A housewife who checked into a respected Tokyo hospital recently for a minor operation on her finger died when a nurse mistakenly injected disinfectant into her intravenous drip. Doctors initially covered up the mistake, but members of the victim's family pursued their suspicions and forced the truth into the open.
At another hospital, surgeons mixed up two patients in the operating room, performing major heart surgery on a lung patient, and lung surgery on a heart patient. Both survived, but the hospital's bungling made national headlines.
Not long ago in Japan, such mistakes were routinely covered up and never disclosed to the patients, their families or the public. But a new patients' rights movement is growing, part of a larger trend of Japanese citizens demanding more accountability from doctors, government officials, educators and other authority figures.
For decades, people here have contentedly followed the decisions made on their behalf -- but rarely with their input -- by the pillars of Japanese society. But amid the pessimism and disillusionment that is rampant in Japan these days, people are raising their voices and demanding change. In the case of the medical profession, which has been called the last sacred institution in Japan, many Japanese no longer unquestioningly accept that doctor knows best.
"There is anxiety and distrust and frustration toward the medical profession; the whole atmosphere has changed," said Hisashi Katsumura, 37, a patients' rights activist who is launching an Internet home page this week to help aggrieved patients exchange information.
"People have known that problems existed, but because it was a closed system, they couldn't do anything about it," said Katsumura, who this year won a medical malpractice lawsuit involving the death of his newborn son.
Hisako Sato, 60, another activist, organized a symposium in Tokyo over the weekend to educate patients about how to sue doctors, and even how to ask them questions. Many Japanese will not seek a second opinion, knowing that many doctors consider it an insult.
Sato said Japanese people used to be more trusting of "those who held titles," but now are more likely to challenge them.
Sato's activism started when her husband, Mamoru, died suddenly in 1989 after going to a hospital complaining of a backache. He was never given any basic tests, "his blood pressure wasn't even checked," she said. Still unclear about what led to her husband's death, Sato is furious because, she said, hospital officials have never given her what she considers a straight answer.
Legal complaints and lawsuits against doctors, including Sato's, which is pending before the Supreme Court, are at record numbers. Activists also are pressing lawmakers to give people a legal right taken for granted in other democratic countries: access to their medical records and hospital charts.
In Japan, medical records are the property of whoever bought the paper upon which they are written: either the doctor or the hospital. Because of this, it has been easy for medical staff to alter records and hide mistakes and difficult for many patients to fully understand their condition.
A recent survey presented to the Japanese Cancer Association showed that only about one in four doctors is willing to tell cancer patients about their illness, even if the patient asks.
Doctors defend the secrecy as good medical practice in line with Japanese sensibilities. For example, many doctors here say patients should not be told if they have cancer, and many Japanese agree. But more and more patients see that as condescending and paternalistic, and are demanding the truth from their doctors.
"Many doctors do not tell the truth [about cancer] because they do not want patients to be disappointed, to lose the will to live," said Akira Koizumi, a physician and top official for the Japan Medical Association, which represents 150,000 doctors.
But Koizumi said times are changing and doctors must go along with growing public demand for more information about their condition and treatment. "The general thinking among doctors was, `Just follow me.' This was wrong," he said.
In an effort to be more forthcoming, the medical association in February urged doctors to tell the truth about terminal diagnoses to those who want to know and to show medical charts to those who ask.
But at the same time, the association is using its enormous political clout to block legislation that would require doctors to show patients their medical records. The doctors argue that the law should not interfere with the patient-doctor relationship.
Because the association is one of the most powerful groups in Japan, and a key supporter of the ruling Liberal Democratic Party, the fledgling patients' rights groups say they have virtually no hope of passing legislation over the objection of the doctors.
Still, "It's a new day," said Shigemi Oshida, a physician who teaches at Nihon University in Tokyo, specializing in legal issues related to medicine.
But Oshida wondered how far patients can push the establishment. He said he feared that the drive to open medical records would not result in more sunshine, but more maneuvering in the shadows. He said doctors might simply start keeping two sets of records: true ones and the ones they want their patients to see.
Many also noted that doctors and nurses here are overburdened. Japan's national medical system provides inexpensive care to all. But, partly because cost is not an obstacle, people visit the doctor in vast numbers -- often 10 are scheduled in the same time slot -- and are expected to wait until the doctor is ready to see them.
Even when they get in, many patients find out little about what ails them. Because of the time crunch and the doctor's traditional role as unquestioned authority figure, physicians do not spend a lot of time explaining. Often, they will examine a patient and simply write a prescription, without describing the condition or what medicine they are prescribing to cure it.
Until recently, people were happy to do as instructed. Now, more and more are wondering, as patients' rights activist Ikuo Kondo said, "Who is medicine for, anyway?"
CAPTION: Hisako Sato holds a portrat of her husband, Mamoru Sato, who died suddenly in 1989 with no clear explanation from the hospital.