Doctor G 3 のメディカル・ポプリ

地域医療とプライマリケア、総合診療などに関係したネット上のニュースを記録。医学教育、研修、卒後キャリア、一般診療の話題、政策、そしてたまたまG3が関心を持ったものまで。ときどき海外のニュースも。

10月15日 

https://news.nifty.com/article/domestic/society/12156-10642/
医者と病院の不足が極まる「2030年問題」
2016年10月15日 15時00分 まいじつ

東京五輪から5年後に“2025年問題”が待っているのだという。

2025年には、団塊世代がすべて75歳以上になる。そして、国民の3名に1名が65歳以上、5名に1名が75歳以上という、これまでの日本が経験したことのない高齢化社会を迎え、医療と介護の提供体制が追い付かなくなる。

「東京、神奈川、千葉、埼玉の首都圏と愛知県、沖縄県、滋賀県のみが、現在と同水準の人口を維持できる自治体です。東北や中四国は、軒並み1割ほどの人口を減らします」(都市問題に詳しいジャーナリスト)

厚労省の推計によれば、2025年の医療保険給付は総額54兆円と、現在より12兆円以上も増える見通しだ。衰えゆく日本の国力で、とうてい賄える額ではない。

「厚労省は、医療保険が破綻するシナリオを回避するために、医者と病院を減らそうと必死です。現在、病院の身売りや倒産が全国的に相次いでいますが、国は抜本的な手を、わざと打っていません。その結果、日本の医師数は世界の主要国のなかで最低のレベルです。医者がいなければ治療はできません。治療できなければ、医療費が膨らむこともない。だから、医療費を抑えるためには医師の数を減らし、病院の数も抑えるのが一番手っ取り早いというわけです」(医療ジャーナリスト)

同省の試算では、2030年には約47万人が死に場所が見つからない“死に場所難民”になる可能性があると警告している。いまは75%の人が病院で亡くなっているが、高齢者が増えると病院のベッドが足りなくなる。つまり、全ての人が病院や介護施設を死に場所にできるようにはならなくなってしまう。


自宅で最期を迎えたいと望んだとしても、いまのままでは在宅医や訪問看護師、訪問介護ヘルパーの数も不足する。

「在宅医に訪問診療を願い出たとき『いまの患者さんで手いっぱい』と断られたとします。その場合、もし自宅で亡くなっても、かかりつけ医がいないので『不審死』として扱われ、警察に届け出ないといけなくなる。こうした状態にもかかわらず、市町村議会議員は、いまだに高齢化問題への対応を甘く見ている人が大半です」(同)

あと15年もすれば、病院でも家でも死ねない時代がやってくる。



http://mainichi.jp/articles/20161015/ddl/k09/040/068000c
佐野市民病院
民営化、27日に集中審議 市政策審 /栃木

毎日新聞2016年10月15日 地方版 栃木県

 佐野市が民営化方針を打ち出した佐野市民病院の経営形態について諮問を受けた市政策審議会(委員長・三橋伸夫宇都宮大教授、委員17人)は13日、第2回会議を開き、初会合で市側が提示した同病院の概況をテーマに審議した。

 質疑応答では、委員から「指定管理者制の現在も実質的に民間が経営しているが、赤字になっている。民営化するとなぜ黒字にできるのかよく分からない」などと、市が民営化方針を決めた根拠について説明を求める質問が相次いだ。

 市側は「医療設備の導入や更新が、議会承認が必要な現在と違って迅速にでき、医師の招へいにつながる」「経営責任が明確化される」などと説明した。委員からは方針決定の根拠を文書で示すよう要望があり、次回の27日の会議では、市側の民営化方針の理由について集中審議する予定。【太田穣】



http://www.tokyo-np.co.jp/s/article/2016101501001729.html?ref=rank
救急延命、本人の意思尊重 終末期高齢者、情報共有へ
2016年10月15日 19時11分 東京新聞

 がんなどの重い病気で終末期の高齢者が心肺停止といった状態で救急搬送される際に、本人の意思表示がないまま蘇生・延命措置を受けるケースが増えているため、厚生労働省は2017年度から、在宅医療に携わる医師や看護師、救急隊が連携し、患者の情報を共有する取り組みを支援する。先進的な自治体の取り組みを参考に研修会を開き、患者の意思を尊重した終末期医療を目指す。
 消防の救急隊や搬送先の病院は応急処置をするのが原則だ。一方で、終末期の高齢者の中には、回復が見込めなければ延命を望まない人も多い。
(共同)


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G3註:国内のニュースが少ないのでアメリカの昨日のニュースから/デルタ航空、飛行中の急病人に対応しようとした黒人女性医師に差別

http://www.nbcnews.com/news/us-news/black-female-doctor-delta-discriminated-barred-me-sick-passenger-n666251
Black Female Doctor: Delta Discriminated, Barred Me From Sick Passenger
by EMMA MARGOLIN
OCT 14 2016, 1:41 PM ET NBC News

A black doctor has accused Delta Air Lines of discrimination after a flight attendant allegedly shooed her away from a passenger in need of medical attention and said "actual physicians" were needed.

Delta said in a statement Friday afternoon that the airline is investigating the incident.

Dr. Tamika Cross, an OBGYN resident at Lyndon B. Johnson Hospital in Houston, wrote in a Facebook post that she was on a flight from Detroit last week when someone two rows ahead her of starting screaming for help.

"I naturally jumped into Doctor mode as no one else was getting up," she wrote on Sunday in the account that has been shared more than 35,000 times.

But as she was about to stand, Cross said a flight attendant told everyone to stay calm — the man was just suffering from a night terror. Minutes later, the flight attendant yelled for a physician on board, Cross said.

Cross raised her hand to get the flight attendant's attention, but her help was rejected, she said.

"She said to me 'oh no sweetie put ur hand down, we are looking for actual physicians or nurses or some type of medical personnel, we don't have time to talk to you,'" Cross wrote. "I tried to inform her that I was a physician but I was continually cut off by condescending remarks."

As the overhead speaker called for physicians on board to alert the flight attendants, Cross said she pressed her button, staring at the flight attendant who had just cast her aside.


"She said 'oh wow you're an actual physician? I reply yes. She said 'let me see your credentials. What type of Doctor are you? Where do you work? Why were you in Detroit?'" Cross wrote.

She added: "Please remember this man is still in need of help and she is blocking my row from even standing up while Bombarding me with questions."

Finally, Cross said a "seasoned" white man approached and told the flight attendant he was a physician as well. Without asking for his credentials, the flight attendant immediately accepted his help, Cross said.

"Mind blown. Blood boiling," she wrote.

Delta said three medical professionals offered help on the flight, but only one provided credentials, "and that is the doctor who was asked to assist thecustomer onboard. In addition, paramedics met the flight to assist the customer further."

Later on, the flight attendant started asking Cross for input on how to help the unresponsive man, who was showing signs of improvement, Cross said. She added that the flight attendant had also apologized to her several times and offered her SkyMiles.

"I kindly refused," Cross wrote. "I don't want SkyMiles in exchange for blatant discrimination. Whether this was race, age, gender discrimination, it's not right. She will not get away with this....and I will still get my skymiles."

Delta said it is "in the process of conducting a full investigation" into the incident.

"We are troubled by any accusations of discrimination and take them very seriously. The experience Dr. Cross has described is not reflective of Delta's culture or of the values our employees live out every day," the company said in a statement.

Cross, meanwhile, told NBC News in a phone interview Thursday night she thinks the flight attendant could benefit from sensitivity training.

"Someone's life was on the line," she said, noting that the outcome could have been much worse. "Luckily the man was okay."



http://www.nytimes.com/2016/10/15/us/black-doctor-says-delta-flight-attendant-brushed-her-aside-in-search-of-an-actual-physician.html?_r=0
Black Doctor Says Delta Flight Attendant Rejected Her; Sought ‘Actual Physician’
By CHRISTINE HAUSER
OCT. 14, 2016 Mew York Times

Dr. Tamika Cross, a black physician at the Lyndon B. Johnson Hospital in Houston, could not immediately come to the phone on Friday. She was busy delivering a baby boy by C-section.

So, yes, in case anyone has any doubt, Dr. Cross is an “actual physician.”

But the 28-year-old doctor said that was the question hanging in the air, raised by a flight attendant, when she volunteered to treat a sick passenger on a Delta flight from Detroit to Minneapolis on Sunday.

Dr. Cross wrote about the episode in a Facebook post later that day, saying she had put her hand up to help, but was met with the kind of skepticism she had encountered before as a black doctor. A flight attendant demanded her “credentials” and confirmation that she was a real physician.

“She said to me: ‘Oh no, sweetie put ur hand down; we are looking for actual physicians or nurses or some type of medical personnel. We don’t have time to talk to you.’ ”

Dr. Cross wrote, “I’m sure many of my fellow young, corporate America working women of color can all understand my frustration when I say I’m sick of being disrespected.”

By Friday, Dr. Cross’s story had been shared more than 38,000 times and had attracted more than 14,000 comments, transforming her Facebook page into a forum where minority professionals reflected on the difficulties they face from people who doubt their qualifications or abilities.

It was also shared widely on Twitter under the hashtags #TamikaCross and #WhatDoctorsLookLike to highlight offensive assumptions about diversity in the medical field.

“Tamika, I know exactly how you feel, when people don’t want your help, because of the color of your skin,” Iniece Crawford wrote on Facebook. “I go through this on a regular basis and I’m just a pharmacy associate. They assume that I don’t know what I’m doing or don’t want to deal with me at all, but have to.”


On Friday, Delta Air Lines said in a statement on its website that it was investigating what happened and had reached out to Dr. Cross. The statement said: “Three medical professionals identified themselves on the flight in question. Only one was able to produce documentation of medical training.”

The statement continued, “The experience Dr. Cross has described is not reflective of Delta’s culture or of the values our employees live out every day.”

Reached by telephone between surgeries on Friday, Dr. Cross said that it was not the first time she had encountered assumptions that as a black woman, she could not be a doctor, and that she has heard similar stories from colleagues.

“I think minorities in general, especially in my field of practice — I feel that they are always questioned and always assumed to be the nurse or the nurse’s aide or here as part of the janitorial team or ancillary staff,” she said. “Several times I come in the room, I am assumed to be one of the ancillary staff.”

Some of the conversations spurred by Dr. Cross’s Facebook post centered on what researchers call implicit bias, or unconscious processing about race. According to the Kirwan Institute for the Study of Race and Ethnicity, implicit bias can affect the decisions jurors make in courts, the assumptions by law enforcement officials about minorities and the relationships between students and teachers, and doctors and patients.

In its 2016 report, the institute highlighted how people with a “black-sounding name” had a lower response rate when trying to get help for public services.

Dr. Cross said in her post that she had been to Detroit for a wedding and that Delta Air Lines Flight 945 was midair when a male passenger two rows in front of her became unresponsive; his wife started screaming for help.

“I naturally jumped into doctor mode as no one else was getting up,” she wrote. At first, the flight attendant told everyone to stay in their places, but then called out for a doctor.

“I raised my hand to grab her attention,” Dr. Cross wrote, referring to the flight attendant. “She said, ‘Oh wow, you’re an actual physician?’ I reply yes. She said: ‘Let me see your credentials. What type of doctor are you? Where do you work? Why were you in Detroit?’ ”

Dr. Cross said she told the woman she is an obstetrician-gynecologist in Houston, but did not show any credentials. Then a white male passenger approached the flight attendant and said he was a physician. According to Dr. Cross, the flight attendant turned to her and said, “Thanks for your help, but he can help us, and he has his credentials.”

On Facebook, Dr. Cross wrote: “Mind you, he hasn’t shown anything to her. Just showed up and fit the ‘description of a doctor.’ ”

After returning a phone call seeking comment on Friday, a Delta spokeswoman referred any further inquiries back to the company’s statement. It says about the flight crew: “When an individual’s medical identification isn’t available, they’re instructed to ask questions such as where medical training was received or whether an individual has a business card or other documentation, and ultimately to use their best judgment.”

Catherine Sirna, a Delta spokeswoman, declined to answer a question about the race of the flight attendant, saying the company does not comment on personnel matters.

But Deborah Lake, a spokeswoman for McGovern Medical School at UTHealth, Dr. Cross’s employer, said, “To my knowledge, the flight attendant is white.”

Dr. Cross said that she had written her Facebook post during the layover before traveling to Houston. She then filed an official complaint with the airline on Tuesday and received a general reply that the airline was investigating and did not discriminate.

An airline representative also left her a voice mail message to speak with her, Dr. Cross said, but she had been unable to return the call because of her operation-room and medical schedule.



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