Chapter 300: Twists and turns, pathology diagnosis promoted to level 5
Medical fraudsters have evolved a lot these days. They are no longer the foolish ones who used to be like pimps, waiting in the outpatient halls and entrances to solicit patients. News reports about medical fraudsters tricking patients into small hospitals and private clinics to get treatment and cheating them out of money have long been deeply rooted in people's minds.
Ordinary people are not fools either.
If you encounter a medical agent who strikes up a conversation for no reason and enthusiastically introduces a "miracle doctor" or a cheap hospital, you will immediately be alert.
In order to increase their success rate, medical fraudsters have long learned various disguises.
It can not only evade the crackdown by hospital security, but also better deceive the trust of patients and their families.
No one knows whether the family member requested to transfer the patient to another hospital on his own initiative or was persuaded by others. Zhou Can would not inquire about the patient's privacy.
What he needs to do now is to sort out the entire progression of the patient's illness from the onset to the present, as well as what treatments he has undergone and what are his current symptoms?
"I noticed that he looks quite thin now. Was he fat before he got sick?"
"Not bad! My son must have been fatter before he got sick. He used to weigh nearly 70 kilograms, but now he only weighs 59 kilograms."
The family member replied.
In just over two months, I lost 11 kilograms, which is another very bad sign.
A persistent low-grade fever also indicates that there is a serious problem with the patient's body.
For example, the most common leukemia and most cancers basically present themselves with symptoms of persistent low-grade fever.
Zhou Can once again read through the patient's various examination records from beginning to end, and formed a complete pathological mechanism in his mind.
"Little boy, 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 wanted to challenge himself to do a case that gave others a headache.
Du Leng just glanced at the examination records and pushed the patient out.
But Zhou Can couldn't do such a thing.
First, carefully follow the consultation process, examine the patient, and complete the medical record information.
There are no major problems with blood pressure and heart rate.
The patient was thin, had a low-grade fever of 37.9 degrees, and his legs shook uncontrollably when he stood up. This was probably not caused by pain in both knee joints, but rather by the patient's physical weakness or even a problem with his nervous system.
Nerves do not just refer to the narrow brain neurons, but all kinds of nerves in the body, including motor nerves, pain nerves, sympathetic nerves, etc.
“Are there any pain or swelling in these areas of your neck?”
Zhou Can touched the patient and asked him questions.
Palpation is a basic physical examination skill.
"No!"
The patient shook his head.
Zhou Can did not feel any lump on his neck. With a rigorous attitude of not missing any details, he touched the patient's armpit.
"Um?"
His eyes lit up slightly.
The patient, however, could not stand the itchiness and giggled, trying to avoid his hand.
"Don't move, don't move, be patient, I think I feel a lump."
Zhou Can looked serious.
After palpation, he found that both sides of the patient's armpits had nodular masses of varying degrees. Many people only know that the neck is rich in lymph nodes, but they don't know that the armpits are also rich in lymph nodes.
If I'm not mistaken, the patient's bilateral axillary lymph nodes have become swollen.
This is a new and important discovery.
Urine protein 3 plus, swollen axillary lymph nodes, sudden weight loss of more than ten pounds, persistent low-grade fever... These symptoms combined are definitely not the power of ordinary diseases.
When Zhou Can diagnoses diseases for patients, he never uses conventional thinking, but prefers to step out of the box and look at the problem from some special angles.
Although there was no test data to indicate that the patient had a malignant disease, he directly labeled the patient as a malignant disease patient in his mind.
It must be a serious disease like leukemia or cancer.
Of course, before it is clear, this idea must not be told to the family members. Otherwise, the family members will think that I am cursing their son and will definitely curse me.
"Let's get a CT scan of his chest, abdomen, and pelvis! Judging from his current symptoms, the situation is not optimistic."
Zhou Can looked at the family members.
"Can!"
The family now just wants to find out the cause of their son's illness as soon as possible and do more tests, which they are not opposed to.
Not long after, the patient came back after the CT scan.
Zhou Can checked the test results and indeed made a new important discovery.
The patient had bilateral axillary lymphadenopathy and bilateral pleural effusions.
Enlarged spleen.
In fact, the patient had always had an enlarged spleen. This was the result when she was first examined at the County Maternity and Child Health Hospital.
The bladder wall was thick, and both renal pelvises and bilateral ureters were dilated and effusion-filled.
There was also pelvic effusion and left colon wall thickening.
Seeing that the patient had so many lesions and they were serious, Zhou Can was worried that the patient's heart might also have problems. For the patient's safety, he asked the family to take the patient to do an echocardiogram.
This examination uses the special physical properties of ultrasonic short waves to examine the anatomical structure and functional status of the heart and large blood vessels.
It is a non-invasive test.
It is an advanced inspection technology.
The fact that Xinxiang Women's and Children's Hospital can perform these tests is enough to prove that it has a very solid foundation.
The strength of a hospital is not just about having complete hardware facilities. No matter which hospital it is, the most important thing is still talent. To put it bluntly, the level of doctors directly determines the diagnosis and treatment level of a hospital.
Echocardiogram showed LVEF 48% and pulmonary artery pressure 34 mmHg.
This pulmonary artery pressure is significantly higher than the normal value of 12-20mmhg.
Now that everything that needs to be checked has been done, the next step is to diagnose the specific cause and location of the lesion.
Although the patient was already ill, Zhou Can knew that there was probably only one cause, and it was a major malignant chronic disease.
Ureteral dilatation, proteinuria, weakened heart function accompanied by pulmonary hypertension, these newly discovered symptoms combined together, the first thing that came to his mind was urinary tract tuberculosis.
In addition, the patient has been suffering from urinary urgency and frequency, which made him more suspicious in this regard.
He took the patient's urine routine test results from another hospital and examined them carefully.
Pro 0.3g/L.
The WBC count in the blood test was only 2.2*10 to the 9th power per liter, which is significantly low. Normally, the white blood cell count for an adult should be above 4.0*10 to the 9th power per liter.
EOS%15.1%, the eosinophil value was significantly higher than the normal value.
The Hb and PLT data are normal.
Looking at these test data, Zhou Can's diagnostic thinking at this moment, like that of the expert from the Provincial Children's Hospital, fell into a pit of thinking.
Urinary tract tuberculosis?
Parasitic infection?
These two diseases were lingering in his mind.
"Doctor Zhou, what disease does my son have?"
The boy's father seemed to be losing his patience.
A lot of tests were done, and Zhou Can was so young, but there was still no diagnosis result.
The family members' trust in Zhou Can is gradually decreasing.
His situation was very similar to the day when Du Leng was pointed at and scolded by his family members.
"Wait a moment, our Doctor Zhou is diagnosing your son! This kind of extremely difficult and complicated disease is very difficult to diagnose. It requires reasoning, differentiation, and consideration of the factors and medical principles that are extremely complex. Please wait patiently and try not to interrupt Doctor Zhou's diagnostic train of thought."
Ji You, who was sitting next to Zhou Can, fully played the role of a "good wife".
He spoke up to explain a few words on Zhou Can's behalf and calmed the family members' emotions.
The effect of her explaining it out loud was much better than Zhou Can himself explaining it out loud.
If Du Leng had such a caring nurse to help him, he would not have been scolded so harshly by the family members.
After calming the family members and eliminating their worries, Zhou Can immersed himself in the diagnosis.
He was seen with a frown on his face, a deep look in his eyes, and his eyeballs rolling occasionally, indicating that he was thinking deeply.
Diagnosing a disease is more mentally demanding than solving word problems.
Especially solving difficult cases like this one requires a lot of mental effort.
"Check the urine acid-fast stain again!"
Zhou Can thought for a long time and submitted a new examination application to the patient.
The family members were a little emotional this time.
"Hasn't the urine routine been checked several times? Why do you need to check it again?"
It is not a good sign when family members begin to question the tests prescribed by the doctor.
This means that if Zhou Can does not make significant progress in the next diagnosis, he will completely lose the trust and cooperation of the family members. This patient's illness can basically not be diagnosed and treated further.
Because it was just a diagnosis, the family members had already raised questions.
When prescribing medicine or proposing surgical plans for patients, family members will be even less cooperative.
Doctors are paid for their work, so they will be somewhat unhappy when encountering such family members. It really doesn’t matter to doctors whether they treat one more patient or one less patient.
The end result is that the family members and patients are sent away.
"The test I prescribed for your son is a urine sediment test, which is different from a routine urinalysis test. The causes of the disease are also different. A routine urinalysis test is just a common routine test, which mainly checks the red blood cells, protein, glucose, nitrite, white blood cells and other indicators in the urine. A urine sediment test is a method . It is mainly used to diagnose diseases of the urinary system."
"After careful analysis and further diagnosis, I think your son's illness needs to be checked for urinary tuberculosis."
Zhou Can patiently explained and communicated with the family members.
When he communicates, his eyes are sincere and his attitude is friendly and sincere.
This undoubtedly increased the family members' favorability.
"I'm sorry, we misunderstood you! Please prescribe this examination for my child, and we will pay the fee and do it right away."
The patient's mother quickly stepped forward to smooth things over.
Although the boy's father didn't say anything, an apologetic expression appeared on his face.
When people communicate and talk with each other sincerely, they can feel the other person's sincerity.
Zhou Can's sincerity touched the family members, making them feel ashamed and guilty.
Soon, the urine sediment results came out.
WBC 118.1/ul, epithelial cell count 72/ul, bacterial count 8317.6/ul...
Zhou Can did not give up, and performed PPD skin test and blood TB-AB test on the patient, and the results were all negative.
At this point, urinary tract tuberculosis can basically be ruled out.
What kind of disease could that be?
He couldn't help but pick up the patient's CT film again to check it.
A tumor was discovered at the Provincial Children's Hospital and was removed surgically.
However, this does not rule out the possibility that there are other malignant tumors lurking in the patient's body.
When many cancer tumors first occur, they are smaller than 5 mm in size and are generally difficult to detect.
In medicine, tumors with a diameter of less than 1 cm are called microtumors. Doctors' attitude towards microtumors is a bit like that towards ants on the ground, which is actually not taken seriously.
This 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 they grow to a certain size will they cause obvious adverse effects on the body.
If a tumor is too small, it is difficult to determine whether it is benign or malignant.
A biopsy is needed to confirm the diagnosis.
Doctors usually ask patients to have regular check-ups and closely monitor the growth of the tumor.
Why does it involve human nature?
After all, the tumor did not occur in the doctor's body. When the tumor was still small, it was observed whether it continued to worsen, which was completely in line with medical rules. However, when the nature of the tumor was unclear, it was removed.
What if it is found to be a false tumor after surgery?
Also, pathological biopsy means taking samples, which will definitely stimulate the tumor.
Some tumors are inherently difficult to sample.
Asking doctors to take great risks in doing this may end up being a thankless task, so naturally no doctor would be willing to do it.
Zhou Can frowned and thought hard.
At this point in the diagnosis, we have actually reached a deadlock.
Director Zhang finished treating the patient in his hand, stood up and walked over.
She had been secretly keeping an eye on Zhou Can for a long time.
I also know that Zhou Can was facing an extremely difficult and complicated disease that was passed around by Dr. Du and Director Dai.
Zhou Can dares to take responsibility and is not afraid of being embarrassed by failing to make a diagnosis. This adventurous spirit and courage to save patients is very valuable.
"Doctor Zhou, if this patient's disease is really difficult to diagnose, you can admit him to the hospital for observation before making a diagnosis. Maybe you will get something! After all, this patient has been treated in the Provincial Children's Hospital for a long time. If even the experts in the Provincial Children's Hospital can't cure the disease, it must be extremely difficult."
Zhang Bihua not only intended to speak well of Zhou Can, but also to advise Zhou Can not to be anxious when encountering such patients.
You can admit the patient to the hospital first and then slowly resolve the problem.
More haste, less speed.
No matter how great a hospital is, it is impossible to determine the cause of all patients' illnesses in the outpatient clinic.
Many difficult cases that cannot be diagnosed are first arranged for hospitalization for observation. If we can find out the cause, that's the best. If not, we can only tell the family members and patients that we have tried our best.
"Thank you Director Zhang for your concern. I will try again. If nothing can be found, I will discuss hospitalization for observation with the family." Zhou Can nodded gratefully to Zhang Bihua.
He stood up and handed the examination records to Zhang Bihua for review.
Director Zhang came over and naturally helped him with the consultation.
There is no need to say this kind of thing explicitly.
"At first I thought the patient had urinary tract tuberculosis, but after multiple screenings, this disease can be basically ruled out. The possibility of parasitic infection has also been basically ruled out."
Zhou Can told Director Zhang about his diagnostic ideas.
After reading all the examination data and combining it with Zhou Can's diagnostic ideas, Director Zhang advised Zhou Can, "The cause of this child's illness is confusing and indeed very difficult to diagnose. You can try to start with the patient's two initial symptoms, vomiting and diarrhea, and have the patient hospitalized first."
As Zhang Bihua is able to secure the position of the head of the Department of Obstetrics and Gynecology at Tuya Hospital, her diagnostic skills are naturally beyond doubt.
Her words made Zhou Can's eyes light up.
Yes, we are used to taking unconventional approaches to diagnosis. How could we ignore the first two symptoms?
The way of truth is simple.
Martial arts masters often say that no moves are better than moves.
Everything in the world is connected and the principles are the same.
Medical diagnosis is similar to the practice of martial arts. At the beginning, you just copy others' moves, learn them, practice them until you are proficient in them, and then you can start to incorporate your own ideas and be flexible.
In diagnosis, Zhou Can often takes an unconventional approach and uses different diagnostic angles and ideas to diagnose cases, which is almost equivalent to the second stage in martial arts.
After becoming proficient and proficient, start to incorporate your own ideas.
Finally, we have a unique diagnostic method and distinctive diagnostic thinking.
Now, Director Zhang's words awakened him from his dream, making him feel as if he had been enlightened.
It was like I suddenly had a greater understanding.
It is not the accumulation of diagnostic experience, nor the deeper understanding of a certain disease, but a major breakthrough in diagnostic thinking and methods.
This is an improvement in realm.
His pathological diagnosis skills have taken the first step towards the path of simplicity.
[Your pathological diagnosis thinking and methods have made a qualitative leap, and your pathological diagnosis experience value has increased by +10,000. Congratulations on your advancement to level 5. Your current experience value is 1/100,000 of level 5, the junior level of associate chief physician.]
The last time he received a reward of 1,000 experience points, he felt that it was a historical first.
Because most of the time, the maximum amount of medical experience points rewarded is 100 at a time.
Unexpectedly, the reward limit was broken by him again.
The fundamental improvement in his diagnostic thinking actually directly advanced his pathology diagnosis skills to a higher level.
This should be an unprecedented advancement in medical skills.
Although his diagnostic experience and medical knowledge may not meet the level 5 standard, the system has already forced him to the level 5.
This kind of epiphany can only be encountered by chance.
It will probably be difficult to happen again next time.
Zhou Can believes that medicine and martial arts are becoming more and more similar and 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 achieved a major breakthrough, which was somewhat similar to his understanding of martial arts reaching a new level.
After his pathology diagnosis was promoted to level 5, Zhou Can found that he had a different experience when diagnosing the child's disease. When he looked back at the patient's disease, some previously obscure and vague aspects suddenly became clear.
