Complementary and alternative medicine use by visitors to rural Japanese family medicine clinics: results from the international complementary and alternative medicine survey.

BACKGROUND: There is growing interest in the use of complementary and alternative medicine (CAM) throughout the world, however previous research done in Japan has focused primarily on CAM use in major cities. The purpose of this study was to develop and distribute a Japanese version of the International Complementary and Alternative Medicine Questionnaire (I-CAM-Q) to assess the use of CAM among people who visit rural Japanese family medicine clinics. METHODS: Using a Japanese version of the International Complementary and Alternative Medicine Questionnaire (I-CAM-Q), a cross-sectional survey was conducted in three rural family medicine clinics. All patients and those accompanying patients who met inclusion criteria were eligible to participate. Data were entered into SPSS Statistics and analyzed for use by age, gender, and location. RESULTS: Of the 519 respondents who participated in the project, 415 participants reported CAM use in the past 12 months (80.0%). When prayer is excluded, the prevalence of CAM use drops to 77.3% in the past year, or 403 respondents. The most common forms of CAM used by respondents were pain relief pads (n = 170, 32.8%), herbal medicines/supplements (n = 167, 32.2%), and massage by self or family (n = 166, 32.0%). Female respondents, individuals with higher levels of education, and those with poorer overall health status were more likely to use CAM than respondents without these characteristics. Only 22.8% of CAM therapies used were reported to physicians by survey participants. CONCLUSIONS: These data indicate that CAM use in rural Japan is common. The results are consistent with previous studies that show that Japanese individuals are more interested in forms of CAM such as pain relief pads and massage, than in mind-body forms of CAM like relaxation and meditation. Due to the high utilization of certain CAM practices, and given that most CAM users do not disclose their CAM use to their doctors, we conclude that physicians in rural Japan would benefit by asking about CAM use during patient interviews, and by familiarizing themselves with the potential benefits and risks of commonly used CAM modalities.

Which medical interview behaviors are associated with patient satisfaction?

OBJECTIVE: The objective of this study was to investigate the association between several medical interview behaviors and patient satisfaction. METHODS: The subjects were 158 new patients who visited an outpatient facility of a university hospital in Japan. All medical interviews were videotaped and reviewed by a trained rater using a medical interview rating scale (Takemura Medical Interview Rating Scale) for evaluating medical interview behaviors. To measure patient satisfaction, a self-administered questionnaire was also developed. Both the rating scale and the questionnaire were assessed for validity and reliability beforehand. RESULTS: A significant positive association was found between the behaviors of reflection and legitimation on the one hand, and patient satisfaction on the other. The positive association between reflection and patient satisfaction existed after adjusting for both the duration of the interview and the other medical interview behaviors used. The association between legitimation and patient satisfaction also existed after adjusting for the duration of the medical interview but disappeared after adjusting for the other medical interview behaviors used. When we investigated the strength of the relationship between each medical interview behavior and patient satisfaction, reflection was found to be the strongest determinant of patient satisfaction. CONCLUSIONS: This research revealed a significant positive association between reflection or legitimation and patient satisfaction in an actual clinical practice setting.

Utility of self-competency ratings during residency training in family medicine education-emerging countries: findings from Japan.

BACKGROUND: Family medicine education-emerging countries face challenges in demonstrating a new program's ability to train residents in womb-to-tomb care and resident ability to provide such care competently. We illustrate the experience of a new Japanese family medicine program with resident self-competency assessments. METHODS: In this longitudinal cross-sectional study, residents completed self-competency assessment surveys online during 2011-2015. Each year of training, residents self-ranked their competence using a 100-point visual analog scale for 142 conditions: acute (30 conditions), chronic (28 conditions) women's health (eight conditions), and geriatrics/home (12 conditions) care; procedures (38 types); health promotion (21 conditions). RESULTS: Twenty residents (11 women, 9 men) participated. Scores improved annually by training year from baseline to graduation; the mean composite score advanced from 31 to 65%. All subcategories showed improvement. Scores for care involving acute conditions rose from 49 to 75% (26% increase); emergency procedures, 46-65% (19% increase); chronic care, 33-73% (40% increase); women's health, 16-59% (43% increase); procedural care, 26-56% (30% increase); geriatrics care-procedures, 8-65% (57% increase); health promotion, 21-63% (42% increase). Acute care, chronic care, and health promotion achieved the highest levels. Women's health care, screenings, and geriatrics experienced the greatest increase. Health promotion gains occurred most dramatically in the final residency year. CONCLUSIONS: A resident self-competency assessment provides a simple and practical way to conduct an assessment of skills, to monitor skills over time, to use the data to inform residency program improvement, and to demonstrate the breadth of family medicine training to policymakers, and other stakeholders.

Describing the factors that influence the process of making a shared-agenda in Japanese family physician consultations: a qualitative study.

BACKGROUND: Patients cannot always share all necessary relevant information with doctors during medical consultations. Regardless, in order to ensure the best quality consultation and care, it is imperative that a doctor clearly understands each patient's agenda. The purpose of this study was to analyze the process of developing a shared-agenda during family physician consultations in Japan. METHODS: We interviewed 15 first time patients visiting the outpatient clinic of the Department of Family Medicine in the hospital chosen for the investigation, and the 8 family physicians who examined them. In total we observed 16 consultations. We analyzed both patients' and doctors' narratives using a modified grounded theory approach. RESULTS: For patients, we found four main factors that influenced the process of making a shared-agenda: past medical experiences, undisclosed but relevant information, relationship with the family physician, and the patient's own explanatory model. In addition, we found five factors that influenced the shared agenda making process for family physicians: understanding the patient's explanatory model, constructing the patient-doctor relationship, physical examination centered around the patient's explanatory model, discussion-styled explanation, and self-reflection on action. CONCLUSIONS: The findings suggest that patient satisfaction would be increased if family physicians are proactive in considering these factors with respect to both the patient's agenda, and their own.

The cultural context of teaching and learning sexual health care examinations in Japan: a mixed methods case study assessing the use of standardized patient instructors among Japanese family physician trainees of the Shizuoka Family Medicine Program.

BACKGROUND: In contrast to many western nations where family medicine is a cornerstone of the primary care workforce, in Japan the specialty is still developing. A number of services within the bailiwick of family medicine have yet to be fully incorporated into Japanese family medicine training programs, especially those associated with sexual health. This gap constitutes a lost opportunity for addressing sexual health-related conditions, including cancer prevention, diagnosis, and treatment. In this mixed methods case study we investigated the perceived acceptability and impact of a standardized patient instructor (SPI) program that trained Japanese family medicine residents in female breast, pelvic, male genital, and prostate examinations. CASE DESCRIPTION: Building on an existing partnership between the University of Michigan, USA, and the Shizuoka Family Medicine Program, Japan, Japanese family medicine residents received SPI-based training in female breast, pelvic, male genital, and prostate examinations at the University of Michigan. A mixed methods case study targeting residents, trainers, and staff was employed using post-training feedback, semi-structured interviews, and web-based questionnaire. DISCUSSION AND EVALUATION: Residents' and SPIs' perceptions of the training were universally positive, with SPIs observing a positive effect on residents' knowledge, confidence, and skill. SPIs found specific instruction-related approaches to be particularly helpful, such as the positioning of the interpreter and the timing of interpreter use. SPIs provided an important opportunity for residents to learn about the patient's perspective and to practice newly learned skills. Respondents noted a general preference for gender concordance when providing gender-specific health care; also noted were too few opportunities to practice skills after returning to Japan. For cultural reasons, both residents and staff deemed it would be difficult to implement a similar SPI-based program within Japan. CONCLUSIONS: While the SPI program was perceived favorably, without sufficient practice and supervision the skills acquired by residents during the training may not be fully retained. Deep-rooted taboos surrounding gender-specific health care appear to be a significant barrier preventing experimentation with SPI-based sexual health training in Japan. The feasibility of implementing a similar training program within Japan remains uncertain. More research is needed to understand challenges and how they can be overcome.

Responsibility and cancer disclosure in Japan.

In Japan, as in many countries around the world, cancer patients are often not told the truth about their illness. Despite polls showing a majority of those surveyed wish to be told, surveys of physicians indicate only a small percentage will tell, especially when the cancer is advanced or terminal. We interviewed physicians from various specialties with experience managing advanced or terminal cancer patients to investigate their approaches to cancer disclosure. Our analysis reveals physicians divide into two groups: those who usually do not tell (non-tellers) such patients and those who usually do tell (tellers). Non-tellers reported the shock of disclosure inhibits telling patients, families' wishes for non-disclosure cannot be ignored, and most patients themselves do not wish to be told. Tellers asserted disclosure is unavoidable and patients want to be told, few problems result when they tell, and telling has many advantages such as not having to lie to the patient. Despite the experience of non-tellers, most physicians continue to follow the traditional approach, for advanced or terminal cancers. Physicians, as well as families and patients, display an aversion to taking responsibility for the potential risks of disclosure, and this may perpetuate the status quo.

Identifying medical interview behaviors that best elicit information from patients in clinical practice.

Many textbooks indicate the desirability of using specific medical interview behaviors to obtain information from patients, although little evidence has been presented. The aim of this study is to investigate the relationships between the use of medical interview behaviors and the amount of information obtained. The behaviors studied included: open-ended questions, facilitation (comments or interviewer behavior that encourages the patient to continue talking), the open-to-closed cone (the gradual narrowing of focus from an initial nondirective approach to a more direct exploration), summarization (providing the patient with an explicit verbal summary of the information gathered thus far), and surveying problems. The subjects were 315 patients who visited an outpatient facility. These medical interviews were videotaped and reviewed by a trained rater using the Takemura Medical Interview Rating Scale, which was developed to assess the use of particular medical interview behaviors and to measure the amount of information obtained from patients regarding their chief physical complaints. Significant positive relationships were found between three particular interview behaviors and the amount of information obtained: facilitation, the open-to-closed cone, and summarization. These positive relationships were still present after adjusting for other medical interview behaviors used, and after adjusting for the time duration of the medical interviews (F = 15.3, p < 0.0001; F = 40.1, p < 0.0001; F = 5.57, p = 0.019, respectedly). This study reveals a positive relationship between three specific medical interview behaviors (facilitation, the open-to-closed cone, and summarization) and the amount of information obtained in a real clinical practice setting.

Development of a questionnaire to evaluate patient satisfaction with medical encounters.

Given that a medical practice exists for patients, it is worth determining the degree of patient satisfaction with regard to the medical practice's quality of care. Considering the importance of noticing patient satisfaction and its influence on clinical care, intense evaluation of a questionnaire's validity and reliability is essential. The purpose of this study was to establish a valid and reliable self-administered scale to measure patient satisfaction with fewer questions than previous scales applicable in medical settings in Japan. A qualitative method was used to develop and revise content-valid question items of the questionnaire. Factor analysis revealed five subscales among 12 items: "overall satisfaction", "complete examination", "patient centeredness", "examination time", and "whole person care". A test of internal consistency was also assessed. The concurrent validity was assessed to evaluate the association between the score of the current questionnaire and that of the visual analogue scale or other questionnaire. Agreement between two sets of score, scores just after consultation and 30-50 min after that, was assessed to evaluate the test-retest reliability of each question item. The results revealed satisfactory validity, including the content and concurrent validity, internal consistency (Cronback alpha = 0.77-0.85), and the test-retest reliability of our questionnaire (Kappa score = 0.61-0.71). In conclusion, we have developed a short-form self-administered patient satisfaction questionnaire applicable in Japan, with acceptable validity and reliability. This questionnaire may contribute to conducting further studies related to patient subjective responses to encounters in Japanese medical settings, and evaluating and improving the clinical interview skills of medical students or trainees in medical education.

Open-ended questions: are they really beneficial for gathering medical information from patients?

Open-ended questions, which allow patients to discuss their concerns freely, are widely considered an efficient method gathering medical information from patients during a medical interview. However, few studies have examined the relationship between the use of open-ended questions and the amount of information obtained from patients during the medical interview. This study examines this relationship using a relatively large sample size under more standardized conditions than in previous studies. The Japanese Group for Research on the Medical Interview undertook this research in 2002-2003. A total of 1,527 medical students conducted medical interviews with standardized patients, and 1,220 met the inclusion criteria for this study. The interview was limited to five minutes. Evaluators (medical school faculty physicians) evaluated the use of open-ended questions during the medical interview. The reliability of the evaluation sheet was also examined. The amount of information obtained was measured through the medical interview evaluation sheet. The use of open-ended questions was positively related to the amount of information elicited from the patients (F = 41.0, p < 0.0001). This study provides data to support the hypothesis regarding the favorable relationship between the use of the open-ended questions and the amount of information from the patients.