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The True Nature of Physicians and Diagnosis

Japanese Chinese

I am a pediatrician, but I have also been active in the fields of childhood development and education for many years, and this seems to have enabled me to view medicine and medical care from a slightly different perspective. Through these perspectives, I have come to understand one of the true natures of physicians.

Of course, doctors are also involved in promoting the health of children and adults, but their main work is diagnosing and treating illness. Treatment is predicated on finding the causes of various symptoms in order to provide the treatment. In other words, doctors are good at finding what is physically wrong with patients.

Once diagnosed, the illness is given a name. As for the names, they are wide-ranging. Some names simply state the condition objectively (such as haien, literally meaning the inflammation of the lungs or pneumonia), while other names describe symptoms (such as kouketsuatsu, literally meaning high blood pressure or hypertension), and others bear the name of physician who discovered the disease (such as arutsuhaimabyo, or Alzheimer's disease).

As for my experience, patients show a variety of reactions when given a diagnosis and told the name of the disease. Most who are diagnosed with cancer usually express surprise and plead for treatment that will cure them. On the other hand, many who are told they have common diseases such as diabetes or hypertension, but have no symptoms do not show much surprise, and because they feel no pain, many do not approach treatment seriously. Patients are the ones who decide whether to receive treatment or not, but it is in the nature of physicians to persuade the patient to undergo treatment.

This nature is sometimes reflected in the diagnosis when conveying a message that the disease should not be neglected and requires proper treatment. Of course, the physician does not disclose the name of the disease to frighten the patient, but from a true desire to persuade the patient to seek treatment and a cure for the problem.

Recently, I came across in the newspaper a frightening disease called koukuu houkai (oral disintegration). A careful reading indicates that this refers to a state of impaired oral function with ten or more teeth in a decayed state. Children with this condition are considered to be koukuu houkaiji (children of oral disintegration).

The name of the diagnosis reveals the doctor's honest concern that patients "should brush their teeth properly" and "an increase in tooth decay will cause problems," but is it necessary to surprise and frighten parents and children to such an extent? The word "houkai (disintegration)" has a certain impact and the power to draw attention. It is not an illness, but the similarity with terms such as katei houkai (family disintegration) and gakkyuu houkai (classroom disintegration) has heightened interest and concern. One surmises that the term koukuu houkai (oral disintegration) derives from desire to prevent dental decay, but if you were a child or parent, how would you feel if someone told you your oral cavity is disintegrating or that you were a "child of oral disintegration"?

In my field of child neurology, there are a few conditions that are diagnosed with similar such names. For example, one of the epileptic syndrome is called hakyokugata tenkan (catastrophic epilepsy), and a disability that is similar to autism is called shouniki houkaisei shougai (childhood disintegrative disorder). Both have been directly translated as such into Japanese, so it may not be the fault of the Japanese translator. In any case, having viewed medical care from various perspectives, I would like to see the use of diagnostic names which shock patients as well as parents discontinued.

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sakakihara_2013.jpg Yoichi Sakakihara
M.D., Ph.D., Professor Emeritus, Ochanomizu University; Director of Child Research Net, Executive Advisor of Benesse Educational Research and Development Institute (BERD), President of Japanese Society of Child Science. Specializes in pediatric neurology, developmental neurology, in particular, treatment of Attention Deficit Hyperactivity Disorder (ADHD), Asperger's syndrome and other developmental disorders, and neuroscience. Born in 1951. Graduated from the Faculty of Medicine, the University of Tokyo in 1976 and taught as an instructor in the Department of the Pediatrics before working with Ochanomizu University.
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