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4/3

●本日の勤務時間

8時半〜18時

●今日行ったこと・見たこと・知ったこと
総合外来

●今日うまくいかなかったこと・失敗
上司とのディスカッション
基本的に自分に自信がなさ過ぎる。上司や専門医に何か言われると、それに無条件に従うように頭を作ってしまってもいる。きっちりその場で逆らいきることが肝腎。そうしないと、見えていないところで従わない、という状況になってしまう。もっとも、頭がそんなにはやく回らない…。

●今日できたこと・成功

●今の気持ち・今後学びたいこと・気づいたこと

漢方を嫌う人たちは、東洋医学診断しない、と言う。
そうではなくて、東洋医学的診断を理解する気がないひとたちにどう説明すればいいのかわからない状況がある。
しかし、心気症、としてリーゼがよく処方されるが、そのリーゼを封印した上でなければそのような批判をする資格はないはずなのだが…。

東洋医学を否定するひとたちに感じる気持ち悪さの一つが今日わかった。
現病歴や身体所見で鑑別をあげる技術が浅く、また検査所見の感度・特異度が完全ではないことへの認識が甘い。
また、一つのプロブレムから鑑別をあげて検討する訓練はよくされているが、多数あるプロブレムを同時平行で検討して、そのすべてを満たす原因を検討するという訓練が弱い。だから、特定の検査所見があるときに疾患を想起し「検査しなければいけない!」と指導が入るが、ほかの所見とどう合わないのか検討するステップに欠けることがある。
それらがあるため、検査の閾値が低く、また感度・特異度への認識が甘い。

入院時のルーチンの尿検査なども、頭使っていないんじゃないかと感じる。アメリカ医師が、入院時にルーチンで心電図をとる日本の診療をみて、「日本の医者は診察していないのか」ときいたという話がある。明らかな肺炎で入院したとき、高齢者で膿尿があったからといって腎盂腎炎と診断するのは思考力のなさの露呈でしかない。

仕事が多ければルーチンワークで思考停止したほうがらくだとは思うが、研修中は好きになれない。

しかし、ルーチンワークでひょいひょいと動く医者のほうが、スマートに周りからはみられるもの。
でも、やはりそんな医者にはなりたくない。

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