医療を街に置く ― かしまモデル 二十年の軌跡 ―
第55話 病院紹介を作っていたら、私の人生になってしまった件
かしま病院には、ありがたいことに、たくさんの方が見学・実習・研修に来てくださいます。
医学生。
研修医。
専攻医。
看護学生。
医療・介護・福祉に関わる方々。
時には、海外からも。
そこで今回、
「かしま病院がどんな病院なのか、初めて来る人にも分かる資料を作ろう！」
と思い立ちました。
救急。
訪問診療。
総合診療。
高齢者医療。
介護との連携。
医学教育。
地域活動。
そして、「いとちプロジェクト」。
これらを整理して、
「なるほど、かしま病院ってこういう病院なんですね！」
と、一発で分かるPowerPointを作る。
そのはずでした。
ところが。
作り始めて、すぐに困りました。
「なぜ、かしま病院はこんなことをやっているのか？」
を説明しようとすると、
どうしても現在の取り組みだけでは説明できないのです。
救急を説明する。
なぜ断らない方向へ進んだのか。
訪問診療を説明する。
なぜ病院から外へ出るのか。
総合診療を説明する。
なぜ臓器ではなく、人をまるごと診ようとするのか。
いとちプロジェクトを説明する。
なぜ病気になる前から地域とつながろうとするのか。
一つひとつ、
「なぜ？」
を遡っていきました。
すると――
なぜか、
プロパンガス屋のお兄さんにたどり着きました。
（笑）
幼い頃の私は、医者に憧れていたわけではありません。
憧れていたのは、家にプロパンガスを届けてくれるお兄さんでした。
ただのガス屋さんではありません。
何か困ったことがあると、
何でも相談できる。
そして、
何でも直してしまう。
壊れた傘まで、
「ちょちょいのちょい」
と、その場で直してしまいました。
子どもの私には、
スーパーマンに見えました。
「自分も、何でも相談できて、何とかしてくれる大人になりたい。」
どうやら、ここが最初の伏線だったらしい。
次に出てきたのが、
イボ。
10歳頃、両手の10本の指先すべてにイボができました。
一年近く治らない。
ところが、いわきで開業医をしていた伯父・中山元二先生に診てもらうと、
「もうそろそろ勝手に治る。」
と言われました。
一年も治らなかったのに、
そんなわけあるか。
と思っていたら、
翌月、本当に治りました。
預言者か。
（笑）
そして12歳。
今度は、一緒に暮らしていた祖母が、根治不能のすい臓がんになりました。
祖母を自宅で最期まで診てくれたのも、元二先生でした。
勝手に治るものには、
余計なことをしない。
治らないものには、
最期まで付き合う。
子どもの私には、
その守備範囲の広さが、
あのガス屋のお兄さんと重なりました。
今なら分かります。
どちらも、
プライマリ・ケアだった。
さらに人生を遡ってPowerPointを作っていると、
中学生の私まで登場しました。
受験科目の5教科は、
パッとしない。
ところが、
音楽も、
美術も、
技術家庭も、
保健体育も、
特に嫌いではない。
9教科をまんべんなく勉強したら、
全教科総合で学年トップになってしまいました。
つまり、
昔から、
専門特化が苦手だった。
（笑）
医学部に入ってからも同じでした。
内科も面白い。
外科も面白い。
小児科も面白い。
救急も面白い。
どの科も嫌いではない。
結果、
ほとんどの診療科の見学会に出没する、
かなり迷惑な学生
になりました。
そんな時に出会ったのが、
生坂政臣先生でした。
そこで初めて知りました。
「全部を診たい」というのも、専門性になる。
家庭医療・総合診療との出会いでした。
その後、
「そんな道に進んだら一生を棒に振るぞ！」
と言われながら総合診療へ進み、
かしま病院へ戻り、
葛西龍樹先生と出会い、
医学生や研修医、専攻医が地域で学ぶようになり、
多職種の仲間が増えていきました。
やがて病院全体が、
あることに気づいてしまいました。
高齢者救急を診る。
訪問診療をする。
介護とつながる。
暮らしを見る。
地域へ出る。
学生を育てる。
これらは別々の事業ではない。
全部、
「地域をまるごと診る」
という一つのことなのではないか。
そして、それは、
かしま病院が目指してきた
「面倒見の良い病院」
そのものなのではないか。
ここまでPowerPointを作ったところで、
私は気づきました。
あれ？
病院紹介を作っていたはずなのに、私の人生になっている。
（笑）
でも、考えてみれば、
それでよかったのかもしれません。
病院というものは、
建物でも、
病床数でも、
診療科の一覧でもありません。
そこで働いてきた人たちが、
何を大切にして、
どんな患者さんと出会い、
何に困り、
何とかしようとしてきたのか。
その積み重ねが、
少しずつ文化になります。
もちろん、
かしま病院は私一人が作った病院ではありません。
元二先生をはじめとする先人たち。
理事長夫妻。
医師。
看護師。
リハビリ。
薬剤師。
栄養士。
MSW。
介護職。
事務職。
そして地域の皆さん。
たくさんの人たちの思いが重なって、
今のかしま病院があります。
私自身もまた、
その長い物語の中にいる一人にすぎません。
ただ、
自分の人生を振り返ってみると、
不思議なくらい、
今やっていることにつながっていました。
何でも相談できたガス屋のお兄さん。
治るものには余計なことをせず、
治らないものには最期まで付き合った元二先生。
何でも面白がってしまった学生時代。
「全部診る」という専門性を教えてくださった生坂先生。
地域で家庭医を育てることを教えてくださった葛西先生。
そして、
それを受け入れ、
一緒に育ててくれた、
かしま病院の仲間たち。
全部つなげてみたら、
現在の
「面倒見の良い病院」
になりました。
そして、
医療と地域をつなぐ
「いとちプロジェクト」
になりました。
だから、これからかしま病院へ来てくださる皆さん。
病院を見学するとき、
建物や設備だけを見ないでください。
救急車の台数だけを見ないでください。
診療実績だけを見ないでください。
患者さんの物語を聴いてください。
職員と話してください。
そして、
病院の外へ出て、
街を歩いてみてください。
なぜなら、
かしま病院の診療範囲は、
病院の敷地の中だけではないからです。
結局、
かしま病院の紹介資料を作っていたら、
一人の少年が、
ガス屋のお兄さんに憧れ、
イボを作り、
預言者のような伯父に出会い、
9教科をまんべんなく勉強し、
診療科を選べず、
総合診療にたどり着き、
地域へ飛び出していく、
壮大な伏線回収物語になってしまいました。
そして最後に、
全部を一つの鍋に入れてみたら、
救急も、
在宅も、
介護も、
教育も、
地域活動も、
いとちも、
全部入った、
巨大な「具沢山の闇鍋」
が出来上がりました。
何が飛び出してくるか分かりません。
でも、大丈夫。
かしま病院では昔から、
想定外も、想定内です。
そして不思議なことに、
最後には、
結構いい出汁が出るのです（笑）。
Bringing Healthcare into the Community
The Kashima Model: A Twenty-Year Journey
Episode 55 – I Tried to Make a Hospital Introduction… and Somehow Ended Up Explaining My Entire Life
We are fortunate to welcome many visitors to Kashima Hospital.
Medical students.
Junior doctors.
Residents and trainees.
Nursing students.
People working in healthcare, long-term care, and social welfare.
And sometimes, visitors from overseas.
So I recently had what seemed like a perfectly sensible idea:
“Let’s make a PowerPoint presentation that explains Kashima Hospital clearly to people visiting us for the first time!”
Emergency care.
Home visits.
Generalist medicine.
Healthcare for older people.
Collaboration with long-term care.
Medical education.
Community activities.
And, of course, the Itochi Project, which connects healthcare with the community.
I would organise everything neatly so that, by the end, visitors could say:
“Ah! Now I understand what Kashima Hospital is all about.”
That was the plan.
Then I started making the slides.
And immediately ran into a problem.
Whenever I tried to explain what Kashima Hospital does, I also had to explain:
“Why do we do it?”
Why do we try to accept emergency patients rather than first looking for reasons to decline them?
Why do we leave the hospital and provide care in people’s homes?
Why do we try to see the whole person rather than simply an organ or a disease?
Why does the Itochi Project connect with people in the community even before they become ill?
Every time I asked “Why?”
I had to go further back.
And further back.
And further back.
Until eventually—
I arrived at the man who delivered propane gas to my childhood home.
Seriously.
When I was a boy, I did not dream of becoming a doctor.
My hero was the young man who delivered our propane gas.
He was not just the gas man.
Whenever something went wrong, you could ask him.
And somehow, he could fix almost anything.
Once, he even repaired a broken umbrella on the spot—
just like that.
To a little boy, he looked like Superman.
I remember thinking:
“I want to become an adult people can ask about anything—someone who can somehow help.”
Apparently,
that was Foreshadowing Number One.
Then came…
the warts.
When I was about ten, I developed warts on the tips of all ten fingers.
They remained there for almost a year.
Nothing seemed to work.
Eventually, my uncle, Dr Genji Nakayama, a community physician in Iwaki, took a look at them.
He said:
“They’ll probably disappear on their own soon.”
I remember thinking:
They’ve been here for a year. There is absolutely no way they are suddenly going to disappear.
The following month,
they disappeared.
Was this man a prophet?
（笑）
Then, when I was twelve, my grandmother, who lived with us, developed incurable pancreatic cancer.
It was the same Uncle Genji who cared for her at home until she died.
If something was going to get better by itself,
he did not interfere unnecessarily.
If something could not be cured,
he did not walk away.
He stayed with the person until the end.
To my twelve-year-old eyes,
that enormous scope of responsibility somehow resembled the propane gas man I had admired.
Today, I know what connected them.
Primary care.
As I continued making my PowerPoint,
my teenage years somehow appeared on the slides too.
I was never particularly outstanding in the five subjects used for entrance examinations.
But I did not especially dislike music.
Or art.
Or technical studies.
Or physical education.
In fact, I did not really dislike any subject.
So when I studied all nine subjects fairly evenly,
I somehow came top of my year overall.
In other words,
even back then,
specialisation was apparently not my greatest talent.
（笑）
Medical school did not solve the problem.
Internal medicine was interesting.
Surgery was interesting.
Paediatrics was interesting.
Emergency medicine was interesting.
Everything was interesting.
As a result, I became the rather troublesome medical student who appeared at almost every specialty orientation session.
Then, shortly before graduation, I met Professor Masatomi Ikusaka.
He had returned to Japan after studying family medicine at the University of Iowa in the United States and was introducing young doctors and students to the still relatively unfamiliar ideas of family medicine and generalist care.
And suddenly I discovered something extraordinary:
Wanting to see everything could itself be a specialty.
I had found family medicine and generalist medicine.
After my initial postgraduate training,
while most of my colleagues entered established specialties,
I chose generalist medicine.
A senior doctor warned me:
“You’ll ruin your entire career!”
There was not even a formal specialist training pathway in Japan at the time.
I went anyway.
Apparently, if I was going to ruin my career,
I was going to do it properly.
（笑）
I returned to my university and learned as much as I could from Professor Ikusaka.
Then, in 2002,
I came to Kashima Hospital.
At the time, hardly anyone here—doctors or other healthcare professionals—fully understood what family medicine or generalist medicine meant.
So I practised it.
I held teaching sessions.
Then practised some more.
And gradually, something interesting happened.
People began to realise that this strange thing called “generalist medicine” fitted remarkably well with the philosophy Kashima Hospital already had:
“Community healthcare and whole-person care.”
Colleagues from many professions began to understand its value.
And I stopped being alone.
Then, in 2006, another important person arrived in Fukushima.
Professor Ryuki Kassai.
Professor Kassai was another pioneer who had studied family medicine internationally and brought those ideas back to Japan.
He had trained directly under Professor Ian McWhinney at the University of Western Ontario in Canada—the physician often described as one of the fathers of modern family medicine.
My encounter with Professor Kassai changed what happened next.
Medical students began coming to Kashima Hospital.
Junior doctors came.
Family medicine and general practice trainees came.
Those trainees became specialists.
The specialists became teachers.
And then they began training the next generation.
Meanwhile, the leadership of Kashima Hospital increasingly understood and supported the importance of building clinical care, education, and research around generalist medicine.
Little by little,
generalist medicine stopped being something one doctor was trying to practise.
It became part of the hospital.
Then Japan became a super-ageing society.
Our community faced a shortage of people able to provide emergency care for older adults.
A shortage of doctors able to provide home-based care.
More people living with multiple illnesses.
More people whose medical problems could not be separated from their social circumstances.
And eventually,
the leadership of our hospital—clinical and non-clinical alike—realised something.
Emergency care.
Home visits.
Long-term care.
Whole-person care.
Community activities.
Education.
These were not separate projects.
They were all expressions of the same idea:
Caring for the whole community.
And perhaps that was exactly what we meant when we described Kashima Hospital as:
“A hospital that takes good care of people.”
At this point in making the PowerPoint,
I suddenly realised something.
Wait a minute.
Wasn’t I supposed to be making a hospital introduction?
Why was I now explaining my entire life?
（笑）
But perhaps that was exactly the point.
A hospital is not simply a building.
It is not its number of beds.
It is not a list of clinical departments.
A hospital is shaped by the people who have worked there—
what they valued,
which patients they met,
what problems they encountered,
and what they decided to do about them.
Over time,
those choices become culture.
Of course, I did not create Kashima Hospital by myself.
Far from it.
Uncle Genji and the people who built the foundations before us.
Our current chairman and his wife.
Doctors.
Nurses.
Rehabilitation professionals.
Pharmacists.
Dietitians.
Medical social workers.
Care workers.
Administrative staff.
And, above all,
the people of our community.
Kashima Hospital today is the result of all those lives and ideas overlapping.
I am simply one person within that much longer story.
And yet,
when I looked back at my own life,
I was surprised by how many apparently unrelated experiences had somehow been pointing towards what we are doing today.
The propane gas man who could be asked about anything.
Uncle Genji, who knew when not to intervene—and who stayed when cure was no longer possible.
The student who found almost every subject interesting.
Professor Ikusaka, who showed me that seeing the whole person could itself be a medical specialty.
Professor Kassai, who showed us how family medicine could be taught in the community and passed on to the next generation.
And the people of Kashima Hospital, who embraced those ideas and made them their own.
Put all those pieces together,
and somehow they became the hospital we have today:
a hospital that takes good care of people and their lives.
And eventually,
they also became the Itochi Project—
our attempt to connect healthcare with the places where people actually live.
So, to everyone who comes to visit, study, or train at Kashima Hospital:
Please do not look only at the building.
Do not look only at the equipment.
Do not judge us only by the number of ambulances we accept or the services we provide.
Listen to our patients’ stories.
Talk to our staff.
And then,
leave the hospital.
Walk through the town.
See where people live.
Because the true clinical territory of Kashima Hospital does not end at the hospital gates.
In the end,
I tried to make a simple presentation about Kashima Hospital.
Instead, I ended up with the story of a boy who admired a propane gas delivery man,
developed warts on all ten fingers,
met a prophetic uncle,
studied all nine school subjects,
could not choose a medical specialty,
discovered generalist medicine,
and eventually wandered out of the hospital and into the community.
It turned into one enormous exercise in connecting the dots.
And when I threw all those dots into the same pot—
emergency medicine,
home care,
long-term care,
education,
community activities,
generalist medicine,
and Itochi—
I discovered that we had created one enormous,
ingredient-packed mystery hotpot.
You never quite know what is going to come out of it.
But that is all right.
At Kashima Hospital,
even the unexpected is expected.
And strangely enough,
when everything has simmered together for long enough,
the broth usually turns out pretty good.
（笑）
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