Gou is practicing medicine in the clinic

Chapter 188 A false alarm, played by a germ

Li Jingsheng did not stop checking after finding a tender point, but continued to press her abdomen.

Pressing all the way along the periphery of the right abdominal cavity, she kept crying out for pain.

When approaching the pubic bone, the patient's tenderness response is still strong.

"Check it out!"

After finishing speaking, Li Jingsheng left the infusion room first, and Han Siying helped her get out of bed, and then followed.

"Do you have blood in your stool apart from diarrhea?"

"It seems to be a little bit, but it's not very serious. There is a little bloodshot."

"Is there a lot of abdominal pain?"

"Recently, I often have abdominal pain, but the pain will relieve itself after a while."

After all, she is a medical student, and her answer was quite detailed.

"Is it a dull pain or a sharp pain?"

"Dull pain!"

"I'll take a B-ultrasound for you to check the condition of the abdominal cavity."

"Ok!"

As she agreed, she took out the charging code on the scanning table on her mobile phone.

"Is it 100 yuan?"

It seems that she already asked Han Siying yesterday.

"Aren't you Siying's classmate? The inspection fee will be waived! Anyway, for our clinic, they are all ready-made equipment, and there is no major loss."

That electricity bill is almost negligible.

When Li Jingsheng checked her just now, he found that the tops of her panties had been washed to rot, and the clothes she was wearing were also very simple.Although the neckline and cuffs are well washed, the fluff and delineation are quite serious.

There are black hair clips on the short ear-length hair, the kind that can buy many for one dollar.

Girls nowadays love beauty, and her age is the best time in a girl's life. She dresses so plainly, which can only explain one situation, that is, she has no money.

As long as the economic conditions are a little bit better, I will not wear underwear to that extent and be reluctant to throw them away.

Li Jingsheng himself had a period of extreme poverty, and he knew that a penny is hard for a hero.

She is so seriously ill but unwilling to go to a big hospital for examination, not because she doesn't understand medicine, but because she is worried that she can't see a doctor.

It was her luck to meet Li Jingsheng.

"How dare you not give me money!"

"It's okay, it's okay, I really don't need to pay the examination fee, I'm always treated like this when acquaintances come. If I can help you find out the cause later, and if I can cure it here, you can just pay for the medicine."

Li Jingsheng tried to keep her face.

No acquaintances will be treated like this when they come.

He charges 100 yuan for filming.

After all, this is a clinic, not a charity hall.

"Okay then! Boss, thank you!"

She smiled and said yes.

After an abdominal ultrasound was performed on her, it was concluded that the bowel wall was significantly thickened.

The intestinal walls of the ascending colon, transverse colon, and descending colon were all markedly thickened.

The colonic pouch disappears, the thickening of the mucous membrane dominates, and the layers of the intestinal wall remain.

The rich blood flow in the thickened intestinal wall indicates that the lesion is in an acutely active stage.

"Okay, put on your clothes and pants!"

Li Jingsheng breathed a sigh of relief after checking the B-ultrasound for her.

The most worrying thing is colorectal cancer.

Because when she was examined for tenderness, she complained of pain around the right side of the abdominal cavity.

And it extends all the way to the back wall of the pelvis.

This means there must be something wrong with the colon, and probably something wrong with the rectum.

The human colon is M-shaped and is located just outside the abdominal cavity.

The colon and rectum are the most prone to cancer. In addition, she has a long-term low-grade fever, diarrhea, and a certain degree of bloody stools. This is very similar to the performance of colorectal cancer.

Fortunately, after the ultrasound, no obvious tumor was found.

He has also been worried that cystic tumors or solid tumors will appear after B-time inspection.After checking, he was relieved.

Sometimes it really is that bad luck only looks for the poor, and the hemp rope is only picked at the fine points.

It is not easy for a poor family to train a graduate student.

This girl could very well be the hope and pride of the entire family.

When she finishes her Ph.D., her fate will most likely change.

Poverty is only temporary.

He began to think about the cause of the girl.

Now the lesion has been basically identified, it is the colon lesion, and the mesentery may also be involved.

Her colonic mucosal problems were evident.

No local abscess was found, indicating that intestinal perforation can basically be ruled out.

It shouldn't be a big problem.

According to the symptoms of the patient and the results of the ultrasound examination, there are many diseases that can be thought of that are consistent with it.

For example, chronic bacillary dysentery can only be confirmed by routine stool culture and stool culture.

There are chronic amoebic enteritis, Crohn's disease, irritable bowel syndrome, colitis, schistosomiasis, intestinal tuberculosis and other diseases.

Li Jingsheng ruled out these diseases one by one.

His current gastrointestinal diagnosis is at the Xiaocheng level, which is the level of a senior attending physician.In addition, there are proficient general external diagnosis, internal and external auxiliary diagnosis, and mutual support.

This makes his diagnostic ability better than the general level of senior attendings.

Chronic amoebic enteritis mainly affects the right colon, with deep ulcers and insidious margins, which is highly consistent with this patient.

However, considering the patient's medical history and intestinal mucosal manifestations, he finally ruled out this highly consistent disease.

The mucous membranes are often normal in this disease.

As for bacillary dysentery, there is often a history of acute bacillary dysentery, which the girl did not have.

are therefore also excluded.

……

In the end, he thought colitis was more likely.

But ordinary colitis usually has mild symptoms, but this girl's symptoms were more severe.Considering the long course of her disease, coupled with the results of B-ultrasound images, he was more inclined that the girl had ulcerative colitis.

Now that the cause has been diagnosed, treatment is easy.

Both colitis and ulcerative colitis are not difficult to treat.

At least with his current prescription level, he should be able to cure the disease with the medicine.

"Boss, have you found out what's wrong with me?"

She got up and put on her pants, and asked a little nervously after finishing her clothes.

"Don't worry, it's not a serious illness. It may be that the colon is inflamed, and it has been delayed for a long time, so the symptoms are relatively severe. There may be colon ulcers at present. I will prescribe some medicine for you. You cooperate with the treatment yourself, control your diet, and pay attention. Rest, you should feel better soon."

Li Jingsheng comforted her.

"Really! Thank God, thank God!"

She heard that it was just colitis and ulcers, and a ecstatic smile burst out on that malnourished face.

The worry between brows also disappeared in an instant.

These days, she herself is probably suffering too.

I am a medical student, so I know a little bit.It must be a serious illness, especially cancer.

Now that it was just colitis, it was like a new life for her.

"It shouldn't be wrong! Of course, if you suspect that my diagnosis is wrong, you can also go to a big hospital for a few more tests to make sure."

Li Jingsheng said to her with a smile.

"No, no, that's not what I mean. I saw the report about the Sunshine Clinic in the newspapers and news, and then I learned that Han Siying works here, so I thought of looking for you based on this acquaintance. I There is no doubt about your medical skills."

She quickly waved her hands to explain to Li Jingsheng.

"Hehe, I can see that you must have come to look for me because you trust me. Otherwise, you wouldn't have come here twice."

Li Jingsheng nodded with a smile.

Judging from her performance, this is an inexperienced girl.

A high degree of education sometimes does not mean a deep social experience.Many young people with high academic qualifications actually have no social experience and are as pure as a blank sheet of paper.

"I'll prescribe medicine for you right away. Your diet must match your treatment. Milk and dairy products must not be touched. You should eat foods that are easy to digest, low in fiber, and rich in nutrition. Then after you take the medicine from me, see Look at the effect. If the effect is not good or the diarrhea is still severe, it may be necessary to cooperate with the treatment through fasting."

If ulcerative colitis is a minor disease, it cannot be justified.

It is a relatively common disease in clinical practice.

Her abdominal pain and diarrhea are relatively severe, and atropine is actually a good choice of medication.

It's a pity that the outpatient service is no longer allowed to sell.

Probensine, compound phenethylpiperidine, and loperamide can replace this drug.It's just that these drugs cannot be used in large quantities, let alone for a long time.

Li Jingsheng prescribed her the cheapest one, which is used in small doses for a short period of time.

The above-mentioned drugs have a side effect, which is easy to cause toxic intestinal dilation.

If the efficacy and pharmacokinetics of his medicine did not reach the level of Xiaocheng, he would not dare to prescribe this kind of medicine to such patients.

Next, he prescribed aminosalicylic acid drugs in combination with two other drugs.

There are not many medicines, as long as they are used correctly, they will be effective.

"If you are not effective after taking these drugs, or if the rectum and sigmoid colon still have severe pain, then I will prescribe another suppository for you. Enemas are not recommended as the first choice."

Li Jingsheng considered the clinic's limited conditions and manpower shortage.

She is also an unmarried girl, and it is probably difficult for her to accept the drug enema treatment.

Eventually, she paid 37 yuan for some medicine and left.

You could tell she was in a good mood when she left.

The treatment fee was so cheap that it was beyond imagination, and the cause of the disease was found out for her, so she was naturally very happy.

Li Jingsheng barely made her money.

When encountering such patients, he is willing to treat them even at a loss.

Ulcerative colitis must be treated promptly.

Any ulcer should be left alone.

Recurrent ulcers in the digestive tract can greatly induce the risk of cancer, which has been confirmed by the World Health Organization.

He checked the results of the attribute panel, which was very gratifying.

Doctor level experience +10, gastroenterology diagnostic proficiency +10, general external diagnosis proficiency +1, drug efficacy and pharmacokinetic proficiency +1, HP +101.

At the beginning, he would be very happy to get a good review and earn 10 health points.

Earning more than 100 at a time made him ecstatic.

Now, he is used to it.

It's nice to earn 100 health once in a while, but it's not as pleasant as it used to be.

"Boss, my classmate Momo sent a message, do you know what she said?"

Han Siying came over.

"What else can I say? Thank you!"

Li Jingsheng responded with a smile.

"Cough... she said, Siying, your boss is a good person!"

Han Siying solemnly relayed the content of the female classmate's text message.

Li Jingsheng smiled after hearing this.

It's hard to say whether he is a good person, but his heart is not bad.

Hope that girl named Momo can recover soon.

It was still busy in the afternoon, and patients continued to come to see a doctor.Basically, they are residents or tenants in the neighborhood.

With the Sunshine Clinic on the TV news, Li Jingsheng's reputation gradually became apparent.

In addition, he now has the status of an official doctor of the Second Hospital, which makes his authority a bit higher.The patient's trust in him has been significantly enhanced.

There are so many patients in Sunshine Clinic, Mr. Zhao from Kuaikang Clinic should probably cry.

There are only so many patients in this area, and only a small part of them are willing to go to the clinic to see a doctor.

Now that Li Jingsheng has taken away most of them, the business of Kuaikang Clinic will definitely deteriorate.

Then Sunshine Clinic's health medicine business beats the entire old street area in the south of the city, and even those pharmacies can't compete with him.Not to mention Kuaikang Clinic.

Today, Li Jingsheng's Sunshine Clinic has directly become the second strongest medical institution in Chengnan Old Street.

The only regret is that I couldn't recruit a certified doctor to come to see me.

Otherwise, the diagnosis and treatment business of the clinic should be more stable.

After all, Li Jingsheng was not in the clinic three days a week.

And as his medical skills continued to improve, he joined a large hospital again, which opened up the situation and more and more opportunities for development.

His development ideas are making new adjustments little by little.

In the future, common diseases will be diagnosed and treated by other doctors in the clinic, and he will be responsible for overcoming difficult ones.

When he was busy until four o'clock in the afternoon, his cell phone rang.

It was Lian Tao calling.

Because he was too busy, he received two messages on his phone, but he never had time to read them.

"Brother Lian Tao, is there any new progress in the patient's examination?"

"That's right, I found out after three o'clock. I sent you a message and haven't replied yet."

"Sorry, I've been busy seeing patients. What kind of disease did you find out?"

Li Jingsheng quickly apologized.

"Understood, I am impatient. I guessed that you were busy, so I called directly. You don't know, this disease has troubled me for nearly three days. Now that I find out, I feel very relieved. "

Director Lian Tao couldn't hide his excitement and joy in his voice.

"Unexpectedly, the cause of this patient is neither nasal polyps, tuberculosis, or lung cancer, but cryptococcal infection in the lungs. Damn, I have diagnosed many cases of lung diseases. I didn't expect a little The cryptococcus in the hospital is so treacherous. I worked together with Director Yang and failed to find it out. Fortunately, I listened to your advice, stopped using prednisone, and then checked step by step.

If I knew it earlier, I should have taken the specimen for biopsy as soon as possible, which caused me to take a lot of detours. "

Talking about the experience of diagnosing the disease, Lian Tao felt very upset.

Played by a little cryptococcus, he, the chief physician of the People's Hospital, has no place to put his face.

"Hehe, clinical practice is like this sometimes, and it is often unexpected. Those diseases are clearly under the noses of our doctors, but we just can't catch them."

Li Jingsheng responded with a smile.

"Isn't it! I still remember a sentence that Mr. Fu Jie said during his overseas study. His diagnosis was similar to mine. He was also played by a very inconspicuous cause, and he couldn't find it out. Finally, he asked an expert from another top medical center and one of his teachers to help, and then he found out. He said at the time that the first time he knew about this disease was in textbooks, the second time was from his general teacher, and the third time he knew about this disease. It was in that clinical practice that he said he was still too young."

I really envy Lian Tao's dazzling experience. Studying abroad or studying abroad is a big plus.

It can indeed greatly broaden your horizons and increase a lot of medical knowledge.

"Jingsheng, what kind of medicine do you think is better for this patient?"

"Your level is so high, I don't dare to fight against others!"

How dare Li Jingsheng act like a big garlic in front of him.

Although this case was diagnosed with the help of Li Jingsheng, a case cannot represent the real level of medical skills.

Lian Tao's strength is very strong.

It just happened to encounter a 'blind spot'.

Every doctor has such a blind spot, which can also be called a short board.

"It's boring to talk about professional titles. I'm older than you and have a higher professional title than you, so what? When I encounter a case that I don't understand, why don't I just ask you for advice. Medicine shouldn't look at these things."

Lian Tao is a more down-to-earth person, he only cares about ability and character, and nothing else.

"Let's talk about it, if you were to treat it, what kind of medicine would you give this patient? We can also testify to each other!"

Lian Tao urged again.

"In terms of medication, oral administration of fluconazole should be a better choice! I'm just a personal opinion. It can only be used as a reference, and it can't affect your treatment ideas."

After serious consideration, Li Jingsheng wrote out a prescription.

"Is there any other medicine?"

After Lian Tao heard this, he didn't say anything.

"One medicine should be enough."

Li Jingsheng doesn't think it's a good thing to use more drugs.

The patient's condition seemed to be serious, with a lot of symptoms, which was scary.

In fact, as long as the right medicine is used, a simple fluconazole can do it.

Too much medicine, more toxic side effects, but not a good thing.

"It's really a gentleman who sees the same thing! Haha, I just want to hear your opinion. In my impression, many clinic doctors like to prescribe a lot of expensive medicines that can't kill people and have no therapeutic effect. They have to make money Ah! I didn't expect Jingsheng to be the same as the outside, and he has always adhered to the original intention in terms of medication, which is really rare."

Lian Tao didn't laugh this time, but praised him in a very serious tone.

"Hey, have I ever been worse than the outside? Really!"

Li Jingsheng smiled proudly.

"Jingsheng, when it comes to this matter, let me give you a reference. We are good friends, so I won't beat around the bush. My original purpose of being a doctor was to make money, to make my family and myself live a better life Now, my goal is still this, but my interest in medicine is getting stronger and stronger. When encountering difficult cases in my field of expertise, I can’t help but want to get to the bottom of it.”

Lian Tao really dared to say anything.

Most of the doctors in the world study medicine in order to have a good and stable job, right?
It is the consensus of all that the income of a doctor is high.

It is precisely because of this that it has attracted countless top students to take medical examinations, study medicine, and then become doctors.

This is a virtuous circle.

Top students, top students become doctors, this can ensure the prosperity and development of medicine, and the level of medicine is getting higher and higher.

"I believe that your purpose of opening a clinic is also to make money, and at the same time, you can gain greater freedom from the constraints of the system."

"Yes! Making money is a must. When people have no money, even dogs look down on you when you walk on the road."

Li Jingsheng remembered the difficult days in the past, and his desire for money never weakened.

When he can't even pay the employees' wages, it's really difficult for him to be the boss.

"Haha! I have experience with this. I remember that I had no money when I was studying. I saw a poodle on the road. I waved at it and told it to come over. It ran away without saying a word. At first I I was thinking, do I look so vicious? Later, when I realized it carefully, I realized that the dog smelled poverty on my body, and was afraid that I would stew it into dog meat."

Lian Tao had experienced poverty when he was studying.

It seems that every strong person gradually becomes stronger after experiencing hardships.

"Speaking seriously, if you want to make money, I think you can follow the model of foreign free doctors and nurses. They work less, have high status, and high income, which is really enviable."

Lian Tao provided Li Jingsheng with a development idea.

"Tell me, what kind of model?"

When Li Jingsheng heard about such a good thing, he was naturally very interested.

(End of this chapter)