記事「患者の絶望を叶える」
『週刊医学界新聞』2772 号
〔連載〕 名郷直樹の研修センター長日記 (50) 患者の絶望を叶える
http://210.139.254.43/cl/JuU/MsT/eT/6Lh3c/
名郷直樹先生の週刊医学界新聞での連載、今回も面白かったので紹介してみます。
話は外来。検査をしてくれ、と外来に来る患者の話。大丈夫だから、といっても
通用はしない。
(以下抜粋)
『結局そうなるんだから,患者の希望をさっさと叶えて,CTを撮ってしまえばい
いのだ。確かにそうだ。それも一理ある。で,実際そうなる。そのほうが数こな
せるし,病院も収入になる。そこで別の研修医のまた別の患者。 』
『またか,そういう感じである。そんな患者に,ただ心配ないといっても納得し
ない。医者より検査のほうが信頼できる。そういう信念がある。』
『保険を使うということは3割負担だ。それを多いと見る向きもあるが,これは
普通の買い物からしたら恐ろしく安い。常に7割引で検査を買えるのだ。少しで
も健康に不安があれば,次の検査を買いたくなるに決まっている。』
外来とかでつくづく、力が抜けることがあります。
検査をしてくれ、という患者。
検査するまでもなく重い病気である可能性が低い人の検査を、なんで保険でやら
なきゃならないのか。健康診断うければ10割負担なのに、ちょっと健康について
不安を持って病院にいけば、頭のてっぺんからつま先まで、7割引で検査を受け
られる。そして、受けさせなきゃいけない。今の世の中、訴訟やら医療過誤やら
の怖いから、訴えがあれば、病気じゃないと思いつつも病院側も防衛のために検
査をしなきゃいけない。でも、無駄な検査をすればするほど、ほんとうに必要な
ひとへの検査がやりにくくなる。
検査をしても、ほんとうは安心なんかできない。
何か異常があることをみつける検査は難しくはないけれど、異常がないと断言す
る検査なんてあんまりないのだから。値段の高い検査ほど、そんな傾向があった
りします。
まさしく、異常があることをみつける、「絶望を叶える」ための検査が、値段の
高い、患者が好む、信用できると思っているけれど実は信用できない、検査。
また違う視点で書けば、だいじょうぶですよ、というプロの医者の言葉は今時の
都会の患者さんたちは信用しないから、検査を好む、ともいえる。人より機械が
信用できる。機械より人は信用ならない。結局のところ信じちゃいない。そんな
感情を感じ取って、医療者側もやる気をなくす。
そんな医者の気持ちを医療者じゃないひとたちにぜひ読んでみてもらいたいな…
と思った文章だったので、紹介してみました。
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