The Practice of Clinical Medicine in a Rural Area Importance and Perspective

Abstract

1) Japan made a remarkable recovery from ashes in the aftermath of World War II due to the people's effort to rebuild their lives and policy markers strong leadership. Moreover, great progress in medicine improved the quality of life.
2) A sweeping change in the living environment brought about a salient change in “disease structure.” There is no major difference between diseases endemic in the rural area and those in urban area.
3) Services provided by hospitals affiliated Koseiren (the Agricultural Cooperation for Health and Welfare) include internal medicine, pediatrics, surgery, orthopedics and obstetrics and gynecology. Medical services are provided by expert doctors in each department, and their mission is to improve the quality of rural medicine.
4) Apart from department-wise treatment, there is an interdisciplinary system making it easier for clinicians in different departments to cooperate. More attention should therefore be given to medical practices by these clinicians. Clinical medicine needs not be considered a particular type of practice in a rural setting. Rural medicine should be included in the category of general medicine.
5) Unlike teaching hospitals affiliated with a university, Koseiren hospitals have an extensive range of services including treatment of common diseases (eg, common cold or diarrhea, etc.), primary care, prevention of the three most common causes of death, treatment of lifestyle-related diseases, emergency treatment, a routine health checkup, home-visit nursing care services and home care. Given the present status surrounding a rural hospital which offers extensive services, young clinicians should no longer be equally encouraged to embrace the traditional idea of rural medicine. They should rather make better use of their expertise in the management of community-based medical services.
6) Studies on clinical medicine have gradually outnumberd those on rural medicine in the collection of lectures given at the general meeting of the Japanese Association of Rural Medicine (JARM) since its establishment indicating a change in the trend of rural medicine.
7) A course in rural medicine is not offered by the faculty of medicine in Japanese universities, which indicates that Japanese Ministry of Education, Culture, Sports, Science and Technology underestimates the importance of rural medicine.
8) Rural medicine dedicated to maintaining and improving the health of the rural populace is not related to the declining tendency of agriculture and rural population as a result of irresponsible Japanese agricultural administration. Rural clinicians are not responsible for that.
9) There is no point in discussing a definition of rural medicine usually influeneced by the thought, career and religious idea of those who govern. From my standpoint as a director of a community general hospital, I think clinical medicine should cover a broad range of areas.
10) Last but not least, my strongest hope is that an increasing number of young researchers will be interested in rural medicine besides pursuing their interests im their own area of expertise, and will be enrolled a members of the JARM. With a reduced number of members, the society's idea will die. I will follow the way that the JARM changes over time hoping for its further develpoment.