12/26(火)
◆今日の気持ち
(外科 3ヶ月目)
・発熱あった患者さんの血液培養とろうとしたら、結果が出るころには熱下がっているよと、抗生剤がはじめられた。ナースでは血液をとれないような血管が目立たない人だし手術があったから自分の手を出せなかったのは、残念だった…。感染症。癌治療と同じで、どこに病巣があるのか、どこから原因は進入したのか、どんな経路で病気が広がっているのか、どんな治療が効果あるものなのか、きちんと診断しておくことは重要だと思うのだけれどな…。まあ癌と違ってそこそこ適当な治療で状態はよくなりうるのが感染症ではある。けれど不十分な治療はその患者の急速な状態悪化につながり、余計な治療は他の患者に院内感染として迷惑かけるのが、抗生剤での治療。だと思うけれど…。でもまあ、誰の主治医でもない無責任者はぼちぼちと、無意見で生きていくのが正しい道なのかなぁ。
・そういえば、自分の仕事がよくわからない。何か、病院運営に意義のある仕事、責任って今の自分にあるのかな? 学生のように、日々課題とか、参加しなきゃいけない項目とかはあっても、責任もってしなければならない仕事って今はあるのかなぁ…。
・明日のカンファをイメトレしてて思う。外科は治療をピークとする診断が主。内科は病状把握をピークとする診断が主。なのかな? そこからいろいろ違いがでてるのかな?
・意見を持ったら嫌がられる。本とかで得た知識と今の治療のずれを見つけると嫌がられる。そして教えてもらえることはなくなる。それは一般的なあり方ではあるのだろうけれど、へつらうイエスマンでいることってできないなぁ…。いっそ議論をしてしまえばいいのか? 打ちのめされてもそれも道かな。
●目指す医師像
総合内科医 問診を極めたい
西洋医学的には1〜2剤のみつかう医師
症状には漢方を使用する医師
●今日の新患・診断
・胃潰瘍出血
●今日の病院滞在時間
8時半〜18時
●今日行ったこと・見たこと・知ったこと
・開腹総胆管切除結石摘出
●今日うまくいかなかったこと・失敗
・寝過ごした…
●明日の予定
・健康診断(受診)
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