Cutoff pointがぐちゃぐちゃでわけが分からない…
Cutoff pointがぐちゃぐちゃでわけが分からない…
まだ科不適合を起こしている…。産婦人科を回っていて毎日昼ごはんご馳走してもらったり、お世話にはなってはいるのだけれど、どうにも理屈が読みきれない…
産後のとても元気なひとのCBCをどうしてとる必要があるのだろう…。少し調子が悪かったってまってれば治るだろうし…。Hbが下がっているとすれば持続的な女性器または腹腔内の出血とか考えるのだろうけれど、だったら痛みとか結膜の貧血とかなにより訴えがあるだろうし。WBCも炎症や感染みえるとはいえ、発熱や痛みなどの訴えがないときにどこまでいみがあるのか…。だいたい、CRPだって測る意味もどこまであるのか…。検尿だって、浮腫とか高血圧とかないときにどこまで測る必要があるのか。顔見ないでもひっかけられるルーチンの大切さも分かるけれども。でも、検査値以上に顔色の変化のほうがずっといろいろわかると思うのだけれど。
まあ、仕事の遅い自分は特に、ルーチンは他の作業をする余力をつくるためにたいせつだとはつくづく思う。
でも。
どこまでがルーチンなのかマニュアルなくてよくわからないから…と生化学基本セットまで入れると、ムダだ、と文句を言われてみたり…。そもそものルーチン検査自体にムダがあるんだから、生化学がムダだなんて、わかんないよ…。そういった、微妙なラインを読みきれず、バカにされ、消耗していく。
同じ針さすんだったら、どうせムダな検査だし、基本セットだったら検査室でもルーチンな作業だろうから大して手間もかかんないだろうし、どうでもいいじゃないか。
あああああ。
新生児のビリルビン採血にもつかれた。ミノルタのあるこの時代、ルーチンで採血・計測する必要がどこまであるのか。まあ、それまでならいい。どうして検体を検査に送ろうとしたら、医者が計測するという前提を持っていなかったら、バカにされなきゃいけないのか。医者が計測するなんて大学くらいじゃないか。そんな非常識、知らないよ…。赤ちゃんになんども針をさすはめになってかわいそうだけれどそれは俺の責任か。常識が通用しない大学病院なんてきらい。
あああああああ。疲れる。
コストとリスクとアウトカムを考えたとき、その評価者の経験と気分でいくらでもcutoff pointなんて動くもの。それぞれの科でそれぞれのcutoff pointがあるのだろうけれど、自分たちの科と同じ前提がないとバカにするのは、疲れる。いちいち自分をtuningしなおさないといけないのも、ほんとに疲れる…。
でも、そのあたりにパッと阿吽で馴染む研修医が、「正しい研修医」とされるのだろうな…。
いちいち悩む研修医は、バカとされるのがこのスーパーローテートなんだろうな。
ふぃ〜〜〜
コメント
初めてコメントさせていただきます。必修化以前に私もスーパーローテートしました。標準化された診療なりマニュアルなりがあまりなかったりしてなかなか苦闘したのを覚えています。論理性があまりなかったりすることもあったりしていろいろと困りますよね。幸いスーパーローテートを何年もやっている病院だったのでなんとなく研修医の実力なりするべき範囲が指導医・看護師に理解されて多感はありました。先生の施設がなれてくれば将来は良くなるのではと思います。また先生と同じような悩みを共有したと思われる先輩が各科のマニュアルのようなものをある程度作るようにしていたと記憶しています。各科によって指導医がマニュアルを作り、オリエンテーションをしていました。
患者安全の観点からは数ヶ月におきにまっさらの研修医がくるのですから各科が率先して資料づくり励む気もしますね。
先生のようにいろいろとものの背景や論理性を考える方は後期研修でとても素晴らしい成長をされるのではと思います。また今の経験を反面教師に後輩に色々とと与えることが出来ると思います。
理不尽なことたくさんありましたが、そのときはつらくてもあとで振り返ってみると色々と学んだなあと今は思っています。
偉そうに失礼いたしました。お互いに今後とも研修頑張りましょう。
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投稿者: how to train a afghan hound | 2011年06月12日 00:22
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投稿者: Mickie Pressman | 2011年06月12日 02:09