JMIR FORMATIVE RESEARCH

Aoki et alViewpoint

AI Analysis of General Medicine in Japan: Present and Future
Considerations
Nozomi Aoki, MD; Taiju Miyagami, MD, PhD; Mizue Saita, MD, PhD; Toshio Naito, MD, PhD
Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan

Corresponding Author:
Taiju Miyagami, MD, PhD
Department of General Medicine
Juntendo University Faculty of Medicine
2-1-1Hongo
Tokyo, 113-8421
Japan
Phone: 81 3 3813 3111
Email: miya0829gami@gmail.com

Abstract
This paper presents an interpretation of artificial intelligence (AI)–generated depictions of the present and future of general
medicine in Japan. Using text inputs, the AI tool generated fictitious images based on neural network analyses. We believe that
our study makes a significant contribution to the literature because the direction of general medicine in Japan has long been
unclear, despite constant discussion. Our AI analysis shows that Japanese medicine is currently plagued by issues with
polypharmacy, likely because of the aging patient population. Additionally, the analysis indicated a distressed female physicianand evoked a sense of anxiety about the future of female physicians. It discusses whether the ability to encourage the success offemale physicians is a turning point for the future of medicine in Japan.
(JMIR Form Res 2024;8:e52566) doi: 10.2196/52566
KEYWORDS
artificial intelligence; physicians; hospitalists; polypharmacy; sexism; Japan; AI; artificial intelligence; medicine; Japan;
gender-biased; physicians; physician; medical care; gender; polypharmacy; women; Pharmacology; older adults; geriatric; elderly;
JapaneseIntroduction
The concept of “general medicine in Japan,” born around the1970s, led to 2 main physician categories in Japan: family
doctors and hospitalists. Unlike general medicine departments
overseas, there are no barriers to practicing within either family
medicine or hospital medicine; both are unique specialties that
require the adaptation of work to the size and conditions of theinstitutions they belong to, such as hospitals and clinics [1].
Additionally, some general medicine department managers arephysicians who have transferred from specialized departments,
and the mindset and competencies differ across institutions.
Thus, the state of general medicine in Japan is unclear, and wehave been unable to provide a clear answer despite more than
50 years of unremitting discussion. Since then, the field ofgeneral medicine has gradually expanded, and as of 2017, 86%of university hospitals have a department of general medicine[2]. Although the Japanese government and patients themselves
have recently begun to recognize the importance of general
medicine doctors, the public still lacks awareness of general
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medicine practitioners who do not require patients or theirfamilies to visit the hospital [3,4]. Therefore, we used artificial
intelligence (AI) to assess the society’s perception of general
medicine doctors in Japan. What answer will AI provide?

What Is the Answer Shown by AI ?
We used a tool called DALL-E (Open AI), which analyzes text
from a neural network and produces a graphical representation.
We inputted the text “General medicine in Japan” and “Futureof general medicine in Japan” to generate fictitious images [5].

General Medicine in JapanThe entry “General medicine in Japan” generated a picture ofseveral drugs (Figure 1), which we interpreted as being
indicative of the polypharmacy observed in Japanese medicine.
Compared to the rest of the world, Japan is a superaging society.
As of 2013, 25% of the population is older than 65 years [6].
Polypharmacy, the combination of various drug therapies forcomorbid diseases, is one of the problems seen within an aging
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society [7]. In Japan, polypharmacy has other causes. For
example, all citizens are covered by medical insurance,
providing ease of access to hospitals and medical care at
reasonable fees at any time. One of the disadvantages of thissystem is that patients can see specialists immediately, which
is why family doctors have fewer patients. This further
encourages polypharmacy as patients visit multiple departments

Aoki et al[8], leading to a growing need for doctors who can provide
broad-spectrum diagnostic and treatment opportunities topatients. Both general doctors with diverse work backgrounds
and polypharmacy are complex issues in Japan, which require
total reform. Based on this concept, AI may have createdpolypharmacy as a graphic representation of the most common
medical issue seen in Japan.

Figure 1. General medicine in Japan.

Future of General Medicine in Japan
Interestingly, “Future of general medicine in Japan” presented
a completely different graphic. Despite approximately 70% ofdoctors in Japan being male, only 4 female doctors weredepicted to be distressed (Figure 2). Although the percentageof female doctors in Japan is on the rise, in 2018, it was reported
that women are less likely to be accepted into some medicalschools than men [9], therefore raising awareness of sex
discrimination in the Japanese medical community. Several
reports describe the difficulties of working as a female doctor;
during promotions and evaluations, women in Japan often feel
discriminated against [10-13]. Moreover, the gender gap at workin Japan is by far the largest among high-income countries [14].
Currently, all the 19 medical specialty societies in Japan are
primarily represented by men; a survey study of the actual statehttps://formative.jmir.org/2024/1/e52566

XSL• FORenderXof general medicine found that the ratio of men to women was9:1, indicating that women are grossly underrepresented ingeneral medicine [15]. Many within general medicine haveexpressed concern about the impact of this issue on future healthcare. In response, the Japanese Society of Hospitalists andGeneral Medicine established a division for female physiciansin February 2021. In 2022, as part of the Women Physicians
Subcommittee’s activities, national and international
comparisons of female hospitalists were proposed [16].
However, activity still remains limited: the inclusion of women
has increased only slightly since inception, and the number offemale leaders remains low [16]. It must also be stated that an
absence of women in leadership positions can cause female
doctors to lose their role models, create an even wider gender
gap, and encourage further bias in the medical workforce [17].

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Aoki et al

Figure 2. Future of general medicine in Japan.

The future that AI envisioned may have focused on femalephysicians, who are currently reported to be oppressed in Japan.
As a solution, it is necessary to support the activities of female
physicians in general medicine and develop a workplace where
women can work comfortably as general physicians. It has beenreported that older hospitalized patients treated by femaleinternists have lower mortality and readmission rates than thosecared for by male internists [18]. The activities of female
physicians may have important clinical significance for future
medical care in the superaged Japanese society. Social change
in the current gender-biased image of physicians and acceptanceby the population is a great hope for Japanese medicine.

Limitations
Using AI, we assessed the current and future status of general
medicine practice in Japan. However, the criteria used to selectthe AI image output are unclear, making the academic evidence
less credible. Scientific publications on the subject of AI havebeen submitted since 2023. While it has been reported that AI
may be an effective tool in medical education [19], careful
evaluation of the preparation of the article is recommended [20].
However, the picture painted by the AI in this report isconsistent with previously reported social facts. It is aperspective that we humans are unaware of or avoid looking at;
we believe that this view cannot be easily ignored.

Conclusions
AI depicts “General medicine in Japan” as polypharmacy, the“Future of general medicine in Japan” as distressed female
physicians. While this AI-generated picture cannot be verifiedor avoided, it shows the future challenges associated with thepractice of general medicine in Japan.

Conflicts of Interest
None declared.

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Abbreviations
AI: artificial intelligence

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Edited by A Mavragani; submitted 08.09.23; peer-reviewed by M Rizvi, Y Ono; comments to author 28.01.24; revised version received
17.02.24; accepted 19.02.24; published 29.03.24
Please cite as:
Aoki N, Miyagami T, Saita M, Naito T
AI Analysis of General Medicine in Japan: Present and Future Considerations
JMIR Form Res 2024;8:e52566
URL: https://formative.jmir.org/2024/1/e52566
doi: 10.2196/52566
PMID: 38551640©Nozomi Aoki, Taiju Miyagami, Mizue Saita, Toshio Naito. Originally published in JMIR Formative Research(https://formative.jmir.org), 29.03.2024. This is an open-access article distributed under the terms of the Creative Commons
Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction
in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The complete
bibliographic information, a link to the original publication on https://formative.jmir.org, as well as this copyright and license
information must be included.

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