臨床医と産業医の連携 : その重要性と課題(シンポジウム:職場のメンタルヘルス最前線,2008年,第49回日本心身医学会総会(札幌))  [in Japanese] The Cooperation between the Clinician and the Industrial Physician and their Associated Problems(Symposium/The Latest Frontiers of Occupational Mental Health)  [in Japanese]

筆者はメンタルヘルス活動の諸過程には次の7つの段階があると考えている.(1)予防,(2)早期発見,(3)相談,(4)診断,(5)治療,(6)復職,(7)再発予防である.一般に産業医は(1)予防,(2)早期発見,(3)相談,(6)復職に関与している.臨床医は,(4)診断と(5)治療の業務が主である.産業医も臨床医も(7)再発予防に関してはあまりなされていないように思う.筆者は上記の(1)〜(7)のすべてに関わる臨床医兼産業医という立場で日々業務を行っている.臨床医と産業医が連携を取りつつ,業務を遂行することは重要なことである.しかし現在その連携は必ずしも良好とはいえない.特に復職に関して,臨床医と産業医の見解の相違がみられることが多い.一般に産業医は,勤労者の健康を守りながらも,事業所の生産性について配慮しながら業務を行う.事業所のことを把握しているので,患者が週40時間の労働力が提供できるか否かという雇用契約に基づいて復職の判断を行う.産業医には,正確で客観的な判断が求められる.一方,臨床医は,弱き患者を守る"弁護人"である.そのため疾病が,十分に寛解していなくても,病者をいたわり,復職させる傾向にある.また臨床医には,自分の患者を診断,治療し,復職させるのは自分であるという自負がある.しかし,この自負だけでは,職場に通用しないことが多いのである.本稿の目的は,臨床医と産業医の立場の相違を明らかにし,両者の連携の重要性とそれに伴う課題について論じることである.特に復職に関する両者の見解も述べた.

Background: The author thinks that there are following seven stages in many processes of the mental health activity: 1) prevention, 2) early detection, 3) consultation, 4) diagnoses, 5) treatment, 6) reinstatement and 7) recurrence prevention. Generally the industrial physician participates in 1) prevention, 2) early detection, 3) consultation, 6) reinstatement. As for the clinician, duties of 4) diagnoses and 5) treatment are important. Not much is done about 7) recurrence prevention. The author performs duties every day in a situation where the industrial physician and the clinician are concerned with all processes mentioned above. Results and Conclusions: When the clinician and the industrial physician cooperate, it is important for each one to accomplish his own duties. However, this cooperation is not always attained in practice. With regard to reinstatement in particular, it is often the difference in opinion between the clinician and the industrial physician which needs to be. Generally the industrial physician follows the health of the employee, but considers the productivity of the business establishment. Reinstatement is accepted only for the employee who can offer work force more than 40 hours a week. An accurate, objective judgment is requested by the industrial physician. On the other hand, the clinician is "a defense lawyer" who protects a weak patient. Therefore even if illness does not improve good enough, the clinician consoles an invalid and tends to let him return to work. In addition, the clinician makes a diagnose of his patient and cures him. Therefore he thinks highly of himself when he lets his patient return to work. However, it is often the case that the self-confidence of the clinician is not always acceptable in his workplace. The purpose of this report is to clarify the differences in viewpoint between clinician and industrial physician, and to discuss the importance of their cooperation and its related problems. The author also introduced their opinions about reinstatement in particular.