昨年12月15日から本年1月7日まで、UCLA（カリフォルニア大学ロサンゼルス校）の学生であるEliot雅広Kagan君が当科に見学に訪れました。彼は私がアメリカ留学中に娘の英語の先生をしてくれていた方で、当時はハイスクールの生徒でしたが、現在はUCLA4年生で脳科学を専攻しています。ホスピスや看護サポートのボランティアも経験し、老年医学やアルツハイマー病、パーキンソン病などの神経疾患に深い関心を抱いています。今回の見学での経験を通じ、当院緩和医療科、神経内科、総合医療センター心臓内科、理化学研究所でのラボ見学などから得た印象や感想をまとめ寄稿いただきましたのでぜひお読みください。（神山哲男）
Hello everyone. My name is Eliot Kagan and I am currently a fourth year undergraduate student at UCLA with an interest in geriatric medicine. I recently had the privilege to shadow the Palliative care team at Saitama Medical University for four weeks under the tutelage of Professor Satoru Iwase, clinical director of the Palliative department. The core team comprised one dietitian, two nurses, and six doctors, and mainly focused on treating pain in patients recovering from previous surgeries or conditions. A distinctive aspect of this department is its integration into the emergency room with several doctors working in both the emergency room and palliative care departments. This has allowed me to experience a care plan that is not very common in the US. Additionally, due to the nature of palliative care, I was also able to closely observe and work with a number of different specialties including the toxicology, psychiatry, and physical therapy departments.
A normal day consists of multiple conferences in the morning (one with the palliative care team, one with the palliative care doctors, and one with the emergency room department), patient rounding before noon, and patient care in the afternoon. Depending on the day, each doctor had different responsibilities in the afternoon. For example, Dr. Natsumi Niino, a doctor on the palliative care team, divided her week into doing research, in-patient care, and house calls (a practice not very wide-spread in the US). Due to this, I was able to shadow multiple doctors with different responsiblities in the hospital.
During my stay, I was able to experience many eye-opening differences between the practices in the US and Japan. I was particularly surprised by the integration of traditional Chinese medicine and western medicine. The traditional medicine came in the form of “Kampo,” which incorporates a number of different herbs to target specific symptoms. While opinions on this type of medicine may vary among western medicine practitioners, in Japan, this form of medicine is widely incorporated, even having insurance coverage, and is used to complement western medicine. This spiritual healing may also be an important implementation to western medicine.
Another thing I noticed was the teams’ dedication to care and establish a relationship with their patients. While I cannot comment on the quality of the actual care (due to my limited knowledge and patient exposure as an undergraduate), the doctors I shadowed displayed a remarkable ability to emotionally connect with their patients. They would carefully craft conversations to not only extract the necessary information, but also to create an atmosphere that felt like they were talking to someone they can trust. While observing these interactions, there were multiple times where the patient felt comfortable enough to open up about their minor concerns. It showed me just how important it is to connect with the patient on an emotional level.
Finally, I was fascinated by each doctor’s dedication to research. Each of the doctors I shadowed were all involved in some sort of research to further their treatments. For instance, Dr. Iwase is involved in a project to bring American medical practices to Japan in the form of an app so that he can bring better care to a wider audience. These experiences showed me the multifaceted approach of Japanese medicine and has opened my eyes to the many differences between our environments. I am forever grateful for the opportunity to shadow them and hope to be back soon!
