Gou is practicing medicine in the clinic

Chapter 278 Rushing to the first place, super long diarrhea

If patients are treated for antral gastritis, the consequences will be very serious.

Because the disease has progressed for a long time, the patient is even vomiting a lot of blood.There are only two possibilities for treating him for antral gastritis.The first type is death if the condition does not improve.

In the second case, the condition temporarily improves, the gastric cancer metastasizes, the chance of surgery is lost, and eventually death occurs.

This is the horror of missed diagnosis and misdiagnosis.

Every year, a large number of patients and their families file lawsuits against the hospital. In some cases, the family members may have misunderstood or failed to understand what the doctor meant during the communication, and signed the words in a daze.

Then after treatment, it is discovered that sexual function has been lost, the sequelae are serious, or medication needs to be taken for life... In the end, the patient feels that he cannot accept the result, and in turn sues the hospital.

Another part is that doctors are not standardized in the diagnosis and treatment process, and there are indeed problems.

There is nothing much to say about this. How to compensate is just a matter of following the procedures.

Xiao Linlin now completely treats Li Jingsheng like a god.

"Dr. Li, which surgery is better for treatment?"

"Theoretically, several surgical methods are possible. However, considering the patient's physical condition, location, size, and depth of the lesion, laparoscopic surgery may be more ideal. Postoperative radiotherapy is the first choice because his body is already very thin. , the side effects of chemotherapy are too great, and I’m afraid it will be difficult for him to tolerate it.”

Li Jingsheng gave a specific treatment plan.

The treatment of this patient is not difficult.

Mainly because it is difficult to diagnose.

Because the possibility of misdiagnosis is very high.

"Okay, submitted!"

After Xiao Linlin submitted the results, she began to repeatedly review Li Jingsheng's entire diagnosis process.

Gastroscopy is the most reliable way to diagnose gastric cancer.

But who would have thought that the most reliable method may sometimes be unreliable.

Cancer of the gastric antrum occurs deep in the stomach because the gastric wall mucosa is special.When cancer occurs in the deep layers, the mucosa is affected and symptoms of inflammation appear.It doesn't even look like an ulcer.

When taking specimens for biopsy, in order to reduce harm to the patient, only superficial tissue cells were taken for biopsy.

Both examinations allowed the cunning stomach cancer to escape smoothly.

Out of ten doctors, at least nine will fall into this pit.

"Director Xiao, congratulations, you have reached No. 1!"

Vice President Jin turned to look at Xiao Linlin in the back row.

She was carefully summarizing the diagnosis experience of this case. After hearing this, she raised her head and looked at the big screen.

For a moment, she opened her mouth wide and wanted to scream again.

Hurry up and cover it up.

The expression on his face was full of excitement and excitement.

"This is so unreal, just like a dream! Oh my God, I really can't imagine being able to reach No. 1. If this is a dream, I don't want to wake up!"

She speaks quite humorously, and her expressions and words are full of joy.

It makes people laugh when they hear it.

"There should be only the last question, so be sure to hold on. Dr. Li, please help Director Xiao. As long as she really wins the award, you will definitely receive a reward."

Vice President Jin was like a mirror in his heart, naturally knowing that Director Xiao could kill No. 1 only with the help of Li Jingsheng.

To be honest, Li Jingsheng shined in this skill competition, and his performance was so good that it was far beyond his expectations.

I originally thought that it would be great if Li Jingsheng could win a bronze or silver medal in the manual bone setting competition.

Unexpectedly, Li Jingsheng won a gold medal in the field of blood diseases as soon as he entered the competition.

Later, when Dr. Xu collapsed, a super bone-setting master appeared in Jiupeng Guoyuan Hospital, and famous bone-setting families like Jiang Family and Luo Family took action, Vice President Jin almost did not dare to hold out any hope.

In the end, Li Jingsheng was stunned and came first, and even defeated the super expert from Jiupeng International Hospital.

At this moment, Vice President Jin understood why many chief doctors showed their kindness to Li Jingsheng one after another, said hello, and asked him for help.Why did Director Hua repeatedly support Li Jingsheng and persuade the hospital's top management to admit this person to the hospital?

At that time, Vice President Jin and many hospital executives strongly disagreed with offering such generous conditions to a small doctor in the clinic.

Later, Dean Fu couldn't stand it anymore and insisted that the introduction of special talents should be eclectic.

In the end, everyone debated for more than an hour before settling on the decision.

Now that I think about it, Dean Fu is worthy of being the great dean. He is far-sighted and far-sighted, which is beyond the comparison of his deputy dean.

"Okay, now the second round of competition in the Department of Gastroenterology has ended. According to background statistics, there are only eight people with correct diagnosis results. The patient was finally diagnosed as early-stage gastric cancer."

One hundred, seventy-eighty hospitals participated in the skills competition, and gastroenterology was basically a department in every hospital.

Major top three hospitals like Qiao Bang and People's Hospital are even subdivided.

It can be divided into sub-departments such as hepatobiliary medicine, gastroenterology, bile and pancreatic diseases, and early gastrointestinal cancer.

Even if these participating hospitals receive some discounts, some specialized hospitals may not have gastroenterology departments, and some hospitals believe that their gastroenterology departments are weak and dare not sign up to participate.Even if only seven out of ten hospitals participate, there are still doctors from more than 100 hospitals participating in this round of competition.

Surprisingly, only eight people had the correct diagnosis.

This shows how terrible the rate of misdiagnosis and missed diagnosis of this disease is.

When encountering such a serious disease, it is necessary to seek diagnosis from experts in large hospitals.

Many doctors participating in this round felt their faces burning.

"This patient was in critical condition because he had vomited blood many times when he was admitted to the hospital. Therefore, timeliness has also become a bonus point for this question. Among them, the best performer was Director Xiao Linlin of the Second Hospital, affiliated with Jiangli Medical University Director Luo Hou of the hospital, after the results of the first examination came out, they both applied for the second examination without hesitation. Director Luo Hou of the People's Hospital applied for chromoendoscopy.

Director Xiao Linlin applied for endoscopic ultrasound and secondary pathological biopsy, and specified that the tissue deep within the lesion should be taken as a specimen.

It is very good that these two directors were able to persist in getting to the bottom of the investigation when the results of the first round of gastroscopy and pathological biopsy showed that it was antral gastritis.So both got bonus points. "

No wonder Xiao Linlin was able to successfully rise to No. 1.

She is currently tied for first place with Director Lian Tao of People's Hospital.

Director Lian Tao originally scored No. 1 in the first round, leaving Qiaobang Hospital behind.

Xiao Linlin tied for second place with doctors from four other hospitals.

At this moment, Xiao Linlin caught up with Director Lian Tao, and their scores were tied for first place.

It can also be seen from here that Lian Tao's diagnosis was correct in the second round, but his timeliness bonus points were not as good as Xiao Linlin's.

This is also a common problem in large hospitals.

The requirements for diagnosis in the compound are strict and step-by-step, and the emphasis is on step-by-step procedures.

After doubting the results of the initial diagnosis, they generally will not rush to do a second repeat examination immediately.Instead, we need to find more evidence, and after more analysis and differentiation, we can decide whether to repeat the inspection.

The formality and rigor of large hospitals have basically been deeply rooted in the hearts of the people.

Unless individual departments and doctors do things that violate medical ethics and harm the interests of patients for their own selfish interests, this is not included.

Some hospital doctors will recommend patients or family members to buy some expensive nutritional supplements and special medicines, and sell them privately in designated pharmacies or on WeChat. At this time, patients should be more careful.

Theoretically speaking, when buying any medicine nowadays, it is basically the cheapest to buy it from a hospital pharmacy.

Because of the medical reform, hospital drugs are sold at zero profit.

For medicines that can be bought in hospitals, we must let doctors prescribe them and never buy them outside.

As for the patient's worry about not listening to the doctor's instructions and offending the doctor, there is basically no need to worry about this.The worst case scenario is to change doctors. If every doctor in this hospital is the same, then change hospitals.

Under normal circumstances, it should not exist that all the doctors in the hospital are rotten.

The vast majority of doctors have conscience and ethics.

"Dr. Li, in this case, would it be more efficient to do chromoendoscopy during the second re-examination?"

Xiao Linlin now has deep trust and admiration for this young doctor who is more than ten years younger than herself.

Because Li Jingsheng is too strong.

She was not ashamed to ask, and asked Li Jingsheng for advice.

"Well...this has its pros and cons! Chromoendoscopy, mainly methylene blue and toluidine blue, has a coloring rate of more than 90% on malignant tissue. It can identify early cancer lesions smaller than 4mm. Also It has good diagnostic significance for gastritis-type gastric cancer that is difficult to identify with ordinary endoscopy. However, methylene blue is not ideal for coloring some malignant tumors or lesions, and it is easy to cause misdiagnosis or missed diagnosis.

So I don't think there's a best way to check.

As long as you analyze symptoms, medical history and other information, and have a relatively intuitive initial diagnosis result in your mind, you basically don’t have to worry about not being able to find out the cause of the disease.

If one method cannot detect it, you can switch to another method of examination. If you try two more methods, the disease will have no way to escape. "

Li Jingsheng's point of view is that the doctor's diagnostic direction is more important than any instrument examination or laboratory examination.At this time, Li Jingsheng received a message from Lian Tao.

"Jingsheng, is it your handiwork?"

Needless to say, Lian Tao's strength was now being overtaken by the Second Hospital, a third-level hospital that was very popular, and tied for first place with him.

All he could think of was that Li Jingsheng had taken action.

Because the Gastroenterology Department of the Second Hospital has always been mediocre, he really couldn't think of any other doctor in the Second Hospital who had this ability except Li Jingsheng.

"I'm just a support person!"

Li Jingsheng was very humble.

If Lian Tao hadn't had such a good relationship with him that he was like a brother, he wouldn't even have answered directly.

"Damn, I knew it was you who took action. Can you save some face? It's so ugly to have a female director of your hospital ride on my head!"

Lian Tao sent a painful and aggrieved expression.

"Haha, come on! Who doesn't know that you are a famous diagnostic madman? You have to have confidence in your own ability. Besides, I am only a half-assed person, and Director Xiao is the real main force."

Li Jingsheng and Lian Tao are their respective masters.

They belong to different camps, so there is no such thing as letting them go.

And with Lian Tao's arrogance, there was no need for anyone to give in.

He was just joking with Li Jingsheng.

"Okay, it's better to be fucked by your second hospital than to be fucked by Qiao Bang. There's only one last question left, let's have a hearty battle!"

Lian Tao sent the message because he was actually curious and wanted to confirm whether it was Li Jingsheng who took action.

Now that he knew that Li Jingsheng was working as Director Xiao's assistant behind the scenes, he was excited and looking forward to a showdown with Li Jingsheng.

"The patient just now had early-stage gastric cancer, which was indeed beyond the expectations of many doctors. The causes are sometimes so difficult to diagnose. They are good at disguising and like to hide deep or in inconspicuous corners of the body. This requires our doctors to rely on their rich experience With his clinical experience, solid basic medical knowledge, and tireless persistence, he fights wits and courage with the disease, and finally finds it and eliminates it.

Please look at the third question below. Since the examination, testing, diagnosis and treatment of digestive tract diseases are very time-consuming, and in order to reduce the occurrence of safety accidents, this question still requires written answers. "

To put it bluntly, it is to take a case that has been diagnosed and treated and let the contestants make a diagnosis and give a treatment plan based on the condition.

On the one hand, the organizers considered that there was not enough time for on-site diagnosis. On the other hand, the bone-setting technique in the morning almost caused a serious accident, which also made the leaders feel frightened.

Almost all leaders have one thing in common: they are more cautious when it comes to taking responsibility.

Avoid it if you can.

This is why it is so difficult to find leaders of companies and units to do something.

It is better to do nothing than to do something wrong.

This is what most leaders think.

The first two questions are not very difficult.

The difficulty of the last question will definitely increase significantly.

As soon as the host finished speaking, the question appeared on the big screen.

The patient, a 37-year-old male, suffered from diarrhea and abdominal distension for nearly half a year before being admitted to the hospital for treatment.

When he was admitted to the hospital, he was extremely thin and could no longer get up on his own.

This is too scary. I had diarrhea for half a year and didn’t even get treatment in the hospital.He was so thin that he couldn't get up on his own, so he was taken to the hospital.

Prolonged diarrhea like this is a bit like boiling a frog in warm water.

At first I thought there was nothing wrong with it. Apart from diarrhea, there was no other discomfort.

However, long-term diarrhea will cause nutrient loss and poor nutrient absorption.

Just like a tree, if it lacks nutrients for a long time, it will slowly become yellow and withered, and eventually die.

After questioning by the treating doctor, the patient went to a super first-tier city in the south to work alone. Due to high work pressure and irregular work and rest, he gradually developed diarrhea symptoms.

The patient is introverted, not good at talking, and because of his poor financial income, he has never found a girlfriend.

Later, when the diarrhea lasted for more than four months, he was fired from his job because he was too thin and developed physical fatigue, muscle atrophy, and mental fatigue.

Since then, he has been living alone in a rental house and has not gone out to find a job.

Until a former female colleague of the company heard that he had not had surgery for more than a month and came to check and found that he was bedridden, so he was immediately sent to the hospital for treatment.

This male patient didn't know how much virtue he had accumulated in his previous life to meet such a kind-hearted female colleague.

It's also possible that the female colleague has a crush on him.

Otherwise, after leaving the company, people will basically just go away and have little contact with each other.

The doctor examined the patient and found that the patient was extremely thin, cachectic, with muscle atrophy throughout the body, and no abnormalities were found in the heart, lungs, and abdomen.

The patient has seven to eight bowel movements a day, which are heavy and smelly.

Stool examination showed no red blood cells or white blood cells, and the occult blood test was negative.

No parasites or eggs were found in the feces.

The symptoms are actually not complicated, just diarrhea and abdominal distension.

The patient reported that he had been to the hospital for diagnosis and treatment once, but no obvious cause was found.The doctor prescribed medication for enteritis, which cost nearly 2000 yuan in total.Because there was no effect after treatment, the patient went to the pharmacy to buy antidiarrheal medicine many times, but it also failed to work after taking it on his own.

In the end, the patient simply gave up treatment.

This is diarrhea to the point of despair.

I went to the hospital for examination and medicine, and the treatment cost nearly 2000 yuan.

Then I bought a variety of diarrhea medicines, but none of them worked.Patients think that the disease may not be curable, so they choose to give up treatment.

Living in a first-tier city, I have to pay for rent, food, commuting expenses, etc. My daily expenses are huge, and I can’t save much money in a month.

There is really no way to spend too much money on treatments that have no effect.

After reading the patient's basic information, Li Jingsheng had already begun to make a preliminary diagnosis in his mind.

This is the benefit of opening a clinic.

After receiving a patient, we basically don’t think about doing this test or that test. Instead, we make a preliminary diagnosis based on the symptoms described by the patient, and then combined with the patient’s physical condition, medical history, age, gender, and whether there are underlying diseases. .

Li Jingsheng developed a habit of handling patients in this way, which made his diagnostic thinking more agile than that of doctors in large hospitals.

A bit like the difference between domestic rabbits and wild rabbits.

In any case, the family does not have to worry about being preyed upon by predators such as foxes, hawks, and weasels, and there is no need to worry about food.Living in a rabbit house, the conditions are very good in all aspects.

Their reactions naturally become slower.

However, because of the harsh living conditions outside, hares not only have to find food on their own, but also have to worry about various wild beasts preying on them.Therefore, he is extremely alert and extremely agile and quick when escaping.

Li Jingsheng is that hare.

And those hospital doctors are just rabbits.

In the clinic, Li Jingsheng may not be as experienced and knowledgeable as the doctors in the hospital, but his diagnostic thinking is sharper and his diagnostic direction is sharper.

Even if it's just a little clue, he might smell something different.

There is a standard medical definition of diarrhea. Diarrhea can be defined as having more than three bowel movements a day, the daily stool volume being greater than 200 grams, and the liquid content in the stool increasing.

If the stool is watery, it is severe diarrhea.

On the contrary, the less liquid content, the milder the diarrhea.

This patient has diarrhea seven or eight times a day, which must be severe diarrhea.

Then analyze it from the course of diarrhea.

There are two types of diarrhea: acute and chronic.

A disease duration of less than three weeks is defined as acute diarrhea.

Not many patients understand that sudden diarrhea is acute diarrhea.

Diarrhea that lasts for more than four weeks is defined as chronic diarrhea.

This patient has had diarrhea for more than half a year, which can be defined as chronic severe diarrhea.

Once defined in this way, one can realize how serious the patient's condition is.

(End of this chapter)