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Preventive Care in Japan: Yearly Health Checks (Kenko Shindan)

We all want a clean bill of health. Japan is known for its preventive medical care, and we are so lucky to be eligible for a free, comprehensive, yearly health check (covered by your employer or national health insurance), also known as the Kenko Shindan.


And yet… I seriously used to dread these annual checkups. Was it fear of finding a disease or cancer? Perhaps I was embarrassed for not having a lower BMI? Was I anxious about the discomfort I might feel during an exam or procedure (like a mammogram or endoscopy)? In the age of Covid, was it fear of exposure from going to a hospital? And I'm a doctor! I should know better. But we are all human and all have these fears.


This year, I was able to wrap my head around these fears and realize that burying my head in the sand does nothing to change the situation. So many people are now being diagnosed with cancer at a later stage due to such fears, rather than getting tested early when the chances of successful treatment are much higher. Rather than being in avoidance or denial, it's much more constructive to tell myself "To the best of my knowledge, at this time I do not have a disease or a cancer in my body. I'm getting tested to make sure and to catch any problems as early as possible."

There is a bit of preparation involved before your yearly checkup. Typically your company will give you a choice of dates and times for an appointment to the clinic your company has selected. The types of tests may vary slightly, and you will be asked to fill out a bunch of forms on your medical history and lifestyle. These are usually in check box format (so do-able using google translate even if Japanese is difficult for you) and then you sign the standard consent forms. A couple of days in advance you will have to provide stool tests from home - you will receive 2 kits to on different days swab your own poop (!) and take a first morning urine sample on the day of your test. You will need to refrain from eating and drinking from around 9 pm on the night before your exam.

So for my health check, after verifying that I didn't have a fever, I checked in the front desk, showed them my health insurance card, they confirmed my paperwork and specimens, and I was directed to the locker room to change into what look like PJ's and disposable slippers. Everything is highly organized as you are directed from one test to another, a bit like going through an obstacle course. First, I was called in to speak with the doctor, and asked if I had any particular concerns. She listened to my heart and lungs with her stethoscope and took my blood pressure. Next, I was directed to a room where a technician measured my height, weight, waist circumference, and body fat analysis. I was given a vision and hearing test, and then was ushered to various rooms for blood tests, an EKG, chest x-ray, bone density test, mammogram, breast ultrasound, and abdominal ultrasound. I was then sent to the gynecologist for a breast exam, PAP smear and an ultrasound of my uterus and ovaries.


Finally, it was time for the upper GI endoscopy exam (my least favorite). In the US, every time I had an upper endoscopy (EGD) it was done under anesthesia - so I was shocked to learn that here, this is done as an awake procedure with an anesthetic spray to the back of the throat. And yes, it is super-gaggy and uncomfortable, but the whole thing is over quickly (within 5 minutes or so), and the trick is to follow the nurses cues to help you relax and breathe throughout the procedure. I find that breathing through procedures is always the key - whether for this, a mammogram, or anything that causes pain or discomfort.


If you don't have a history of gastric problems (I have polyps), you can opt to do a barium swallow. Here, you would drink a bubbly and chalky solution and then x-rays are taken while being turned this way and that on a mechanized table. If you really don't think you can tolerate an awake endoscopy, there are other hospitals that can knock you out for the procedure.


So that was my yearly health check experience! I overcame my fear, and did not procrastinate. All social distancing, disinfecting procedures were in place, it was not crowded, and I felt completely safe. Other people's experiences may be different from mine, with different tests for different age groups and sexes. In my case, my results will be delivered to me at my workplace within 3 weeks. I was not charged a single yen. And the time it took to do all of these tests? The clinic was a well-oiled machine and I doubt that this is typical, but from walking in the door to walking out, I kid you not, ONE hour!


What was I so afraid of? I went from being fearful and uncertain, to confident and moving on with my life. So please, I urge everyone to not let the fears stop you from a potentially lifesaving health check. I am comfortable in the knowledge that I was thoroughly checked, so that if I do have any medical problems they will be caught early. And if I am told that everything is normal, I can put my mind to rest, and keep doing my best to live as healthfully as I can.