プライマリ・ケアにおける心身医学の必要性について : 第一線病院の臨床から(プライマリ・ケアと心身医学)

抄録

The purpose of this paper the practical psychosomatic approach through the medical out-patients clinic of St. Luke's Internatinal Hospital, Tokyo, Japan and to discuss the relationship between psychosomatic approach and primary care. At first, author studied 100 patients who made their first visit to our medical out-patient department in recent 2 weeks in order to analyze the nature of their sicknesses. Author tried to divide these material into illness and disease according to Anthony Reading's Theory. Consequently, these materials were divied into about 80% of illness and 20% of disease. This results suggested that the psychosomatic approach was necessary to treat these patients with practicing first, second and continuous rtimary care through the out0patient clinic. Author used various psychosomatic approaches such as comprehensive interview including psychological approach, mental and physical examinations as diagnostic procedure ; medication, brief psychotherapy and as behavioral approach as thrapeutic procedure. An illustrative case was presented who received the above-mentioned procedure ; a 42 year-old man with unstable hypertension whole clinical course was a great success as his blood presure was made stable through a behavioral approach. Author believes that it is necessary to use comprehensive approach to treat, to cure or to care the entire group of medical patients visiting our clinic as a part of primary care.