By Judit Kawaguchi

Kae Wakita MD, is a dermatologist and owner of Skin Solution Clinic in Shintomicho, just steps from Tokyo’s Ginza area. A confessed workaholic and red wine drinker, she is perfectly happy with her life, but not with the state of the Japanese medical system. She thinks she might have the cure or at least a few treatments to fix it, though.

We need to be interested in humans, not in diseases. The main criteria to become a doctor are deep interest in humans and a strong desire to help and serve others. We need kids who love psychology, history, literature and art to be physicians.

Now the people least suited to become doctors get into medical schools. The emphasis on math and natural sciences for the entrance exam is　miscalculated.

Most Japanese patients love scary, condescending and arrogant doctors, simply because patients have been abused by such mean physicians for too long. Sadly patients expect and accept the maltreatment willingly: they are used to it.

Being kind, patient and a woman is probably the worst combination for a doctor. Even if she is a genius and the greatest physician, few believe she can do more than check temperature and call in the real doctor: of course a male authority figure, who is ready to yell at the patient for bothering him.

Being a puppet feels safe. Being controlled like a marionette on strings is safe because even if we fall, we always get picked up. This is how doctors are controlled and protected by their medical schools.

There is no freedom for young docs. Every medical school is connected to particular hospitals where the graduates are sent for internship and later on for work. The university department head has all the power to hire and fire and control the movement of the graduates. Most physicians work at least five or ten years under the medical school’s umbrella but many stay there forever. 2-3 years ago the system began changing for the better but it is just not good enough yet.

There is no competition between hospitals and there is no competition for jobs, either. Doctors from the same medical school stay together in the same hospitals for many years, often till their retirement. In this system their jobs are guaranteed and therefore they can behave like public servants: superior and authoritative. They can also cover each other’s back and protect themselves and their schools.

Natto and red wine are a great match and very good for skin. At night, I drink a glass of red wine and eat rice and natto. This combination is delicious and does wonders for the skin because red wine is high in polyphenol and natto is full of so many healthy ingredients, such as isoflavone which is very beneficial for the skin.

Patients should be treated as clients or important customers, because they are. In my clinic I take care of patients like I would like to be treated. We have appointments, spacious private rooms with heavy doors and not curtains to protect privacy and nobody is called by their names in front of others. Patients pay in the treatment rooms and I spend a long time talking and learning about them. I know this is basic stuff but in Japan it is special.

At least half of all public servants should be fired. They are wasting our national budget and our taxes. Go to any city hall and you see hundreds of people sitting around shuffling documents in often gorgeous designer buildings. The money we spend on them needs to be used for health care instead.

The Japanese medical system is really behind the rest of the world. In super developed Japan it is a shame and a nightmare to see the condition most hospitals are in. Many old buildings need renovation but they have no money. The industry itself is not healthy because we have don’t have healthy rivalry.

Against all odds, Japanese docs and nurses are doing a great job. Considering the state our health system is, we are doing fabulously. We treat the sick and save lives but imagine how much better we could do if we had strong competition.

The level of our medical care is high thanks to individual effort. The system is actually against the doctors and against the patients.

The outpatient system is out of control. For a three-hour wait one gets a three-minute consultation. The problem is that most people go to big hospitals on their first visit, instead of the local clinic. If I talk for thirty minutes to one patient, I still get paid the same as the doctor who chats for 3 minutes.

We doctors really don’t how it feels to be an average patient. When I am in the patient’s shoes, I am still a doctor so I get lots of attention and care. I always try to give such service to all my patients.

Doctors must be able to think from various angles. Just science alone can’t cure humans: love is necessary.

I always do what nobody dares to try. I opened a clinic in Shintomicho, where very few clinics operate due to the outrageous rents. Most other clinics in this area do not accept health insurance but I do. I make less profit and am in the red every month. So in order to stay in business, I must do profitable procedures like laser hair removal.

Japanese love pain and suffering. Enduring pain is considered the sign of maturity and our medical system is based on this principle. This is why we never even think about giving pain killers. Let the patient suffer: it makes them stronger.

Medicine is really expensive, but why? It seems that there is virtually no competition among pharmaceutical companies. The market is tightly shut and the markups must be humongous but I am actually not sure why the prices are so high.

Being a woman doctor is not tough, as long as she is a workaholic and enjoys being single. I am perfect for the job.

We doctors need a tougher evaluation system. At the moment, once a person gets a medical license, he or she can practice as a doctor forever. We need to implement a rigorous system of tests every couple of years to make sure docs are at the top of their game.

Men and women’s roles are a mess. Most men are wimps without any sense of responsibility so next to them, any woman seems too strong. I am one of those.

I almost gave up on finding a partner. I want a man whom I can respect but most guys are just too weak or married. A cool man has dreams and makes effort, works hard and succeeds. His dream is not making lots of money but to be of service to others. He is proud and responsible. Where is he?

Looks like I’ll be single forever. Ideally I would like to be married and have a baby but I can’t find a husband and I don’t even have time to have a baby. I’ll probably end up living happily with a couple of dogs.

My father is the greatest influence on my life. There are three of us sisters and I am the oldest. We all became doctors because we adore him. He is a physician, and just like Akahige, who was a famous doctor, he is unselfish and motivated to cure people because he cares. Making money is not a priority to him or to us.

I worry about younger people who do not love Japan. They never think of working for others, just themselves.

I hate expensive restaurants. I rarely go to fancy places but every time I do, I feel the same: price is not proportional to good taste. I love simple mom-and –pop shops with wonderful home cooking and unpretentious atmosphere.

Tokyo people are much kinder than I expected. I am from Nagoya where people always say Tokyo is a cold place but they are wrong.

I want what nobody has. I always look for unique things and never buy famous brands because I think it is silly to follow the crowd.

Art and ikebana are the best tools to relax patients–and me. I design and make arrangements for my office using fruits and flowers.

My friends teach me a lot. I hang out with people from all walks of life because it is more fun than staying among doctors only.

My patients do my advertising. They bring their friends and send me cute letters and even bring me lots of gifts, such as tofu, cherries, veggies, pickled squid or shiokara, which is my favorite food, and once I got a whole octopus that I had trouble squeezing into my fridge.

I work alｌ day and night. In the evening I look at the next day’s schedule and think about each patient’s treatment. All night, in my dream, I keep talking to them and trying various procedures. I’m sick but I don’t need a cure. I am happy this way.

More at skinsolutionclinic.com.
A version of this interview appeared in the Japan Times on May 9, 2006
http://www.japantimes.co.jp/life/2006/05/09/people/kae-wakita/