Category: Scientific Program Committee

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Annals of Internal Medicineに4報のレターが掲載

ACPJC年次総会2018での「レターの書き方」と題したワークショップの結果、ACPの機関誌であるAnnals of Internal Medicineに4報のレターが掲載されました。その過程を片岡裕貴先生から報告いただきましたので、広報いたします。（PRC委員：前田正彦）

・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・

兵庫県立尼崎総合医療センター 呼吸器内科・臨床研究推進ユニット

片岡裕貴

ACPJC年次総会2018において、「レターの書き方」と題したワークショップ(WS)を行い、その結果、ACPの機関誌であるAnnals of Internal Medicine (AIM)に4報のレターが掲載されましたので、その過程をご報告いたします。

もともと筆者らは、「誰でもできる臨床研究」を合言葉に、多忙な日本の臨床現場でも実施可能な臨床研究のやり方を学ぶ各種WSを運営していました。その中の一つに、系統的レビュー(systematic review)を学ぶワークショップがあります(1)。

ご承知のとおり、系統的レビューとは、一つの臨床疑問を元に、その臨床疑問に合致するありとあらゆる研究をまとめる技術であり、その利用はEBMの実践にあたって必須とされています(2)。一方で、研究論文にアクセスすることができて、一定の英語力を元にその解釈ができる人であれば、一定の時間をかければ誰でも実践できる臨床研究でもあります。

系統的レビューの過程においては、組み入れた一次研究のバイアスを評価する、というステップがあります。これを応用すると、レターを書けるということを共同運営者である辻元啓先生が発見し、いくつかのレターを書きました(2)。

この経験を元に、臨床研究の遠隔学習プログラムであるMCR extension (3)において、2日がかりのWSを実施し、実際に受講生がレターを書けるようになる、という効果を確認しました (4)。

その際の受講生はあくまで臨床研究に関して一定の学習経験がある人たちでしたので、このWSを経験のない医師に適応可能か、という疑問を元に、今回のWSを企画・運営することにしました。

実際のプログラムは以下のとおりです。

事前 – 事前学習動画を見る（15 分） https://youtu.be/mQ8BXtw_cVI
– 課題論文（Graham KL, et al. Preventability of Early Versus Late Hospital Readmissions in a National Cohort of General Medicine
Patients. Ann Intern Med. [Epub ahead of print 1 May 2018] doi: 10.7326/M17-1724 http://annals.org/aim/article-abstract/2680053/
preventability-early-versus-late-hospital-readmissions-national-cohort-general-medicine）を読む
当日 「交絡」に着目したRisk of Biasの吟味とポイントの指摘を考えるhttps://drive.google.com/file/d/1NX3ejjD0pmlrxP1MWamnGHODcLO42

FX5/view?fbclid=IwAR01jb0u-zbW40P6CLpC68kc99Gl9wq-WXwl8rhHSqXhFuv5VehQ1_z7Dso
事後 グループごとにレターを投稿

論文は、AIMがACPの機関誌であることに加えて、比較的レターが乗りやすい雑誌であったこと、Epub ahead of printとして掲載されたので、レター投稿の締切（冊子版に載ってから1ヶ月）までゆとりがあることなどを鑑みて選びました。

事前に当院で行ったテスト版には3名、当日は28名(含学生3人)の参加がありました。4通のレターがAIMのウェブサイトに掲載され、その後本誌に掲載されました。のべ13人が著者となり、1st authorとなったのはいずれも臨床論文を書いたことがない人達でした。

レターを書くことは、英語論文を書くことの練習にもなりますし、単なる揚げ足取りにとどまらずに結果を解釈する、という意味で科学的思考を涵養する役にも立つと思います。

資料は全て公開しておりますので、新しい論文をみなさんの施設でジャーナルクラブとして取り上げる際には、ぜひご活用ください。

また、レターを通じて、次にある一次研究としての臨床研究の実践へとつなげていただければと思います。

引用文献

  1. システマティックレビュー（系統的レビュー）作成ワークショップ:誰でもできる臨床研究 https://www.facebook.com/SRworkshop/
  2. Users’ Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed. McGraw-Hill. 2014
  3. 「レター」の書き方の作法-週刊医学界新聞 http://www.igaku-shoin.co.jp/paperDetail.do?id=PA03164_02
  4. MCR extension https://www.google.com/search?q=MCR+extension&hl=en&safe=off
  5. Writing letters to the editor: A workshop. https://www.mededpublish.org/manuscripts/1824?fbclid=IwAR33ZVH1RZRDmgEI3wvbhzYSbi7JRGBf4irDKwb00Z9bvth1jKPRsFnyKOg

掲載されたレター
https://www.ncbi.nlm.nih.gov/pubmed/30716746
https://www.ncbi.nlm.nih.gov/pubmed/30716748
https://www.ncbi.nlm.nih.gov/pubmed/30716749
https://www.ncbi.nlm.nih.gov/pubmed/30716750

当日の様子

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ACP Japan Chapter Scientific Program Committee Interim Report

 

********************************************

Chair: Sugihiro Hamaguchi, MD, FACP

Fukushima Medical University

 

What We Accomplished

We planned and held the ACP Japan Chapter Annual Meeting 2018 at Kyoto University. We attracted almost 700 participants with approximately 40 sessions and 100 abstracts. We invited Dr. Jack Ende, the immediate past president of ACP, and has a constructive discussion with eager participants about “Mind & Arts as Essentials for Internists” in the plenary session. The new session, Kurokawa Award, a competition of clinical research presentations, gained a large amount of attention and gave an initial push for increasing academic atmosphere into the annual meeting.

 

What We Are Working On

We are preparing for the upcoming ACP Japan Chapter Annual Meeting 2019 at the same venues. The theme of the 2019 meeting is “Fostering Lifetime Fundamental Competences for Internists －Beyond Board Certification System－”. The board certification system has been recently revised in Japan and how to integrate mind and experience of general internal medicine into the system remains a great matter of debate in Japan where most medical residents strive to become a life-time specialist. We will have Dr. Robert M. McLean who is the president of ACP to discuss “the wider the general basis, the higher the special peak as a specialist” in plenary lecture before the plenary session with Japanese seasoned physicians.

In addition, we will offer many attractive sessions. The Lecture Marathon starting with Latest Paper reviews is a new session where a summary of the up-to-date papers will be introduced first followed by many short lectures on basic internal medicine will be provided. A special lecture concerning the nuclear plant disaster operation in Fukushima after the East Japan Earthquake will be presented by Dr. Kurokawa. We have also planned the same sessions that are popular in the previous meeting: Dr’s Dilemma (an inter-institutional Quiz tournament by teams of residents), MKSAP, and Kurokawa Award for poster session.

Many attendants will enjoy and learn a lot from English-speaking sessions as well.

We are sure that the increasing number of attendants will be expected to the 2019 meeting with plenty of attractive sessions.

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Scientific Program Committee welcomes new members!

New members are joining on!

Hi all,

I am very pleased to introduce the members of Scientific Program Committee (SPC). Nine new members joined the SPC. Please keep in mind these wonderful members.

Best regards,

PRC member Takamasa Miyauchi  MD

Scientific Program Committee

Sugihiro Hamaguchi MD, MSc, PhD, DTMH, FACP

Institution
 Fukushima Medical University
Department/Division
 General Internal Medicine
Job Title
 Professor
Message
 Think rich, look poor.
Scientific Program Committee

Eiichiro Sando MD

Institution
 Kameda Medical Center
Department/Division
 General Internal Medicine
Job Title
 Deputy Chief
Scientific Program Committee

Sho Sasaki MD, DrPH

Member
Institution
 Aso Iizuka Hospital
Department/Division
 Nephrology/Clinical Research Support Office
Job Title
 Chief physician/Chief advisor
Message
 Step by step

Hiroyasu Nakano MD

Member
Institution
 Kawasaki Municipal Tama Hospital
Department/Division
 Department of medicine, division of gastroenterology and hepatology
Job Title
 Assitant professor
Message
 I am not discouraged, because every wrong attempt discarded is another step forward (from Thomas A. Edison).
Scientific Program Committee

Yuki Kaji MD

Member
Institution
 The University of Tokyo
Department/Division
 School of Public Health
Job Title
 Graduate Student (MPH)
Message
 "To become a doctor implicitly places us on the side of those who believe the world can change (By Jonathan Mann)
Scientific Program Committee

Hiroyoshi Iwata MD, MSc

Institution
 Tokyo Jikei medical university
Department/Division
 Clinical Epidemiology
Job Title
 Phd　candidate
Message
 Every cloud has a silver lining
Scientific Program Committee

Yuka Kitano MD

Member
Institution
 St.Marianna University School of Medicine, Yokohama Seibu Hospital
Department/Division
 Emergency Medicine
Job Title
 Assitant Professor, Physician
Message
 Always think what's best for the patient.
Scientific Program Committee

Miho Tagawa MD, PhD

Member
Institution
 Nara Medical University
Department/Division
 Nephrology
Job Title
 Clinical Fellow
Message
 Heaven helps those who help themselves.
Scientific Program Committee

Urara Nakagawa MD, B.Ed.

Member
Institution
 Sapporo Tokushukai Hospital
Department/Division
 Primary center
Job Title
 Vice-president
Message
 Let it be
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Doctor’s Dilemma in ACP Japan Chapter Annual Meeting 2018 (2)

 

Dr. Uchiyama and I joined Doctor’s dilemma on behalf of our hospital. Doctor’s dilemma is one of the most popular part of Japan chapter, which is held every year in Kyoto. Luckily, We could win the championship. This article will be a simple report of my experience. It would be my pleasure if you get a rough image of what ACP Dr’s dilemma is and get interested in it.
Doctor’s dilemma is so called medical knowledge competition. Residents from many hospitals join it in pairs. More and more teams are taking part in it every year. The winner will be given the chance to participate in Doctor’s dilemma held in USA.
Doctor’s dilemma is divided into two parts, Preliminary and Final. In the Preliminary, we used smartphones to answer the questions. The questions were not so difficult, which made us a little bit nervous as losing even one question would be deadly. Ten team passed the Preliminary, which included us.
The Final started after short break. We answered 25 question from 5 areas, GIM, ID, Collagen, Nephro and Hemo. The questions were very practical and connected directly to what we do every day. We finished 25 questions at the second place.
The final question was to diagnose the case. I felt a little bit awkward because I have never seen the disease. However, the case was so typical that we were able to give the right answer. The final question was special because we could bet points as we wanted. We bet all the points and got our score double. We succeeded in making comeback to win.
It was a good match. Many factors contributed to our win. One of the reasons I would like to emphasize is that we belong to Tokyo bay medical center. We bought MKSAP with help and we use it as a self assessment literally. Attending stuffs are also very educative and nice. They Kindly cheered for us on the day. I strongly recommend you come to our hospital.
Finally, I would like to thank everyone who helped holding the ACP Japan chapter. I expect Dr’s dilemma to be even more competitive next year.
Keisuke Takano
Tokyo Bay Urayasu Ichikawa Medical Center
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Drʼs Dilemma に参加して（2）

先のACP日本支部総会におけるDoctor’s Dilemmaで見事優勝した東京ベイ・浦安市川医療センターチームの高野敬佑先生からの寄稿（日本語ver）です。是非、ご覧ください。（PRC　小尾佳嗣）

　この度、京都大学で開催されたACP日本支部のDr’ Dilemmaに参加させて頂きました。パ－トナーにも恵まれ優勝する事ができ、2019年にフィラデルフィアで開催される本選に日本支部代表として参加することになりました。簡単ではありますが、当日の報告をさせて頂きたく思います。
　私はACPの会員ではありましたが毎年京都で行われている日本支部には参加したことはなく、もちろんDr’ Dilemmaという企画の存在も知りませんでした。しかし今回参加してみて、非常に教育的なセッションが多く、充実した2日間を過ごす事ができたと感じています。京都へのアクセスが大変という方もいるとは思いますが、その労力をはるかに上回るものを得られるので、ぜひ1度は参加してみることをお勧めします。
　Dr’ Dilemmaは2日目に行われました。合計20チーム以上が参加していました。予選と決勝の2部構成で、予選ではスマートフォンを使って回答する方式でした。問題の内容はCBT～国家試験レベルで一見簡単ですが、その分1問のミスも許されないレベルの高い争いとなることが予想されたためかえって緊張しました。結果は4問間違いの4位で通過することができました。
　10分ほどの休憩を経て決勝が始まりました。総合内科、感染症、膠原病、腎臓内科、血液内科の5分野から10、20、30、40、50点の5問が出題される形式でした。10～30点は早押しの問題でしたが問題はそれほど難しくなく、各チームが一斉に押している状況でした。我々も必死になってボタンを押しましたがなかなか回答権が得られず、気づいたらトップのチームとは100点ほど差がついていて非常に焦りました。
　40、50点問題は各チームが一斉に回答する方式でした。問題の難易度はやや上がりますが、確実に回答権が与えられ、何よりパートナーと議論してから回答する事ができました。ほぼ全問に正解し、気づいたら2位の状態で最終問題に臨む事ができました。
　最終問題は診断当てでした。自分が診たことがない疾患を鑑別として書くのには抵抗がありましたが、典型的な症例であり自信を持って回答する事ができました。最終問題は持ち点のうち好きなだけかける方式だったのですが、持ち点を全てかけ、結果的に逆転する事ができました。
　振り返ってみると点数は拮抗しており、厳しい戦いでした。運によるところも大きかったと思いますが、我々が優勝する事ができた要因の1つに、当院の総合内科では全員がMKSAPを購入して自己学習教材としている点があると思います。当日は多くのスタッフが応援してくださり本当に良い研修環境だと思っています。もし当院での研修に興味を持たれた方がいらっしゃいましたらご一報いただけると幸いです。
　末筆ではありますが、このような貴重な体験を与えて頂いたACP日本支部の先生方、開催にご尽力されている方々に心から感謝を申し上げたいと思います。多くの方に興味をもって頂き、年々レべルが高くなっていくことを切に願います。
東京ベイ・浦安市川医療センター
高野　敬佑
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Doctor’s Dilemma in ACP Japan Chapter Annual Meeting 2018

 

I am honored to report that Dr. Takano and I won first prize in the American College of Physicians (ACP) Doctor’s Dilemma competition in Japan.

At first, my goal in joining the competition was simply to assess my skills as an internist. Since distinguished young doctors from all over Japan would be in the contest, I wanted to compare my abilities to theirs. However, with the support of my partner, Dr. Takano, I ended up winning the championship.

Several factors contributed to our victory. First, we prepared for the competition by working up many MKSAP questions to enhance our medical knowledge. Second, our teamwork might have been superior to that of other teams because Dr. Takano and I have been colleagues since we were junior residents. Above all, I believe that our success resulted from our day-to-day sincere attitude and strong passion for helping every patient we see in our hospital. Our success was cultivated in the excellent environment that the attending doctors in our hospital promote. The victory led me to conclude that our hospital is the ideal place to practice medicine and improve my skills as a physician.

I am quite excited about the chance to participate in the ACP Doctor’s Dilemma Final that will be held in Philadelphia in 2019. Since Japanese teams typically struggle in the tournament, our biggest goal is to win the first game. I have no doubt that we can do it. I look forward to it and will continue to brush up on my medical knowledge until then.

Finally, I would like to express my heartfelt gratitude to the attending doctors who gave us the chance to join the competition, the friends who congratulated us, and my family who support me unconditionally.

 

Shuhei Uchiyama

Tokyo Bay Urayasu Ichikawa Medical Center

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Drʼs Dilemma に参加して

先のACP日本支部総会におけるDoctor’s Dilemmaで見事優勝した東京ベイ・浦安市川医療センターチームの内山秀平先生からの寄稿（日本語ver）です。是非、ご一読ください。（PRC　小尾佳嗣）

この度、京都にて開催されました米国内科学会(ACP)日本支部総会におきまして、Dr.’s dilemmaで優勝をおさめ、2019年に行われるPhiladelphiaでの本選に出場する機会を頂くことができました。日本全国の名だたる病院の若手医師が集まる中、優勝という最高の形で終えられたことは私にとって大きな驚きであり、また同時に喜びになりました。これからPhiladelphiaにおける本選に向けてさらに知識を高め、本番ではできる限りの力を尽くし、悔いのないように取り組みたいと考えております。

出場者にとってのこのイベントの最大の魅力は、日常のトレーニングの成果を試す機会が得られることであると感じています。日々の診療は一つの施設内で行われるため、自身の医療知識やスキルを相対的に評価する場面はなかなかありません。今回のDr.’s dilemmaは、非常に限られた領域ではありますが内科医師としての力を他施設の若手医師の皆様と比較する非常に良いチャンスとなりました。この文を読んでいる初期研修医・後期専修医の皆様、自身の力試しと考えて、ぜひ奮って来年以降の本イベントへの参加をご検討ください。

今回優勝することができた理由は、第一に、当院ではMKSAPによる自己学習を推奨しているため、それに取り組み日々の医学知識の研鑽を重ねたことが考えられます。第二に、チームワークが良かった点もあるかもしれません。高野先生と私は後期専修医としての同期ですが、それ以前に初期研修医として同じ施設で勤務していました。気心がよく知れていたのでお互い遠慮せずに回答できるため、クイズでは相互に知識を補完しあいながら協力し、その結果、後半はほとんど全問正解することができました。しかし何より、私たちの最大の力の源は当院の指導医の先生方が作り出す日々の素晴らしい教育環境と、全国各地から集まった切磋琢磨できる素晴らしい同期の皆であると感じています。優勝はもちろん嬉しいことではありますが、当院での日々の努力が正しい方向に働き、医師としての力が育っていると実感できたことが何よりも嬉しく感じられました。

私たち二人だけの力では、優勝には到底たどり着かなかったでしょう。今回の優勝は東京ベイ・浦安市川医療センターの総合内科全員で勝ち取ったものであると考えています。この機会に、日々お世話になっている皆様にあらためて感謝を申し上げます。

そして、このような貴重な機会をいただくことができましたACP 日本支部の諸先生方に感謝を申し上げ、優勝報告といたします。

 

東京ベイ・浦安市川医療センター

内山秀平

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Greetings from Dr. Ende (Immediate Past-President of ACP)

Impressions of Japan ACP Chapter Meeting 2018

Jack Ende, MD, MACP, Immediate Past-President, ACP

 

I was honored early in June to present a plenary talk on Professionalism and the College Update for the ACP Japan Chapter Annual Meeting 2018.  The meeting was a great success.  The topics presented ranged broadly across the practice of internal medicine, medical education, professional development, and, even, physical diagnosis.  What left the greatest impression on me, however, was the theme of the meeting:  “Mind and Arts as Essentials for Internists:  Beyond Evidence and Technology.”

As Meeting Chair, Yugo Shibagaki, MD, FACP, so eloquently wrote in the program guide, “Patients’ needs are not only for medical treatment or cure, they’re also for relief and comfort, sincere attitude and sympathy, and for compassion of doctors and medical staff to listen to their mental as well as physical suffering.”  Dr. Shibagaki continued, “Medical schools tend to teach only skills and knowledge, but not professional or affective attitude or mindfulness.”

What is mindfulness and how does mindfulness relate to practicing internal medicine?

Mindfulness can be defined as the psychological process of bringing one’s attention to experiences occurring in the present moment.  It is a heightened sense of awareness of what is really happening.  In our field, internal medicine, mindfulness is appreciating that a patient is sad or angry or confused – and doing something about these emotions, even if it is merely providing an empathetic comment.  It is appreciating that a patient’s clinical situation is determined by their environment, their relationships, and their lived experiences – and then factoring those social determinants into the treatment plan.  It is also the doctor recognizing within him or herself that, at least at that moment, the stress may be too intense, or the workload too great – and then taking steps to improve those unfavorable conditions.

I also appreciated the message of the program was intended to move us forward, not backward.  This was clear from the subtitle:  “Beyond Evidence and Technology,” calling attention to the word “beyond.”  Mindfulness does not take us back, it moves us forward to a different level – I would say a higher level – of clinical expertise as internists.

The 2018 ACP Japan Chapter meeting was enormously successful, which is not at all surprising given the outstanding commitment and energy of the Chapter’s leadership, members and staff.  The program demonstrated just how enriching medical practice can be, particularly when that practice goes beyond evidence and technology.  I am grateful to have been part of the meeting.

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Greetings from Dr. Muruganathan (Governor of ACP India Chapter)

 

Date: June 9th, 2018

Dear Brothers and Sisters, Greetings!

Thank you for inviting me to attend the ACP Japan Chapter Annual Meeting 2018. I thank Governor ACP Japan Chapter Dr. Fumiaki Ueno and family for the nice welcome and hospitality. You have chosen the right theme “Mind & Arts as Essentials for Internists: Beyond Evidence & Technology”. The practicing medicine is both science and art. Science of uncertainty and art of probability.

The arrangements, the venue, the registration procedures were really good. The workshop on Statin was very innovative and involved everyone. The participants in the workshop were made to ask clinical questions and also were made to use the internet to search the latest guidelines and articles relevant to the topic. There were debates whether they can trust the answer

they found.

The participant clearly understood the 5 steps of evidence based medicine. With the above background applying and sharing the decisions with the patient was also highlighted. I understood in Japan they use only small dose of Statin to reduce cholesterol. On the whole the workshop was simple and

complete to cover all the points regarding Statin usage.

I could attend only one workshop. There were other useful interesting topics in other halls like How to evaluate jugular venous pulse at bedside – you can do it, from now on, Minds and arts for end of life discussions through case discussions of cancer patients at terminal stage, A workshop to write “letter to the editor” and etc.

We had a good lunch with the dignitaries who include Dr. Jack Ende Past President ACP, Governor Dr. Fumiaki Ueno, Dr. Kenji Maeda Governor Elect and others. Regarding the session on hypertension there was an initial discussion about how to develop guidelines. During my talk on “Recommended Treatment Protocol for Improving Management of Hypertension Globally” I recommended the following 2 protocols.

HYPERTENSION PROTOCOL – SINGLE PILL COMBINATION AS FIRST-LINE TREATMENT

HYPERTENSION PROTOCOL – CALCIUM CHANNEL BLOCKER AS FIRST-LINE TREATMENT

There were lot of questions on hypertension regarding the definition, the target especially for elderly population etc. I always used to promote home blood pressure monitoring in my country. I am very happy to know most of the patients in Japan are using the home blood pressure monitoring. Ambulatory Blood Pressure Monitoring (ABPM) is ideal but it is not practical. Sooner there may be some devices like wrist watch which can record ABPM very easily. There were lot of discussion about automated office BP monitors. There were lot of lively questions on various aspects of treatment from the audience and

the hall was full.

I was fortunate to be a referee for the “Kurokawa Prize” for poster presentation. Lot of innovative original research papers were presented by the junior doctors. The talk given by ACP past President Dr. Jack Ende on Professionalism was mind boggling. Overall I learnt lot of new points both in academics and organizing. The award function and reception were well organized. I could meet lot of new fellows during the reception and made friendship with them. This also helped me to initiate exchange programme and other joint activities between Japan and India ACP chapter.

The people in Japan are very nice, cordial, honest and helpful. The transport like bullet train, subway train and busses were amazing. I and my family thoroughly enjoyed every movement of our stay in Japan both at Tokyo and Kyoto. We are looking forward to the next best opportunity to visit Japan again. Congratulations to Dr. Fumiaki Ueno, Dr. Yugo Shibagaki, MD, FACP Chair, ACP Japan Chapter Annual Meeting 2018, Governor Elect Dr. Kenji Maeda and members of the organising committee for the wonderful conference.

Thank you once again.

 

A. Muruganathan, MD, FACP
Governor, ACP India Chapter

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Kurokawa Prize in Student

Toshiro Goto, senior medical student

Tokai University

I performed my presentation titled“Cavitary Lung Lesions in a Patient with Positive IGRA and PR3-ANCA are not Always due to TB or GPA: a Case Report of Right-Sided Infective Endocarditis”. It was an honor to receive first place in theKurokawa prize competition, the best abstract award (medical student section) at the annual conference of the ACP Japan Chapter 2018.
I am interested in clinical reasoning, so I often attend case conferences and journal club sat the General Internal Medicine department to read and discuss cases from theNew England Journal of Medicine. A doctor suggested that I write an abstract. However, I was a fourth-year student at that time and had not started my clinical clerkship yet, so I started asking about cases for the abstract. Since I have a passion for studying infectious diseases and rheumatology diseases, I still remember how excited I was when I took this case.

In this case, it was saddening to learn that is under standing of laboratory data led to them is diagnosis of the patient which resulted in anatrogenic exacerbation of the patient’s condition. We must consider bacteremia and infective endocarditis from the history and vital signs, and send a blood culture for examination. If the culture is positive, then we need to perform an echocardiogram. There is no doubt that his quality of life would have been improved with those few non-invasive procedures. A famous Japanese doctor who I respect says that the essence of the physician is the differential diagnosis. You can’t take note of the patient’s history, conduct a physical examination, perform a laboratory examination, and conduct the treatment without a differential diagnosis. So in this case, if infective endocarditis was included in the differential diagnosis in the early stages, we could have avoided such a situation by conducting a blood culture and an ultrasonography. It is said that a lot of unneeded laboratory examinations are performed in Japan. Some people even say “clicking the order button is not the prescription for a doctor’s anxiety to misdiagnosis”, but the lesson I learned from this case is that laboratory examinations sometimes startle us, not knowing the character of the laboratory examination.

In closing, I would like to take this opportunity to express my appreciation to you all. It would be impossible to have this award without your help. I will go forward on my newly set goal, which is to do a presentation at theACP Internal Medicine Meeting 2019 in Philadelphia, PA, USA. Thank you for your time.

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