Standing by Patients and Helping Them Live on Their Own Terms

2026/05/28

The Work of a Palliative Care Physician

“I want to create a society where everyone can naturally receive palliative care whenever they need it." So says Dr. Mari Takeuchi, a neuropsychiatrist and Senior Assistant Professor who serves as Center Director of the Keio University Hospital Palliative Care Center.

As a psychiatrist and palliative care specialist, Dr. Takeuchi has consistently practiced an approach to medicine focused on both mind and body.

Here, we speak with Dr. Takeuchi about what palliative care really means, why its importance is growing, and what she wants the next generation of doctors to know.

When you hear the term "palliative care," what image comes to mind?

- Something you receive when treatment is no longer an option

- End-of-life care

- Care focused solely on pain relief

- Exclusive to cancer patients

- Specialized care provided only by palliative care physicians

—In fact, these are all misconceptions.

"Because of these misconceptions, many patients do not receive the palliative care they should be getting at the time they need it most," says Dr. Takeuchi.      

She wants people to see palliative care not as something special, but as a more accessible option in healthcare. That conviction comes through in her every word.

Many patients who come to see Dr. Takeuchi will say that they feel it's still too early for palliative care, that they’re not at that stage yet.

"Palliative care tends to be seen as 'care for when treatment is no longer an option,' but that's not the case. Palliative care is not about stopping treatment. It is care that works alongside treatment."

Physicians walk alongside patients from the early stages of illness, supporting them through anxiety and uncertainty as they navigate decisions about their lives. Palliative care is available at any point—right after a diagnosis, during times of anxiety, or when uncertainty arises.

"And palliative care is not something only specialists provide. Ideally, all physicians should be able to provide basic palliative care."

The true purpose of palliative care is still not widely understood.

"Palliative care aims to enhance quality of life (QOL) by relieving distress such as pain, breathlessness, and anxiety, so that patients can live in a way that is true to themselves."

While cancer is increasingly becoming a curable disease, many people still worry about suffering severe pain. The portrayal of pain in medical dramas may, in part, amplify that fear.

“With advances in pain medication, we are now in an era when we can manage pain. By receiving palliative care from an early stage, more and more people are continuing to work, manage household responsibilities, and raise their children. They’re living their everyday lives alongside their illness."

Because palliative care developed within the field of cancer medicine, it tends to be perceived as "care for people with cancer." Today, however, its scope has expanded.

"Cancer is not the only disease that involves pain and suffering. Palliative care is available to anyone experiencing distress, regardless of their diagnosis."

And it is not limited to physical symptoms.

It also addresses mental distress, such as anxiety and fear, as well as social concerns, including work, family, and financial challenges.

As a psychiatrist herself, Dr. Takeuchi has been particularly dedicated to supporting patients through emotional care.

One distinctive feature of palliative care at Keio University Hospital is that it does not have a dedicated palliative care ward.

This is rooted in the belief that patients should be able to receive palliative care regardless of which ward they are admitted to.

If the attending physician determines it is necessary, or if a patient requests it, a physician from the Palliative Care Center visits the ward to provide a consultation.

As a result, Dr. Takeuchi says she sometimes logs nearly 10,000 steps a day walking through the hospital. 

Alongside clinical practice, Dr. Takeuchi is deeply committed to educating students and junior physicians. Students from the School of Medicine, the Faculty of Nursing and Medical Care, the Faculty of Pharmacy, and junior physicians gain exposure to palliative care through lectures and hands-on training.

“I want all students to learn about palliative care, not just those hoping to become specialists in the field someday. Learning to recognize suffering that doesn't show up in test results or imaging is invaluable, no matter which specialty you pursue."

Palliative care is delivered by a multidisciplinary team. Physicians, nurses, pharmacists, social workers, and dietitians, each bringing their expertise to the table.

“I think we’re probably the closest-knit team in Japan,” says Dr. Takeuchi, describing a culture where people can speak freely across professional roles and boundaries, ultimately helping them provide better support for their patients.

Dr. Takeuchi's career path has been anything but straight. She originally set out to become a researcher, studying at Keio University's Faculty of Science and Technology before investigating cancer mechanisms in graduate school. After completing her master's program, she joined a pharmaceutical company.

But a growing desire to work directly with patients, rather than in the lab, led her to re-enroll in medical school.

"Looking back, it was reckless. I quit my job even though there was no guarantee I'd get in."

Yet her resolve never wavered, and she transferred into medical school. Dr. Takeuchi earned her medical license at the age of 30.

At first, she went into internal medicine determined to cure cancer. But an encounter with a patient would profoundly change her perspective.

"It happened when I was caring for a patient who was no longer expected to recover. Their symptoms had worsened to the point of hospitalization, and they were close to giving up on an overnight trip with their family. However, palliative care improved their symptoms enough for them to go on the trip as planned. When I saw that patient walk back into the room with the biggest smile without any health complications, something shifted inside me. I realized that easing suffering, including emotional suffering, is just as important as curing disease."

That experience led Dr. Takeuchi to decide that she wanted to become a palliative care physician capable of providing emotional care as well, prompting her to leave internal medicine for psychiatry. To those around her, it may have seemed like yet another reckless decision.

"I still have plenty of doubts. But I'd rather regret doing something than regret not trying."

One of the greatest joys of this work is seeing patients who were devastated by a cancer diagnosis and anxious about the future gradually regain their sense of self, later sharing updates such as how they went to a concert.

"We cannot change the fact that they are ill, but when I see patients able to forget about their illness, even for a moment, and living with real vitality, I feel truly grateful to be doing this work."

At the same time, Dr. Takeuchi says that parting with patients she has grown close to is still deeply painful.

"Part of me always wanted to be a doctor who could cure diseases. But now, as a palliative care physician, I find purpose in being there for my patients. And going forward, I believe my new mission is to help grow the number of healthcare professionals in palliative care."

As Japan moves toward a super-aged society, Dr. Takeuchi believes the need for healthcare professionals specializing in palliative care will only grow.

“I want to help young physicians not just understand palliative care correctly, but see how meaningful and rewarding it can be. Even when a cure is out of reach, easing a patient's suffering, and knowing that your presence genuinely mattered to them and their family, can be profoundly sustaining.

I hope that as more people gain that kind of experience and encounter role models in palliative care, it will come to be seen not as an 'option for a select few,' but as a path open to many more physicians, and one that people will naturally aspire to."

Asked what makes Keio University special, her answer came without hesitation: "They let you do what you want to do."

“As long as it helps others, contributes to society, or is academically meaningful—and does not cause trouble for others—Keio is a place where people are encouraged to take on challenges regardless of age or experience. The School of Medicine is the same way. It’s a place where everyone is given an equal opportunity. Another great strength is the large number of passionate mentors and faculty here.”

She felt this most keenly when she decided to transition from psychiatry to palliative care.

"There was no precedent at the time for a psychiatrist becoming a palliative care physician, but not a single person at Keio told me it was impossible. Instead, they asked how they could help make it happen. When a palliative medicine course was established at the Keio University Graduate School of Medicine, some professors even went out of their way to call and let me know personally. I wouldn't be where I am today without the support of all of those people."

"If a patient walks away feeling genuinely glad I was their doctor, there is no greater joy," says Dr. Takeuchi.

"There are so many doctors out there with far greater technical skills and abilities than mine. I could never compete with them. So I'd rather focus on what I alone can offer."

Dr. Takeuchi's motto is ichi-go ichi-e, the idea that every encounter happens only once and deserves your full presence.

“Even with the same patient, their condition, their mood, where they are in life, it's always a little different each time. Each of those moments is precious and will never come again.”

Precisely because time is limited, she treasures every moment with the patient before her.

That philosophy may well define Dr. Takeuchi's approach as a physician and the very essence of palliative care.

Mari Takeuchi

Center Director, Palliative Care Center, Keio University Hospital

Assistant Professor, Keio University School of Medicine

Mari Takeuchi graduated from the Keio University Faculty of Science and Technology in 1995 and completed the Master's Program in Medical Sciences at the Keio University Graduate School of Medicine in 1997. She then graduated from the Shimane University School of Medicine in 2003. After completing an internal medicine residency at Keio University Hospital, she joined the Department of Neuropsychiatry as an assistant professor. She earned her Ph.D. in Medicine in 2013. After serving as a lecturer at the Palliative Care Center from 2020, she was appointed Center Director in 2021. Her specialties are palliative medicine and psycho-oncology.

*All affiliations and titles listed are those at the time of the interview.