Elective Evaluation: Juntendo University Hospital, Tokyo
Andrew Whitfield is a medical student at the University of Sheffield. He is interested in neuro-rehabilitation having just returned from a medical elective in Tokyo, Japan.
Having now completed my elective at Juntendo University Hospital, Tokyo, I have had some time to reflect on what I learned under the guidance of Professor Fujiwara in the Rehabilitation Medicine Department. Rehabilitation Medicine is not a speciality in and of itself in the UK but brings together the typical responsibilities of Care of the Elderly, Physio/Occupational Therapy and Neurophysiology as well as a high level of radiological knowledge.
The department itself consisted of a few clinic rooms and a large hall equipped with many physical and exercise aids and staffed by dozens of therapists of every description. Outpatients would be assessed in a doctor-led clinic and prescribed various forms of rehabilitation or adjuvant therapies including physiotherapy, botox injections, orthoses, and even specialist treatments including transcutaneous spinal stimulation. While some patients attending clinic were younger people requiring botox injections for spasticity related to cerebral palsy, the majority of attendees were older adults. These outpatients mostly had impaired mobility post-stroke.
While Rehabilitation Medicine had no inpatient beds of its own, doctors were called to assess patients all over the hospital. Typical referrals were following joint replacements to facilitate early mobilisation, post head, neck or spine surgery to assess if there was any lasting neurological damage (including swallow assessments under video fluoroscopy), and frail older people who had come in with any number of ailments and were recognised as being amenable to Rehabilitation’s input.
I was surprised at the breadth of knowledge of the Rehabilitation doctors, needing full understanding of neurological and musculoskeletal systems in order to assess functionality and scope for improvement. In-depth knowledge of various surgical techniques was also necessary to predict recovery or diagnose which cranial nerves may have been bisected during an operation. The doctors also carried out many tasks themselves that would be delegated to other members of the MDT in the UK, including video fluoroscopy, EMGs and EMG-guided botox injections. As well as all this, doctors had their own academic interests as Professor Fujiwara is currently undertaking research in transcutaneous spinal stimulation with stroke patients in order to improve mobility.
All in all, Rehabilitation medicine is an interesting speciality which expects increasing demand as the population of Japan ages. Doctors from China were also shadowing as they have recognised the issues that will come with an ageing population as well. I think the UK can learn a lot from the Japanese in trying to keep older people as mobile and independent as possible for as long as they can. Many of the issues of old age including social isolation and loss of dignity can be averted by maintaining physical function and having a speciality devoted to this seems like a sensible way to start.
In conclusion, my experience at Juntendo University Hospital was an invaluable learning experience and one that was thoroughly enjoyable. I gained perspective on a different healthcare system in an equally developed country and was able to become accustomed to a different way of living. I would like to express my gratitude to the British Geriatrics Society for its support during my elective.