If you are passionate about primary care then it is always uplifting to meet people who feel the same. The argument for a structured primary care system in Japan has been ongoing for some time but it is only in the last few years that it is gathering momentum. Indeed, from a distance one might wonder why on earth Japan needs to change anything? It has one of the highest life expectancies in the world and has a vaccination coverage that outshines the UK.1 It was therefore with great excitement that I set off to meet some the forerunners in the argument for Japanese family medicine. To visit is to travel simultaneously forwards and backwards in time. This dualism is personified by taking the Shinkansen (bullet train) from Tokyo to the ancient temples of Kyoto. The world of medicine travels along similar lines. In the metropolis of Tokyo there is no shortage of specialist doctors, with investigations and procedures everywhere. If you have a headache, it is acceptable to go and see the neurosurgeon. However, in the more rural parts of Japan it becomes harder to recruit doctors. Throughout Japan medical care is predominantly free, with a national insurance-based system that requires patients to contribute 30% of the costs of any medical encounter, although many people have additional insurance through company schemes. However, Japan's ability to continue providing such high levels of hospital-based medicine is facing a considerable challenge. The population is aging while the birth rate is decreasing. In 2002 there were significant problems with the healthcare budget2 and suggestions were made to decrease the number of long-term hospital beds from 380 000 to 150 000.3 As the President of the Japan Hospital Association has written: ‘We are seeing the phenomenon of an aging society with a falling birthrate, using Japan's financial situation as an excuse in reforms that promote low-spending on medical expenses has caused the quality and safety of medical treatments to drop to very dangerous levels.’2 Did anyone shout ‘Family medicine to the rescue!’? Despite a reputation for cutting-edge hospital-based interventions, the role of the GP/family physician remains underdeveloped. Some argue that a primary care system, not dissimilar to that found in the UK, needs to be rolled out. Since 2005, members of the RCGP have been visiting Japan to offer advice. Such a change in emphasis would represent a dramatic break from the past. Before formulating any argument about the need for family medicine one has to define the discipline. In Japan the definitions are multiple.