--- Vol. 5 Pediatrics: Maki Kano, MD

Posted in JMSA Projects

Dr. Kano is an internist and pediatrician at the Japanese Medical Practice in Hartsdale, Westchester County.  As one of the few Japanese-speaking general pediatricians in the New York tri-state area, she sees many Japanese pediatric patients not only from Westchester, but also from New York City, Connecticut, and New Jersey.  Dr. Kano is also actively involved in community outreach programs in JMSA.

Undergraduate: Cornell University
Medical School: Mount Sinai School of Medicine
Internal Medicine/Pediatrics Residency: Mount Sinai School of Medicine

Thank you for your time today. First, could you tell us a little about your background?

Sure.  I was born in Japan and came here when I was three years old.  I started thinking that I wanted to become a doctor sometime in college.  I went to Cornell University for undergrad and was in the College of Human Ecology.  My major was human development and family studies, which is kind of like a study in development and psychology.  During my junior year at Cornell, I worked at Cornell New York Hospital in the Child Life Program for a semester.  That’s when I decided that I did want to go forward and work in a healthcare setting.  I went to Mount Sinai School of Medicine right after college, and I really enjoyed it.  The atmosphere was very nice and it was fun being in the city.  After four years of medical school, I did a Med/Peds residency, which is a combined residency in internal medicine and pediatrics.

Could you tell us more about the med/peds combined residency?

Yes, it was at Mount Sinai.  There are actually not that many programs.  A residency in pediatrics is three years, and an internal medicine residency is three years.  The combined program is four years long and you take both boards.  In some ways it may be more competitive to go into just internal medicine or just peds, because there’s more demand for that. But there are only four or five places in each med/peds program, so in that way I think it’s hard to match.  So with my training I’m certified in both pediatrics and internal medicine.  Here in the office it works out really nicely because I can see anywhere from newborns all the way to elderly people in their 80’s.  But I think my love, my focus, and what I’m known for in the community is my work with children.  Unfortunately there aren't that many Japanese-speaking pediatricians in this area, in Conneticut, in New Jersey, and in New York.   I guess in general it seems like less people are going into primary care lately, and more people are specializing; there are always different trends. I know in Japan, there are few people going into Ob/Gyn and pediatrics.  I hear there’s a big problem.

So is this combined residency mainly for people who want to do primary care?

Yes, it is a primary care specialty, although in my residency group of four, a lot of them ended up specializing.  One woman went into medical education. She doesn’t really work with adults at all; she kind of went into the pediatric realm.  Another is doing adolescent medicine.  I’m doing pure primary care med/peds.  Another friend in my foursome ended up doing allergy and immunology, so she sees both kids and adults.  I think a lot of people who do med/peds find it challenging to do both, or it doesn’t work in their setting, so they end up focusing.  From med/peds you can do any internal medicine or any pediatrics subspecialty.  I think med/peds gives you the comfort of getting a training and seeing patients in any age.  But after that, people often end up specializing.  You’ve trained for four years seeing kids and adults, so you know the basis to go into any specialty.  You can even go into dermatology if you wanted to.

It’s good to have that flexibility. Could you tell us about how you chose your field and how you chose to do a combined residency in pediatrics and internal medicine?

Going through medical school I realized that I wasn’t so happy being in the OR or being in the ICU setting.  I think I liked more the primary care setting.  It was kind of clear early on from the different experiences I had.  And then I liked working with kids, but I also liked working with adults too. I think what I really enjoyed was working with the whole family.  But I wasn’t so interested in family practice.  I felt like in a three-year family practice residency, they pack in surgery, psychology, just so many areas.  General practitioners are I think perfect if you’re in an area where there are very few doctors, like you’re the only doctor in a 20-mile radius.  Then you can really do the basics and take care of a lot.  But I knew that I wanted to be in this area, where there are tons of Ob/Gyn’s and surgeons, so I thought the med/peds training would make more sense to me, in which I would get the medical background in internal medicine and pediatrics.  It’s been working out really well because here I can see anybody who walks into the door.  If I had to choose one I think I would have chosen just to do pediatrics.  Now that I have the boards in both, it’s kind of a pain because I have to keep it up; every few years I have to recertify.  For internal medicine, every 10 years you have to recertify, pediatrics, every seven years.  It’s good, it makes you refresh stuff that you forgot.

Would you mind explaining how you found the Japanese Medical Practice?

Sure, I'll start by explaining the history of this practice.  This practice started 20 years ago.  Some officials from a Japanese insurance company called Tokyo Marine and Beth Israel Medical Center (the head at the time was Dr. Robert Newman, who had an interest in Japanese culture) felt that it would be an interesting venture to start a Japanese medical practice.  At the time, I think there were even more Japanese ex-pats here than now, so they started the office first in the city on 34th street, and maybe a year or so later they opened this branch.  As a medical student, I was granted a scholarship from the Japanese Medical Society.  Dr. Newman was affiliated with JMSA and somehow we met that way, I heard about this practice.  I think he was very interested in my background, the fact that I spoke Japanese and English, so Dr. Newman took interest in me and luckily when I finished my residency, he was wondering if I would be interested in practicing here.  Before I came here, there were a few doctors who had been in this position, but none of them spoke Japanese or were Japanese.  When I finished my residency, they gave me this position, and that’s how it started.

Could you tell us more about this practice?

The medical director of this office is Dr. Kuwama.  He has a very interesting background.  He trained in Japan in medical school, at Tokyo University.  He came here through the Beth Israel Japanese medical student or resident exchange program, in which every year Japanese residents and fellows in internal medicine or pediatrics come here, do a residency here, and then go back to Japan.  He did an internal medicine residency at Beth Israel and became chief resident there.  He then went on to become the medical director of our practice.  So this is a practice that’s very close with Beth Israel.  It’s basically run by Beth Israel, and a lot of the administrative things, supplies, and payroll are all affiliated with Beth Israel.  It’s a unique practice that I feel lucky that I fell into 10 years ago.  I have a lot of support here.  I have two receptionists, a medical assistant, an RN, and another physician, Dr. Kimura, so it’s a really fun environment. 

It sounds like you really enjoy your work environment. Could you tell us more about what you like about your job?

One of the reasons I like my job is that I just like the people I work with.  We all work as a team, and everyone enjoys it.  It’s not like there’s a hierarchy.  Everyone starts working here and nobody leaves, so everyone’s been here a long time, like 5 years, 6 years, 10 years.  I think we accomplish a lot here.  We also go out to dinner together and so forth after work. 

It also feels safe to be an employee of a group practice because of the billing and hiring, firing, all the supplies, ordering, all that’s taken care of.  In this day and age, being a private practitioner in any field, I think particularly in primary care, is very difficult, in terms of finance and dealing with all the demands.  I know some people in private practice who have one medical assistant and maybe a receptionist and that’s it.  They end up doing all the stuff, like drawing bloods and sending the labs off, all the stuff that I probably don’t even realize needs to be done to make an office run.  In my position, there are some negatives such as I don’t have a lot of control over some of the things, the way the office is run.  Ultimately decisions have to be okayed by someone higher up than me, but at least the day-to-day things are taken care of, so it makes it easier for me.  Sometimes I think it would be great to have my own practice, just having my own office where it’s just my entity, but I think in this day and age with the insurance system and with other priorities like my family, that would be a lot.  So for now it’s good.

Can you tell us more about the patients you see at Japanese Medical Practice?

I see about 30 patients a day on a busy day. If it’s less busy, I see about 20. Many of my patients are kids. Pediatrics is good because I get to see a lot of healthy kids and a lot of it is preventative care, anything from well-child checkups to vaccinations to anticipatory guidance. We also do urgent care for people with fractures, skin issues, or other acute problems. A big part of my job is working with the patient, the child, but also with the family, which is very interesting.  Although I mostly see healthy kids, there are also some older patients and some really sick people who come through here.  I've taken care of some patients with serious conditions like end stage cancer, so I’m learning more about things like dosages of medication for pain control through hospice nurses who are very experienced in that area. Dealing with really sick patients and their families is very challenging, but you realize that if you really care and if you really figure out what the patients need, you have such an ability to make a positive impact on their last few months or weeks. And also, with the family, you’re helping them to cope with their feelings -- the family’s in sort of a crisis mode because their loved one is rapidly dying. In some ways if you think about it too much, it’s kind of overwhelming. Obviously you’re not going to make everything better or save everyone, but there’s a lot you can do to help, and that’s rewarding.

That's great that you can provide support for the patients and their families, especially in such tough situations. What would you say is unique about your patient population?

This is kind of a niche practice. Most of the patients are from this area, but we also have patients from Connecticut, all the way upstate, and New Jersey, and a lot of them just don’t speak English that well. They have a lot of fears about going to non-Japanese-speaking practices, so we take care of these families and their kids.

Do you provide any sort of extra support for these patients?

I think what I love about what I do is that I feel like I’m really helping in several different ways. I’m trying to provide the best medical care I can, but also there’s a whole social cultural element of reassurance. In Japan the vaccine system is very different, from the types of vaccines to the number you get at one time. Here, so many shots are recommended now -- two month old babies are getting 3-4 shots in one day -- but in Japan you always do only one vaccine per visit. There’s no particular reason for it, but doctors are cautious, and they say things like, “You can’t take a bath the day of the shot.” So I get a lot of questions from  Japanese parents, like, "Can we take a bath today?” or “Can we go out and go shopping?” and I say “Oh, yeah.” I guess in that sense I bring forward my Western education, but after 10 years I’ve come to understand some of the fears that Japanese patients have and some of the cultural differences, so I try to reassure them about the vaccine schedule in the U.S.

Even in this country, parents in general are concerned about vaccines, especially because some of them have preservatives. There’s a big issue now with the flu shot and thimerosal. Thimerosal has mercury in it and is used as a preservative for multi-dose vials. Apparently the amount of mercury in the vaccine is small -- the same as the amount that you can get by eating a can of tuna or maguro. There’s no hard evidence that the flu vaccine is harmful; it should be safe even for people who are pregnant or young kids, but there’s such a public fear about the mercury. Issues like this are hard because it’s hard enough talking to any parent about the flu shot or the swine flu shot, without having to think about the extra cultural component. So here, I find that a lot of my job is  educating the family and trying to reassure them. It’s very interesting work. I think over the last ten years,  I've started realizing what people are worried about, and what the average person’s questions are. It’s all very challenging because these visits are very brief and you have a lot of patients to get through, especially lately with the flu. But with experience you get more efficient at it, and you get to go right at what patients are wondering about, kind of answering questions before they ask you. Patients really appreciate it when you try to reassure them, give them information and answer questions, so it’s very rewarding.

We also help patients when we refer them to specialists. There’s some fear with referrals, because we don’t send patients to specialists just because they speak Japanese. I like to pick a good practitioner, and often that person doesn’t speak Japanese. Our office does a lot to support patients and make sure that the symptoms are communicated to the specialist. I might write extra letters for patients, and the staff here  speaks Japanese and English, so we do a lot of that kind of support, more than a usual practice. Some situations are complicated because you want to do as much as you can, but you obviously can’t do everything for every patient.  But overall I think that it’s nice to be able to reassure the family, and to do the extra things that help them to feel comfortable. I go home and say everyday, “this was a really enjoyable day.”  It’s great to feel that I can help the Japanese population here.

Your practice seems pretty busy.  Do you feel that there is a need for more Japanese-speaking doctors in this area?

Oh, absolutely. There’s a huge need in the city, especially for Japanese speaking pediatricians. There’s a lot of young families in the city who have babies. Usually when kids are under one, they need special attention, but the families end up going to these Japanese-speaking practices where the doctors mean well but haven’t trained in pediatrics. It’s not always the safest or best care for newborns, but the families don't necessarily have a good place to go. I have some patients who come here from the city. They take the train or they drive up here.  So there’s a huge need for general pediatricians.

There is a small network of Japanese-speaking primary care physicians in this area, though. There’s a family doctor who practices in New Jersey. In my office here we also have Dr. Kimura who is an internist and also has geriatric training. And then in our office in the city, we also have internists who are Japanese.

Thanks for telling us about your patients and your practice!  Could you talk about the community outreach projects you're involved in at the JMSA?

The JMSA has been great -- I got a JMSA scholarship, and I found out about this practice through the JMSA too. Since then I’ve become very active in the society, and now one of my roles is chairperson of the JMSA Community Outreach Program (JCOP). We get corporations and individuals to donate money to JCOP, and then we distribute the funds to various Japanese community healthcare groups. This is our third year and we just had our selection committee meeting, so we distributed $25,000 to 11 groups. The groups range from those providing healthcare to uninsured Japanese people in the city, to the Hamilton-Madison House, to the Japanese Education Center -- they provide telephone hotline counseling to Japanese families who are having issues with school-aged children. We've also sponsored social service programs for the elderly, and a lot of other great grass roots community organizations that really need a lot of funding.

The JMSA also gives out scholarships to medical students, and we have an annual dinner every year where we honor the scholarship recipients. To receive a scholarship, you don’t have to be of Japanese descent, but just have to have some kind of connection with Japan. Recipients in the past have been really bright, and really cool people to work with.

What else do I do?  Something that I’m pretty excited about is a program I founded with a social worker and a nurse called Sukusuku-kai (www.nysukusukukai.org). "Sukusuku" means when children thrive and grow, and our program is an organization for Japanese families, especially mothers and their kids. We founded this about 6 years ago after I had my daughter. For whatever reason I never get depressed, and I’m pretty good with stress, but after I had my daughter, I must have had post-partum depression. I think it was just because I’m a Type A person, and I’m used to getting everything done and organized, but after you have a child, everything just is not organized, and you can’t control anything. I was so happy to have my daughter, but I had to come back to work after 3 months and it was such a stressful time. That led to us forming this organization to give support and establish a sense of community for mothers with children and ex-pat Japanese families.

There’s a component called Pre-Mama-Kai that helps women who are having babies for the first time in the US connect with other pregnant women and learn about the whole healthcare system here. We have dinner gatherings every three months in the city where we get 20 pregnant Japanese women together. Most of them are mothers-to-be for the first time, and we talk about issues like the use of epidural anesthesia in the US -- in Japan, it’s all natural -- and what to expect in the hospital and in the first month after delivery. I always talk about how I got depressed, and signs to look out for and so forth, as well as basic medical issues like vaccines. Kumiko Seki, an RN who works at the consulate general, organizes the sessions with me. She was also a josanpu-san (midwife) in Japan, so she always talks about breastfeeding to the mothers.

Would you mind talking about how you handle things with your family and take care of your kids?

Sure, I’d love to. I have two young kids: a daughter who’s six and a son who’s three and a half so I try to make time to spend with them.  As a woman, as a parent, as a mother, I feel like I’m always wanting to do more for them. It’s hard, it’s like you’re always torn between dedicating yourself to work and your patients and also wanting to make time to spend with your family.

I used to go to Manhattan once a week, but now I work 4 days a week every other week. My husband also works, but my parents live nearby so they help me a lot. I went back to work about 2.5-3 months after I had my children and that was really challenging for me, but we used a really good daycare center right near my house. We've also had an au pair who helped us picking up and dropping off and helping prepare dinner. Now that our kids are getting a little older it’s getting a little easier. When they were younger it was harder. When you come home, they haven’t seen you all day so they’re just dying for your attention. I don’t even have my coat off and they’re climbing on me.

I used to think when your kids are younger they need you more, but actually when they get older and when they start having homework and more serious issues in their life, they might need you even more. The idea of having the nanny or the au pair, no matter how good they are, being the one who’s dealing with those problems, kind of bothers me personally. At some point, as the kids get older, I think it might be hard for both my husband and I to have full on careers. I think somebody has to sacrifice a little bit, so that’s something we'll have to discuss. But at least, my hours are pretty regular. I get here by 9, and get to leave by 6 or 6:30 so that’s not bad. Personally I’m very glad that I have a career and that I’m working. I think I wouldn’t be happy if I was always at home. I think ideally I would work part time, like three days a week or four days a week. But I love what I do.  It's very rewarding. Striking the balance is really difficult.

Thank you very much for sharing your thoughts about your career and your family with us.  Any parting thoughts?

It was a pleasure to talk with you guys!  Medicine is a wonderful career. There are a lot of negative things being said about medicine, but I look at it very purely. When can you get so close to somebody telling you about their life and what’s really bothering them? I mean, it’s very personal. Being a doctor, I sometimes say, “okay, give this three-month-old baby this medication” and the parents do it. You realize you have a lot of power to help people, and people really listen to you because you’re the doctor. Sometimes I have a bad patient interaction and I lose sleep thinking, "I should have said it like this," or "I should have been more sensitive." But you just learn. You guys are going to be learning so much in medical school. Who knows, maybe you’ll end up in surgery or psychiatry. I'm excited to see where you guys end up and I wish you the best of luck.

Thank you!

The interview with Dr. Kano took place at the Japanese Medical Practice in Westchester, on November 4, 2009, by Lindsay Gibbon and Miyuki Tanino (Cornell MS-1). Since then, Lindsay and Miyuki have been able to work with Dr. Kano in her clinic and community service programs.