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< マイ手帳大賞No.9:「はっきりしていな... | メイン | 容疑者Xの献身 >
2008.11.08 22:00 |  診療  |  医療制度 / 行政  |  その他(医療関連)  |  ミチバ  | 推薦数 : 3

社会資源の活用を

・木曜前泊で、金、土の午前中は呼吸器関係の研究会、土の午後は振動病の研究会に参加しておりました。研究会に参加することは、モチベーションを挙げられるし、教訓になること、自分たちに足りないこと等、日常診療に流されて気がつかないことに気づかせてもらえます。

・呼吸器の研究会では、じん肺という病名で、生活保護を受けていた人が、MSWの介入で労災認定がうけられた事例を聞きました。この事例で思ったのは、まず、生活保護の診断書をうけとった福祉事務所がじん肺は労災の対象にならないかと思わなかったのか?また、その診断書を提出した医療事務は、何も思わなかったのか。医師は?といった思いをいだきました。労災になる疾患には敏感になってほしいなと思いました。ただ、これは医師や医療事務の個別の問題ではなく、システムとして、労災になる可能性がある病名を見た場合、なんらかの形で議論の俎上にのせるようなシステムがいるのではないかと思いました。

・労災に限りません。本来なら特定疾患になる特発性間質性肺炎が、なにも申請されていなかったり、身体障害者手帳がもらえるはずのHOTの患者さんが、毎月高い自己負担を払っているとか、ときどき、私は経験します。労災にもどれば、アスベスト関連疾患というのは最たるものでした。いや、これだけ社会問題になったのに、スルーされている場合があります。医療機関は、社会資源がきちっと活用できるようなシステムを構築すべきだし、医学部や看護学校の教育でも、社会資源について十分教育してもらいたいと思います。(初期研修の要綱に、「社会資源が適切に利用できる」といったものがはいっているのでしょうか?)

・ちなみに思いつくままに、呼吸器疾患関係の社会資源を以下に書いてみます。

労災保険 

じん肺法

いわゆるアスベスト新法

特定疾患:IPFやサルコイドーシス、原発性肺高血圧症、特発性慢性肺血栓塞栓症

身体障害者手帳

健康管理手帳:じん肺、石綿、コークス、クロム、ベリリウムetc.

他にもあるでしょうが、酔っぱらって書いているので、こんなもんです。エンタの神様みなくっちゃ。

 

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多すぎてわかりにくい、使いにくい、というデメリットはあるかも。

でも役人にとっては利権天下りポストが増えるのでメリットなのでしょう。

>Paul Carpenterさま、コメントありがとうございます。
本当に制度が分かりにくいです。医療費みんなタダとしたら、一番分かりやすいと思います。
written by Paul Carpenter / 2008.11.10 08:50

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