医療はどう変わるべきか 〜医療政策への期待〜
東大の、10月から開催される医療政策についての公開講座に申し込んだ。通るといいなあ。それに向けて書いた文章を、ここにも出してみようと思う。
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医療政策で取り扱われるべき様々な問題がある。超高齢化社会、医療費の上昇、医療従事者の労働条件、等がある。しかしその中で、もっとも重要な課題は、情報の流通性の向上であると、私は考える。
医療情報を患者という側面からまず考える。カルテ開示が一般的になった。コミュニケーション能力が高く、スムーズに医療行為を行える医療者が求められている。書店では健康に関する雑誌・書籍が積まれ、病院・医師のランキング本が売れている。インフォームドコンセントやインフォームドチョイスといった概念が広まってきた。多くの患者は、病気や施設に関する知識を強く求め、必要としているのである。また、患者の情報を、家族が持つのか、患者が持つのか、といった日本では解決されていない問題も忘れてはならない。
また、医療従事者についても、医療についての情報は重要性を増している。例えばインターネットが普及し、EBMの概念が普及し、以前よりもより最新の知見にアクセスできるようになり、またそれらを利用しなければいけなくなった。感染症主流の時代から、慢性疾患が主な病気になり、患者の生活を知るという過程がより大切になった。医療過誤訴訟では、医療情報の隠蔽の害が明らかになってきている。病院も潰れるという時代になり、患者の病気や背景だけでなく、マーケティング、市場・患者自体を知るということも重要になっている。そして、医療従事者たちの間でも、高い専門性や縦割り構造の弊害で、職種間の情報交換が行いにくいという問題も、明らかになっている。
社会に目を向けてみると、マスコミには医療叩きの記事を含めた医療に関する記事があふれている。しかし、医療者の労働状態などを、多くの市民は知らずにいる。エイズ、ハンセン病、障害者、精神疾患などの事例を通して、市民による患者の差別の実態が問題になった。また、そのような病気を持つ患者たちへの差別は、市民だけでなく、病気についてのプロである医療者たちも行っていることが明らかになってきた。そして、そのような事態が起こるからではあるが、患者たちは社会から隔離され、差別の存続が許されてしまう状態が、維持されている。
医療はどう変わるべきか。
以上に考察したことから私は、患者、医療従事者、社会(市民)の3者の間で、医療に関する情報が適切にやり取りされるシステムが整理されるべきであると考える。また、それら3者それぞれの内部にも複数の立場・組織があり、それらの間での情報の流通も整理されるべきである。さらに、整理された情報が流通するための基本として、その3者がそれぞれの立場、レベルで、病気についての適切な情報を得られるシステムが確立されるべきである。それは大きな力と予算が必要であり、またそれが実現されてこそ、様々な医療問題が解決されるはずである。そこには、医療政策の力が、必須である。
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