日本人の心を考慮したケア改善を目指して(<特集>日本人の心身観と医療)

抄録

This presentation considers three aspects by which an understanding of Japanese patient psychology can improve medical practice in Japan. (1) Recent advances in holistic and psychosomatic medicine illustrate that patients' psychology can influence medical outcomes. While it has long been common knowledge that bodily conditions influence mental moods, the burgeoning new field of psychoneuroimmunology is demonstrating that mental attitudes and emotions influence illness and health. The commonest stress-related ailments in Japan, from ulcers and high blood pressure to eczema and stiff shoulders, can be significantly alleviated by psychosomatic medical techniques such as relaxation and biofeedback. (2) The psychology of Japanese patients differs in many respects from that of Americans. For example, Japanese rarely strive to participate actively in their own healing processes, express individual decisions in writing, write living wills or advance directives, or consider themselves equal in status to their physicians. Given such deep-rooted cultural differences, even their best attempts to imitate Western medical practices encounter many difficultes. This section considers more suitable ways of counseling Japanese chronic and terminal patients based on their cultural expectations. (3) Similarly, the spread of bioethics has been closely linked to Western conceptions like full disclosure of information, second opinions, third-party review boards, and the legitimacy of whistle-blowing. The social hierarchies of Japanese hospitals render such practices counterproductive if not impossible. In the care of Japanese patients, mutual understanding based on discussion and family participation in decision-making produce far higher trust and satisfaction than information disclosure. This suggests that Japanese develop their own ideals and conceptions of bioethics based on their own cultual goals and assumptions.