{"id":179412,"date":"2026-09-01T11:50:46","date_gmt":"2026-09-01T02:50:46","guid":{"rendered":"https:\/\/www.fukuoka-now.com\/?p=179412&lang=en"},"modified":"2026-09-01T11:59:59","modified_gmt":"2026-09-01T02:59:59","slug":"dr-ronald-schlemper-healthcare-japan","status":"publish","type":"post","link":"https:\/\/www.fukuoka-now.com\/en\/dr-ronald-schlemper-healthcare-japan\/","title":{"rendered":"A Doctor Between Two Medical Cultures: Dr. Ronald Schlemper on Healthcare in Japan"},"content":{"rendered":"\n

Sixteen years after Fukuoka Now first profiled him, the Dutch-born physician reflects on 22 years at International Clinic Tojinmachi, his new model of care, and what Japan gets right and wrong about medicine<\/strong>.<\/p>\n\n\n\n

By Nick Szasz, Publisher, Fukuoka No<\/em>w<\/p>\n\n\n\n

When Fukuoka Now first profiled Dr. Ronald Schlemper in November 2010<\/a>, he had been in Japan for 15 years and had run International Clinic Tojinmachi for six. The interview introduced a physician with an unusual vantage point: trained as a specialist in internal medicine in the Netherlands, drawn to Japan by its expertise in detecting and treating early gastrointestinal cancers, and ultimately licensed to practice medicine here.<\/p>\n\n\n\n

Sixteen years later, much has changed. International Clinic Tojinmachi has closed after 22 years. Dr. Schlemper now runs International Clinic Terukuni<\/a>, an appointment-based clinic offering both in-person and online consultations, while continuing to work part-time at Fukuoka Sanno Hospital.<\/p>\n\n\n\n

What has not changed is his directness. Dr. Schlemper has strong views about how medicine is practiced in Japan, particularly around communication, prescribing, teamwork and medical education. But his perspective is not simply that of an outsider criticizing the Japanese system. Japan is where he acquired skills he considered far ahead of Western practice, built a career, treated patients for decades and wrote a book sharing Japanese expertise with an international medical audience.<\/p>\n\n\n\n

\"Dr.<\/a>
Dr. Ronald Schlemper speaking with Fukuoka Now at International Clinic Terukuni.<\/figcaption><\/figure>\n\n\n\n

Our conversation lasted well beyond the planned questions. At one point, it briefly became a consultation about my own cholesterol treatment. That exchange captured much of what distinguishes his approach: ask more questions, explain the risks, agree on a goal and make sure the patient understands why the treatment is being given.<\/p>\n\n\n\n

Ahead of his appearance at Kyushu Roundtable #6, we spoke about what 22 years of following patients taught him, why he changed the way he works, the difference between language and medical culture, and the deceptively difficult question at the center of healthcare: what does \u201cquality\u201d actually mean?<\/p>\n\n\n\n

This interview was conducted in English at International Clinic Terukuni on August 18, 2026, and has been edited for length and clarity<\/em>.<\/p>\n\n\n\n

Twenty-two years of following patients<\/h2>\n\n\n\n

Fukuoka Now:<\/strong> Looking back over 22 years at International Clinic Tojinmachi, what stands out most?<\/p>\n\n\n\n

Dr. Schlemper:<\/strong> When I started the clinic, if you advised patients to exercise more, eat healthier, eat less fatty meat and eat more fish, vegetables and fruit, most would not listen. They would continue with their own habits, and often the only way to improve their cholesterol, control their diabetes and reduce their risk of heart attack and stroke was with medicine.<\/p>\n\n\n\n

A lot has changed in 22 years. Patients have really become health-conscious. Now I cannot do one run around Ohori Park without seeing one of my patients doing his or her exercise.<\/p>\n\n\n\n

When you can see that your advice on preventive healthcare really bears fruit, that is very rewarding. People have good cholesterol values, their diabetes is under control, their hypertension is well managed, or their fatty liver has improved because they lost weight and began exercising.<\/p>\n\n\n\n

The great thing about having your own clinic in Japan is that you can follow patients over a long period. You can see that your advice and medication are having an effect. As a hospital-based specialist in the Netherlands, I would not have been able to follow the same patients in that way. They would normally be referred back to a general practitioner.<\/p>\n\n\n\n

Fukuoka Now:<\/strong> International Clinic Tojinmachi was widely known among Fukuoka\u2019s international community, but most of your patients were Japanese.<\/p>\n\n\n\n

Dr. Schlemper:<\/strong> Seventy percent of my patients were Japanese, and that was also the case 22 years ago. It was not just a clinic for foreigners.<\/p>\n\n\n\n

Many Japanese patients came by word of mouth. Someone had been to me, felt they received good care and advised a friend to come. Many did not live close to the clinic. They traveled 30 minutes by subway, bus or car.<\/p>\n\n\n\n

To have so many Japanese people coming to a foreign doctor was gratifying. Apparently, they appreciated the care. They received explanations about the examinations we were going to do, the diagnosis and the possible treatments. Many patients want to be properly informed.<\/p>\n\n\n\n

Why he closed Tojinmachi and started again<\/h2>\n\n\n\n

Fukuoka Now:<\/strong> Why did you decide to close the Tojinmachi clinic?<\/p>\n\n\n\n

Dr. Schlemper:<\/strong> Several things came together. First, I was simply too busy. The Japanese health-insurance system also created a great deal of administration. For every blood test, examination or prescription, you have to enter the appropriate diagnosis and submit the claim correctly. If you are busy seeing patients during the day, you have to do the administration in the evening or on Sunday.<\/p>\n\n\n\n

My best nurse, who had worked with me for almost seven years, got married and wanted to start a family. The rent was also going up, and finding another English-speaking nurse had become very difficult.<\/p>\n\n\n\n

Then my children told me, \u201cYou should stop working like this. You should enjoy life and have some free time.\u201d All of those things happened at the same time.<\/p>\n\n\n\n

Fukuoka Now:<\/strong> What did you expect when you opened International Clinic Terukuni?<\/p>\n\n\n\n

Dr. Schlemper:<\/strong> I thought patients with Japanese health insurance would go to Sanno Hospital and that only patients without Japanese insurance would come here. I thought I would have a very easy life in this clinic. It did not turn out that way. [Laughs.]<\/em><\/p>\n\n\n\n

I also wanted to focus on online consultations so that not only people living in Fukuoka, but foreign residents throughout Japan, could benefit from my experience with the Japanese medical system. Online consultations still make up a minority of my work, but they are growing.<\/p>\n\n\n\n

\"Dr.<\/a>
Dr. Ronald Schlemper outside International Clinic Terukuni in Fukuoka.<\/figcaption><\/figure>\n\n\n\n

Fukuoka Now:<\/strong> What is different for patients here at International Clinic Terukuni?<\/p>\n\n\n\n

Dr. Schlemper:<\/strong> It is purely an appointment system. If patients arrive on time, there is virtually no waiting. After a consultation, I can send the prescription information to the patient\u2019s chosen pharmacy, so the medicine can be prepared before the patient arrives. It saves a great deal of time.<\/p>\n\n\n\n

Some patients who have Japanese health insurance still come here even though they know they cannot use it and will have to pay the full amount. They are tired of spending hours waiting at a large hospital when the consultation may simply be to review their condition and renew a prescription.<\/p>\n\n\n\n

Fukuoka Now:<\/strong> If the purpose of moving was to improve your work-life balance, why continue working at Sanno Hospital?<\/p>\n\n\n\n

Dr. Schlemper:<\/strong> Many of my patients have Japanese health insurance and do not have the luxury of paying 100 percent instead of 30 percent. Many of them had visited me for decades. To just say goodbye? I could not do that.<\/p>\n\n\n\n

On the days I work at Sanno, the work-life balance is not very good. I am supposed to finish at five and often finish at seven, sometimes with no time for lunch. But here at my own clinic, it is much better. I can choose when to work and when not to work. If I want to do something with my family, I can block half a day or multiple days.<\/p>\n\n\n\n

So, for 23 days of the month, the work-life balance is working out.<\/p>\n\n\n\n

Communication is part of treatment<\/h2>\n\n\n\n

Fukuoka Now:<\/strong> In our 2010 interview, you said many international patients came to you not primarily because of language, but because of differences in medical culture. Is that still true?<\/p>\n\n\n\n

Dr. Schlemper:<\/strong> It is still exactly the same. They receive explanations about the diagnostic process, the diagnosis and the treatment. In the Netherlands, that is how we are trained: to explain everything to the patient.<\/p>\n\n\n\n

In the medicine I was taught, we try to find the cause of the disease and then treat the cause. If a patient has a viral infection, for example, you can give something to relieve the symptoms, but an antibiotic will not treat the virus.<\/p>\n\n\n\n

Some patients initially find that difficult because they expect antibiotics or several different medicines. But if you explain why they are not needed, they understand. When those patients come back, they often say they recovered just as quickly without the antibiotic.<\/p>\n\n\n\n

Fukuoka Now:<\/strong> How does explanation affect preventive care?<\/p>\n\n\n\n

Dr. Schlemper:<\/strong> Patients need to know what the treatment is intended to achieve, for example, how much it will reduce their risk of heart attack and stroke. If the blood results improve but have not yet reached the appropriate goal, I ask: what shall we do? Is it realistic to exercise more or improve your diet? Or have you already done what you can, and should we adjust the medication?<\/p>\n\n\n\n

You discuss it with the patient. Without talking, you do not find these things. A doctor can only understand the risk factors by speaking with the patient and should explain the goals of therapy.<\/p>\n\n\n\n

Fukuoka Now:<\/strong> At this point, our interview briefly became a consultation. I told you that I take cholesterol-lowering medication, but I could not tell you my LDL cholesterol level or the treatment target my doctor was aiming for.<\/p>\n\n\n\n

Dr. Schlemper:<\/strong> You have to look at the individual patient, count the relevant risk factors, estimate the chance of that person having a heart attack or stroke in the next 10 years, and decide on an appropriate goal, such as reducing that risk to below 10 percent. The target is not necessarily the same for everybody.<\/p>\n\n\n\n

You were satisfied because you were taking medicine and the laboratory sheet might show that a value was within its printed \u201cnormal\u201d range. But a general laboratory range is not the same as a personal treatment target. A value may be inside that range and still not be the appropriate goal for a patient with several risk factors.<\/p>\n\n\n\n

The question is whether the doctor is observing, communicating and making sure the goals are achieved. Patients should understand why they are taking a medicine and what they are trying to accomplish.<\/p>\n\n\n\n

\"Dr.<\/a>
Dr. Schlemper reviews medical reference materials in his consultation room.<\/figcaption><\/figure>\n\n\n\n

Fukuoka Now:<\/strong> Is language still one of the main barriers for international patients?<\/p>\n\n\n\n

Dr. Schlemper:<\/strong> I do not think language is necessarily the biggest problem. It is often the way medicine is practiced.<\/p>\n\n\n\n

Nowadays, translation tools can help a great deal. I have a Chinese patient who cannot speak English or Japanese, and my Chinese is very bad. But with Google Translate we can have a normal conversation. If the spoken translation is not clear, we type it.<\/p>\n\n\n\n

Translation technology cannot decide how much time a doctor spends listening or how much explanation the patient receives. Those are questions of medical culture and practice, not only language.<\/p>\n\n\n\n

What Japan taught him<\/h2>\n\n\n\n

Fukuoka Now:<\/strong> We have discussed areas where you believe Japanese medicine could improve. What does Japan do particularly well?<\/p>\n\n\n\n

Dr. Schlemper:<\/strong> The strengths are in areas where Japan has seen a very large number of patients. Gastroenterology is the field that brought me to Japan in the first place.<\/p>\n\n\n\n

Japan has had a high incidence of gastric cancer, so Japanese doctors had to become very good at finding it at an early stage, when it can often be treated through an endoscope. They also became highly skilled at detecting early colorectal cancers. In this area, Japanese medicine is the best in the world.<\/p>\n\n\n\n

Fukuoka Now:<\/strong> Was learning those techniques your original reason for coming?<\/p>\n\n\n\n

Dr. Schlemper:<\/strong> Yes. If you see that Japan is diagnosing many cancers at an early stage while your own country is not, you want to know why. That was the main purpose of my coming to Japan: to learn how they did it.<\/p>\n\n\n\n

I learned those methods and later helped write a book, Early Cancer of the Gastrointestinal Tract<\/em>, to explain the Japanese approach to an international audience. Japanese doctors used simple and inexpensive techniques, such as spraying dye during endoscopy, to make subtle changes in the tissue easier to see.<\/p>\n\n\n\n

\"Dr.<\/a>
Dr. Schlemper with Early Cancer of the Gastrointestinal Tract, which he co-edited to share Japanese diagnostic and treatment methods with an international medical audience.<\/figcaption><\/figure>\n\n\n\n

Before the dye is applied, an early cancer can be almost impossible to identify. Afterward, the shape and edges become visible. I wanted to help transfer that knowledge to Western medicine.<\/p>\n\n\n\n

Fukuoka Now:<\/strong> Are there broader strengths in the Japanese healthcare system?<\/p>\n\n\n\n

Dr. Schlemper:<\/strong> Access is much better than in many countries. There are usually no very long waiting lists. If you have a serious problem, in most cases you can proceed with the examinations and then treatment.<\/p>\n\n\n\n

Japanese nurses also have a very strong commitment to caring for patients. Their medical education could be better, but the care they want to give is very good. That is something I sometimes missed in the Netherlands.<\/p>\n\n\n\n

Where he believes the system falls short<\/h2>\n\n\n\n

Fukuoka Now:<\/strong> You have said that choosing the right doctor matters more than simply choosing a famous hospital. Why?<\/p>\n\n\n\n

Dr. Schlemper:<\/strong> Some departments in a hospital may be very good and others may be poor. You have to find out which individual doctor is working where. I refer a patient to a particular specialist, not just to the name of a hospital.<\/p>\n\n\n\n

In large Western hospitals, specialists regularly meet to discuss complicated patients together. The patient is at the center, and the doctors move around the patient. In Japan, the patient often has to move from one doctor to another. In my experience, there is less discussion among the different specialists responsible for the same patient.<\/p>\n\n\n\n

Fukuoka Now:<\/strong> Does the same concern apply to communication between doctors and nurses?<\/p>\n\n\n\n

Dr. Schlemper:<\/strong> Yes. In the Netherlands, doctors and nurses make rounds together. The nurse may know something about the patient that the doctor does not know. The doctor learns from the nurse, and the nurse learns medicine from the doctor because the doctor explains why a particular examination or treatment is necessary.<\/p>\n\n\n\n

In many Japanese hospitals, nurses make their rounds and doctors make separate rounds. The doctor later writes the orders, and the nurse reads and follows them. It becomes one-way traffic. Going to the patient together would help the doctor, the nurse and the patient.<\/p>\n\n\n\n

Fukuoka Now:<\/strong> You are also concerned about antibiotic use.<\/p>\n\n\n\n

Dr. Schlemper:<\/strong> Antibiotics are still prescribed when they are not necessary, particularly for infections that are probably viral. That contributes to antimicrobial resistance.<\/p>\n\n\n\n

Bacteria are not stupid. If antibiotics are used repeatedly and unnecessarily, bacteria develop ways to resist them. Then, when a patient has a serious bacterial infection and truly needs an antibiotic, the medicine may not work as well.<\/p>\n\n\n\n

This is not only a Japanese problem, of course, but Japan has recognized antimicrobial resistance as a serious issue. Changing prescribing habits requires continuing education for doctors and a better understanding among patients about when antibiotics help and when they do not.<\/p>\n\n\n\n

Fukuoka Now:<\/strong> What would you change about medical education?<\/p>\n\n\n\n

Dr. Schlemper:<\/strong> Young doctors need more direct teaching from experienced physicians. Too often, junior doctors are mainly taught by doctors who are only a few years ahead of them, while senior doctors focus on research or their own work.<\/p>\n\n\n\n

There can also be too much \u201ceminence-based medicine,\u201d where people follow the view of the senior or famous doctor rather than evidence-based medicine grounded in research. Of course, there are excellent Japanese doctors who study continuously and give very good care. But the educational structure could do much more to spread that quality.<\/p>\n\n\n\n

Medical students, as well as newly graduated doctors, are often taught by relatively inexperienced physicians. During the two years I trained young residents at Fukuoka University Hospital, I noticed significant gaps in general medical knowledge compared with Dutch medical graduates.<\/p>\n\n\n\n

The best solution would be for me to become Minister of Health and completely change the medical education system. Of course, that is never going to happen. [Laughs.]<\/em><\/p>\n\n\n\n

A rare career between systems<\/h2>\n\n\n\n

Fukuoka Now:<\/strong> Your own route into Japanese medicine was highly unusual.<\/p>\n\n\n\n

Dr. Schlemper:<\/strong> I was already a specialist in internal medicine in the Netherlands. I came to Japan to learn endoscopic diagnostic techniques and treatment, but I found it difficult to be treated as an equal in the medical setting without a Japanese license.<\/p>\n\n\n\n

I originally intended to return to the Netherlands. Then Fukuoka University Hospital offered me the opportunity to do research and study for the Japanese national medical examination. I passed the examination and stayed at Fukuoka University Hospital for five years.<\/p>\n\n\n\n

At that time, I found myself in a strange situation. I had passed the Japanese medical examination, but my immigration status did not initially allow me to earn money through medical practice. I had a Japanese medical license but still faced another legal barrier before I could build a normal career here.<\/p>\n\n\n\n

Fukuoka Now:<\/strong> How common is it for foreign-trained doctors to qualify and practice independently in Japan?<\/p>\n\n\n\n

Dr. Schlemper:<\/strong> It is still very rare. A foreign-trained doctor has to meet the requirements to take the Japanese national examination, master medical Japanese, including the necessary kanji, and secure a status of residence that permits the intended medical work. The hurdle is extremely high.<\/p>\n\n\n\n

There are some special arrangements under which limited numbers of foreign-licensed doctors can treat designated patients in Japan, but that is different from holding a full Japanese license and opening a clinic that treats both Japanese and international patients.<\/p>\n\n\n\n

\"Dr.<\/a>
Dr. Ronald Schlemper at the entrance to International Clinic Terukuni.<\/figcaption><\/figure>\n\n\n\n

If Japan wants to attract more international doctors as its foreign population grows, it will have to examine those language, licensing and immigration barriers. Otherwise, there will continue to be very few people able to follow the route I took.<\/p>\n\n\n\n

\u201cWhat is quality?\u201d<\/h2>\n\n\n\n

Fukuoka Now:<\/strong> For someone living in Fukuoka, is access to quality healthcare different from elsewhere in Japan?<\/p>\n\n\n\n

Dr. Schlemper:<\/strong> I do not think there is a very large difference between Fukuoka and Tokyo. But what is quality? Judged by whom? Is it based on patient satisfaction, or is it the medical quality as a doctor would judge it?<\/p>\n\n\n\n

You can be very satisfied with a friendly doctor. But if you have received treatment for years and do not know why you are receiving it, what the goal is or whether that goal has been achieved, I would question the quality. The patient may still be happy.<\/p>\n\n\n\n

That is why I am interested in hearing other people’s experiences. Doctors and patients may judge the same care very differently.<\/p>\n\n\n\n

Fukuoka Now:<\/strong> You will join us on September 25 for Kyushu Roundtable #6, \u201cHealthcare in Kyushu: What Works, What Doesn\u2019t?\u201d What would you like to hear from the people in the room?<\/p>\n\n\n\n

Dr. Schlemper:<\/strong> I want to hear what they experience from their side. Some patients will have had problems with Japanese doctors. Others may be very happy with care that, from a Western medical point of view, could still be incomplete.<\/p>\n\n\n\n

I learned something from speaking with you. You were happy with your doctor even though you did not know the goal of your cholesterol treatment. That was very interesting for me to hear.<\/p>\n\n\n\n

I am sure I will hear many interesting things at the Roundtable. I am sure I will learn a great deal from the people in the room.<\/p>\n\n\n\n

Kyushu Roundtable #6: Healthcare in Kyushu: What Works, What Doesn\u2019t?<\/h2>\n\n\n\n
\"\"<\/a><\/figure>\n\n\n\n

Dr. Ronald Schlemper will be the featured guest commentator at Kyushu Roundtable #6 on Friday, September 25, 2026, from 18:30 to 20:00 at CIC Fukuoka in Tenjin. The English-language event is free, but advance registration is required <\/a>and seating is limited.<\/p>\n\n\n\n

\n
Register for Kyushu Roundtable #6<\/strong><\/a><\/div>\n<\/div>\n\n\n\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

Sixteen years after Fukuoka Now first profiled him, the Dutch-born physician reflects on 22 years at International Clinic Tojinmachi, his new model of care, and what Japan gets right and wrong about medicine. By Nick Szasz, Publisher, Fukuoka Now When Fukuoka Now first profiled Dr. Ronald Schlemper in November 2010, he had been in Japan […]<\/p>\n","protected":false},"author":5,"featured_media":179419,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":true,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_locale":"en_US","_original_post":"https:\/\/www.fukuoka-now.com\/?p=179412&lang=en","_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[4910,4911],"tags":[5266,5229,5259],"class_list":["post-179412","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-beauty-health","category-people","tag-health","tag-interview","tag-kyushu","en-US"],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/www.fukuoka-now.com\/wp-content\/uploads\/2026\/08\/schlempler-interview-talking-002.jpg?fit=1400%2C1050&ssl=1","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.fukuoka-now.com\/wp-json\/wp\/v2\/posts\/179412","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.fukuoka-now.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.fukuoka-now.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.fukuoka-now.com\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/www.fukuoka-now.com\/wp-json\/wp\/v2\/comments?post=179412"}],"version-history":[{"count":3,"href":"https:\/\/www.fukuoka-now.com\/wp-json\/wp\/v2\/posts\/179412\/revisions"}],"predecessor-version":[{"id":179549,"href":"https:\/\/www.fukuoka-now.com\/wp-json\/wp\/v2\/posts\/179412\/revisions\/179549"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.fukuoka-now.com\/wp-json\/wp\/v2\/media\/179419"}],"wp:attachment":[{"href":"https:\/\/www.fukuoka-now.com\/wp-json\/wp\/v2\/media?parent=179412"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.fukuoka-now.com\/wp-json\/wp\/v2\/categories?post=179412"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.fukuoka-now.com\/wp-json\/wp\/v2\/tags?post=179412"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}