"I went into the Specialist Roster not so much with an open mind about how I can go anywhere, but rather with a targeted goal that I'd like to effect and exchange somewhere in Japan," recalls Dr. Macauley. Since his wife had lived in Japan for 10 years, speaks Japanese and has quite an affinity for the Japanese culture, his sympathy with and interest in Japan is strong and avid.

While on a visit to Japan for 4 weeks with his wife and 4 children, he completed a 3-week placement as a palliative care specialist at the Graduate School of Medicine Kyoto University and Kyoto University Hospital. "I did a combination of following the [medical] team around, and meeting with other ethicists and palliative care doctors. I also did a lot of teaching and some international seminars in Kyoto University Hospital, Kyoto University, and University of Tokyo."

He was motivated to observe the similarities and differences between the palliative care offered in the US and Japan. Although he did not engage in any clinical care, he participated in the doctors’ rounds and clearly understood how Japanese doctors did their rounds and treated their patients. As an experienced physician conforming to the American medical culture, he had assumed that, worldwide, everybody follows the same procedures of doing things as he does. However, his experience in Japan made him realize that various parts of the world have different and diverse medical cultures. "There is a significant difference in how we do things in the United States compared to Japan," he points out, "for instance, the composition of the palliative care team is different in Japan. They put more emphasis on psychiatry and pharmacy than we do here."

Dr. Macauley and his family received a gracious welcome from his host doctor and colleagues, and enjoyed their life in Kyoto. He remembers, "They didn't have to, but they rented us a house in Kyoto and we were very comfortable there." One anecdote he shared was that neither he nor his colleagues could believe that the house itself told him another difference between himself and the Japanese people. All the doorways of the house were a little less than 6 feet high, whereas Dr. Macauley is quite tall, approximately 6 ft 3 in (190cm). "I was sitting in the living room and one of my kids came up to me and held my head, and they were like, 'Oh no, Dad!' because I had all these cuts and bruises. It took me a while to remember to duck wherever I went."

Despite finding the doorways to be inadequate in terms of height, his total rating of his experience in Kyoto remains very high. "I certainly enjoyed being in a different country and seeing a different way of life. I found my host and his team to be not only extremely intelligent and hardworking but also very delightful and fun to be with and extremely warm in their welcome," remarks Dr. Macauley.

Because of his satisfaction with his stay in Kyoto, Dr. Macauley is willing to popularize this Specialist Roster to his colleagues and other researchers in the United States. "I think the Specialist Roster is a very well-kept secret, and it shouldn't be a well-kept secret. I wish that it was better known," he claims emphatically. "It is a rich opportunity for collaboration and building bridges between cultures. I believe it is worth trying."