遠くまで来て、身近な医療の意味を知る。
――医学部2年生、たった一日の地域医療体験
11月2日、かしま病院に一人の医学生がやって来ました。
杏林大学医学部の2年生です。
今回の地域医療体験プログラムは、たった一日。
しかも、同級生のほとんどが大学近隣の医療機関を選ぶ中、この学生さんが選んだのは、東京からはるか遠く離れた福島県いわき市のかしま病院でした。
いやいや、どうしてまた、こんな遠くまで（笑）。
もちろん、来てくれるのは大歓迎です。
でも、わずか一日の実習のために、わざわざここを選んでくれた理由が気になります。
聞いてみると、お父様が高齢者を多く診る医療機関を経営されているとのこと。
そんな家庭環境もあって、何となくかしま病院に興味を持ち、足を運んでくれたようです。
何となく。
実は、この「何となく」という感覚が、私は結構好きなのです。
まだ明確な目標や答えがなくても、心のどこかに引っかかるものがある。
その小さな好奇心が、時として人生の大切な出会いにつながることがあります。
さて、そんな学生さんが、一日の実習を終えて書いてくれたアンケート。
これが、実に嬉しい内容でした。
■ 医師にとっては大勢の患者さんの一人。でも……
今回の実習では、外来での診察や入院患者さんとのコミュニケーション、リハビリテーションの様子などを見学してもらいました。
また、地域医療のあり方や、特別養護老人ホームなどの施設についても学んでもらいました。
実習後のアンケートには、特に印象に残ったこととして、こんな趣旨の言葉が綴られていました。
医師にとっては、日々診療する大勢の患者さんのうちの一人かもしれない。
しかし、その患者さんには、それぞれの人生があり、病気があり、さまざまな背景がある。
そして患者さんにとって、その医師は、自分の身体を診てもらう大切な存在なのだ、と。
私は、この感想を読んで、思わず嬉しくなりました。
医学部2年生。
これから解剖学や生理学、病理学、薬理学など、膨大な医学知識を身につけていく時期です。
しかし、この学生さんは、その前に大切なことに気づいてくれたようです。
医師にとっての「患者さんの一人」と、患者さんにとっての「自分を診てくれる医師」は、決して同じ重さではない。
医師は一日に何人もの患者さんを診察します。
けれども、患者さんにとって、その診察は一日の中の大きな出来事かもしれません。
診察室に入るまで、どれほど不安だったか。
家族に何を相談してきたのか。
医師の一言で、どれほど安心したり、逆に傷ついたりするのか。
診察室の中だけを見ていては、分からないことがたくさんあります。
だからこそ、私たちは病気だけでなく、その人の暮らしや人生にも目を向けたいと思っています。
■ 医療を教えたつもりが、病院の姿勢を見てくれていた
もう一つ嬉しかったのは、学生さんが医師の診療だけでなく、病院全体の雰囲気にも目を向けてくれたことです。
アンケートには、指導医だけでなく、スタッフの皆さんが親切に接してくれたことへの感謝も書かれていました。
これは、院長としてはかなり嬉しい。
いや、正直に言えば、医師の説明が褒められるより嬉しいかもしれません（笑）。
医学生の実習というと、どうしても指導医が何を教えるかに注目が集まります。
しかし、医療は医師だけで成り立つものではありません。
看護師、リハビリテーション専門職、薬剤師、医療ソーシャルワーカー、事務職員……。
さまざまな職種が、それぞれの立場から患者さんを支えています。
そして、その人たちがどんな表情で働き、どんな言葉を交わし、患者さんにどう接しているか。
学生さんは、そんな日常の姿からも医療を学んでいるのだと思います。
病院全体が、医学生にとっての教科書なのです。
■ 遠くまで来て、実は身近にあった医療の意味を知る
今回の学生さんのお父様は、高齢者を多く診る医療機関を経営されているそうです。
つまり、この学生さんにとって、高齢者医療はもともと身近な存在だったのでしょう。
けれども、身近にあることと、その意味を自分の言葉で理解することは、少し違います。
家族が携わっている医療。
日常のどこかで見聞きしてきた医療。
それが、遠く離れたいわきの病院で、患者さんや医療スタッフの姿に触れることによって、少し違った輪郭を持ち始めたのかもしれません。
実際、本人も今回の経験を通じて、何かが腑に落ちたようでした。
これは、なかなか面白いことです。
わざわざ遠くまで来て、初めて自分の身近にあったものの意味が分かる。
旅行でも、勉強でも、人生でも、時々こういうことがあります。
遠くへ行ったつもりが、実は自分の原点に近づいていた。
そんな一日だったのかもしれません。
■ たった一日で、何が教えられるのか
地域医療実習を受け入れる側として、いつも考えることがあります。
たった一日で、いったい何を教えられるのだろう。
医療制度を説明する。
地域の高齢化について話す。
診療を見学してもらう。
多職種連携の現場を見てもらう。
もちろん、どれも大切です。
でも、一日ですべてを理解することなどできません。
むしろ、私たちができるのは、学生さんの心に小さな種をまくことくらいなのかもしれません。
医療って、何だろう。
医師って、どんな仕事なのだろう。
患者さんを診るというのは、どういうことなのだろう。
そんな問いを一つでも持ち帰ってもらえたら、それだけで十分です。
答えは、これから何年もかけて、自分で見つけていけばいい。
そして、その答えは、医師になってからも変わり続けるものだと思います。
■ 地域医療の魅力は、地域医療の中にある
私たちは長年、地域医療の現場で医学生や研修医を受け入れてきました。
地域医療の魅力を、言葉で伝えようとすることもあります。
でも、結局のところ、一番伝わるのは現場そのものなのかもしれません。
患者さんとの何気ない会話。
スタッフ同士の自然なやり取り。
病気だけでは説明できない、その人の暮らし。
そうした日常の中に、私たちが大切にしている医療の姿があります。
今回の学生さんは、遠くからそれを見に来てくれました。
そして、何かを感じ取って帰ってくれた。
それが何より嬉しいのです。
最後に、アンケートの「実習中に困ったこと」という欄には、
「特になかったです。」
と書かれていました。
よかった、よかった。
遠くまで呼んでおいて、困ったことだらけでは申し訳ありませんからね（笑）。
そして、自由記載欄には、今回の実習への丁寧な感謝の言葉とともに、この経験をこれからの学びにつなげていきたいという思いが綴られていました。
こちらこそ、ありがとう。
数ある実習先の中から、かしま病院を選んでくれて。
たった一日のために、遠くまで来てくれて。
そして、私たちが日々大切にしているものを、こんなにも素直に受け止めてくれて。
医学生が何かを学んで帰るだけでなく、私たち自身も、自分たちの医療の意味を教えてもらう。
地域医療教育とは、案外そういうものなのかもしれません。
いつか医師になったとき、今回のいわきでの一日を、ふと思い出してくれたら嬉しいですね。
そのとき、どんな医師になっているのでしょう。
今から、ちょっと楽しみです。
A Long Journey to Discover the Meaning of Medicine Close to Home
— One Day with a Second-Year Medical Student
On November 2, a medical student came to visit Kashima Hospital.
He was a second-year student at Kyorin University School of Medicine in Tokyo.
His community healthcare experience would last just one day.
Most of his classmates had chosen medical institutions near their university. But this student decided to travel all the way to Kashima Hospital in Iwaki City, Fukushima Prefecture.
That is quite a journey for a single day of clinical observation!
Naturally, we were delighted to welcome him.
But I couldn't help wondering:
Why on earth did he choose a hospital so far away?
When I asked, he explained that his father runs a medical institution that cares for many elderly patients.
Perhaps because of that family background, he had developed a vague interest in Kashima Hospital and decided to visit.
A vague interest.
I rather like that expression.
Sometimes, we don't need a clear objective or a carefully planned career path to take an important step.
A small curiosity can lead us somewhere unexpected.
And occasionally, it can change the way we see the world.
After completing his one-day experience, the student filled out our feedback questionnaire.
His reflections were truly encouraging.
One Patient Among Many — But One Doctor Who Matters
During his visit, the student observed outpatient consultations, communication with hospitalized patients, rehabilitation, and various aspects of our daily clinical practice.
He also learned about community healthcare and the role of residential care facilities for older adults.
In his questionnaire, he reflected on something that had particularly impressed him.
For a physician, a patient may be one among many people seen throughout the day.
But every patient has a unique life, personal circumstances, medical history, and individual concerns.
And for that patient, the physician examining them may be someone on whom they place enormous trust.
Reading his words made me genuinely happy.
Here was a second-year medical student, still at the beginning of his medical education, already recognizing something essential about being a doctor.
For a physician, someone may be one patient among many. But for that patient, the physician may be one of the most important people in their life at that moment.
Doctors see many patients every day.
But for each patient, a medical appointment may be a major event.
How anxious were they before entering the examination room?
What conversations did they have with their family beforehand?
How much reassurance—or distress—might a physician's words bring?
There are countless things we cannot understand simply by looking at a disease.
That is why we believe medicine must consider not only illness, but also the person living with it.
Their family.
Their circumstances.
Their everyday life.
Their story.
The Hospital Itself Is a Classroom
Another part of his feedback made me particularly happy.
The student had noticed not only the physicians and their clinical work, but also the atmosphere throughout the hospital.
He expressed appreciation for the kindness of our staff and the warm welcome he had received.
As hospital director, I must admit that this was especially gratifying.
Perhaps even more gratifying than receiving praise for the doctors!
(Please don't tell my colleagues I said that.)
When we discuss medical education, we tend to focus on what supervising physicians teach.
But healthcare is never delivered by doctors alone.
Nurses, rehabilitation professionals, pharmacists, medical social workers, administrative staff, and many others all contribute to patient care.
And students learn by watching how these professionals interact.
How they speak to patients.
How they support one another.
How they respond to difficulties.
How they create an environment in which patients feel safe.
These everyday interactions teach lessons that cannot always be found in textbooks.
The entire hospital is a classroom for future healthcare professionals.
And sometimes, the most important lessons are taught without anyone realizing they are teaching.
Traveling Far Away to Understand Something Close to Home
The student's father runs a medical institution that cares for many older adults.
In other words, healthcare for elderly people was already a familiar part of his world.
But being familiar with something is not necessarily the same as understanding its meaning.
Perhaps he had grown up hearing about his father's work.
Perhaps caring for older patients had always seemed like a natural part of medicine.
Yet during his visit to a hospital far from home, something appeared to fall into place.
By observing patients, physicians, and other healthcare professionals, he began to recognize the deeper significance of the kind of medicine that had long been close to him.
There is something rather wonderful about that.
He traveled a considerable distance, only to discover something meaningful about his own familiar world.
Sometimes, traveling far away helps us understand what has been right beside us all along.
We may think we are exploring somewhere new.
But perhaps we are also discovering something about where we came from.
For this student, his journey to Iwaki may have been just such an experience.
What Can We Really Teach in Just One Day?
Whenever we welcome medical students for short clinical experiences, I find myself asking a question.
What can we possibly teach someone in a single day?
We can explain Japan's healthcare system.
We can discuss population aging and the challenges facing local communities.
We can introduce multidisciplinary collaboration.
We can show students how outpatient care, hospital medicine, rehabilitation, and community services connect.
All of these are important.
But no one can fully understand community healthcare in just one day.
Perhaps our role is not to provide all the answers.
Perhaps it is simply to plant a small seed.
What does it really mean to practice medicine?
What kind of physician do I want to become?
What does it mean to care for a person rather than merely treat a disease?
If a student leaves our hospital carrying even one of these questions, I believe the experience has been worthwhile.
The answers can come later.
Over years of study.
Through encounters with patients.
Through mistakes, challenges, and unexpected discoveries.
And even after becoming a physician, those answers will continue to evolve.
I certainly know that mine have.
The Best Way to Discover Community Medicine Is to Experience It
For many years, Kashima Hospital has welcomed medical students and residents into our community-based healthcare environment.
We often try to explain why community medicine matters.
We talk about continuity of care, comprehensive care, collaboration, and the importance of understanding people's lives.
But perhaps the most convincing explanation is not something we say.
It is something students see.
An ordinary conversation with a patient.
A nurse quietly helping someone feel comfortable.
A rehabilitation professional encouraging a patient to take another step.
A physician listening carefully to a concern that cannot be explained by laboratory results.
A team working together to support someone returning home.
These everyday moments reveal what we value.
And this student traveled all the way from Tokyo to experience them.
He came with curiosity.
He left with something to think about.
That alone makes us happy.
Incidentally, our questionnaire also asks students whether they experienced any difficulties during their visit.
His answer was wonderfully straightforward:
“Nothing in particular.”
Excellent!
After asking someone to travel such a long distance, the last thing we would want is for the experience to be filled with problems.
At least we managed to avoid that!
In the final section of his questionnaire, he expressed sincere gratitude for the opportunity and wrote about his desire to carry what he had learned into his future medical education.
But the gratitude is mutual.
Thank you for choosing Kashima Hospital among so many possible destinations.
Thank you for making such a long journey for a single day.
And thank you for recognizing something meaningful in the ordinary work we do every day.
Medical students come to our hospital to learn. But sometimes, through their reflections, they remind us why our own work matters.
Perhaps that is one of the most rewarding aspects of medical education.
I hope that someday, after he becomes a physician, this student will remember his brief visit to Iwaki.
Perhaps a conversation, a patient's expression, or a small moment from that day will come back to him.
And perhaps it will help him make a decision when he needs it most.
I wonder what kind of doctor he will become.
I am already looking forward to finding out.
At Kashima Hospital, we believe that community healthcare is not simply about treating diseases. It is about understanding people, their lives, and the communities in which they live.
And sometimes, even a single day is enough to begin understanding what that means.
