宴席で飲酒後お産取り扱い

産科医というのはたとえ非番の日であっても、他に常勤スタッフが何十人いたとしても、緊急で呼ばれる可能性がゼロではないのだから、３６５日２４時間一滴も酒を飲んではいけません。

どうしても酒を飲みたい人は産科医を辞めて下さい。

＞緊急対応の必要がないのに病院に宿泊し、臨時当直手当を受け取っていたこともあった。

どうしてこんな情報が新聞社に流れたのか不思議です。また、記事によると

「副院長は０６年度、月平均１２．７回の当直を務め、時間外・当直手当として計約１千万円を受け取った」そうですが、一晩約６万５千円の当直手当がそれほど法外な金額とは思えません。

なんだか、新聞社の悪意が強く感じられる記事ですね。

これは医療者側を擁護できないですね。一人医長ならともかく、８人体制の病院で、かならず一人当直・待機のある状態では・・・

「正規の当直では飲酒はなかった」と言いますが、ということは必要もなく勝手に飲酒後病院をホテル代わりにして、当直大を要求していた、ということでしょう。
しかも、自分で酔ったまま分娩まで行っている。処分されてしかるべきです。

飲酒分娩罪を制定すれば良いでしょうｗ

　時代に取り残された感じがしますね。

　病院としては深刻に反省し、まず周産期センターを返上すること辺りからはじめると、厚労省の担当者も喜ぶことでしょう。

http://headlines.yahoo.co.jp/videonews/mbs/20090420/20090420-00000017-mbs-loc_all.html

rijinnさんへ

＞　病院としては深刻に反省し、まず周産期センターを返上すること辺りからはじめると、厚労省の担当者も喜ぶことでしょう。

とおっしゃいますが、「深刻に反省」も程度もんでしょうし、「周産期センターを返上」すると「厚労省の担当者も喜ぶ」っていうご意見は、どんなもんでしょうかね。

私は産婦人科医ですが、この「事件」で問題かと思ったのは、酔ってホテル代わりに病院に泊まって、それで当直料を貰っていた、出していた，と言う馴れ合いの体質かと思いましたが。

　自分も昔は完全に酔っ払った上司の前立ちで緊急手術をやっていたクチなので、あまり厳しいことを言う気にはなれません。年中昼間っから酒臭い上司の下で働いていたこともありました。それでも最早時代に合っていないとは思いますが、これは民間病院です。

　公務員がまともな仕事もせずに給料を取っているというのであれば如何なものかと思いますが、現に病院にいて、何かあれば若手にそれなりのアドバイスをするというのであれば、民間の場合はむしろ手当を出すべきでしょう。

　また、産婦人科は２４時間以上の連続勤務が珍しくありませんが、これは酔っ払っているのと同じ程度の注意力と巧緻性しか残さないことが知られています。

　酔って仕事するような危険を人に強制しておいて、都合の良いときだけ口を拭って小ぎれいなことを言うというのはどういうもんでしょうね。

　また、誰にせよ、箸の上げ下ろしまで口を出すようなことを言うなら、それなりの責任を感じた方が良いだろうと思います。

　偉そうな説教をするなら、まず現場に充分な産科医を配置する工夫をするのが役所の責任でしょう。酔っ払いが泊まれる当直室が空いているということは、当直医はまともに眠れていないのです。ベッドが埋まっていれば、酔っ払いの医者も家に帰るしかないでしょうに。

年間１８００件の分娩を取り扱っていて、かつ周産期センターであれば、当直・待機の2名の医師だけでは対応が出来ない事態が起こることは、日常的な事だと思います。
当番ではなくても呼び出しがかかる事なんて、それこそ週に１～2回はあるんじゃないでしょうか？
副院長と言う立場でもあり、責任感も強い先生のようですから「ごめん。酒飲んじゃったから行けないわ。他のセンセ呼んでくれる？」とは言えない状況だったでしょう。
脇が甘いとも思いますが、民間病院ですし、馴れ合いだのなんだの言う事でもないと思います。

＞＞厚労省医事課は「飲酒した医師に診療させてはいけないのは常識。法に定めがないのは、他に医者がいない場合の緊急避難的な措置を想定してのことで、通常ならあり得ない」としている。

医師としては、飲酒した場合には診療をしてはならない　と、はっきり法で規定して頂けたらと思います。その方が分かり易いですしね。
ついでに、飲酒と同等の危険性のある当直明けの勤務も明確に禁止して頂きたいですね。

告白しますが、昔ハルシオンを飲んで寝てから緊急手術に呼び出され、手術をしたんですが、、、翌日まったく手術の内容を覚えていませんでした。その患者さんが退院するまでとっても心配で一日に何回も見に行きました。手術の前立ちはいたんですが、どんな手術をしたなんて、そんなことは聞けずに終わりました。
　今は、耐性ができたのか、多少の薬ではそんなことはおきませんが、酔っ払っているのとどの程度違うのかということになれば、問題があると思います。
　ある程度、起こされる恐れがないときには、疲労がたまっている状態で、どうしても早く寝付きたいために、、眠剤を使うようになってしまいます。
　そのようなことが当直が頻回で慢性的になると、以前報道された麻酔科医のように自分で、麻酔薬を打って死亡という事態もありえます。（麻酔科の先生に聞くと、結構やってるんですね！）
　
　飲酒手術ですが、ある公立病院での私の以前の上司はほぼあるチューで、代々の病棟婦長の申し送りが、○○部長には夕方5時になるまで絶対にお酒を飲まさないように監視すること。でした。したがって5時以降の緊急手術は自動的に飲酒手術でした。　

私はどうしてもこの先生を責める気にはなりません。若い頃一人でオロオロしながら処置をしている時に（当直看護婦が勝手に呼んだ）オーベンが飲み会から戻ってきて、「俺が見ていてやるからそのままやってみろ」 と言ってくれた時の安堵感を今でも思い出します。

院長も”「副院長は酒も強いので酔わない。急患を助けるために仕方ない面もあり、飲酒運転のように法律違反ではない」と主張。処分などは考えていない”と言ってますし・・

ただ、この件に関しては医者と一般人との間で絶対に受け止め方が違うだろうなと認識はしております。

院長も”「副院長は酒も強いので酔わない。急患を助けるために仕方ない面もあり、飲酒運転のように法律違反ではない」と主張。処分などは考えていない”と言って

外科系と内科系で文化の違いもあるかもしれませんが・・・

この副院長がきっとデキる人だからこそ院長もかばうのでしょうけど、昔自分が当直しているときに循環器当直の先生をお呼びしたらすっかりベロンベロンで意味不明のトンチンカンな説教を始めたのには参りました。
年次もずいぶん上の先生なので黙って聞いてましたけど。
結局その先生がしてくれたことで唯一よかったのは、別のまともな循環器Drを呼んできてくれたことでした。
酩酊した先輩の余計なヘルプって、意外と嫌な思いをした後輩ドクターも多いんじゃないですかね。

　飲酒した状態での医療行為は、まずいです。飲酒した状態での自動車の運転が犯罪として取り締まられるぐらいですから、飲酒した状態での医療行為も取り締まられてもいいのではないかと思います。本人が思っている以上に、判断力が落ちていると考えられますから。
　同様に当直明けの勤務も取り締まるべきです。長時間睡眠なしで勤務することは、飲酒した状態と同様な判断力と医学的に証明されています。やはり医療を行う判断力が落ちて危険な状態です。
　このふたつの問題はあやふやにせず、法律をきちっと作って対応すべきです。

　ただし、その後の医療の状況がどうなるかという疑問がありますが…。

残念ながら,多少の酩酊状態でも応召義務は化せられるようですよ。以下のスレのNo.13fuka_fukaさんのコメント参照。

http://www.yabelab.net/blog/2009/01/16-222457.php#comment-1408

呑んだら診療してはいけないけれど,呑んでも緊急呼び出しには応じなければいけません。矛盾した話です。

でも泥酔状態では無理ですよね。でも、泥酔かどうかの判断は誰がするのでしょうか(笑)

そこで、病院にも呼気アルコール測定装置を導入ですよ。

もはや笑うしかないですね。

＞そこで、病院にも呼気アルコール測定装置を導入ですよ。

　お医者様もラインパイロット並みにショーアップでアルコール呼気検査の時代でしょうか＿|￣|Ｏ

> 厚労省医事課は「飲酒した医師に診療させてはいけないのは常識。
> 法に定めがないのは、他に医者がいない場合の緊急避難的な措置を
> 想定してのことで、通常ならあり得ない」としている。

このご時世、厚労省としては、たとえ軽微であっても、飲酒しての診療を容認するような発言はできかねたでしょうねぇとは思いつつ。

さはさりながら、非公式にとはいえ、厚労省として、医師法第19条第1項に定める「正当な事由」に酩酊が相当しうることをあらためて表明した上で、その酩酊の程度について今日的解釈を示したようにも受け止めうる話ではあります。
というのは、従来の通達(?)では「病気、酩酊により事実上診療できない場合」とされており、換言すれば、診療できないほどではない程度の酩酊であれば正当な事由には相当せず、応召義務が生じると解することができたように思うからです。
その点、マスコミフィルターを介しているとはいえ、今般の厚労省医事課の論調は、診療できないほどでない程度の酩酊についても正当な事由に相当するとの主張にも見えます。

ここは一発、医師会や医師連盟あたりが動いて、今般の報道について、どこかの都道府県や保健所設置市を通じて、正式に疑義照会してやると話が明確になるんでしょうけどね。「程度の如何を問わず、酩酊が正当な事由に相当するとしたものか」と。
このまま誰も動こうとしなければ厚労省はだんまりを決め込むでしょうし、寝た子を起こしたくない都道府県は疑義照会などしたくないでしょうが、そこは、医療の現状に理解のある議員に議会で質問してもらうなどして、照会をかけざるを得ない方向にもっていってやるとか。

今日のご時世では、いい加減なことは許されません。
0.25mg以下なら診療して良いとか、客観的できちんとした数字を法律や政令で明記する必要があります

ぜひとも国会で質問してもらいましょう。厚生労働省返事しろ。

通りすがりの公衆衛生医 先生

No.4 rijin 先生の仰る通りに、
　
　周産期センターを返上すると、言って見れば、よろしいかと。

何らかのご返答がございますでしょう。

No.18 元外科医さま

> ぜひとも国会で質問してもらいましょう。

実際には逃げる、すなわち「正当な事由」に係る行政解釈を避け、「当方の意図が先方に正しく伝わらなかった」とするか、もしくは「本来慎重に事実認定が行われるべきところ、慎重さを欠いた」として謝罪するかのいずれかでしょうけどね(^^;「それぞれの具体的な場合において社会通念上健全と認められる道徳的な判断によるべき」（昭和24年9月10日医発第752号）という従来の見解はそのまま維持されるであろうと。

それでもなお、昨今話題になっている過重労働絡みと併せて、国会質問なり疑義照会という具体的行動でもって、産科医が国にシグナルを伝える意義はあると思うのです。その意味では確かに、国会答弁の方がよりアピール度大かも。

No.19 omizoさまにツッコミ

> 周産期センターを返上

医師の飲酒に絡めて指定返上を申し出る理由付けをどういたしましょう(^^;

通りすがりの公衆衛生医　さま。

かなり強引ですかね。(^^;;;;

社会通念上健全と認められる道徳的な判断

なあなあの基準は許されなくなった時代です。呼気アルコール0.15mgとか絶対的な基準を出さなければ市民オンブズマンが黙っていないです。今まで黙認だった官製談合も、今では主導した政令都市の市長が逮捕される時代です。ムラ社会から、グローバルな法の支配する世界へ移行してますからね。

>呼気アルコール0.15mg

まぁ、いつぞやのクロルピクリン服用例のように、医療従事者が揮発性中毒原因物質による二次被害に遭うこともありますから、北川式検知管ぐらいは常備しておいていいのかも(^^;

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I'll gear this review to 2 types of people: current Zune owners who are considering an upgrade, and people trying to decide between a Zune and an iPod. (There are other players worth considering out there, like the Sony Walkman X, but I hope this gives you enough info to make an informed decision of the Zune vs players other than the iPod line as well.)

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