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The Humanization of Medical Care: Thoughts on Hospitals Refusing to Admit Pregnant Women

Recently, the media has been outraged at reports that a number of pregnant women have been transported by ambulance from one hospital to another after being refused admittance, and this has even resulted in the failure to save the lives of their precious babies. Anyone can understand that not having a vacant room is not a good reason to turn away a patient who should have been hospitalized even temporarily and received some sort of care even if it had be given in the corridor.

But in reality, this is not always possible in an affluent, advanced society that places supreme value on science and technology. As equipment, facilities and medical care become more sophisticated, hospitals not only need specialized physicians, but also nursing staff who are specialists and a whole host of technicians. Moreover, physicians and staff also need days off and there are labor laws that require compliance. Western medicine necessarily requires people and things. And in Japan, hospitals also have to deal with labor unions of the hospital employees. The medical practice and medical care systems also have their own restrictions. In the above example, the problem is said to have been a stipulation that the patient could not be treated without notification from her regular doctor. Shouldn't this sort of restriction be eased a bit? In case of an emergency, a referral to another doctor is totally worthless.

The vast majority of the world's population makes use of what is called traditional medicine. According to estimates, less than 10% have access to western medicine. And, of course, even for these patients, actual access to this medical care presents problems. The realities of life in the developing nations make this very clear. In the United States, an example of an advanced nation, there have been discussions over the past ten years on the possibility of combining western and traditional medicine such as Chinese medicine, which has been proven effective, either as an alternative or complement. This would have the advantage of bringing medical care closer to the patient, making it more patient-centered and reducing cost. In other words, Chinese medicine, acupuncture, massage, osteopathy, aromatherapy, etc., are considered to be alternative or complementary care to existing western medicine.

Furthermore, obstetric care by midwives could serve as an alternative or complement to the obstetrics departments of large hospitals, private clinics run by doctors or women's clinics. Of course, I am not able to judge whether the medical problem that was refused treatment by successive hospitals could have been handled by a midwife. But if so, there must have been some way -- if midwifery had given a place within obstetric medicine and accommodated within an expanded medical care system. At least up until WWII, obstetric care in Japan relied on midwives, and even now I recall seeing, as an elementary and junior high school student, the midwife with her black bag dashing into the houses of expectant and new mothers.

Western medicine, based on the analytical method and element reduction theory of science, rests on a history of the separation of the self and other, attempts at the most objective diagnosis of the patient's illness, clarification of the etiology, and the development of medicines and treatments. As a result, western medicine has been judged to have ignored the facet of the ailing human being who suffers, feels pain, and worries. Since the 1970s, a period of continual student unrest, it has become clear that we need medical care that takes the mind and body of the patient into greater consideration, and this has resulted in a trend toward the humanization of medical care. Within the context of western medicine, however, placing the patient's feelings and mind at the center of medical care is not an easy task. This involves thinking about and adapting the attitude of doctors and nurses who touch the patient, communication skills, demeanor, and manners to the hospital building, medical technology and equipment, etc. And the humanization of the medical system itself is fraught with many difficult issues.

But, upon reflection, anyone can understand that the humanization of medical care all starts with the doctor listening to the patient's experience and views. The problem of pregnant patients being shunted from one hospital to another is nothing new. But, why weren't these incidents considered and analyzed comprehensively? That might have changed the system and prevented the recent incidents.

On August 25 and 26, the Society of Ambulatory and General Pediatrics of Japan held its seventeenth annual meeting in Kumamoto. The society is made up of pediatricians who treat children, whether in private practice, in hospitals or in outpatient clinics. The meeting included a symposium on "How Family Associations for Ill Children and Hospital Staff Can Work Together." The particular ailments discussed were Sudden Infant Death Syndrome (SIDS), bacterial meningitis, and influenza-associated encephalopathy. The discussions included mothers whose children had died, mothers caring for children left with disabilities, and pediatricians, either directly or indirectly involved. As such, they were extremely instructive and illuminating.

This opportunity for communication was not just meant for mothers to psychologically comfort one another, but to provide a basis for real mutual help and support. For doctors, it was not just a chance to acquire the experience-based knowledge, but also to learn how to influence medical care at the national level. The Hib vaccine is effective in various ways to prevent infection of the influenza bacterium that causes bacterial meningitis, and it will soon be available for use in Japan. In the United States and other advanced nations, Hib vaccination of infants has long been a regular practice.

The purpose of the humanization of medical care is providing good, patient-centered medical care, and the key to this is communicating with patients and their family. This is something that we should never forget.

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