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Cut in doctors' working hours at hospitals hits medical services

Notices that partly read, "We have suspended accepting patients at night," are seen at Kyorin University Hospital in Mitaka, Tokyo, on July 4, 2018. (Mainichi)

Reductions in the working hours of doctors at hospitals designated to provide highly advanced medical services have led to cuts in medical services at these institutions, such as consultation and treatment hours.

However, these hospitals that function as the last resort to save patients' lives also find it difficult to sacrifice the quality and quantity of medical services for patients to improve the working conditions for doctors. Therefore, reforms of the way doctors work at such specialized medical institutions has a long way to go.

Notices that partly read, "We have suspended accepting patients at night," were posted at the reception area for urgent patients at Kyorin University Hospital in Mitaka, western Tokyo, this past May. Specifically, the hospital stopped accepting patients with light conditions at its 12 departments including urology, neurology and ophthalmology after 10 p.m.

The move was triggered by an instruction from the local labor standards inspection office last autumn to rectify the long working hours of doctors at the institution. The hospital is staffed by 676 full-time doctors, but it was inevitable that reforms of their working conditions would adversely affect medical services provided at the institution.

Kyorin University Hospital, which has an around-the-clock advanced emergency medical service center capable of accepting patients with life-threatening conditions, serves as a core emergency hospital in the Tama district of western Tokyo.

Since the beginning of this year, the hospital has provided explanations of patients' conditions to their families only during the day, in theory. However, if patients' family members visit the hospital on their way home after work, doctors have no choice but to respond to them even at night. A hospital official said the institution "would like the cooperation of patients" in reducing doctors' work hours.

Work-style reforms are also beginning to affect ordinary hospitals. St. Luke's International Hospital in Chuo Ward, Tokyo, has downscaled its medical services on Saturdays, while the Niigata City General Hospital, one of whose trainee doctors took her own life in 2016 as a result of overwork, is asking patients with slight conditions not to visit the institution on Sundays and national holidays or at night. The Japanese Red Cross Society Suwa Hospital in Suwa, Nagano Prefecture, has also decided to provide explanations of patients' conditions to their families only during the day.

However, some doctors and hospital operators are perplexed by the work-style reforms.

A general hospital in Tokyo has provided explanations of patients' conditions to their families only on weekdays since last year at the instruction of the local labor standards inspection office. However, a hospital insider admitted that opposition was voiced to the decision within the institution.

"Amid keen competition between hospitals, we are required to provide convincing explanations. Those critical of the move (to limit the time when explanations can be provided) say it 'would run counter to' the trend of being required to provide thorough explanations,'" the hospital insider said.

Medical practitioners are required to constantly boost their knowledge by reading research papers and attending academic societies' study sessions in order to maintain and improve the quality of the medical services they provide.

The head of a university hospital expressed concerns that work-style reforms "would adversely affect not only medial services but also doctors' research and education."

Under the Medical Practitioners' Act, doctors are banned from refusing to provide treatment without justifiable reason.

Therefore, a cap that was set on overtime hours for general workers that comes with punitive provisions under work-style reform legislation approved in the last regular Diet session will not apply to medical practitioners over the next five years.

The government is seeking to prevent work-style reforms for doctors from adversely affecting medical services. The basic economic and fiscal strategy that the Cabinet of Prime Minister Shinzo Abe approved in June states that restrictions on overtime work for medical practitioners "should be considered while examining how such efforts will affect regional medical services."

The government intends to determine the upper limit on overtime hours for medical practitioners toward the end of the current fiscal year, but it is no easy task.

Satoshi Imamura, vice president of the Japan Medical Association that submitted its opinion on work-style reforms for doctors to the health minister, underscores the importance of maintaining doctors' health for not only doctors themselves but also patients.

"It's difficult to carry out reforms that would largely affect the current medical services, but medical practitioners' health is also important for the general public," he said.

Ikuko Yamaguchi, president of the incorporated nonprofit organization COML that offers advice to medical institutions from the standpoint of patients, underscores the importance of making it easier for families of patients to visit hospitals during the day to receive explanations of their kin's conditions.

"Patients don't want to receive treatment from doctors who are sleepy or exhausted," she said. "It's necessary to prevent doctors' work hours from increasing as a result of being forced to explain patients' conditions to their families at night or on weekends. To that end, society should change to make it easier for workers to receive some time off during their daytime shifts to hear explanations from doctors.

Current medical services have been maintained by allowing medical institutions to have doctors work extremely long hours.

Roughly two-thirds of 85 hospitals designated to provide highly advanced medical services have signed agreements with their labor unions under Article 36 of the Labor Standards Act to allow doctors to perform long overtime in excess of the 80-hour-per-month death-by-overwork line, according to documents that the Mainichi Shimbun obtained this past March under the freedom-of-information system.

Labor-management agreements at over 10 of these institutions for fiscal 2016 and 2017 allowed doctors to do 100 hours or more of overtime a month. Previously, the National Cerebral and Cardiovascular Center in the Osaka Prefecture city of Suita had a labor-management accord allowing management to have doctors work 300 hours of monthly overtime.

(Japanese original by Go Kumagai, Tokyo Medical Welfare News Department, and Shunsuke Kamiashi, Tokyo City News Department)

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