過ぎたるは及ばざるより強し

過ぎたるは及ばざるがごとしという言葉があるが、こと医療に関してはドンドン過ぎていったモノの方が強い印象がある。

 

今日あったことは顔が浮腫んでいる気がする90才の老母、どう見ても浮腫んでいない感じだけど本人は気にしていると言うヒト。そういう看護師さんのアナムネからの流れで、研修医も「浮腫んでないですねぇー」などという。

上級医はいや頸静脈張っているし、slow edemaだし、Ⅲ音も聴取、心不全の初期段階かもなどという。研修医は「ほー」と関心して各種検査施行、結局まだ介入するほどではないね。なんだけど、知識があって感心させた分勝ち！みたいになっている。

うらを返せばやり過ぎなのに。

 

こういったことはしょっちゅうこの世界ではおこっているのだ。患者の安全と、検査許容国なだけに許されて、まかり通っているのだが、、果たして患者のリスクを負わさずに医療費を抑える方向には永久にならない。

Too much is more powerful than too little

There is a saying that "too much of a good thing is better than too little of a good thing", but when it comes to medicine, I have the impression that too much of a good thing is stronger than too little of a good thing.

I had an incident today with a 90 year old woman whose face seemed to be swollen, and she said she was concerned about it, even though she didn't seem to have any swelling. The nurse's anamnesis led the resident to say, "You don't look edematous.

The senior doctor says that the jugular vein is dilated the edema is slow, and the III sound is heard, and it may be the early stage of heart failure. The resident said, "Wow," and performed various tests, but in the end, it was not enough to intervene yet. But the more knowledgeable and impressed they are, the more they win! It's like a win-win situation.

On the other hand, it's too much.

This kind of thing happens all the time in this medical world. It is allowed and tolerated because of patient safety and the fact that we are an inspection-permissive country, but it will never lead to a direction where medical costs are reduced without putting patients at risk.