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The Medical Maverick
Doctor pays a price for his reform drive

Fed up with medical blunders, Japanese patients fight for greater accountability from doctors and hospitals

By rights, Dr. Kondo Makato should probably be a full professor of medicine now, with a fine office and an entourage of physicians waiting for him to dispense advice. But he's not. Kondo, 52, is a kind of leper in the Japanese medical world, shunned by his peers and out of favor with his bosses. Despite his seniority and skills as a radiologist, he bears the lowly title of "assistant doctor" at Tokyo's Keio University Hospital, where he spends most of his time in a shared top-floor room, doing research.

His crime? He has offended the medical establishment by campaigning for more transparency between doctor and patient and for other reforms, including the patient's right to see his records and seek a second opinion. In Japan, where nobody tells doctors what to do, Kondo is seen as a revolutionary in a white coat. He could not care less. Unless attitudes change, he says, patients will continue to die or be injured in mishaps, and the ensuing cover-ups will go on.

Kondo's first slide down the career ladder was in 1985, when, after three years in the U.S., he began telling his cancer patients precisely what they were suffering from. He says: "I wanted doctor-patient relationships to be based on trust. By taking this step, I was promoting the concept of informed consent — a practice that is badly needed in Japan." Other doctors didn't agree. Colleagues who once referred about 10 patients a month to him for radiation treatment cut him off completely. He found he was no longer asked to deliver lectures or attend meetings with senior figures at the hospital.

Undeterred, Kondo says his approach works. "When I explain to sick people that I am telling them the truth because I want them to play an active role in their treatment — which is important for their getting better — they are appreciative and cooperative." Statistics seem to be on his side. A poll released last month by the Ministry of Health and Welfare shows that 64% of out-patients and 54% of in-patients would like to see their records. The most common reason: they wanted to learn more about their treatment.

The maverick doctor has published 15 books, all of them taking the medical establishment to task for its poor practices and advising members of the public on how to protect their rights and get the best possible treatment. One of his targets: doctors who over-prescribe medication. That won him few friends in the powerful pharmaceutical industry. He is unconcerned about that too. In Kondo's view, too many doctors are in the pockets of the drug companies.

Recent publicity over medical mishaps has turned Kondo into a celebrity. He frequently gives media interviews and lectures on the topic of informed consent. Patients still seek him out for radiation treatment, but most of the time he is in his room doing research. "I don't miss being a professor," he says, "because becoming one means you have to create a following for yourself. I'm not much of a diplomat." But to many patients and inspired activists, he's a hero.

— By Suvendrini Kakuchi

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