人と人がつなぐ医療のかたち　Hands-on Healthcare Service Provider

Introduction

“Medical care (healthcare) creates a connection with people.”
A medical column by Medi Legato. We would like to introduce medical workers in high-profile roles and to think about what medical services should be done from now with you.

In this third article, we are pleased to introduce Dr. Eijiro Hayashi of Synthesis shinkawabashi Hospital. Dr. Hayashi has been in charge of cardiovascular internal medicine as an attending doctor for over ten years. As the Director of the cardiovascular center since April this year, he has engaged in over 500 cardiac catheter treatments.
Today, patients in Japan and overseas require invasive treatments focused on improving their quality of life and reducing their physical discomfort. Sharing the skills of leading medical workers and the services of medical institutions both across Japan and overseas will contribute to improving the state of medicine in Japan and will also lead to improved credibility with patients as well as medical workers and the medical institutions they work for.
In this article, we also interview Ms. Mikiko Suzuki, the chief nurse and coordinator of a wide variety of collaborative works at the cardiovascular center in Synthesis shinkawabashi Hospital.

Sonoko Hirose　President & CEO　Medi Legato

Interview

－Why did you become a doctor?

My father worked for a local general hospital for a long time as a physician in cardiovascular internal medicine. I have heard about the work and responsibilities of doctors and their contribution to society since childhood. This naturally inclined me to choose a career as a doctor.
When I was a student at medical school, I studied in all diagnosis and treatment departments related to internal medicine, surgery, pediatrics, obstetrics and gynecology, ophthalmology, and dermatology. I actually provided medical treatment in these departments in a clinical training hospital after graduating.
After completing the initial training, I chose to specialize in cardiovascular internal medicine without hesitation. Cardiovascular internal medicine is one of the few internal medicine diagnosis and treatment departments that can offer not only medical treatments but also operations for patients: a doctor is able to take care of a patient from the start to the end of their first visit, their checkups, the operation, and subsequent outpatient visits. In this department, most treatments are for acute illness. For instance, I felt strongly attracted to medical care that provides rapid and urgent catheter treatment to a cardiac infarction patient transferred to the hospital, succeeds in helping a patient who has faced death make a strong recovery, and then helps that patient with rehabilitation several days later.

Treatment for the heart is basic. I was also attracted to work that requires knowledge of a variety of conditions that are risk factors for heart disease, such as diabetes, high blood pressure, and lipid abnormalities.

－It is said that, in general, catheter treatments are less stressful for patients' bodies than open-heart surgery. Could you describe the current situation of invasive treatments in the field of cardiovascular medicine?

A catheter is a tubular, pliant medical device, 1–2 mm in diameter and about 100 cm in length. By taking an X-ray of the vasculature of the arm or foot that the catheter is inserted into after injecting a radiopaque dye, every blood vessel throughout the body, especially those in the cardiovascular system, can be examined. To be more specific, stenosis or obstruction caused by arteriosclerosis of a blood vessel can be diagnosed.

The cardiac catheter test is used to examine blood flow of the blood vessels. Angina and myocardial infarction can be thus diagnosed. As an anesthetic is used only locally where the catheter is inserted, it causes little physical stress for the patient, and an examination can be completed in 10 min. For patients diagnosed with angina or myocardial infarction, treatment can also be conducted using the catheter. Approximately 10 years previously, treatment for angina, for example, required major open-heart surgery such as a heart bypass; however, treatment methods have drastically changed with the development of new catheter techniques. By inserting a catheter equipped with a balloon, the stenosis or obstruction in the blood vessel can be dilated and a metallic pipe called a stent can then be put in place. As this treatment uses a very thin catheter, an incision into the skin is avoided. Treatment takes up to approximately 30 min to 1 h only, and as the anesthetic is injected only where the catheter is inserted, the patient is able to eat and walk after treatment.

In addition to cardiovascular treatment, catheter treatment can also be used for arteriosclerosis obliterans of the lower extremity, which involves poor blood circulation to the feet, and for carotid atherosclerosis, which causes cerebral infarction. Invasive treatment for elderly people and patients with many complications involves an extremely high risk. Catheter treatment provides an alternative to extreme invasive procedures and can be used in all ages.

－A variety of medical workers such as nurses, radiology technologists, and clinical engineers are involved in the treatment of patients and in operations at the cardiovascular center. What steps do you take to implement effective teamwork between a variety of workers?

Catheter examinations and procedures involve extreme cutting-edge technology resulting from the progress in medical technology. However, the treatment is not performed by the doctor alone. It is essential to build a team including nurses, radiology technologists, and clinical engineers. I mean that steadily establishing team-based medical care is very important. To carry out a procedure, first we need to clarify the final goal for the patient, and all of the staff need to share this goal.

We hold a meeting for staff from each department once or twice a month (lasting for 40–90 min). Doctors, nurses (from outpatient departments and the ward), radiology technologists, clinical engineers, and clinical laboratory technologists attend the meeting, a total of around 10 people. At the meeting, the staff from each department discuss current issues and potential improvements, as well as providing a better environment for patient treatment and future work environment. It is important for the whole department, including doctors, to collaboratively think of their ideas and to share directions, with each person clarifying their independent roles.

－What types of doctors are you looking for at the cardiovascular center?

I am expecting to meet with young, diligent, assertive and sociable doctors.

－What is your message for patients?

I am currently working at an outpatient clinic four times a week. I tell each patient that if a disease is found at an early stage, they do not need to be scared. There is no one who has never suffered from a disease in their entire life. Complete recovery is possible with early detection. When patients have any concerns, I would like them to speak about these, and I would like to resolve these concerns together with them. In addition to offering effective treatment, I believe our work as doctors includes both supporting and enriching our patients' way of life.

Interview with Ms. Mikiko Suzuki, the coordinator and the chief nurse at the cardiovascular center

－Could you explain your role as a coordinator at the cardiovascular center?

I support patients by providing explanations regarding catheter examinations and treatment and by managing a catheter schedule. I have been working as a nurse for 23 years. During that period, I worked as an assistant in an operating room for approximately 12 years, and also in orthopedics, neurosurgery, an ophthalmology ward, and an outpatient clinic. I have been working as a coordinator of catheters since 2010, when the cardiovascular center was established.
After a doctor explains the procedure to the patient, I check the lesion image and the examination data. Then I schedule the catheter procedure, taking into account the patient’s schedule and the time required for their treatment. The catheter examination by Dr. Hayashi is rapid, and it usually ends within approximately 10 or 20 min at most. There is one room for catheterization, and approximately eight cases a day of treatment or examination are performed from Monday to Friday. Usually, one doctor, two nurses, two radiology technologists, and clinical engineers attend the catheter treatment.
In a tough working day, I try to schedule a 1-h break and lunch at a normal time to help improve the concentration of the staff and to contribute to maintaining their health.
The age of the patients ranges from 40 to 90 years. Many patients undergoing a catheter examination or treatment for the first time face concerns, regardless of their age. I try to take the opportunity of communicating with each patient to listen to their concerns before I arrange their procedure. Furthermore, when I speak with patients to explain the treatment, I try to take off my mask and smile.
Some patients want to talk with me after they finish their checkup because sometimes they forget to ask the doctor about their treatment during their checkup time and later remember what they wanted to have asked or what they hesitated to raise with the doctor. This makes it important to have this opportunity for speaking with the patients. Although the schedule management of the catheter procedures is part of the role of a coordinator, I believe it is also a part of the role to support the patients in addressing their range of concerns and questions and for ensuring their examination or treatment is comfortable and performed with their full consent after explaining the details of the catheter examination or treatment again if required.

Ms. Mikiko Suzuki (center)

－What are the attractions of Shinkawabashi Cardiovascular Center and of working with Dr. Hayashi, the head of the center?

The environment is well organized. I mean that there are regular teamwork meetings involving a range of specialties such as doctors, nurses, and medical workers, where we can frankly discuss the issues of the moment and resolve them.

Dr. Hayashi is currently in charge of 60%–70% of the catheter examinations and interventions at the center. The patient limit of the outpatient clinic is also being expanded as much as possible. I have never heard any negative comments from Dr. Hayashi, such as “I can’t take any more patients” or “I feel tired,” over the 5 years since he started working for this center. Many patients are fans of Dr. Hayashi, and I am impressed that when he says, “Yes, it’s going to be fine” to a patient, the patient starts to look relaxed. He also talks positively to new staff, and he seems to try and create an environment for good communication. Through teamwork between a range of specialists from the cardiovascular center and other departments, I would like to continue providing a high quality and reliable treatment for our patients.