Gou is practicing medicine in the clinic

Chapter 256 Healing deafness, the muddy boy meets a violent mother
"Her child started to bleed again because of a sneeze last night. I came to my clinic in the middle of the night. After examination, I found purple ecchymosis on the back of the child's hands and feet. Then I checked the child's mouth. There were sublingual and oral Mucosal blood blisters, I think it is more likely to be acute ITP. Because the child is still young, only 5 years old, the possibility of congenital T cell defects is low, and finally my first diagnosis is acute ITP caused by viral infection."

Li Jingsheng talked about his own diagnosis in detail.

Dr. Wang can't intervene in such a difficult case.

So Dr. Shao can participate.

Internal medicine actually tests clinical experience, clinical diagnostic thinking, basic medical knowledge, and case knowledge.

Only a doctor with the above four advantages can become an excellent physician.

If you want to become a top physician, you need to have a high level of prescriptions and medicines on this basis, as well as bold, careful, thoughtful thinking, and good at careful observation.It would be even better if we can communicate well with patients and their families.

The breakthrough of many difficult cases may be a trivial matter or an unspeakable symptom reported by the other party during communication with patients or family members.

"I really learned today! I didn't think about it at the time, and I was always worried that the child would break a deep artery and cause intracranial hemorrhage. Who would have thought it would be ITP!"

Doctor Shao looked at Li Jingsheng with a hint of admiration.

It has only been a few days since I came to Sunshine Clinic.

However, Li Jingsheng has already performed more than a little better than his old doctor in many fields of internal medicine.

Young, knowledgeable, and top-notch clinical diagnostic thinking, such a young doctor has limitless potential!

"Doctor, can you please check my child's ears? Recently, the teacher reported that she was not concentrating in class and was always distracted. I called her from behind, but it seemed that she couldn't hear. I was worried about her hearing problems?"

A mother in her 30s brought an eight or nine-year-old girl to see a doctor.

Basically, there are only a few types of patients who come to the clinic to see a doctor.

One type is greedy for cheap, poor or moderate economic conditions, afraid of spending too much money in the hospital.

The second category is for convenience, living close to each other, and no need to queue up to see a doctor at the clinic.

In fact, before the Sunshine Clinic recruited doctors, people had to queue for a long time to see a doctor.

But now there are three doctors attending consultations, and this situation has been greatly improved.

Some elderly people don't know how to register, let alone draw blood here and do tests there in big hospitals, and they are afraid of entering the hospital.The children were not around, so they came to the clinic for treatment.

Not to mention cheap, there are not so many complicated procedures.

The third category, out of trust, may also be for reasons of convenience and benefits.

Basically these three types of patients.

This mother should have brought her daughter to the clinic to see a doctor for the sake of saving time and money.

"Girl, please close your eyes!"

Li Jingsheng said to the girl.

She closed her eyes.

"How old are you?"

"Nine years old!"

"What grade are you in?"

Li Jingsheng deliberately lowered his voice.

"I didn't hear you clearly, please speak louder."

"May I ask what grade you are in?"

"In third grade."

"What's your name?"

Li Jingsheng deliberately asked from her right side this time.

no response.

"What's your name?"

This time it was on the left side.

"Wang Chunlan!"

She can hear clearly.

Li Jingsheng had a bottom line in his mind.

"Okay, open your eyes! Have you felt uncomfortable in your ears recently?"

"Not really! It's just that sometimes the right ear is a little itchy."

"Have you ever picked your ears?"

"Pick it with your fingers."

"Do you feel uncomfortable elsewhere in your body?"

"No."

At this point in the consultation, Li Jingsheng basically concluded that there was something wrong with the little girl's right ear.

"Come here, I'll show you your right ear."

He took a small flashlight and took pictures of the child's right ear, and he could see that the ear was basically blocked by black things.

It doesn't look like blood, it feels like cerumen.

"Lie down on the bed over there! There is a foreign object in your ear, I will use tweezers to remove it for you."

Two treatment options quickly appeared in Li Jingsheng's mind.

Take it out with tweezers, or use 5% sodium bicarbonate solution to instill earwax, let the cerumen expand, and then wait a few days before letting the child come over to rinse the external auditory canal.

The first method is efficient, quick and less expensive.

Children suffer less.

After he let the child lie down, he turned his head and called Han Siying, "Siying, come and help this little girl's head."

Now as long as she has time, she will run into the drug sales area to sell medicines.

It was really busy there too.

Of course, the reason why she is so active is because of the considerable commission for selling medicines.

After she received the customer, she hurried over to help.

"I will remove the cerumen in the child's ears. You have to hold her head steady and don't let her turn."

"understand!"

She nodded in agreement.

When picking up foreign objects in the ear, the child will feel itchy or painful and will move around.

This can easily poke the external ear canal, or even the inside of the ear canal, including the eardrum.

Security is an issue that cannot be ignored.

After Han Siying supported the little girl's head, Li Jingsheng carefully helped her pick up the foreign object in the ear canal.

It feels extremely stiff and snaps tight.

It may have something to do with the little girl usually picking her ears with her fingers.

This will only cause the cerumen to get stuck deeper and tighter.

Because the ear canal will automatically secrete 'earwax', especially oily ears, it is more serious.

Under normal circumstances, the ear canal will have a self-cleaning mechanism.

It will keep moving as we talk, chew food, etc., and automatically expel the dirt in the ears.

It can be understood that it is a helical movement mechanism.

It is precisely because of this special ability of the ear that we can ensure that our ears will never be blocked by earwax.

When the ear canal is blocked, the garbage inside cannot be transported out, and new earwax is continuously produced, which will accumulate more and more, and eventually become this huge cerumen.

After a lot of effort, a huge cerumen with a length of more than two centimeters was removed.

The little girl showed an extremely comfortable expression.

"Don't move, I'll show you again."

Li Jingsheng checked her again, and cleaned out some small cerumen, and finally finished cleaning.

Then she checked her left ear and found a large piece of cerumen.

It's just not as blocked as my right ear.

"Don't pick your ears with your fingers in the future. Our ears, it will automatically clean up the garbage."

Li Jingsheng said to the little girl.

"Wow, I think the sound is so clear to my ears!"

The little girl's face was filled with joy.

"Did you hear what Dr. Li said? Tell you not to pick your ears with your fingers again."

"Know, know!"

The little girl has grown up so much that she no longer likes to listen to her parents' nagging.

In the end, Li Jingsheng received 20 yuan.

The patient was sent away, and another new patient came over.

This time it was a young guy in his 20s with a cyan tattoo on his arm, only partially exposed.

It seems to be a dragon.

His hair was dyed light yellow and long, covering his ears long ago.

The ears are pierced and studs are worn.

The skin looks quite fair.

Wearing ripped jeans and a floral shirt.Accompanied by him should be his parents, who seem to be very honest ordinary workers.

The wrinkles on their foreheads were extremely deep, and their faces were full of sad expressions.

If you have educated your son like this, which parent would not worry about it?

Children's education must be started at an early age, and it is difficult to re-educate after the age of 11.They already have their own thoughts and opinions, and they will not listen to many words of their parents.

If it is the rebellious youth at the age of fourteen or fifteen, it goes without saying.

Sometimes, it really is what the cause is, what the result is.

When I was young, I was neglected in discipline, but when I was old, I could only watch anxiously and wipe tears secretly.

"Doctor, help me take a look, there seems to be a bag growing here."

The boy opened his mouth first.

The point is the cheek.

It can be seen that the left cheek seems to have a piece of sugar in his mouth, and it is swollen to the size of half an egg.

"smokes!"

After the young man finished talking about his condition, he took out a pack of cigarettes from his pocket and handed one to Li Jingsheng.

Place directly on the examination table.

"Thank you, I don't smoke."

Li Jingsheng quickly declined.

After hearing this, the young man didn't mind, picked up the cigarette and put it in his mouth.

The parents behind him looked silent, as if they had been used to it for a long time.

"Smoking is not allowed in our clinic, please cooperate."

Li Jingsheng said to the boy.

"There are so many rules!"

The young man took out the cigarette and clipped it to his ear.The movement is called a skillful one, it is absolutely amazing.

"Do you want to eat betel nuts?"

He always felt that he had to treat Li Jingsheng to something to help him see a doctor.

"Thank you, I don't eat betel nuts!"

It's been a long time since Li Jingsheng has received medical treatment, this is the first time he has seen such a top talent.

The boy took out a piece by himself, skillfully peeled off the black medicine in the middle of the betel nut, threw it into his mouth and chewed it.Snapped!
His mother saw it, and without saying a word, there was a slap on the back of her head.

"Hey, why did you hit me?"

The boy hurriedly blocked it with his hands.

"People say that eating betel nuts causes cancer. Your mouth is swollen. If you still eat this, you'll die a long time, right?"

The boy's mother scolded people very fiercely.

Beating people is also very heavy.

The slap on the back of the boy's head just now shocked Li Jingsheng a lot.

There are many important acupuncture points, blood vessels and nerves in the back of the head.

Sanda and fighting games are forbidden to hit the back of the head and crotch.

This mother must have been so disappointed in her son that she hit such a heavy hand.

"So many people eat it, aren't they all right? You see, it says on the cigarette pack that smoking is harmful to your health. Why don't you still smoke? Don't beat people up at every turn, can you?"

The boy was beaten by his mother. Although he was very angry, he didn't fight back.

From this point of view, at least not to the point of no cure.

At least I know how to respect my mother.

"Others smoke it, that's someone else. If I see you chewing betel nuts in the future, I will still beat you."

With that said, my mother snatched away the bag of betel nuts.

Frightened by his mother's big slap, the young man had no choice but to honestly spit out the betel nut in his mouth.

He spat it out, first caught it with his hand, and then threw it hard.

Accurately fly into the trash can a few meters away.

People who are used to being mixed up in society basically have this habit.

Li Jingsheng didn't speak the whole time, and he didn't stop the boy's mother from beating him.

"Doctor, please take a look at my son. I'm afraid he has oral cancer. One of my relatives got oral cancer from eating betel nuts. He cut off half of his tongue and his face. part."

pleaded the boy's mother.

Hitting my son just now was love.

On the contrary, the young man's father did not speak the whole time, standing behind him like a log.

Sometimes, there must be a reason for a family's failure to educate their children.

"Let me take your temperature first."

Li Jingsheng took the boy's forehead temperature, 36.5 degrees, normal.

Then he reached out and touched the lump on the boy's cheek. It was soft and didn't look like a malignant tumor.

"Open your mouth and let me see."

I took a photo with a flashlight, and there was obvious redness and swelling on the left cheek.

No suppuration.

"How long is this lump?"

"About a month or so! At first I felt a little pain, I thought it was a fire, so I ignored it. A lump slowly grew in the back, and it didn't subside for a long time, so I told my mother."

"You should have told me immediately."

His mother started yelling at him again.

Educating children by yelling and threatening them at every turn is actually not good at all.

It will only make the child feel scared, and he will be even more afraid to say something next time.

Li Jingsheng checked it carefully again.

"Let's take a picture for you first! If the problem is not particularly serious, you can choose to have surgery here or in other hospitals."

When paying the inspection fee, the father who didn't say a word paid the bill.

According to a B-ultrasound, the boundary of the tumor is clear and the diameter is large.

Li Jingsheng believed that he was sure of completing the operation.

It depends on whether the family and the patient agree.

"You need an operation to remove the tumor. The cost is about two thousand. If you do this operation in our clinic, you don't need to be hospitalized, but you need to follow the doctor's orders."

Not a major surgery.

It can be done directly in the clinic.

If you go to a hospital that lacks inpatients, you may also keep patients in hospital for surgery.

In a big hospital, it must be cut directly in the outpatient department.

"Is it so expensive? I have to ask my mother for the money. Doctor, is this oral cancer?"

The young man only asked this question in the medical laboratory.

In front of his parents, he really has a fearless attitude.

It's as if he doesn't care about his body at all.

"It's hard to say for the time being. After we're done, we'll do a pathological biopsy for you. When the results come out, we'll let you know. You can also come to our clinic to get the pathological biopsy results on the third day after surgery."

Li Jingsheng brought another business to the Second Hospital.

Before the operation, his clinic could not do the biochemical examination.

Because it is an outpatient surgery, it is not a problem not to check the routine blood test.

All I can do are minor surgeries.

If he really encounters a surgical patient with high risk, after evaluation, he feels that it is necessary to improve the preoperative examination, and he can cooperate with the community health station.

It's also close.

Just draw the patient's blood and send it over.

“Why do we still eat betel nut if we are worried about oral cancer?”

Li Jingsheng asked him.

"Betel nuts and cigarettes have boundless magic power. When you hang out outside, you don't invite people to smoke, and you don't recognize people to eat betel nuts. Who cares about you? I didn't like smoking or chewing betel nuts at first, but I gradually got used to it. .Now that I don’t chew betel nuts, I just feel uncomfortable, and I always feel that something is missing.”

The young man is quite solid.

Li Jingsheng nodded, "Go to your parents to discuss and ask their opinions. Your tumor is getting bigger and bigger, so the sooner the surgery, the better. If it is a malignant tumor, it will spread to the lymph or other organs. Difficult to clean up."

It's really not to scare this guy.

The cheeks and neck are close together.

There are very dense lymph nodes under the cheek, and if it is not surgically removed in time, it is very easy to transfer.

"That man is not my father! It's my stepfather!"

said the man.

"Anyway, it's your elders. Go to them and discuss it! I saw that the inspection fee was paid by your stepfather for you."

Li Jingsheng finally understood why the young man's father was silent.

It's hard to be a stepfather!

Just look at the young man's attitude towards his stepfather.

In my heart, I don't recognize this father at all.

After the young man went out, he went to discuss with his mother.

His stepfather sat in the rest area and watched from afar, not daring to go over at all.

Li Jingsheng continued to see other patients.

After more than an hour, the boy's mother came over, "Doctor, the surgery fee is still close, can I pay you after next month's salary?" The woman begged in a low voice with a smiling face.

"I'm afraid this won't work. Our clinic has clinic regulations."

Clinics are not like other industries.

You can't do things like credit.

Because the patient may be grateful to the clinic before treatment.But after being cured, some patients will keep their promises and make up the owed expenses.Most patients will 'forget' this matter.

Even conversely, the clinic cured him badly, and some new problems appeared after the operation.

This is also the reason why hospitals rarely pay patients in arrears.

Some patients are anxious to save their lives because they don't have money with them, or they can't make up that much money at once.The doctor in the hospital kindly settled the arrears for him. After trying to rescue him, the patient died in the end.

At this time, the arrears are difficult to recover.

Even if the hospital doesn't issue a certificate, the family members have no way to get the body, and still can't get it back.

Moreover, in law, it does not support the hospital to claim the medical expenses owed by the patient by deducting the corpse.

Li Jingsheng's small clinic can provide some support when encountering patients who really need emergency treatment, but this kind of owed surgery fee will definitely not agree.

Opening a clinic is for making money, not for charity.

He is also incapable of doing charity.

At most, when you meet someone who needs help, you can help as much as you can.

"Does he have to do this operation now?"

"Given that his mass has been getting bigger and affecting normal eating, the sooner the operation is, the better. To put it bluntly, if it is malignant, it will be a pity if it is delayed for a period of time and leads to metastasis." Is it? 2000 yuan is not much, compared with a human life, it is definitely worth it. Think again."

Li Jingsheng believes that as long as the family's credit is not bankrupt, it should be possible to get two thousand from relatives and friends.

If relatives and friends do not even lend two thousand, it is even more impossible for Li Jingsheng to agree to let them owe the money.

It shows that the integrity of this family is not good.

"I paid the money, let him do it!"

The boy's stepfather stood by and listened.

This is the first sentence he said in such a long time.

Simple and straightforward.

The operation fee is borne by him alone.

Like this kind of second-marriage family, because they belong to half-way couples, the money earned by the two people is generally kept separately.

The man may take on a little more in life.

"If you don't take out the money sooner, you're stingy!"

The lad muttered.

"Shut up! Have you ever talked to your father like that? If you dare to say that again, I will slap you."

The woman scolded her son, then looked at the man.

"Old Liu, I borrowed this money from you, and I will pay you back when I get paid."

"Need not."

Men should belong to the type that is not good at words.

He took out a plastic bag directly from the inner pocket of his clothes, and then counted 2000 yuan out of it.

"Give!"

He handed it over to Li Jingsheng's reception desk.

The money was the hard-earned money saved by the man, and he took it out for the young man's surgery without much hesitation.

Li Jingsheng looked at the young man, and found that this guy still had a look of disgust and dissatisfaction.

Sometimes, people's feelings are really too complicated.

The man had obviously paid so much for this unrelated son, but the young man refused to acknowledge it.

Raising other people's children is tiring both physically and mentally.

It's really hard to get their approval.

(End of this chapter)