Yusha Atake (5th grade)

I recently had the opportunity to participate in a one-week training program at the University of Washington, and it was such an intense, meaningful and valuable experience that it felt like it was just a week.

I am grateful to Dr. Yamanishi and the other teachers and staff at Hirakata Rehabilitation Center for providing me with this opportunity. Through this training, I learned how big the world is and how small my mind is. There are billions of people in the world, but I was reminded of the obvious fact that everyone has different ways of thinking, individual beliefs, and is never the same as me. When problems arise in the future due to such things, I believe that the bioethics that I learned in this training will serve as a guidepost. I would like to introduce some of them. First of all, what shocked me the most during this training was the several facilities that I visited, especially the children's hospital. I was surprised by their extraordinary size, but what was most shocking was that there was no "hospital smell". It looks like an office building in a prime location and is very luxurious. It seems that it is not uncommon for hospitals over there to be established through large donations, so it is possible, but it may be difficult to establish such a hospital in Japan. However, in Japan, they have places that would be laughed at as unnecessary facilities, such as a room for parents to relax, a beautiful balcony, a training gym, pictures on the walls that connect the first to seventh floors, and uneven walls that you can touch. These may not be typical of hospitals, but they are all full of consideration for the patients. For example, the room for parents to relax had a massage room and shower room that seemed luxurious at first glance. The staff there said, "For a child to be healthy, the mother must be healthy first." I was very envious of the hospital's strong expression of consideration for patients in this way. In addition, at this hospital, we received a lecture from Dr. Hays, who is involved in pediatric palliative care, through the story of a girl with leukemia. During the lecture, a girl about 10 years old thought about what she valued most in her life, and based on that, decided on a treatment plan with the doctor and her family. It was very impressive to see her desires change as her condition progressed. The "4 box method" that was used in the lecture was the one that Professor McCormick taught in the first class. Next, I would like to introduce this method. This method helps the patient to organize their own feelings about what should be prioritized when they encounter a problem. It also allows medical professionals to grasp the focus of the problem from a broad perspective that includes the background surrounding the patient, and to grasp it over time. First, create four boxes. In them, list four topics: (1) Medical indications (medical information such as illness, care plan, etc.), (2) Patient preferences (patient information and the patient's wishes), (3) Quality of Life (differences in quality of life due to treatment policy, etc.), and (4) Contextual features (background surrounding the patient, hospital, etc.), and write them down. By approaching the patient from not only the disease and treatment but also from the four important topics, you can find the best treatment policy for that person. In addition, it is designed to be easy to understand even from a third party, so the patient's family and all medical professionals involved with the patient can understand the patient's situation. And because it can be rewritten as many times as you want, you can re-plan your approach as many times as you want depending on the progression of the disease. I learned about the 4 box method for the first time during this training, but it seems to be somewhat popular in the United States. It came up many times during the week, was used in cases, and became very familiar to me through debates with everyone. First, I said that I learned that there are many different ways of thinking. I think that when many people encounter a way of thinking that is completely different from their own, they cannot immediately accept that idea because it is beyond their scope of understanding. Compared to the past, not only in Japan and the United States, but also around the world, the way of thinking about medicine has changed significantly, and doctors are no longer first, but I still think that sometimes doctors, because of their medical knowledge, force patients to receive the treatment they think is best. When such ethical issues arise, I think that the "4 box method" is a tool that can be easily used anywhere in the world. I learned a lot through the training program, but in addition to studying, the teachers gave me many experiences. We went shopping at markets and supermarkets, listened to the stories of the accompanying teachers at dinner and laughed together, and had the opportunity to tour the beautiful, economically developed and sophisticated city of Seattle. The dinner cruise was very luxurious and was another experience I would never have had in my lifetime. Looking back on this week, it was truly dense, and I was able to experience facilities that I would never be able to see in my lifetime and lectures that I would never be able to hear. As I mentioned at the beginning, the greatest benefit for me was that I was able to learn about diverse ways of thinking and have a broader perspective. All the teachers and staff I met in Seattle were very kind and gentle, and as fellow medical practitioners, they generously provided us with their knowledge and shared their experiences. I am very grateful for this precious opportunity. The people who allowed me to participate in this training were Dr. Yamanishi from Hirakata Rehabilitation Center, our accompanying Dr. Gamo, Dr. Seki, Dr. Nakano, Dr. Tomita, Kanazawa-san, Kajiwara-san, our guide Yoshiko Brown-san, and our interpreter Turid-san, who always helped us. I would also like to express my sincere gratitude to Dr. McCormick and Dr. King from the University of Washington, the many other professors who gave me wonderful lectures every day, and to Mr. Torii from the International Center who arranged my stay in Japan. Thank you so much. Nothing I absorbed during this training was wasted, and I believe it will be a source of nourishment for my future. It is a lifelong memory. I will use this experience to become a doctor I can be proud of. Thank you very much.