8Healthcare Experiences Among English- Speaking
International Residents
q The following four themes emerged from the interviews

1) International English-speaking
residents are satisfied withhealthcare in Japan• The system overall is easy tonavigate and accessible• Although some come from 100%
free healthcare countries (e.g., UK)
the costs seem fair and affordable2) Communication/Language barriers
3) Japanese physicians could work to 4) International English-speaking
exist even among higher-level
improve patient-centered care andresidents want to take an active part
Japanese-speaking international
bedside mannerin their treatment
residents• Expressed feeling more reassured
if an interpreter or Englishlanguage service was available,9even if not used

• Seeing a doctor and receiving
treatment is efficient• Residents speaking in Japanesewith physicians sometimes felt afeeling of nervousness justbecause they were foreign• Being able to choose any doctor orspecialist is convenient• Many still struggle with medical
terminology in Japanese• Engage in active listening andunderstanding of patients'
concerns• Implement a culturally sensitive
trauma-Informed care approach• Patients feeling like just a number
in a system and not being taken
seriously• Want the ability to advocate for
their own care
• Prefer more explanation about
exams, diagnosis, treatment, andprocedures• Interested in more of a holistic
approach to care
• Want to be treated as an equal
partner in their care.

Voices of English-Speaking International Residents“Health care (in Japan) isreasonably priced and accessible.”“The biggest frustration is that the doctors
I have visited were dismissive – I felt as
though I was not being heard.”“There seems to be a culture of notquestioning doctors in Japan,
where the doctor is always right.”“When using an interpreter,
I always felt like I was part of thebackground.”“The quality of care here (in Japan) is
high, and I trust that the doctors areknowledgeable.”“I want to work with them(the doctors)
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to find out what is wrong and find asolution, not just take medicine andhope that it goes away.”“Making appointments here isfairly easy, and the visits areusually efficient.”“I wish I could have been given moredetailed information about my treatment.”“As an international student, I feel lucky to havea lot of support from the university.”“Even though I’m comfortable using Japanese, I still try
to look for clinics or doctors who have some English orprovide other language services, as I feel they may be
more internationally-minded and more caring about
foreign patients.”“I was surprised when I accompanied arefugee to the hospital as their interpreter, butthey were denied care, due to language.

“I have a lot of trust in the system that they
are systematically on top of things.”

Recommendations
To serve the needs of a culturally diverse population, the healthcare system must take measures to improve
the knowledge and understanding of cultural competence and trauma-informed care.
q Cultural Competence
Cultural competence is the ability to collaborate andcommunicate with individuals from different cultures
to effectively deliver healthcare services that meet thesocial, cultural, and linguistic needs of patients.
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It also encourages active dialogues in which patientsand providers can ask questions, correct
misunderstandings, and build trust.

Source: Betancourt, J. R., Green, A. R., & Carrillo, J. E. 2002. Culturalcompetence in health care: Emerging frameworks and practicalapproaches. New York: The Commonwealth Fund.

q Trauma-Informed Care
A trauma-informed approach to care acknowledges that
healthcare organizations and professionals need tohave a complete picture of a patient’s life situation —past and present —to provide effective health careservices with a healing orientation.
Adopting trauma-informed practices can potentially
improve patient engagement, treatment adherence, andhealth outcomes.
Source: Trauma-Informed Care Implementation Resource Center

Requests from English-Speaking InternationalResidents“Training is needed across the board for how to deal with other cultures and how to be a people
person, as a doctor, it should be a standard for how to deal with people in this field.”“Mental health is also an important part of health and depending on the care that is received, theoutcomes may be different, work on creating an atmosphere for the patient where you do notreinforce or create new trauma.”“Dig around more and ask broader questions12to look into the deeper causes of the problem rather
than just a check box list for symptoms.”“Listen more actively and not just assume what is wrong; try to work with the patient to find out
what is the root of the problem and find a long-term solution.
“Treat the patient and not just the symptoms”

Summary
There are many positive and negative experiences among English-speaking international residents, but
their overall satisfaction with healthcare in Japan is high.
When dissatisfaction was expressed, it was related mainly to the following:• Communication with the physicians and cultural sensitivity• Lack of detailed information provided about diagnosis and treatment• The feeling of not being treated as a person
Recommendations
13• Gain an understanding of Cultural Competence
and Trauma-Informed Care; consider implementing
this approach in your own patient interactions.
• Encourage an atmosphere of active dialogue with the patient• Build a rapport with patients and try to connect on an individual level
Practicing these can lead to an increase in the level of trust from patients, better adherence to treatment,
and better health outcomes.

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THANK YOU!