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12/27(水)

◆今日の気持ち
(外科 3ヶ月目)
・培養のない抗生剤での感染症治療って、病理診断のない抗癌剤治療と同じな気がするのだけれどな
・ひとの診断を終ってからなぞっても、記憶、できるものなのか? 無茶を要求され続けてる気がする。でも、外科医師は通った道、なのだろう。けれど3〜4ヶ月の研修は無茶を受ける時間としては短すぎやしないのかなあ?
・カンファでカルテを読むなという。どうせ上の先生も、いつもカルテかいていないし、ここにいるうちにカルテをかくことって、無意味なのかな。無意味なことは、やっぱりすべきではないのかな。
・初めてGF受ける。咽頭麻酔が効いていなくて、カメラが入っている間吐き続けた。…いい勉強になった。

●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

●今日の病院滞在時間
6時〜16時

●今日行ったこと・見たこと・知ったこと
・ラパコレ

●今日うまくいかなかったこと・失敗

●明日の予定

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内科の先生の下で研修してると、自分も内科医的な考え方が身に付いてしまってついつい外科のおおざっぱにみえる治療を馬鹿にするようになってしまうところがあるんだけど、実際自分はいっさい手術ができないんだし、将来内科に行くならなおさら今は外科になりきって外科の考え方を理解すれば?けんかしたらだめだよ。自分はまだ研修医なんだから。上の先生は自分よりは絶対に経験あるし耳を傾けるべきだよ。そしてなんで自分がそんなに嫌われてしまうのかよく考えるべきだ。内科に行ってもその態度を変えないといつか上司とぶつかるよ。自分のためにも上とは絶対にうまくやんないと

いやいや、外科は大雑把、というよりも、「一点集中」だと思います。瞬間的な集中力や瞬発力は内科よりずっと上だし、しかもその瞬間がいつくるのかわからなかったりします。ぜんぶに細かく四六時中見ていたら、人間の限りある体力はもちません。いざというときに動かなきゃいけないのが外科で、余力はとっておかないといけないのは当たり前だと思うのです。検査のこまっちゃい項目を気にしつつ集中し続けるのも逆に人的無駄が多くなるものかなとは思います。
でも、抗生剤の使用方法でミスをすると簡単に人は死にますから、そこは譲っていてはいけないと思っています。

付け加えると、自分の手で白黒つく状態で人を救えるのはやっぱり外科だなと感じます。内科は、治すのは医者というより薬だったり、患者自身だったり、ということが多いと感じます。もちろん、デジタルにわけられるわけではないですけれど。

外科は外科として、あって。そこにはそこの強さがあって。でも、その外科の本質・骨格が結局なんなのかが、なかなかつかめずにもだえてしまっていました…。

流されきって修行するのもいいことだったのかもしれませんが、残り少なくなった今、それをしても時間がもったいない気が…。とにかくも、ひとつひとつ手段を試してみたいと思っています。

早速お返事ありがとう。しかしお返事の中に君の欠点が見えた気がします。君は抗生剤や抗癌剤で人が死んだのを見たことがあるの? あるのだったら謝りますが、一年目なら恐らくないでしょう。経験のない、あるいは少ない症例について勝手に自信を持つのは非常に危険です。好き嫌いや得手不得手は誰にでもあるものだが、君の思いがどんなに強くてもそれが客観的な事柄や経験を凌駕することはできない。もし君の(ブログに書かれているような)持論が顔に出ているのなら外科内科に関わらず良い顔はされないかもしれませんね。がんばって下さい。

そのとおりなのですよね…。
従おうとしても従う軸がなかなか見えず、怒られているのか排除されているのかよくわからないと軸を見失い、だったら逆らってみて軸を探すべきなのかとも考えつつ迷っていました。けれど、正月あけて気が落ち着いてみると、考え込みすぎているなと、感じています。

きっかけはいろいろあるにせよ、気持ちに余裕があれば気にならないようなことを気にしすぎてしまっているのだと、上の先生方を見ていると感じます。
もっと余裕を持って、今は役立たずに勉強していきたいと思います。

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