臨床医学に環境・労働の観点を

2005年の「クボタショック」以来アスベストが社会問題となりました。アスベストは、さまざまな問題を提起していますが、ひとつに、現在の臨床医学がいかに職業・環境因子を軽視していたかが明らかになったと思います。現在の臨床医学に欠けている職業・環境因子の疾病へのかかわりを考えていきたいと思います。私が一人情報発信するのではなく、問題提起をしてそれにこのブログを見てくださった皆さんが応えてくださることにより知識・情報を集積したいと考えています。よろしくお願いいたします。

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・精読はしないけど、好きな雑誌はLancetです。最近とんと見かけないのですが、時々Uses of Errorというのがあります。お医者さんの教訓となる失敗談ですね。世界のお医者さんがどんな失敗をしているのかわかって、自分の位置も分かっておもしろいです。たとえば、↓

Eye know it's red

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)67630-1/fulltext

まあ、この報告、表題からシャレているのですが、結構中もおもしろいですよ。著者が研修医時代、結膜炎と思われる患者さんに抗菌剤入りの点眼薬を処方するのですが、全然改善しなくて何回も患者さんが受診するのですね。結局何回かして上級医に相談すると、それは細菌性の結膜炎ではなくて、点眼薬に入っている防腐剤にたいするアレルギーだったということです。

・他にもおもしろい失敗談が載っております。私が印象に残っているのは、パーキンソン病の旦那さんに付き添っている奥さんも、実はパーキンソン病だったというお話。旦那さんの主治医は、奥さんを冷たい人（英語表現では、cold fishとなってました）だなとおもっていたとのこと。

Conjugal Parkinson's disease

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(03)12277-5/fulltext

・さて、先週の土、日の研究会の行き帰りで、『日本のこどもの自尊感情はなぜ低いのか児童精神科医の現場報告』（古荘純一。光文社新書。2009年）という本が読めました。いろいろおもしろかったのですが、その中で、いじめをしている子供の背景を見ると、その子が虐待をうけていたといった問題が見られる事があるという話ですね。いじめをするやつは悪いけど、その背景は何かを考えないといけないと言うこと。

・さて、今回ブログの表題にもどって：患者さんに家族が付き添ってくる場合、特に診察室で普通に家族とやりとりができれば、その家族には何も問題がないと思ってしまいますよね。でも、それって診察室という針の穴から、その人の全体を評価しているわけで、付き添っている家族の方が問題を抱えている可能性だってあるわけです。忙しい外来でそういう視点は、なかなかもてませんが、時々気にする必要があるのではないでしょうか？たまには家族の人に「大変ですね」とか、「（付き添っている）○○さんは大丈夫ですか？」とか声をかけることが必要でしょう。

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