Cultural competency can help radiologists and other radiology personnel provide better care to patients. This article illustrates this point with reference to Japanese culture.
Cultural competency is an important facet of professional education. Health professionals can be highly knowledgeable and skilled in technical senses, yet fail to care effectively for patients because of a failure to understand cultural differences. The same thing can happen in interprofessional domains, as when a physician interacts with nurses and technologists or with representatives from industry. Although the time available to devote to cultural competency in an educational program is small, merely making professionals aware of the importance of this dimension and providing examples of the differences it can make can be very important. Consider the differences between the US and Japanese culture.
Radiologists come into contact with Japanese for a variety of reasons, although many are unfamiliar with Japan’s cultures and traditions, which can lead to avoidable misunderstandings. Japan has the world’s third largest economy, $5.9 trillion. It is also the world’s 10th most populous nation, with 128 million people . Japan plays a major role in the world’s electronic industry, including companies with substantial presences in radiologic imaging, such as Toshiba, Hitachi, and Fuji. Japan is the fourth largest trading partner of the United States, and there are many US residents and visitors from Japan, particularly in the western United States .
Japan is often referred to as the “land of the rising sun.” Geographically, the nation is an archipelago, consisting of nearly 6900 islands, the four largest of which constitute nearly all of Japan’s land mass. It has over 100 active volcanoes, and powerful earthquakes, which are sometimes associated with tsunamis that occur several times a century. More than 30 million people live in the vicinity of Japan’s largest city, Tokyo . Buddhism and Shinto are the largest religions; however, 70% of Japanese say they are not religious . In terms of public health, Japan has the highest life expectancy at birth and the lowest homicide rate in the world .
Japan is a remarkable country demographically. For example, its birth rate has plummeted since the post-World War II baby boom . As a result, it is projected that by 2050 the population will fall to 108 million, and 40% of the population will be aged >65 years . This will pose an important economic challenge in the form of a worker shortage. Japan is also a much more genetically, culturally, and linguistically homogenous nation than the United States. For example, foreign-born, non-naturalized workers make up <2% of the population, and >99% of its people speak Japanese as their first language . By contrast, only about 80% of Americans are native English speakers .
In terms of healthcare, Japanese culture differs from that of the United States in a number of important respects. Patients are accustomed to being seen on a first-come first-served basis, and not by appointment, and those who arrive by ambulance usually have priority . Otherwise, a patient would need to be in extremis to move up the priority list. Another major difference concerns the nondisclosure of life-threatening diagnoses. It is much more common in Japan not to tell patients that they have a disease such as cancer, and in some surveys less than one-third of physicians say they would inform a patient of such a diagnosis . It is believed that disclosure of such a diagnosis may cause stress and precipitate psychiatric problems, or even suicide .
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