Perspectives in medical education. 3. Reforming medical education to change healthcare practice in Japan.

The enviable health status of Japanese citizens is one of the reasons for obdurate opposition to reform of Japanese healthcare practice. Change is widely believed to be unnecessary for a system that is both successful and profitably exploited to universal benefit. However, societal trends are conspiring to make current healthcare practice patterns and expenditures unsustainable in the future. In particular, Japan has undergone an unprecedented demographic shift from a society of young (and healthy) workers to one of older retirees with a higher prevalence of obesity. As a result, an equally dramatic future increase can be anticipated in the prevalence of age- and obesity-related disorders. The traditional paradigm of Japanese healthcare is not conducive to the restraint necessary for preserving its future viability, given these trends. Japanese healthcare does not reward clinical problem-solving skills, values specialists over generalists, places a heavy reliance on expensive technology, does not require interventions to be evidence-based, and provides no incentives to improve quality or efficiency. If this paradigm endures, Japanese healthcare faces the real prospect of bankruptcy. The failure of Japanese medical education to inculcate clinical skills and stress evidence-based medical practice lies at the heart of the impending crisis in healthcare. To solve the crisis, medical education in Japan must change its focus to training and developing a cadre of physicians with the broad-based expertise and clinical skills to make evidence-based decisions in a medically and fiscally responsible manner. The future health of the system and of the Japanese people depends on it.