Interactive Journal of Medical Research

Background: Second opinion (SO) is widely recognized in Japan, but we do not know how patients view and use SO.Objectives: To investigate optimum seeking of SO in Japan's universal health‐care system.Design, participants, and methods: Survey of patients at Tokyo Medical and Dental University Hospital. Of 365 responses, 67 had experienced SO with standardized protocol at SO Clinic; 82 had obtained SO elsewhere without instruction; 216 had never sought SO.Main outcome measures: Views of values and risks of SO.Results: Second opinion patients with standardized protocol better understood their illness, treatment options, individualized plan, and uncertainty in medicine, and also reported improved decision making compared with SO patients without the protocol (P < 0.05). However, more than half of respondents misunderstood SO as a way to change doctors or treatment. Second opinion respondents (n = 149) had a propensity to request treatment changes (P < 0.1) and more than one‐third (n = 82) did not tell SO doctor they were being treated by another doctor. The absolute majority of non‐SO patients would seek SO for a serious illness but would hesitate to tell their doctors.Discussion and conclusion: Respondents recognized value of SO to improve understanding and decision making. This study also found risks in SO misuse which may be reinforced by Japan's cultural tendencies and universal health‐care system. Our findings suggest steps to increase the benefit of SO: ensure involvement of original doctor, instruct patients about SO and help them organize their thinking before SO and facilitate patients' return to the treating doctor for discussion and decision making.

Background: Generally, vaccination uptake in Japan lags behind World Health Organization targets.Objective: This study aimed to understand how risk information and advice affect intention to receive vaccinations.Methods: This study had a within‐subjects design. An online survey based on the Health Belief Model was sent to 2501 Japanese individuals (≧20 years) to assess the intention to be vaccinated for influenza and rubella after receiving minor and severe risk information and hypothetical advice about each vaccine. Regression analysis was used to measure changes in intentions to receive each vaccination after being provided with (1) risk information about each vaccine and (2) hypothetical encouragement and discouragement to be vaccinated.Main Outcomes: The main outcomes included changes in vaccination intentions from baseline.Results: Forty‐one percent (N = 1030) of those sent the survey completed it. At baseline, 43% and 65% of the respondents intended to have influenza and rubella vaccinations, respectively. Being provided with information about severe risks and susceptibility increased the intention to have the influenza vaccination among females in their 40s. Receiving inaccurate and discouraging information from one's mother significantly decreased the intention to have the rubella vaccination. Women 50 and older were more likely to intend not to have vaccination for rubella. Severe risk information decreased rubella vaccination intention in all age groups, except women in their 30s and 40s (p < .05).Conclusion: For both vaccinations, older individuals demonstrated vaccine hesitancy. This group requires tailored messaging to help them understand their vulnerability (to influenza) and their role in transmission (for rubella) to encourage uptake of essential vaccinations.Patient or Public Contribution: Members of the Japanese public responded to our online questionnaire on vaccination risk.

This study examines perceptions of persons who experienced a medical error and elements that may serve to open communication with those who experienced a medical error in Japan. Survey of individuals who reported a previous medical error in their care and those who did not. Tokyo, Osaka and Nagoya metropolitan areas, and in Fukuoka, Shimane and Miyagi rural townships in Japan. Questionnaires were distributed to 80 people who had experienced a medical error and 300 people who had not. Prevalence of views, expectations and psychological needs regarding medical error. Forty (50%) questionnaires from those who experienced the errors and 201 (67%) from those who did not experience a medical error were completed. Among those who experienced error, 95% (38/40) preferred to be informed of a medical error immediately by senior personnel (57.7%: 23/40). Those who had not experienced error preferred to be informed by a directly responsible provider (87.6%: 176/201). The perception differences regarding who should break bad news showed statistical significance (P<0.001). Respondents reports that ‘communication’, ‘apology’ and ‘corrective actions’ can contribute to promoting resolution. This study showed that after the immediate disclosure of a medical error by senior medical personnel and medical providers should create an environment to continue ‘communication’ in order to accommodate shifting perspectives of those who experienced the error.

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Patient data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) are used to assess the effect of biguanide administration on rates of lactic acidosis (LA) in hospitalized diabetes mellitus (DM) patients. In this retrospective cohort study (from April 2013 to March 2016), we compare DM inpatients prescribed biguanides to DM inpatients who were not prescribed biguanides to quantify the association between biguanides and incidence of LA. In total, 8,111,848 DM patient records are retrieved from the NDB. Of the 528,768 inpatients prescribed biguanides, 782 develop LA. Of the 1,967,982 inpatients not prescribed biguanides, 1310 develop LA. The rate ratio of inpatients who develop LA and are administered biguanides to those who developed LA without receiving biguanides is 1.44 (95% CI, 1.32–1.58). Incidence rates and rate ratios for both sexes are elevated in the group prescribed biguanides for patients aged 70 years and older, markedly in those 80 years and older: 40.12 and 6.31 (95% CI, 4.75–8.39), respectively, for men and 34.96 and 5.40 (95% CI, 3.91–7.46), respectively, for women. Biguanides should be used conservatively in patients older than 70 years, particularly for those with comorbidities, and with caution in patients 80 years and older.