General medicine does not select patient and his problem, and is concerned with the same patient for a long time. We think together with patient and share joys and sarrows with him in order to solve his problems towards the final outcome that he expects, and pursue the quality of solving process and his satisfaction with special regards for dynamics of his family and community.
The characteristics of general medicine in comparison with differentiated medicine, basic requisites, frequently used tools, favorite jobs and the future of general medicine were described. Specific need to develop own tool for “integration”, initiative role of general medicine in medical education and the systems which support general medicine were mentioned.
Several matters which should be seeked in the education and training of general medicine was discussed.

Visceral impairment (VI), including cardiac, renal, pulmonary, hepatic, intestinal, urinary and rectal, AIDS is a worldwide public health problem. Recently, the number of patients with VI dramatically increased, reaching 30% of the total population of disabled patients in Japan in 2006, which corresponds to 60% of patients with limb impairment. Visceral rehabilitation (VR) is a coordinated, multifaceted intervention designed to optimize a patient’s physical, psychological, and social functioning, in addition to stabilizing, slowing, or even reversing the progression of the disease, thereby reducing morbidity and mortality. VR includes five major components : exercise training, diet & fluid management, medication & medical surveillance, education, psychological & vocational counseling. VR is a feasible, effective (Class I, evidence label A) and safe secondary prevention strategy following VI, and offers a promising model for a new field of rehabilitation. Medical science basically aims to “Adding Years to Life” by increasing life expectancy. Rehabilitation generally aims to “Adding Life to Years” by helping patients with impairment achieve, and use, their full physical, mental and social potential. However, recent growing evidence suggests that rehabilitation for patients with VI not only improves exercise performance and quality of life, but also increases survival. Therefore, modern comprehensive rehabilitation for patients with visceral impairment does not simply aim to “Adding Life to Years” but “Adding Life to Years and Years to Life”, which is a new rehabilitation concept. Urgent efforts should be made to increase the implementation rate of VR.

The number of the patients requiring rehabilitation has been rapidly increasing. Rehabilitation patients and their families face various troubles and problems in their illness, their functional state, their convalescence, and a wide range of domains including their at-home life and care burden. And rehabilitation staffs must deal with these problems appropriately and take pride in their efforts and strive to provide continuing reliable care. However, most hospitals and rehabilitation centers only have one or at most a few physiatrists. Thus, most physiatrists and co-medical rehabilitation staff have few advisers and are frustrated by the many kinds of problems faced in providing medical service and management. In this lecture, I discuss how to build safety measures, how to write medical records to prevent future troubles, the proper on-site manner, and the 15 traits of a disliked physiatrist. I hope that this lecture can blow away the frustration from the rehabilitation scene and be helpful not only for patients and their families, but also for physiatrists and co-medical rehabilitation staff.

The Great East Japan Earthquake occurred on March 11, 2011. As a representative of a local earthquake relief headquarters, I report what we have done in the stricken area following the Great East Japan Earthquake for the three months afterwards. As a result of this report, I strongly recommend the establishment of a “Disaster Rehabilitation” and “Disaster Acute Rehabilitation Team (DART)” as well as creating a “Disaster Rehabilitation Manual or Guideline” in order to pass the knowledge learned through our experience on to future generations and to be able to respond to any forthcoming disaster quickly and efficiently.

Subacute myelo-optico-neuropathy (SMON) is a neurological disorder caused by an anti-diarrhea drug, chinoform. It was not easy to find the cause of SMON, because chinoform was believed to be one of safe drugs. Prescription of chinoform was stopped temporary to investigate the cause of SMON, then there were no new cases of SMON and SMON was confirmed to be caused by chinoform. It was not easy to find all of the side effects of new drug on clinical trials, especially adverse drug reactions (ADRs) emerged following a long administration. Because the duration of trials was not long enough and the number of patients was small. Drugs, especially new ones, should be kept under watch following marketing to find ADRs as soon as possible. Insert packages of most drugs for neurological or mental disorders give warn not to let patients to drive because of sleepiness induced by the drugs. However there are no information showing how much risky to drive on taking the drug. It is not appropriate to inhibit driving legally on taking the drug, but the drug should have any information in the insert package how it is risky on driving under the drug.
 Drug-drug interactions are one of important issues on the treatment. The information in the insert package says physicians should be careful in prescribing drugs on drug-drug interactions. However, in many drugs applied in the treatment, there are no information how much the interaction affects pharmacokinetics of the drug in the insert package. It is essential to know the pharmacokinetics of drug interactions. In putting the warning of drug-drug interactions, the information how much it effects the pharmacokinetics of the drug should be given in the insert package.
 Pharmacovigilance is an essential system to apply new drugs to the therapy. Research and development of new drugs is promoted by pharmaceutical companies and physicians are required to cooperated to develop new drugs, however, on pharmacovigilance, it is essential for physicians to collect the information from their patients properly and to report it promptly. All of physicians should have training on the idea and action of pharmacovigilance on drug treatments.

　As medical safety attracts attention, it has become increasingly important to ensure the quality of medical education, and more emphasis has been placed on educational outcomes. An ideal form of training, in which medical students undergo medical education and then transfer to residency training seamlessly, can be conducted by setting general competencies required for all physicians as educational outcomes, as well as setting milestones in the process. Accomplishing competencies is the pillar of outcome-based education, and the assessment of students' achievements is important.
　The multilateral assessments of their competencies should be conducted, including written examinations, performance tests, observational assessments, and portfolios. In the existing national examination for medical practitioners, no such multilateral assessments are conducted. To promote seamless transition from under- to post-graduate education, it is important for the Faculty of Medicine and medical colleges to appropriately assess students' educational milestones as a condition of awarding them with degrees, in addition to the setting general competencies and such milestones.