海外からみた日本の整形外科―あくせく働かずに，賢く働こう

Work Smarter, not harder

　野球のニューヨーク・ヤンキースは，好成績を収めているにもかかわらず，大リーグのトップであり続けるために新しい人材と技術を常に探し求めている．黒人選手や日本人選手を最初に採用したのはドジャースやジャイアンツなどであったが，ヤンキースも球団に必要な人材の枠を広げる重要性にすぐに気が付き，今では松井やクレメンスのような優秀な選手を獲得している．ヤンキースは，選手たちから最高のプレーを引き出す伝統とチームワークで有名だが，そこに世界的な視点を効果的に取り入れている．そのやり方がいかにうまく機能しているかは，ワールド・シリーズにおける優勝回数や殿堂入りした選手の数の多さを見ればわかる．

　医学の世界でも同様で，チームワークと伝統による業績を土台に，国際的視点と国内の専門知識との融合が図られている．こうしたアプローチにより，医学は進歩する．私は，学界や研究者機関などの知的共同体を交流させる1つの手段として，整形外科の国際化に取り組んでいる．日本の整形外科の皆さんもこの作業に非常に熱心で，私は感心している．外部の考えを取り入れてそれを独自の国内状況に応用しようという皆さんの意欲こそが，整形外科の国際社会が日本の整形外科のリーダーシップに期待を寄せる理由の1つである．この目標に向けて皆さんの努力をどのように傾けたらよいかが，この小論のテーマである．

　Despite their success on the baseball diamond, the New York Yankees are constantlｙ searching for new talent and techniques to keep them atop majpr league baseball. Although they were not the first to include black players (Dodgers and Indians) or Japanese players (Giants and Dodgers) they rapidly recognized the importance of broadening the talent pool for their organization and now go out and get the best players (e.g. Matsui and Clemens). The Yankees effectively apply a global view to their legendary teamwork and tradition to get the best performance from their players. The high numbers of team world championships and individual Hall of Fame careers show how this prescription works in baseball. Analogously in medicine, blending international perspective with domestic know-how builds on what can be achieved by teamwork and tradition alone. This approach facilitates medical progress to the betterment of all peoples. I am committed to foster the globalization of orthopaedics as a way to cross-fertilize our respective intellectual communities for the benefit of our patients. The commitment of the Japanese orthopaedic community to this process inspires me. Your willingness to entertain outside views and adapt them to your unique domestic circumstances is among the reasons the international orthopaedic community looks to you for leadership. The theme of my comments is how to channel your efforts to achieve this goal.

　Some may wonder how I claim the moral vantage to offer this commentary? Mine are but humble observations that I offer with the greatest esteem for your system and especially your people. My perspective has been forged during eleven trips to your country in the last 16 years, from a long relationship with the recently deceased Professor Daigi Kashiwagi, and from my interactions and friendship with seven Japanese orthopaedic surgeons who have worked in my department at Memorial Sloan Kettering Cancer Center. I have observed various strengths of your system and people that will help take Japanese orthopaedics to the next level.