2023年4月から医局長を拝命しました。どうぞ宜しくお願いいたします。2021年度は病棟医長、 2022年度は外来医長をさせていただきましたが、振り返る機会もありませんでしたので、少し思い出してみようと思います。

　病棟医長では日々の手術を組みながら、眼科医師と病棟看護師や手術室との連携が良好となるように調整していく仕事でした。コロナ禍で思うように手術を入れられず、どんどん溜まっていく緑内障患者の入院予約をどうこなすかが一番の課題でした。手術時間をこれまでよりも厳密に設定することで1件でも多く手術を入れる、術者の少なかった金曜午前の有効利用、緑内障術者の拡大の提案など色々やってみました。木嶋副病棟医長には多くの実務をサポ ートしてもらい感謝しています。この年、過去最高の手術件数となりましたが、勝因は自分のちまちました工夫のおかげ…ではなく、圧倒的な数の臨時手術をやった三田村先生の剛腕の結果だと思います。

　外来医長で大変だったのは年度が始まる前の専門外来担当の割り振りでした。医師の異動によってどうしても手薄になる外来が生じ、数人の先生には希望していない外来をお願いせざるを得ませんでした。1週間での外来負担が均等になりつつ手術する機会もできるだけ均等にすることは難しく、年度が始まってからも齋藤病棟医長や木嶋副病棟医長、医員の先生たちと話し合って細かい調整をしました。また、この年度から網膜剥離などの紹介患者さんは原則断らないという方針となり、手術件数と収益は跳ね上がりました。その分職員の負担は大きく、秋頃には疲労がピークに達していました。若干のペースダウンだけでその後を乗り越えられたのは、研修医や医員の先生の頑張りに他なりません。あの時は本当にお疲れ様でした。

　2023年4月から医局長となりましたが、病棟医長や外来医長とは全く仕事内容が違うことに戸惑いました。これまでは臨床のことを考えていれば、自ずとやるべきことも見えてきました。しかし医局長は人を管理する仕事で、医局員が病院職員としてしなければならないことの指導や管理、医局員やその家族の生活を考えた上での相談への対応、年々増加している秘書さんの業務管理など、医療とは全然別のことを考えなければなりませんでした。2022年の本報告書で、岩田医局長がサッカーに例えて、医局長はアンカーだと書いていましたが、とても適切な例えだと実感しています。一人一人を見ながら、かつ全体を俯瞰し、チームワーク良く全体が連動するようにサポートしていく役割だと思います。大学の医局とは臨床だけでなく研究や教育も行うべき責任のある組織ですが、今後スタートする働き方改革の中でどのようにバランスを取っていくのか、難しい課題だと思います。チーム一丸となってバランスを崩さずに前へ進めるよう、尽力したいと思います。

　　Hello, I have been appointed as Department Director since April 2023. I was the Inpatient Medical Director in FY2021 and the Outpatient Medical Director in FY2022, but I haven’t had a chance to look back, so I will try to recall a few things.

　　As Inpatient Medical Director, my job was coordinat-ing the daily surgeries and ensuring cooperation between ophthalmologists and inpatient nurses or the operating room. The biggest challenge was how to handle the grow-ing number of glaucoma patients who had to be admitted for surgery, because we were not able to put in as many surgeries as needed due to the Coronavirus. I tried several things, such as setting a stricter operating schedule than before so that as many surgeries as possible could be per-formed, making effective use of Friday mornings when there were few surgeons, and proposing the expansion of the number of glaucoma surgeons. I am grateful to Dr. Kijima, the Deputy Inpatient Medical Director, for her sup-port in many practical matters. The number of surgeries this year was the highest ever, but I think the victory was not because of my ingenuity... but because of Dr. Mitamura’s rigid skill in performing an overwhelming number of temporary surgeries.

　　One of the hardest things for me as the Outpatient Medical Director was deciding who to assign to which spe-cialty outpatient clinic before the start of the fiscal year. The transfer of doctors inevitably resulted in some short-staffed subspecialty clinics, and I had to ask several doctors to take subspecialty clinics they did not wish to be assigned to. It was challenging to equalize the weekly outpatient load and to provide as many opportunities for surgery as possible, so even after the start of the fiscal year, I had dis-cussions with Inpatient Medical Director Saito, Deputy Inpatient Medical Director Kijima, and medical staff mem-bers to make detailed adjustments. In addition, from this fiscal year, the number of surgeries and revenue jumped because of the policy of not refusing patients referred for retinal detachment and other procedures. This placed a heavy burden on the staff, and by the fall, fatigue hadreached its peak. The fact that we were able to get through the rest of the year with only a slight slowdown was due to the hard work of the residents and medical staff. I appreci-ate their hard work at that time.

　　I became the Department Director this past April, and I was perplexed that my job description is completely dif-ferent from that of the Inpatient Medical Director and Outpatient Medical Director. Until now, if I thought about clinical care, I could naturally see what I needed to do. However, the Department Director’s job is to manage peo-ple, and I had to think about something completely different from medical care, such as instructing and man-aging medical staff on what they must do as hospital employees, responding to consultations with consider-ation for the lives of medical staff and their families, and management of secretarial work which is increasing year by year. Last year, Dr. Iwata, the Department Director, said that the Department Director is like an anchor in soccer, and I feel that this is a very appropriate analogy. I think the role of the Department Director is to look at each patient while at the same time looking at the whole picture and supporting teamwork so that the entire team works well together. A university medical office is an organization responsible not only for clinical work but also for research and education, and I think it is a difficult task to find a bal-ance in “the work system reform” that will start soon. I would like to make an effort to move forward without los-ing the balance by working together as a team.