Gou is practicing medicine in the clinic

Chapter 225 Inexplicably thin patient, good news keeps coming
After hanging up the phone, Li Jingsheng's heart was still heavy.

However, he still had many waiting patients in his hands, and he soon put himself into intense work again.

Busy until close to one o'clock in the afternoon, I finally finished dealing with all the waiting patients.

"Boss, go to the office to eat quickly, I'm afraid the food will be cold!"

Tang Ping felt helpless and distressed seeing her boss miss her meal.

"It's okay, as long as you have a stutter! There are indeed a lot of patients today, and several of them are quite complicated."

He tends to be more cautious when encountering patients with more complicated conditions.

For fear of being misdiagnosed.

The benefits of such a fight are not small, and it will definitely be of great help to the improvement of personal medical skills.

This even he can feel.

"In the future, there should be no limit to the number. If you can handle [-] patients in one morning, you will be limited to [-] morning numbers. You can only wait until the afternoon for diagnosis and treatment. Otherwise, if the patient is cured and the doctor is tired, then Certainly not!"

Tang Ping made a suggestion.

She is very concerned about the health of her boss, and the relationship between the two is very delicate.

Not lovers, more like close comrades-in-arms.

"Let's take a look the day after tomorrow! If there are still so many patients, I'm afraid we can only limit the number. We moved to a new location, and my biggest worry is that the original patients can't find us here. Now it seems that my worries are unnecessary. of."

Li Jingsheng treated a total of nearly fifty patients this morning.

This is almost the amount of outpatient visits many doctors make in a whole day.

Fracture patients and patients with complicated conditions need to spend a lot of time.Sometimes when encountering difficult patients, just explaining can make people crazy.

He came to the office for dinner, and only then did he have time to check the messages received on his phone.

"Have you eaten? I miss you a little bit!"

Ou Qinglan sent him a message around twelve o'clock.

I also took a picture of eating in the hospital cafeteria.

"Come to my clinic at night and take you shopping."

Li Jingsheng usually reads books or practices surgery at night.Now that you are in a relationship, you must spend more time with your girlfriend.

"Oh my god...you don't know how to eat at this point! I don't allow you to torture your body like this."

"Roger that!"

"Don't be duplicity, take a photo when you are eating tomorrow and send it to me. Work is important, and your body is even more important."

"Okay! There are a lot of patients today. If they don't finish processing, they will cause trouble. Next time if there are a lot of people, I will use the number limit to solve it."

Li Jingsheng didn't expect that the number limit would start so soon.

Judging from today's situation, the limit processing capacity of a day cannot exceed one hundred patients, and in fact it may be even less.

This needs to be practiced slowly to know.

And as his reputation continues to increase, the probability of receiving various difficult cases will also increase significantly.

At present, only Dr. Wang can share a small part.

After Dr. Wang grows up, he should be able to share more. Han Siying has no certificate, so she mainly focuses on assistants and internships.It is impossible for her to be the chief physician, let alone prescribe a prescription.

If Li Jingsheng was present, her independent diagnosis and treatment ability could be properly exercised.

People call him master, but she can't let her call him in vain.

"I'm busy, I'll come to you tonight!"

She texted back and got no response.

There should be patients who need to be treated.Especially some emergencies.

Li Jingsheng went down to check the messages sent by other people.

It's really not that he values ​​sex over friends, the main reason is that he hasn't completely left the order yet, so he must be more careful.

Director Mu sent a message to praise him.

"Good boy, you are really here, and you have successfully diagnosed the real cause of the disease again! Next time I have a difficult case, I will ask you for help as a consultant!"

It is absolutely impossible for Director Mu to ask him for advice, because he can't hold back his face!
Anyway, he is an old expert.

"no problem!"

Li Jingsheng readily agreed.

There are also two messages from Zhang Chao from the Department of Cardiac Surgery of the People's Hospital, asking if he is busy?When are you free to have a potluck together!
Just looking for something to say.

Li Jingsheng has seen through this kind of classmate relationship after experiencing the fickleness of the world.

He ignored it, but continued to scroll down.

Lian Tao from the People's Hospital also sent him a message.

Brother Lian Tao's message must be answered.

"Jingsheng, last time I was entrusted to pay attention to the second-hand equipment in the operating room. If you are not in a hurry, you can wait. Our hospital may have a batch of good operating room equipment replacements, most of which are imported, and I will do my best to help you fight for them. .”

Lian Tao is actually very busy, and he can still take what Li Jingsheng told him to heart.

This man kept his promises and was very popular with Li Jingsheng.

"Okay, Brother Lao Liantao, please take care of me."

Most of the funds he has on hand have been used up due to renovations and rent payments.Take it easy.

Now that he doesn't keep two or three million yuan in his hand, he is not at all at ease.

By next month, Modu Youyao should be able to refund him 20 decoration money.

The premise is that good drug sales performance must be maintained.

Then the 20 was returned to him in the form of payment for goods, and this needs to be purchased to realize it.

If the performance is good, you may be able to get more than 20 yuan in about a month.

Therefore, calculated in this way, it will take at least two months for the 20 decoration subsidy to actually fall into his bank card.

Now the net profit of a day is more than [-] when it is high, which refers to the money that falls into his personal pocket.

I have never had such a high income before, and I am afraid that I will have to pay a lot of money to pay taxes.

No way, who told him to be a law-abiding citizen.

"Jingsheng, there is a complicated case here. I will send you the information and help with the consultation."

Lian Tao responded to the message almost instantly.

"send it!"

Li Jingsheng didn't have a clue in his heart, and the case that even Tao couldn't handle would definitely not be a simple case.

However, he has accumulated a lot of life points now, and he has a certain level of diagnostic and medical skills, so he is not afraid to challenge difficult cases.

Coming soon.

The patient is an old man over 60 years old. The symptoms are weight loss and recurrent lower extremity rashes, which have lasted for nearly four years.Recently, there has also been fatigue, even to the point where she cannot walk independently.

So I went to the People's Hospital for treatment.

There was also treatment before, but it was only in a small local hospital, and it was always treated as a wet clinic.

Recurrent.

Many treatment methods have been used but no good effect has been obtained.

Not to mention rooting.

Skin clinics are actually quite torturous, and the itchiness and psychological pressure they bring cause great distress to patients.

It is impossible for ordinary wet examination to cause the patient to be too weak to walk.

After examination, there is also an oral ulcer among the symptoms, which is the same as the skin diagnosis of the lower limbs, and it has been recurring for nearly four years.

And the tongue always feels very painful, and it also hurts for four years.

I feel that the patient's disease should not be a simple digestive tract disease.It's more like something is wrong with the immune system.

The patient has been eating normally for the past four years.

Since eating is normal, how can people still lose weight and become thinner?

Lian Tao has already prescribed clotrimazole to the patient, and asked the patient to put it in his mouth to relieve tongue pain.

But this is a palliative, not a permanent solution.

And the patient's symptoms are not limited to oral ulcers.

According to the medical records sent over, the patient is 1.7 meters 49 tall and weighs [-] kg, which must be on the thin side.

Cardiopulmonary examination revealed no abnormalities.

The patient had mild abdominal tenderness about 3 cm below the right costal margin of the liver, and there was no moving dullness in the abdomen.

There are scattered dark erythema on the front of both shins, and there is a loose bulla with a diameter of nearly 1cm on the erythema on the right shin.

You can also see scattered bullae ulcerated, and shallow erosion, and some have crusted.

Some skin lesions showed obvious lichenification changes.

Judging from the erythema, bullae, and superficial erosions on the legs, they are very similar to eczema and tinea pedis.

Li Jingsheng has treated some patients with tinea manus and pedis, some of which have been in progress for more than six years and are very stubborn.

Because tinea pedis is a fungal infection, its biggest feature is that it is difficult to cure and easy to relapse.

The main attack site is the skin, which will cause intense itching, cracking, blisters, and erosion.And rubbing the general dermatology ointment can take effect quickly, but it will relapse after a while.

This is not the most evil.

After using a kind of ointment many times, the fungus develops drug resistance, and the effect will decrease significantly when it is used again.

Many patients will think that there is no cure when they encounter this situation.

The patient's course of disease lasted for four years, and the symptoms of the lower limbs were exactly the same as those of tinea manus and pedis caused by fungal infection.

However, the patient also has two symptoms of oral ulcers and weight loss, which seem to rule out the possibility of tinea manus and pedis.

Tinea manus and pedis tend to occur on the hands and soles of the feet, but it is very contagious. If it is not treated for a long time, it may infect other parts of the body.

Such as perineum, neck and other parts.

Lian Tao has checked the patient's urine routine and stool routine, all of which are normal.

Sudan stain was negative.

Blood in the stool can basically be ruled out.

The patient's food intake has not decreased, and there are no obvious gastrointestinal symptoms such as blood in the stool, so why does he continue to lose weight?
Lian Tao initially suspected that it might be diabetes, but the urine test results were normal.

Then, in order to avoid misdiagnosis, fasting blood glucose was measured for the patient.

The first time was 4.9mmol/l.

Maybe I was worried that the result was inaccurate, or I still suspected that the patient might have a pancreatic problem, so I took another test.

5.7 mmol/l.

Fasting blood glucose 3.9-6.1mmol/l is within the normal range.

Although the fasting blood sugar of this patient fluctuated somewhat, they were all within the normal range.

Diagnosis to this step, basically should transfer the diagnosis target.You can't hang yourself on the tree of pancreas.

But Lian Tao has the same virtues as Li Jingsheng, he likes to dig into the horns when encountering difficult cases, and likes to be self-confident.

He asked the patient to test the blood sugar again two hours after the meal, and this time the result was 8.3mmol/l.

Lian Tao still did not give up, and gave the patient oral glucose for a tolerance test.

The blood sugar test at 0 minutes after taking it was 5.2, 12.7 after half an hour, 18 after one hour, 15.6 after two hours, and 8.0mmol/l after three hours.

The patient appears to have mild diabetes.

However, the patient's blood routine, urine routine, and stool routine were basically normal, and his fasting blood sugar was also normal.

Although the glucose tolerance test fits the diabetes curve, it is difficult to determine how severe the patient's diabetes is.

And the patient never experienced ketosis or acidosis.

It is precisely such a strange condition that makes Director Lian Tao, the chief physician of the Department of Gastroenterology, in trouble.

It can be seen that the patient's liver was checked later, and the patient had never had hepatitis, but according to the patient's self-report, he had hepatic hemangioma.

Lian Tao checked the patient's liver function, which was normal.

Kidney function was checked again, and it was still normal.

Moreover, the patient's body temperature is also normal.

I can eat and drink, the food intake has not decreased, the three basic routines are normal, and the liver and kidney functions are also normal.So where did the energy go?
The patient also did not have blood in the stool.

If you grasp the symptom of weight loss, you can hunt it down and find out the real cause.

But how can it be so easy in actual diagnosis?

The diagnosis of this patient is already in trouble, and basically everything that can be checked has been checked.All normal.

There is persistent weight loss for no apparent reason.

There are also lower extremity dermatology and oral ulcers.

Li Jingsheng didn't have a clue for a while, his gastroenterology diagnosis is currently at the level of Xiaocheng, only more than 200 away from Dacheng.

It just so happened that he had saved a lot of life points.

And now, no matter in the clinic or the hospital, he can earn a lot of life points every day.So he is no longer as petty as before when using it.

Directly upgrade the diagnosis of gastroenterology to Dacheng.

I thought to myself, I should be able to diagnose it this time, right?

As a result, there is still no clue.

It seems that when encountering such a difficult case of top difficulty, blindly improving the proficiency of diagnostic and medical skills does not seem to have much effect.

Some other assistance may be needed.

Such as doctor grade, surgical diagnosis experience and so on.

When diagnosing such difficult cases, it is most likely to encounter areas where the lesions are not locked.

For example, this patient looks like a disease in the digestive tract field.Li Jingsheng upgraded the diagnosis of gastroenterology just now.

But the lesions are actually in other areas, such as the liver, gallbladder, kidneys, etc., are all possible.

He is only good at the gastrointestinal field, and if the lesion is in other parts, naturally he has no clue.

"It's a bit difficult, I'll let you know when I find out."

Li Jingsheng replied a message to Lian Tao, and then went to work in the reception hall.

Compared with the morning, some patients still came to visit in the afternoon.

The number seems to be quite a lot.

Li Jingsheng wondered if he had snatched the patients from the health station?

Because the patient base in Chengnan Old Street is so large, there is no such thing. Because the Sunshine Clinic moved to a new location, the venue became larger, and the number of patients who fell ill increased.

If this is the case, Li Jingsheng's clinic should be smashed down.

Most likely, the growing reputation of the Sunshine Clinic has attracted some patients from Chengnan Old Street.

Patients who originally wanted to go to Kuaikang Clinic or Health Station felt that the medical skills of Sunshine Clinic were better, so they went to Sunshine Clinic one after another.

He has been busy, constantly dealing with patients who can eat.

Some diseases are too serious, or beyond the scope of his diagnosis and treatment, so he can only give up decisively and advise the patient to go to a big hospital.

It was almost five o'clock in the afternoon, and Li Jingsheng's mobile phone seemed to have received two messages.

But he didn't have time, so he didn't check.

After a while, the call came directly.

"Doctor Li, you must be busy!"

It was Director Hua's gentle voice.

"Director Hua, if you have any instructions, please tell me."

Li Jingsheng's tone became respectful.

"Haha, don't be so serious. You are a member of our orthopedic surgery department. You can relax a little in front of me! The paralyzed patient took bone marrow fluid for testing according to your diagnosis, and initially confirmed the presence of parasites." Infection. It is currently being further investigated and confirmed, and the cause of the disease has been basically found out. You have made another contribution to our orthopedic surgery department."

Director Hua smiled and praised him.

Not in vain, Li Jingsheng took a taxi at his own expense to rush to the Second Hospital last night, and worked until after one o'clock in the night before returning to the clinic to sleep.

Both difficult cases have been solved, which is really good news.

The meaning of studying medicine has been well reflected.

Without the participation of Li Jingsheng, these difficult cases may also be solved by other doctors, but for him personally, the meaning is definitely different.

If you break it by yourself, you will feel a sense of accomplishment.

It is also a very big growth for me personally.

"I didn't expect it to be a parasitic infection. No wonder the patient's bones felt so strange. No wonder the vertebrae were healed and the nerves were normal, but the patient kept complaining of lumbar pain and couldn't stand on his lower limbs."

All doubts are well explained at this moment.

It's like doing a math problem. There are many ways to solve the problem, but there is only one correct answer.

"If you come to pick up Xiaoou from get off work later, come to my office. Let's have a chat. It doesn't matter if you don't have time today. You will come to work tomorrow anyway. You can come to my office after work or at noon. I."

Director Hua didn't know what else he was looking for.

Listening to the tone, it must be a good thing.

Ascension and indications have been resolved, so what good would that be?
Li Jingsheng couldn't guess.

(End of this chapter)