people, different concerns and patients are different. Well, which of them is more anxious or depressed, American or Japanese? I'll answer both.

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I thought that Americans are more anxious and you happen? Even more depressed, really. I mean, that's a that's a broad common. But I really thought that through and with the Japanese psychiatrist stock we gave a seminar on this anxiety and depression comparing United States and Japan

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and really looking into it with some depth. Our feeling was that the Japanese tend to look in really and get the press morning and the Americans look more externally. It pressures on. Let me get more anxious, Which is better. I don't know. Yes, I'm not gonna

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best avoid both. Gonna get that with a 10 foot pole. Now, let me get you. I'm not sure that I caught this woman to go. Are there groups without medical coverage in Japan? In America we have I don't know what someone once said. 30 or 40%

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of our people don't have well, actually what is presented in our population? It's about 36 million out of populace. About 200 way have no health insurance. No, in Japan, everybody has insurance because it's universally given by the government is part of a commitment they made to

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provide universal health care with easy access. This has to do with a commitment made again, historically, that the key law was 1922. But it goes all the way back to the 18 eighties, but they do have universal health care. But you know, there's some real differences

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rich in our country. We have a population which is very hetero genius. We have no Anglo White, We have Hispanic, we have black, we have Asian, and this is great variety. And it's hard sometimes to bring health care to all of the different areas. If poverty

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comes in or litter, she comes in or a ghetto comes in. It's hard to get to them. In Japan, there's homogeneity. Everybody, Japanese. They all have that beautiful black shiny hair. They look the same. They don't have the differences within the population of, for example, someone

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who looks different. So the fact they all are homogeneous more makes it easier to reach them. For example, um, if you become pregnant Japan, you're given a booklet. Everybody gets it in terms of keeping your pregnancy low risk and everybody's followed up. That's why, for example,

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there live birth rate. This isn't the thickness of the mortality. I'll put it in reverse terms. The mortality per 1000 births in Japan is six, which is the lowest in the world. Our mortality is nine and whites and 18 and blacks. I see the differences. We

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have area in this country. We are not getting to in terms of preventive care regarding pregnancy. Now that's one instance of a population being homogeneous. You get to everybody, everybody gets the information. They all see the doctors. There's no blocking towards health care. It's almost easier

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to do in Japan because they don't have the big cultural poverty and literacy problems we have. True, we're pause right here and you stay tuned for this important announcement at two. It's Dr James Good and I will come back. We'll talk more about medicine and we'll

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talk more about his visit to Japan. How medicine is in Japan first, this message. Hi, I'm Johnny Miller. I'm at the hand of Boys Center, giving some of the boys a few golf tips. I've got six Children of my own, and believe me, shooting under par

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in golf is easier than raising kids today. Making sure they realize their potential and then leading responsible and productive lives is a challenge. Why? There's a lot of diversions that can attract youngsters and create hazards for them. Recovering kids from these traps is a lot tougher

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than hitting a golf ball out of one. And a boy center is a special place that extends its hand to troubled and misdirected kids so they can have a second chance to find the right course in life. This isn't easy. Like off. It takes a lot

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of practice to straighten things out, and a boy center provides determination and desire for them to succeed. Hannah is at capacity now and has a waiting list in the hundreds. It would love to accommodate more boys, but Dillman cottages and acquiring personnel means money. Will you

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help please lower their financial handicapped and send your deductible contribution to Hannah Boys Center, P O. Box 100 Sonoma, California 95476 Thank you. Welcome back to this edition of cinema can in the nineties, a pretty interesting addition because we're talking to a friend of our Dr

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James Good who spent a year in Japan and has been telling us about Japanese medicine and even started out with remarking Japanese, That's 10 me entirely. Uh, what is it like to be a professor, uh, of medicine. Let's say in Japan, as opposed to the United

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States, Wonderful. The commission. The respect for educating, leaving? No, really. I mean, I came back spoiled. I truly did their system, like the German system I've been in The German system also really honors the professor being a professor there you were above the businessman above, military

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above other individuals and society political, for example. Um, and it was an honorific position. For example, given example, Um, when you walk in a room is professor. If there are other people, there be the engineers or politicians and so on your given the favorite seat, that's

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right. And, ah, the, um, respect your shown is something which is spoiling. I mean, I really left there taking people should bow to me and I came back to the community hospital where in the Americans, rude awakening. I know, you know. People are very challenging and

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questioning. And so, for example, in Japan on rounds, you really couldn't question anybody who was higher than you are in authority. Challenge them. Where's when I around a community hospital? The first year residents are saying Why do you say that? Do you have proof to back

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that up? Our system is, I think, healthier. But the Japanese system, with its a pyramid with its hierarchy, is very strong. And I liked being that I conceived it. What about the residents? Life in Japan? The family practice residents as opposed to his life. Here at

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the Center Mechanic Community House near Sting Switch, the American resin worked much harder. You hear stories about Japanese working harder hours and so on. I wish I had shrieked. Can't hear she's the resident. 33 Americans came over and spent time with me there, and we're on

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the the Japanese medical servers where I was a professor and their comments in General Word that they were much harder here, put in much longer hours and have MAWR. They have to do themselves. It's interesting turnabout industry. Perhaps they work harder in terms of hours and

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less vacation time. It's one, but in medicine. I think our residents in our physicians were Carter. Well, you talked about getting greater respect, if you will, a meme or honored position. But what difference exist in medical ethics? Let's say between Japan and the United States. I'll

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give an example, um, at the community hospital. If I see someone who has cancer and we diagnosed to cancer and so on, I'm a blind to sit with them and tell them what they have, what I can do for them, what the prognosis is and to

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really sit and talk about it. In Japan, we didn't tell them to diagnosis. We talked to the family. It's a confusion society where the individuals not most important, like in our society, we have the locking in Jeffersonian society, where the individual is key in the Orient.

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In the confusion system, the families, the key around the individual and I would sit with the family and tell them that this individual had cancer, and four times out of five, you wouldn't tell the individual, and that individual wouldn't ask what they had. We go ahead

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and treat them. They're gonna be treated. And they didn't know what they're being treated for. They were accepting. It was felt that you might hurt a person's energy if you told him very bad news. So what you did was you went ahead and treated them, and

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the family knew they didn't know overtly. They probably knew indirectly, but they had. But it was a system where you don't challenge people. For example, I wouldn't tell the patient a Dave camp that have cancer. Because in the confusion system, I might hurt their longevity by

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shocking them with bad news that they couldn't handle very different ethical system in this country. I'm liable if I don't tell the person of diagnosis withholding information. Yeah, Pan. No such thing. When I first had the first cardiac problem about making 74 1st base I ever

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saw was a gentleman sitting over here, you know, and I'm not just your I was thrilled about your telling me that day there. No, but you knew. And you have got in. And you took it in here now because that's right. That's right. Um, what's the

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food like in Japanese hook hospitals? Well, I have the Japanese fair in a really consistent of fish rice, seaweed, very healthy diet. For example. The diet diet is probably the key to Japanese longevity. The Japanese there there, the longest lived people, the world the average age

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for a woman dying. Japan is 82 for a man at 76 for this country. For a woman, it's 78 for man. It's 71. But the key to that longevity isn't the health system, Mr Diet. They have less than 23% fat in their diet, their thin. Before

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we exported our diet to them, they had hardly any cardiovascular disease. They're developing out because they're getting more fat in their diet. Um, but their diet is so healthy the seaweed, the fish and the rice. My first problem that dies. I went there and I'm pretty

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not too heavy thin, but I want that I lost £15. Imagine me losing £50 because I was working hard. I was exercising. I didn't realize I was taking in less calories, and Sally came over. I was there too much by myself, and better in Osaka. The

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airport, she hoped. He said, Jim, wherever you go on your bones and I said, I'm still here and she said, No, you've lost all your fat So she got over them fat me up again. But their diet is amazingly healthy. For example, you talk about McDougall

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diets and this in and so on. Just go live in Japan on the country's diet, not supplemented by Western diet. And that's enough to cut down all your risk factors. For Carter Vastra disease, however, it has a problem. They have 1.5 times more salt than we

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have in our diet, the soy sauce and so on. So hypertension is a very big problem, much bigger than here, wouldn't you think? Maybe hypertension fact that it's so high. There might also be accounted for by the condemned condensation of people in Japan. I'll give you

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figure. How many Americans are pure here, pure per square kilometer. What's our figure? I don't know. 25 per square kilometer. Japan is 325. I think of that. The world averages 35 but but they have a second to Bangladesh and South Korea. Japan is the most densely

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lived in country in the world. It's amazing. How about the drinking and smoking? Now? You've been on the program for the year telling people here, quit smoking and we were doing for sure into you left ran off for a year. Okay, we've only had Jim to

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tell him Jim Price, but about smoking and drinking and in exercising. I can give you all three. They smoke more, drink less and extras list now more small bore. The, for example are figure for men smoking about 30%. This country. He was 60% in Japan, 60%

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and I had to prohibit smoking on my rounds over there. I said no one smokes in my round because doctors were smoking on rounds in the hospital. I think they drink list. Now. When they drink, they drink sake, which is, Ah, wine liquor. But but, uh

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um, in terms of the rate of alcoholism, as far as I could see, it's less. That's about half what ours is now that it's a hard figure to get at you. And I couldn't get really good statistics. Turns of exercising, Um, the that the doctors with

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whom I spent time didn't exercise as much as American doctors or my colleagues and where I live in Santa Rosa. It was, for example, um, very unusual. I jog to the hospital three times a week. They looked upon that is very bizarre, very peculiar for this

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American to be running to the hospital when he could be driving a car. Um, so high position. But again, the key to their health is their diet. That's the key. It's not exercising. And despite the smoking and so on again, Japan has the lowest infant mortality

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in the world and the oldest people in the world. What that means is, by the year 2020 they're going to be a very old society. They really are. And that's going to be more than 325. For that. They're gonna face a directive. Problems like it's gonna

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be there. Huge new problem. For example, they're gonna have the problem. When you have a big geriatric problem who's earning the money to pay for the system because you have a lot of retirees, but they're gonna face that. That's a good point. Who had the I

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don't If you have this in hand, who has a better health? Statistics Japan in the United States, Japan. They do that. They have better health statistics, and we have. But I gave some of the reasons for it. One is universal healthcare. Second is they don't have

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groups that aren't reached. Everybody is covered by, um insurance, and they have a system that gets information to everybody. Officially with that is health care access open in Japan? Yes, it is. For example, I was at University Hospital and anybody could walk into the clinic and

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be seen anybody or be admitted the hospital and they could walk into any hospital they wanted under the Japanese system and be seen with universal healthcare and access. It's a very sexist and it was the same price. You said. Every place there's no difference. Tokyo sets

00:26:19.280 - 00:26:36.710

the park nicely. Tokyo. The Ministry of Health and Welfare sets the price, for example, um, to be seen in a clinic there. It at my hospital was $33. That included the doctor's visit and lamp test. We can't do that in this country and also add fair.

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And I think another key for their having a less of on expensive system is this. In the Shinto Buddhist world, surgery is not welcome. They're surgical rates are 1/4 are surgical rates. The reason being that when you vice surgery to the Japanese, they say No. I'm

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going to solve this by diet and rest, and they and their operative rates are 1/4 United States. Well, we asked this real here. That's the cage and the lower mortality in infancy at longer life, they must be on the right. Try. I think they have some

00:27:14.050 - 00:27:26.550

things to tell us. That's part of the reason I was there to try to say, What are they doing? Right. And how can we help ourselves from that? Information is really available right now. Is there what you might call by now? They have problems, too, though

00:27:26.560 - 00:27:42.440

if you don't talk about the problems, talk about the problems too. They're not perfect. You want Labrador? Yeah. I'll give you a time. Um, for example, there is a general common Japan that when you go to these clinics, you have a three hour wait and a

00:27:42.440 - 00:27:58.360

three minute visit, even though the Japanese How does that compare with here? O, for example, if you go in a physicians office or in the clinic, you don't wait three hour gently and no physician here Season. Three minutes. No, I do. I spend three minutes with

00:27:58.360 - 00:28:11.300

you if you come in the office. Oi, You've at least that. Oh, that you were talking about 15 minutes to 1/2 0 yeah. All right. But in a way to probably, but they really have a problem. They, the doctors, eyes with words. We're seeing 100 patients

00:28:11.300 - 00:28:27.310

in mourning. Now, that's that. That's just very skipping on the surface. And if you will, I don't think American patients would allow you to let them wait three hours for three minute visit. The second thing is that they prescribed way too many medications. They didn't talk

00:28:27.310 - 00:28:37.980

to people, for example, like that since you quick and I'll give you a pill for anxiety. And home you go. I'm not gonna talk to you. It's a three minute visit. I'm gonna give you pills. The last thing is, we did a poll in our clinic.

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How many of the patients were happy with their system? This isn't SOG. In the General Medical Clinic, 12% were happy with their system. So if you really look in their system long waits, quick visits, pills given readily and patient satisfaction was 12%. What? You always use

00:28:54.700 - 00:29:04.460

the time up so quickly where we have things to say to get on the program with him. And then all of a sudden, the times going him. Thank you. Very pleasure. You and Jim Bryson. Come back in the fall. We got to go back to the

00:29:04.460 - 00:29:22.020

no smoking deal. Okay? Don't matter. Got, uh, Domo. I got to thank you. I'm sure. I think ladies and gentlemen, the guests. James Good. Dr James Good Lily Hospital in private practice areas. A teaching position. Has been in Japan for years with sharing some of his

00:29:22.250 - 00:29:35.550

experience. Japanese medicine experience, if you will. With us. My name is restricted to the program. So McCann in the nineties. See you next week with another member of the county government family or an interesting individual like Jim. Good. Jilin. Good night. Good luck. Good help to

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each and every one of you.