BACKGROUND: Understanding the job satisfaction and dissatisfaction of physicians might help to improve health care in Japan. Nevertheless, no job-satisfaction scale for physicians has been validated in Japanese.
OBJECTIVE: To develop a Japanese version of the Physician Job Satisfaction Scale (JSS), a multi-dimensional questionnaire developed by the Society of General Internal Medicine (SGIM) Career Satisfaction Study Group (CSSG), and to evaluate its reliability and validity.
METHODS: A Japanese version of the JSS was developed according to the standard protocol of scale translation. A focus group of 7 Japanese physicians was established to identify “Japanese-specific” facets of job satisfaction. After revising the scale based on the discussions of the focus group, a cross-sectional sample of 87 Japanese physicians from hospitals in different regions completed the Japanese version of the Physician Job Satisfaction Scale (JSS-J) to assess its reliability and validity.
RESULTS: A focus group identified a Japanese-specific facet, “prestige”. Content validity was also established through the focus group. Internal consistency ranged from 0.53 to 0.83. Test-retest reliability, convergent and discriminant validity were good to excellent.
CONCLUSIONS: Although the overall results suggest that the JSS-J can be applied to assess the job satisfaction of Japanese physicians, further qualitative research is required to refine the JSS-J.

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BACKGROUND: Japanese family physicians have limited psychiatric training, see a large volume of patients, and would benefit from the use of a mental-health screening tool. This study was an initial investigation into the feasibility and validity of using the Patient Health Questionnaire (PHQ) in the primary care setting in Japan.
METHODS: Feasibility was determined by surveying 149 patients from three primary care practices. Of this sample, a Japanese psychiatrist interviewed 98 participants to assess the validity of the PHQ. Based on the psychiatrist's results, sensitivity, specificity, positive predictive value, kappa statistic and the Likelihood Ratio were examined.
RESULTS: Some 83% of patients reported being “comfortable” in filling out the PHQ. Physicians (82%) reported that the information provided was “valuable” in understanding and treating the patient. The sensitivity of the PHQ in detecting any mental diagnosis was 93%, specificity was 81%, and the positive predictive value was 47%. In subjects with mood disorders, sensitivity was 75%, specificity was 88%, and the positive predictive value was 47%. The kappa reliability coefficients between the PHQ and psychiatrist diagnoses were 0.53 for any mental disorder and 0.51 for any mood disorder. In the case of any mental disorder, the Likelihood Ratio of a positive test (LR+) for the PHQ was 4.8. In the case of any mood disorder, the LR+ for the PHQ was 6.5.
CONCLUSIONS: The Japanese version of the PHQ was useful for detecting mental and mood disorders.

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BACKGROUND: In general practice, though patients often stop visiting ambulatory clinics of their own vo-lition despite the need for ongoing medical treatment, there is little reported research on the reasons for nonattendance in Japan. In this study, we investigated whether the patient/doctor relationship influences nonattendance rates in general practice. In addition, we investigated the reasons why patients stopped visiting the hospital.
METHODS: We collected data from 115 patients (58 males, 57 females; age range: 16 to 94 years old, median age: 52 years old) whose initial diagnoses were made in our department from June to July 2000. We classified the patients into five groups based on the level of their complaints concerning the initial consultation (‘A’ representing the highest degree of complaint, ‘E’ representing the lowest) and determined the relationship between the strength of complaints and the non-attendance rate. Furthermore, we investigated the reasons for non-attendance concerning 28 patients who stopped visiting the hospital from April 2000 to November 2001.
RESULTS: The non-attendance rates were 0% (014) for group A, 14.3% (2114) for group B, 5.6% (5189) for group C, 33.3% (216) for group D, and 50% (1/2) for group E. The rate tended to be higher in groups with fewer complaints. The reasons for non-attendance were the following: remission of symptoms (9 patients), request for another hospital or department (6 patients), relief due to consultation at the university hospital (6 patients), and lack of time to come to the particular hospital (5 patients) . In contrast, the most common reason for satisfaction at the time of consultation was ‘enough explanation and listening to complaints well’ in 7 of 11 patients who were satisfied with the consultation.
CONCLUSIONS: The level of patient's complaints at the time of consultation is related to the non-attendance rate. However, sufficient explanation about symptoms and careful listening to complaints are important for establishing a good patient/doctor relationship.

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We report the case of a 59-year-old man who presented with classical-type fever of unknown origin (FUO) during observation of hypertension and polycystic kidney. The presence of malignancy was suspected based on elevation of tumor marker levels. We examined the patient carefully and attempted diagnostic imaging, but definitive diagnosis was difficult due to the presence of multiple hepatic cysts. Hepatic biopsy detected adenocarcinoma, but identifying whether lesions were primary cholangiocellular carcinoma or metastases was difficult, and we were ultimately unable to diagnose the tumors as cholangiocellular carcinoma until autopsy. Polycystic kidney with hepatic cysts and complicated by cholangiocellular carcinoma is rare, but should be considered among the differential diagnosis for FUO, which itself is frequently encountered.

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