神経系疾患における全人的治療(内科領域のおける全人的医療)(第31回日本心身医学会総会)

抄録

According to the recent increase in needs for rehabilitation medicine, the author as a physiatrist has been faced more and more with varieties of diseases. Among them, impairments of neurological origin are given much weight. In our department of rehabilitation medicine, patients with neurological impairment account for 20% of all the newly admitted patients. Cerebrovascular diseases are most common. As a matter of common knowledge, rehabilitation medicine aims at "holistic medicine" which includes the approach for not only physical disability but also psychosocial problem accompanied with "mourning work". Moreover, this ideal is to be realized through the care of medical team which consists of many kinds of staff. Thus, such a problem as an unreasonable psychological conflict within staff members or a distortion of team organization sometimes arises to interfere with our comprehensive rehabilitation program. In order to cope more adequately with the psychosocial problems as well as physical ones and to consider what the team management for the patient should be, we have held a liaison conference for four years. It is held weekly amang rehabilitation staff members (including a physiatrist, a physical therapist, an occupational therapist, a speech therapist, nurses and a medical social worker) and a liaison psychiatrist. In the conference, we discuss psychological or behavioral problems of patients caused by psychosocial conflicts or mourning work, negative counter-transference of therapist to patient and problems of interpersonal relationship among patient, family and therapist. From April in 1986 to March in 1990,more than 40 cases were presented to the liaison conference. Results obtained through questionnaires to our staffs proved the conference to be effective in the rehabilitation setting (1) to promote a better understanding for psychological problems, (2) to consider interpersonal relationship between staff and patient, saff and staff, patient and family, staff and family, and (3) to make clear the role of each staff in team management.