熱い医師たちの、その先へ。 Beyond the Passionate Doctors

 

第96話　熱い医師たちの、その先へ。

――在宅医療を「個人の頑張り」から「地域の仕組み」へ。

昨夜、福島県医師会主催の「ふくしま在宅医療塾」に参加しました。

今回は、いわき市で在宅医療に取り組む方々による意見交換。

いわきの在宅医療は、決して恵まれた条件の中で発展してきたわけではありません。

広大な市域、地域による医療資源の偏在、そして医療・介護人材の不足。

そんな中、訪問診療に情熱を注ぐ診療所の先生方や、病院に勤務しながら在宅医療にも奔走する先生方、そして多職種の皆さんが、それぞれの立場で患者さんの暮らしを支えてきました。

その努力には、本当に頭が下がります。

ただ、昨夜の議論を聞きながら、一つ考えたことがあります。

「あの先生なら何とかしてくれる」という地域医療を、いつまで続けられるだろう。

どれほど熱心な医師でも、一日は24時間。

休日も必要ですし、家族との時間も必要です。

そして、いつかは次の世代にバトンを渡す日が来ます。

だからこそ、これまでの個人の献身を、持続可能な地域の仕組みへと発展させていきたいのです。

顔の見える関係、その次へ。

いわきでは、長年にわたり在宅医療に関する多職種研修会が開催されてきました。

私自身、初回開催に向けて千葉県柏市まで視察に出かけ、総合司会を務めた一人です。

当時は、医療と介護の関係者が顔を合わせ、互いの仕事を知ること自体に大きな意味がありました。

その積み重ねは、今も地域の大切な財産です。

ただ、そろそろ次の問いを考えてもよいのではないでしょうか。

「何回集まったか」ではなく、「集まったことで、患者さんの暮らしはどう変わったか」。

顔の見える関係ができたことで、在宅療養を希望する人が安心して自宅に戻れるようになったか。

急変時の対応は円滑になったか。

医療者の負担は軽くなったか。

こうした成果を振り返り、次の実践につなげていく。

それが、これまで築いてきた関係を、さらに価値あるものにするのだと思います。

みんなが訪問診療をする必要はない。

私は、すべての医師が訪問診療を行うべきだとは思っていません。

一人で診療所を切り盛りする先生に、外来も訪問診療も夜間対応も看取りも、すべてお願いしますというのは無理な話です。

大切なのは、それぞれが得意な役割を担い、必要なときにつながれること。

訪問診療を担う医師がいる。

外来で患者さんを支える医師がいる。

急変時に受け入れる病院がある。

そして、訪問看護や介護の専門職がいる。

みんなが同じ仕事をするのではなく、みんなで一人の患者さんを支える。

そんな仕組みが必要なのだと思います。

かしま病院でも、外来、入院、リハビリ、退院支援、訪問診療、看取りを、できるだけ連続した医療として捉えてきました。

もちろん、課題は山ほどあります。

ただ、特定の医師が頑張り続けなければ成り立たない仕組みにはしたくありません。

医師も看護師も多職種も、それぞれが無理なく働き続けられること。

それもまた、地域医療の大切な条件だと思っています。

熱い医師たちの、その先へ。

これからの地域医療構想では、在宅医療のあり方も重要な議題になっていくでしょう。

そのとき、単に訪問診療を行う医師の人数を増やすだけでなく、病院と診療所、医療と介護がどう支え合うかを考えたいのです。

いわきの在宅医療をここまで支えてきた先生方の情熱は、地域の宝物です。

だからこそ、その情熱を個人の頑張りだけで終わらせず、次の世代に引き継げる形にしたい。

「あの先生だからできた」から、

「あの先生たちが頑張ってくれたから、今は地域のみんなで支えられる」へ。

熱い医師が必要なくなるわけではありません。

熱い医師が、燃え尽きずに働き続けられる地域をつくりたいのです。

医療を街に置く。

それは、医師が街の中を走り回ることだけではありません。

医療が必要な人を、地域全体で支え続けられる仕組みを、街に根づかせること。

昨夜の勉強会は、そんな未来を改めて考える機会になりました。

石井 敦

Episode 96 — Beyond the Passionate Doctors

From Individual Dedication to a Sustainable System of Community-Based Healthcare

Bringing Healthcare into the Community — Twenty Years of the Kashima Model

Last night, I attended the Fukushima Home Medical Care Forum, organized by the Fukushima Medical Association.

This time, the discussion focused on home-based medical care in Iwaki City.

Iwaki's home healthcare system has not developed under particularly favorable conditions.

Our city covers an enormous geographical area, medical resources are unevenly distributed, and shortages of healthcare and long-term care professionals remain serious challenges.

Despite these difficulties, dedicated physicians, nurses, and other healthcare professionals have worked tirelessly to support patients in their own homes.

Some physicians specialize in home visits. Others provide home-based care alongside their hospital duties.

I have tremendous respect for their commitment.

But as I listened to the discussion, one question kept coming to mind.

How long can a community depend on the idea that “that particular doctor will somehow make it work”?

Even the most dedicated physician has only 24 hours in a day.

Doctors need time off. They need time with their families.

And eventually, every generation must pass the responsibility to the next.

That is why I believe we must transform individual dedication into a sustainable community healthcare system.

Beyond Knowing Each Other by Face

For many years, Iwaki has organized multidisciplinary workshops and meetings to strengthen collaboration in home healthcare.

I was involved from the very beginning.

Before the first workshop, we even traveled to Kashiwa City in Chiba Prefecture to observe its pioneering approach. I subsequently served as the moderator of our inaugural meeting.

At the time, simply bringing healthcare and long-term care professionals together was a significant achievement.

Getting to know one another, understanding different professional roles, and building relationships made future collaboration much easier.

Those efforts have become a valuable asset to our community.

But perhaps it is time to ask the next question.

Rather than asking how many meetings we have held, shouldn't we ask what those meetings have actually changed for our patients?

Have more patients been able to return home with confidence?

Has emergency support become more reliable?

Have we reduced the burden on healthcare professionals?

Reflecting on these outcomes and using what we learn to improve our practice is the next step.

This is not about dismissing the relationships we have built.

It is about turning those relationships into something even more meaningful.

Not Every Doctor Needs to Make Home Visits

I do not believe that every physician should be expected to provide home visits.

It is simply unrealistic to ask a doctor running a solo practice to manage outpatient consultations, home visits, emergency calls, and end-of-life care all at once.

Instead, we need a system in which different professionals contribute according to their strengths.

Some physicians provide home-based medical care.

Others support patients through regular outpatient consultations.

Hospitals accept patients when emergency admission becomes necessary.

Visiting nurses, rehabilitation professionals, and long-term care workers provide essential support in everyday life.

The goal is not for everyone to do the same work. It is for everyone to work together to support the same patient.

At Kashima Hospital, we have long tried to connect outpatient care, hospitalization, rehabilitation, discharge planning, home visits, and end-of-life care as parts of a continuous healthcare journey.

Of course, we still face plenty of challenges.

But one principle remains central to our approach.

We do not want a healthcare system that can function only as long as a particular doctor keeps working beyond their limits.

Physicians, nurses, and other professionals must be able to contribute their expertise while maintaining sustainable working lives.

That, too, is an essential condition for good community healthcare.

Beyond the Passionate Doctors

As Japan continues to reconsider the future organization of regional healthcare, home-based medical care will become increasingly important.

But the challenge is not simply to increase the number of physicians providing home visits.

It is to build a system in which hospitals, clinics, healthcare professionals, and long-term care providers can share responsibility.

The passionate physicians who have sustained home healthcare in Iwaki are a tremendous asset to our community.

Precisely because their contributions have been so valuable, we must ensure that their achievements can be passed on to future generations.

I hope we can move from:

“That was possible because of that extraordinary doctor.”

To:

“Thanks to the dedication of those doctors, our entire community can now provide that care together.”

We do not need a future without passionate doctors.

We need a community where passionate doctors can continue working without burning out.

Bringing healthcare into the community.

That means more than having doctors travel from house to house.

It means establishing a sustainable system in which the entire community can continue supporting people who need medical care.

Last night's discussion reminded me once again that this is the future we should be working toward.

Atsushi Ishii