日本専門医機構2024/06/28社員総会にて日本医学会会長と日本医師会長が不穏な発言

皆さま、こんにちは。
ブログを書くのは久しぶりです。
今回は、2024年6月28日に行われた日本専門医機構の社員総会で、日本医学会会長の門脇先生と、日本医師会長の松本先生が、「どうしてこの場でこんなことを言わないといけないの？」という内容を言及したことを記事にしてみたいと思います。
これは、シリーズで深堀していきたいと思いますので、どうぞよろしくお願いいたします。

日本専門医機構とは？

日本専門医機構は、医療の質を向上させるため、専門医の育成・認定を統一的に管理する目的で設立されました。この機構は、医師の専門的な知識や技術を標準化し、継続的な教育と研修を提供することで、質の高い医療を患者に提供することを目指しています。また、専門医の認定や更新を通じて、医師が最新の医療技術を維持し続けるためのサポートも行っています。

日本専門医機構の社員とは？

日本専門医機構は一般社団法人です。
一般社団法人法における「社員」とは、会社でいう「株主」に相当する存在で、法人の設立者やその後に加入したメンバーを指します。社員は、法人の最高意思決定機関である「社員総会」に参加し、法人の運営に関する重要事項を決議します。社員の地位は、通常は譲渡や相続ができず、退社や解散までその地位を保つことが一般的です。また、社員は報酬を受け取る存在ではなく、出資者でもありません。
日本専門医機構の社員は、個人ではなく、機構の意思決定に関与する法人や団体がなっています。

上記の23団体が、日本専門医機構の社員となっています。

このうち、日本専門医機構の設立当初から社員だったのは、日本医師会、日本医学会連合、全国医学部長病院長会議、四病院団体協議会の4団体で、これらの4団体は、理事の定員枠を2個持っています。
あとは、内科系、外科系、有識者、一般枠でそれぞれ理事の定員があります。

日本専門医機構社員総会で行われた不穏当発言

日本医学会会長の門脇先生は、このような内容を日本専門医機構の社員総会で言及しました。

そのあと、日本医師会長の松本氏が、以下のように発言しました。

大体こういう内容の発言をなさっています。

これに対して、日本専門医機構理事長の渡辺氏は、以下のような内容を述べています。

おかしいと思いませんか？
門脇先生の発言は、伝聞のみです。
そのような内容を社員総会で言われたところで、執行部だったら、普通はこういうのではないでしょうか？

「門脇先生が述べられた内容について、事実確認をまずは致します。そのうえで、対処が必要なことについては対処してまいります。」

なのに、渡辺理事長はなぜ、いきなり、「やります！」に相当する内容を述べたのでしょうか？？？？

ここから浮かび上がってくることは、「社員総会で主要社員がこのような内容に言及した」ので、「対処しなければならない」という、「手続きの適正性」を担保しようとしたのではないか？という疑問です。

手続きの適正性だけを担保しようとすると生じる問題

手続きの適正性だけを担保すると、以下のような問題が生じる可能性があります。

実質的な公正さの欠如: 手続きが形式的に適正でも、その結果や内容が公正でない場合があります。これは特に、実質的な不平等や不公正な結果が放置されるリスクを伴います。

不当な結果の正当化: 手続きが適正であれば、その結果が正当と見なされることがあり、問題の本質に目を向けず、不当な結論が見逃される可能性があります。

透明性の欠如: 手続き自体が適正であっても、その背後にある意図や目的が不明確であれば、不信感が生じ、信頼が損なわれる恐れがあります。

手続きの適正性のみを重視した場合の良い例として、法廷裁判が挙げられます。例えば、適切な手続き（証拠の提出、証言など）がすべて守られていても、冤罪事件が起こる可能性があります。このようなケースでは、手続き上は正しかったとしても、事実の解明や公正な結果が得られていないため、被告が不当に有罪とされるリスクが生じます。このように、手続きの適正性だけでは正義が完全に実現されない場合があります。

また、手続きの適正性だけを担保された具体的な例として、ナチス・ドイツ時代のニュルンベルク法が挙げられます。この法律は、手続き上は適正に制定され、当時のドイツ政府によって合法的に運用されましたが、その結果、ユダヤ人をはじめとする少数民族や異なるグループが著しく差別され、人権が侵害されました。この例では、法の制定や手続きが形式的には正しかったものの、実質的な公正さが完全に欠如していたために、重大な不正義が生じました。

近代社会では、手続きの適正性だけでなく、公正な結果を確保するために、以下のような取り組みや義務が行われています。

1.コンプライアンス（法令遵守）: 企業や組織は法律や規則を守るだけでなく、倫理的にも適正な行動を求められています。

2.ガバナンス（統治）体制の強化: 組織内に内部監査や取締役会などの仕組みを導入し、透明性や責任を確保します。

3.情報公開の義務: 公共機関や企業は、重要な意思決定や活動に関する情報を公開し、透明性を高めています。

4.平等な機会の提供: 雇用や教育の場では、年齢、性別、人種、障害の有無にかかわらず、平等な機会を提供することが法的に求められています。

5.ホイッスルブロワー制度: 内部告発者を保護する法律が整備され、不正や不公正な行為を報告しやすい環境が構築されています。

これらの措置によって、手続きだけでなく、実質的な公平性や公正な結果が保障されるように努力されています。

日本専門医機構でこの後に勃発したおぞましい問題

これについては順次レポートしていこうと思います。

Hello everyone.
It’s been a while since I last wrote a blog post.
This time, I would like to write about the content of the speech given by Dr. Kadowaki, President of the Japan Medical Association, and Dr. Matsumoto, President of the Japan Medical Association, at the general meeting of the Japan Medical Specialty Board held on 28th June 2024, where they said, ‘Why do we have to say this here?
I would like to delve deeper into this in a series of posts, so please look forward to it.
What is the Japan Medical Specialty Board?
The Japan Medical Specialty Board was established with the aim of unifying the training and certification of medical specialists in order to improve the quality of medical care. The organisation aims to provide patients with high-quality medical care by standardising the specialised knowledge and skills of doctors and providing them with ongoing education and training. It also supports doctors in maintaining the latest medical technology through the certification and renewal of specialist doctors.
Who are the employees of the Japan Medical Specialty Board?
The Japan Medical Specialty Board is a general incorporated association.
In the General Incorporated Association Act, ‘employees’ are equivalent to ‘shareholders’ in a company, and refer to the founders of the corporation and members who subsequently join. Employees participate in the ‘General Meeting of Employees’, which is the highest decision-making body of the corporation, and pass resolutions on important matters concerning the management of the corporation. The position of a member is not normally transferable or inheritable, and is generally maintained until the member leaves the company or the company is dissolved. In addition, members are not paid for their services, and are not investors.
The members of the Japan Medical Specialty Board are not individuals, but rather corporations and organisations that are involved in the decision-making of the board.
Japan Medical Association
The Japanese Medical Science Federation
Conference of Deans of Medical Schools and Hospital Directors
Conference of Four Hospital Groups
Japan Cancer Treatment Certification Organization
Japanese Society of Internal Medicine
Japanese Society of Pediatrics
Japanese Dermatological Association
Japanese Society of Psychosomatic Medicine
Japanese Surgical Society
Japanese Orthopaedic Association
Japanese Society of Obstetrics and Gynecology
Japanese Ophthalmological Society
Japanese Society of Otorhinolaryngology-Head and Neck Surgery
Japanese Urological Association
Japanese Society of Neurosurgery
Japanese Society of Medical Radiology
Japanese Society of Anesthesiologists
Japanese Society of Pathology
Japanese Society of Laboratory Medicine
Japanese Association for Acute Medicine
Japanese Society of Plastic and Reconstructive Surgery Japanese Society of Rehabilitation Medicine
The above 23 organisations are members of the Japan Medical Specialty Board.
Of these, the Japan Medical Association, the Japan Medical Congress, the Conference of Deans and Directors of Medical Schools, and the Council of Four Hospital Organizations have been members since the establishment of the Japan Medical Specialty Board, and these four organisations have two seats on the Board of Directors.
There are also fixed numbers of directors for the internal medicine, surgery, expert, and general categories.

Unreasonable comments made at the Japan Medical Speciality Board General Meeting

Dr. Takashi　Kadowaki, President of The Japanese Medical Science Federation:
My name is Kadowaki, and I am the President of The Japanese Medical Science Federation. As President of The Japanese Medical Science Federation, I would like to express my opinions regarding the Japan Medical Specialty Board. I think I will only have about three minutes to speak, so please bear with me.
I would like to take this opportunity to express my sincere gratitude to the Board of Directors and all those involved who have worked so hard to manage the fifth term system. The Japan Medical Specialty Board has been in existence for 10 years now, and I would like to express my gratitude for the way in which it has shaped the specialist system in Japan to this day, responding to the changing needs of society and the times, such as the introduction of the ceiling system and work-style reforms.
Under the leadership of President Watanabe, the organisation has continued to work with the existing executive team, but has also adopted a stance of listening to the opinions of academic societies, and in recent years the financial situation has improved, and although it is still dependent on subsidies, it is on the verge of becoming profitable , and that there has been a change in attitude towards considering certification fees from the perspective of residents and young specialists, and towards listening to the opinions of residents, young specialists and other stakeholders.
On the other hand, there are some concerns about the administration of the secretariat and the collaboration between the secretariat, the board of directors, the various committees and the various academic societies. At the extraordinary general meeting of employees on 29th February, when President Watanabe was trying to explain the number of residents to be employed in 2024, there was a situation where the materials were not distributed to the employees and directors, and a misunderstanding occurred. I was concerned that this was not just an administrative mistake, but that there was a lack of coordination between the board of directors and the secretariat.
After that, I heard from many people involved that the secretariat was not able to provide various reports and explanations to the board of directors, committees, academic societies, etc. The secretariat strongly requested that academic societies in each field register their systems without sufficient preparation, causing confusion, and it took time for the board of directors to be informed of the multiple leaks of personal information, and the list goes on.
In addition, I have heard on multiple occasions that the person in charge at the secretariat approached various academic societies with a story that had no basis in fact, and that this led to a situation that was considered suspicious. While the individual secretariat staff are working hard, I have serious concerns about the external governance of the person in charge at the secretariat, who has contact with various doctors and business partners. I have also heard that the working environment is such that the treatment of secretariat staff is influenced by the decisions of the secretariat’s responsible persons without consultation or approval from the President or Board of Directors, and that secretariat staff cannot engage in their work with peace of mind.
I have just approved the 25 directors, but I would like the next executive board to make sure that the treatment is fair, and to work hard to create a good working environment with good communication and psychological safety, and to establish proper governance as a specialist medical organisation. That is all.
Dr. Kadowaki, President of The Japanese Medical Science Federation, made the above remarks at the general meeting of the Japan Medical Specialty Board.
After that, Dr. Matsumoto, President of the Japan Medical Association, made the following remarks
I am Matsumoto, the President of the Japan Medical Association. I would like to state that the Japan Medical Association agrees with the comments made by Dr. Kadowaki.
Firstly, I would like to express my sincere respect for the efforts made by the secretariat to date, but on the other hand, I think that there is a need to fundamentally review the situation, as there are instances of inaccurate and unfair treatment of individual academic societies.
In addition, in relation to this, we would also like to request that the President and Vice President become involved in the management of the organisation on a full-time basis. In particular, we would like to request that you consider the possibility of the President taking on the role of Secretary-General on a full-time basis. In some cases, it may be necessary to consider the selection of an Executive Director.
The Japan Medical Association will continue to firmly support the Japan Medical Specialty Board, so we ask that you kindly consider the above.

(Japan Medical Association President Matsumoto said as following;) What I would like to ask is that, although the JMA President Watanabe said earlier that the General Assembly is in a position to listen to opinions, I would like the JMA President and the other members of the Board of Directors to take seriously the fact that such strong opinions have been expressed, and I would like them to respond to these opinions properly, rather than just treating them as mere opinions.

In response to this, the President of the Japan Medical Specialty Board, Mr Watanabe, made the following statement
I did not mean to say that we would just listen to your opinions. As I have just said, we will take your comments seriously and work towards the goal of improving the work of the organisation and building a better specialist system in Japan.

Don’t you think that’s strange?
Dr. Kadowaki’s comments are based on hearsay.
If the executive board had been told such content at a general meeting of employees, wouldn’t they have said something like this?
‘We will first check the facts regarding the content Dr. Kadowaki mentioned. After that, we will deal with any issues that need to be dealt with.’
So why did Director Watanabe suddenly say something equivalent to ‘We’ll do it!
What emerges from this is the question of whether he was trying to guarantee the ‘appropriateness of the procedures’ by saying that ‘the main employees referred to this content at the general meeting of employees’ and that ‘it must be dealt with’.
Problems that arise when only the appropriateness of the procedures is guaranteed
If only the appropriateness of the procedures is guaranteed, the following problems may arise
Lack of substantive fairness: Even if the procedures are formally appropriate, the results or content may not be fair. This carries the risk of substantive inequality and unfair results being ignored.
Justification of unfair results: If the procedures are appropriate, the results may be seen as legitimate, and the possibility exists that the unfair conclusion will be overlooked without looking at the essence of the problem.
Lack of transparency: Even if the procedures themselves are appropriate, if the intentions and objectives behind them are unclear, it can lead to a lack of trust and undermine confidence.
A good example of a case where only the fairness of the procedure is emphasised is a court trial. For example, even if all the appropriate procedures (presentation of evidence, testimony, etc.) are followed, there is still a possibility of a wrongful conviction. In such cases, even if the procedure was correct, there is a risk that the defendant will be wrongly convicted because the facts have not been clarified or a fair result has not been obtained. In this way, justice may not be fully realised simply by ensuring that procedures are appropriate.
Another example of a case where only the appropriateness of procedures was guaranteed is the Nuremberg Laws of Nazi Germany. Although these laws were enacted appropriately and were legally implemented by the German government of the time, they resulted in the significant discrimination of minorities and different groups, including Jews, and the violation of human rights. In this example, although the law was enacted and the procedures were formal and correct, there was a complete lack of substantive fairness, resulting in serious injustice.
In modern society, in addition to ensuring that procedures are appropriate, the following initiatives and obligations are in place to ensure fair outcomes.
1. Compliance: Companies and organisations are required to not only abide by laws and regulations, but also to act ethically and appropriately.
2. Strengthening governance systems: Organisations introduce mechanisms such as internal audits and board of directors to ensure transparency and accountability.
3. Duty to disclose information: Public institutions and companies disclose information on important decisions and activities to increase transparency.
4. Equal opportunities: In employment and education, it is legally required to provide equal opportunities regardless of age, gender, race or disability.
5. Whistleblower system: Laws have been established to protect whistleblowers, and an environment has been created in which it is easy to report misconduct and unfair acts.
Through these measures, efforts are being made to ensure not only procedural fairness, but also substantive fairness and fair results.
The appalling problems that subsequently broke out at the Japan Medical Specialty Board
I will report on these in turn.