This article has been deidentified to protect the anonymity and confidentiality of the patient in the story. Any matches in names or circumstances to other patients are entirely coincidental.
Guest Blogger Ursula Gately is a second-year medical student at Johns Hopkins from Arizona, who discovered her passion for medicine while working as a wrangler on a dude ranch. Her professional interests focus on making medicine more responsive to communities by addressing social and environmental factors that influence health. In her free time, she enjoys running, volunteering in her community, and sharing her love of plants and home-baked treats with friends.
Ms. N was a woman in her 50s with stage 4 cervical cancer. I watched as the physician hooked an intravenous bag to an artificial olive tree in the patient’s home in Mino, Japan, while chatting with her about the latest movie she had seen and Ms. N’s upcoming trip to Tokyo to go to a concert. Dr. Mitsuyama saw 45 patients a week. Dr. Mitsuyama and I had traveled 30 minutes to get to her home. We sat with the patient and went over her medications for her trip, placed in little plastic baggies stretched full with multicolored pills.
This past summer, I took part in the Nagoya University School of Medicine Bridging Community Medicine and Innovations in Japan program. This experience provided an opportunity to engage more deeply with the Japanese health care system, including a visit to the Kagayaki General Home Care Clinic, a unique home care clinic founded by Dr. Ryōichi Ichihashi in Ginan, a town in Gifu Prefecture.
During a visit to the Kagayaki Clinic, I accompanied physicians, including Dr Mitsuyama, and nurses as they conducted home visits for patients with complex medical and social needs. These visits were not just medical check-ins; they were holistic assessments of the person’s environment, nutrition, support system and quality of life. It was clear that continuity of care, trust and social context were prioritized just as much as clinical accuracy. Through this experience, I saw how deeply Japan’s medical system values relational, longitudinal and community-embedded medical care.
As I thought about the lessons from this experience, I kept returning to the importance of a concept I’d seen while shadowing Dr. Panagis Galiatsatos, a pulmonology and critical care physician at Johns Hopkins and associate director of the Johns Hopkins Hereditary Hemorrhagic Telangiectasia (HHT) Center of Excellence — the patient-centered medical home (PCMH) model.
The PCMH model in the U.S. aims to institutionalize many of these same principles. It emphasizes continuous, comprehensive and coordinated care. PCMHs integrate behavioral health, chronic disease management and social determinants of health into routine practice — ideals that were on full display in the Japanese community clinics and home care settings I encountered.
At the HHT Center of Excellence, I saw Dr. Galiatsatos meet with families, discussing every aspect of patients’ care, from newly formed arteriovenous malformations to finding a job that can accommodate unique health challenges. In these encounters, Dr. Galiatsatos provided holistic care based on individual needs, referring patients to multidisciplinary teammates at the center.
Patients came from destinations ranging from Baltimore to Pittsburgh to be seen. A comment Dr. Galiatstatos made to a new patient stuck with me: “Now that you are here, you are part of the family, and we will do anything we can to help you. You can contact me anytime for anything, no matter how small.”
We need centers like the HHT Center of Excellence across the U.S., providing care to patients with complex medical and social needs. A task like this demands a cultural shift in how we think about primary care.
My experience in Japan reinforced the importance of continuity, trust and communication in clinical practice. These are not just niceties; they are essential elements of care, especially in medically complex or underserved communities. Patient-centered care must extend beyond the simple clinic visit. It requires an understanding of the social and cultural fabric of the communities we serve. Whether through a home visit in Mino or a neighborhood clinic in Baltimore, I hope to carry forward these lessons, working toward a health care system that truly centers around the patient — mind, body and environment — to the benefit of individuals and communities.
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