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		<h1 class="catchCopy">どの科の医師にも必要な基本スキル･･･それが問診！読んで，考えて，臨床力を伸ばす１冊!!</h1>
		

		<h1 class="title">総合診療外来の問診ライブ<span class="version"></span></h1>
		<h2 class="subTitle">これを聞けば大丈夫</h2>

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					編集：神田善伸（自治医科大学附属さいたま医療センター血液科教授）
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					<span class="transparent">編集</span>　本村和久（沖縄県立中部病院プライマリケア・総合内科）
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					<span class="transparent">編集</span>　（協力：ジェネラリストのこれからを考える会）
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				<ul class="property"><li class="disc">A5判・252頁・2色刷</li><li class="disc">ISBN&nbsp;978-4-8306-1016-5</li><li class="disc">2013年3月27日発行</li></ul>

				
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">綿密な問診と病歴聴取なくして外来診療は始まらない．でもその一方で，病態の評価に役立つ情報を患者から効果的に聞き出し，鑑別を組み立てることができるようになるまでには，相応のトレーニングを必要とする．本書は研修医や若手内科医を読者対象に，初診外来での問診と病歴聴取の実況中継を通じて，執筆者の豊富な臨床経験に基づいた鑑別診断とその臨床思考を擬似的に体験・トレーニングできる画期的な実践書！各論では，臨床現場でいつかは必ず遭遇するであろう様々なCaseを用意．ここで展開される問診例を，一緒に考えながら読み解くことで，臨床思考における３つの重要な方法論を自分のモノにできる！　①“頻度順に鑑別疾患を絞り込んでいくには”　②“頻度は少なくても重要な疾患を見逃さないためには”　③“特異的なkey featureを指摘できるようになるには”　さらに，鑑別診断を目的とした病態を突く病歴聴取のみならず，心理社会的背景へのアプローチやコミュニケーションスキルまでリアルに実感できる．どの科の医師にも必要な基本スキル･･･それが問診！！専門領域の垣根を越えて，「総合的な診療力」を高めたいあなたにまさにうってつけの１冊！<br>☆図版4点，表組45点</section><section class="preface">序　文<br><br>　「総合診療」という言葉が流行語のように広まり，『総合診療医ドクターG』なる番組がNHKで放送されるほどである．総合診療医の役割は，その所属する施設によって若干の差異はあると思われるが，「全人的医療」や「初診外来での的確な診断」などがキーワードに挙げられている．私が勤務する自治医科大学附属さいたま医療センターでも内科系医師は全員が総合医学第一講座に所属し，その中で総合診療科を含めた各科に配属されている．「総合回診」と呼ばれる週に一度の内科系全科による症例検討会で症候から診断までの過程を議論することなどによって，細分化された専門を持つ医師も一定レベルの「総合診療力」を維持できるように努力している．<br>　しかし，私たちのセンターを含めて国内の大部分の施設において，レジデントの外来初診診療の教育が十分にできているとは言えない．学生時代のBSLや初期臨床研修の期間に実際に外来初診患者を診察する機会は数えるほどである．病棟での実習・研修で担当するのはすでに診断がついている患者がほとんどであり，診断のためのトレーニングとしては不十分である（初診から診断までの流れを振り返って学習することは可能であるが）．<br>　そこで本書は，総合診療初診外来での医師と患者のやり取りを記した「問診ライブ」を中心とし，この対話を通して擬似的に症例を体験しながら，綿密な問診・病歴聴取の手法を学んでいただくことを目的として企画された．鑑別診断のために病態に切り込んでいく病歴聴取のみならず，心理社会的背景へのアプローチやコミュニケーションスキルが垣間見えるような診察まで，リアルかつ幅広い具体例を通じて実際の患者さんを目の前にしたような臨場感を感じていただきたい．また本書は，頻度順に鑑別疾患を絞り込んでいく問診技術，頻度は少なくても重要な疾患を見逃さないための問診技術について，執筆陣の豊富な臨床経験に基づいた鑑別診断とその臨床思考をひもとく実践書である．いわゆる「総合診療医」を目指す医師のみならず，「総合診療力」を高めたいというすべての医師に役立つ一冊として愛読されることを期待している．<br><br>2013年3月<br>自治医科大学総合医学第一講座<br>自治医科大学附属さいたま医療センター血液科<br>神田　善伸</section><section class="indexes">1章　なぜ「問診」にこだわるのか─患者さんのための重要技法としての問診─<br>　総論1．問診とは？<br>　総論2．問診から診断を絞り込む醍醐味〜いわゆる臨床推論について〜<br>2章　実践問診ライブ─何を考え，どうコミュニケーションを進めるか？─<br>　case1.　失神を主訴とする68歳男性<br>　　Memo　1．主訴の時間経過（LQQTSFA）　2．解釈モデル　3．既往歴はMISIA（ミー<br>　　　　　　シャ）　4．系統的問診　 5．Valsalva手技　6．head-up tilt試験　7．植込み<br>　　　　　　型心電用データレコーダ　8．失神のリスク層別化のスコアリング<br>　case2.　頭痛を主訴とする19歳女性<br>　case3.　複数回の貧血発作の主訴で訪れた24歳女性<br>　　Memo　起立性低血圧の検査（立位負荷試験）<br>　case4.　ふらつき，めまいを主訴とする48歳女性<br>　case5.　両足のしびれを主訴とする65歳男性<br>　case6.　持続する発熱を主訴とする38歳男性<br>　　Memo　診療の場は…<br>　case7.　疲労感を主訴とする52歳男性<br>　　Memo　ROS<br>　case8.　息苦しさを主訴とする44歳男性<br>　case9.　持続する咳嗽を主訴とする68歳男性<br>　case10.　咽頭痛を主訴とする33歳男性<br>　case11.　胸痛を主訴に来院した61歳女性<br>　case12.　動悸を主訴に来院した58歳男性<br>　　Memo　脈の診察<br>　case13.　浮腫を主訴とする70歳女性<br>　case14.　吐き気を主訴とする58歳男性<br>　　Memo　境界型糖尿病<br>　case15.　腹部膨満を主訴に来院した60歳男性<br>　　Memo　1．CAGE質問票　2．SAAG（血清腹水アルブミン勾配）　3．腹水の身体診察<br>　case16.　血便を主訴に来院した48歳男性<br>　　Memo　痔核からの出血に大腸癌の合併がありうるかという難題<br>　case17.　腹痛を主訴とする32歳女性<br>　case18.　黄疸を主訴とする73歳男性<br>　case19.　腰痛を主訴とする56歳男性<br>　case20.　紫斑を主訴とする27歳女性<br>　case21.　リンパ節腫脹を主訴とする53歳男性<br>　　Memo　リンパ節腫脹患者での必須確認項目〜ALL AGES<br>　case22.　頻尿を主訴とする48歳女性<br>　　Memo　1．間質性膀胱炎　2．泌尿器科系の診察<br>　case23.　血尿を主訴とする30歳男性<br>　　Memo　尿路上皮癌のリスクファクター<br>●索　引</section></article>
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