〈邦訳〉消化器病学—われわれは医師なのか，内視鏡屋なのか？

Gastroenterology: Are we physicians or endoscopists?

［訳文］

　日本の消化器診療について述べることを依頼されました．私は日本で多くの時間を過ごしてきましたが，日本の消化器内科医と仕事で接触する機会が少なかったため，診療の質や消化器内科医が患者と十分話し合い診察しているかという点について評価する資格があるかどうかわかりません．けれども，関西のある一般病院を訪れたとき，頭を使う消化器内科医に驚いたと聞かされ，衝撃を受けました．日本の消化器内科医は内科全般について討論できないか，患者のすべてを診る医師としての時間を作りたがらないかであり，コンサルタントのみとして機能したがるというのが彼の印象でした．

　1970年代にColorado大学消化器内科の主任教授であったDr. Fred Kernは，消化器領域における内視鏡の将来の役割について確信をもてないでいました．「消化器研修医は，患者と話し，臨床生理学を学び，図書館で勉強して考えるといった学究的で思慮深い専門医を生むための時間を，内視鏡をはじめとした手技に費やしている…」と指摘していました．Dr. Kernらは，内視鏡の技術的な部分は医師以外にも教えることができ，そうすれば消化器内科医が問診や診察をして治療計画を練るための十分な時間を提供できると提言していました．

［原文］

　I have been asked to write my thoughts about gastroenterology in Japan. Although I have spent a great deal of time in Japan, I have spent little professional time with gastroenterologists so do not feel qualified to make judgments about such things as quality of care and whether or not gastroenterologists in Japan spend enough time speaking to and examining patients. I was struck, however, when visiting a community hospital in Kansai that one of the senior doctors remarked how surprised he was to hear a gastroenterologist who could think. It was his impression that Japanese gastroenterologists either were unable to discuss topics in general medicine or they were unwilling to make enough time to be complete physicians with their patients and were happy to serve only as consultants.

　In the 1970’s Dr. Fred Kern, Chair of Gastroenterology at the University of Colorado, was uncertain about the future role of endoscopy in gastroenterology. He said, “GI Fellows devote a major portion of their time to performing procedures, primarily endoscopy, instead of tending to activities that would produce scholarly and thoughtful consultants；talking to their patients, learning（by doing）clinical physiology, reading in the library and thinking……” Dr. Kern and others suggested that the technical part of endoscopy could be taught to non-physicians allowing gastroenterologists more time to take histories, examine patients, and produce a treatment plan.