Guides · 診療文化 · shinryō bunka
Why Your Doctor Gave You Three Days of Medicine
Foreign residents rarely complain that Japanese medicine is bad. What they find difficult is that it is different in ways nobody explains — and unexplained difference feels like being dismissed.
Here is what is actually going on behind the customs that most often puzzle new arrivals.
The three-day prescription
You have a chest infection. At home you would leave with a full course of antibiotics and instructions to finish it. Here you leave with three days of medicine and an instruction to come back.
This is not a lack of confidence in the diagnosis. Japanese outpatient practice is built around short intervals and re-assessment. The reasoning: most acute illness declares itself within two or three days, and seeing you again is the most reliable way to catch the case that is not going the way it should. Clinics are dense, cheap to access, and quick to get into — so a return visit costs you far less here than it would in a country where the next appointment is three weeks away.
There is a financial layer too. Japan's fee schedule pays clinics per visit, which does not exactly discourage the pattern. But it genuinely does catch deteriorating patients early, and for a first visit it is reasonable practice.
Once you are stable on a long-term medication, longer prescriptions are normal and available — 30, 60, even 90 days for well-controlled blood pressure or thyroid conditions. Many foreign residents never discover this because they never ask. Say plainly: "chōki shohō wa dekimasu ka" (長期処方はできますか) — "can I have a long-term prescription?"
The five-minute consultation
Japanese consultations are short. This reflects volume — a clinic doctor may see forty or more patients in a day — and a communication style that treats efficiency as respect rather than as rushing.
The way to get what you need is to arrive prepared. Write your questions down before you go, in order of importance, and lead with the most important one. Bring a list of your current medications, or your お薬手帳. If you have a specific worry — that this could be something serious — say it explicitly rather than hoping it will be inferred. Japanese medical communication is less indirect than the surrounding culture might lead you to expect; a direct question usually gets a direct answer.
Referral letters and why you were turned away
You went to a big university hospital with a straightforward problem and were told to see a clinic first, or were charged an extra fee — currently ¥7,700 or more for a first visit, including tax — on top of your normal costs.
This is deliberate policy, not obstruction. Japan lets patients choose freely among clinics — there is no gatekeeping GP system as in the UK — but large hospitals are meant to handle complex cases and surgery, not sore throats. The selection fee (選定療養費) for arriving at a large hospital without a referral exists to keep them from silting up. It applies to designated large hospitals — broadly, those with 200 beds or more — not to ordinary clinics.
The practical rule: for a new problem, start at a clinic (クリニック or 医院). Clinics are usually single-specialty, so you go directly to the relevant one — 内科 internal medicine, 整形外科 orthopaedics, 皮膚科 dermatology, 耳鼻咽喉科 ENT — with no referral needed. If you need hospital-level care, that doctor writes you a 紹介状 (referral letter), and the extra fee disappears.
Keep that letter and any imaging discs you are given. In Japan the records travel with the patient more than they do between institutions.
The intravenous drip you did not expect
Being offered a tenteki (点滴) — an IV drip — for dehydration, a heavy cold, or general exhaustion surprises many Westerners, where the same complaint would get oral fluids and sympathy.
It is culturally embedded here and, in genuine dehydration, entirely appropriate. In milder cases the medical benefit over drinking fluids is small. You are allowed to decline politely: "kyō wa daijōbu desu" (今日は大丈夫です) — "I'm alright today, thank you."
Kampo on your prescription
Being handed a traditional herbal formula by a Western-trained physician is not a slip into alternative medicine. Kampo (漢方) is integrated into mainstream Japanese practice — covered by insurance, manufactured to pharmaceutical standards, and prescribed in ordinary hospitals. The evidence base varies from formula to formula, from reasonable to thin. It is generally safe and generally mild. If you would rather not take it, say so; nobody will be offended.
"Please don't wash your hair" and other rest advice
Advice to avoid bathing while feverish, to keep the neck warm, or to rest more than seems necessary reflects a durable strand of Japanese health culture that takes convalescence seriously. Much of it is harmless custom rather than clinical necessity. Follow what helps you and let the rest go — but notice that the underlying instinct, that recovery deserves time, is not the worst instinct a medical culture can have.
What Japanese medicine does unusually well
It is worth stating plainly, because the friction points get all the attention. Access is remarkable: you can see a specialist tomorrow, without a referral, for a few thousand yen. Imaging is fast and inexpensive — Japan has more MRI and CT scanners per capita than almost any country, and a scan that would take weeks to authorise elsewhere may happen the same afternoon. Costs are capped by the high-cost medical expense benefit. Outcomes, by international comparison, are among the best in the world.
The consultation is shorter than you are used to. Almost everything surrounding it is faster, cheaper and more available than you are used to. That is the trade, and on most days it is a good one.