My medical skills add experience

Chapter 190 You Continue Acting, So He Isn't Acting

This ability to diagnose and detect patients' hidden diseases in advance by visual observation and intuition was extremely popular in ancient times.Almost all skilled Chinese medicine practitioners know how to do it.

It's called visualization.

In traditional Chinese medicine, looking, smelling, asking, and feeling are the four most basic means of diagnosis.

Outreach comes first.

It is the eldest among the four diagnosis methods of traditional Chinese medicine.

By observing the patient's complexion, skin color, nails, tongue coating, body shape, etc., give the most intuitive first impression of diagnosis.The types of diseases can be roughly delineated to facilitate subsequent diagnosis of lesions and pathological dialectics.

Zhou Can's three-month training in the Department of Critical Care Medicine has gained beyond imagination.

At first, he didn't think so, but now that he has been trained in other departments, he realized that the three-month study in the Department of Critical Care Medicine has greatly helped him practice medicine.

Whether it is in rescuing critically ill patients, or in pathological diagnosis, unexpected situations encountered during surgery, etc., he can give him two points more confidence than others.

Vice President Ye personally extended his training time in the Department of Critical Care Medicine for two months, which can be described as well-intentioned.

For example, I went to the ward round not long ago. Even Director Jia didn't find out that the patient in the third bed had cancer, but Zhou Can found out.

Of course, this is only Zhou Can's preliminary diagnosis.

Also called guesswork.

Whether the patient really has cancer needs further verification.

It is impossible for Zhou Can to tell Director Jia directly without evidence, that the patient may have cancer, right?

It was the first time the two met today, and Director Jia's trust in him was still very limited.

In order for Director Jia to approve his diagnosis opinion, he must provide a reliable diagnosis basis, and it is best to point directly to the area where the lesion is located.

According to Zhou Can's experience, diagnosing this highly difficult recessive disease has a high probability of obtaining an additional reward of 100 pathological diagnosis experience points.

"Doctor Zhou, I guess your girlfriend must be very beautiful! Very attractive!" Qiu Hong suddenly smiled and said something confusing to Zhou Can.

"why would you say so?"

Zhou Can asked her puzzledly.

If Su Qianqian was not considered pretty, there would probably be no woman in this world who could use the word beautiful.

"Seeing how out of your mind you look, I guess you must be thinking about your girlfriend, right?"

Qiu Hong joked in a joking tone.

She was not malicious, but full of kindness.

Because when Zhou Can answered Director Jia just now, he seemed somewhat perfunctory.Director Jia's face was actually a little unhappy.

She has followed Director Jia for five years, and she knows Director Jia's temperament very well.

It was intentional to help Zhou Can explain.

He also intentionally reminded Zhou Can not to wander off.

"Hehe, Senior Sister Qiu is really humorous. I didn't miss my girlfriend just now, but I was thinking about the patient in the third bed. I don't think that patient is a simple duodenal ulcer."

Zhou Can is also a smart person, and he knew what was going on as soon as he heard it.

Taking a peek at Director Jia's slightly cold face, he quickly explained the reason for his absent-mindedness.

"That patient's duodenal ulcer is indeed very serious. They have a history of nearly 20 years. Can it be simple!"

she responded.

"No, no, I mean the patient may have other diseases!"

Zhou Can could only express his doubts in advance.

Don't let Director Jia misunderstand that he is a lazy person who doesn't concentrate on studying.

A small thing, seemingly insignificant.

But it may cause his image in Director Jia's mind to be greatly damaged.

You may not be able to see through a person in a lifetime, but one thing can really underestimate a person.

"Other diseases? Director Jia has already diagnosed liver cirrhosis and chronic superficial gastritis!"

she asked suspiciously.

Qiu Hong had just met Zhou Can, so she didn't know that he was deliberately making an excuse to explain to Director Jia the reason for his desertion just now.Or really diagnosed patients with other diseases.

She prefers the former.

He thought Zhou Can was just making an excuse so as not to give Director Jia a bad impression.

After having such an idea, her perception of Zhou Can suddenly changed a lot.

People who like to play tricks are generally not very attractive.

"I mean other diseases, like cancer!"

Zhou Can's words are really shocking and endless.

This time even Director Jia looked at him again.

Qiu Hong curled her lips, a trace of disdain appeared on her beautiful face.She didn't expect Director Jia's new student to be so exaggerated, you can just find an excuse, but now, in order to sensationalize, he directly said that the patient had cancer.

Fortunately, the family members are not here, otherwise there may be a quarrel.

"Director Jia, can I ask you for twenty minutes off? I want to check the patient's examination report. If the patient really has cancer, I'm afraid the feasibility of the operation plan needs to be re-evaluated. The patient is so old , there is a very high risk of surgery. I see that you set the surgery time for the patient at 1 p.m., wait until noon to check, I am afraid that the time will be too late."

Zhou Can explained the reason in detail.

The tone is sincere and the expression is sincere.

Qiu Hong almost didn't laugh out loud, and said it as if it was true, it's a pity that the new Dr. Zhou didn't go to act.

Her affection for Zhou Can was also gone.

"Go ahead!"

Director Jia readily agreed.

Zhou Can stopped talking nonsense, quickly returned to the inpatient department, and went to the third bed to check the patient's examination report.

"The patient had a history of smoking for nearly 50 years. His father died of typhoid fever 20 years ago, and his mother died of a mass in her abdomen 10 years ago. Because no pathological examination was performed, the nature of the mass is unknown."

In other words, the patient's mother is likely to have died of cancer as well.

The patient himself had undergone routine examinations such as X-ray barium meal examination, gastroscopy, blood and stool tests.

In addition, a B-ultrasound examination of the liver was also done.

"The upper border of the liver is 6 intercostal spaces, the oblique diameter of the right lobe is 13.5cm, the thickness of the middle clavicle is 2cm below the costal margin, and the length is 1.5cm, the thickness of the left lobe is 7cm, and the length is 8cm, the thickness of the subxiphoid process is 4cm, and the length is 3cm, and the light spot in the liver is thickened , enhanced, the echo distribution is still uniform, and the blood vessel course is not clear..."

B-ultrasound is mainly an examination of the liver.

At present, the possibility of liver cancer cannot be ruled out.

Because the liver has no pain-sensing nerves, it is called the most silent organ.

Many patients with liver cancer, once confirmed, are in the late stage.

Before this, there were hardly any obvious symptoms.

Zhou Can squinted and carefully examined the B-ultrasound film.

It is undeniable that the diagnostic basis of the Western medicine system is mainly based on the comprehensive dialectical results of various examinations.

At this point, there must be a wave of traditional Chinese medicine.

Experienced Chinese medicine practitioners only need to press the Cunguan ruler on the patient's wrist, and they can quickly get a clear picture of the patient's condition.It is comparable to Western medicine giving a whole body physical examination to a patient.

Why are ordinary people unwilling to go to the hospital now? Once you go in, no matter whether you are sick or not, you will go through a wave of routine checkups first.

If you want to be hospitalized, do more tests.

A few hundred yuan, thousands of yuan are gone.

As a result, I queued up for a whole day, and I was lucky to get the test results before the receiving doctor got off work.

Traditional Chinese medicine used to charge a fee for seeing a doctor, but it was often very cheap.

There are many Chinese medicine practitioners with noble medical ethics. When they meet poor people to see a doctor, they even pay for the medicine themselves.

Looking at the current Western medical system, people who have no money basically have to wait to die.

Don't naively think that public hospitals can settle the arrears anyway, and pay after treatment.

Those are emergency patients.

And not all emergency patients are in arrears.

Because in case the patient and his family renege on their debts, the unlucky ones will be the doctors and nurses in that department.

From this B-ultrasound film alone, it is difficult to tell whether the patient has liver cancer.

At least with Zhou Can's current level, after reading it, he thinks that the possibility of the patient getting liver cancer is very small.

Since it is not liver cancer, what kind of cancer is it?

There are too many cancers.

Excluding liver cancer, if there are cancer tumors in other parts, the patient will feel pain and abnormality to some extent.

Zhou Can read the patient's symptoms again.

The patient was then asked simple questions such as whether they had pain elsewhere.

When the patient responds to the onset, sometimes there will be pain in the back, which should be radiating pain.

At this point, liver cancer, abnormalities in other parts or severe pain are basically ruled out, and only the last case remains.

The symptoms caused by this cancer site were merged into the duodenal ulcer.

Gastroscopy has been checked, and gastric cancer is basically ruled out.

At this time, Zhou Can suddenly realized, could there be a gallbladder problem?
There are two reasons. The liver and gallbladder are blood brothers. If the liver is hardened, the gallbladder will be more or less affected.Cirrhosis of the liver, however, is not directly associated with gallbladder cancer.

The duodenum is very close to the gallbladder, which is equivalent to the relationship between cousins.

Gallbladder problems, there will be symptoms of abdominal pain.Jaundice is also common.

However, patients with cirrhosis of the liver may also have jaundice.

It is equal to the very occasional high overlap of each symptom.

It was precisely this kind of coincidence that even Director Jia, an old doctor with extremely rich experience in diagnosis and treatment, went astray.

Zhou Can carefully checked the B-ultrasound film again. The sound transmission of the gallbladder was good, and there was no abnormal reflection.

However, Zhou Can was unable to see the condition of the cystic wall and common bile duct very clearly because he did not take a special photo of the gallbladder.

It is very tempting to let the patient do another B-ultrasound, but the family members will have doubts.

Moreover, Zhou Can himself did not have the right to apply for examinations for patients.

This matter has to be referred to Director Jia or the treating doctor.

"I'll show the film to Director Jia for another look. If there are any problems, we will give you feedback in time."

Zhou Can went to Director Jia with the patient's B-ultrasound sheet.

Perhaps with Director Jia's level, he might be able to discover the abnormality.

At least the shape of the gallbladder is slightly abnormal for now.

Back in the outpatient room, Director Jia has already started seeing patients.

Although his Special Needs Specialist account is limited in supply, he is very famous and there are too many people who come to see him.

In order to prevent patients from waiting for a long time, or even find scalpers to buy high-priced numbers, he often tries his best to add a few patient numbers.

In addition, he often attends consultation in the morning and performs surgery in the afternoon, which makes his time very tight.

Holding the film, Zhou Can stood behind Director Jia, patiently waiting for the patient to see the doctor, and then showed Director Jia the B-ultrasound sheet.

"Director Jia, just now I went to the ward to check the patient's condition carefully. The patient has both symptoms of jaundice and abdominal pain, and he has expressed it. There is an obvious mass in his abdomen, but he has not expressed anything. I suspect that the patient may have There is a possibility of gallbladder disease or even cancer. It just happened to coincide with the symptoms of duodenal ulcer and liver cirrhosis, so it was not detected."

Zhou Can didn't dare to speak too harshly.

Because the basis for diagnosis is too little.

A medical diagnosis requires at least one solid diagnostic basis.

Such as B-ultrasound, MRI, CT, blood routine, urine routine and so on.

In the actual diagnosis and treatment process, doctors often need to have more than two solid diagnostic evidences before they dare to give a preliminary diagnosis opinion.

What is a first opinion?It is the kind with a question mark behind the diagnosis result.

"Gallbladder cancer?"

Director Jia took the B-ultrasound sheet and looked at it carefully.

Then his face became slightly dignified, he picked up the magnifying glass, and began to examine it carefully.

Qiu Hong, a young and beautiful doctor who was standing next to her, had a look of disdain for what Zhou Can said about gallbladder cancer at first.Because she had a preconceived opinion that Zhou Can was still acting.

However, when she noticed that Director Jia's face became serious a little bit, and even took a magnifying glass to check the B-ultrasound sheet carefully, she began to mutter in her heart.

Shouldn't there be a real problem?

Isn't this Gui Peisheng acting?

"It seems that there is something wrong with the gallbladder. Qiu Hong, call the B-ultrasound examination room immediately to see if the gallbladder is clearer in this patient's B-ultrasound film."

Generally, the imaging results of the examination are archived.

It is not that after printing to the patient, the hospital will not keep it on file.

In some responsible large hospitals, doctors in the medical technology department may even archive multiple copies.There may be one sheet that is actually printed for the patient, or only some of the better ones.

Qiu Hong hesitated, "Is your outpatient work temporarily suspended?"

"If this patient really has gallbladder cancer, it will be a big deal. It doesn't matter if the outpatients are delayed a little bit. Big deal, I don't take a break at noon and work overtime."

The work of a doctor is inherently more active.

When encountering a problem, the patient's life safety must be the most important thing.

"Okay! I'll call and ask right away."

After she finished speaking, she looked up at Zhou Can.

"Doctor Zhou, tell the guide outside, don't call your number yet."

Qiu Hong's tone has obviously changed, and Zhou Can can feel it.

He opened the door, explained to the guiding nurse outside, and returned to the outpatient room.

Medical guides are also nurses, and their status and salary are lower than those of department nurses.

Generally, the guides get 4K for one month, and the nurses in the department get at least 5K.

In terms of status, the guide nurses are also full of sadness.

In fact, it is similar in any unit. For example, the assistant police, the treatment and status are also worse than the official staff.

After Qiuhong got in touch with the B-ultrasound department on the list, the other party quickly sent all the B-ultrasound films of the patient.

Sure enough, there was a clear picture of the gallbladder.

As if finding a treasure, Director Jia hurriedly checked it with excitement, and looked at it very carefully.

"There is indeed a problem with the gallbladder, and it is very likely to be malignant. We must immediately notify the treating doctor and communicate with the family members to see if a multi-slice spiral CT can be performed. If necessary, an endoscopic ultrasonography can be performed. The patient The surgery schedule is temporarily cancelled."

Director Jia realized the seriousness of the problem.

The patient's condition was not very good, but after Zhou Can's reminder, it was discovered that the patient may have gallbladder cancer.

The operation must be canceled first.

Must be reassessed.

"The doctor who treats this patient seems to be Dr. Tang. I'll tell him right away." Qiu Hong made a phone call on the spot but didn't mention it.

After the communication, notify the outside guide to continue calling.

Many of these patients took leave of absence and even traveled thousands of miles to seek medical treatment.

Certainly cannot cancel their registration.

What should be read must be read all on the same day.

This is the professional ethics and sense of responsibility that doctors should have.

After experiencing this incident, Zhou Can's status has obviously improved a lot.

Director Jia looked at him more kindly.

Qiuhong's attitude towards him has also undergone subtle changes.

Strength is really a good thing, it can help Zhou Can quickly establish a position in new departments time and time again.

At this time, a young woman with a slightly pale face walked into the outpatient room.

A registration fee of several hundred yuan is required for a special-needs expert account. Ordinary patients, if they do not have difficult and miscellaneous diseases, will choose a more economical general doctor's consultation account when registering for this account.

The woman came alone, with no one to accompany her.

"Hello, Mr. Jia, I heard that you are very good at treating gastrointestinal diseases, so I came here from other provinces to see you."

"Beauty, let's sit down and talk. When we get here, Director Jia will definitely help you take a good look!"

Qiu Hong comforted her warmly.

The girl looks like she should be 24 or [-] years old, quite young and very fashionable.

Looks bad.

"Thank you!"

After she sat down, she began to describe her condition.

"I don't know what's going on recently. I have been having diarrhea recently. It was even worse yesterday. I vomited after eating. It was very uncomfortable. I had an examination at the local hospital and said that I might have enteritis. They prescribed some medicine for me. It doesn't work anymore."

She showed the inspection list to Director Jia for review.

Basically, the patients who come to the specialists with special needs have already been examined in other hospitals, and may even have been treated.

Therefore, they basically have one thing in common, they come to see a doctor with the inspection report from another hospital.

After Director Jia took it, he carefully checked each one.

"Did you have any chronic discomfort before the diarrhea?"

Three feet frozen, not a cold day.

Some of the more serious diseases do not happen instantly.Instead, it accumulates slowly and eventually erupts like a volcano.

Her situation belongs to vomiting and diarrhea, and colds may also cause these symptoms.

When experienced doctors diagnose and treat patients, they will check them one by one.

rather than jumping to conclusions.

The higher the level of experts, the more comprehensive their consideration.Therefore, don't question the level of experts.

Maybe he is just thinking about you more comprehensively.

"I don't have any other symptoms, but I have had constipation for a long time. It may have been more than two years. I searched on Baidu myself, and said that eating more fruits and vegetables can relieve it, so I adopted diet therapy. It has indeed been relieved to a certain extent. , but has been constipated."

She was somewhat embarrassed when she spoke of constipation.

After listening to Director Jia, he nodded and recorded it carefully in the medical record.

Zhou Can began to think about what disease this female patient had?

(End of this chapter)