筆者は数年前から、ヨーロッパの某航空会社の顧問医を務めている。乗務員が大阪滞在時に体調を崩した時に、診療するのが私の役目である。

　先日、夜の11時に携帯で連絡を受けた。32歳の男性乗務員が、夕食中に意識消失発作を起こしたという彼の同僚からの連絡であった。意識は回復しており、現在は問題ないが、てんかんの既往もなく、原因がはっきりしないので不安だと言う。時間が時間だし、こちらも飲酒していることもあり、救急車を呼び救急病院を当たってもらうことにした。

　救急隊員に携帯で、事のあらましを説明し、救急性の有無だけをチェックして欲しいと依頼すると、気持ちよく引き受けてくれた。それから1時間たっても返事がないので、こちらから連絡すると、大阪市内の救急病院を3つ当たったが、すべて日本語をしゃべれない人は受けいれできないと、門前払いされたそうだ。状態は安定しているとのことなので、仕方なく滞在ホテルまで救急車で送り帰してもらった。

　患者の乗務員もその同僚も、英語は母国語ではないが、職業柄流暢にしゃべる。救急室で診療に当たる若手医師は、医学部の難解な英語の入試問題を突破してきた人間である。英語ならそこそこの対応は出来るはずである。翌日、滞在ホテルに往診し、問題のないことを確かめ、患者は無事帰国したが、もし何か問題が起こっていれば、患者の務める航空会社は世界中の誰でもが知る会社でもあり、大きく報道されていたに違いない。「国際都市オーサカの夜は外国人にとっては無医村」といった見出しが踊るのが目に浮かぶ。

　筆者のアメリカやフランスでの診療体験からしても、欧米の普通の先進国で、その国の言葉をしゃべれないからといって門前払いする救急病院は存在しない。知事と市長が同時に新しく選ばれた大阪の目指す目標の一つに国際化があるようだ。都市の国際化に不可欠のインフラの一つが医療である。日本の先端医療を金持ち外国人に利用してもらって利益を得る、いわゆる医療ツーリズムのみが現在語られているが、今の大阪の外国人医療の状況は、上に述べたように、その前段階で足踏みしているようである。

　なぜ門前払いなのかを考えてみた。日本語をしゃべれない外国人を受け入れれば、診察時間が長引く、問診の不完全さのため誤診する可能性がある、誤診すれば訴訟に及ぶかも知れない等々の理由であると推察する。しかし、コミュニケーション不能というだけで、診療できないというのは理由にならない。意識不明の行き倒れの患者や、乳幼児の診療を思い浮かべるだけで十分である。

　我々日本人は、完璧を目指し過ぎる傾向があるようである。言葉の壁が少しあるために診療を門前払いするより、不完全でも一応は受け入れ、出来るだけのことをするのがまともな医療ではなかろうか。普通の先進国では、このことが普通に行われている。本来の意味での「いい加減」な医療をすることが、大阪の医療を国際化する第一歩であると考える。

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For several years now, I have been serving as a consulting physician to a European airline company. It is my role to provide medical treatment to crew members who become ill while staying in Osaka.?

The other day, I received a call on my mobile phone at 11pm. It was from a colleague of a 32-year-old male flight attendant who had lost consciousness during dinner. He had regained consciousness and was fine now, but he said he was worried because he had no history of epilepsy and the cause was unclear. It was late at night, and I had also been drinking, so I decided to call an ambulance and ask them to check the nearest emergency hospital.

I explained the situation to the emergency crew on the phone and asked them to check whether or not he was in a state of emergency, and they happily agreed to help. After an hour, I contacted them again as I hadn't heard back from them, and they told me that they had tried three emergency hospitals in Osaka City, but they had all been turned away because they couldn't accept anyone who couldn't speak Japanese. As the patient's condition was said to be stable, he was sent back to his hotel by ambulance.

Neither the patient nor his colleague spoke English as a native language, but they spoke it fluently due to their jobs. The young doctor in charge of the emergency room had passed the difficult English entrance exam. for medical school. He should be able to handle English to a certain extent. The next day, I visited the patient at the hotel where he was staying to check that there were no problems, and the patient returned home safely. However, if there had been any problems, the airline company for which the patient worked is a company that is known by people all over the world, and it would have been widely reported. I can imagine the headlines “Osaka, a cosmopolitan city, is a village without doctors at night for foreigners” dancing across the pages.

From my own experience of working as a doctor in the US and France, I know that in ordinary developed countries in Europe and North America, there are no emergency hospitals that turn away patients just because they can't speak the local language. It seems that one of the goals of Osaka, where the governor and mayor have both been newly elected, is to become more international. One of the essential infrastructures for the internationalization of a city is medical care. At the moment, the only thing being talked about is so-called medical tourism, where Japan's advanced medical care is used by rich foreigners to generate profits, but as I mentioned above, the current situation for foreign medical care in Osaka seems to be at a standstill at the preliminary stage.

I tried to think about why they were turning away patients at the door. I suspect the reasons are that if they accept foreigners who can't speak Japanese, the consultation time will be prolonged, there is a possibility of misdiagnosis due to incomplete medical history taking, and if there is a misdiagnosis, it could lead to a lawsuit, etc. However, the reason for not being able to provide medical treatment simply because of a lack of communication is not good enough. Just thinking about treating unconscious patients who have collapsed or infants is enough. It seems that we Japanese have a tendency to aim for perfection. Rather than turning away patients because of a language barrier, wouldn't it be proper medical practice to accept them, even if imperfectly, and do what you can? In other developed countries, this is the norm. I think that providing “lax” medical care in the true sense of the word is the first step towards internationalizing medical care in Osaka.

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