わたしはいつもかかり付けのお医者さんにお世話になっている慢性病を抱えています。一方、よく名前の変わる地域の集中医療センター病院もすぐ近くにあって、ときどき入院・手術などでお世話になっています。国立病院なんだけれど「機構改革」の結果名前だけ変わるので、病院名はいまでもよくわからない（笑）。しかし札幌都市居住ということで医療については非常に利便性の高い幸福な環境に住んでいると思っています。
　で、最近の「かかり付け医」制度というものにも妥当性は高いモノがあると思っています。地域の中核的な医療を担う大型病院への患者集中による弊害を避けて、効率的な医療体制を構築していくことはまことに素晴らしいと思っています。
　先般、わたし自身ある急患的なことにも遭遇したのですが、あわてて救急対応とすることなく、幸いにも小康を得ていたので、まずはかかり付け医に連絡して受診させてもらってから、そこからの「紹介」ということで国立病院のお世話になって、合理的な診察・処置をしていただくことができた。制度の趣旨に沿うように対応したのですね。そういうことで医療機関同士の「連携」を取ることで投薬情報の連携などで患者としての利便性も高まる。
　ただ、こういう関係性の中で、ややもすると患者がいろいろと気遣いせざるを得ないような局面に遭遇することもあり得ることがわかってしまった。
　国立病院の方でお世話になった病変について、その後の経過状況をチェックしていただくために受診したいと思っていたのですが、当然かかり付け医さんと国立病院の間に立たざるを得ず、いわば事務連絡的な詳細部分にまで、患者が状況整理しなければならないことになってしまった。もちろん勝手などはまったくわからないし、そもそも、国立病院から個人病院に送られたわたしの病気の「連絡書簡」には封がされていたので、わたし自身はその中身の詳細などは見ていない。どんな内容が書かれていたか、またどのような「連携」内容だったかについて詳細はわからない。
　一方そのあたりのことが、事務連絡としては必要不可欠なのだそうで大病院側からは「かかり付け医に直接聞いてもいいか？」というちょっとカドが立つかも知れない口調で同意を求められた。
　診ていただく患者としてはどちらにもお世話になっているので、それぞれの心証を害したくはない。「う〜む」と考え込まされた次第。個人病院さんに過大な事務連絡責任を負わせるのも、申し訳ないという「繊細な」患者心理。
　まぁ事実としては滞りなく進展して、本日、無事に国立病院での予約が取れたのですが、かかり付け医制度の運用面で、まだ詳細部分では練り込まれていないなぁと感じた次第。

English version⬇

Community Centered Hospitals & Family Physicians: Patients Struggle with Schema?
As a patient, I aim to build a good-circulation relationship with the doctors and medical systems that are involved in my body. I don’t want to be thrown into an “in-between-the-board” situation that goes against my will. …

　I have a chronic illness that is always taken care of by my family doctor. On the other hand, there is also a local intensive care center hospital nearby, whose name often changes, and I sometimes go there for hospitalization and surgery. It is a national hospital, but only its name changed as a result of “organizational reform,” so even now I am not sure of the name of the hospital (laughs). However, as a resident of the city of Sapporo, I feel that I live in a very convenient and happy environment with regard to medical care.
　I believe that the recent “family doctor” system has a high degree of validity. I think it is a wonderful idea to build an efficient medical system that avoids the harmful effects of concentrating patients in large hospitals that provide core medical services in the community.
　Recently, I myself had a medical emergency, but fortunately, I had a lull in the situation and was able to contact my family doctor first, who referred me to a national hospital, where I was able to receive a reasonable medical examination and treatment. I was able to get a reasonable medical examination and treatment. You responded in a way that was in line with the purpose of the system. That kind of “collaboration” between medical institutions will increase convenience for you as a patient through the coordination of medication information, etc.
　However, it turned out that in this kind of relationship, it is possible to encounter situations in which the patient is forced to be somewhat concerned about various things.
　I wanted to see a doctor to check the progress of a lesion that had been taken care of at the national hospital, but of course I had to stand between my family doctor and the national hospital, and the patient had to sort out the details, so to speak, of the administrative communication. Of course, I had no idea how to do this, and since the “communication letter” from the national hospital to the private hospital was sealed, I did not see the details of its contents. I do not know the details of what was written or what kind of “cooperation” was involved.
　On the other hand, I heard that it is essential for them to have this kind of information as an administrative contact, so the big hospital asked me, “Is it OK if I ask your family doctor directly? The hospital asked me for my consent in a tone that might have raised a few eyebrows.
　As a patient, I am a patient of both hospitals, and I don’t want to offend either of them. I was left thinking, “Hmmm. I am sorry to make a private hospital bear the responsibility of excessive paperwork, which is a “sensitive” patient mindset.
　Well, as a matter of fact, things progressed without a hitch, and today I was able to get an appointment at a national hospital, but I felt that the details of the operation of the family doctor system had not yet been worked out.
　

Posted on 11月 15th, 2024 by 三木 奎吾
Filed under: 状況・政治への発言