手元が狂う状況について

安易な決め付けはイクナイ。これ鉄則。

こういう見出しは最悪ですね。
スポーツ紙というのは言い訳にならない。
http://www.nikkansports.com/general/news/p-gn-tp0-20090508-491826.html

これって、逮捕されてますね。

5年近く前の話しで、しかも、今年の2月に被害届を出して数ヶ月後の逮捕ですか。。。

逃亡や証拠隠滅のおそれでもあったと、裁判所は判断したんですかねぇ。

「私は逃げも隠れもしないし、証拠を隠したり、他の人と口裏を合わせたりはしない事を誓いますので、逮捕はしないで下さい」という誓約書（？）を出して、逮捕を免れる手続きがあれば良いのですが。

それにしても容疑段階から実名報道と言うのも、おかしな話です。

内視鏡で膣内を観察したって、面白いですか？
内視鏡を全麻でやるとも思えませんし、意識のある患者の膣に内視鏡突っ込めば、当然トラブルになる事は誰だって分かるでしょう。そんな状況で、リスクを犯してやるような行為ですか？

そういう意味でも、故意に行った行為とは思えないんですけどね・・・。

自験例としても、看護師が座薬を入れようとして膣の中に入ってしまったというコールを受けた事もありますし、あり得ないことではないと思いますけどねぇ。

大腸の内視鏡を行うときは助手をしている女性の看護師に臀部を大きく広げて貰って肛門をしっかりと見て肛門内に内視鏡を挿入するのですが、一人で肛門内に内視鏡を入れようとすると内視鏡を持っている手の甲で臀部を広げながらもう一方の手で内視鏡の先端部を把持して肛門内に入れなければならなくなり肛門口の確認が充分に出来ず、肛門に入れるつもりが肛門に力が入っていると内視鏡が入らず、前方に滑って膣内に入ってしまうことはあり得ます。膣内に入れてしまったという話を先輩から聞いたこともあります。一人で内視鏡の挿入を行っている施設は少なくないはずです。

遅くなりました。今お昼になったモンデ。

　ほかのコメントを読んでいないので、自験例でお話します。
太った方、直腸癌の方で、検査をしようとしました。左側を下にして、横になっていただき検査開始。太ったお尻のためお尻の穴を直接観察できず、指で肛門を確認したのですが、肛門がやや細めの方で、裂肛（裂け痔：結構痛いモンです）を合併しているためか指を入れるだけでもとても痛がる。
　肛門の位置に内視鏡の先端を当てて、少し力をかけたのですが、肛門をしっかり閉じておしくらまんじゅう。（どうしても入れてみたい私と、生理的に拒否するお尻の戦いです。）声をかけて、力を抜いてもらって（もらったつもりで）こちらの力をかけたところ抵抗がなくなり、そこで、（それまではモニターを見たって何も見えますぇん。）モニターを見ると、、、子宮頚部が見えました。

　教科書的には、指を添えて、挿入することになっていますが、指一本入れても痛がる人もおり、指プラス内視鏡口径では入れる段階で拒否されてしまうこともあります。
　また、挿入するときに力をかけるベクトルとして肛門に対して直角に位置取りしようとしますが、その状況で、内視鏡の先端が肛門から跳ねると、前方にほとんど行きます。運が悪ければそのまま、膣に入ることになります。
　実際にいつもやっていることを思い起こすと、（ほとんど自動的になっており、何も考えていないで挿入していると思いますが）
　まず肛門を一度観察する。
　指を入れて潤滑剤を肛門にまぶす。
　内視鏡の先端を当てる、それから先は、入るまで肛門は直視しないで、左手の操作に神経を集中する。右手は内視鏡のシャフトの先端から10センチ程度のところをもって、押し付ける力の加減のみを考える。（右手にはほとんど神経を集中させていません。）ほとんどの場合、通過する肛門の状況を観察するためにモニターを見ていますが、たまには、視界が開けた瞬間までモニターを見ないことがあります。（この先生はその瞬間膣の中を見たんではないでしょうか）どだい、最初に通過するときには見はするものの、肛門の病変はほとんど観察できないんです。
　大腸内視鏡の数をいっぱいやっている人ほど、やっちまった経験が増えるんでは。
　たまたま若い方で、結局病変がなかったりした場合に騒動になってしまうんではないでしょうか。（なにかやばい病変があればそれどころじゃありません。）

　これ見ると明日はわが身。看護師にしっかり証言してもらえるようについててもらわなければ。

> どういう場合に「手元狂う」ことがありうるのか

　場合分けするという発想に無理があります。

　全ての条件がうまく行ってはじめてきちんと安全な挿入が行われます。

　その条件のどれか一つでも問題があれば、入らないか、危険な入り方をするか、「手元が狂う」ことになるでしょう。

　まず絶対に必要なことは患者さんが動かないこと。（とくに過度に緊張していないこと。）前処置・前投薬が予定通り終了できていること。操作に充分な視界が確保されていること。（たとえば検査着が邪魔にならないこと。）

　検査台がガタついたりしていないこと。

　内視鏡に問題がないこと。（…以前、出張先でふだんと軸が９０度ずれた内視鏡があって、えらい苦労していたことがありました。上にアングルをかけると右を向く、といった感じです。）

　術者の体調が万全であること。

　最低でもこれぐらいは必須条件になります。どれがだめでも、きちんと入りません。検査が無事終了するまでなら、もう少しあります。

自分はこれ、やったことがあります。
臀部の脂肪がやや多めの方で（珍しいくもない程度です）、肛門を確認してスコープを当てたつもりが、つるっと滑って。おや何か変だな、と思ったのでやり直してちゃんと肛門に入りました。
エントリに挙げられている例では、膣へのスコープ挿入以外にも強制わいせつ罪を疑う根拠があるのかもしれませんが、「手元が狂う事」それ自体は、ことさら特殊な状況でなくてもある事と思われます。
私の時は「失礼しました」の一言で特に問題にならなかったのですが、それは私が女医だからだったかもしれません。男医であれば、患者さんが後でセクハラだと訴える事はあり得た気がします。
それ以後なるべくちゃんと挿入できるまで局部を直視するようにしておりますが、男性医師にそれをされたら、それはそれで不快に思う方も居そうです。

いろんな見方はあるように思いますが、やっぱり、看護師さん不在の状況で起こってしまったと言うのは、非常に不利な立場になってしまいますね。

私は、某救急部で仕事をしていますが、救急車で搬入された重症患者の初期治療の場で、迅速に治療するために（意識のない）患者の着衣をはさみで切りとることが多いです。これは、決してひとりの状況では行いません。緊急の場で、看護師さんがモノをとりに初期治療室から出る事がありますが、必ず手を止めます。研修医にも「決してひとりで裸にするな」と口を酸っぱくしています。

わいせつと疑われることも恐ろしいですが、衣服を脱がせる際にサイフを抜き取っただの、指輪をかすめ取っただの、家族から疑われる事を避けるためです（実話）。

今回報道の外科の先生は、ちょっと、身を守るすべが甘かったと思います。

　内視鏡の挿入の瞬間は、われわれは意識していないのですが、実は航空機の離着陸と同じ危険があります。具体的には胃カメラの（本当は胃内視鏡というべきですが）喉頭通過の瞬間もブラインドです。このとき力の方向を誤ると、じゅうかく内に挿入して、患者を殺すこともあります。（食道と、気管の間から組織を掻き分けて。）食道を破ることもあります。いずれも見たことがあります。
　それぐらい慎重を期するべき瞬間です。
　大腸内視鏡の挿入ははそのようなことはありませんが、逮捕される危険があると合併症のところに書いておくべきでしょう。（ブラックジョークです念のため）

　大腸内視鏡で穴を開けるのはもっと後の工程です。
　大腸内視鏡はうまい人にやってもらいましょう。でも、うまいひとでも穴あけることはありえます。

大腸内視鏡の合併症の説明文書にあらかじめ、｢女性の方は誤って膣内に挿入することがあります｣と大きく書いておけばすむことのような気もするが。

で，こんな判決があったりする。

東京地検は大丈夫か？

事件番号:平成１８年（わ）第２０１号
事件名　:準強制わいせつ事件
裁判所　:京都地方裁判所
判決日　: 平成18年12月18日 （2006-12-18）
判示事項:
臨床検査技師である被告人が、女性患者に対し、検査名目で、肛門部から陰核に至るまで、検査器具を押し当てながら往復させたという準強制わいせつ被告事件について、検査器具を陰核に至るまで動かされたという点についての同女の供述の信用性を否定し、被告人にわいせつ目的があったと認定するには合理的な疑いが残るとして、無罪を言い渡した事案（確定）

専門家である皆さんのご意見によって、「手元が狂うことはありうる」というのはよく理解できました。ただ、「手元が狂うことはありうる」と「本件の医師にわいせつな意図はなかった」とは必ずしもイコールではありません。「なんでまた、そんな立場でそんなことを・・・」という事件が世間に山ほど存在することは間違いなく事実です。
そして、報道された情報だけで白黒つけることの危険性は、これまで沢山のケースを通じて学んできました。

現段階で「潔白だ！」「不当逮捕だ！」「医療崩壊だ！」と一方的に叫んでしまうこともまた、ある種のバイアスを伴っているということを自覚しておく方がいいように思います（もちろん、双方に争いがある状況で実名報道に踏み切ったマスコミの短絡さはいわずもがなです）。

膣への誤挿入のリスクは、多くはないもののあります。以前注腸造影で子宮が造影されたりしたのもみたことありますし、恥ずかしながら僕も直腸診が内診になったこともあります。
以前、このような医療ミスとして報道されたこともありました。

http://web.archive.org/web/20011211221820/www.topics.or.jp/Old_news/n01091407.html

みみみさんのおっしゃるとおり、こういう事もあるからこの医師がわいせつ目的では無いとも言い切れませんが、本人が言っているとおり間違えただけかもしれない。そういった例が何例もあればわいせつ目的かもしれませんが。
その段階で昨日TBSは、顔写真いり、自宅までうつして報道する必要があったのでしょうか。

また、マスコミもそういった誤挿入があり得ることも取材すべきでなかったのでしょうか。

　これは民事訴訟ではなく、刑事事件についての報道です。

？

みみみさんのコメントは、刑事事件であるという前提で読んで何の違和感もないのですが・・・。

＞No.13 nomnom さん

たしか類似事件の報道があったはずだと思い，探しておりました。
判決かとも思って判例データベースをみていたのですが，新聞報道だったのですね。

東京地検は大丈夫か？

送検を受け、勾留請求までは既定コースではないかと思いますが、不起訴になる可能性も十分ありうるのでは。

弁護人がついているならば（報道では現時点で不明ですが）、腕が鳴る事件でしょう。

　手元が狂ったのなら、痴漢冤罪事件と同じ構図で、自称被害者のみの証言で逮捕されたことになりますね。それ以外、証拠が何もない場合は有罪になりますかねぇ。
　当該医師が以前にも同様のことで、苦情が複数有ったという場合にはかなり不利になりそうですが。被検者と医師の個人的な関係などは無かったのでしょうか。

内視鏡を入れるなどわいせつな行為をした疑いが持たれている。

　手元が狂って違う方に入ってしまうことは、あり得ないことではないようですが、「手元が狂った」という弁明が通じなかったようですから、それ以外にもわいせつ目的だと思われてしまうような行為をしていたのかもしれません。一方で、患者さんの被害妄想という可能性も無いわけではない。

　看護婦が目を離している間の出来事で、他に目撃者が居らず、内視鏡を入れた＝わいせつ目的　という単純な図式ではないのだとすると、わいせつ目的であったかどうかを立証するのはかなり難しいのではないでしょうか。痴漢裁判と同じような難しい事例であるように思います。

　しかし私のような一般人は、実際に手元が狂うこともあるとは思わないので、この記事から「何を苦しい言い訳をしているんだ、盗っ人猛々しい。」というような印象を受けてしまいました。この医師が無罪になったとしても、本当はわいせつ目的だったのにうまく言い逃れた、としか考えないかもしれません。記事を書いた記者も同じように考えているのかもしれませんが、冤罪である可能性もある事を考えると、適切な記事とは言えないように思います。

この記事から「何を苦しい言い訳をしているんだ、盗っ人猛々しい。」というような印象

このサンスポの記事が、見出し・本文とも最悪級です。
http://www.iza.ne.jp/news/newsarticle/event/crime/251129/

見出し↓

時効目前…Ｈドクターわいせつで逮捕「手元狂った」

本文より↓

検査の際に立ち会っていた看護師がその場を離れたスキに内視鏡で“悪さ”を働いた。

女性はすぐに抗議したが、堀江容疑者は「手元が狂った」と言い訳をしたという。

完全に、「故意に挿入した」ことを前提に書きまくっています。

名誉毀損で損害賠償請求してもいいくらいじゃないかと思います。

誤解を受けることのないよう女性看護師立会いが必要というのは、その通りです。

しかし、ウチの病院では男性産婦人科医も患者もいるのに、女性看護師が出払っているため、いつまで経っても診察を始められないという悲劇が有ります。喜劇というべきかもしれません。

そのためか、午後８時頃になっても産婦人科外来が終わらないということもあるようです。

なかなか理想通りにはいきませんねえ

何年か前に検査技師さんがエコーで会陰部走査をして強制わいせつで捕まりましたが、結局無罪になりましたね。

http://www.daiichi.gr.jp/syoukai/yanagi/2007spring/09.html

当時は、僕自身も会陰部走査の必要性などは、知らなかったので有罪との印象を抱きました。マスコミは捕まったときは報道しましたが、この方が無罪になったことの報道はなされたのでしょうか？

　ちなみにこの条文の制度趣旨が実感されました。誤解招かないという配慮もあるんですね。m(_ _)m

[刑事訴訟法]
第百三十一条　身体の検査については、これを受ける者の性別、健康状態その他の事情を考慮した上、特にその方法に注意し、その者の名誉を害しないように注意しなければならない。
　２　女子の身体を検査する場合には、医師又は成年の女子をこれに立ち会わせなければならない。

　ご参考になるかどうかは分かりませんが、実際に経験のない方には、「手元が狂う」とは言ってもなかなかどういう状況なのか想像しづらいかと思いますので、身の周りの物で可能な限りの説明を試みてみます。
　具体的な想像をしてしまうと不快だ、という方は、以下の文はどうぞ読み飛ばしてください。

　まず、板に張り付いたままのカマボコを想像してください。そのカマボコの上面に、切れ込みを一つと穴を一つ開けます。以下のような感じです。

　－　　○

　－←これが入るべき方、○←これは入ってはいけない方です。
　管の方は、太さは成人の人差し指くらい、固さはガス管くらいのものを思い浮かべてください。摩擦が少ないように、よく滑るゼリー（食器用の洗剤などが近いと思います）が塗ってあります。

　先ほどのカマボコを横倒しにして固定し、片手ででガス管を持って　－　の切れ込みにそれを入れます。カマボコの固さや切れ込みの大きさによっては入りづらく、そこで力を入れると管が滑って横へ逸れる場合もあるでしょう。実際には狙う場所は左右のお尻に挟まれていますので、滑るとしたら　－　と　○　を結ぶ直線方向しかありません。　○　に管が入ってしまうこともあり得ます。

　いかがでしょうか。正しい場所が分かっていて狙っても、別の方へ行くこともあるということで、右眼と左眼を取り違えて手術したというような話とは異なります。「間違えた」ではなく「手元が狂った」という表現には、その辺りのニュアンスが含まれているように私は思いました。
　看護師による介助の有無や、スコープの種類、患者さんの個人差等によって条件には幅がありますが、上記の説明で何となく理解していただければ幸いです。

　念のために申しますと、決して今回のケースについて冤罪だと断定している訳ではなく、ただ「手元が狂う」とは実際どういうことかをお伝えし、有り得る事態であると皆様にご納得いただきたくて、このレスを書きました。
　もし本当にわいせつ目的の行動があったのであれば、当然容疑者は罰を受けるべきですし、悪意がなかったとしても被害届を出された女性のショックは無視されてはならないと思います。いずれにせよ、この段階での実名報道はいかがなものかと感じました。

みなさん書いていらっしゃるように、誤挿入自体は
めずらしいことではありません。私も膣の入り口までなら
間違って挿入した経験があります。

ただ、この事件の経緯からしますと逮捕するにあたって
警察は検察と協議してそれなりに検討しているんじゃ
ないでしょうか。
逮捕すると決めた事情に興味があります。

単に誤挿入しただけでしたら、内視鏡界の大御所たちが
「わたしも誤挿入したことがあります」と続々と裁判で
証言することになるでしょう。

まずは、起訴するか不起訴になるかですね。
この記事だけではなんとも言えません。

なんで逮捕したのかはかなり謎ですねえ
最高裁の痴漢冤罪判決とか大野病院なんかの判決は
ちぃーとも抑止になってないようで

すいません、適当なこと書いちゃいました。
26の後半2行は取り消します。

5年もたって証言のみで逮捕ってのが解せなかったもので

　皆さんの説明をお聞きして、「手元が狂って」膣に触れたり入ったりする可能性があることは分かりましたが、その一般的な可能性ないし蓋然性が本件において故意を否定する積極的根拠にもなりません。
　
　ただし、当然のことながら故意を認める証拠にもならないわけですから、逮捕するためには、故意であることを示す積極的根拠（証拠）が必要だと思います。
　時効間際のこの時期に逮捕するということは、起訴を前提として逮捕したのではないかと思っているのですが、そうであるならば報道に表れない証拠があるはずだと思われます。
　善意解釈ですけど。

　これで不起訴になったら、かなり問題のある捜査と言わざるを得ないように思います。

モトケンさんやみみみさんの仰るとおり「誤挿入はありうる」＝「今回の手が滑っては悪意はない。」とは出来ませんし、逆に「誤挿入した」＝「猥褻行為である」ともなりません。

今回の件に関しては、今の報道から得られる情報だけでは、白とも黒とも言いがたい灰色だと思います。

ただ、モトケンさんも最初の感想は、「私の第一印象的には、手元が狂うことがあるんかいな、」でしたし、ほとんどの方はそのような感想を持ったとおもいます。ほとんどの方は、きちんと説明されれば、今の段階では灰色である事は理解できるとは思うのですが、そういった点には一切触れずに昨日のテレビでも顔写真入りで報道されていました。明らかに行き過ぎと思います。(報道に関して）
本当に、誤挿入はありえないのか、きちんと取材してそういった可能性もある事を付記したうえで報道すべきだと思います。どうしてもこういった報道は興味本位に走りがちですので、考えただけの根拠ではなく、専門医のコメントを求めるなどしっかりとした裏づけが必要でしょう。

警察のやり方や逮捕については、今の情報のみではなんともいえませんが。

もうひとつ確認。
　現代の医療現場では看護師もマルチユースを求められており、ほかの用事で呼ばれて出て行ってしまうという事態はまれなことではなく、小規模の施設であればあるほど、多種多様な仕事を並行して抱えることがありうる。
　たとえば、、、内視鏡室の看護師がすぐそばの患者用トイレから救急コールがあって、ほかの看護師がすべて手がふさがって見に行くことを要請される。
　大腸内視鏡検査を待っている患者の最後の排便の性状をトイレに確認に行った。
　内視鏡待ちの患者の点滴がなくなった、あるいは落ちなくなったとヘルパーから呼ばれた。（ヘルパーは交換する資格がありません。）
　私、前のコメントででてく看護師に"馬鹿やろーでてくな"とわめくというコメントを書きましたが、しょっちゅうわめいていました。
　
　本来、大腸内視鏡を実施するときに看護師がいないで一人でやることはいけないことですが、押せ押せになっていて、すべての準備が整って、一人法の挿入術にたけた術者がじっと漫然と時を待っていることに耐えられなくて、はじめてしまった。
　わたしも、大腸内視鏡を終了させなくては手術が始められない状況をずっとこなしてきたので、一人ではいじめてしまったことはいくらでもあったと思います。（だって、昼休み2時間のうちに、大腸内視鏡4例こなして、食事して、それから胃ゼンテキ術するなんて今から考えればきちがい沙汰ですが、ほんの数年前までは当たり前のようにこなしていたんです。看護師だって食事時間削ってます。）

　忙しい現場であればあるほどありうる状況に思います。
よりによってということは忙しい、混乱した状況下ではおきうります。そして、今の医療現場は、恐ろしいほどの人手不足の元で、恐ろしいほどの混乱した状況の下ですべてのことがこなされていることが現実です。

　私としては、この先生が陥った状況が当たり前のように起こりうる条件下で仕事をしてきたので、どうしても同情が先にたって、性善説を唱えてしまうんです。（警察、性悪説になります。）
　これで、証拠が自白だけといったら、私冤罪だと叫んでしまいます。

でもさんのお気持ちはよくわかりますが（僕自身も内視鏡はしていませんが、医療従事者として同業者を信じたい気持ちはあります）、現在の状況では白とも黒ともいえないとおもいます。ただ容疑の段階で、またこのように過失でもあり得るという状況で現在のような報道はどうだかなと思います。

しかし、このニュースは世間的には、おもしろ半分に取り上げられていますが、結果によっては結構大変なニュースですね。

もし、わいせつの意図がなくて、有罪となれば大腸内視鏡を行う医師は、戦々恐々。
もし、わいせつの意図がなくて、無罪となってもきちんとその結果は報道されるのでしょうか？

またもしわいせつの意図があって、この医師が常習的にこういったことを行っていたのであれば、それはそれで一般の先生方は安心できるのでしょうが。そのあたりをきちんと報道してもらいたいが、最初から先入観に染まっているマスコミには無理なんでしょうね。

この件では、ネット上での一般市民（と思われる人々）の反応を見ていて、医療従事者とそうでない人との間では、こうも認識が違うものか、と驚かされました。モトケンさんも最初はそう思われたように、ほとんどの反応が
「そんなところ間違うわけがないから故意に決まってる」
「（間違ったとしても）手元が狂うような外科医は失格だ」
だったからです。

本件で最も危惧されることは、警察が女性からの訴えを受けて、上記と同様の直感で“故意”と決めつけた上で安易に医師を逮捕してしまったのではないか、ということです。

> 故意であることを示す積極的根拠（証拠）が必要
> 報道に表れない証拠があるはず

仰る通りでして、何らかの証拠が別にあるはずだと考えたいところですが、「大腸内視鏡検査で故意に内視鏡を膣に挿入したと認められる証拠」というのが考えつきません。
カルテには検査の日時と結果しか残らないでしょうし、証人もいなさそうですし、私が思いつくのは、複数の被害者がいる（常習性の傍証）とか、内視鏡でわざわざを膣を外から撮った写真が出てきたとかくらいで、どちらも現時点で可能性は低いように思います。

私の個人的感覚では、もし本件が故意でなかったとすると、逮捕されたことの影響は大野病院事件より大きい気がします。大野病院事件で問題になったのはいわば医師の技術の部分でしたが、ことが強制わいせつだと、医師としての適格性や人間としての人格まで疑われてしまうからです。

私の懸念が杞憂に終わるといいのですが。

若年女性患者に対する男性医師の診察：
最近本当に問題になりますね。

私なんて、左胸が痛いから、と診察に来た４０台の女性に対して胸をはだけてもらって聴診したら後で病院にクレームが来たことがありました。その女性の知人男性と言う人から。

「他の医療機関ではいつも胸の聴診は着衣のまましてもらっていたのに、なんでお前のところでは胸をはだけさせたんだ。彼女は精神的に参ってしまったぞ」
だそうです。

個人的にはきちんと胸を出さずに診察するほうが問題だと思うのですが。もしも、胸を出さずに診察して病気を見逃しても彼女は文句を言わないのだろうか？

「きちんとした診察を希望されない方はどうぞお引取りください。私は高名な占い師ではなく普通の内科医ですから、きちんと診察しないと診断が付けられません。」

と事務方に告げ、事務方に差しさわりのない文章で返答していただきました。

大腸がん検診を、厚生労働省は勧めていますが、二次検査は可能な限り、全大腸内視鏡を実施することを基本としています。
　すべての内視鏡医が大腸内視鏡にたんのうなわけではなく、ある意味職人芸の世界でもあります。もともとは外科医の領分であったこともあり、外科の先生で大腸内視鏡を行う先生も歴史的に考えるととても多いと思います。

　また挿入の部分を、医師が一人で行うか看護師がやってしまうかについても、新谷の一人法か田島の二人法のどちらで教育されたかなど、それなりの事情があるものです。（若い先生は知らないと思います）

　内視鏡学会や消化器病学会、大腸肛門病学会もきちんと事件の検証や、必要があるならきちんとしたサポートを行うことをお願いしたいものです。それぞれの学会の存在意義すら問われかねないことだと思います。簡単に、ガイドラインで"挿入に注意し、単独ではじっししないこと”で終わりにしないことが必要です。

　私の周囲の状況を見てみると、大腸内視鏡の供給キャパシティはかなり不足しており、近隣の大病院の検査待ちはかなり長くなっています。

　このような安易な報道が相次ぐことにより、若い女性の検査、診察は鬼門となれば、潰瘍性大腸炎、クローン氏病などの診断の遅れなどをもたらすこともありえるのではないでしょうか。

　いっそのこと、経営者からヘルパーまですべて女性の病院を作って、この辺の微妙な病気をすべて任せてしまうこともありかもしれません。（医師や検査技師が女性ということを売りにしている施設は結構あります。）

このブログを見られる方で、これから大腸がん検診を受けられる方もいらっしゃると思います。一次検査の便潜血スクリーニングで陽性になられる方も相当数いらっしゃると思いますが、われわれが一番危惧するのは、この件で二次検査（大腸内視鏡検査）を受け損なう方がいらっしゃることにあります。
　指摘を受けているのに放置して、（一次検査を受けたなら、やはり二次検査を受けていただくべきなのですが）あるいは、検査の手続きが煩雑化し、処理可能な症例数の減少など
の要因により検査が受けず楽なる。検査の遅れで（翌年回しになったとか）決定的にまずい状況に至ったケースを何例も知っておりますし、ごく一部の癌化ですんでいて、外来治療で終了する方の多さから考えると、検査がこのようなことですすまない状況になることを危惧いたします。

私は服は脱いでもらってブラジャーはつけたままで診察しています。しかし、当然のことながら雑音が入るため、正確な診断が出来ているのか？と問われれば自信はまったくありません。つまり、誤診は大いにあり得るということです。実際に（幸い）誤診には至らなかったけど、自分の反省事例を一つ。
一度、熱発、席のある若い女性の方で、胸の音を服の上から聴診やって、（当たり前ですが）雑音の有無は良く解らなかったのですが、本人の症状は軽いので問題なさそうだけど念のため写真を・・・といったら見事な肺炎でした。さすがに今度は説明をして素っ裸になってもらって聴診したら「バリバリ」という音が聞こえました。やっぱり聴診は全て脱いでもらってじゃないと責任とれないな、と思った瞬間でした。しかし、レントゲン写真という侵襲的な検査を全ての女性に出来るわけではありません。妊娠していたらレントゲンは不可能です。

しかし、時間がない医師としては説明するのも面倒で、つい、ブラジャーをつけたまま診察してもらってしまいます（もちろん、本当はダメです）。脱いでもらって話がこじれてしまったという友人の話を何度も聞いているし（幸い私は何百人と女性の聴診をしてきてセクハラ扱いされたことはありませんが、いつセクハラ扱いされることやら）、企業の検診では最初に女性は服を脱がさないでくださいと企業の担当者から説明があるほどだからです（こうなると耳を痛めてまで聴診するのがアホらしくてまともにやってられず、聴診はいい加減になりがちです）。
こうした企業体質は論外ですが、通常に診察に於いて、本来は説明をきちんとして、出来ることなら看護師を同席させて診察をするという手順が必要だなと考えます。ただ、クリニックでは看護師のいないところも多いわけで、一般の方々の常識を啓蒙することも必要だと思います。

女性の方々に強く言いたいのは、セクハラだと人を責める前に、必要なことと必要でないことを感情的に判断するのではなく、理論的に判断して欲しいと言うことです。そして、自己責任（誤診があっても責めない）ということです（概してセクハラだと文句を言う方に限って誤診だと責める方が多いのが現状です）。

ちなみに内視鏡についてですが、私は最初は肛門と膣を間違えるはずは無いと思っていました。しかし、私自身CFの経験は研修医時代に助手を務めた以外無く、注腸を数十例経験しただけですが、それは局部をちゃんと露わにして（つまり膣の位置をきちんと見て）確認した上での話です。わずか数十例（その中に挿入しにくい人は皆無でした）で「間違えるはずがない」と言うのはおかしなことだな、とここにコメントされた先生方のコメントを読んで強く感じました。ごめんなさいです。

やっぱり経験豊富な先生方の意見って大事だな、と感じました。

トピずれですが、妊娠していても必要ならX-pは撮ってください。
胸部単純写真なら１０００枚撮影しても、胎児の被爆量は奇形が出る閾値には達しません。
腹部単純写真でも１００枚とっても閾値には達しません。
CTも、注腸造影ですら、普通の撮影法であれば可能です。

> 妊娠していても必要ならX-pは撮ってください
ご安心ください。それは心得ていますので大丈夫です。でも、原則避けるべきで、必要と説明しても断られることが多いし、原則ダメだと私は考えておりますが・・・・。確率論で言えば大丈夫かもしれませんが、個人的にはやはりリスクはあると考えます。やはり避けるべきだと個人的には考えます。ま、これは持論なんで、医師によって判断は違いますね。

ということで、本当は「不可能」ではなく、「避けるべきと思われる」と書くべきでしたね。済みませんでした。

本日いっぱいで、この件は時効になります。いまだ続報はないようですがどうなったのでしょうね。
　モトケンブログのほうで、エントリのコメントの中で、このようなブログの紹介がありました。
　　http://www.nakashimalaw.com/essay/miyamoto/0903.html
これを見ると、われわれがどうやって身を守るか、患者さんのことを考える以前に自分の身を守ることから考えなければならないように思えてなりません。
　もちろんこのような意見はおそらくモトケンさんの意図する意見ではないと思いますが、法律の専門家にこのような意見があるということを知ると、法律の専門家でないわれわれとしては、いざことになったらどのような悲劇が待っているのかとても心配です。
　たとえ生死のかっかった救急の場でも、決して一人で手を出してはいけない。そんなことを考えざるをえない日本という国の将来を案じます。
　悪いやつほど法律や、司法の手から逃れるすべに長けているでしょうから、網を大きくすることで社会不安をきたす心配を感じますが、かといって、つみなき無辜の民が司法により破滅する事態は避けていただきたい。相反する事象なのでしょうかね、、、

　医療行為が強制わいせつという犯罪に問われることは、手術で死ぬと業務上過失致死というのとおなじくらいのインパクトがありますなぁ。
　まあ政策的に医療崩壊をねらうのなら(秘書逮捕みたいに)ありかも。

　事実関係がよくわかりませんが、起訴前の被疑者弁護で弁護人はついていたのでしょうか？　ついているなら弁護人は被疑者弁護を有効かつ丁寧にされたのでしょうか？
　リーガル問題は、一般の人でも専門家の医師でも、もちろん専門外ですので、その道の専門家である弁護士による起訴前弁護がなされていることを期待します。m(_ _)m

この事件とは別物ですが。こういった判決が出ていました。一般の人から見て猥褻行為と思えても、こういったこともありえるのだという事です。

http://www.47news.jp/CN/200905/CN2009052801000614.html
産婦人科医に２審は全面無罪 撮影などわいせつ証明なし

　診療を装って３人の患者に陰部を触ったり写真を撮るなどのわいせつ行為を繰り返したとして、準強制わいせつ罪に問われた産婦人科医平嶋仁博被告（４５）の控訴審判決で、福岡高裁は２８日、一部有罪の１審福岡地裁判決を破棄、全面無罪を言い渡した。

　判決理由で松尾昭一裁判長は被害者の供述について「時間の経過による記憶の薄れや診療行為への勘違いの可能性が否定できない」と指摘。陰部と顔を同一フレームに入れた写真の撮影も「患者識別のためとする被告の供述を不合理と排斥することはできない」と述べ、わいせつ目的の証明はされていないとした。

　一方、松尾裁判長は「十分に意図や目的を説明せずに、写真を安易に確認の手段とした点は問題がある」と戒め、「このような姿勢が患者の不審を買い、トラブルの要因をつくった」と批判した。

　平嶋被告は、福岡市中央区の女性専門のクリニックで２００６年３－４月に診察と称して当時１６歳と１７歳、２６歳の女性の体をデジタルカメラで撮影したなどとして起訴されたが、一貫して「医療行為だった」と無罪を主張していた。
2009/05/28 17:15 【共同通信】

医療上写真を撮るって、どう見てもちょっと無理がある弁解だと思いますが。。。
裁判所と言うところはどれほど上手に屁理屈を作るかと言うことを競う場でもあるのですな。

陰部と顔を同一フレームって・・・。
アングルがかなり限定されますよね。患者にとっては相当屈辱的な経験になると思うのですが、医療上は必然性のあるものなのですか？
外傷とか皮膚病とかでも必ず顔を同一フレームに入れるのですか？

医療に絡んで無罪判決が相次いでいるのは結構なことですが、本件は何となく釈然としません。内視鏡の手元が狂う、という件は理屈として了解できたのですが、こっちはどうも・・・。
非難を承知で言いますが、「素人さんにはわからんだろうが、これが医療行為と言うものだ」という言葉が口実になってるケースもあるんじゃないか、という気がしてくるんですよね。

＞「素人さんにはわからんだろうが、これが医療行為と言うものだ」
だと思うけど。法廷ではこれを主張する弁護士のほうが弁が立ったのでしょう。

本来どうしても記録しなくていけないような病変の場合。患者記録をまず撮影して、その後必要な部分を限定して撮影します。私も肛門部の病変を撮影することはありますが、その場合、女性器は必ず隠してとります。大半はそこが隠されていたからといって、記録的には問題になりません。しかしごく少数ながら、肛門と女性器の両方を撮影する必要な疾患もあり売ります。
　婦人科は守備範囲ではありませんが、報道のような撮影（顔と陰部を同一アングルに入れる）が許されるわけはありません。このようなものが、混合されると本来事故であるようなこと、医療上必要とされることまで疑われるような事態になることを問題視します。
　（婦人科の先生のコメントをお願いします。）

>本来どうしても記録しなくていけないような病変の場合。患者記録をまず撮影して、その後必要な部分を限定して撮影します。

これが普通の方法だと思います．写真の時系列で撮った本人はすぐに確認できます．デジカメなら撮影時刻がファイルの時刻としても画像のヘッダとしても残りますからね．
敢えて顔を同時撮影するようなことは「通常」行なうことはないでしょうね．今回のような訴訟，クレームを付けられないように自己防衛するという意味でも...

一般論としては避けるべきやり方なのは間違いないでしょう。

でも、「患部を記録のため撮影すること」と、「その症例がどの患者のものか特定すること」自体が必要であることまでは是認されるのであれば、証拠（特に当該医師本人の供述調書や被告人質問の内容）を見ない状態で、「わいせつ意図があったと考えて当然」と断定するのは躊躇します。

大多数の医師が支持しないやり方をあえてやって、そのせいで患者が死傷したのであれば、損害賠償責任が発生する、というのは理屈が通っています。

しかし、わいせつ事犯の場合には、「大多数の医師が支持しないやり方」であることは、「わいせつの意図があった」いう事実とは必ずしも直結しません。

男性医師と女性患者が１対１で密室で乳房・陰部付近の診察をするのはリスク・マネジメント上は御法度です。必ずシャペロン（女性の保護者）の立ち会いを。さもないと申し開きができません。（そのためには外来看護師が必要ですし、次の患者さんを待たせたりの不便もあると思いますが、遵守しておかないとあとで困るのは医療側です。）

起訴したニュースは無かったから時効ですね。証拠不十分で起訴できんかったのか？

あくまで，署のおまわりさんにこっそり聴いた話です。

示談となって，釈放，不起訴，だそうです。

警察は示談金を高騰させるために利用されたのでしょう。
続報がないのは，当該医師本人が公表を止めている可能性もありますが，この強制わいせつ事件も，警察，メディアが暴走した報道だったと思います。
なんらかの検証は必要でしょう。

　示談で良かったですね。たしかに過失自体はあったわけなので、なにがしかの支払をするのでしょうけど。
　でも今後は示談金をつり上げる手段として使われる可能性もありますね。

　警察沙汰にならなければ「あぁごめんごめん」で済む程度の問題だと思いますが、被害者側がそう考えなければこういったことが繰り返されるおそれはあります。

これは情報が少なくて状況が判らなかったのですが、ご本人のお話だとかなりこの先生は災難だったみたいですね。
示談じゃなくてきっちり決着つけたほうがよかったんでしょうが事が微妙だからあえて示談なのかなあ。
５年前のことで逮捕、起訴されたわけでもないのに実名で報道。
う〜ん,......

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