Gou is practicing medicine in the clinic

Chapter 120 Indication-level strength, strong diagnostic ability

The crying of the baby in his arms stopped instantly in fright, and after two or three seconds, the baby's small eyes saw that there was no movement, and then continued to cry, and the crying became more violent.

"Sister, don't scare the child!"

Li Jingsheng could only secretly help that poor daughter-in-law.

He can't take care of other people's family affairs, and he won't take care of them.

"Mother of the child, go to the rest area to sit and rest for a while!"

Li Jingsheng looked at Tang Ping at the counter.

In fact, the movement here has long been noticed by the customers over there.

One by one is watching it openly or secretly.

He and Tang Ping have been working together for more than nine months, and they can't say that they have the same heart. If they have any intentions, they can understand each other's meaning with just a glance.

Tang Ping said hello to the two customers she was serving, and then went straight to the young mother.

After taking her to sit down on the row of chairs in the rest area, he poured her another glass of water.

After a few words of comfort, she took the bottle from her hand and gave it to the child's grandma, who helped stop the child's crying, and then returned to the counter to continue selling medicine.

Li Jingsheng knew very well that the best way to help the family calm down was to cure the child's illness.

The baby has been sick for more than a month, and many hospitals have failed to cure him. The baby's parents and grandma must be exhausted physically and mentally.Moreover, the process of seeking medical treatment was time-consuming, labor-intensive and costly, which was even worse for this already unharmonious family.

After the child's illness is cured, the child's grandma and parents are happy, and the sharp contradictions are naturally eliminated.

The idea is good, but it is not easy to cure this child.

He subconsciously checked the properties panel.

Now he has become dependent. When encountering difficult patients, the cause of which cannot be found out, or the surgical skills are too weak, he will subconsciously temporarily hold the 'Buddha's feet' of the attribute panel.

And it's tried and tested.

The premise is that you need to have sufficient health, and you also need to have learned the corresponding medical skills, and practice the proficiency to the entry level.

If you can't even get started, the golden finger with the empty attribute panel can't do anything.

The child's disease must be a digestive disease.

Gastrointestinal diagnosis is key.

The inspection data of the two major hospitals are sufficient, which can provide him with a very good diagnostic reference.

What is worse is the level of gastrointestinal diagnosis.

Gastrointestinal diagnosis is now proficient level, which has reached the peak.If you want to upgrade again, you must first upgrade the doctor level to another level.

There are many benefits of upgrading the doctor level.

It is equivalent to the internal strength of a doctor.

It can provide a wider and thicker carrier for all medical techniques.

It is the foundational platform for all medical techniques.

Li Jingsheng still benefits from the promotion from a junior resident to a senior resident last time.

Moreover, he also found that the higher the doctor's level, the stronger the learning ability, and the comprehension and understanding of medical knowledge, especially the comprehensive cognitive ability, comprehensive diagnostic thinking and even the understanding of surgical operations, can be comprehensively improved.

Li Jingsheng has long wanted to upgrade the doctor to the attending level.

A while ago, he was too much in the limelight, and he was afraid of becoming the beaten bird among the birds with a gun, so he tried his best to reduce his presence.

It was his low profile that allowed the Sunshine Clinic to spend half a month of making money quietly and quietly.

The rent was collected, the salary owed to Tang Ping was settled, and there was still a little balance in hand.

Never go around borrowing money again.

Now that his clinic has become more ordinary, the attention and jealousy of his competitors should have dropped a lot.

It's time to secretly upgrade the doctor's level and medical skills, and increase the strength again.

After the level is upgraded to attending, the upper limit of the proficiency of various medical skills can be raised to a higher level, reaching the senior attending level.At that time, in the area of ​​Old Street in the south of the city, his medical skills should be able to fear no opponents.

Including the three "bad guys" at the community health service station, they will all be surpassed by him.

At that time, there will be more patients who can eat it.

Now we see more than a dozen patients every day, but not all of them can handle it.

Some are too risky, some causes are difficult to find out, and some are not in the field of treatment that he is good at, all of which can only be pushed away.

The baby's illness came and went, but it was not fatal in a short period of time, which also gave Li Jingsheng the courage to try to challenge.

If it is really cured, it will not only enhance the reputation of the clinic, but also be very beneficial to the relief of the family's conflicts.At the same time, his diagnosis and treatment ability in the field of digestive diseases will also get a good exercise.

For any doctor, the only shortcut to improve his medical skills is to challenge difficult cases.

For example, if a medical doctor who has just participated in the regular training can get a chance to suture skin in the operating room, it will be more useful than pulling a hook a hundred times.

The courage gained through suturing the skin of patients and the practical operation under high pressure and tension will be a leap in the level of medical skills.

After making up his mind, Li Jingsheng subconsciously checked the attributes.

Grade: senior resident physician 692.5/1000.

Proficiency in gastroenterology 131.7/500.

Health: 541.

Whether it is level experience or medical proficiency, the improvement is quite slow.

If you want to upgrade the doctor level and the proficiency of gastrointestinal diagnosis at the same time, you need 677 health points.

This is far from enough.

Even if all the life points were spent in one breath, there was still a shortfall of 136 points.

"I can only try to raise the level first and see the situation. If it really doesn't work, I can only persuade the family members to take the child to a big hospital for treatment."

Li Jingsheng knew very well in his heart that neither the Children's Hospital nor the People's Hospital could cure the child's illness, and the difficulty must be at the ceiling level.Even if he upgrades both the doctor's level and the gastrointestinal diagnosis to one level, he still may not be able to diagnose it.

After all, the attending physician of a large hospital is at least at the level of deputy director.

They couldn't make a diagnosis, but a small doctor in Li Jingsheng's clinic made a diagnosis. Could it be that they are eating dry food?
The competition in large hospitals is more intense. Doctors without real talents will not engage in clinical work even if they are rated as deputy high or senior professional titles.

It's about doing research and teaching.

Otherwise, if something goes wrong and the signboard of the hospital is smashed, who will be responsible?
All the chief physicians who are qualified to go to the outpatient clinic or lead a group in the inpatient department have real skills.And at least in one area has a very high level.

A rare opportunity, Li Jingsheng just hesitated, and directly spent 308 health points to upgrade the doctor level.

Grade: junior attending physician 1000.5/2000.

If you want to upgrade to the next level, you need 1000 experience points, which is too scary.

If he is down-to-earth and works diligently in the hospital to accumulate experience points, with his mediocre medical talent, he might not even think about it for more than ten years.

Now, Li Jingsheng finally understands why some attending physicians, who have worked for 40 to [-] years, are still attending doctors until they retire.

The height is not cold.

Only when you have reached the level of Indications, do you understand how difficult it is to advance to the next level.

He is now a junior attending physician, and he should be a senior attending physician at the next level, which already requires 1000 level experience points.

After being promoted to a senior attending physician, one can only be promoted to the deputy chief physician.

It is estimated that the required experience value will be a more terrifying number.

Not to mention the leveling up by working hard, even if it is open, he needs to save thousands of health points, and he only feels that his knees are weak.

I want to kneel!

At this moment, the level has been successfully raised to the level of indications, and the first feeling is that looking back at the past, I am a piece of garbage.

That's really what it feels like.

Far from being arrogant.

The attending doctor and the resident doctor seem to be only one level behind. The understanding and application of medical knowledge, the height and breadth of diagnostic thinking, as well as the thinking of medication, surgical thinking, and understanding of surgery are really different.

Even in a large hospital, you can start outpatient clinics, lead interns, independently preside over some diagnosis and treatment work, etc. only after you have received the attending treatment.

The attending physicians in large hospitals have a very large base and a lot of moisture.

For example, medical students who have been studying for eight years of undergraduate, master, and doctoral studies will be directly promoted to attendings after graduation and work for one year.

His thesis level and theoretical level may be very high, but his clinical practice level and experience in clinical diagnosis and treatment may be a little better than ordinary regular Pearson.

This is not belittling, but the real situation.

For example, Li Jingsheng used to work in a large hospital, and with his years of work, he has already reached the level of a senior resident doctor.

The actual level of diagnosis and treatment is only a junior resident physician.

"It's awesome to be promoted to the attending level!"

The 308 health points spent are too worthwhile.

He realized how beautiful the "scenery" of the attending doctor was when he was promoted to the attending doctor.

His health has only 233 points left.

It is no longer enough to support him to upgrade his gastrointestinal diagnostic skills.

Life is never enough!

When the level of medical skills improves, every day you have the opportunity to receive banners and praise from patients, and you even have the opportunity to rescue critically ill patients every day. At that time, the speed of earning life points will be astonishingly fast.

Right now, I can only boil slowly.

He again took the child's medical record information to try to diagnose.

The level of a doctor is equivalent to 'skill', and various medical skills are 'tricks'.

When the skills are improved, even the simplest moves can be astonishingly powerful.

In the past, the grade was only at the level of a resident doctor, but the gastrointestinal diagnosis reached the low-year attending level, which is equivalent to a calf pulling a cart, and there is no way to exert its full power.

It's different now, the level is equal to the medical skill, and it can already play [-]% the level of attending gastrointestinal diagnosis.

His diagnostic thinking was also opened.

Since the cause of the child's persistent diarrhea cannot be found, can we start with other symptoms?

Such as swollen legs.

Li Jingsheng thinks this is a good breakthrough.

Because the people's hospital has already checked, and the liver, kidney, and heart functions are all normal.

The most common clinical cause of lower extremity edema is kidney problems.

Now that the kidneys are found to be fine, what causes the edema of the lower extremities?
The child is pale and underweight.

Moreover, according to the family members, not only did the child not grow up for more than a month, but he lost about 0.7 kilograms.

It's a full 1.4 catties lighter, which is very scary for a baby who is only seven months old.

Because his total weight is only over ten catties.

Under normal circumstances, babies belong to an absolute high-speed growth period from birth to one year old.

Many male babies weigh only about 3 kilograms at birth, and can reach more than 10 kilograms by the time they are one year old.

The child weighed 4.9 kilograms when he was admitted to the hospital, and it is estimated to be lighter now.

Causing weight loss must have something to do with nutrition.

Consistent diarrhea in a child can lead to poor nutrient absorption and eventually malnutrition.

Is his lower extremity edema related to malnutrition?
Li Jingsheng discovered that after being promoted to an attending physician, a lot of theoretical knowledge can be integrated, and a systematic in-depth analysis of the etiology can be carried out.

This capability was not available before.

Acquiring knowledge and applying it are two different things.

During the junior residency period, medical knowledge can only be initially applied to clinical practice.At the senior resident level, the medical knowledge learned can already be flexibly applied to practice.

Now it's even more awesome.

You can start to use medical knowledge together, and make systematic analysis and diagnosis.

Malnutrition causes lower extremity edema, and the most common cause is hypoalbuminemia.

The baby's blood routine results showed that there was anemia and low hemoglobin.

It is normal to have lower extremity edema when combined with malnutrition.

The doctors at the People's Hospital must have also diagnosed the cause of the edema of the lower extremities.

But if you want to treat lower extremity edema, you must find out the cause of anemia and hypoalbuminemia.

Considering that the baby has diarrhea for nearly a month, and has diarrhea many times a day, the stool is watery and contains mucus, which is one of the main causes of malnutrition.

There is also the fact that babies eat less and less food, which is another major cause of malnutrition.

After going around in a circle, the real cause of the disease came back to diarrhea and reduced eating.

Li Jingsheng now finally understands why the attending doctors of the Children's Hospital and the People's Hospital can't get around the vicious circle of stool inspection.

Because the final diagnosis direction points to diarrhea.

Diarrhea in babies under half a year old is not a big deal, it is a common phenomenon.But normal babies have loose stools that don't contain mucus.

Moreover, the baby was half a year old, and the frequency of diarrhea was as high as five or six times a day. The stool was watery and contained mucus, which made people have to suspect intestinal disease.

Imaging examination showed that the liver, heart, and abdominal cavity were normal.

Then we can only suspect intestinal bacterial infection, flora imbalance, enteritis, physiological disorder, food problem, these are several reasons.

Li Jingsheng grabbed his hair vigorously, racking his brains to identify the real cause of the disease.

It seems to be back to the university classroom of studying medicine.

Every time the teacher talked about the symptoms of some diseases, he always wondered if he also had the disease.

At this moment, he felt that all of the listed causes were possible.

What a headache.

Let's start with the simplest investigation.

"May I ask what brand of milk powder you usually give your children?"

"We are eating... brand milk powder, which is a big domestic brand, so there will definitely be no problem. Because my nephew's child also eats this brand of milk powder. We bought it in a group."

The child's grandmother replied.

Because of the large quantity of group buying, the price can often get a discount.

The brand that the child's grandma mentioned is indeed a well-known domestic milk powder brand, and the possibility of problems is very small.

Li Jingsheng ruled out food problems and began to investigate the possibility of enteritis.

It can cause diarrhea in children for such a long time, and the medicine has almost no effect after treatment, so people have to suspect fungal enteritis first.

Such as the most common Candida albicans.

It's just that the attending physician of the People's Hospital has done three stool cultures, all of which were negative.

The possibility of fungal enteritis can basically be ruled out.

Considering that the baby has a long treatment cycle and long-term use of antibiotics during treatment, oral thrush and perineal and perianal fungal infections are prone to occur.

However, when the baby's mouth was checked before, the oral mucosa wall was smooth, and thrush was basically ruled out.

Perineal and perianal fungal infections were also ruled out after Li Jingsheng's on-site inspection.

And the stool culture is negative, which can further rule out the possibility of fungal infection.

"Could it be an intestinal flora imbalance?"

After Li Jingsheng ruled out many possible causes, he realized that long-term use of large doses of broad-spectrum antibiotics in infants could easily lead to the suppression of normal intestinal flora and the proliferation of drug-resistant bacteria, leading to severe diarrhea.

In particular, Staphylococcus aureus enteritis and pseudomembranous enteritis are most likely to occur.

This suspicion was also directly ruled out because the stool culture result was negative.

The attending physician at the People's Hospital performed three stool cultures on the child in a daze, not without reason.

Then there is only the last possibility, physiological diarrhea.

Normal physiological diarrhea, usually manifested as frequent stools, loose and mushy.But appetite and eating, growth and development are not affected.

The baby was eating less and less, and he was already half a year old, and he was still malnourished. The combination of these items can completely rule out the possibility of physiological diarrhea.

At this point in the diagnosis, Li Jingsheng is already in trouble.

Ability is limited, level is limited.

That is to say, his doctor level has been upgraded to the attending level, coupled with his proficient gastrointestinal diagnosis and medical skills, so many diagnostic ideas can appear, and they can be ruled out one by one.

Otherwise, it was impossible to even do this step before.

At his current level, even if he were thrown into a tertiary hospital like the Second Hospital, he would already be a master.

At least you can start to stand alone in the inpatient department.

As long as you don't encounter particularly difficult conditions, you can basically share the worries of the chief physician.

It must be much more advanced than a resident doctor.

"It would be nice to have 136 more health points."

He felt very unwilling.

Diagnosing the cause of this child has obviously made great progress.But after one by one ruled out, the diagnosis is finally in trouble.

If the gastrointestinal diagnosis can be upgraded to another level, he believes that it is possible to diagnose the real cause.

He looks gentle, but he has a stubborn temper in his bones.

If he fails in doing one thing, he is not afraid of setbacks, but will continue to work hard and must do it well.

If you were an ordinary person, half a year after opening the clinic, you couldn't even pay the staff's wages, so you bowed to reality and sold the clinic directly.Then honestly find a hospital to go back to work.

If he did that, the girlfriend might not run away either.

Because at that time, the two of them just quarreled a lot, and their relationship gradually became rusty, and it became worse than before.

Later, the girlfriend couldn't persuade him, and at that time, she probably already had a new suitor by her side.After all, Li Jingsheng has always been picky about choosing girlfriends, and he is not interested at all if his looks are too low.

Beautiful women never lack suitors.

After his girlfriend became dissatisfied with him, other men could easily snatch her away as long as he was a little better than Li Jingsheng.

that's the truth.

Li Jingsheng was worried, where could he earn so much life in a short time?

(End of this chapter)