皆さんこんにちは！
巷で流行中の感染症について、一向に収まる気配がありませんね。
少なくとも、出口は全く見えません。
いつかまた、飛行機に乗れる時代がやってくるのでしょうか・・・
さて、今回は、巷の疾患を反映して、内科医の存在価値がここにきて見直されているという話です。
従来の「内科業務」
「内科の業務」って何？
線を引くのは結構難しいです。
基本的には、「内科学」を収めたものによる内科診療を指します。
でも、「内科学」の範疇ってとても大きく広いため、その定義が難しいです。
世の中のイメージでは、「手術をしない人」「外科の対極」のように思われている人もいますが、内視鏡で手術をしたり、心臓カテーテルで狭心症を治療したり、必ずしも外科的処置をしていないことが内科医であることを定義しているわけではないのです。
一般的には、耳鼻科や皮膚科、泌尿器科、等は内科とは対極をなすと思われていますが、こちらも、現実的にはめまい⇒耳鼻科or内科、尿路感染⇒泌尿器科or内科、蕁麻疹⇒皮膚科or内科、と診療能力的に被る部門はいっぱいあります。
その結果、内科医は「なんでも屋さん」とか、他の科に該当しない疾患やその診断に至るまでの過程の診療を担うような役割でイメージが定着しています。
しかし、そこに現代の内科医の抱える悩みがありました。
それは、都合よく「内科」という言葉を使われてしまうという事です。
例えば強い腹痛があって手術をしないといけない疾患かもしれない患者さんがいるとします。そのような可能性があるとき、まずは外科医が診察をして、「手術が要る」「要らない」を判断してくれたらどんなに頼もしいでしょうか。
しかし現実には、「外科疾患と決まってないなら内科でまずは診てもらって」というような下請け的な使い方をされることが多いです。
また、「めまい」⇒耳鼻科の問題じゃないから、あとは内科で、というような使い方も。
そう、場面によっては「ゴミ箱」的な使い方をされてしまうのです。
これはその施設ごとの他科とのパワーバランス、科ごとの人員配置によって大きくかわってしまい、普遍的なものではないのですが、少なくとも自分が所属してきた施設ではすべてこの傾向があったことは間違いありません。
内科医にも専門性がある！
ところで、内科医にも専門性があることをご存知ですか？
内科には主に8領域の専門性があります。
循環器、呼吸器、消化器、糖尿病内分泌、腎臓、膠原病、血液、神経です。
最近は、そこに加えて、「プライマリケア」「総合」といった、広く見ることができる専門性というのもうたわれています。
ここ大事なんですが、内科医には、「内科医」という総合的な一面と「○○内科」という専門的な一面の二面性があるのです。
決して、ごみ箱ではないんです。
内科医の本質
× 消極的に、何でもみる科
〇 積極的に、自身の専門の疾患をみる科
でも、内科医の人格というのは、勿論人にもよりますが、積極的に「自分の科の患者ではない！」ということは言えないわけです。少なくとも、見れるDrにつなげてあげるね、そんな気持ちでやっていくわけです。
例えば、糖尿病内科医にとって、肺炎は、「専門ではある」けど「ド専門ではない」というような感覚です。
内科医の存在感が増している
さて、近年の医学では、局所的な処置（外科的な処置）が出来るかどうか、というのは医師の価値にも匹敵するようなものでした。
たとえば、消化器内視鏡における早期胃がん・大腸がんの手術
たとえば、循環器内科における心臓カテーテル
たとえば、腎臓内科における透析
など、多くの、職人芸が存在します。
それらの特技を身に着けておくと、内科医としては付加価値になるわけです。
外科系の科に比べ、内科医にとってはそれらは少ないため、付加価値が少なく見積もられがちです。
さて、このような外科系優位のパワーバランスは、今回のさる感染症流行によって、揺るがされています。
発熱患者に対する他疾患を見逃さないアプローチ
疑われた時に行う適切な全身管理
重症化した時の集中治療
全て内科医にとってはこれまで当たり前に提供していたもの。
ただ、それは、患者も他科も当たり前と思い込んでいた前提だっただけ。
今の医療バランスにおいて、↑が当たり前のように提供できる医師が相対的に不足したことから、今、世間は内科医を求めている。
内科でみていただきたい、と言われるようになる。
そんな現象が起き始めています。
「内科じゃないと見れない」病態が急増しているわけです。
最後に
これからの世の中がどうなっていくのかは誰にもわかりません。
でも一つだけ言えるのは、広く、そして深く診る。
そのような感覚をもっている内科医は、今の時代に最も需要がある存在。
内科学を大切に。
そう。我々の中心には内科学があるのです。
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