23.04.2021

Tokyo Journal; When Doctor Won't Tell Cancer Patient the Truth TOKYO, Feb. 24

Tokyo Journal; When Doctor Won't Tell Cancer Patient the Truth TOKYO, Feb.  24— When Emperor Hirohito began to vomit inexplicably and then lost weight and energy, his doctors never told him what just about everyone else in Japan eventually came to know: He was dying of cancer.

Hirohito may have been a virtual god in the early part of his reign, but he was also a patient  --  and doctors in Japan mostly lie to cancer patients, even former divinities. "I don't regret that I didn't tell him about his cancer," Akira Takagi, the Emperor's chief doctor, said at the time of Hirohito's death in 1989.

But these days, a mild-mannered radiologist is crusading for the principle of telling patients the truth, even when that means breaking their hearts.

The radiologist, Dr. Makoto Kondo, returned from a year in the United States determined to tell  patients bad news, and his campaign for radical change  --  for pulling doctors down a notch and injecting democracy into the Japanese medical system  --  is provoking such outrage among fellow physicians that they refuse to refer patients to him. He is scarcely more polite about them. "The present system is like the medical experiments on prisoners during World War II," Dr. Kondo said as he took a break in his cluttered office, surrounded by books in Japanese and English.

"It's a very awful thing. It's a shame." Dr. Kondo's latest book, "Side Effects of Anti-Cancer Drugs," has hit several best-seller lists since it arrived in bookstores late last year. Patients flock to his practice, and he has become about as much of a celebrity as a full-time radiologist can. Surveys suggest that only about a quarter of Japanese doctors always tell patients when they have cancer.

People are especially unlikely to be told if they have inoperable cancers with a poor prognosis; patients with stomach cancer may be told they have nothing more than an ulcer.

A 50-year-old woman named Kazuko Makino was told that she had gallstones, even though her doctor suspected gallbladder cancer. The doctor recommended surgery, but Mrs. Makino was a nurse and decided that she did not need an operation to remove her "gallstones."

 

The cancer spread, and Mrs. Makino died. Her family sued the hospital for malpractice, but a court rejected the claim, ruling in a landmark case in 1989 that doctors need not tell cancer patients their true condition. Japanese doctors do not disclose bad news primarily because of fear that it would upset the patient and harm the prognosis. 

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