クリニック

クリニックのかかり方 要望を明示しましょう

みなさんこんにちは!

先日、頼まれて非常勤で勤務するクリニック先から、「初診患者用の問診表を作ってほしい」と頼まれました。

その時に

医師
医師
患者さんのどんな情報が診療に必要なのか?
患者さん
患者さん
どんな情報の求め方をすると過不足なく状況が伝わるのか?

・医師側からみて、「患者のどんな情報が診療に必要なのか?」

・患者側から診て、「どんな情報の求め方をすると過不足なく状況が伝わるのか?」

ということについて、熟慮しました。

今回はクリニックにかかる時のコツについて、お話しします。

患者がクリニックにかかるとき

まず患者にとって、クリニックはどんな時に必要になるでしょうか?

勿論、クリニックの規模・キャパシティーにもよりますが、ここでは一般的な「診療所」レベルのクリニックを想定します。

真っ先に思い浮かぶのが、カテゴリーA:定期受診系

・通院中の疾患の管理とその定期的な投薬

・投薬は受けていないけど、定期的な検査目的

ですね。内科系クリニックなら高血圧、糖尿病、脂質異常症、高尿酸血症・・・、整形外科なら変形性〇〇関節症の痛み止めや関節注射、リハビリなどを指します。患者側も医師側も、この受診形態は最も事前にイメージしやすく、長年の通院患者では、「ツーカー」の間合いでお互いに決まっている動きとなります。

また定期検査の方では、例えば「耐糖能異常(糖尿病ではないけど、黄色ゾーンにいる)」に対する定期的な検査、良性疾患(例えば肝嚢胞)のある方の念に1回の画像検査などがそれにあたるかと思いますが、それも多くの場合医師と患者で「いつもの流れ」が出来上がっているケースが多いですね。

次に、カテゴリーB:急病型

・風邪、胃腸炎、頭痛、嘔吐、めまい等・・・

これらは日常生活で起きた急病のうち、患者が一次診療レベルでよい症状と判断した場合(主に軽症で、自宅での療養をイメージしている)や、取り急ぎ検査を受けたい(インフルエンザの有無を調べたい、採血や心電図、レントゲンを見てほしい、等)ような場合に患者が受診するものです。

他には、カテゴリーC:無症候系

・健康診断

・診断書記載

・予防接種

カテゴリーD:その他

・転医やセカンドオピニオン的な受診、他院からの紹介など

すでにかかりつけを持っており、転医を相談したい時や、かかりつけ医として、他院での治療選択について、相談しやすいDrへの相談を目的として来院する、など。

または他院から、自分のクリニックの専門性や検査機器をめがけて紹介受診されるなど。

このような4種類のタイプに分かれるのかなと思います。

医師からみた初診患者を呼び入れるときの気持ち

このようにクリニックを受診される患者さんは、様々なタイプの患者さんにカテゴライズされます。

カテゴリーAに分類される患者さんは基本的に再診患者さんですから診療の内容が読みやすいのですが、B、C、Dに分類される初診の患者さんは、医師から見ても初対面の為、

・どんな理由で受診したのか?

・どんな考え方をもっているのか?

・検査や処方などにある程度決まった考え方があるのか?

・決定への医師依存度はどれくらいなのか?

このようなことが未知のまま、呼び入れることになります。

その結果、医師も上記4項目を手探りで(ハッキリとは言えずに雰囲気で)読み取り、また患者も、人によっては、医師の前では委縮してしまって「実は〇〇の検査をしてほしい、〇〇の心配があって相談したい」などを言えないまま診療が終わってしまうことも起きるのです。

医師から見て、

・医学的に必要十分な診療(検査・治療)を組むことは比較的容易

でも、

・患者にとって必要で十分な(納得していただける)診療を組むことは難しい

のです。

現在の日本では、「医師の裁量」で必要な検査・治療を行うことができるため、そこで患者にとって合点のいかないoutputであった場合に、異論が出てしまうわけです。

患者さんへ 自身の希望をきちんと医師に伝えよう

このような影響から、日本人的に、

「医師が気持ちを汲んで私の思う良い診療を計画してくれる」という幻想は捨てましょう。

もう一回言います。

〇 医師が医学的に必要な診療を計画してくれる

× 医師が患者の想い通りの診療を計画してくれる

ということです。そして「患者の想い」はあなた自身がきちんと発信しなければなりません。

そこで、表題の「初診患者向け問診票」には、今回、思い切って、

「希望の検査はありますか?」

□採血(希望項目:   ) □レントゲン □尿 □CT ・・・

※最終判断は医師が行います

と入れてみました。

勿論希望全て飲むことはありません。症状や状況によって何の検査が必要になるか?ということは医師の判断(=聖域)になりますので。

一方で、「希望の治療はありますか?」という項目は入れませんでした。カゼに抗生剤出す・出さない問題、痛み止めをくれくれ問題が根強く発生しますからね。

でも、フリーコメント欄に、「風邪薬飲むと胃が荒れるから胃薬も欲しい」とかは書けるようにしました。体質は人によって全然違いますし、それはあくまで相談の上です。

不要な手続きを時短して、大事なことに時間を回そう!

というわけで、今回は問診票作成を通して思ったよもやま話をお伝えしました。

「患者が何を思って病院に来ているか」

ということは、症状や既往歴を書くだけではわからないわけで、それについては

医師側=聞こうとする努力

患者側=伝えようとする努力

双方が必要になると思います。

問診票一つにも、これだけの想いが込められている・・・診療所もたまにはありますよ!

ではでは。

 

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