「神々の山嶺」(下)

「神々の山嶺」(下)

以下引用
「高度が高くなったり、疲労が濃くなると、生きようという意志が、つい、粗雑になっちまう。そうなったらおしまいだぞ」

ひとつの遠征で、頂上をねらう者は、何千回、何万回、何十万回ーそれ以上もの一歩を踏み出す。場合によっては、そこで踏み出す一歩ずつのことごとくが、己れの意志でコントロールされていなければならない場所もあるのだ。
しかし、24時間、それを何日も何十日も持続できるか。時には、ふっ、と気が抜ける時もある。ある一歩を、つい何気なく連続した動作の続きとして、前に踏み出してしまうことだってあるのだ。その時に、たまたま、その一歩がその登山家の生命を奪うことあるあるのだ。

以上引用終わり。

極限状態でのみできる、自分の内部との対話。非日常だかこそできる自分の弱さとの対話。
そこでしか対話できない自分の一面があるから、ヒトは山に向かうのかもしれない。

下界に帰ってくると実感する日常のありがたさ。そして、しばらくすると失われてしまうそのありがたさ。
そのありがたさを取り戻しに、ヒトは山に向かうのかもしれない。

神々の山嶺（上）

「神々の山嶺」　夢枕獏

以下引用

人は色々な事情を抱えて生きているものだ。

そういう事情に、ひとつずつ、きっちり決着をつけながらでなければ次のことを始められないというなら、人は何も始めることができないのだ。人は誰でも、様々な事情を否応なく引きずりながら、前のことが終わらないまま、次のことに入ってゆくのだ。そうすることによって、風化してゆくものは風化してゆく。風化しきれずに、化石のように、心の中にいつまでも転がっていくものもある。そういうものを抱えていない人間などはいないのだ。

死にゆくために、山にゆくのではない。むしろ、生きるために、生命の証しを掴むためにゆくのだ。その証しとは何かが、ぼくにはうまく語れない。山にいる時、危険な壁に張りついている時に、ぼくはそれを理解しているのに、町に帰ってくると、ぼくはそれを忘れてしまう。考えてみれば、山にゆくというのは、それを思い出すためにゆくようなものだ。

以上引用終了

「風化しきれない化石のようなもの」を抱えながら生きている。忙しい日常の中で、何が風化していくもので、何が風化しきれていないものか、よくわからないまま混乱しながら惰性で毎日を送ってしまう。

山という非日常だからこそ、普段思いもしないこと、考えもしないこと、がフッと湧いてきて、下界に降りた頃には忘れてしまう。

久しぶりにゆっくり小説を読める、空想の世界に浸れるシアワセを噛みしめたい。。。

外科手術に上達くなる法ートップナイフたちの鍛錬法

外科手術に上達くなる法ートップナイフたちの鍛錬法

Now I rotate surgery section in OCH. I borrowed this book from a supervisor.
You know. I plan to be a specialist of internal medicine.
In this hospital, every PGY1 (Post Graduate Year 1) doctor rotate all devision.

This book is interesting for me. This is because I could know how top surgeon think and work in clinical situation.
I think it is important for me to know how other specialist think. Every specialist have their priority, and it is little different among them. Sometime, this difference would make missed communication. To prevent these situation, it is important for me to know other specialist mind.

In general, surgeon make much of their sense and experience. Almost all surgical technic need artistic sense and practice. I really respect their skill and hard work.

I want to become a specialist of internal medicine who can understand surgeon's mind.
Half of my intern training have ended.

「獄中記」

「獄中記」佐藤優

以下印象に残った記述

ーかつて行った政治的行為が後に「犯罪」として断罪されることはそれほど珍しいことではない。問題は何故にそのような価値観の転換がなされるかということである。ここで個人は記号化、象徴化され、１つの時代の責任を負わされる。重要なことは、このような価値転換の背景にあるパラダイムの転換を見極めることである。

ー尊厳とは、「プライドを高くもつ」ことではない。人間的思いやりをもち、憎悪や嫉妬に基づいた人間性の崩壊を防ぐこと。

ー表彰などということで志気を左右されることは大変恥ずかしい現象である。

ー知識人とは自己の利害関係がどのようなものであるかを認識した上で、自己の置かれている状況をできるだけ突き放してみることでできる人間だと考えている。この訓練が一般教養であり、哲学なのだと思う。この訓練を欠いて知識や技法だけを身に付けると、自分の世界の切り口からしか他の世界を見ることができなくなってしまう。

ー神学的には「非理性的であるが故に私は信じる」ということで、理性的なものを追求しても最終的な意味はないのではあるが、理性的な世界を限界まで追求することにより、それ以外の世界がわかるので、無意味な作業ではない。

ー人間の平均化は危険だ。それを打破するためには、きちんとした学識・教養を身につけ、自分の頭で考える習慣をつけるしかない。

ーフーコーによれば、監獄は近代になってから生まれた制度で、近代の軍隊も病院も学校も工場も役所も、構造は監獄と同じだという。

以上引用おしまい。

この本から構造的には監獄と同じ病院の中で、どのように生き延びればいいかというヒントを得た気がする。

今日は初めて病欠してしまった。体調を崩してみると、同期・先輩・看護士さん・事務の方々など色んな人が優しい声をかけてくれることが如何にありがたいことか骨身に染みる。

体調管理も大切ですね。

久しぶりの（５ヶ月ぶり）更新でした。

インテリジェンス 武器なき戦争

インテリジェンス　武器なき戦争

手島龍一と佐藤優の対談。
インテリジェンスとは何か、その「ゲームのルール」を知るには、適している本だと思う。５年前に出版されているため、今読むと一部合わない点もあるが、インテリジェンスとは？交渉とは？という核心は今読んでも決して時代遅れではない。

以下印象に残った内容
「勝った者は白い歯を見せてはいけない。なぜならば、相手側が譲りすぎたことに気づき、交渉に禍根を残すからだ」


以下印象に残った要点

• 知っていたとしても、決して知っているとは言わない。常に教えを乞う。
• 交渉における自分バイアスを見越しての、自分に４９％、相手に５１％
• 知らなくていいことは、質問しない。この世界は知りすぎてはいけない。
• 情報源としての条件１．知りたい情報にアクセスできる２．知った情報を歪曲せずに伝えてくれる
• 一番大切な事は、情報を集めることではなく、集まった情報の扱い方。そして、それを元にどう判断するか。そこには必ずリスクがある。

インテリジェンスに限らず、日常の人間関係や交渉事にも役立つかも。


言えないことと、言っても大丈夫なこと、の間で、うまく前者に触れないように後者だけを使って話を組み立てている。そして、お互いに距離をはかりながら、核心に迫ろうとし、これ以上は踏み込めない点までくるとスルリと躱す話術は、参考にしたい。

功利主義の読書術

役に立つという観点から本の読み方を紹介してくれる本。

３１冊を取り上げ、佐藤優からみたエッセンスを取り上げている。時間が少ない自分としては３１冊分のエッセンスを知りかつ、「こんな風に読むと役に立つ読み方ができる」と知ることができ、費用時間対効果は高いと思う。

一部ネタバレの本もあるので、取り上げられた本の中で実際に原著（？）読みたいヒトは、読み終わってからこちらを読んだ方がいいかもしれない。

資本主義の限界を知るには、相対化する必要がある。そのために社会主義についての知っておくのは有益
という考え方には賛成できる。これはイデオロギーだけでなく、国や文化、言語についても当てはめられると思う。

以下本文より
「プラグマティズム（実用主義）や功利主義の背後には目に見えない真理がある。読書を通じてその真理をつかむことができる人が、目に見えるこの世界で、知識を生かして成功することができるのである。この真理を神と言い換えてもいい。功利主義の読書術とは、神が人間に何を呼びかけているかを知るための技法なのである。」
以上引用終わり。

古典に刻まれている真の意図は、実用書のようにストレートな言い回しではないかもしれない。しかし、長い月日に耐えて読み継がれてきたということは、そこには伏流として真理のカケラが埋めこまれている証左ではないだろうか。

Test, Test, and Test

I'm sorry not to write any article in my blog recently.
I took 1 Japanese medical board exam, 2 US borad exam (clinical knowledge), and 3 another US board exam (clinical skills).

The end of last week, I got official result of 1 JP med exam from Health ministry. I passed it. It means I can start to work as a doctor from next April.

After I've finished JP med borad exam, I immediately started to prepare US borad exam (clinical knowledge). I took this test in the beginning of this month. The content of this test is partly same as JP med board exam. But there are two different factor between both exam, time limitation and score requirement. First, this test is one day, 8 hours test. On the other hand, JP med exam is 3 day test. Therefore, we need different type of concentration. It is really tough.
Second, score requirement means we need high score. This is different from just pass or fail test.
All things considered, it is difficult of compare these tests.
Anyway my result is still pending.

After I've finished US borad exam of knowledge part, I quickly left my apartment and went to U.S.
During my flight to NY, terrible earthquake attacked to Japan. From U.S. we can know the disaster only through Internet TV, some mail from my family and friends.
This week's cover of the Economist is really shocking. There is the Sun shaped red circle in slope. Japanese people who wear protective clothing try to stop going down the Sun.
I don't know well about nuclear science, but I hope Japan can recover as soon as possible.

In New York, I attended one of prepare course for clinical skill part of US board exam. This course is presented by Dr Mark Schwarz who is author of "physical diagnostic exam." My mentor recommended me to this textbook, so I was really looking forward to meeting him. I brought my textbook from Japan to get sign from him.
This course emphasis on how to communicate well. Some part of this course is beyond mock med interview exam, but it is useful for real clinical situation.
This course is at home, So after finishing this course, I practiced for other participants.

I just spend my time when I don't need to be hurry.
I will go back to my home country

Now I'm in Los Angels international airport to go back to New York. After going back to NY, I'll transit to Narita airport. Unfortunately I cannot find any free Wifi. There is some time lag to post this article.

Taboo

In every culture, there are some taboos. Those taboos are difference among culture. As every person has some sensitive matter,  it is natural for every culture to have sensitive aspect, taboos.

However, there is danger to occur miscommunication.
For one culture, it is just a black joke. It is taboo for another culture.

For example, in a strict religious country, there is taboo to make a satire for god. Recently Muslim's countries enter a protest against a satire of their god by some Western countries.
In our country, it is taboo to make a satire about atomic bomb. Unfortunately some Western media or even in insensitive person make a black joke for it.

There is cultural collision in this world. In my prediction, as a giant country loss their power, small conflicts occur in this world.

We should pay attention for sensitive aspect for other culture. 

Prepare for Moving

When we move, we have to proceed so many thing.
From next April, I start to work as a doctor in another prefecture. While I study for my exam, I have to contact so many offices or companies; water service, electricity company, insurance company, gas company, and so. It is boring for me to do that.
After I finish next test, I don't have enough time to prepare everything for moving.

I recently understand that moving is one of stressful life events. It can become a stress.

I hope there is some service which do those things.

The end of JP board exam

Recently I was little busy to prepare for Japanese medical license exam. Today the test ended. It is totally 500 multiple-choice question which we answer in three days.

There are three major criteria;
1. don't choose contraindicated choice more than three times
2. more than 80% in basic medicine sections
3. more than 70-75% in other sections (the level is changed depend of year)

I think it is little difficult to get more score than 80% in basic medicine sections.
I'm not sure whether pass or failure, but I hope to pass. We can know the result on 12th March. Before that, some cram school provide a scoring system. It means we can predict our result. 

From this night, it is snowing. According to the weather forecast, this snow will accumulate. Tomorrow morning will be little dangerous because of freezing.

USTREAM core-lecture framework (plan)

The following article is written by a medical student. Therefore each reader should make a decision whether this is a value to read or not.

USTREAM core-lecture framework (plan)

（Status quo）
USTREAM（UST） is the following site.
http://www.ustream.tv/
When you want to know the detail of what you can do on the site, please check the following site (written in Japanese)
http://www.dougamanual.com/blog/202/
When you broadcast, there are two main types;
①set a password which inform watchers who apply before broadcast（you can limit the range of watchers）
②completely open（everyone can watch the channel）

Before USTREAM, some central hospitals have already connected the isolated clinics to broadcast their lecture.
After USTREM, individual is empowered. It means everyone can boradcast their voices and videos online which previously depended mass-media.

The characters of USTREM are that we can broadcast in real-time and get feedback or response from watchers. This point is different from Youtube or other share-movie services, like NicoNico Douga in Japan.
But then, we need to pay attention for privacy and copyright, especially when we try to use this
In the conclusion, there are advantages and disadvantages.

Therefore, without someone who have enough IT knowledge, I think busy medical staffs cannot use this tool enough. This means there is possibility that we can use this more efficiently and effectively.



I will continue to think how to use USTREAM for medicine in the next article.

USTコアレクチャー化構想（案）

以下に記すのは、一医学生の妄想なので、一読に値するもしくは、読むに値しないと思うかは、読み手の判断に委ねます。

USTREAMコアレクチャー化構想（案）

（現状）
USTREAM（以下UST）とは以下のサイトのことです
http://www.ustream.tv/
詳しい使い方を知りたい方は動画配信マニュアルを参照してください。
http://www.dougamanual.com/blog/202/
配信する場合
①パスワードをかけて事前登録の視聴希望者にのみ配布（ある程度視聴者を限定できる）
②ネットに完全公開（誰でもそのURLを打ち込めばネットで見られる、いわゆる“ダダ漏れ”）
があります。

このようなサービス登場以前から、拠点病院のレクチャーを離島の診療所に配信するなどの試みは、既に行われています。
USTREMの登場により個人単位でempowermentされ、それまで既存メディアに依存していた画像音声の配信が可能になりました。
USTREMの特徴は、ほぼリアルタイムに画像を配信し、視聴者からのレスポンスを得ることができることです。その点においては、他のYoutubeやニコニコ動画などの画像配信サービスとは違った特徴を有します。

そのような利点がある反面、著作権やプライバシーについては十分な配慮をする必要があり、医学の分野においては、その社会的影響から、より一層の配慮が必要であることは言うに及びません。

以上のような利点と欠点があり、一部のITに詳しい方々を除いて、多忙な医療従事者が十分に活用できておらず、さらなる可能性を追求できると考えられます。

以上のような現状を鑑みて、今後どのように医療分野で活用できるかを考察したいと思います。

（今後の展望）
以下ではある一定範囲の医療圏での活用を 検討します。

・セキュリティーレベルに応じたタグ付け
青、緑、黄、オレンジ、赤、黒の６つにタグ付けを提案します。
青：完全オープン（医師、医学生、薬剤士、看護士、病院勤務者に加え、患者、患者家族、医療を志す高校生を想定）
緑：医療関係者限定（医師、医学生、薬剤士、看護士、病院勤務者）
黄：医療圏内の医療関係者（医師、医学生、薬剤士、看護士、病院勤務者）限定
オレンジ：医療圏内の医師への生中継と録画視聴
赤：医療圏内の医師への生中継のみ
黒：基本的にクローズド、録画のみ

青タグコンテンツについては、Youtubeへのアップ、iTunesUへの配信などを想定しています。英語のレクチャーには日本語字幕を、日本語レクチャーには英語字幕をつけ、将来の医療ツーリズムへの対応、圏内教育機関の国際競争力強化を見据えます。
緑タグコンテンツについては、国内の医療レベル向上に寄与できるだけでなく、将来該当医療圏内への希望者発掘にも効果があると思います。
黄タグコンテンツについては、 圏内の医療レベル向上に寄与できるだけでなく、よりローカルな話題も盛りこむことができます。
オレンジタグコンテンツについては、特に圏内の研修医を想定しています。研修中は時期や日によって忙しさに差があるため、時間に余裕がある際に圏内の指導医のレクチャーによってレベルアップを図ることができます。女性医師への復帰支援や僻地医療従事者へのキャッチアップにも寄与できると考えます。
赤タグコンテンツについては、リアルタイムの質疑応答を想定しているレクチャーが対象です。インターネット上での視聴時間が限られることで、可能なかぎり流出の可能性を下げセキュリティーを上げることができます。
黒タグコンテンツについては、基本的には従来のレクチャーと変わりませんが、後述のように開催の日程は周知されるため、訪問を予定している医療従事者や医学生がその日程を選んで訪れることが可能です。

このようなタグ付けによって、個々のコンテンツに応じたセキュリティーレベルの設定が用意になると考えます。また、演者が視聴対象をある程度把握できるため、内容をどこまで分かりやすくするか、掘り下げるか判断する際にも役立てることができます。
また、各視聴者に応じて、配布パスワードを変更することで、視聴できるコンテンツを変更することも可能です。

コンテンツの管理、視聴者管理については医療圏内にある信頼ある団体が行えるのが理想と考えます。ホームページ上などで、スケジュール管理を行い、圏内医療従事者のみならず、圏内を訪れる医学生も訪問前に周知できるようになります。

・レクチャーの輪番制
臨床研修制度施行後、マッチング制度が導入され、各研修指定施設が研修医にとって魅力的な研修体制の確立を行っています。

各研修施設において、毎日お昼にレクチャーを用意できれば理想ですが、現状では全医療施設で用意することは難しく、指導医への負担になってしまう可能性も危惧されます。
医療圏内の各研修施設が月～金までの担当曜日にレクチャーを配信し、食堂への放映を想定しています。研修医は原則参加の方向とし、昼食を摂る時間を確保するだけでなく、年間を通じて医学全体を網羅した知識習得が可能になります。これにより、On the Job Training (OJT)のみならず、圏内の指導医から座学での効率的な知識習得が可能になります。

内容については、各指導の得意分野を基本とし、年間を通じて偏りがないように 、医療圏内にある信頼ある団体が調整をするのが理想と考えます。


 再掲しますが、以上に記しましたのは、一医学生の妄想なので、一読に値するもしくは、読むに値しないと思うかは、読み手の判断に委ねます。最後までお読みいただいた方はありがとうございますm(_ _)m

2011年1月27日　広沢孝信

Where do you want to go?

Recently I really think it is a great thing that we can go to almost all countries when we want to go. In other countries, people cannot go out from their living places, because of various barrier; visa, money, knowledge, transportation, family and so.
Of course, the effort of our parents' and grandparents' generation made easy-access to foreign countries possible.

In addition, our country is less affected to religious influence. It means we can see this world without religious bias. It is easy to accept other religions, doctrine of evolution or new concept. It is useful to make solutions for recent religious conflict.

I think this country is placed  in good position. Unfortunately many people don't find it. Some people maybe try not to see this good situation consciously.
When we try to use this opportunity, we can get limitless possibility. That is why the sensible elderly encourage us to go out. and to broaden our horizon.

When we wish to go out, we can do. Just wish. That's all.

CS mock interview parctice

Today, I practiced a case of step2 CS in skype.
Today's case was a mock patient who came to clinic because of abnormal result in health fair.

I missed check his physical exams to suspect heart problems. In this case, he has high blood pressure, hyperlipidemia, family history of heart diseases. Based on these, I should check his JVP and pulse.

I've not had enough time to ask CAGE questionnaire.
These questions are useful to screening alcohol dependence.

Time limitation is severe. I should pick up what I ask, and control 15 minutes. Of course, it is ideal to ask all questions. From patients' information, we should change our differential diagnoses, and change our questions to detect diseases. While do that, we also pay attention to patient's concern and personal problems.
Medical interview is difficult to do well.

Failure is good experience. Through failure, I can learn. Before taking real exams, I fail a lot, and learn a lot.

Stocktaking

My lovely racket-bag departed to a new owner yesterday. With this bag, I played tennis eagerly. To be a honest, I was not a good player. But through playing and practicing tennis, I can study so much things which are useful for my life.

First, I have a limitation.
When we are young, we tend to think our potential are limitless. Of course, our brains have unlimited possibilities, but it's one of our organs, same as heart, stomach, kidney, and so. When our physical exhausted, our brain is also affected; we tend to think negatively and nervously.

Second, elemental things are most important.
Physical strength is important than technique. All sport needs physical strength. If you don't practice well, you can cover by your powerful strength. Running and muscle training are boring sometimes. But those will connect to our performance especially hard time.

Anyway, stocktaking is one of good way to think what I want to do in my life. Time is short than we think. I should think my priority, what I spend my time to, what I save it to. I want to be a better time-manager.

H-2B rocket was launched

Japanese Rocket Ferries Supplies to Space Station -NY Times http://nyti.ms/fPtWp9

I have a bachelor of aerospace engineering, and am still interesting to Japanese aerospace development.
According to the article, the Japanese rocket ferries, H-2B, was launched from Tanegashima Island without accident. Now, the US space shuttles have retired. It means the activity of International Space Station (ISS) is depend to other ferries, like Russia , Europe, or Japan.

From the article the budget is about one-fourteenth of what the U.S. After previous economic recession, Japan has not still recovered completely like other countries. The damage also effect to JAXA's budget. There is possibility it decrease more in the near future.
I'm really concerned it.

In this field, there are two major indicators to evaluate aerospace technology in each country, cost and successful rate.
Those effect how the aerospace technology of a country competes.
Unfortunately both are not well. Japanese technology is quite good, but they try to challenge new engine. It means the cost become high. In addition, new technology tend to be unstable before getting enough experiences. There is time-lag before successful rate increases.

Anyway I hope JAXA's next project also continue to be success.

Collagen diseases for non-expert 2

Rheumatic arthritis (RA) is most popular collagen diseases.

Recently the criteria of RA is changed. New criteria is here.
This is because based on old one, we could not diagnose early and treat early. When the joints are broken, it is irreversible. Therefore, new one is modified for early finding and early treatment.

Osteoarthritis(OA) is almost same symptoms and popular. It is important to find whether RA or OA.
How should we find difference between them?

RA tend to become swelling PIP(proximal interphalangeal) or MP(metacarpophalangeal)joints, and the touch sensation is like a bread dough.
On the other hand, OA is tend to DIP(distal interphalangeal) joints, and we can touch the joints as so hard.

When you find joint swelling in PIP or MP joints, you should consult to a specialist of collagen diseases.
He also told that it is also important for PGY (Post-Graduated Year)1 or 2 to do a knee arthrocentesis to rule out septic arthritis.

Collagen diseases for non-expert

Today, I attended a seminar for Young doctors. Today's title was Collagen disease for non-expert.

We can make a diagnosis for 80% of cases only based on history taking & physical exams.
This comment is told by Dr. Lawrence M. Tierney, MD, San Francisco, CA, Internal Medicine.

There is 3 major methods to make a diagnosis;

1. Snap diagnosis
2. Aphorism, Typical rule
3. Analysis

Each method has advantages and disadvantages.
Snap diagnosis is early, but it is impossible for young doctors who don't have the experience to meet same diseases.
Aphorism, Typical rule, is not suitable for untypical cases.
Analysis needs time and enough knowledge to do that.

In the end of medical interview, it is better to say "When you find new symptoms, please come again". It is because some symptoms which needs to make a diagnosis are not clear in first visiting. When the symptoms appears, we can make a proper diagnosis, treat him or her.
We should follow those patients to detect the key to diagnose.

Today's condition of media in Japan

Today I watched a presentation by Mr. Takashi Uesugi, a free journalist.
The title is "Today's condition of media in Japan".
He pointed out today's problem of media in Japan. He tried to explain the problems of press club in journalism. This system means only reporters from large Japanese media can attend political interviews without free journalists and foreign media. Therefore Japanese politician can control mass-media easily. But this club makes inward and conservative perspective.
He used examples, political issues like Mr. Ichiro Ozawa, to make clear how conservative it is.

Mr. Takashi Uesugi is mentally so tough and challenging. It is because he has an ability to bounce back from adversity, and he is enjoying it.
It is one of reporters' characters to ask challenging questions and to find the real side of the interviewee. This gave a glimpse of his persona.

I partly agreed on what he said. I evaluated his statement to report today's problems clearly.
However, in my impression, his presentation is too emotional and agitating. He just criticized the problems of today's media without mentioning how it should change for the future. Maybe he made it simple to clear out his point, and made it easy for students to understand. In whole, his talking is not constructive.

I heard the same things five years ago. The lecture is presented by Takashi Tachibana, an other famous journalist. The former part of it was same as today's presentation.
Mr. Takashi Tachibana added we should take information not only from Japanese media, but also from the other English media. It means we should grow up our information gathering skill to survive today.

Finally I attach Tachibana's lecture note written by me in the above.

Psychiatry

Primary school pupil with gender disorder to get hormone treatmenｔ

We discussed about this article today.

Gender identity disorder is mismatch of physical sexuality and mental sexuality. 

According to the article, this is first time to treat a patient before secondary characteristic by hormonal injection. 

In my opinion, this article should pay more attention to the patient privacy. There is possible people around him/her to notice it. Therefore, it is better to mention just letter of prefecture, or institution. 

Psychiatry is difficult, because there is no clear way to define disorders or normal. DSM-Ⅳ is one of major criteria to diagnose psychiatric diseases. This criteria is changed almost annually. It means the criteria is developing, changes along to social situation, and is not obvious consensus among experts. It is more arbitrary than other organic disability.

構造構成主義とは何か 次世代人間科学の原理

This book is written by Saijio Takeo.

In this book, he tried to explain new framework of logic, structural constructivism.

We usually use a dichotomy between the two to make it simple. Based on this thinking process, we believe without a doubt that our side is right, and another is wrong. It is simple. However this thinking method faces to the limitation. It means when we want to solve complex problems, it is not enough. The dichotomy could not find good solution for religious confrontation.
On the other hand, he doesn't agree with relativism which allow anything.

Therefore, he tries to make a new framework of logic, structural constructivism. In this thinking, first we should become a humble that no belief is perfect and be tolerant to others.

In my impression, this thinking attitude is like a polytheism, comparing to a monotheism.
The dichotomy is a powerful and simple method. First, we should try to use this to explain or to find solutions. After reaching to the limitation, we try to change our mind to use structural constructivism.


My English writing skill is not enough to express complicated things, like these philosophical issue. I'm not sure I can convey what I want to say using suitable words. Recently, I think it is really difficult to find suitable words for what I want to say.

How to learn foreign language?

Some people can speak more than two languages, trilingual and quad-lingual.
Learning languages needs some skills. Some people can learn other language easily, while other cannot do that.

Today, I watched SFC (Shonan Kamakura Campus)'s lecture online. The guest can use Japanese, English, Tagalog, Spanish, and so.
He told participants that finding the suitable materials is the easiest way to improve their language skills. For example, some Japanese housewives are crazy to Korean dramas, and they try to study Hangul eagerly. In my opinion, it is suitable way to start to study new language.
He also told that like a sport, our language skills improve like a stairstep. We need to store some knowledge and experience for it. When these reach to some level, our ability suddenly become better and we can use the language frequency.

One of my friends is an English teacher in a high school in Japan. He told me that there are 4 skills, reading, writing, listening, and speaking. Each skill is not independent. It is a better way to improve all skills to make positive spiral. For example, when we speak English a lot, it is a good opportunity to read a book to find new words or phrases. Those new words can be useful to speak.

In my opinion, it is necessary to stay in an environment which we have to use it. In this country, we can lead our comfortable lives by only using Japanese. Therefore, we should choose other circumstance not to use native language. We can receive English "shower", in other countries.

SFC's lecture by Ms. Fujiyo Ishiguro

I watched  SFC's lecture by Ms. Fujiyo Ishiguro.
This course is one of lectures in Shonan-Fujisawa Campus of Keio University, titled global and innovation. This lecture is opened for everyone, so I can watched it in the internet. It is good effect of E-learning.

She is an active career woman.
Her message was impressive for me. Success experience is curse from the past, so difficult to be free from it. On the other hand, Failure experience is wealth for the future. Therefore, it is importance for the young to get much failure experience.
At last, she told about career of President Abraham Lincoln. 
He failed so many times, but finally he became a President in U.S. and was respected by all. We should go ahead without worry for failure.

I could get energy from this lecture.

Japan is rich, but unhappy?

Recently, many media broadcast that Japanese are too inward, pessimistic, and loss energy too quickly.
One of my friends told me that people in other countries are poor, but happy. On the other hand, Japanese are rich, but unhappy.

Why Japanese people become like that, in my opinion, there are three main reasons:

1. Less diversity
2. Usually comparing to the high-growth period after WW2
3. Evaluation based on stereotyped Japanese success

First, Less diversity
Of course, it is natural that majority of people are Japanese in this country. However, we should accept people from other countries more. It means we learn value variety.
There are so many obstacle to do that. Japanese is too difficult a language for non-native speaker. There is strict law to accept immigrants. High living cost is also a barrier.

Second, Usually comparing to high-growth period after WW2
It is human's trend to think past more beautiful than today. There is no country where continue to grow a high speed.
Japan doesn't have enough nature resources. Therefore, we think of way to keep the nation's sustainable growth through technology, high-quality product, or innovation.

Third, Evaluation based on stereotype Japanese success
This may be related to the first reason. Almost all Japanese think their successes are studying hard, getting into high-grade schools, and working in famous companies. When they don't do that, they and people around them judge that it is failure.
I think this thinking pattern or value is too narrow. We should widen our horizons. What is your lifework, what is your happy, what you want to do in your life?

Of course the above reasons are not only problems. These are part of today's problems in Japan.

Each Japanese should not only think to finding what their is identity, but also what is Japanese identity in this border-less world.

Mock exam 2

Today I practiced mock medical interview with a doctor who also tries to go to abroad.
Recently, we proceed a case book. It means every case becomes difficult.

Usually I pretend a mock patient in first case. After that, we change roles both. I try to ask medical questions as a mock doctor in next case.
There is a time limitation, 15 minutes to take all patient's history. After that, we write the chart in 10 minutes.

In today's case, first I suspected acromegaly based on high blood pressure and foot change. Then suddenly, there was an information about sleep problem. My differential diagnosis changed to sleep apnea syndrome. In physical exam, I listened his gallops on auscultation (of course virtually). Finally I reached to a diagnosis of heart failure.
My differential diagnosis changed time to time. It was interesting, but difficult in time constraints.

Anyway this test is tough.

Systemic teaching for systemic thinking 2

Today I want to write English about previous I wrote in Japanese.

Now I'm thinking how to teach medical student from next April. When I can pass all exams, I start to work as a doctor from April.

Concept
How to teach med student systematic to think systematic.

How to do
First I make A4 size sheet which summarized the following things.
Example
Monday: Clinical thinking, Physical exam (Jugular venous pressure, Auscultation to hear sound)
Tuesday: Gram stain, infectious disease basic
Wednesday: How to read Chest X-ray systematically
Thursday: How to read ECG systematically
Friday: How to read Arterial Blood Gas systematically

I can teach one student up to a week. I want to teach them how to make a good habit which make good Bed-side learning after this rotation.

Unfortunately there is a time when I cannot teach them enough. Therefore, they have to continue to study efficiently even in those time. How they to study efficiently then? They read the sheet which I mention the above in their free time, and when I have a time, based on the sheet, I will teach them by power point or bed-side. Of course, I will change the schedule when I find a good educative case.


I think I'm not afford to make teaching resource after my resident program started. So I want to make a imperfect platform for it, and will up-date.

I will teach med students from Ryukyu University a week.
On the other hands, med students who visited from out of the prefecture will rotate difficult department each day. When all junior residents cooperate for this concept, those med students can study all teaching subject after a week stay. We have to find a way to cover all subject. For example, like a stamp rally, stamp  on back of their name tag to know whether the subject finished to teach or not.

Why I think to do this?
First, I'm not really satisfied to the classes before BSL (Bed-Side Learning). It is better for students to learn clinical things like how to interview as professional and how to read ABG, CXR, ECG before going to wards. It is useful for them. Of course, there are many opportunities to study clinical points there. But, it is better for students to study those basic things systematically before wards.
Second, actually when I attend bed-side learning, I thought there are sometimes time-wasting. Preparing teaching resources for those moments is better for students.
Third, I often attend Young doctor's seminar. In my impression, those subject should be taught in all hospitals and by all doctors. There are many participants in this seminar. It means medical training is not enough to cover those subject in our country. It is natural for all medical staff to know those subject.

I hope to be a doctor who can teach med students well.

Systemic teaching for systemic thinking

英語縛りをはずして、書くことにしたい。

来年4月から初期研修を始める（予定）に当たって、いかに医学生をうまく教えられるか考えている。


コンセプト
系統立てて考える習慣を身につけてもらえるきっかけになるように、系統立てて教える

方法
白衣のポケットに入る4つ折りのA4サイズ
以下の項目についていかに系統立てて考えるかをまとめた内容
例
月：臨床推論、ROS、P/E
火：Gram染色、感染症概論
水：CXRの系統的見方
木：ECGの系統的見方
金：ABGの系統的見方、アンケート

一人の学生と一緒にいられるのは、最長でも1週間。その後も、少しでも充実した実習になるように系統立てて考える習慣を身につけるきっかけになればと思う。

どうしても、しっかり教えられない時間が出てきてしまうと考えられる。そのため、その時間にいかに効率よく学んでもらうか。空いた時間にシートを読んでもらい、その後時間を見つけてクルズス形式で。もちろん、週によっては教育的な例があれば、スケジュールをずらした方が教育効果が高い。

多分、研修開始してしまうとゆっくり造る時間も気持ちも余裕がなくなってしまうので、今のうちにプラットフォームだけでも作っておきたい。不完全でも、アップデートはその後にでもできるはず。

県内の大学医学部からいらっしゃる学生には1週間単位で一緒にいられるだろう。
一方、短期でいらっしゃる県外の医学生には、毎日異なる科を回るので、同期の皆様から賛同いただき同じ形式を導入してもらえれば、1週間でトータルに見たら網羅できるはず。例えば、名札の後ろにスタンプラリーのようなシートを貼って、やった項目をスタンプしてもらい、ずらした内容がわかるようにしたい。

E-learning

Recently I don't have enough time to study other field, and study only medicine. While I eat, I try to learn in the internet.

For example, I can watch Cambrian palace
in the internet. It is really nice for me. I couldn't keep an hour on Thursday night. I can watch this program 20 minute every meal. The internet version is not shorten like TV version.

After I can catch up the TV program, I watch the Internet and innovation in Keio University Shounan Fuzisawa Campus (SFC) site
which is produced by Kiyoshi Kurokawa. I respect him a lot, because he encourage the younger and his widen horizon.

Akira Ikegami VS Michael Sandel

In the last weekly Bunshu, there is a article about discussion between Akira Ikegami and Michael Sandel.

Usually, I don't read this weekly magazine. I don't use train to commute. It means I don't have a opportunity to see the advertisement of those which hung in a commuter train. Today suddenly I get the information about this article.

The article is interesting for me to know humanity side of the professor. The interviewer is one of  great Japanese journalists, so he can ask the professor through "good question."
In the article, they mention the word, "good question."
In the world, there is no "bad question." If you feel that, it means the teacher couldn't lead him or her well. Sometimes, students ask questions based on obscure mean. Good teacher find what they want to ask and know. And the teacher lead them more constructive flow.

His conversational lecture is so impressive for me. Everyone can see it in the internet. It means every teacher and lecture are compared to world best lesson. It nice, but severe.

Anyway tomorrow, I have to take the latter half of mock test. Terrible・・・

Shift of study

Tomorrow I will take a mock Japanese medical board exam. This is first time to take mock test.Unfortunately, I don't prepare for the test. So my result will not be good.
From the last graduation exam, I mainly study for CK. I plan to start my study for Japanese board exam again.

Between both of CK and Japanese board exam, there are not same, but not quite difference. The important points which question tend to ask for exam taker are little difference. CK asks the detail about common diseases and preventative medicine, and the basic questions about unpopular diseases. On the other hands, Japanese exam asks the whole varieties of diseases.

Anyway, I will change my study style from tomorrow.

OJT in Mito

On 3rd January, I visited a hospital in Mito to attend OJT.
The day was just final day of new year. So many patients visited the hospitals, and it means the day was busy.

When you hear crackles on auscultation, check the diaphragm of your stethoscope fitted firmly.
It is difficult to touch the diaphragm to skin firmly, especially skin is wet. Some young doctors and students confuse to the sound as crackle.

To predict the sign of physical exam and the result of workup is most important for physician. However, when it is difficult for young doctors and students, because they don't have enough experiences to do that. All the more reason to do that consciously.

I think this was last time to attend OJT in this hospital. It was my first time to visit there on 4th January 2010. After that, I visited there so frequently. To be a honest, I cannot count how often visit there. There was most educational hospital for medical students and young doctors. I hope I will visit again to return the favor some day.

2011

Happy New Year!!

Last year was little busy year for me. January I studied in Mito hospital. The experience is very clinical and useful for me to be a resident. I could find what I need
From April to June, I visited Canada and Bangladesh. Those experiences were good for me to broaden my vision.
After that, I stayed in Japan, and took  so many graduation exams.

First, this year I have to pass Japanese board exam.
First three months, I studied on a desk so hard. When I pass board exam, I start to work as a doctor in Okinawa.
I think this year will be busier than last year. I hope I can grow up as a doctor though this year.