We spoke with Dr. Kubota, Director of Kubota Children’s Clinic in Osaka, Japan, about how his practice has successfully integrated Online Pediatric Care (medical consultations and counseling, especially for children) with constipation and psychological or developmental concerns. His experience offers valuable lessons for pediatricians and primary care providers in Ontario looking to enhance virtual care services.
1. Why Implement Online Consultations?
Q: You adopted online consultations early on. What prompted this decision?
Dr. Kubota: A colleague recommended it, and I thought it made sense—especially for pediatric constipation cases, which are common and require ongoing care. Many of these patients travel from distant areas, and once symptoms improve, they often stop coming to the clinic. With online follow-ups, we can maintain continuity of care more effectively.
2. What Conditions Do You Treat Online?
Initially, most virtual visits were for constipation management, but today they also include:
– Developmental and psychological consultations
– Developmental assessments and counseling with psychologists
– Remote triage for children with fever or suspected infection
– Follow-up care for pediatric COVID-19 cases
Dr. Kubota also supports Osaka’s home COVID care team and uses online triage to determine which febrile patients should:
– Come in for testing
– Be seen in person urgently
– Be monitored at home with follow-up
Even when in-person visits are necessary, patients can pay through the CLINICS system via credit card, which streamlines care.
3. Changes in Patient Attitudes
Q: Did the pandemic change how patients view online care?
Absolutely. COVID-19 lowered the psychological barrier to virtual visits. More families are open to the idea, and some now prefer it, especially for follow-ups and mental health consultations.
4. What Are the Benefits of Online Pediatric Care in Canada?
Q: What have you learned from using telehealth in your practice?
Initially, I was skeptical, especially about using online sessions for mental health and developmental concerns, thinking it would be hard to read facial expressions or emotional cues. But I was surprised to find that patients, especially children, often feel more relaxed at home, making sessions more effective.
Online care is also ideal for patients who genuinely want treatment but face emotional or logistical barriers to visiting in person. In these cases, virtual care might be the only viable option.
5. Real-World Case Studies
These are simulated cases based on actual experiences at Kubota Children’s Clinic:
Case 1: 21-Year-Old Woman – Generalized Anxiety Disorder
- Online consultation (physician, insured) + Online counseling (psychologist, private pay)
- Could not attend university due to severe anxiety around using public transit.
- Initial visit in person; all follow-ups conducted virtually.
- Counseling every two weeks; monthly online sessions with her parents (who live far away).
- As her anxiety improves, she is gradually expanding her ability to go out, aiming for eventual in-person visits.
Case 2: 8-Year-Old Boy – ADHD
- In-person + online consultation (both insured)
- Recently moved to Japan from the UK. Previously diagnosed with ADHD and on methylphenidate (Concerta®).
- Unable to find a local provider in Japan who could prescribe this medication.
- Referred to Dr. Kubota’s clinic, where care is now managed via alternating in-person and online visits.
- The family communicates well, and the child can describe his school experiences clearly.
- Based on assessments, they are exploring reducing or pausing medication use.
Case 3: 38-Year-Old Mother – Parenting Stress and Anxiety
- Online consultation and counseling (insured)
- Lives in a rural area with no local counseling services.
- Felt isolated after quitting her job to care for a child recently diagnosed with a developmental disorder.
- Received parenting guidance and emotional support.
- Has now started a new job and feels more emotionally stable, though continues occasional online sessions during periods of increased stress.
Case 4: 25-Year-Old Woman – Depression
- In-person care (before and after hospitalization, insured) + Online counseling (during hospitalization, private pay)
- While receiving ongoing in-person therapy, her chronic condition required hospitalization.
- To prevent a disruption in care, online counseling was continued during her hospital stay.
- Post-discharge, she resumed in-person visits.
6. Phone vs. Video: Why Video Wins
Q: Why not use phone calls for these services?
Dr. Kubota: For me, it’s always video over phone. Seeing the patient’s facial expressions, behavior, and non-verbal cues makes a huge difference. Especially with children, just seeing them moving around or smiling can help me assess their well-being.
We also reference the Japanese Primary Care Association’s Telemedicine Diagnostic Guidelines, which I helped develop, to ensure quality and safety in online diagnosis.
7. Final Thoughts for Ontario Clinicians“For patients who need medical care but can’t come in due to physical or emotional reasons, online consultations may be their only option. I truly believe telehealth allows us to deliver care that would otherwise be inaccessible.”
