EHC Shadowing Reflections: Stanford Hospital

Seiya Saito

Hi, this is Seiya Saito. Our group shadowed and visited to the Emergency Department at the University of Stanford. Dr. Mitarai told us the system of its hospital. Now, I will introduce the feature of the system.

If patients have injuries or diseases and come to hospital, general nurses examine and tag patients. This tag can identify patients. And then, patients wait for treatments in the waiting room. During patients waiting for treatments, nurses sometimes take patients’ blood samples for examination. When treatments start, resident doctors at first examine patients, discuss and decide treatment principles. Then, a mentor confirms their principles and examines the patients by himself. The difference of emergency department system between in Japan and in the U.S. is that general nurses can examine patients and resident doctors at first decide treatment principles, I think.

During shadowing with Dr. Mitarai, I was surprised that he spent a lot of time to talk with his patients. Dr. Mitarai was an actually busy physician. However, he talked with patients about many things to make his patients comfortable. He not only made patients comfortable but also examined them in detail. I saw one patient during the shadowing. He suffered from vomiting and hip pain. However, after Dr. Mitarai examined him, this patient’s chief pain was leg pain. He could find this fact by talking with this patient for a long time.

Before this shadowing, I thought I could not take my time to talk with patients if I were a emergency doctor. However, to gain a patient’s confidence, I strongly realized through this shadowing that talking with patients is very important. A mistake will happen if I cannot take information from patients. Preventing from a medical mistake, I will take much time to examine patients and talk with them as possible.

This shadowing is eye-opening experience for me. Thanks to Dr.Mitarai and staffs of the emergency department of Stanford Health Care.


Ayaka Murayama

Hello! This is Ayaka Murayama. I am 4th grade student at Tokyo Medical University.

I would like to talk about shadowing at Stanford University. It was March 17th.We went to the ER tour before going to shadow with Dr.Mitarai. He is the ER doctor at Stanford.

For shadowing, our group divided into two groups, and I was the first group. We followed Dr.Mitarai. The ER doctor work in rotation, that time was the time to change with his partner. His partner told Dr.Mitarai that how many patients he have to take care that day, what is the chief complain of them, what kind of symptoms patients have and what kind of condition patients are in now.

I notice that they use the room numbers to call the patients. I thought that this is easier way to share the information with other doctors, nurses and other health care providers. Of course, they did double check before they go to the each patient’s room.

In the ER of Stanford, the residents ask the patient about history, family, situation and so on. Then they tell those stories to a senior doctor and input data into a computer, so they can share the information on a computer.

I have one very impressive experience. The patient’ chief complaint was emesis. Firstly, Dr.Mitarai asked open question, he said that the main reason is a hip pain. The doctor examined his hips and legs, and he notice that his pain is from a pelvis and his both legs are very cold.

From this experience, I learned that the most important thing is to ask history and think about new other symptoms. Also, don’t forget to get rid of any other fatal diseases.

Secondly, doctor asked the situation when the patient vomited, then the patient told that he didn’t eat enough food for a long days because his nurse said “no”. Therefore, the doctor asked to resident and reception to search more truly information.I was so surprised that the doctor spent much times to one patient, even though they are so busy. If we are busy, it is difficult to keep in mind that the most important thing is to think about each patient.

The most impressive experience is to ask open question, history and situation are very important. I learned that in my university but I didn’t know that it happened often.I don’t want forget this experience as a doctor.

Thank you for giving me this valuable opportunity.


Mayuko Mori

Hi, this is Mayuko. Now, I’ll write down about the shadowing of the ER in the Stanford University.

It was March 17th. I shadowed Dr. Mitarai with 4 members. At first Dr. Mitarai went to a staff room and heard about the patients. They spoke so fast that I couldn’t follow all of them. However Dr. Mitarai taught us later so we could understand that. After that we went to see the patients. I won’t talk about the detail because of their privacy but I will talk about what I have felt. There are 2 things about it.

The 1st one is that the teamwork of the staffs. There are so many staffs there. I was surprised that they divided in their work well and shareed the information about patients. I think it is really good thing because each of them can focus on their work. So doctors and nurses can focus on the patients and don’t need to be bothered by other things.

The 2nd one is the attitude toward the patients. In my image, the doctors in the ER take top priority in the speed. However Dr. Mitarai took many time to ask patients about their medical history or what the patients need. He spoke gently and kindly. He said that the most important thing in the medical treatment is the patient. You may think that it is common sense but it is not easy to do in that way.

Throughout this shadowing, I could see the real working place by my own eyes. This became my precious experience in my life and for my future career.


Yuki Masuo

My name is Yuki Masuo. I am in the fourth year of Kyoto University Faculty of Medicine. Through this program, I visited the mainland of America for the first time in my life and had a totally stimulating two-week stay.

On the 5th day of the program, I visited Stanford Emergency Room in order to shadow Dr. Mitarai, who is working as a clinical assistant professor at Stanford Health Care. I think there are very small numbers of Japanese people who work as medical doctors in America, but he is one of the rare cases. Actually, after he graduated from a junior high school in Japan, he moved to America in order to enter a high school. He then proceeded to a college and a medical school in America, which lead him to get medical doctor’s license in America.

Before I get down to business, let me briefly write as to why I have decided to shadow him during this program. I am now in the fourth year of my university and am going to start clinical training this April. Although my knowledge about hospitals in Japan is still limited, I would like to feel the atmosphere in one of the best hospitals in America and hopefully learn some differences of the systems between America and Japan. Here, what I mean by “system” is how people interact with patients, how medical staff communicate with each other and what kind of people there are in a hospital.

Now I will write about my firsthand shadowing experience that lasted for 90 minutes. The shadowing began at 3:30 in the afternoon by Dr. Mitarai showing up busily. After a short greeting, he took us into the Emergency Room. However, before I actually entered the room, I had to pass through a metal detector, which surprised me a lot. It was something I would least expect to see in a hospital and it taught me one of the biggest differences between hospitals in Japan and ones in America, or the fact that some patients might bring weapons with them in America when they visit hospitals. Therefore, for safety reasons, all patients and their family members are required to go through the metal detector before seeing a doctor.

During the shadowing, I found out that the systems of hospitals in America were different from those in Japan in many aspects. In this post, I will give you three examples of the differences. First of all, medical doctors in America spend much more time talking with patients. They try to refrain from depending too much on physical examinations or investigations and to acquire adequate information from patients’ talks so that they can perform proper differential diagnoses. This also serves as an excellent way for medical staff to build mutual relationships with patients that are indispensable for some painful treatments. There are other methods for doctors to be trusted by patients. For example, when they first meet their patients, they give their name cards with their pictures and spend some time for a greeting and handshake. Besides, they are careful about the privacy of the patients at any time and are willing to choose appropriate treatments by taking the patients’ requests into consideration. Secondly, medical doctors always have some conversation with nurses before they actually see patients. In this way, doctors can avoid asking unnecessary questions to their patients. Moreover, these kinds of communication reduce the risk of malpractice. Finally, in addition to medical doctors, some licensed nurses called nurse practitioners can perform limited amount of medical treatments to patients. This is a completely different point of the clinical situation in America compared with one in Japan. Although there is a limitation of the types of treatment nurse practitioners can give, these people are sure to decrease the amount of work that would otherwise be taken care of by medical doctors. This results in a positive situation where doctors can more intensively focus on important jobs such as surgeries and diagnoses instead of small tasks.

Overall, I learned a lot from this precious shadowing experience. Feeling the unique atmosphere in an American hospital, it became clear to me that there was some room for improvement in the system of Japanese hospitals. I do not mean that the system in America is better but I definitely think that we can learn from other countries’ situations and adopt something that has a potential to make our hospitals better in the viewpoints of both medical staff and patients. I still have two years left for my university days. I am now determined to visit as many facilities in the world as possible in order to keep comparing them and gain a clear image about ideal hospitals.


Nami Tanegashima

Hello, this is Nami Tanegashima. I would like to share my experience of shadowing at Stanford university, ER by Dr. Mitarai. It was only 90 minutes for me to shadow him. I wish I could shadowed more and I might be able to experienced more. However, I experienced a lot and caught some senses that he wanted to tell me.

When it started, he toured around the ER. He explained where patients are to wait, what health care professionals provide the treatment and some differences in terms of the waiting room between pediatric and adult patients. The States have a unique law: see all the patients no matter how their economical problem is. Thus, there are not little patients come both who comes by theirselves or by using ambulance. In the States, there are wider limitation for nurses. Nurse practitioners do pretty much thing like doctors do in Japan. Surprisingly, there are many narrowed specialities such as professionals who does only to move patients with their bed from one place to others. There are technicians who does only take blood and so on. I realize that this allows doctors to work more efficiently. They do not need to worry about the job which is not necessary for doctors. However, it costs more, of course. Here in the States, they use money as many as you want (maybe it is false),they can hire such professionals. When it comes to Japan, because of need to reduce cost which means hospitals are not able to afford hiring more other minor professionals, this will be very hard to be happened. The room for adults look simple. Whereas for children, their room was more decorated and equipped with toys. I thought it was basically similar to Japan. Maybe we have similar ideas for children around the world.

Dr. Mitarai let me see three patients. I found he placed high importance of patients being comfortable or not. For all patients, he never stop trying to do so. Also, he looked higher priority for taking patients history than looking patient note. He went to patients and had a talk and physical examination by himself even he knows their condition via patients note. He said doctors need to go and see patients no matter how they are busy. It is because that is something fundamental for doctors. He did what patients complained even it was not on the patients note or it was not correct to the patients note. I was surprised at the point. It was because I may look patients note more important than going to see patients and do things based on what I saw. The way Dr. Mitarai behave and talk to patients was absolutely wonderful.

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