When You Don’t Speak the Language, Literally: My Experience with the Japanese Health Care System and Radical Empathy

A common thing in my world of behavior change and design is a focus on building empathy by talking to people, sharing their perspectives, and living in their worlds. We talk about not designing for but rather with people, and empathy is required to do that. The truth is that even our best tools don’t really let us inhabit others’ lives. We can gain an understanding and emotional connection, but it’s not quite the real thing of experiencing what they experience.

I recently was able to do what I’ll call “radical empathy building” on a trip to Japan. I’ve done some work on factors that might inhibit people’s ability to effectively utilize healthcare, like health literacy and cultural differences, and thought I had a pretty good handle on the challenges that, for example, a non-English speaker might face at a doctor’s office in the US. Then I got sick in Japan with a persistent and worsening sore throat.  I speak virtually none of the language, and it’s not overstating the situation to say I am illiterate in Japanese. I don’t really understand their medical system, wasn’t even sure how to access care, and I needed to see a doctor.

Fortunately the staff at my hotel were able to find a clinic nearby and direct me there. Without them, I wouldn’t even have been able to take the first step toward receiving care!

Process differences

I didn’t think much about it before I arrived, but once I was in the clinic I realized there’s no reason why the steps of receiving care from a doctor should be standardized across cultures. The waiting room and clinic floor plan were different from what I was expecting; the exam room was immediately adjacent to the waiting area, and the doctor popped out every few minutes to call the next patient himself. The medical staff had me fill out some paperwork, but it didn’t seem to be an issue that I wasn’t already a patient.

Because of my total lack of Japanese, I couldn’t really ask what I was supposed to do, although I did use some of my waiting room time Googling to make sure I didn’t totally embarrass myself. I also watched other people and did what they did, which generally worked out for me. It didn’t help me in the actual exam room, but fortunately the physician was very patient with me. We used a lot of pantomimes.

Difficulty providing the right information

I was unable to fill out my medical background form in much detail, thanks to my pitiful Japanese. Google Translate helped me figure out the yes/no questions, but there was no chance I could provide a full medical history. This resulted in a moment when the doctor looked at my throat and physically jumped in surprise at my lack of tonsils. My guess is that tonsillectomies aren’t as common in Japan as they are in the U.S. The good news was that my lack of tonsils immediately ruled out tonsillitis, making the doctor’s job a little easier.

Although in this case it wasn’t a big deal, this is a missed opportunity for people to receive the best care when there’s a language barrier. What if the missing information from my medical history hadn’t been immediately visually evident to the doctor? What if the doctor hadn’t been good enough at speaking my language to ask the questions he needed for a differential diagnosis? Or patient enough to muddle through our interaction?

Fuzzy boundaries to shared knowledge

Everyone in the clinic understood that I had never experienced their system before, and took great pains to explain in detail. It was quickly apparent that none of us really understood what everyone else did and didn’t understand.

For example, I was prescribed a lozenge that looks like a Life Saver. Both the doctor and the pharmacist made it clear to me that the lozenge is supposed to dissolve in my mouth, not be swallowed whole, which was pretty obvious to me (Life Saver).

What they didn’t (couldn’t) explain and I didn’t understand is that the lozenge is an antibiotic. (Thank you, Dr. Google, for the assist on figuring that out.)  I’ve never seen an antibiotic delivered in that form, but it seems to be common there. The reason that information was important is that I do know it’s important to take the full course of an antibiotic. Without realizing what each medication was, I may have stopped taking the lozenges once my throat felt better.

While I wouldn’t exactly recommend getting sick overseas, I feel lucky to have had this experience with a good outcome. I learned a bit about how the Japanese medical system works and cured my symptoms so I could enjoy the rest of my trip.

And I gained a true sense of empathy for the experience of needing medical care without an ability to speak the language–in a much more literal sense than I meant when I wrote a post called “When Health Care Is a Foreign Language.” I feel naive looking back. I’m sure I’ll continue to be naive going forward. My wish is that this experience will help me recognize my own naiveté so that I better know when to reach out for other perspectives.