Let’s Get Physical: Getting a Standard Medical Check-Up in Japan

Preventative medical care is incredibly important in the detection and early treatment of ailments. Few countries on the planet have a better grasp of this than the fine medical professionals of Japan. This is likely why each year people all over the country get a standard medical check-up or what we like to call a physical.

Unlike what most Americans are familiar with the standard medical check-up that the people in Japan receive is quite in depth and dare I even go so far as to say better. This in depth check-up include a long list of standard tests that include body measurements, ophthalmic exam, hearing test, lung function test, circularity organ test, urine test, fecal exam, hematological test, liver function test, pancreatic function test, sugar metabolism test, lipid test, immunological test, renal function test, gout test, chest X-ray, stomach X-ray and abdominal ultrasound. There is also a long list of optional tests that you can choose from. This includes but is not limited to gender specific tests such as prostate exam and mammograms.

Because the idea of getting your very first standard medical check-up in Japan can undoubtably be intimidating and at times confusing I have decided to outline all of the information you need to know in this post. We will cover everything that you need to know from the moment you make your appointment to the moment you get back home. The only thing that I ask of those reading this is to understand that information may vary slightly based on the medical facility that you visit. However the goal of this post is to provide you with the information you need in order to feel comfortable with the process.

Making Your Appointment

The process of making an appointment for your standard medical check-up will vary based on the company that you work for and the medical facility that you choose to attend. In some cases you will have the ability to simply call the medical facility’s reservation hotline whereas in others your company will take care of the reservation for you.

Upon making your reservation/appointment you will be given a list of standard test (listed above) and you will be asked whether or not you would like to receive any of the optional tests. Once you have informed the medical facility of your requests you will then be given a date and time for your appointment and a packet of information.

What is Included in the Medical Packet

A few days before your appointment  you will receive a medical packet in the mail. This medical packet will include a pamphlets with information about your standard medical check-up, urine test kit and fecal test kit. Because the medical facility we used was aware that we were English speakers we received all of the information in English. However, there were some areas which were challenging to understand if you have no Japanese language ability. We will discuss all of that information later in this post.

What Information is Required By You

In your medical packet you will receive a number of forms that will need to be filled out. Much like any other medical examination you will provide information about yourself, medical history and concerns via checking boxes on the form. If you are a female you will be asked for information regarding your last menstrual cycle and any pregnancies (suspected or otherwise). You will also be asked to provide information about your family history including parents, grandparents and siblings. Again this is very simple and done by checking a box. Finally you will be asked to answer questions regarding your lifestyle such as whether or not you smoke and/or drink and how often.

Special Information Regarding Stomach X-ray

One of the standard tests performed is a stomach X-ray. This test requires the use of barium, a milky substance that is consumed at the time of the exam, which helps show the stomach lining. This test is used to find abnormalities in the stomach, esophagus and duodenum such as cancer, ulcers, polyps and so on. During this X-ray you will also be given a shot which stops the movement of the stomach allowing a clear X-ray image to be taken.

Although this process is based on the guidelines of the Japanese Society of Gastroenterological Cancer Screening there are some risks that the medical facility will want to make you aware of. This includes the potential of minor symptoms such as nausea, stomachache, constipation, diarrhea or pain in the stomach region. There is also the chance of fever or allergic reaction. Very rare cases also cause internal obstruction, perforation and appendicitis. Once you read through the release form and fully understand the information that has been provided to you then you will sign indicating that you would like to have this X-ray taken.

How to Collect Your Urine Sample

Collecting a urine sample with a Japanese urine sample kit is slightly different from what I think most Americans are familiar with. Rather than a small cup that can be urinated into directly you will receive a plastic disposable container, tube with a screw cap and single use dropper. After properly cleaning yourself to ensure that there is no contamination you will then urinate into the disposable container and then use the single use dropper to fill the tube with a screw cap.

*Urine sample should be collected the day of your exam in the morning immediately after you wake up.

How to Collect Your Fecal Sample 

Collecting a fecal sample isn’t quite as straight forward as collecting a urine sample. Your fecal sample kit will include three pieces all of which will come to you sealed; 2 rectangular tubes and 1 flushable/disposable “toilet” or “Toreru Paper” (トレールパーパ).  When you are ready to collect your fecal sample put 3 or 4 layers of toilet paper on the surface of the water in your toilet bowl. Then place the “Toreru Paper” (トレールパーパ) over the top of it. Finally dedicate in the “Toreru Paper” (トレールパーパ).

Immediately after you will need to collect your sample. You do this with the small rectangular tubes. The first thing you need to do is twist and remove the cap. You will notice that the cap is attached to a small wand. The very tip of the wand is ribbed. This is the area that needs to be covered in fecal matter in order to have a proper sample. Carefully run the wand along the feces to collect your sample. Be careful not to collect to much as too much will result in the inability to be tested. Carefully insert the wand back into the remaining part of the tube and twist the cap to lock. Store this in a cool dark place until the time of your appointment.

Finally write all of the necessary information on the tube. You will need to put your name (名前), whether you are a man (男) or woman (女), and then the date which is the year (年) month (月) and day (日 ).

*Do not use a gel pen when writing your information. It will smudge.

The Night Before and the Morning Of Your Check-Up

Now that you have filled out all of the necessary forms and collected all of the necessary samples it’s time to consider what need to be done before your exam. The day before your check-up you will be asked to ear a light dinner and ensure that you have finished eating my 9:00PM with no drinking after 10:00PM. You will be asked not to consume alcohol the day before your check-up.

On the morning of your exam you are asked to continue fasting and do not eat breakfast, snacks or drink any water/tea. You will also be asked to refrain from smoking the morning of the exam. Those who take medications in the morning are also asked to ensure that they take them with only the smallest amount of water necessary proper to 6:30AM.

Other Important Information

Women who are menstruating cannot have certain exams performed. If you happen to be menstruating during the time of your scheduled exam you may want to reschedule. Women who are pregnant, may be pregnant or are receiving fertility treatments are required to speak with their doctor prior to this check-up as it is not possible to have an X-ray taken.

Those taking medication should speak with their doctor prior to scheduling a check-up and ask whether or not the check-up is possible and safe. Any medications you are taking should be brought with you to your appointment.

Let's Get Physical #2

Now that you have an understanding of what is required before your standard medical check-up it’s time to talk about what to expect when you arrive at the medical facility. Like most other things in Japan medical facilities are held to high standards. You will find that they not only offer quality but also comfort for the guests. This is refreshing especially for someone like myself who is not very fond of medical facilities in general.

Once checking in for your appointment you will give the attendant all of the paperwork that you filled out in your medical packet and samples as well as your insurance card. At this particular you did not receive your insurance card back until the end of the appointment. This may vary from medical facility to medical facility. At this time you will also select one of two lunch options which will be made available to you free of charge (this is part of the standard medical check-up package).  You will then have to sign your name down next to a number. This number is how you will be referred to during your exam.

Once you have completed the check in process you will be directed to a locker room. The locker room is where you will change out of your street clothes and store your belongings. Each locker, which includes a key so that you can ensure your belongings are safe, is numbered and has a size on the outside. This size refers to the garnets that are inside. After choosing a locker with the appropriate size change into your top, bottoms and slippers. You can leave undergarments on however it’s probably a good idea for women to be cautious about the bras (because of metal clasps and underwires). A sports bra or light support garment may be a better choice than a your regular bra.

Let's Get Physical #1

After changing you will then return to the waiting room and wait to be called to the reception desk. You will then be handed a folder with all of your information inside which you will take with you while the tests are being completed.

When the testing begins you, as well as a small group of other guests, will be guided to a series of rooms. Each room is numbered with the number indicating a certain test that is part of the check-up. A coordinator will direct you to the appropriate room so that you and everyone else can efficiently complete the required tests.

Most of the tests are pretty straight forward with the most challenging being the stomach X-ray. Before beginning this particular exam you will be given barium which is a cider powder coupled with a liquid that tastes like watered down chalk. During this exam you will be required to consume the liquid on command as prompted by the technician. At first you will take some slow sips and finally finish when told. Then, like some type of carnival ride, the platform you are standing on will begin to rotate while you hold yourself in place with two wars and a shoulder restraint. This will allow the technician to take detailed images of your stomach. Once you have completed this exam you will be given a laxative and a series of instructions. Because barium is not digested by the body it needs to be passed so that there are no complications. Couple this laxative with some healthy veggies and lots of water and you will have no problems.

Let's Get Physical #2

Once all of the tests have been completed you will then return to the reception desk and inform then that you have completed the tests. They will then direct you to return to the locker room and change before proceeding to where your lunch will be served.

This particular lunch was fish with mushroom miso and a daikon salad. There was also whole grain oats and rice, sesame salad, pickled egg plant, custard and mochi for desert. The lunch came with a detailed description of everything that you were eating as well as a calorie count. This meal was only 660kcal. Unlike what you would expect from hospital food this meal was absolutely delicious. The ingredients were fresh, prepared well and could have easily been from a typical Japanese restaurant.

Finally after lunch it was time to return to the floor where the testing took place and have a consultation with a doctor. At this time the tests were gone over in basic, easy to understand, terms. You will also be informed that a detailed packet or results and other information will be sent to your home within the next 30 days.

Although it can be intimidating to do anything medical related in a place where your native language is not the one that the medical professionals are speaking this medical facility did a great job ensuring English speaking foreigners were in the loop and aware of what was happening. Although none of the technicians or doctor spoke more than basic conversational English they were capable of explaining information about the tests being given and the results.

Overall the experience was a pleasant one, despite the very unpleasant associations that many people have when they hear “doctor”. Each one of the technicians and members of the staff were friendly, helpful and willing to go above and beyond to ensure you know what to do next. Most important to me is that the whole experience is comfortable.

Have you ever had a standard medical check-up in Japan? Share your experiences in the comments below.



“Where are you from?”: A simple question with a complex answer

Being a foreigner living in Japan means that you will find yourself answering a lot of questions. One of the most common questions is “where are you from”. It’s a super simple question that is often asked by other foreigners who are curious as to what corner of the planet the person they are conversing with is from and by Japanese people who want to break the ice. (After all it is one of the first 10 phrases foreign language students learn to say.)

Providing an answer to this question isn’t much of a challenging task. Spit out the name of a place, the other person usually says something like “oh really” and you’re on your way to whatever topic it is that follows. There really aren’t any wrong answers. . . . . . . or are there?

The unfortunate truth of my past experience is that there are in fact wrong answers. The odds that you will say something that someone else won’t necessarily agree with or understand are about 50/50. In fact there is even a small percentage of people that you will flat out piss off because you consider yourself “from” a place that they do not think is acceptable. This can put a person in a very difficult position. Do you answer with the place that you consider yourself from or the place that is socially acceptable to the person asking the question?

Over the years this very question has troubled me. Ok so I’m not having sleepless nights or anything but to say that I haven’t entered a social situation and cringed at the thought of being asked “where are you from” wouldn’t be entirely true either. The reason is quite simple. . . I answer with “Ginowan” and people (particularly foreigners) have a problem with that. How much of a problem you ask? Enough of a problem where people will drill me with questions like “no I mean where is home” or “where is your family” to which I continue to respond Ginowan. My choice of Ginowan as the place that I am from is not because I am some type of smart ass who has anything to prove (anyone who knows me well enough will tell you that) but because for what is coming up on a decade I have made Okinawa, Ginowan being where I have lived for a good chunk of that time, my home. My car is in Ginowan, my home is in Ginowan, my family is in Ginowan. . . . my entire life is in Ginowan. 

Of course the socially acceptable answer to this question is Boston although I anticipate that it doesn’t really matter where you answer as long as it is somewhere within the United States. Then why not just answer with Boston? Isn’t it easier just to fold under the peer pressure rather than making waves? Nope. It’s not me and it’s not home. I mean how can a person even call themselves a proper Bostonian if you can’t navigate your way to a lobster roll or give directions to the best blue plate special in town? The less comedic and more depressing response is that many of the things I remember as being “back home” are now gone. People have moved, local favorites demolished and the nice neighborhoods have edged their way closer and closer to becoming the slums. The reality is after 10 years where you were from becomes more of a memory than anything.

As much as places have changed I too am not the same person that I was, nor am I the type of person that can be represented by saying that I am from Boston. The reality, despite what anyone else will tell you, is that when you start to come in on that 10 year mark almost everything about you changes. The food you eat, crave and make will change. The clothes you wear, how you get around and how you sleep will all change. In other more easy to understand terms if you’re living in Japan as long as I have you start to become more “Japanese” in the way that you live and operate on a daily basis. This is where ‘reverse culture shock’ comes from. People find themselves going back to a place where they grew up, like Boston for example, and realizing that everyone is really loud and there is too much food being served on the plate. . . and what the hell is a cronut?

At the end of the day it’s really the person answering the question who determines what the most appropriate answer is. If you don’t want to know, don’t ask. . . . that’s my philosophy. So what if the answer is Mars, Ginowan, Atlantis or Georgia? Just smile, nod, maybe throw in a “oh that’s nice”. Why not try asking questions that don’t criticize the answer like “how long have you lived here” or “what brought you here”. If you’re not happy with the answer simple move on.

“Is that Kobe Beef?”: What you need to know before ordering!

Kobe beef (神戸ビーフ) is one of the many things that foreigners coming to Okinawa have on their “things to try” list. The chance to eat meat from a cow that has received a lifetime of massages , classical music and being fed beer is the very definition of luxury. Knowing this foreigners enthusiastically pull out their wallets and pay healthy sums of money for the “Kobe beef” on steakhouse menus around the island. However, most would be surprised to find out that the beef they can’t wait to tell their friends about is not Kobe beef at all.

The first and most important thing to understand is what exactly it means for a slab of meat to be called Kobe beef. As disappointing as this is going to be for those who take great pleasure in how weird and whacky Japan is massages, beer and classical music have nothing to do with Kobe beef. Although cows will undoubtably be rubbed down occasionally the notion that some day spa in the fields of unknown Japan exists is a myth created by someone who was clearly overzealous and probably a little drunk. In reality being Kobe beef means that the meat has come from a purebred Tajima steer that was born, raised and butchered in Hyogo Prefecture. The beef must also meet certain guidelines having a meat quality of 4 to 5 and beef marbling standard (BMS) of 6 to 12.

Seeing as how Kobe beef is such a high quality, and very scarce, product there is strict control over it’s distribution. Each and every carcass that meets the grade for both meat quality and beef marbling standard is given a ten-digit identification number (個体識別番号) which can be checked online confirming that you are getting the quality you are paying for. Retailers and restaurants serving actual Kobe beef are also certified and should be willing to provide you with the identification number of the beef that you are being served. If they are not willing to provide you with a ten-digit identification number there’s a good chance it’s not Kobe beef. 

In fact if you’re in Okinawa and are looking for actual Kobe beef you’re out of luck. The reason is because according to the Kobe Beef Marketing & Distribution Promotion Association’s list of certified sellers none of the retailers or restaurants in Okinawa Prefecture are certified. In other, more straight forward, words no it’s not Kobe beef that you enjoy at that teppenyaki place down the road.

The question now is what are steakhouses in Okinawa serving if not actual Kobe beef. Are they even serving high quality beef from Tajima steer at all? More importantly are you overpaying because of false advertising?