【My medical skills can add experience points】【】
The medical care has evolved a long time ago, and it is no longer the foolishness of the past, guarding the outpatient hall like a pimp, pulling people at the entrance and exit. Because the news reports about Yituo cheating patients into small hospitals, private clinics for treatment, and cheating money have already been deeply rooted in the hearts of the people.
Ordinary people are not fools.
When encountering the kind of chatting up for no reason, enthusiastic introduction of 'miracle doctor', medical care from cheap hospitals, one will immediately be wary.
In order to increase the success rate, Yituo has long learned various disguises.
It can not only avoid the attack of hospital security, but also better defraud the trust of patients and their families.
No one knows whether the family member requested the transfer by himself or was transferred under the persuasion of others. Zhou Can will not inquire about these privacy of patients.
What he has to do now is to straighten out the entire progress of the patient's disease from the onset to the present, and what treatments he has undergone. What are the symptoms now?
"I noticed that he looks very thin now, was he fat before he got sick?"
"It's okay! Before my son got sick, he must have been fatter than now. He used to be close to seventy catties, but now he's only fifty-nine catties."
The family replied.
I lost eleven catties in just over two months, which is another very bad signal.
A persistent low-grade fever also indicates that there is a major problem with the patient's body.
For example, the most common leukemia and most cancers basically appear with persistent low-grade fever.
Zhou Can read the patient's various examination materials from beginning to end again, and formed a complete pathological mechanism in his mind.
"Little friend, uncle will give you a physical examination first, be good!"
Zhou Can stood up and took Ji You to do a physical examination on the patient. He wants to challenge the case that others have headaches just by looking at it.
Du Leng just looked at the examination data and pushed the patient out.
Zhou Can could not do such a thing.
First carefully follow the consultation process, give the patient a physical examination, and improve the medical record information.
Blood pressure and heart rate are fine.
The body is thin, the fever is 37.9 degrees, and the legs tremble uncontrollably when standing. It should not be caused by the pain of the knee joints, but may be caused by the patient's weakness or even a problem with the nervous system.
Nerves do not simply refer to brain neurons narrowly, but all kinds of nerves around the body. Including motor nerves, pain sensory nerves, sympathetic nerves, etc.
"Is there pain or swelling in these areas of the neck?"
Zhou Can asked the patient while touching.
Palpation is one of the most basic physical examination skills.
"No!"
The patient shakes his head.
Zhou Can did not feel a lump on his neck. With a rigorous attitude of not letting go of any details, he touched one armpit of the patient.
"Um?"
His eyes lit up slightly.
But the patient was so itchy that he couldn't stand it, he giggled and avoided his hand.
"Don't move, just be patient, I seem to have touched a lump."
Zhou Can has a serious face.
After palpation, he found that the patient's bilateral armpits had different degrees of nodular masses. Many people only know that the neck is rich in lymph, but they don't know that the armpits are also rich in lymph.
If you guessed right, the patient's bilateral axillary lymph nodes have been enlarged.
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【My medical skills can add experience points】【】
This is a new and important discovery.
3 plus urine protein, swollen axillary lymph nodes, weight loss of more than ten kilograms, persistent low-grade fever... These symptoms combined are by no means the power that ordinary diseases can have.
Zhou Can diagnoses diseases for patients. He never uses conventional thinking to differentiate syndromes, but likes to jump out and look at problems from some special angles.
Although there was no examination data to show that the patient had a malignant disease, he directly labeled the patient as a patient with a malignant disease in his heart.
It must be serious diseases such as leukemia and cancer.
Of course, this kind of thinking must not be told to the family members until it is clarified. Otherwise, the family members think they are cursing their son and will definitely curse him.
"Check out the CT of the chest, abdomen and pelvis! Judging from his current symptoms, the situation is not optimistic."
Zhou Can looked at his family members.
"Can!"
The family members just want to find out the cause of the son as soon as possible and do more tests, they are not against it.
Not long after, the patient came back from the CT scan.
Zhou Can checked the inspection results, and sure enough, he made a new major discovery.
The patient had bilateral axillary lymphadenopathy and bilateral pleural effusions.
Splenomegaly.
In fact, the patient has always had an enlarged spleen. This was the result of the first examination at the County Maternal and Children's Hospital.
Thick bladder wall, double renal pelvis, bilateral dilated ureters.
There was also pelvic effusion and left colon wall thickening.
Seeing that the patient had so many lesions and the lesions were serious, Zhou Can was worried that the patient's heart also had problems. For the safety of the patient, the family members were asked to take the patient for an echocardiogram.
This examination uses the special physical characteristics of short-wave ultrasound to examine the anatomical structure and functional status of the heart and great blood vessels.
It is a noninvasive test.
It belongs to an advanced inspection technology.
Xinxiang Maternity and Children's Hospital can do these tests, which is enough to show that its foundation is very solid.
It's just that the strength of a hospital has never been enough to have complete hardware facilities. No matter which hospital, the most important thing is still talent. To put it bluntly, the level of doctors directly determines the level of diagnosis and treatment of a hospital.
Echocardiography showed lvef48%, pulmonary artery pressure 34mmhg.
The pulmonary artery pressure was significantly higher than the normal value of 12-20mmhg.
Now that everything that needs to be investigated has been investigated, it is time to diagnose the specific cause of the disease and the location of the lesion.
Regardless of the fact that the patient already has a whole body of illnesses, Zhou Can knows in his heart that there is probably only one cause. And it is a major malignant disease among chronic diseases.
Ureteral dilatation, urinary protein, weakened heart function and pulmonary hypertension, these newly detected symptoms were combined, and the first thing that popped up in his mind was urinary tuberculosis.
In addition, the patient has always had urgency and frequent urination, which made him even more suspicious in this regard.
He took the patient's urine routine examination results in another hospital and checked them carefully.
pro0.3g\\/l.
The blood wbc is only 2.2*10 to the 9th power per liter, which is obviously low. Under normal circumstances, the white blood cells of an adult should be above 4.0*10 to the 9th power per liter.
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【My medical skills can add experience points】【】
eos.1%, the eosinophil value was significantly higher than the normal value.
The data of hb and plt are normal.
Looking at these examination data, Zhou Can's diagnosis thinking at the moment is also like the expert from the Provincial Children's Hospital, entering a pitted thinking.
Urinary tuberculosis?
Parasitic infection?
These two diseases were coiled in his mind.
"Doctor Zhou, may I ask what disease my son has?"
The boy's father seemed to be losing his patience.
A lot of examinations have been done, and Zhou Can is so young, but the diagnosis result has not come out yet.
The family's trust in Zhou Can is decreasing little by little.
His situation is very similar to the day when Du Leng was pointed at his nose and scolded by his family members.
"Wait a minute, our doctor Zhou is diagnosing your son! The diagnosis of this extremely difficult and difficult disease is very difficult, and the factors and medical principles that require reasoning, syndrome differentiation, and consideration are extremely complicated. Please wait patiently and try your best. Don't interrupt Dr. Zhou's diagnostic train of thought."
Sitting next to Zhou Can, Ji You gave full play to the role of a 'virtuous housemate'.
He explained a few sentences for Zhou Can to calm the emotions of the family members.
It is much better for her to stand up and explain than Zhou Can himself.
If Du Leng had such a caring nurse to help him, he wouldn't be scolded **** by his family members.
After comforting the family members, Zhou Can immersed himself in the diagnosis without any worries.
I saw him frowning tightly, his eyes were deep, and his eyeballs occasionally rolled a few times, showing that he was thinking deeply.
Diagnosing patients is more mentally draining than solving word problems.
Especially the answer to this kind of difficult case is even more exhausting.
Zhou Can thought for a long time, and put forward a new examination application for the patient.
The family members were a little emotional this time.
"Haven't the urine routine been checked several times? Why do you need to check again?"
The family members began to question the examination prescribed by the doctor, which is not a good sign.
It means that if Zhou Can does not make significant progress in the next diagnosis, he will completely lose the trust and cooperation of his family members. The patient's disease basically cannot be diagnosed and treated further.
Because it is only a diagnosis, family members have already raised doubts.
Family members will be even more uncooperative when prescribing medicines or proposing surgical plans to patients.
The doctor himself is paid for his salary, so he will feel a little uncomfortable when he meets such family members. It really doesn't matter to doctors whether to treat one more or less.
The final result is to send away family members and patients.
"The test I prescribed for your son is the urine sediment test, which is two different inspection items from the routine urine test! The causes are also different. The routine urine test is just an ordinary routine test, mainly to check the red blood cells, protein, Glucose, nitrite, white blood cells and other indicators. Urine sediment detection is a method of centrifuging urine with a centrifuge and checking urine sediment with a microscope. It is mainly used to diagnose diseases of the urinary system.”
"After careful analysis and further diagnosis just now, I think that your son's disease needs to be checked for urinary tuberculosis."
Zhou Can patiently explained and communicated to the family members.
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【My medical skills can add experience points】【】
In communication, his eyes are sincere, his attitude is friendly and sincere.
This undoubtedly increased the favorability of the family members.
"I'm sorry, we misunderstood you! You can prescribe this examination for me, and we will pay for it right away."
The patient's mother quickly stepped forward to smooth things over.
Although the boy's father didn't speak, he already had an apologetic expression on his face.
People can feel each other's sincerity when they communicate and talk with each other with their heart.
Zhou Can's sincerity moved the family members, making them feel ashamed and guilty naturally.
Soon, the urine sediment came out.
wbc118.1\\/ul, number of epithelial cells 72\\/ul, number of bacteria 8317.6\\/ul…
Undeterred, Zhou Can gave the patient a ppd skin test and a blood tb-ab test, all of which were negative.
At this point, urinary tuberculosis can basically be ruled out.
What kind of disease could it be?
He couldn't help picking up the patient's CT film to check again.
A tumor was discovered at the Provincial Children's Hospital and surgically removed.
However, this does not rule out the possibility that there are other malignant tumors lurking in the patient's body.
Many cancer tumors are less than 5 mm in size when they first occur, and it is generally difficult to detect them.
In medicine, tumors less than 1 cm in diameter are called micro tumors. The doctor's attitude towards tiny tumors is somewhat similar to that of ants on the ground, but they don't pay much attention to them.
It involves human nature and a lot of medical clinical experience.
The harm of malignant tumors in the early stage is very small and controllable. Only when it increases to a certain extent, will it obviously cause adverse effects on the body.
A tumor that is too small can be difficult to determine whether it is benign or malignant.
Need to do biopsy to be clear.
The doctor's approach is generally to tell the patient to have regular checkups and pay close attention to the growth of the tumor.
Why does it involve humanity?
After all, the tumor did not occur on the doctor himself. When the tumor is still small, it is completely in line with the medical rules to observe whether it continues to deteriorate. But in the case of unclear nature, it was cut.
What if it is found to be a pseudotumor after surgery?
In addition, pathological biopsy means sampling, which will definitely stimulate the tumor.
Some tumors are inherently difficult to sample.
Let doctors take great risks to do this, and the final result may be thankless. Naturally, no doctor is willing to do it.
Zhou Can frowned, thinking hard.
Diagnosis reached here, in fact, has reached a deadlock.
At this time, Director Zhang finished dealing with the patient in his hand, stood up and walked over.
She had been secretly paying attention to Zhou Can's side.
I also know that what Zhou Can encountered was a super-difficult and difficult disease that was kicked by Dr. Du and Director Dai.
Zhou Can dares to take responsibility and is not afraid of being ashamed if he cannot be diagnosed. This kind of adventurous spirit and courage in order to treat patients is very valuable.
"Doctor Zhou, if this patient's disease is really difficult to diagnose, he can be admitted to the hospital for observation before diagnosing, maybe it will be rewarding! After all, this patient has been treated in the Provincial Children's Hospital for a long time. A disease that experts can't cure must be hell-level."
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【My medical skills can add experience points】【】
Zhang Bihua not only has the intention of helping Zhou Can say good things, but also tells Zhou Can not to worry when encountering such patients.
It can be treated in the hospital first, and it can be solved slowly.
Haste makes waste.
Even in the most awesome hospital, it is impossible to say that the cause of all the patients admitted can be found out in the outpatient clinic.
Many difficult cases that cannot be detected are first arranged to be hospitalized for observation. It is best to find out, if not, then we can only tell the family and patients, we try our best.
"Thank you, Director Zhang, for your concern. I'll try again. If I can't find out, I'll discuss with the family members about the hospital observation." Zhou Can nodded gratefully to Zhang Bihua.
He stood up and showed the inspection documents to Zhang Bihua for review.
Director Zhang came over, of course to help him with the consultation.
This kind of thing doesn't need to be said at all.
"At first I thought the patient had urinary tuberculosis, but after extensive screening, the disease can basically be ruled out. The possibility of parasitic infection is also basically ruled out."
Zhou Can told Director Zhang about his thinking on diagnosis.
Director Zhang read all the examination materials, combined with Zhou Can's diagnosis ideas, pointed Zhou Can and said, "The cause of this child is complicated and confusing, and it is indeed extremely difficult to diagnose. You can try to start with the patient's vomiting and diarrhea, the two most initial symptoms, so that the patient can get a better diagnosis. The patient is hospitalized first."
Being able to hold the top position in the Department of Obstetrics and Gynecology of Tuya Hospital, Zhang Bihua's diagnostic level is naturally unquestionable.
Her words made Zhou Can's eyes light up.
That's right, I'm used to taking a slanted sword and not following conventional diagnostic thinking. Why did you ignore the first two symptoms?
From the avenue to the simplicity.
Martial arts masters often say that there are tricks to win without tricks.
All laws in the world are interlinked, and the truth is the same.
The medical diagnosis is also the same as the practice of martial arts moves. At the beginning, I followed the gourd and painted the gourd. After learning other people's moves, practiced them, and mastered them, I can start to incorporate my own things and be flexible.
In diagnosis, Zhou Can often takes a slant and uses different diagnostic angles and ideas to diagnose cases, which is almost equivalent to the second stage in martial arts.
After you are proficient and proficient, start to incorporate your own things.
Finally, there are unique diagnostic methods and distinctive diagnostic thinking.
Now, Director Zhang's words awakened the dreamer, giving him a feeling of enlightenment.
It was as if suddenly there was a greater realization.
It is not the accumulation of diagnostic experience, nor a deeper understanding of a certain disease, but a major breakthrough in diagnostic thinking and methods~www.mtlnovel.com~This is an improvement in realm.
His pathological diagnosis and medical skills have taken the first step towards the "road to simplicity".
[Your pathological diagnosis thinking and method have undergone a qualitative leap, pathological diagnosis experience +, congratulations on your pathological diagnosis being promoted to level five. The current experience value is level 5 1\\/, and the deputy chief physician is at the junior level. 】
The last time he received a reward of 1000 experience points, he felt that it was a precedent in history.
Because in many cases, the reward for medical skill experience is at most 100 once.
Unexpectedly, the upper limit of the reward was broken by him again.
The fundamental improvement of his diagnostic thinking actually directly promoted his pathological diagnosis technique to a level.
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【My medical skills can add experience points】【】
This should be an unprecedented promotion of medical skills.
Despite his diagnostic experience, and medical knowledge may not be up to level five. But the system has forced him to level five.
This kind of epiphany is rare.
It should be difficult to have next time.
Zhou Can believes that medical skills and martial arts are really more and more similar, and they have a lot in common. Many ancient Chinese medicine practitioners came from martial arts families.
Martial arts are divided into moves and mental methods.
His diagnostic thinking has achieved a major breakthrough, which is somewhat similar to the understanding of martial arts mentality that has reached a new level.
After the pathological diagnosis was promoted to the fifth level, Zhou Can found that he had a different experience when diagnosing the child's disease. Looking back at the patient's disease, some things that were originally obscure became suddenly clear.