Anna Katharina Delank

Anna-Lena Thies

Bernhard Marschall

Hildegard Wichtmann

Ikue Ishizaki

Jan C. Becker

Keisuke Hamada

Michiaki Masuda

Mikako Masuda

Nana Yazawa

Ryunosuke Goshima

Sara Bockholt

Sayumi Saida

Simon Shabo

Tamae Kato

Wolfgang R. Ade

Yusuke Terada

English

Dokkyo Medical University Repository / 獨協医科大学リポジトリ

第45回獨協医学会学術集会
Physician-Patient Relationship with 
Regard to the Treatment of Lifestyle-
Related Disorders─German and 
Japanese Perspective─
1）Dokkyo Medical Univ. （DMU） School of Med. 5th Year Student
2）Westphalian Wilhelms Univ. （WWU） Medical Student
3）WWU IfAS
4）DMU, Division of Languages and Humanities
5）DMU, Office for German-Japanese Cooperation
Keisuke Hamada1）, Tamae Kato1）, Mikako Masuda1）, Nana Yazawa1）, 
Sayumi Saida1）, Ikue Ishizaki1）, Ryunosuke Goshima1）, Sara Bockholt2）, 
Hildegard Wichtmann2）, Anna Katharina Delank2）, Simon Shabo2）,  
Jan C. Becker3）, Anna-Lena Thies3）, Bernhard Marschall3）, Yusuke Terada4）, 
Michiaki Masuda5）, Wolfgang R. Ade5）
????????????
Regarding the treatment of lifestyle-related diseases in Japan, patients＇ 
“non-compliance” has been discussed since the 1970s, with wide agreement 
that the ” physician-patient relationship” deserves special attention focusing 
on the necessity to involve patients actively in their treatment.
In this study, we looked at the physician-patient relationship with regard to 
lifestyle-related disorders in both Japan and Germany.
???????
The students among the authors retrieved literature on the physician-pa-
tient relationship in patients with lifestyle-related disorders based on an on-
line search and in relation to an overseas training session at the WWU.  The 
factors that influence this relationship were then discussed with researchers in 
Japan and Germany.
???????
There are two main differences between Japan and Germany, those differ-
ences are found in the medical insurance systems and educational systems 
offered by both countries.
Essentially, all of the residents in Japan are covered by the medical insur-
ance system, and most of the patients can chose the physician without restric-
tions while about 90 ％ of the German population are insured by a public 
health care system which favors the family physician system. Patients who 
opt for the so-called “Hausarztprogramm” （family physician program） are 
promised short waiting periods （mostly less than 30 minutes）. By participat-
ing in this program, the patients commit themselves to consult with their fam-
ily physician first, who then may refer them to specialists and hospitals. Even 
if they join this program, they still have free access to ophthalmologists, gy-
necologists, pediatricians and dentists. In the case of life-changing diagno-
ses, health insurance associations will, on request, introduce patients to spe-
cialists who provide a second opinion. German patients under the public 
healthcare system can also participate in Disease Management Programs 
（DMPs） that provide structured treatment plans for maintaining and improv-
ing quality of life of patients suffering from chronic diseases.
As to the educational system in Germany, the Kassenärztliche Bundesver-
einigung （National Association of Statutory Health Insurance Physicians） 
and the Bundesärztekammer （“Federal Medical Association”） organize 
workshops and other educational activities designed for improving the physi-
cians  to improve the quality of the physician-patient communication skills.
Also, there are facilities as the Studienhospital （simulation unit） of the 
WWU where medical students can be trained in professional communication.
??????????
The family physician System in Germany can enhance patient compliance 
for the long-term treatment and be cost-effective by reducing unnecessary 
examinations and prescriptions. In addition, medical programs such as DMPs 
seem to be useful for sustaining long-term treatment and promoting the 
awareness of a healthy lifestyle. Patients’ active involvement in their treat-
ment is expected to improve compliance with the physician’s directions, and 
regular visits provide patients with valuable opportunities for communication 
with the physician.
The disadvantage of the German system is that patients often have to con-
sult the family physician first and basically do not have direct access to hos-
pitals. Their health insurance may not cover fees for second opinions, either.
???????????
Adequate communication and regular visits to the clinic can be cited as el-
ements to build better physician-patient relationships. In order to improve 
communication skills of physicians, it is desirable also in Japan to start train-
ing at the undergraduate level. Further, the family physician program, despite 
its potential disadvantages, may be favorable for deepening the physician-
patient relationship. In Japan, pysicians of local clinics have often played the 
rôle of the family physician. Specialists called ”Sogo shinryo-i” （often 
translated as general practitioners） may also be expected more often to serve 
as the coordinator or liaison between patients and specialists.
The authors wish to thank Dr. Gen Kobashi of Dokkyo Medical University 
for his precious advice.
Overview of the UC San 
Diego OTP 2017
1）医学部5年，2）語学・人文教育部門
安藤裕子 1），石川　学 1），小野理夏 1）， 
川口俊輔 1），近藤花栄 1），佐々木侑 1）， 
相馬佑樹 1），飯塚秀樹 2），William G Hassett2）
1978 年に設立された Moores Cancer Center（MCC）は，
45 施設ある National Cancer Institutes の 1 つです．これら
の機関はがん治療やその他の地域プログラムに特化して
いて，分子遺伝学の研究から最先端の治療まで，医療の
最前線に立っています．患者ケアは MCC で提供され，多
分野のチームアプローチを採用し，患者と家族支援サー
ビスによって提供されます．これを PFSS と言い，これ
らのチームには，様々な専門分野の専門家が含まれてお
り，PFSS からの助言を通じて，患者は主治医とともに最
善の治療法を決定することができます．彼らの目的は
Well-being を中心とした患者や家族のためのがんケアに
おいて高い基準を設定することにあり，がん患者の苦痛
を引き起こす可能性がある情緒的苦痛を和らげることに
焦点を当てています．
また MCC では，新しいがん治療の研究と開発が充実
しています．一例として，血液腫瘍学の分野で M の研究
について紹介します．Dr.Choi の授業によると，彼のチー
ムは新薬を開発しようと努力しており，慢性リンパ球性
白血病（以下 CLL）の新しい治療法である Cirmtuzumab
を発見しました．CLL は西洋では一般的ですが，投薬や
治療の選択肢はほとんどありません．この新薬は，CLL
患者の B 細胞上の ROR1 と呼ばれる受容体に結合するよ
うに開発されたヒト化 IgG1 モノクローナル抗体で，突
然変異する癌細胞と正常組織とを区別できるように設計
されています．これまでのところ，この新薬は毒性の限
界がある患者にとって耐容性が高いことが示されてい
て，他のがん治療にも有効である可能性があることがわ
かり，期待されています．さらに MCC では，がんの診
断後，患者はすぐに緩和ケアチームに紹介されます．必
要に応じて苦痛を和らげるためにセラピーが提供されて
いることがグラフからもわかります．
この OTP を通じて，特に Oncology の分野において，患
者にどのようにケアを提供すべきかを考える様々な方法
を学びました．MCC は手術，化学療法，放射線療法だけ
でなく，精神医学的サポート，遺伝学的アドバイス，身
体的および瞑想的療法もまた栄養指導をも提供します．
（たとえば，ヨガ，ズンバ，芸術療法，食事など）これら
は非科学的に見えるかもしれませんが，患者がストレス
や不安を克服してより良い治療結果を出すことを助ける
実証済みの方法です．私たちは，MCC のチーム医療を通
じて，患者中心のケアを提供し，また患者の QOL を改
善し，さらに，患者の背景にあるものを通じて患者の気
持ちをサポートすることが大事だと学びました．
84 獨協医誌
4.3.


Physician-Patient Relationship with Regard to the Treatment of Lifestyle-Related Disorders─German and Japanese Perspective─

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Physician-Patient Relationship with Regard to the Treatment of Lifestyle-Related Disorders─German and Japanese Perspective─

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