Chapter 309: Diagnosis by Elimination: People Want to Save Face
Zhou Can was a little puzzled. The diagnosis of this case was not difficult, so why did they invite experts from the two hospitals to discuss this case together?
Even with his half-baked knowledge, he could easily diagnose that the patient's disease was most likely venous thrombosis. He didn't believe that the experts at Xinxiang Women's and Children's Hospital would be so incompetent.
"Director Zhang, what do you think is the cause of this patient's illness?" asked Professor Hu Wanjun.
"Uh... this patient's condition seems to be related to blood vessels. Every profession has its own expertise. I 'm not very good at this area." Zhang Bihua said unclearly, then turned to look at a male doctor in the expert team. "Director Shentu, you are an expert in cardiovascular medicine, so you should be more proficient in this area of disease. Do you have any good suggestions?"
Zhou Can clearly felt that the atmosphere at the scene was a little weird.
Both Professor Hu Wanjun and Director Zhang Bihua could definitely diagnose the cause of the patient's illness at a glance.
But both of them are practicing Tai Chi here.
After all, Zhou Can is a rich second-generation, and his knowledge and mind are much more mature than ordinary people.
After realizing that the atmosphere was not normal, he just kept his eyes on his nose and his nose on his heart, and never spoke a word without thinking.
There has always been a lot of drama in Xinxiang Maternity and Children's Hospital.
The fact that they sent Chief Tang directly to the emergency room that day to recruit him showed what kind of style this hospital is.
If a doctor can only treat illnesses, it will be difficult for him to achieve great success no matter how great his abilities are.
You may even not be able to survive in this industry.
In addition to dealing with complex interpersonal relationships, the ability to cope with various situations is equally important.
For example, during the treatment of a patient, if the doctor missed the vein with the first injection, a second injection is definitely needed. How to explain this to the patient or family members tactfully is a great test of the doctor's ability to respond.
After the explanation, the patient will smile generously and may even think that he has a special physique.
For example, some patients are too fat and have too thick a fat layer, so it is indeed difficult to find the vein.
Some patients are born with small blood vessels, which are not easy to find.
If the doctor misses the vein with the first injection and then gives the patient another injection without explaining anything, the patient will definitely curse in his heart even if he doesn't say it out loud.
If the doctor has low emotional intelligence and poor adaptability , and keeps emphasizing, "I've been giving injections for so many years, and I've never seen a patient like you who can't even grow a blood vessel properly."
I guess after hearing this, the patient would immediately jump up and argue with the doctor with his fists.
At present, Xinxiang Women's and Children's Hospital invited these experts to participate in the consultation, but the case was not difficult. The atmosphere was still so weird, and whoever spoke nonsense would be in trouble.
Director Shentu is here on behalf of the Department of Cardiovascular Medicine of Tuya Hospital.
He was in his fifties, wore black-framed glasses, and was a serious person. He was also very serious when he was treating patients. Zhou Can secretly observed that Director Shentu never smiled when he was treating patients.
No matter what kind of patient he was dealing with, he would frown and speak in a serious manner.
"Then I will throw out some ideas and share my humble opinion!"
Director Shentu did not refuse.
Shentu is actually a double surname, his full name is Shentubao. People who don't know him may think he is the younger brother of the ancient god Shen Gongbao.
"This patient's initial symptom was pain in the left lower limb, which later developed into pain in both lower limbs. Pain in the limbs can be caused by lesions in the skin, muscles, nerves, blood vessels, joints, and bones. I have even seen patients with severe pain in their limbs after their kidneys entered the decompensation stage. Malignant tumors are also particularly prone to causing unexplained pain in various parts of the body."
Director Shentu's commentary is just like his personality, meticulous.
"Neurological pain should be consistent with the distribution area of the nerves. It is often spontaneous and has the characteristics of sharp pain, tingling, burning pain or pulling pain. Nerve tenderness may even be found during physical examination. It may also be accompanied by symptoms such as numbness and weakness of the limbs. Some of the pain symptoms of this patient are consistent with neuralgia."
"However, the patient's main complaint was muscle pain. In clinical medicine, muscle pain is often located in the fascia, not localized or spontaneous, and the pain is mostly dull and aggravated by movement. At the same time, there will be muscle tenderness, muscle weakness, and even muscle atrophy. This patient's pain was not dull, and the relationship between pain and movement was unclear. She had been sitting or squatting for too long, and suddenly felt severe pain when she stood up."
"In addition, after the patient was admitted to the hospital for observation, the latest CK, electromyography, and muscle biopsy results showed no typical muscle damage. Therefore, common causes of muscle pain, including cramps, myolysis, myositis, leptospirosis, dermatomyositis, polymyalgia rheumatica, and fibromyalgia syndrome, can be ruled out."
Every doctor's diagnostic approach is different.
Director Shentu's diagnosis is as rigorous and meticulous as his personality. He uses the method of elimination to diagnose various causes.
In clinical practice, his diagnostic method is time-consuming and laborious, but the probability of error is low.
Zhou Can made a different diagnosis. Based on the patient's symptoms, ultrasound results, and his own clinical experience, he was able to directly diagnose the patient as having vascular disease. And he was able to identify it as venous thrombosis.
In terms of efficiency, Zhou Can's diagnostic method is definitely more efficient.
And Zhou Can's diagnosis is not necessarily wrong just because it is fast. So far, he has not made any misdiagnosis.
As for missed diagnosis, it is inevitable due to my lack of medical knowledge and very limited clinical experience.
Director Shentu's diagnostic method has a lower probability of missed diagnosis, but the possibility of missed diagnosis still exists.
Whenever you meet a patient with multiple lesions, I guarantee he will have to fumble with it for a long time, feeling overwhelmed and overwhelmed.
Therefore, there is no such thing as whose method is good and whose diagnostic method is bad.
No matter whether it is a black cat or a white cat, a cat that can catch mice is a good cat.
"According to the patient's auxiliary examinations, especially the results of B-ultrasound examinations, the possibility of deep vein thrombosis is very high. Therefore, the pain caused by vascular disease is considered. This type of disease includes acute arterial obstruction, arterial stenosis caused by atherosclerosis, thrombophlebitis, deep vein thrombosis, thromboangiitis obliterans, Raynaud's syndrome, etc."
"If the patient has arterial disease, intermittent claudication will occur in the affected limb, which will then develop into rest pain. If the artery is acutely and completely occluded, the patient's affected limb will experience severe pain, the skin will turn pale, the temperature of the skin on the surface of the body will be low, the pain will continue, and there will be no possibility of relief. In addition, limb gangrene will occur..."
Director Shentu is really good at talking. He just talked about a venous thrombosis, but he went on to say a lot of things.
And they are all symptoms and diseases related to the condition.
Some people like the process of elimination, but Zhou Can finds it particularly tiring.
However, it also shows Director Shentu's profound medical knowledge and extremely rich clinical diagnosis experience.
People who don't have any knowledge in their heads really can't analyze the disease like he does.
At least Zhou Can asked himself and realized that he absolutely couldn't do it.
Maybe after another ten or twenty years of accumulation, he will be able to quote extensively and investigate the causes of diseases one by one like Director Shentu. But he will definitely not do so, it is too tiring. There is really no need for this.
"Deep vein thrombosis in the lower extremities can cause pain and edema in the limbs, and sometimes there may be no symptoms. The pain may be intermittent. This patient's symptoms are more consistent with deep vein thrombosis, but the diagnosis cannot be made. I think further examinations are needed, first of all, a vascular color Doppler ultrasound should be performed to clearly diagnose whether there are lesions in the arteries and veins."
After Director Shentu ruled out a lot of possibilities, although he decided that deep vein thrombosis was a high possibility, he still did not jump to a conclusion.
Instead, further inspection is required.
Zhou Can also strongly supports letting patients undergo color ultrasound.
Both B-ultrasound and color ultrasound are ultrasonic examinations, but their functions are different.
Many patients do not understand the principles of the examination and think that doctors are making money by prescribing a B-ultrasound first and then a color ultrasound. Isn't this obviously a way of looking at how much money the patient has?
Not really.
B-ultrasound is a two-dimensional sonographic examination method, which has a very good examination effect for excluding tumors, organ tissue displacement, atrophy, etc. It can more accurately show the size, shape, and location of tissues and organs.
Color Doppler ultrasound uses color to display the direction and relative speed of blood flow in real time based on two-dimensional sonograms, which provides excellent diagnostic support for doctors to observe the blood flow and speed and direction of tissue movement in diseased tissues.
When it comes to checking blood circulation, many doctors even believe that color ultrasound is more effective than expensive MRI and CT angiography.
However, examinations of some deep arterial vessels still rely on angiography, which is a shortcoming of color ultrasound.
In short, in clinical diagnosis, when doctors prescribe both B-ultrasound and color ultrasound examinations, there is a certain meaning behind it.
As long as the doctor has any medical ethics, he is not trying to make money by cheating others, but is really trying to diagnose the patient's disease in a relatively cheap way.
Being a doctor is sometimes quite difficult. Not only do they have to ensure the accuracy of the diagnosis results and avoid misdiagnosis or missed diagnosis, they also have to find ways to reduce the patient's examination costs as much as possible.
But sometimes, patients and their families don’t understand and they verbally abuse or even beat the doctors.
In Zhou Can's opinion, people who choose to work as doctors or nurses all have great love in their hearts.
If you don't believe it, just look at the heroic figures of thousands of angels in white who went against the flow when the epidemic hit. They abandoned their families and rushed to the front line to stop the spread and ravage of the disease.
If possible, whose life is not precious?
Who doesn’t want to stay at home with his wife, children and the elderly and enjoy the warmth of family?
When the motherland and the people are in need, many of them will spontaneously sign up. This kind of great love spirit is really not something that ordinary people can have.
"Please ask the medical technology department to work overtime and perform a color ultrasound examination on that patient immediately."
Professor Hu Wanjun gave the order.
She seemed very calm about Director Shentu's diagnosis, as if she had known this result for a long time.
Zhou Can took everything in and was even more certain that Xinxiang Women's and Children's Hospital was fully capable of diagnosing this patient's disease.
Since they were able to diagnose the cause of this patient's illness, why did they invite Tuya's experts to come for a consultation? Asking doctors from other hospitals for help was not a glorious thing in itself.
What is their purpose in doing this?
Zhou Can quietly waited for the other party to show his true colors.
He remained calm, and Director Zhang Bihua, who was sitting next to him, was even calmer.
Even Du Leng, who usually loves to show off, noticed something strange at this moment. He lowered his head and fiddled with his ten fingers and long nails, which were as slender as a woman's.
Du Leng's IQ and EQ are actually not low.
Because he had been smooth sailing since childhood and had achieved academic success at a young age that ordinary people would never achieve in their lifetime, he was extremely arrogant.
Pride makes people regress, and sometimes makes them do stupid things.
In addition, he had always been beaten by Zhou Can, and he felt aggrieved and wanted to show off. So it was normal for him to confront Zhou Can.
In addition, Yang Chan maintained a very close relationship with Zhou Can, but was always polite to Du Leng, which made Du Leng very uncomfortable.
How could a genius like him have ever been suppressed like this?
What's more, the opponent who suppressed him was an undergraduate with a much lower academic qualification than him.
Also, people who are able to study abroad for a few years generally don't come from poor families.
Because tuition and living expenses abroad are not a small expense.
The tuition fee of hundreds of thousands per year is really not affordable for ordinary families.
As a child of a wealthy family, his academic achievements have reached the pinnacle of his life, and his inner arrogance is even greater than that of an ordinary genius.
His showdown with Zhou Can will definitely happen again.
After many setbacks, he should sum up his experience and lessons, and find ways to make the best use of his strengths and avoid his weaknesses, rather than continue to fight with Zhou Can in areas where he is not very good at.
"Director Zhang, this patient with lower limb pain has been basically diagnosed with this condition with the help of Director Shentu from your hospital. The experts at Tuya Hospital are indeed worthy of their reputation!"
Professor Hu Wanjun smiled and praised Tuya’s experts.
"You're too kind! The doctors at Xinxiang Women's and Children's Hospital are also good, they just have their own strengths."
Director Zhang Bihua handled it carefully.
"It will probably take a while for the ultrasound results of that patient to come out. We just happen to have a few difficult cases here. Can we take this opportunity to ask the experts in your hospital to help diagnose them?"
Professor Hu Wanjun finally revealed her true colors.
The previous case was probably just a bait to invite experts from Tuya Hospital. The following cases are the ones that really need help.
I can understand their half-hidden and half-concealed way of operating.
The poorer people are, the more inferior they feel.
Xinxiang Maternity and Child Health Hospital became notorious due to a series of scandals, and the reputation it had built up over decades has plummeted.
At this time, everyone in Xinxiang Maternity and Child Health Hospital, from top to bottom, had a deep sense of inferiority.
Doctors are the core of a hospital. To put it bluntly, doctors are equivalent to technicians in a large factory.
People who work in technology must be very proud of their research fields.
It was too embarrassing for a big shot like Hu Wanjun to directly present a large number of difficult cases to the doctors of Xinxiang Women and Children's Hospital for help. However, Dean Tian and the hospital management put pressure on them to take this opportunity to solve the backlog of difficult cases.
This will improve the quality of diagnosis and treatment and enhance reputation.
They had no other choice but to finally come up with a solution that they thought was less embarrassing.
Zhang Bihua smiled and said, "Sure. We're just sitting here waiting anyway, so we can consult other cases at the same time. That's good."
As worthy of being the head of the Department of Obstetrics and Gynecology of Tuya Hospital, Director Zhang's bearing and demeanor made Zhou Can admire him.
Knowing some of the other party's tricks, he did not expose them, but instead tried his best to maintain the other party's face.
This is true maturity.
Some people do not understand the ways of the world. They help others but do not show mercy to the other party and even expose their shortcomings to their faces. This is a big taboo.
Also, when the other party wants something, it is very unwise to take advantage of their situation and make demands.
Either don't help, or help more generously.
Just look at Han Xin in ancient times and you will know how miserable his end was.
When Liu Bang and Xiang Yu were fighting, Liu Bang could not defeat Xiang Yu and was in danger of being annihilated. He asked Han Xin for help, but Han Xin took the opportunity to put forward conditions, demanding that the land be divided and that he be crowned king.
At that time, Liu Bang was so angry that he almost flipped the table, slammed it hard, and was about to curse Han Xin's ancestors. Xiao He, the counselor next to him, kicked Liu Bang in an emergency and winked at him.
In the end, Liu Bang had to endure what no one else could endure, and he responded with inspiration. The table had already been slammed and could not be taken back.
What should I do?
He laughed several times and told Han Xin that the conditions you proposed were too shabby. You helped me so much, but you only asked for such a small benefit. Isn't that looking down on me, Liu?
Liu Bang promised Han Xin a larger fiefdom and reward on the spot.
Later, with the help of Han Xin, Liu Bang defeated Xiang Yu, gradually removed obstacles and hostile forces, and sat firmly on the throne. At this time, it was his turn to settle accounts with Han Xin.
People only know that Han Xin was killed by Liu Bang's wife, Empress Lü, but they don't know that the real reason was that at the critical moment when Liu Bang and Xiang Yu entered the final showdown, Han Xin claimed to be ill and did not attend the court or send troops. After being invited by Liu Bang, he took the opportunity to put forward conditions, which violated the taboo between the monarch and his subjects, and this laid the seeds of his own death.
Compared with ancient times, competition is actually more intense in modern times.
People who can hold a certain high position will not be too bad in terms of their breadth of mind, emotional intelligence and IQ.
Director Zhang Bihua showed enough kindness to the doctors of Xinxiang Maternity and Child Health Hospital, which is the most true portrayal.
"Director Zhang, and all the experts and doctors at Tuya, please look, this pregnant woman has a very serious respiratory infection. After being admitted to the hospital, she was given anti-inflammatory drugs. This is the pregnant woman's test results. The fetal heart rate is currently weakening."
When Professor Hu Wanjun introduced the patient's condition, her expression was serious and her tone was solemn.
This is quite different from the situation discussed with the previous patient.
As soon as Zhou Can heard it, he knew that the pregnant woman’s condition must be very serious and particularly tricky.
"She is already 37 weeks pregnant! With such a big fetus, the mother has a serious respiratory infection. It is very dangerous!" Zhang Bihua took the information and took a look at it, but her brows were furrowed more and more.
"That's right. She's only been in the hospital for two days, and her fetal heart rate has been getting weaker. We are very worried that the fetus may die in the womb. Do you think there is any good solution?"
Professor Hu Wanjun humbly asked for advice.
