A diagnosis, a prescription, a checkup result: the sixth Kyushu Roundtable explored what happens when familiar medical encounters come with unfamiliar rules and expectations.
Eight pathologists examined the same 35 microscope slides of stomach tissue. As Dr. Ronald Schlemper explained at the sixth Kyushu Roundtable, the Western doctors diagnosed cancer in 20% of the slides, while the Japanese doctors diagnosed cancer in 80%. He described this contrast from his early research in Japan to illustrate how different diagnostic criteria could lead doctors to classify the same tissue differently.
The finding raised questions that would recur throughout the evening: what does a diagnosis mean, what makes a test reassuring, and how do patients find their way through an unfamiliar system?
At CIC Fukuoka in Tenjin on Sep 25, 2026, a record 50 participants representing at least 15 countries and regions gathered to discuss Healthcare in Kyushu: What Works, What Doesn’t? Thirty-three had attended a previous Roundtable.
Fukuoka Now publisher Nick Szasz moderated, with Schlemper, a specialist in internal medicine and Medical Director of International Clinic Terukuni, and software engineer Laurie Griffiths as guest commentators. As the microphone moved around the room, the discussion became a comparison of experiences: efficient treatment, confusing paperwork, unexplained results and the difficulty of speaking up.
The Same Slide, a Different Diagnosis
The study Schlemper described, published in The Lancet, examined how pathologists classified stomach lesions. Most Western pathologists placed greater weight on whether abnormal tissue had invaded the surrounding tissue; Japanese pathologists emphasised the appearance of cells and glandular structures.
The distinction mattered particularly for early lesions. The study found no major diagnostic differences for the seven slides showing clearly invasive cancer. Its lesson was about specific diagnostic criteria, rather than cancer being a matter of national opinion.
Subsequent research authored by Schlemper showed that a common classification substantially improved agreement. Differences that seemed fundamental could be reduced by making the definitions explicit.
Sam, a graduate student from Arkansas who praised the care he had received in Japan, asked a question that brought this exchange of knowledge back to the doctor’s own practice:
“In what ways have you altered or adapted or improved your practices after being here?”
Schlemper had come to Japan to learn about detecting early gastric cancer. Watching Japanese endoscopists was only a beginning: he wanted to carry out the procedures himself, become proficient and take that knowledge back to Dutch colleagues. That ambition helped persuade him to pursue a Japanese medical licence.
A doctor critical of aspects of Japanese practice had built part of his career around learning from it. For more on that experience, read Fukuoka Now’s interview with Dr. Ronald Schlemper.
Fast Treatment, Slow Paperwork
Laurie’s experience offered a more immediate reason to value the system. After developing chest pain, he went to hospital and was taken through tests quickly. He left reassured, with a small bill.
“I wasn’t shoved on a waiting list or ignored.”
Alison, a Canadian who has lived longer in Japan than in Canada, contrasted the travel and difficulties accessing care she had experienced in Canada with the availability of specialists and testing here. Her appreciation led to a question:
“So why is the Japanese system not going bankrupt? How can they afford to do all this testing?”
The discussion left the financing question open, but the benefit was clear to Alison: care close at hand, without a long wait.
But Laurie had also encountered a problem that no medical test could solve. During a residence-card renewal, the expiry of his health insurance card left him unable to fill a prescription. He said City Hall and his doctor had assured him that he had coverage. Yet he still could not obtain the medication.
As a software engineer, he connected that experience to a familiar problem: systems that work smoothly for expected cases can struggle when someone’s circumstances fall outside them.
“And it’s a bit of a funny story when it’s a restaurant booking app, but when it’s your hospital, it’s another thing.”
For Laurie, being told he had coverage offered little comfort when he could not fill the prescription. The precise administrative blockage remains unclear.
What Does a D Actually Mean?
Devran from the Netherlands described a result on her medical checkup:
“It was outside of the range. I got a D for it. I failed my medical check, apparently.”
She took it to Schlemper and, according to her account, was told it was normal for her. The exchange prompted questions about reference ranges, differences between populations and how well medical evidence represents women.
The measurement was not identified in the discussion. The story exposed the gap between a stark letter grade and an explanation of what it meant for the person receiving it.
Schlemper said reference ranges could differ between hospitals and laboratories. Devran needed more than a translation of her report; she needed someone to interpret it in context.
The same issue ran through the discussion of testing. Laurie had found his thorough investigation reassuring. Schlemper described other patients who worried about why so many examinations were being ordered. A test can settle one person’s fears and create new ones for another if its purpose has not been explained.
The Questions Patients Don’t Ask
Todd, a long-term resident originally from Idaho, recalled a motorcycle accident almost 40 years earlier. During the shoulder surgery that followed, he said, the doctor began drilling into his collarbone before he was under anaesthesia.
He described it as his only really bad experience. But his question reached beyond that operation, to a time when a doctor’s authority seemed beyond challenge:
“When I first came here, doctors were treated like God. In other words, you did not question whatever they said.”
Had that relationship changed? Schlemper said many of his Japanese patients still brought him questions they did not feel able to ask their Japanese doctors specialized in fields other than internal medicine. Even a shared language did not necessarily make it easy to speak up.
Matt, who teaches English to nursing students and researches patients’ experiences of cultural competence, asked about care across linguistic and cultural differences. Schlemper answered with a contrast from his experience of hospital life: doctors and nurses making rounds together and exchanging knowledge, versus doctors making rounds alone and leaving written instructions for nurses.
He questioned how much opportunity the latter arrangement gave nurses to learn from doctors and contribute to the discussion. Yet he was emphatic about the care they provided:
“Japanese nurses are really very caring for the patients.”
A participant from France raised a related question about where to place that trust. After about a decade in Japan, he had often read that university hospitals offered a superior experience. Was that reputation a reliable guide?
Schlemper’s answer was blunt. He described good specialists in general hospitals and weaker departments in some university hospitals. For him, making a referral meant knowing the expertise of the individual doctor in his/her field, rather than choosing a hospital by its name.
“You have to know which particular specialist is good in which hospital.”
His own referral list illustrated the point:
“For certain medical conditions, I send a patient to this hospital. For another medical condition to the other hospital, there are 10 different hospitals that I send patients to with different conditions because the quality is so different.”
He also described junior doctors working at night who might hesitate to wake a senior colleague for advice. Experience and supervision mattered at the moment a decision had to be made.
His answer shifted attention from a hospital’s reputation to who would actually treat the patient and what support that doctor would have. Those are details a trusted referral can help uncover.
The Prescription Is Only Part of the Answer
Arin, a Kyushu University student from New York City, recalled a fever that persisted after tests at the university clinic came back negative for COVID-19 and influenza. Attending classes became difficult. The medicines were unfamiliar too: different packaging and none of the familiar cues that helped Arin recognise treatments back home. What was being prescribed, why, and were there other options?
The question prompted Schlemper to emphasise the importance he placed on establishing the diagnosis:
“First we want to have a diagnosis, and then we want to prescribe medicines.”
Another participant asked why people taking medication for long-term conditions needed to return so regularly for repeat prescriptions. Schlemper pointed to restrictions within the insurance system. The audience member described the repeated visits as a barrier.
An Extra Day of Life, but What Kind of Day?
Bastien, a Kyushu University graduate student, introduced kaigo, or elder care, asking about staffing pressures. Schlemper’s answer moved from the number of people providing care to the kind of care being provided near the end of life.
He described terminally ill patients undergoing operations, including procedures to place feeding tubes, that he considered excessive. Hospitals could provide further interventions, he argued, while the person receiving them might still be in pain. He raised pain-medication coverage as another concern and questioned the priorities reflected in paying for procedures without ensuring adequate comfort.
Schlemper wanted doctors to call families, discuss the final months and find out their wishes before deciding how to proceed. Without those conversations, he argued, extending life could take precedence over the quality of the time remaining.
“And then they just value the one day extra life much more than the quality of life.”
Pain relief is part of palliative care in Japan: the National Cancer Center describes using medicines such as morphine. The concern raised by Schlemper’s account was whether relief from suffering and discussion of wishes received enough attention alongside the ability to perform another procedure.
Bastien’s staffing question remained largely open. But the exchange prompted Lisa, recently arrived from the United States, to ask what this might mean for arrangements she had already made:
“So if I have my end-of-life care directives that I brought from the U.S., will they be respected?”
She also asked whether translating them would help.
A document carried across borders had become a question about trust. Would the wishes it recorded guide decisions when Lisa could no longer speak for herself? The exchange did not settle how her directives would be handled.
A Question to Take Forward
At the close, Nick asked Laurie whether the discussion had changed his perspective.
“I think a lot of the comments from the room and from the doctor have given me a lot of explanation for the experiences I’ve had accessing healthcare.”
Schlemper proposed learning in both directions:
“Take the good aspects of Western medicine to Japan and export the good aspects of Japanese medicine to the West.”
Kanji had asked the question that connects those ambitions to everyday life:
“So yeah, just how would you guide us on taking control of our own individual care journey?”
The discussion did not produce a specific answer. Yet for international residents, this is where comparisons between systems become personal: how do we get the best possible care in the system we use?
Looking back as moderator, I would like us to return to this question. We live here, and Japan’s healthcare system is the one we need to navigate. Its strengths matter, from ready access to specialists to the care Laurie received when he had chest pain. So do the experiences we bring from other countries, including expectations about explanations, treatment choices and a say in decisions.
The next step is to explore how to put those experiences to use here: finding trusted guidance, understanding our treatment and making our wishes heard. That feels like a worthwhile focus for a future Roundtable.
Also on the Agenda: Kyushu Newsflash
Kyushu Newsflash is a regular part of the Roundtable format, opening the evening with regional stories for discussion. This time, topics included robotics, data centres, tourism and Yame’s tea industry. Laurie highlighted practical uses of AI in manufacturing, while Josh questioned data centres’ use of local resources. Amandeep drew a comparison with the telecom boom.
Julie asked whether tourism incentives could also recognise residents’ role in introducing visiting friends and family to regional destinations. Other contributions considered changing school rules and how visitors might learn more about the work behind Yame’s tea.
The Conversation Continues
Both guest commentators joined participants for drinks and informal conversation afterward. The microphone had stopped circulating, but the exchange continued.
Join the Next Kyushu Roundtable
Kyushu Roundtable is Fukuoka Now’s English-language discussion series bringing together people from diverse backgrounds to explore life in Fukuoka and Kyushu. Each gathering combines Kyushu Newsflash, guest commentary, audience participation and informal conversation afterward.
Looking ahead, Kyushu Roundtable #8 on December 4, 2026, will focus on Education in Fukuoka and Kyushu, featuring Brian Freeman, Head of School at Fukuoka International School, followed by an end-of-year bonenkai.
But first, join us for Kyushu Roundtable #7 on October 30, 2026. The theme will be announced soon, and registration is already open. Bring your questions, share your experiences and help shape the conversation.