This doctor has a system

Chapter 387 452. Missed diagnosis
In fact, men do get breast cancer. Male breast cancer patients account for 1%-2% of breast cancer patients.

The cause of breast cancer in men is not yet fully understood. It may be related to a variety of factors, such as common genetic factors, liver function abnormalities, testicular damage or drug factors.

Zhang Wei's color ultrasound examination showed that there were indeed two masses in his left chest, and the probability of breast cancer was very high.

The breast surgeon also confirmed Gao Feng's judgment.

"Stay in the hospital, you're inseparable." She said to Zhang Wei, "We still need to complete your examination to see if there is any chance of surgery."

Unfortunately for Zhang Wei, follow-up examinations confirmed that he had breast cancer. But he was lucky. After evaluation, it was found that the stage was at an early stage and the diseased tissue could be removed through surgery.

"This is really..." He felt quite complicated in his heart. His girlfriend who came here specifically to check was okay, but on the contrary, he was about to lose his left breast.

Who can I talk to to explain this?

Director Shen of the provincial hospital suddenly received a call from Director Zhang of the Department of Respiratory Medicine of the First Affiliated Hospital.

"Do you have any advice, Director Zhang?"

"He went to the capital and has been there for the past two months." Director Shen suddenly realized, "He usually only comes back on weekends."

His student said: "Professor, of course you are good at surgery. Director Xu is not at the same level as you at all."

After receiving a call from Director Shen, Gao Feng said that he should think about it. He was running between two places now, which felt quite energy-consuming.

The next day, a representative from an equipment manufacturer came to visit and sat in the director's office. Director Zhang talked with him about the bidding for surgical equipment.

"Haha, advice is out of the question." Director Zhang said cheerfully, "Aren't we going to hold a special conference on lung cancer treatment? I'm thinking of inviting a few of you to come over and participate in the conference."

So, he asked his doctoral candidate: "Xiao Wang, tell me, is my surgery better, or is Director Xu of the cancer hospital better?"

He said to his wife: "Honey, who does the surgery better between me and Director Xu of the cancer hospital?"

"The development momentum of the First Affiliated Hospital has been so strong in the past few years." Li Youliang said on the side, "Their policies seem to be more flexible, but what the provincial hospital does here is still relatively rigid."

His wife said: "What are you thinking about? How can Director Xu compare with you?"

Director Xu is a veteran in the respiratory field in the province. Director Zou does not believe that he can perform bronchoscopy surgery better than Director Xu.

Director Zhang of the First Affiliated Hospital has a fund of tens of millions and has many academic appointments. He is the incoming chairman of the Department of Respiratory Medicine.

This made Director Zhang very embarrassed. After much deliberation, he decided to invite. After all, their names are written in the guidebook. If you don't come, it seems that the meeting is not very high-end.

All this actually has a lot to do with Director Zhang of the Department of Respiratory Medicine there.

"Invite us?" Director Shen was a little confused. The First Affiliated Hospital held a special conference on lung cancer treatment every year to expand its influence. In previous years, they were not invited to play.

"Is Gao Feng here? We would like to ask him to talk about the great value of bronchoscopy in the diagnosis and treatment of lung cancer." Director Zhang said.

What happened this year?
As the saying goes, if you show courtesy for nothing, you are either committing adultery or stealing.

Director Shen was silent on the phone for a while.

Director Zhang actually doesn't really want to invite people from the provincial hospital, but bronchoscopy intervention is the focus of the annual meeting. Many doctors attending the conference had watched Gao Feng’s bronchoscopy operation videos, and many asked him if he would come to participate.

When he got up one morning, he turned on his mobile phone, clicked on the official account, and saw a notification. It was Director Xu of the cancer hospital next door who had performed another difficult stent implantation surgery.

Moreover, the scientific research level of the First Affiliated Hospital has improved rapidly in the past few years, and even provincial doctors feel that it is difficult to compare.

"Our meetings will be held on these two days on the weekend." Director Zhang smiled, "You must make time to come over."

After the conversation, Director Zhang asked him: "Mr. Li, tell me, who is better at bronchoscopy between me and Director Xu of the Cancer Hospital?"

The representative of the equipment manufacturer hurriedly said: "Director Zhang, you are the most powerful bronchoscope I have ever seen!"

Another day later, there was a live broadcast of a surgery on the Internet. Director Xu performed an interventional surgery for airway malignant tumor stenosis. Director Zhang looked at it carefully and thought he did a wonderful job. He looked at the replay of his surgery again and still felt that it was not as good as Director Xu's.

At night, he lay in bed thinking about it and said: "My wife thinks I did a good job in surgery because she favors me; my students think I did a good job in surgery because they are afraid of me; the equipment dealer thinks I did a good job in surgery. , you are asking for something from me."

So, the next day, he came to the dean's office and met Dean Qi from the First Affiliated Hospital.

"Dean Qi, although I have published many SCI papers, received many funds, and was elected as the chairman-elect, my surgery is indeed not as good as Director Xu of the cancer hospital. However, my wife prefers me and my students are afraid of me. , my equipment manufacturer asked me for help, so they all said that my surgery was better than Director Xu."

"Today, our hospital has dozens of departments, thousands of beds, thousands of surgeries every year, and millions of outpatient and emergency services. All your secretaries like you, and all the directors of various departments are not afraid of you. None of the company's equipment vendors and medical representatives are asking for anything from you, so it seems that you have been deceived too seriously."

Dean Qi said: "What you said is really good."

So a rule was promulgated: "All department directors, chief physicians, resident physicians, and regular training physicians, who can get major projects from senior officials such as Outstanding Youth, Excellent Youth, etc., and who publish in top CNS journals will receive superior rewards; Those who can get the National Natural Science Key Projects and General Projects and publish SCI papers in District 1 will get medium rewards; those who can get the National Natural Youth Projects, prefecture-level projects and publish SCI papers with 5 points or more will get the lower prizes. Reward."

As soon as the regulations came out, all doctors began to engage in scientific research and apply for funds. Every time it is time to apply for various funds, the scientific research department is as busy as a market.

After a few months, fewer and fewer people were serious about clinical practice and surgery. Each department set up laboratories one after another, recruited postdoctoral fellows, and let doctors do scientific research and publish papers.

Since then, the First Affiliated Hospital has been ranked very high in scientific research, and there has been an endless stream of patients.

After listening to Li Youliang's words, Gao Feng felt quite magical and couldn't help but smile and shake his head.

He thinks this is a bit exaggerated. The main reason for the rapid development of the First Affiliated Hospital is that it is backed by Z State University. They are under the dual leadership of the Department of Education and the Department of Health, and have a great policy bias.

Moreover, students from the First Affiliated Hospital will always have inextricable relationships with their teachers after graduation, which is like constantly sowing seeds. It is not obvious in the early stage, but as time goes by, the seeds can always grow into towering trees.

This is the reason why many large hospitals affiliated with medical schools have developed rapidly in recent years.

The Provincial Hospital is at a disadvantage in this regard. Compared with the First Affiliated Hospital, they are like rootless duckweeds.

And what Li Youliang said is not wrong. The provincial medical mechanism is indeed somewhat rigid, which is inseparable from some historical reasons.

The provincial medical department has always been responsible for many political tasks, such as the health care of cadres across the province, and sometimes some people do not want it to undergo any major changes.

However, after President Guo became the top leader, Gao Feng felt that the hospital was much more energetic than before, possibly because of many substitutions in key positions.

I heard that they are going to cooperate with South University recently and add the name of South University Affiliated Hospital. I don’t know if it will happen.
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"Doctor, I have a severe cough." A middle-aged man in his 40s said to Gao Feng, "It's been more than three months." In the past three months, he has taken a lot of medicine, including antitussives. I tried it over and over again, but the coughing symptoms didn't ease at all.

"In fact, I think it's gotten a lot worse!"

This is why patients come to Union Medical College Hospital.

"It still hurts here now, and it hurts obviously when I cough and inhale." The patient pointed to the right side of his chest and said.

As he spoke, he couldn't help coughing a few times, and then quickly held his right chest with his hand, his expression slightly painful.

"Does it hurt?" Gao Feng asked with concern.

"Fortunately, it hurts more than it does now when I have a severe cough." The patient said with a grin.

Gao Feng stood up and performed a physical examination and cardiopulmonary auscultation on the patient. The patient's lungs had rough breath sounds, but no obvious wet and dry rales were heard.

As for the cause of his pain, it was probably a broken rib.

"Ah?" The patient was stunned for a moment, "I haven't had any bumps recently. How could I have a fracture?" He didn't believe it.

"It's caused by coughing," Gao Feng said.

Usually the main cause of rib fractures is a fall and a blow to the chest.

But sometimes severe coughing can also cause it. When the pressure generated by a sudden cough is greater than the elastic limit of the ribs, it can cause fractures in the most vulnerable parts.

It usually occurs in the middle and lower ribs, and is more common in the 8th, 9th, and 10th ribs. Some studies believe that the 10th rib is the most likely to fracture.

The patient's pain was around the 10th rib on the right side.

"Have you brought the chest CT that you took before?" Gao Feng noticed the information bag in the hands of the family members nearby.

"Take it with you." The patient's family members hurriedly took it out. "I don't see anything special in the report, and the doctor over there said it's not a big problem."

But the cough was so severe that it was very severe during the day and night, making him very anxious.

Gao Feng picked up the patient's chest CT and took a look at it. He soon discovered something was wrong. He picked up the report sheet and looked at it, and his expression became a little solemn.

"Doctor, what's the problem?" The patient had a strong ability to observe words and emotions, and immediately became a little nervous.

"Well" Gao Feng thought about it, "This may have been missed."

"Missed the diagnosis?"

"Yes." Gao Feng pointed to the chest CT film and said to him, "There is a high-density shadow here in the right main bronchus, but it was not mentioned in the report."

"Ah? Does my cough have something to do with this?" the patient asked a little excitedly.

"It's hard to say, but I think there should be a connection." Gao Feng said, he felt like this piece was a foreign object.

I asked the patient if he had choked on anything, and he looked confused.

"I don't know, I'm often drunk." The patient was a little embarrassed.

"If that doesn't work, just do a bronchoscope and take a look." Gao Feng suggested that in this case, it is best for patients to do an enhanced CT before a bronchoscope, which will come in handy in case a biopsy is needed later.

The patient's compliance was very high. He was so tortured by the cough that he couldn't bear it anymore. When he suddenly heard the doctor's discovery, he suddenly became hopeful.

After the patient went to hospital, Gao Feng looked at the chest CT report again. This was issued by a second-grade hospital. Logically speaking, such a mistake should not be made. After all, it is obvious on the images.

It's like a Rolls-Royce Phantom parked on an empty road. A car reviewer looked around carefully and said he didn't find anything.

It may not be called medical malpractice, but it is definitely an obvious medical error. If the patient goes back to make trouble, the doctors in the imaging department and respiratory department will definitely be overwhelmed.

You may want to ask, the report was issued by the imaging department, why does the respiratory doctor still have the responsibility?

That’s because reading chest CT pictures is a basic skill that every senior respiratory physician should master. The level may be high or low, but no matter how low it is, as long as one has the qualifications to make outpatient visits, such mistakes are not uncommon. Should.

In provincial hospitals, only senior attending physicians, deputy senior doctors, and senior senior doctors are qualified to go to outpatient clinics.

Of course, then again, sometimes the hospitals down there can’t do anything.

Many times, there may be only one senior professional title in the department, so you can’t let someone sit in the outpatient clinic seven days a week, right? It is also common for young doctors to rush to the shelves.

The patient had an enhanced CT examination the next day, which clearly showed that his right 10th rib was broken. As for the high-density shadow of the right main bronchus, the imaging doctor also wrote it down truthfully.

"I guess it's peanuts." Fan Yulong said. According to the patient's confession, he likes to drink and be jealous of twins.

"I think it's bones, fish bones or chicken bones." Zhang Zhengye also expressed his opinion.

高风也倾向于后者的说法，生花生、干花生、熟花生的CT值分别为19～43、-9～65、5～19，而患者肺中这个东西CT值要高的多。

In any case, as soon as the bronchoscope is done, it will show its original shape immediately.

As the bronchoscope entered smoothly, the situation under the microscope also appeared in everyone's field of vision. It was really a bone. Judging from the shape, it was most likely a chicken bone.

There was a sharp part in front of the bone that pierced the right main bronchus, and the surrounding mucosa was obviously red and swollen. This should be the reason for the patient's frequent coughing.

"Fortunately, the penetration was not deep, and there are no large blood vessels around it." Gao Feng said easily, and he motioned to the nurse to apply the foreign body forceps.

The nurse who set up the stage looked at Gao Feng's handsome face and felt a little confused, but she still handed over the pliers with quick hands and feet.

"Open." Gao Feng said, and the little nurse quickly opened the pliers.

"Clip." Gao Feng said quickly, and the little nurse quickly closed it.

With Gao Feng's gentle force, the bone that had penetrated the trachea was brought out. There was a small amount of bleeding on the mucous membrane, but it soon stopped on its own.

(End of this chapter)