The Instructor Kobayashi of the University of is the general secretary of the Japanese equivalent of the . Very francophile (and French-speaking person), this famous surgeon of the knee tells us his two stays with Lyon and his formation near his Lyons friends A. and H. . Doctor , Associate professor in Medical Osaka College in the service of the Instructor . He is the assistant secretary of association and fact proof of a great dynamism to animate these exchanges. He also knows France well, where it often goes. It practices the spine surgery and the pediatric csotcina.comaedics. Especially we hope that this evocation of Japanese csotcina.comedy will give you desire for better knowing this country with the so different but so rich crop, and to discover the great friendship and the regard which our Japanese colleagues carry us.

 

Mr. O.: Mr. Kobayashi, can you forward yourselves?

. : I am Associate professor part-time lecturer to Faculty and Directeur of the csotcina.comedic hospital of . Currently, I am Chairman of the Japanese company of csotcina.comedy.

 

Mr. O.: To when does go back your first stay in France?

. : It was almost 40 years ago, with the autumn 1961. After having made a success of a difficult contest of the French government (I was in 5th year of training of csotcina.comedic surgery), I decided to go to France.

 

Mr. O.: Why France?

. : Our generation of Japanese doctors had a tradition of exchanges for the medical studies towards Germany or more and more towards the United States as of the end of the second world war. After the success with my contest, many friends had assailed me by questions: why France? The answer was very simple: because French medicine was unknown for us and I wanted to speak this beautiful language, and to live in a beautiful stone-built house.

 

Mr. O.: Why Lyon?

. : The cultural attache of the Embassy of France in Japan advised me to remain elsewhere than in Paris where the life was very expensive. csotcina.comedy Lyons traumatology was then famous in France: it was the era of - Joseph and George De . They accepted my request for training course.

There were a large activity of traumatology at and De , in particular of many interventions for fracture of the mining area. This frequency, by comparison with our csotcina.comedic department of , was explained by the difference of the means of transport (we did not have many cars). It was also the unhappy time of the free-Algerian war which generated many casualties repatriated in the aircraft above the Mediterranean.

Mr. O.: How did you know Mr. ?

. : At that time, it directed the department of emergency of the Hospital Edouard and I met it from time to time.

After my return to Japan, where I remained during 13 years, I wished to turn over in his service in 1975 thanks to a new purse of the French government. At that time, I was Pr Associated in the csotcina.comedic department of the University of with whose owner was Pr T. , former chief executive of the in 1978 and the largest specialist in the knee in Japan of the time. He had also spoken me to him about Mr. and had advised to go to visit it because of his great fame in this surgery. The chance wanted that it directs Pavillon I then, where I had remained several years before!

Mr. Henri , of the same generation that me, its core opened to me very frankly. It became one of my friends very expensive. It should be said that I remained almost two years in Lyon.

 

Mr. O.: which memory did you keep of Albert ?

. : Mr. asked me of an imperative tone to address as tu it and to call it only by his first name “Albert” as of the first day. In consultation, Albert carefully listened to the clinical history of a patient and very of a blow it was turned over towards me of clicking away at me of questions in salvo and asking me my opinion. If I answered in an erroneous way, or if I kept silence, its voting right of thunder fell: “you will be guillotine”. He did not believe in the arthrography nor with the (which had just appeared in France) because its clinical direction very sure, was supported on the detailed history of the patient and its clinical exam. Indeed, the safety of its diagnosis was checked at the time of the operation and for me it was always a marvellous surprise.

 

 

Mr. O.: how was held the operations?

. : The operating-rooms of Pavillon I functioned like a true factory with patients deadened and awaked out of the operating-room. The owner showed me the technique, for him essential, of “No
” in particular for the knee, surgery in which he excelled (, patellar instability, surgery , in particular in the footballers).

At the end of one year, I was accustomed to environment merry and clear Pavillon I and I truly understood the spirit of Albert and Henri. It is to make known this Lyons spirit, of the knee surgery, with the Japanese csotcina.comedic surgeons, whom I invited Albert with the annual convention of the Japanese company of csotcina.comedy in 1982 and Henri with the annual convention of the Japanese company of Rheumatology and articular surgery in 1989 for Conferences of teaching. These voyages sealed my friendship with Lyon.

 

Mr. O.: Taking into account your knowledge of our 2 countries, can you explain us the characteristics of the Japanese system for the course and the exercise of csotcina.comedy?

. : There are edical colleges. The entrance examination is very rigorous. Approximately 8000 doctors leave each year. The medical course lasts six years; one or two for fundamental sciences, the foreign languages (English, German, and very little French) and some social sciences. After the of the diploma follows to a national examination, the boarding school (American system of rotation) obligatory which lasts two years. After the boarding school, one can choose either the installation, or the university work of search, or specialization, etc… they are directly related on Faculty or , except very few independent hospitals.

As for specialization, for the csotcina.comedic surgery for example, it takes six years of experience practical which follows an oral examination and writing of the Japanese company of csotcina.comedy. To continue the qualification of csotcina.comedist, one must obtain unities necessary to renew it every 6 years until the 65 years age.

There are no yet specialists in the parts (like the hand, the foot, the knee, etc…) in the csotcina.comedic field.

 

Mr. O.: Which is the health-care system in Japan?

. : All Japanese must adhere to the Social security which is obligatory. The services of Insurances of Health consist of four systems according to whether one is official, employee, workman or peasant. The rates of distribution and settlement are fixed according to the system. Because of the budgetary crisis, the rates of settlement tend to decrease.

The assumption of responsibility of the novel methods represents an important issue for the insurance as well as the ageing of the population.

 

Mr. O.: Which are your impressions on the differences between our two countries from the medical point of view?

. : To answer, I will quote extracts of the report of voyage written on his return in France by Dr. (which remained in Japan in 1991).

“In Japan, the csotcina.comedic surgeons are csotcina.comedists before being surgeons. This precision is fundamental. The French csotcina.comedists, before any surgeons, often consider condescending eye all that does not refer directly to the operational act. The Japanese csotcina.comedist does not reason as a technician, but rather as a doctor who deals with overall the disease or the accident and integrates the operational act like a stage in the healing process. The surgery is thus a technique among others, like the rheumatology, functional rehabilitation. They also take part in the realization of complementary examinations like the reading of the blades of pathologic anatomy or the diagnostic use of three-dimensional systems of analysis of the movement.

Japan, very organized, very Community, emergency traumatology is not ensured by the University hospitals that they are public or private. They are the satellite hospitals of the precedents or rather of the deprived hospitals especially devoted to the greeting and the processing of the surgical urgencies.

There exists very little of doctors rheumatologists in Japan. They are the csotcina.comedic surgeons who are responsible for this activity. Within a great csotcina.comedic department, even the Instructor often has charges with it this speciality whose it ensures at the same time the diagnosis and the processing, (by using all the diagnostic techniques)” ......

It has been only for two years that the Department of health adopted specialization in rheumatology. The number of the doctors rheumatologists since then increases.

 

Mr. O.: Which is the place of rehabilitation in Japan?

. : Rehabilitation occupies an important place in Japanese csotcina.comedy. This situation devotes the existence of hospitals entirely devoted to the activity, the presence within all the csotcina.comedic departments of a structure of rehabilitation to the long course which partly explains the long life of stay of the patients at the Hospital until they recovered their complete range, the relative dissatisfaction of the surgeon for one more or less long period, and finally overall the assumption of responsibility of the disease and not simply of an acute problem as one too often sees it in Japan. This situation has advantages and disadvantages.

Recently, of the specialists in rehabilitation appeared whose majority are still csotcina.comedists. In some universities, the services of rehabilitation appeared.

 

Mr. O.: And seeks it?

. : The Japanese csotcina.comedist understood a fundamental thing: the teaching of search forms integral part of the training of any surgeon. The number of titular Japanese csotcina.comedists of a thesis in science doctorate is enormous. However, it is clear that this omnipresence of search slows down the training of the Japanese surgeons whose surgery is only one of the activities. The education level with the operative technique is probably the same one in our two countries, with the difference nearly a few years to shift.

 

. : Could you describe us one of your day's works?

. : I have two mornings of consultation per week or I see a score of patients.

The majority of the patients are forwarded by the doctors of city in order to have a diagnostic, therapeutic or surgical opinion. We operate three days per weeks.

The operational day begins with 9:00 from the morning and continues without interruption up to 18 or 19 hours. We practice about thirty interventions per week.

As of 7 a.m., Thursday morning, the whole of the surgeons meets to discuss the pre and postoperative cases during approximately two hours.

Monday morning, the meeting of bibliography keeps us informed of the especially Anglo-Saxon worldwide topicality.

In our hospital, 14 surgeons with 180 ancillary medical assistants work full-time for 200 beds of csotcina.comedy.

The activities of teaching are obligatory there as well as search. We communicate to each congress.

 

Mr. O.: Could you conclude?

. : Although the French csotcina.comedic surgery has a brilliant and old tradition, it is not yet sufficiently known in our country. I believe that it has completely original aspects which would deserve to be better known. It thus frequently sometimes happens to me to write items in the reviews and newspapers Japanese, emphasizing these original aspects.

It seems essential to me, as far as possible, to maintain close contacts between the French and Japanese csotcina.comedists.