This doctor has a system

Chapter 516 579. The more you talk, the angrier I get!
Gao Feng was speechless for a long time after listening to this. What the hell is this expert?

"They are not engaged in clinical work. They only care about so-called details," said Li Youliang.

There is nothing wrong with being picky about details in medical procedures, such as the three checks and seven comparisons, but this should be done in different situations. It is absolutely stupid to be picky about first aid procedures.

A doctor can only suffer a loss once, and the next one to suffer is the patient.

This is the case with one bad apple spoiling the whole barrel.

The doctor-patient relationship is ruined by a few patients and doctors.

"Ma Liang, what do you think we should do about this?" Gao Feng asked. It would definitely not be okay for Doctor Zhou to do this, as his students would be led astray by him.

"I don't know," Ma Liang was very hesitant. He also felt that Dr. Zhou's behavior was wrong, but it seemed understandable.

"He was hurt before, but the other patients are innocent." Li Youliang said, "The vast majority of patients are good people!"

Gao Feng went directly to see Director Dong, who looked helpless.

"Xiao Zhou is a bit boring and likes to dwell on trivial matters." He said, "In fact, his personality is not suitable for emergency work."

"But I have to find a place for my student. After all, he is studying this major."

After all this time, Dr. Zhou is still Director Dong's close student.

"If it doesn't work, let him go to the emergency observation ward as a second-line patient." After a moment's hesitation, Gao Feng suggested, "I think Dr. Zhou's title and years of experience are both suitable."

"It's reasonable to be a team leader."

"This needs approval from the hospital." Director Dong said with embarrassment. The emergency department does not lack second-line staff, but what it lacks is people who can work the night shift.

According to convention, Dr. Zhou will have to work on the front line for at least another 3-4 years before he can get out of it.

So even though he made a mistake, he can still get promoted early?

Director Dong felt very embarrassed. Although he was Dr. Zhou's graduate supervisor, he was also the director of the emergency department, managing more than a hundred people.

Once this loophole is opened, it will inevitably damage his authority.

You see, if we work diligently and honestly here, his students will be able to lead the group ahead of time.

As a person who attaches great importance to rules and conventions, Director Dong is reluctant to do this.

"We can talk about this here, why don't we ask Doctor Zhou for his opinion?" Li Youliang suggested.

Doctor Zhou soon arrived at the department director's office. He was not good-looking, the kind that you wouldn't be able to pick out on the street. He looked much older than his actual age and was exhausted.

The other party greeted Gao Feng.

"Why do you look so depressed?" Director Dong asked.

"I worked all night yesterday." Doctor Zhou yawned. He was originally preparing to go off work, but a doctor in the same group had an emergency at home, so he asked him to stay for another 2 hours.

"Zhou, do you feel tired working in the emergency department?"

Doctor Zhou looked at Director Dong in confusion, "Director, are you stupid?"

Do you think I’m tired in this state?
"I heard there's a small flaw in your work process," Director Dong said politely, "You like to do an electrocardiogram on patients with no heartbeat."

Upon hearing this, Doctor Zhou immediately understood what was going on.

"It's only one minute, so it won't delay anything." He replied, "Didn't the expert say it last time? The process is very standard and the information is very complete."

"It's better not to do that. Every second counts in emergency rescue," said Director Dong.

"It depends on the situation." Doctor Zhou didn't want to talk more about this.

"Teacher Zhou, do you have feelings for the emergency department?" Li Youliang asked, "Have you ever thought about changing departments?"

After all, I have been working here for so many years, it would be a lie to say that I haven’t experienced any, but not many.

"I would like to go to the medical records room. I applied for it once two years ago, and Director Wang from the Medical Department even called me and scolded me," said Doctor Zhou.

Director Wang said that he had no ambition and was just thinking about hanging out with a bunch of old men when he should be working on his career.

"You want to do medical record management?"

"It's not really necessary to do medical record management. I just don't want to have direct contact with patients anymore."

Director Dong finally listened to Gao Feng's advice and decided to let Dr. Zhou lead the team in the observation ward starting next month.
-
At 10 p.m., the Provincial Hospital Intensive Care Unit

A man in a deep coma and on a ventilator was urgently transferred from a local hospital.

"What's going on?" asked Dr. Ye on duty.

"Zhou Shuai, male, 29 years old, suffered a fractured tibia and fibula in a car accident and is in a coma." The doctor who transferred him quickly explained the condition to Doctor Ye.

Patients who were involved in car accidents were not uncommon, but the patient in front of him felt very strange.

"Why did he fall into a coma?" A big question mark arose in Dr. Ye's mind.

"Did you hit your head?" he asked the family members.

"No!" The family member looked anxious, but answered with certainty, "I was with him at the time."

The two are brothers, they like fishing and are real fishermen.

Look, a fish pond in the neighboring county is having a big sale and is not charging any fish pond fees.

When the two brothers heard this, they immediately got on their motorcycles and set off.

"I was sitting in the back seat," said Zhou Shuai's older brother Zhou Gang. "When we were turning a corner, a small car came towards us out of nowhere."

The front fender of the car stuck the front half of the motorcycle inside. Fortunately, both cars were driving slowly and Zhou Gang in the back seat was not hurt at all, but Zhou Shuai's left leg was broken.

"I didn't touch any other part of his body, I just touched his leg," Zhou Gang said. "He was shouting so loudly at that time."

Examination at the local hospital showed that only his left leg was fractured. However, on the second day after the accident, Zhou Shuai suddenly developed impaired consciousness, respiratory failure, and urinary incontinence.

The cause of the sudden change in his condition was difficult to identify, and the planned fracture repair surgery had to be shelved. The local doctor wrote "Trousseau's syndrome?" in the diagnosis opinion.

Terrouseau syndrome? Dr. Ye was a little confused. To be honest, this was the first time he had heard of this disease.

After some research, I found out that Trousseau's syndrome is a paraneoplastic syndrome, which is mainly manifested by neurological lesions related to malignant tumors.

In the case of Trousseau's syndrome, the malignant tumor activates the patient's coagulation system, causing systemic thrombosis and cerebral infarction.

Zhou Shuai's MRI film was full of bright spots, indicating that there were multiple scattered acute infarction lesions in his bilateral thalamus, basal ganglia, lateral ventricles, and bilateral frontal and parietal lobes.

This is also the reason why the hospital below considers this disease.

Doctor Ye had some doubts about this matter, so he called his superior doctor and prepared to send the medical records to him for review.

"What? The patient's condition is urgent? What about the rescue?"

"Can't do without me?"

"Okay! I'll be there right away!"

Director Xie was on a day off today as his wife had him mopping the floor and wiping the table at home. He was very happy to receive the call. He lives nearby and came here on his broken bicycle.

He had a small electric donkey before, but the battery was stolen, so Director Xie simply bought himself an eight-hand bicycle. At first, the old man guarding the staff shed wouldn't let him park it there, saying it wasn't worth it and no one would steal it.

"A common manifestation of Trusseau's syndrome is acute multiple cerebral infarction. We should indeed take this possibility seriously." Director Xie said after looking at it for a long time.

"It may not be Trusso!" Doctor Ye quickly added that Zhou Shuai was alive and well before the car accident and had no history of cancer.

"That's strange. How could a simple fracture lead to a cerebral infarction?" Director Xie couldn't understand it. At present, it seems that the cause of the patient's coma is probably due to cerebral infarction.

Since you can't figure it out, just ask someone for a consultation.

Doctor Ye quickly wrote down a few lists, all of which ended with: Please consult with your department for guidance on diagnosis and treatment.

The director of the imaging department took another careful look at the film and said, "It is definitely acute cerebral infarction. He has multiple scattered lesions, which are not very common. It is best to look for the cause carefully."

Doctor Ye looked at him without saying anything. Didn’t I come here to find out the reason?

"Director, you've seen a lot. What do you think is the cause?"

"How can I explain that?" The director of the imaging department said worriedly, "Isn't it the job of you clinicians to find the cause? We are just responsible for issuing a report."

He said and withdrew.

The neurologist also rushed over at this time and found some problems.

There are large red bleeding spots on Zhou Shuai's skin, as thin as a needle tip, and they can easily be overlooked if you don't look closely.

"It's hard to say. Why don't we treat the cerebral infarction first?" The director said, "Sometimes it's hard to find the cause of the disease. I guess it has a lot to do with his trauma this time."

Gao Feng received a call from the intensive care unit the next day.

Zhou Wei is still in a coma, which is why Dr. Ye is anxious.

Looking at the young patient on the ventilator, Gao Feng also felt very strange.

The patient is a young fisherman with good physical condition. There is no obvious abnormality in the test results.

It's just a fracture of the tibia and fibula, how could he suddenly fall into a coma?

The patient has no high-risk factors for cerebral infarction.

Is it really bad luck?
Thinking of this, Gao Feng subconsciously shook his head, saying that it seemed a bit too early to say this.

He patiently performed a physical examination on the patient, but because Zhou Wei was in a coma, he did not get much information.

There were red bleeding spots on the patient's abdominal skin. According to Dr. Ye, there were more of them before, but they have subsided a lot in the past two days.

"I really don't have any idea." Gao Feng said, "What are your considerations?"

"A doctor previously said it might be Trousseau's syndrome."

"It shouldn't have anything to do with this." Gao Feng said after thinking for a while. The patient's coagulation function has always been normal.

In the case of Trousseau's syndrome, the coagulation system in the patient's body would be activated by the malignant tumor, but the patient does not have any malignant tumor.

"I'll go back and check the information." Gao Feng said and prepared to leave. At this time, the nurse came to provide care. She took a piece of gauze dipped in some saline and wiped the patient's facial area.

“There’s quite a lot of sesame paste.”

Sesame paste is what we often call eye boogers.

Gao Feng paused when he heard this. It seemed that he had forgotten to look at this during the physical examination.

He walked forward and opened Zhou Shuai's eyelids. Five or six almost invisible white particles were attached to his eyelids.

Gao Feng picked it up with a cotton swab and examined it carefully, but couldn't recognize what it was.

He talked to Doctor Ye and asked him to send the sample for testing.

When he returned home in the evening, Dad Li was entertaining guests in the living room. When the guests saw him coming back, they tactfully stood up and said goodbye.

"Old Yang from our unit is here to be evaluated as an advanced worker." Dad Li said this with a complicated tone. Once upon a time, he was also jealous of these advanced positions every year.

But now, he has become the one who can decide who to give the quota to, which is really amazing.

Sure enough, you can’t rely on yourself, you have to rely on others!
"Good son-in-law, drink some tea, I just brewed some Tieguanyin."

Gao Feng's son now sleeps with his grandmother or great-grandmother. The two elderly people are afraid that Li Xinyao will age quickly if she stays up late.

"I'm quite bored all day long. All I do is feed the kids." Li Xinyao was abused at work before, so she's a little uncomfortable with the free time now.

She went shopping with a few of Yao Dan's close sisters, but they were all very busy. If she went alone, she wouldn't know what to buy.

It seems that she has everything she needs, and the things she used to want are no longer of interest to her. She wants to buy something for her son, but the elderly don't let her worry about it, and the baby products they bought fill up the house.

"Why don't I just go back to work?" Li Xinyao hesitated. "By the way, my mom said I can't have another child."

Gao Feng was looking up information in the system space. Hearing this, he immediately came out and started taking off his clothes.

"No. That's not what I meant. It's not necessary today." Li Xinyao hurriedly stopped him.

"It's too late for you to say that. I'm already naked." Gao Feng picked up his wife and said, "Let's just give it a half-hearted approach." "But I'm a little tired today."

"Why are you tired?" Gao Feng said, "You don't have to move."

After half an hour of work, Li Xinyao fell into a deep sleep, while Gao Feng continued to look up information. His mind was indeed clearer under the sage time, although he was a little tired.

Ordinary people are very familiar with the disease of cerebral infarction, and they are terrified when talking about it.

Cerebral infarction, also known as ischemic stroke, is a cerebral blood circulation disorder, which causes localized ischemic necrosis or softening of brain tissue due to ischemia and hypoxia.

It can cause many consequences. In mild cases, it is just abnormal limb sensation, which can be cured by simple medication. In severe cases, it can be terrible, and brain death is not uncommon. Most patients with serious illnesses will develop symptoms of limb paralysis in the later stages.

There are many causes of this disease, but the main ones are large artery atherosclerosis, cardiogenic embolism and small artery occlusion.

Zhou Shuai's case is relatively strange. Large artery atherosclerosis can be ruled out and the probability of cardiogenic embolism is also very small.

Arteriolar occlusion?
At this moment, Gao Feng suddenly remembered the white particles he saw in the patient's eyes during the day, and a light seemed to flash in his mind.

He immediately walked out of the bedroom and called Dr. Ye, who was also busy giving birth at the time.

"It's so annoying, don't answer it!" said my wife.

"How can that be possible! What if the patient has some emergency?" As a doctor treating critical illnesses, Dr. Ye does not receive as many calls as ordinary clinical doctors, but most of the time they are about emergencies.

He took a look and saw that it was Director Gao who called. He was a little surprised.

"Doctor Ye, have you rested?" Gao Feng asked, "I just thought about that patient. Could it be post-traumatic fat embolism syndrome?"

“Those white particles are supposed to be fat particles!”

"Post-traumatic fat embolism syndrome?"

"Yes, please ask about the test results tomorrow and we will communicate then." Gao Feng said.

Dr. Ye hung up the phone and prepared to get out of bed.

"Hey, where are you going?" asked my wife.

"Check some information."

"No...you here, me here," the wife said speechlessly, "If you're not in a hurry, why don't we finish what we just did first?"

"Everything has to be done one by one. Having a baby is also important, don't you think? Doctor Ye?"

Fat embolism syndrome refers to a syndrome of a series of pathological changes caused by intravascular fat particles with a diameter of 1040-2448 μm blocking the vascular lumen. It often occurs - hours after severe trauma or fracture (especially long tubular bone fracture).

It is characterized by impaired consciousness, progressive hypoxemia, respiratory distress, and skin ecchymosis. It may also occur in other major surgeries, severe infections, fat metabolism disorders, decompression sickness, etc.

Human tubular long bones are rich in fat, especially the femur. When the femur is broken due to trauma, the ruptured fat cells may form fat droplets (10-40 μm in diameter).

What Zhou Shuai broke was a long tubular bone.

It enters the blood circulation and accumulates and embolizes in the microvascular-rich tissues and organs, thereby affecting the functions of related organs and causing a series of pathological and physiological changes such as dyspnea, impaired consciousness, skin ecchymosis, etc.
Fat embolism syndrome usually occurs within 1-3 days after the trauma. The incidence rate is not high, averaging about 7%, but it progresses rapidly and is serious, with a mortality rate of up to 8%.

However, if it is complicated by traumatic shock, infection, etc., the mortality rate can be as high as 50%-62%.

Once the cause of the disease was found, the direction of treatment became clear, and Dr. Ye's heart finally settled down.

Many times, when faced with some difficult and complicated diseases, not only the patients are anxious, but the doctors are also confused.

But as long as the diagnosis is clear, some diseases are easy to treat and doctors naturally have no pressure.

Some people argue that what if the disease is difficult to treat or incurable? Doctors would be under a lot of pressure.

You are wrong. If there is really no cure, then doctors will have no pressure at all.

"Take it home."

"Eat what you should eat, don't pay attention to anything."

Zhou Shuai woke up three days later and was taken off the ventilator on the same day. After all, he was young and recovered quickly.
-
"These surgeons would like you to teleport over to them immediately when they ask for a consultation." Mao Wen complained in the general practitioner's office.

Bu Zhengyang, who was standing by, smiled and said, "Isn't it the same when we asked the surgeon for a consultation?"

"That's true."

Bu Zhengyang was just about to go when he saw Gao Feng coming over. Well, now he doesn't have to run.

"Director, the orthopedics department is looking for a consultation."

"Hello, Director Jin."

Gao Feng greeted Director Jin of the orthopedics department, who looked serious and stern.

"Hello, Director Gao." Jin Guangming tried hard to force a smile, but it was uglier than crying.

Gao Feng had heard of the other party. He had a very good reputation in the circle. In addition, his skills were good, so the families of the doctors in this hospital also liked to see him.

Director Jin has a straightforward personality and likes to speak directly, with the competence that is consistent with a surgeon.

Once, a department of the National Health Commission organized a meeting to discuss the suicide rate in hospitals.

A patient in Director Jin's department just happened to jump off a building, so the hospital asked Director Wang from the Medical Education Department to take him to the event.

At the meeting, an expert talked a lot about the need to strengthen inspections, focus on patients' psychological treatment, resolve patients' worries, etc.

Director Jin was very disapproving after hearing this. He was sitting in the first row, and his disdainful expression deeply hurt the experts on the stage.

"Comrade, do you have any comments?"

"I have a lot of complaints." Director Jin ignored the look Director Wang gave him and said directly, "I think what you said is bullshit and useless."

"How can I strengthen my patrols? Do I have to hang the patients on my belt?"

"Psychological treatment is even more nonsense. Do you really think that psychologists can do everything? Besides, psychologists are not afraid of trouble. Just ask how many patients are willing to accept it?"

"As for resolving patients' worries, the biggest problem for most patients is money. So, you give it to them?"

The expert was so angry that he rolled his eyes, "So what do you say we should do? Do you have a good idea???"

"It's very simple, these patients who commit suicide in hospitals either have bad character or their family members are bad grandchildren." Director Jin expressed his opinion, "To commit suicide in a sacred place like a hospital that saves lives and heals the wounded is an extremely immoral act."

He was about to continue speaking when the expert on the stage spoke up.

"Cold-blooded!"

"Is it appropriate for you to say that about these patients? They must have been sick and desperate before they committed suicide!"

"They are already pitiful enough, why are you so hard-hearted? You actually scold these poor people and say that their character is problematic?"

"You know nothing!" Director Jin said loudly, "If you say that, I'll have a good talk with you."

"Director Jin, please be careful with your words," Director Wang from the Medical Education Department reminded.

"Patients" are not a group divided according to moral standards. A person becomes a "patient" because he is sick, which has nothing to do with his moral level.

Good people and bad people all get sick.

A good person is still a good person even when he gets sick. He is still a good person even when he has a terminal illness. Even when he chooses to end his life because he cannot bear the pain and is pessimistic and disgusted with the world, he will still act as a good person.

A scumbag is still a scumbag even when he falls ill. He is still a scumbag even when he has a terminal illness. When he tries to end his life because he cannot bear the pain and is pessimistic and disgusted with the world, he will still act like a scumbag.

Director Jin talked about an incident that he had personally experienced. One of his patients had a bone tumor that had metastasized throughout his body. The pain was so severe that he couldn't sleep all night, so he thought about committing suicide.

He ran out of the house when his family was not paying attention. At first, he wanted to cut his wrists in the hotel, but later gave up because he felt that this was unfair to the hotel and the owner was so innocent.

Finally, he ran to a remote forest and ended his life. Before he died, he wrote a suicide note in which he stated his home address and contact information of his relatives.

At the end, he also expressed his apologies to the people who might have found his body and to the police officers who came to deal with the situation.

There is another type of people who don't care about the patient when he is alive, but when you need to spend money on the patient's treatment, they will shirk their responsibilities;

When they need to take care of patients, they are very impatient, extremely indifferent to patients, and even speak bad words to them and show disgust.

However, after the patient died, they all became the most filial sons in the world, shouting and beating their chests and stamping their feet, chasing the doctor and asking: Why did he die? Wasn't he alive and well before? You have to give me an explanation for his death~~

"The family members of the deceased who come to the hospital to demand compensation after the patients committed suicide are the most shameless people in the world," said Director Jin.

"Don't you have any idea why your family members committed suicide?"

"grass!"

"Old Jin! Pay attention to your manners." Director Wang, who was sitting next to him, was about to cry. He had made up his mind that he would teach this young man a lesson when he got back.

"The patient committed suicide simply because of pessimism and despair. If you had given him more care and warmth, would the tragedy have still happened?"

"If the family members give the patient enough warmth, will he be so desperate? If the family members and the patient have deep affection and feelings, will the patient choose to leave them without saying goodbye?"

"If the family members care about the patient enough, will they turn a blind eye to the various signs of suicide?"

"If these patients who committed suicide had mental problems, I would not say anything. But how many of them were mentally ill? The vast majority of them were adults with full autonomy!"

These family members, as the patient's biological children, biological parents, and married couples, did not notice any suicidal thoughts or signs in the patient.

"How dare they come here indignantly to accuse medical staff who are strangers to the patients of not caring enough about their relatives and demand that we take responsibility?"

"MD, the more you talk, the angrier I get!" Director Jin blurted out. The experts on the stage were silent at this moment, and the audience was also very quiet. Everyone was shocked by Director Jin's outspokenness.

A leader of the National Health Commission who was attending the meeting was also grinning. Come on, I've met someone who's serious today.

In fact, this meeting is just a formality, with the intention of everyone being happy. After all, the high suicide rate data does not look good.

Even if the problem cannot be solved, you still have to hold a meeting or something. Otherwise, what if people accuse you of turning a blind eye?
Director Jin took a sip of water and continued speaking.

"Old Jin, why don't you just stop talking? Forget it. Just be happy." Director Wang of the Medical Education Department has already given up. He will definitely be criticized anyway, so there is nothing to worry about.

"I have a way to completely prevent patients from committing suicide in the hospital from happening again," said Director Jin.

"You say!" The expert on the stage didn't believe it.

"That means the family of the suicidal patient will have to pay the hospital money!"

Why do patients commit suicide in hospitals so frequently? We can even see it on the news every few days.

A very important reason is that death is worth it.

You read that right, it’s a good deal.

Nowadays, if someone jumps from a building in a hospital, no matter what the injury is, most of the time the hospital will treat them free of charge, and the patients and their families do not have to spend a penny on medical expenses.

Regardless of whether the patient went to see Marx or not, the hospital would be blackmailed by the family of the deceased. Unless the amount was truly unaffordable, the hospital would often choose to pay the money due to public opinion.

This practice by hospitals and some departments is actually a disguised way of encouraging patients to commit suicide and jump off buildings in hospitals.

Some patients even regard this extreme method as the last benefit and contribution to their families.

Director Jin believes that the cost of treatment for patients who commit suicide and are injured should not be borne by the hospital or medical insurance, but should be borne in full by their families.

In addition to the medical expenses, the hospital should also require the family to compensate for other economic losses, such as the cost of repairing damaged items, the cost of cleaning the ground, the cost of security to maintain order, and the mental loss caused to hospital staff and other patients by frightening them.

If the family refuses to pay these medical expenses and compensation, the hospital should sue in court and apply for compulsory execution, seize the deceased's estate, and compensate the hospital for its losses.

In this case, jumping off a building in a hospital would cause at least hundreds of thousands or even millions of losses to the family.

"If we do this, will there still be patients jumping off the hospital building? Will there still be bastards coming to the hospital to blackmail people?" Director Jin asked, "Should we still hold such a crappy meeting?"

At the end, there was warm applause in the venue.

Director Wang from the Medical Education Department was scolded by his leader for more than 10 minutes, saying that he was mentally ill for bringing such a person to the meeting.

The patient who came for consultation was a 51-year-old middle-aged female patient. She was riding an electric bike and was hit into the air by a car coming from the opposite direction.

However, the patient was lucky and landed in a green belt, with only his two arms broken.

Another thing is that her face was disfigured, but this is not important. Appearance is not the patient's strong point. In fact, her husband felt that her face looked much better after being bandaged with gauze.

(End of this chapter)