Wednesday, December 16, 2015 Think College Vol.38
Lecturer: Director Representative Fumitake Sakamoto/Medical Studio
Lecture series "Think College" to think about to listen to story of person working on problem in the world together.
Theme of December "turning society from medical care."
When we got sick, we have an examination at hospital and we cure and get medicine.
But how should we face each other when the disease is not cured immediately?
If cause of illness is human being of the workplace, and there is for the way of own life, what should we do?
If there is doctor giving advice to such a thing, surely we are stouthearted.
Anyone thought about such medical way that could pursue healthy living forward together.
It is Sakamoto of Medical Studio. Instructional activity to perform that we do it for health profession. Briefly, we tell doctor relation and town development with area with medical care as base. Originally volunteers approximately 20 were gathering led by teacher of pediatrician and they are engaged in community improvement until now and are form that increased me who have know-how that accumulated by administration of NPO. This Medical Studio starts and is the fourth year, but is still the situation that is not good until takeoff. We want to put on orbit for another several years.
At first, we will tell that way of thinking "that disease lets you recover completely at hospital and lets leave with cheerful health as the medical major premise in house" is not mainstream anymore. There is the medical industry now for the revolution period once in 100 years.
People that there is neither fatigue nor tiredness without problem at all in health do not always have many well even if we see around us. The times when we live a life that oneself wants to live for while anyone has healthy problem more or less in this sense. Person of medical care "to have possibilities to be bad, but to live a life as for convenience well somehow or other a little" is necessary for perfect state even if defective in health rather than going to get over.
And most of causes are psychological problems and are work and domestic trouble, and symptom called headache may come, for example, from the world different from medical care again, too. On the contrary, the side that life produces illness becomes big when we say. In such a meaning, medical person is coming to have to consider now to social life domain.
There was way of thinking to "be medical social application with medical care" from the old days. What identify cause of problem based on science, and cope scientifically "medicine." It is "medical care" that thinks about how you apply the medicine to living of today's individuals in the present society.
As for the advanced doctors, as for "the medicine, medical care is often called art in science". The individual nature is very strong, and the world where rigid evidence does not pass is medical care, and people of medical care to think that partner that medical care rather overcomes various problems and contradiction of living can be enough increase. But the increase is very slow, and absolute number is not enough.
If way of thinking of medical person changes, the life and our way of living change, too. If which "you must not do that" is only doctor "whom this will manage with medicine", our living is limited very hard. On the contrary, is interesting if doctors to support way of living that seems to be oneself to the maximum increase though there is some risk; think that social.
Medical Studio is going to stimulate that by method educating for medical person. By changing people offering doctor and nurse, health care service like pharmacist with national qualification, is going to turn Japanese society.
We will give some grounds that we want to change medical care to.
The first of problem of health is multi-. For example, elderly people 65 years or older always have diseases four or more on the average. High blood pressure or diabetes or hyperlipidemia are that it was said that we break a bone a little. And Japanese receive 13 times of medical treatment per person a year. This is double of developed countries at the world clear top-class. It ends in none of the diseases in 1 clinical department and, because of disease of head, consults otolaryngology and internal medicine.
In fact, we can drop 80% of ordinary medical practitioner and patient coming to small place such as general medical office into disease of 40 patterns. In other words, generally we can examine people if it can support 40 ways. You should introduce thing which is not made to specialist. There are 300,000 doctors in Japan, is person who is multi-, and is examined in anything around 5% sensuously? Such a doctor occupies a one-third of the whole when we go to other developed countries.
For the second point, 60% of patient is chronic disease. Chronic disease is disease that it has difficulty in getting over basically or is impossible. When we give medicine in vain to cure that somehow and repeat operations, what you must not do increases, and a person's living is limited more and more after all. It is not so, and chronic disease and doctors who can go together patiently must increase more.
The third. Among Japanese, person who is good at pin pin suddenly overnight is less than 5%. When 95% die, they die as person with a disability of half assistance or all assistance. I entirely run out of doctor who can keep company at reaching last moments while subtracting medical care for the end period.
It is said that 290,000 people need home medical care to the fourth by 2025. The number of doctor and nurses corresponding to this is predominantly short. This is because it becomes for all specialty, and it works for hospital. Nurse call is not at home usable. We visit doctor only around once in two weeks. You must think by shift different from medical care past hospital-centered for medical care to support a person's life properly in environment where does not have good medical equipment at all.
For the fifth, it may be said that many diseases are social origin like the said article. People begin to have illness from trouble in thing, way of working and family coming from lifestyle, various troubles in area. That means, on seeing physical organ, it means that we accomplish no meaning by medical care that only the malfunction cures.
There are few systems that utmost protection can catch to the sixth on medical treatment and hospitalization now. It is difficult to support company totally. We cannot but cure in spite of being all work. For example, we give artificial dialysis after work in dialysis clinic at around 8:00 p.m. and it is at 11:00 or comes home at around 12:00 in the middle of the night and you stay and dialyze, and lot does that we go to our office from clinic on the next morning. In addition, 1 of 20 people of the nation overcomes cancer and continues working. Totally different treatment policy and methodology are necessary for doctor supporting that until now.
It is also the seventh. We cannot expect thing that it is like "the brains of grandmother" in the present age when we became nuclear family. If malfunction comes out a little, anyway, we cannot but go to doctor. Then you should be able to feel free to contact doctor knowing oneself. We do not have you examine only from each side if we go to otolaryngology, internal medicine, surgery and separate places. After all, so-called "family medicine" is desirable.
From such a point we all; can examine in terms of human resource, and have viewpoint called support of life, and want to increase "doctors who can accompany" who sometimes set foot until the prevention, if necessary, and appear in town more. If group like private us can push forward remedial education gaining such doctors, we feel like seeming to become interesting.
As doctor is specialized at stage to graduate from university, is it not difficult to be multi-, and to turn by education later?
Student who graduated from the medical department after deciding own specialty clearly occupied 95% until before for 5-8 years. It is said that even general medical treatment system that is anything aims at examined doctor in around 15% when we ask medical student of five or six years student now. Medical education produces constant result and, as measure of country, decides when we add general medical treatment specialist to specialist who was 18 for the 19th until now.
It is doctor of for late 30s so as that it leaves the medical department that we are going to work and stood for ten years in fact. We are in specialist in instruction-like situation in the training for 5 more years for first five years. Therefore some people begin to feel limit for own specialty department. For example, still there is life not to be able to save, or cardiac surgeon operated on from Japan and North Korea to evening feels limit if there are much more cancers which specialist of cancer doing chemotherapy of cancer cannot cure after all. Therefore we are going to intervene in teacher thinking about turn.
We call all people we can examine patient in terms of human resource and to step forward to area "generalist". It is central activity of Medical Studio that develops virtual schooling like Shibuya University Network that these people gather and make place to be able to learn. This "generalist school" has primary care subject, community design subject, community health care leadership subject by 3 subject constitution.
Primary care is "primary medical care". Medical care is arranged with three classes basically, and primary (primary) is arrested with medical institution that trouble looks at slight health malfunction. There is this around a one-third in Europe and America. Japan on the other hand has predominantly few these.
By the way, second (secondary) is medical institution of the nucleus scale that ambulance said to be so-called city Hospital is accepted. Place that the third has high medical technology like so-called university hospital and carries that out. This becomes pyramid, too, and there should be originally little Miyoshi of in most the first, but the just pyramid becomes unshapely.
In any case, it is collective strength that is necessary for primary care. We spend this winter and are going to develop e-learning to offer in mobile to widen this, and to have you raise.
Generalist to exceed 30% is Japan in Europe and America, and why are 5%, the difference?
It is the 1950s through the 1990s that hospital medical care grew drastically in Japan. Until around 1950 in being at home nursed, and percentage was 80%. However, it is just a little over 10% now. Hospital is specialized, and it is the cause that subdivided. In a sense this is necessity, but has the collection and function differentiation because it is not developed when each is not specialized in comparison with the times when medical care was immature as we cannot but make large hospital when we pursue efficiency at the same time.
They will go from one many clinical departments to another after all, and, under the divided medical care, medical expenses soar. This situation was the same in Europe and America. However, in the case of Europe and America, medical system had not been maintained as Japan and was stopped before being developed to here. For example, in the U.K., we cannot suffer from the second, the third medical institution so that high medical institution does not become complicated if it does not let family medicine that each contracted by all means go through.
Free access system still proud of to the world in Japan (anyone can have a medical examination at all hospitals) is maintained. Even if medical expenses rose for the period of high growth as medical security system was substantial very much early in Japan, social security was supported by population growth and improvement of productivity. And the universal care still functions. Former prosperity of Japan contributes to this. As foreign country did not have that, we increased primary medical institutions. Budget was dropped on university to bring up the leading figure, and system design was done.
Clinical accuracy how deals with disease as primary care is necessary, but there are various kinds of poverty and abuse, garbage mansion, things that are regarded as the starting point of patient in question except that it is physical including withdrawal. Approach should change very much when we understand that. We elaborate a plan how we should solve that in community design subject and have you acquire way of thinking of community design in the extension. It is "sociology for medical person". This is going to unfold in e-learning and the meeting training in parallel from the next year.
Furthermore, oneself jumps out to be concrete in town and, in community health care leadership subject, has you learn whether there is way of display of what kind of leadership when we say to do something. This provides in the set training of camp type, and we lead and open a course.
We brandish authority of doctor and are not like interesting people even if we say the leadership and assume cooperative thing which we support to hear what, if anything, people of inhabitants want to do saying it is there saying "it is possible if we do it this way" as expert.
In fact, in place having difficult this, as for the doctor, there are many people in all position that made decision from pyramid all the time until now. But doctor never pulls when we do not change this sense of values, and the situation that local medical care reform is delayed there if doctor disappears is repeated.
Furthermore, oneself doing it of person of medical care do not become self-satisfied, or is thorough by training to see in viewpoint that always overlooked.
We say "case method" as the part and set the local situation in detail and take method to have "we would do what to you" argue for half day at this time. For self-righteous judgment of medical viewpoint to come out of student attending a lectures or person of medical care from this "is really so?" "Are there not other viewpoints?" We shove "there is different way of thinking according to inhabitants" more and more saying it "may be self-satisfaction slightly that you are thinking".
We repeat this curriculum three sets for half a year in 2 days and 1 night from the afternoon of Saturday to the evening of Sunday. We open a course with Sapporo and Tokyo, Osaka, whole country four of Fukuoka parallel to the same time.
There is my project to push forward parallel to the training in hometown and has you come home with progress at every lecture. It is practical activity such as going to doctor, temporary nursing at home, care manager, medical therapist, occupational therapist, the making of network of specialist job including dentist and local community space supporting elderly person of single life as example, and holding enlightenment seminar of dementia and health care. Student attending a lecture must push forward such my project with subsequent learning and prior learning for two months until the next camp.
We hear story in seniors of the industry while eating supper in addition to lecture in the daytime, and place that looks up at advice what you would do when you failed what you would do to difficult judgment when it was approached prepares. We design such an element to acquire hint that we want to think about when medical person flocks in town.
There may be sense of incongruity from glance of inhabitants still more. But people coming for at least leadership subject notice how oneself were thinking in person of medical care glance. As person specialized in medical care knows the way of study if even problem and directionality become clear, it begins to run at speed frightful by oneself afterward. It is place where the third quarter is over, but we are improved still more and want to build other subjects more and more from now on.
When it is withdrawal due to bread and butter of dweller or is depression or is concerned with such a consultation in form called general medical treatment, burden on person of medical care grows bigger. How will economical security turn out?
Current medical system is called medical service fees system, and score is included in act of one one. Medical reward is paid according to the score. There is revision once in two years, and system changes, but revision of big medical service fees is planned in April, 2018, and it is expected that movement of de-hospital becomes definite. Place stepping forward to until life support, independence support still has score to some extent.
Activity of NPO is, are there administration and pressure to the authorities? Is form called NPO best?
It is upbringing of human resources who do not depend on system that we want to do it. Even if medical service fees are paid, we will not arrive, but it is for patient and does not intend to take area whether it is so far administrative support and assistance in wanting to bring up doctor with intention to be hatched and tries so hard when we want to do for mobility in independent form.
Juridical person is only means in fact. Flexibility is high in fact, and it is organization form that it is easy to run for the time being that needs in "Medical Studio".
In addition, we make subsidiary called medical learning studio two years ago, and I act as representative. As initial investment was needed for contents production such as e-learning, this established. Nonprofit undertaking corporation has slightly inconvenient place to depend on contribution and financing, loan not investment to raise large-scale money. It is to think that crowd funding is difficult by activity that is niche for specialist jobs like us in particular.