Gou is practicing medicine in the clinic

Chapter 276: Just check if you need to, and directly help you get ranked second on the list
The second hospital did not send anyone to participate in the next two competition events.

If the level is not good enough, it would be embarrassing to send someone on stage.

Very few people do this kind of thing.

Almost all larger hospitals are very protective of their reputation.Do not do anything that will have a negative impact on the hospital or expose major shortcomings of the hospital.

Li Jingsheng sat in the audience and watched, but he also gained something.

You can get a lot of inspiration from the expert diagnosis and treatment of other hospitals.

"Today's sixth competition event is the diagnosis and treatment of gastrointestinal diseases that many doctors have been waiting for. However, one thing is different from other events. We consider that internal medicine is mainly drug treatment, so we specially adjusted the competition event of digestive surgery to digestive surgery. After internal medicine. If the gastroenterology department diagnoses the cause and requires gastrointestinal surgery to remove the lesion, then the gastrointestinal surgery department can come into play."

The difference between internal medicine and surgery is that internal medicine mainly uses drugs, physical therapy and other treatment methods, and can deal with almost most diseases.

Surgery is the main treatment method, supplemented by drug treatment.

It is not the general public who understands that a surgeon can only play with a knife, but cannot diagnose or prescribe medicine.

From the perspective of development prospects, surgical treatment is becoming more and more important.

For example, exploration, early resection of cancerous tissue, resection of necrotic tissue, anastomosis of nerves and intestines, etc.

These are the specialty of surgery.

There are many diseases that cannot be treated by internal medicine, and may even delay the treatment.

Physicians are also aware of this problem, so interventional surgery, which has emerged in recent years, has become a surgical treatment method quietly developed by internal medicine.Less trauma, good results, and short recovery time.

This makes interventional procedures more popular with patients than traditional surgical procedures.

When the surgery department saw that the internal medicine department had created a "secret skill" and wanted to take away their jobs, they were very anxious!

In order not to be eliminated, surgeons chose to keep pace with the times. They were inspired by interventional surgeries and developed minimally invasive surgeries.

Therefore, competition is actually a good thing.

It can become a driving force for rapid progress in medical skills.

"Now, please ask all the gastroenterology doctors present to diagnose this patient who has just been admitted to the hospital."

As soon as the host finished speaking, the patient's detailed information appeared on the big screen.

This patient is ill, which is unfortunate.

But with so many doctors and experts providing on-site consultations for him, this kind of treatment should be unmatched across the country.

With the wisdom of so many experts gathered, it is estimated that no matter how difficult the disease is, it can be diagnosed on the spot.

Patient: Male, 51 years old, male, worker.

Recently, I have developed a strong feeling of choking when eating hard objects such as fruits and vegetables.

There is also a slight choking sensation when drinking water, porridge, or soup, but it is not strong.

When you experience choking when eating, you will also experience severe pain behind the sternum, which is somewhat similar to the pain caused by burning.

There are no symptoms such as acid reflux, belching, coughing, nausea, and vomiting.

There is no weakness in chewing or hiccups.

There are no symptoms such as fever, weight loss, and fatigue.

The body temperature is 36.6 degrees, the pulse is 80 beats/min, the respiration is 21 breaths/min, and the blood pressure is 125/85mmhg.

These basic signs are normal.

Li Jingsheng felt that it was either a minor problem or a serious illness.

Considering that the patient is working and older, the possibility of a serious illness is higher.

During the physical examination, no murmurs were heard in the patient's valve auscultation areas, the breath sounds in both lungs were clear, and no dry or wet rales were heard.The abdomen was flat and soft, no mass was palpable, and there was no tenderness or rebound tenderness.

There was no enlargement of the tonsils, no congestion in the pharynx, no sunken or bulging eyes, and no superficial lymph nodes in the body could be touched.

The chest is symmetrical, without tenderness or percussion pain.

From these examinations, it can be basically concluded that the scope of the patient's lesions should be very small, and if it is a serious disease, it should be in the early stage.

The results of the patient's routine blood, urine, and stool examinations were all normal.

The test results of serum creatinine, creatinine isoenzyme, blood urea nitrogen, and blood alpha-fetoprotein were all within the normal range.

"This definitely requires an X-ray barium meal for further diagnosis!"

Li Jingsheng said to himself.

After hearing this, Xiao Linlin, chief physician of the gastroenterology department who was sitting in front of Li Jingsheng, immediately lowered her head to operate on the tablet computer.

Looking at this situation, it may coincide with Li Jingsheng's idea when he is undecided.

"The results of the requested examination came out. There are burr-like changes in the wall on the right side of the middle esophagus, ranging from about 1cm by 0.7cm."

Xiao Linlin informed Li Jingsheng of the results of the barium meal examination.

The Gastroenterology Department of the Second Hospital was average, and Xiao Linlin had also heard that Li Jingsheng was good at diagnosing difficult cases.

This case is not a difficult case now, but everyone is rushing to diagnose it and time is precious.

Let Li Jingsheng help with the consultation, and the efficiency will be higher.

"It may be esophageal cancer! It is recommended to have a gastroscopy and then take a biopsy sample."

Li Jingsheng's gastroenterology diagnosis has reached a high level, and his level is not low.

He already had the results of the initial diagnosis in his mind, but now that he heard that the wall hairs in one area of ​​the esophagus had changed like thorns, he became more confident in the results of his initial diagnosis.

After listening to Li Jingsheng's suggestion, she thought for a while and then submitted the inspection application.

The reason why Li Jingsheng has a clear diagnosis and clear goals is because the patient's symptoms are very simple.

Apart from the choking sensation when eating and the burning pain behind the breastbone, there were almost no other abnormalities.

The patient has no obvious choking and difficulty in articulation, so cranial nerve diseases can basically be ruled out.

The absence of symptoms such as chewing weakness and eyelid ptosis can rule out myasthenia gravis or polymyositis.

The absence of symptoms such as dry mouth and tears can rule out Sjogren's syndrome.

"Achalasia also has similar symptoms! Is it possible to be complicated by esophageal ulcer?"

Xiao Linlin said hesitantly.

"Achalasia will have difficulty swallowing, but there will also be vomiting after meals. The patient does not have symptoms of vomiting after eating, so I think esophageal cancer is more likely."

Li Jingsheng seemed very rational and his thinking was extremely clear.

After listening to his analysis, Xiao Linlin secretly admired this young orthopedic surgeon who was more than ten years younger than herself.

I really didn’t expect that he was not only excellent at bone setting, but also excellent at gastroenterology diagnosis.

Without any further hesitation, apply for gastroscopy directly.

After a while, Xiao Linlin responded with information.

"A gastroscopy has been performed. On the right side of the esophagus, which is about 29cm away from the incisors, a localized erosion of about 1.2x1cm was found. The edges were clear and the center showed granular changes."

Li Jingsheng was not surprised by the test results.

From the beginning, I suspected that it might be esophageal cancer. Now I have done two tests in succession, both of which point to esophageal cancer.

The center of the lesion shows granular changes, which indicates that cancer cells are rapidly proliferating. There are various malignant tumors. Almost most malignant tumors have a common feature, that is, the surface is not smooth and the shape is weird.

Such as scaly, granular, irregular, etc.

"Did you take a biopsy? Basically the cancer is gone."

"A biopsy has been done, but the results haven't come out yet. I see that the test was sent more than an hour ago, and the results should be available soon. This also shows that the gastroenterologist at Qiaobang Hospital has the same diagnosis idea as you."

Xiao Linlin chatted with Li Jingsheng in a low voice.

She also greatly admired Li Jingsheng's diagnostic ability in the field of gastroenterology.

"It is estimated that most gastroenterology doctors will have similar diagnostic ideas. I suggest that you wait until the biopsy results come out. If it is indeed esophageal cancer, then submit an application for endoscopic ultrasound."

Li Jingsheng said to her.

"Didn't the judges say that we should do fewer examinations? I have already done several examinations on patients. With gastroscopy and biopsy, it is completely enough!"

Xiao Linlin asked puzzledly.

Points will be deducted for doing more inspections.

This is a competition, and she doesn't want to win any championship, at least not to be at the bottom.

An irregular inspection will result in a deduction of 2 points, which is very detrimental to her.

"What the judges advocate is not to perform excessive examinations on patients, so as not to waste precious medical resources and increase the financial burden on patients. I ask you to perform this examination on the patient, which can distinguish the mucosal layer, submucosa, muscular layer, and adventitia of the esophagus Whether all lesions have occurred and to what extent the lesions have infiltrated. You can also observe the lymph nodes around the esophagus and posterior mediastinum to better identify whether it is a malignant lesion and whether mediastinal lymph node metastasis has occurred.

This will be very beneficial to the patient's surgical planning.

They are also responsible for the patient’s life safety.

In case of metastasis, the operation must expand the scope of cleaning, otherwise it will easily cause recurrence.

Compared with the patient's life safety, the cost of this endoscopic ultrasound examination is almost nothing.There is no such thing as occupying medical resources. "

All medical resources are intended to diagnose and treat patients.

Li Jingsheng talks eloquently and has his own set of thoughts and cognitions.

On the other hand, Xiao Linlin is a bit constrained by rules and regulations and seems too rigid.

In Buddhist terms, it means you are a female benefactor.

"Dr. Li is right, but I am stuck in a rut. I am not afraid of your jokes. Before this expedition, the dean told me to strive for a good ranking and change the current situation of the decline of the Department of Gastroenterology in the Second Hospital. The pressure was too great, and I It became like walking on thin ice, but I was a little constrained everywhere.”

Due to the limited number of entries, she fought alone this time, and she was the only one who came to the Department of Gastroenterology.They are also among the very young chief physicians of the Second Hospital.

Naturally, the clinical experience cannot be compared with those of older experts. In addition, the Gastroenterology Department of the Second Hospital is already weak and there are not many patients.

The practical opportunities she can get are definitely not comparable to those of strong universities such as the top three universities.

Especially for difficult cases, which cannot be solved, the standard of diagnosis and treatment has not improved much.

This makes it understandable why she was nervous.

"This is completely understandable. If Director Xiao is willing, I can act as your temporary assistant."

Li Jingsheng decided to provide help to the young female chief physician.

Everyone is a doctor at the Second Hospital and has little contact with them.

It's good to have a good relationship with her this time.

If there is any need for help in the future, I believe she will be very enthusiastic to help Li Jingsheng.

"Really! Great, can you sit next to me? It will be easier to discuss the case."

After Xiao Linlin heard this, she couldn't help but be very happy.

Because she was not familiar with Li Jingsheng and was thin-skinned, she was embarrassed to ask Li Jingsheng to be her assistant.

You know, Li Jingsheng has already won two gold medals for the Second Hospital. After returning, his status will undergo earth-shaking changes.

No one dared to treat him as an ordinary attending physician in orthopedic surgery.

The status is at least equal to that of ordinary chief physicians.

"no problem!"

Li Jingsheng stood up, walked to the front row, and sat next to her.

The seats in the back row are quite empty. The venue itself is very large, so when arranging seats, some extra empty seats will be allocated.

This allows doctors from other hospitals to have a place to sit when they come to communicate.

"I'll write the inspection application first, and I can submit it directly when the results come out."

After Xiao Linlin had a strong assistant, she suddenly became more confident.

Dean Jin was naturally very happy to see Li Jingsheng taking the initiative to help Xiao Linlin.

His goal in leading the team this time is to return with more good rankings.

It would be best to win one or two more gold medals.

He won two gold medals on the first day. Not to mention him, even Dean Fu and other hospital executives who were not here felt extremely excited after hearing this.

"The biopsy results are out! It's really esophageal cancer!"

Xiao Linlin said slightly excitedly.

Without thinking, she immediately followed Li Jingsheng's suggestion and submitted an application for endoscopic ultrasonography.

"Someone messaged me privately! He asked why he chose endoscopic ultrasound."

Xiao Linlin clicked on a jumping message box on her tablet computer. After reading the message, she looked very surprised.

Actually it's nothing.

It is estimated that the judges will have a big data statistics.

She was the first to submit this application, which may have aroused the interest of the judges or an expert, so she sent a message to inquire.

It is also possible that the receiving doctor is worried about excessive examination and wants to ask her why she requested this examination.

"Tell him directly that there are many types and stages of esophageal cancer. Doing this examination will help determine the patient's cancer stage. It also has certain auxiliary diagnostic significance for the classification."

Li Jingsheng's answer is simple.

The purpose is to find out which stage the cancer is.

"The other party complimented you and said he would arrange it immediately!"

Xiao Linlin said with a smile.

She never imagined that she would be able to get ahead of other experts.It was also praised by the organizer.

Time passes little by little.

In less than 10 minutes, the results came back.

The patient's examination result was stage 1 esophageal cancer, with no regional lymph node metastasis.No distant metastasis was found either.

However, esophageal cancer has invaded the lamina propria and submucosa of the mucosa.

This is a fortune in misfortune.

With early detection and early treatment, as long as this section of the esophagus is removed, the problem should be minor.

The success rate of radical surgery is very high.

"Is thoracic surgery a good treatment option?"

She asked Li Jingsheng for his opinion.

"pretty good!"

Li Jingsheng confirmed it.

After she submitted the surgery plan, not long after, the scores were displayed on the big screen. Xiao Linlin from the Second Hospital was actually ranked No. 2.

"Ah...god, my rating is actually only one point lower than No. 1. If I had brought you over as my assistant earlier, maybe I would have reached No. 1 directly."

She almost screamed, her face turned red with excitement.

Although a 45-year-old woman is well-maintained and has a good temperament, she cannot compare with a young girl.

At this moment, she rarely showed her girlish look.

If the doctors and nurses from the Gastroenterology Department of the Second Hospital saw this, they would be surprised.

"Director Xiao, you have done a great job, try to keep it up. If you go back with the silver medal, I will personally ask Dean Fu for credit."

Dean Jin Fu was also extremely excited.

The blood pressure increased a lot.

I originally thought that Xiao Linlin could break into the top ten, even if she burned high incense.

After all, there are too many strong hospitals on site.

There are several gastroenterologists at county and municipal hospitals who are very famous.

At present, all major hospitals in Jiangli City, except the People's Hospital and Qiaobang Hospital, have no shortage of gastroenterology patients. Other hospitals, including the powerful Affiliated Hospital of Jiangli Medical University, are short of patients.

Because the vast majority of gastroenterology patients are treated locally.

Needless to say, minor illnesses such as appendicitis, hemorrhoids, and gastric ulcers are almost all cured by local county-level or prefecture-level hospitals.

Many serious digestive diseases are also cured by county and municipal hospitals.

For example, two county-level hospitals can treat common gastric cancer, cardiac stenosis, intestinal obstruction, intestinal polyps, etc.

And the curative effect is very good, not much worse than a compound like Qiao Bang.

Patients are also willing to be treated nearby.

Because of the convenience, the cost is also much lower.

Patients from Qiaobang and People's Hospital, such as expert accounts and director accounts, and patients from other places basically buy them from account dealers.

Can't get it at all.

For treatment in local hospitals, some medical insurance reimbursements will be greater.

The benefits are many.

Li Jingsheng thinks this kind of letting a hundred flowers bloom is actually quite good.

"The first case tests the doctor's judgment and acumen, and requires boldness, carefulness, and courage to act. The top-ranked doctors must have performed very well in this diagnosis. Esophageal cancer Discovery and treatment are not particularly difficult, but how to accurately diagnose the type of esophageal cancer, which stage it has progressed to, and how to cure it are all difficult.

The second case below is a case under treatment. The difficulty of diagnosis and treatment has increased. Please read the questions. "

As soon as he finished speaking, the patient's information was displayed on the big screen.

Patient: 57 years old, male. Main complaints include abdominal pain, bloating, and poor eating. This symptom has been present for more than a month.This time he was admitted to the hospital because he suddenly vomited blood and he vomited blood multiple times within four hours. Only then did he go to the hospital for examination and treatment.

I feel sorry for this patient. He is so sick that he only wants to go to the hospital for treatment.

If we had more money, or if hospital charges weren't getting more and more expensive, patients wouldn't have to wait so long.

In the early years, the cost of medical treatment for ordinary people was actually not expensive.

It only costs a dozen yuan or dozens of yuan to get it done.

Nowadays, a few examinations cost hundreds or thousands of yuan, and the cost of hospitalization for just one or two days is two to three thousand yuan, which the common people really cannot afford.

Many people's monthly income is only 3000 to [-] yuan, and there is not much left after excluding living expenses.

This has to be done frugally.

If you encounter a serious illness, let alone two or three thousand, even two or three thousand may not be able to cure it.

Medical insurance is a very good protection, but it cannot stop all kinds of 'rats' who are crazy about medical insurance benefits.Invite the elderly to the hospital, and the hospital will provide meals. The elderly can share a table and play mahjong without spending a penny.

Is this money a rebate from the hospital?

Naturally, it was reimbursed by medical insurance.

(End of this chapter)