Cross-cultural communication （48）　

48）The Risks of Treating Foreign Patients
As I have written in this blog, since returning to Japan after completing my medical training in America, I have treated several hundred foreign patients. For this reason, I have been asked many times to write articles on treating foreign patients for medical journals. The question that always arises is whether or not there is a risk of medical malpractice due to treating foreign patients who have difficulty communicating.

It is true that in the US, even the most trivial medical error or simple patient dissatisfaction can lead to a medical lawsuit. However, this is not a problem for the medical profession, but for the judiciary. There are so many lawyers in the US that there are many who make their living solely from medical lawsuits. They are called ambulance chasers. Originally, American lawyers did not charge consultation fees, but rather a success fee system. For this reason, patients often take up the offer of a lawyer even though they have no hope of winning.

Even in the US, the Good Samaritan Act often means that doctors are not held responsible for their actions during a flight. (This differs from state to state.)　Therefore, they are quite tolerant of medical treatment that was carried out in good faith and was the only treatment available at the time. If it weren't for ambulance chasers, Americans are quite sensible people. Christian countries other than the US also have the spirit of the Good Samaritan, so they are tolerant of medical treatment that was carried out in good faith, even if it wasn't the best possible treatment.

I don't think that the Good Samaritan law, which is the same as that on an airplane, can be applied to medical treatment in a foreign country, especially in Japan, where the language system is completely different, but I think that if the medical side shows a reasonable amount of effort and sincerity, the situation will be quite similar. Of course, I myself have never been sued by a foreign patient I have treated, nor have I ever been in a similar situation. I can guarantee that if you are a doctor who is confident in your English and willing to treat foreign patients, you will not have to worry about being sued. At first, your treatment may be a little awkward, but after a few patients you will gradually get used to it.

Rather, the risk of treating foreigners arises when it comes to payment. The simplest example is when the patient is in financial difficulty and has no cash, savings or anything else. This was a social problem that arose for a time at public hospitals in areas with a large number of illegal foreign workers. Therefore, it is necessary to ask foreigners who do not have Japanese health insurance what type of insurance they have before the examination, and if they do not have any, to ask if they have cash for the estimated cost of the examination. This is done anywhere in the world, and is not rude. (Doctors who are magnanimous and super-humanitarian enough not to worry about not getting paid do not need to ask these questions, though.)

Please be careful, as another example is not well known in general. There are cases where foreign patients who have been hospitalized due to a serious traffic accident or other incident have insurance (often private insurance) in their home country, and they ask that the hospital negotiate with the insurance company to pay the bill. In short, they are asking you to temporarily pay for the rather expensive medical fees. I myself have been asked to do this several times by other medical institutions, but you must never accept it. The correct way is to have the patient pay the bill temporarily, and then have them negotiate with the insurance company after they return home. Even if Japanese medical institutions try to negotiate with overseas insurance companies, they often find it difficult to get a handle on the negotiations. Even if you try to negotiate payment by email, you won't get a reply. The only way is to appoint a representative (usually a lawyer) who is fluent in the language of the country and have them negotiate over the phone, but after all, the other party is a professional at handling money, so they will easily brush off a lawyer from the tiny country of Japan in the Far East. When I was practicing in Paris, I only provided cashless services to patients with insurance policies that I had a direct contractual relationship with. For patients with other insurance policies, I would ask them to pay in cash first, and then I would sign the necessary documents for their insurance and let them negotiate with their insurance company.

| BACK |