Gou is practicing medicine in the clinic

Chapter 145 This is not bronchitis, the identity seems to have come up

There are even many 60-year-olds who insist on exercising, and their physical fitness is stronger than that of 30-year-old boys.

"This is an old problem for me. I have been coughing for more than 30 years. At first it was just coughing, with a lot of phlegm, and then I was a little short of breath. I am a quick-tempered person. When teaching students, I saw that they were disobedient and did not study hard. , If I don’t finish my homework well, I will get angry. This anger will make my cough worse, cough cough..."

After the man finished speaking, he began to cough violently again.

Unexpectedly, this man is also a teacher, no wonder his temperament is very unique.

It gives people a clean and tidy, serious feeling.

"Have you been to the hospital for an examination?"

"I've seen it, and said it can't be cured, so I can only take some medicine to control it."

"Is there any illness?"

"It's because my lungs are not very good. I also heard people say that your technique here is good and the medical ethics are noble, so I wanted to come here and get some medicine for a try. I used to go to designated hospitals to get medicine."

The man is a teacher, so he must have bought medical insurance.

And the age is at least 57 or 25 years old, and the medical insurance payment has probably exceeded [-] years, and you can already enjoy lifelong medical insurance.

Now I went to Li Jingsheng's small clinic to buy medicine, but I haven't got the qualifications for designated medical insurance yet!
Patients can only pay at their own expense.

"It's okay for me to prescribe some medicine for you, but our clinic can't be reimbursed by medical insurance. Can you accept it?"

"If you don't have much money, you'll be fine. If it's too expensive, I'll go to the hospital to get it, ahem..."

Men can't talk too much.

He coughs violently when he talks too much.

"Do you usually smoke?"

"do not smoke."

"Do you have symptoms such as chest pain, coughing up blood, chills?"

"No, I just feel out of breath and have to inhale very hard."

The man's breathing was rapid from the moment he entered.

"Okay, let me listen to your heart and lung sounds first, and then take your blood pressure and temperature."

After measurement, the man's body temperature was normal and his respiratory rate was 19 breaths per minute.

Lung breath sounds are rough, but there are no obvious dry and wet rales.

Heart sounds are also normal.

Blood pressure is a little bit high, but it's okay.

The man himself is thin, with obvious barrel-shaped chest, and the rib gap is wider than normal.

After Li Jingsheng measured the man, he was initially diagnosed with chronic bronchitis.

Chronic bronchitis is very common clinically.

This is an intractable disease, which is difficult to cure and easily recurs.

His small clinic couldn't do a blood gas analysis for the patient. After a comprehensive diagnosis, he believed that the man's condition was not serious and he had the ability to treat him.

Patients mainly present with shortness of breath and shortness of breath.

It should be chronic bronchitis, yes, just follow this treatment.

The man was coughing and spitting.

Very quality, wrapped in a tissue.

Li Jingsheng saw that the phlegm was yellow and sticky.

Oddly enough, it was also mixed with serous frothy sputum.

It doesn't seem to be an ordinary old slow branch performance!

Considering that the patient's body temperature is normal, the lung sounds are normal except for heavy breathing.

An acute attack of bronchitis is prone to elevated body temperature.

"I'll listen to your lung sounds again!"

After feeling that it didn't look like bronchitis, Li Jingsheng decided to check it out again.

This time, he paid extra attention to the lung sounds.

"The lung sound is very strange, it is the kind that gradually thickens. This is somewhat different from the lung sound of bronchitis."

If it's not bronchitis, what is it?

Li Jingsheng was worried about misdiagnosis, so he immediately became 12 cautious.

After all, his small clinic had just been troubled by patients.

His internal call diagnosis is currently at the proficient level.

Diagnosis of most respiratory diseases is sufficient.

However, when encountering some difficult to detect, or obscure, and the clinic itself lacks various auxiliary examination methods, his proficient-level callidiagnosis is obviously not enough.

There are still 402 health points remaining, which is more than enough to upgrade the call diagnosis.

This diagnostic medical skill is used almost every day, and the frequency of use is extremely high.

Early upgrades benefit early.

Based on this idea, Li Jingsheng began to prodigal.

Directly upgrade the internal call diagnosis to the Xiaocheng level.

500/1000 in Respiratory Medicine.

Diagnosis and treatment of Hu Nei has always been Li Jingsheng's old line of work, and it is also the medical skill he is best at.

Many other medical skills have already achieved overtaking with the help of the attribute panel, leaving it behind.

Even the diagnosis of gastroenterology has already reached the level of Xiaocheng.

At this moment, it finally caught up again.

His health has almost been wiped out again, only 24 points left.

Feeling that the upgraded Hu Nei Diagnosis is extremely powerful, he feels that no matter how much life is spent, it is worth it.

Try to re-diagnose this patient with a small Cheng-level exhalation diagnosis.

"Wow, it's so powerful! It's actually possible to start with the nasal mucosa, the amount, concentration, and color of sputum, as well as the roughness and shortness of breath sounds."

During the diagnosis, Li Jingsheng felt how good Xiaocheng's exhalation diagnosis was. When one symptom appeared, many diseases that matched the symptom immediately popped up in his mind.

Even like a computer, it can automatically filter.

Rank those diseases that have a relatively high probability and are consistent in all aspects.

"When did you start feeling short of breath?"

"It suddenly got worse yesterday."

"Is it like this when you were sick before?"

"Yes, almost. It seems to be a little more serious this time."

The patient is a teacher after all, and highly cooperated with Li Jingsheng's consultation.

"The onset should be relatively urgent, and the condition is still getting worse rapidly. The main manifestations are heavy breathing and shortness of breath. It's not bronchitis, what kind of disease could it be?"

He racked his brains to diagnose the cause of the patient.

A disease name that was highly consistent with these symptoms and course of disease appeared in his mind.

COPD.

This is the name of a disease that causes excruciating distress to many who suffer from it.

It is not a terminal disease in itself, but it is very difficult to reverse the disease once you get it.

Just like liver cirrhosis and kidney failure, once it is turned on, it cannot be reversed.

There is no cure for this disease.

Only drugs and other treatments can be used to alleviate the condition.Such as oxygen.

If the disease is not treated in time after the onset, the condition will worsen rapidly, and the patient may even die directly in a dream.

Also, people with COPD cannot do strenuous exercise.

Cannot engage in heavy physical labor.

It will have a great impact on life.

The patient also said that after an examination in a large hospital, the doctor told him that there was something wrong with his lungs.

Li Jingsheng's eyes became bright and confident.

It must be the disease.

The symptoms, as well as the course of the disease, are highly consistent in many aspects.

Now I finally understand why the patient spits out yellow sticky sputum mixed with serous foamy sputum.

"Doctor, have you found out what's wrong?"

The patient appears to be very patient.

Seeing that Li Jingsheng seemed to have a diagnosis, he asked a question.

"Your disease is highly similar to chronic obstructive pulmonary disease."

Li Jingsheng replied.

A hint of appreciation was evident in the patient's expression.

"Since it has been found out, please prescribe me medicine!"

"Row."

Li Jingsheng began to prescribe medicine to the patient calmly.

The efficacy and pharmacokinetics of Xiaocheng level are enough for him to prescribe the prescription easily.

The patient has been treated with medication for a long time in another hospital, so avoiding some long-term medication must be taken into account when prescribing.

Drug resistance can greatly reduce efficacy.

He quickly made a judgment in his mind. Bronchodilators dilate and relax the airway, and glucocorticoids increase exercise tolerance and reduce the probability of acute exacerbations.

Expectorants promote the expulsion of sputum and reduce the chance of repeated exacerbations of the disease.

Antibiotics prevent infection.

Symptomatic treatment from four aspects, after the patient takes the medicine, the curative effect should not be bad.

There are three types of bronchodilators commonly used clinically, and β2-receptor agonists should be the most commonly used type.

He decided to bypass this category and try a cholinergic receptor blocker, eventually choosing tiotropium bromide.

In fact, aminophylline can also be used, but considering that the patient's physique is poor and he is too old, in case something happens, his small clinic cannot bear the responsibility.

……

In the end, Li Jingsheng prescribed prescriptions for patients, some of which required oral or nebulized inhalation, and some required intravenous infusion.

This patient has just been settled here, and a new patient has come.

Li Jingsheng was happy to find that the small clinic became busy again.

If it is really reported and successfully broadcast on TV, it is not impossible for the small clinic to be overcrowded.

When he was on TV, he was both nervous and looking forward to it.

First of all, I can be sure that being on the TV station is definitely a great thing.But if it provokes the nerves of a certain boss in this area, it's no joke.

Don't even know how to close the door.

Boss Zhao told him mysteriously that day that in this area in the south of the city, no matter whether it is a small clinic or a grassroots medical institution, it is best not to try to make it bigger.

It's just that some things are out of Li Jingsheng's control at all.

For example, if he goes on TV, will other reporters listen to him?

Everyone works for their own interests, and it is impossible to take care of others.

Li Jingsheng was busy working until nearly seven o'clock, and finally he took care of all the patients in his hands.

The patient with chronic obstructive pulmonary disease has already achieved curative effect after taking medicine.

When I left, it was quite satisfying.

He gave a thumbs up and praised Li Jingsheng for his ability, and he was cured well.

Li Jingsheng also managed to earn 61 health points from this patient.

Successful diagnosis of COPD should reward 50 health points.

Then when the patient leaves, give a good review, and then award 10 points.

The remaining 1 point is earned by diagnosis.

After the patient is cured in a few days, he can get another 1 point of life.

The income is pretty good.

One such patient can be worth dozens of ordinary patients.

Li Jingsheng also experienced how good Xiaocheng's internal breath diagnosis, drug efficacy, and drug kinetics are.

None of the patients who came this afternoon were pushed away.

All done.

And he can predict that the curative effect of these patients will be very good.

I believe that at least most of them will become his repeat customers, or introduce relatives and friends around him to see a doctor.

It's been a while since Brother Qiu took away his clinic materials last time, but there has been no movement.

It would be even more perfect if it could enter the centralized procurement platform.

Because although his current level of prescriptions and medicines is very good, it is difficult for a clever woman to cook without rice. There are many medicines that clinics and pharmacies simply cannot get.This is a big question.

In addition, there is another great advantage of joining the centralized procurement platform, which can automatically obtain the extremely difficult medical insurance qualification by the way.

At that time, with both, the road to the rise of small clinics will be much smoother.

"Brother Li!"

A fat head came in from outside the door, it was Boss Zhao.

I haven't seen Boss Zhao coming over for several days.

After the Sunshine Clinic was troubled by patients, customers were afraid to enter and went to Kuaikang Clinic.

Boss Zhao's life these days is probably quite nourishing.

"I haven't seen Boss Zhao for a while. The business of your clinic should be very good these days!"

Li Jingsheng walked out consciously.

Whether you like it or not, everyone is making a living on this street, so you must keep your face calm.

As long as Boss Zhao doesn't play tricks on the Sunshine Clinic, it's pretty good.

With Boss Zhao on this street, it is estimated that it will be very difficult for new competitors to squeeze in.

Even the ostentation of the Freedot drugstore can be said to be cold overnight.

That Internet celebrity is afraid that she wants to die.

If I had a choice, I probably would never come to Chengnan Old Street again in this lifetime.

"Hey, compared to Brother Li's place, it's far behind!"

"Boss Zhao, don't make fun of me. It's not like you don't know. I was harassed by patients a few days ago, and I couldn't be colder. Those patients and customers have all gone to your Kuaikang clinic. I know that." of."

Li Jingsheng showed a miserable face.

In front of competitors, you must sell badly.

It's right to make a fortune in silence.

"Hmph, two days ago, I really thought so. I ran over and stood outside the door for almost two hours just now. I didn't call you when I saw you were busy. I counted, you two Seven patients were diagnosed and treated within an hour, and the success rate was 100%. By the way, your medical skills seem to have improved a lot recently? I heard that you now go to the Second Hospital for further training from Monday to Friday. You can make money by doing further training and opening clinics , get it right."

Boss Zhao said sourly.

Sure enough, there is nothing that can be hidden from Boss Zhao.

This old boy stares at others all day long.

He knows exactly which pharmacy is doing well and which clinic is doing well.

Then again, Li Jingsheng used to stare at other competitors.

"Who said that? I'm just running errands, doing odd jobs, and studying! It's not like you don't know, how can a big hospital treat our clinic doctors as human beings? It's a gift for us to treat them as slaves. "

Li Jingsheng would definitely not tell the truth.

Unless he's stupid.

"The arrogance of the big hospital is true. But I believe that people can't get up early without benefit. If there is no great benefit, can you leave the clinic alone every day and go to the second hospital?"

Boss Zhao half believed his words.

It seems that it is not clear why Li Jingsheng went to the Second Hospital.

This also means that Xiao Gao didn't eat inside and outside.

Just now, Li Jingsheng really suspected that Xiao Gao leaked it to Boss Zhao.

Now it seems that I am overthinking.

But think about it, Xiao Gao’s salary at the Sunshine Clinic last month was 11752 yuan.A little less than Tang Ping, but already very impressive.

After all, he has not been in the job for a long time.

Selling health medicines, when he was not here, Tang Ping's daily sales were not low.

Also, Tang Ping's basic salary was one thousand higher than his.

And this month, his salary is likely to exceed Tang Ping's.

"Just two hours ago, I saw that Xiao Gao sold a full 12 orders of health medicines and tonics. Why didn't I realize that Xiao Gao had such a good sales ability?"

Boss Zhao would be wasting his talent if he didn't become an agent.

I stayed outside the Sunshine Clinic for two hours, and just stared at it for two hours.

He knows exactly what the Sunshine Clinic does.

"Aren't there sales talents everywhere? Boss Zhao has a very wide network of contacts. If he wants to recruit talents who sell medicines, it can be done in a matter of minutes? Don't think about poaching Xiao Gao back again!"

Li Jingsheng greeted him.

"I want to dig but I can't. Xiao Gao is just a deadhead."

Boss Zhao realized that he had slipped his mouth, so he stopped immediately.

"Have you really dug him? It's unethical for you to talk about my brother Li, saying that I am your savior, and secretly poaching my salesman!"

Li Jingsheng immediately accused him after hearing this.

"Ahem... I'm just testing it out, to help you test the loyalty of the employees, how can I really dig it!"

Boss Zhao hurriedly took the words over.

"Brother Li, I really underestimated you before. That person made a big fuss in your clinic that day, and I was still worried about you, thinking that the Sunshine Clinic would suffer disaster. I didn't expect it to be a unparalleled trick by you. After a few days, a good show of apology was directly staged, which earned your clinic enough popularity and image. Do you know? Now in this area, out of ten people, at least eight people praise your Sunshine Clinic for its excellent medical ethics.

I went to eat noodles in the morning, and someone praised Sunshine Clinic.I went to the restaurant for lunch, and some people still praised Sunshine Clinic.Even when you go to the supermarket to buy things, you can still hear compliments.

Brother Li's trick is really clever. "

That sourness was about to overflow from Boss Zhao's face.

The words that come out are more sour than green bayberry.

"Really? Why can't I hear it?"

Li Jingsheng naturally would not admit it.

Even if Boss Zhao's words were a bit exaggerated, it shouldn't be too far from the truth.

The crisis of the Sunshine Clinic has indeed turned into business opportunities and vitality.

After Kuang Jia published an apology in the newspaper, the benefits to the Sunshine Clinic have also become greater.

Today's newspaper, the effect is not so fast.

It is estimated that in the next few days, Sunshine Clinic will definitely win a small peak.

"Brother Li has learned how to play tricks now! Well, I won't argue with you about this matter. It is your skill to be able to stir up the popularity of the Sunshine Clinic with this method. I heard that you won the Award for Justice and Bravery today. It's a good signboard! Why do I feel like I'm always making wedding dresses for you?"

Boss Zhao complained.

Li Jingsheng's eyes were condensed slightly, Lao Zhao has lost his standard today, his words made it to the bottom again.

The Bravery Award is to make a wedding dress for Li Jingsheng, what does this mean?
Isn't it tantamount to indirectly acknowledging that Boss Zhao created the incident at Fredo Pharmacy?
"Boss Zhao made a wedding dress for me? That's interesting!"

Li Jingsheng smiled meaningfully.

"Ahem... just casually. Brother, stop calling me Boss Zhao one after another. Call me Lao Zhao, brother. You and I will definitely be hard-core allies on this street from now on. Wait for me I can't work anymore, I've retired, and my son has taken over the family business, so I'm afraid I'll have to take care of you in the future!"

Boss Zhao thought too far.

But it also shows that he has really accepted Li Jingsheng's rise and existence from the bottom of his heart, and has made a plan to share the country with Li Jingsheng equally.

Realizing that he slipped the tongue twice, Boss Zhao didn't dare to talk any more.

It's too much to say, so wrong, if Li Jingsheng knows all about some veterans, wouldn't that be giving others a handle?
Boss Zhao will not trust anyone.

"I almost forgot the business. I came here to pass a message. Are you free tonight? How about having a meal at Judonglou? Someone wants to meet you."

Boss Zhao quickly got down to business.

"Who? A little shrimp like me, I'm afraid no one wants to see him?"

Li Jingsheng asked curiously.

　Thank you

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(End of this chapter)