Looking Beyond Systems to See the Individual

Keita Shimizu,

2nd-year student, Science Class III,

The University of Tokyo

Lessons from the Front Lines That Systems Alone Cannot Teach

Imagine a child with limited mobility racing a wheelchair around a relatively small room.

Most people would probably react in a familiar way. They might think, "If the child crashes, it could be dangerous," or "There are other children in the room. Someone could get hurt."

Yet in the setting I visited, that conventional way of thinking simply did not apply.

Instead of saying, "Stop because it's dangerous," the staff calmly said,

"It's lunchtime now. Why don't you help everyone prepare?"

That moment stayed with me.

A year ago, I contributed an essay to this publication based on conversations with Professor Jiang in China. Speaking about the country's still-developing health insurance system, he often used the phrase,

"The more, the better."

At the time, I understood this as a lesson about the importance of healthcare systems and institutional design.

That lesson remains true.

But over the past year, I have come to appreciate something equally important: what can only be learned from real clinical settings.

In China, where healthcare systems continue to evolve, strengthening institutions remains an urgent national priority.

Japan presents a different challenge.

Here, the healthcare system is already highly developed. What is increasingly required is the ability to recognize and respond to situations that fall outside the boundaries of any formal system.

I have learned that systems alone cannot solve every problem, nor should they.

Seeing the Patient as an Individual

This realization became especially clear during a recent visit to Orange Home Care Clinic in Fukui Prefecture.

Under the leadership of Dr. Hiroyuki Benitani, the clinic practices medicine in a way that differs fundamentally from conventional thinking.

The child I described earlier was one of Dr. Benitani's patients.

Interestingly, it was not Dr. Benitani himself who said,

"Why don't you help everyone prepare?"

Rather, it was one of the staff members working alongside him.

That, however, does not mean everyone at the clinic simply shares identical opinions.

On the contrary, staff members openly challenge one another whenever they disagree. I was told there have even been occasions when Dr. Benitani himself changed his mind after listening to others.

Their discussions are vigorous.

What unites them is not agreement, but a shared commitment to one principle:

What is best for the patient.

Importantly, the "patient" they speak of is not an abstract concept.

It is the unique individual standing before them.

The boy racing around in his wheelchair was not viewed merely as "a child who uses a wheelchair."

He was seen as A, a child with his own identity, personality, and aspirations.

What does the ability to move freely mean for him?

For those of us who have always walked without assistance, freedom of movement is something we rarely stop to consider.

For him, it carries an entirely different meaning.

Every clinical decision begins there, and ultimately returns there.

The Essence of Medicine That Supports the Individual

Watching A reminded me of my junior colleague at university, whom I will call S.

S has used a wheelchair since junior high school because of cerebral palsy.

During lectures, he studies from designated wheelchair-accessible spaces while receiving assistance with taking notes.

I can only imagine the challenges he overcame before entering the University of Tokyo.

Yet today, he makes full use of every resource available in his environment.

Once, he told me that he wanted to do so "simply because it is a right I naturally have."

Those words should not be interpreted too literally.

Before arriving at that conviction, he undoubtedly received countless pieces of advice, struggled with difficult decisions, and reflected deeply on his own circumstances.

Only after passing through those experiences could he express such a thought.

In that sense, I see S as embodying an ideal toward which medicine should aspire.

Only recently did I realize that the true meaning of the phrase "for the patient" had been present close to me all along.

Medicine should never stop at serving a diagnosis, a disease, or even a healthcare system.

Its ultimate purpose is to support the individual human being who stands before us.

This article has been reprinted and translated from the Japanese original text published in Web Medical Times.20260311.