Gou is practicing medicine in the clinic

Chapter 382: A tumor that has been burning for eight years, a hide-and-seek tumor

"Thank you! How much does it cost to check it for me? Can I scan the QR code and give it to you?"

She took out her mobile phone and prepared to scan the QR code to pay.

"Free clinic! No charge."

Li Jingsheng always treats people free of charge.

I also thought about charging five or eight yuan, but after thinking about it later, it was not necessary.

In the past, free clinics were provided, but suddenly charging fees will cause patients to think that the business is getting bigger and they are starting to make money.The reputation of Sunshine Clinic has been maintained at a high level, and local patients have made great contributions.

It’s best to avoid burning bridges across rivers.

At least for now it's better to keep things as they are.

All the clinics in the south of the city are similar, and there is no charge for medical treatment.Instead, the money is added to the cost of medicine.

It is also a means of competition to attract customers.

The female staff member named Liu Ying showed her childish side when she heard that Li Jingsheng would not accept payment.

"Could it be that you didn't accept the money when you saw that I am a staff member of the department in charge? I must pay you. I can't let you work in vain."

"You really don't need to pay. Since I entered the clinic, I have never seen my master accept any consultation fees from patients."

Han Siying advised from the side.

"Then...thank you! Goodbye."

She waved her hand sheepishly and walked out of the clinic.

Li Jingsheng continued to diagnose and treat other patients.

"Doctor Li is amazing. He really diagnosed her illness."

The family members waiting nearby laughed and joked.

"Haha, it's just a coincidence! It took a while and kept you waiting."

Li Jingsheng looked at the patient.

"What's wrong with you?"

"I've been feeling weak recently, and I seem to have a slight fever. I took dialysis injections at the Chengnan Health Service Station for a week but it didn't work. I heard that your medical skills are excellent, so I came over quickly."

Upon hearing the patient's symptoms, Li Jingsheng immediately became vigilant.

Fever and fatigue are two symptoms that have a wide range of applications.It can be a minor cold, a common viral infection, or a serious illness.

The strength of the Chengnan Health Service Station is not bad, but because of its special geographical location, it has been suppressed and has not been able to be upgraded to a health service center.

In fact, its medical capabilities are no different from those of weaker Class A hospitals.

The infusion there for a week showed no effect, indicating that the cause of the patient's illness was not simple.

"Did you draw blood and do tests over there?"

"The blood was drawn."

The family members put the blood routine report sheets and other information on the consultation table.

Li Jingsheng took it and looked at it. The hemoglobin was only 71g/L, the red blood cell count was 2.7 times ten to the power of 7 per liter, and the white blood cell count was [-] times [-] to the ninth power per liter...

The patient's hemoglobin was significantly lower than the normal level for adults.

Even for women, at least 110g is considered normal.

If it is a healthier adult woman, it can even reach [-] to [-] grams.

The standard in the textbook is that anything between 110 and 150 grams is considered normal.

Her body also looked extremely thin, really skinny.The face is slightly pale and the skin is a little dark. Maybe he is exposed to a lot of sun at work.

Li Jingsheng realized that the female patient's disease was probably a chronic disease.

And it should have taken a long time.

People living at the bottom of society still make up the majority.Many people don't dare to go to the hospital for treatment when they are sick. They buy some medicine and take it on their own. If it doesn't work, they just keep putting it off.

Others showed amazing endurance, gritting their teeth and holding on as long as they didn't fall down.

He even met a patient who lived with the disease for 21 years.

I really admire these people, their endurance is amazing.

"Do you live in this city?"

"Correct!"

"Do you have employee medical insurance?"

"I bought it, but my wife didn't."

"Do you usually stay at home full-time, or do you work outside?"

Li Jingsheng looked at the female patient.

She looks like she is in her 50s, but is actually only 41 years old.

Looks very old.

In this case, either they have been engaged in hard labor for a long time, or they have lived with the disease for a long time and have not received timely treatment.

"I have a job, working in a labor service company."

She refused to talk about her specific job. The skin on her hands and face looked a little rough, indicating that the job she was doing was not ideal.

"It doesn't feel like your illness happened in a short period of time. The course of the disease may have been very long. Have you ever felt uncomfortable before?"

As soon as Li Jingsheng asked this question, the patients and their family members looked at him with admiration.

Needless to say, he was right.

"I have been feeling unwell for a long time, and recently I became very ill, so I went to the hospital for treatment. I don't have any other serious problems, I just feel a little feverish, my head is a little dizzy, and I don't have any energy."

The female patient describes her symptoms.

The most frightening thing is that this kind of chronic disease with mild symptoms, especially among low-income people, many people will tolerate it.

"Siying, check her blood pressure and heart rate."

Li Jingsheng took an ear thermometer and scanned her temperature. It was 37.4 degrees.

This is a body temperature that he hates.

Low-grade fevers, and persistent low-grade fevers, are often difficult chronic diseases.

Seeing how thin she was and her hemoglobin was seriously lower than normal, she was afraid she was seriously ill.

"How long have you had the symptoms you mentioned?"

"Maybe more than eight years ago! I was still in my 30s at that time. Not long after I gave birth to my second child, these symptoms appeared. I saw that I could eat and sleep, so I didn't pay much attention."

Really satisfied.

She has had this disease for eight years, and now she is so sick that she went to the hospital for treatment.

Judging from the weak way she spoke, if she was really seriously ill, she must have been terminally ill.

"Blood pressure 107, 76mmhg, heart rate 86 beats per minute."

Han Siying is now very efficient in taking patients' blood pressure and so on.

"Lay down and let me check you out. Your disease may be troublesome. If I can't cure it here, you may need to go to a large hospital for further examination. The current findings indicate that anemia is very serious. .”

Not only was she thin, but she was also extremely anemic.

The Chengnan Community Health Station only did a routine blood test on the patient and did nothing else.

Li Jingsheng thought to himself, shouldn't the Chengnan Health Station treat this patient as a cold?
There is such a possibility.

A physical examination of the patient showed that there was no obvious enlargement of the thyroid gland, the neck was soft, and there was no tenderness in the chest.

I listened to the heart and lung sounds and they were quite normal.

When the abdomen is pressed, the entire abdomen is soft and flat.

No obvious signs of ascites were seen.

There was also no edema in both lower extremities.

"It shouldn't be possible!"

Li Jingsheng checked the patient's armpit lymph nodes again and found no obvious swelling.

So why do patients experience symptoms such as low-grade fever, weight loss, and anemia?
And it wasn't just one or two days, it lasted for more than eight years.This low-grade fever is really terrible. It lasts for eight years.

Normal people will feel uncomfortable after burning for a long time.I really admire this eldest sister. She has endured it for more than eight years. If she hadn't been so ill now that she couldn't work normally, she might have still endured it.

According to his diagnostic experience, such patients will most likely develop tumors on their bodies.

As long as there is a tumor, based on his experience, it can often be discovered during a physical examination.

But the chest, abdomen, neck, armpit, etc. are all normal. Where does this tumor grow?
Or maybe it's not a tumor, but other chronic diseases.

What kind of disease could it be?

He was thinking quickly about the types of diseases that were close to or consistent with the symptoms.

After much deliberation, I still feel that tumor is the most likely possibility.

Although the possibility of blood diseases exists, many blood diseases are overbearing and can cause multiple symptoms in the body.If left untreated for such a long time, it can easily lead to serious complications.

But this patient does not have these symptoms, which means that the probability of hematological diseases is low.

He still focused on the large tumor.

The patient's neutrophil count was only 0.8, which was lower than the normal level.

This is actually a good diagnostic direction.

In her case, it would be better to have a routine stool and urine examination.

These two inspections don’t cost much, so why weren’t they done?

"Were you hospitalized at the health station or not?"

"I have to take care of the children at home, and my husband is very busy at work and basically has no time to take care of the family, so I didn't go to the hospital. I talked nicely to the doctor and agreed that I could go in for infusion every day."

She looks short and thin, but she shoulders the heavy responsibility of taking care of the family.

It's not easy.

"Didn't the health station ask you to check your bowel movements?"

"The doctor suggested that I check these two items and take two X-rays to check. I was worried that it would cost too much, so I didn't agree."

It turned out to be the case.

No wonder I didn’t even check my toilet routine.

It is estimated that even the blood test was only agreed to by the doctor at his insistence.

Faced with such patients, doctors are actually helpless.

You must insist that she undergo all the examinations before giving treatment, as she will most likely run away.

There are fundamental differences between the way health stations and clinics treat patients and those in larger hospitals.

When you see patients with lower incomes like this, you can’t ask for too much.

If it is like a big hospital, as soon as you enter, you will go through all the examinations that need to be done.As soon as the doctor's examination request form was issued, the patient ran away immediately.

Li Jingsheng treats patients. Sometimes when he sees some patients with poor financial conditions, he will try not to take X-rays if he can.

Unless it's like a broken bone, a film must be taken.

Because we don’t take a film to find out, if the patient bites him back, he will be unable to eat and walk around.

Some patients won't be able to reason with him or anything like that.

Of course, the vast majority of patients and family members are kind.

It's cruel to say it. Even if one hundred patients and their families are kind people, as long as there is one with malicious intent to blackmail the doctor, the doctor will treat these one hundred patients strictly.

In fact, the current poor medical environment is also caused by that small group of patients.

They complain at every turn and even take doctors to court. Which doctor dares to risk his future and career to treat patients?
Even though Li Jingsheng can perform surgery now, he only has the qualifications to participate in the surgery.

If you really want to conduct surgeries independently and have your own medical team, you must at least be the deputy chief physician.

It is beyond imagination to be promoted to deputy senior officer.

Although it is much easier to be promoted to deputy chief physician in some county- and city-level tertiary hospitals, the gold content is low.

Medical students who are more ideal will not consider entering these hospitals after graduation.

They all struggled to get into the compound.

Especially the provincial top three universities, which is the ideal palace that countless medical students dream of.

But after squeezing in, it is absolutely hellish to be promoted to deputy chief physician.Many doctoral students are somewhat doubtful about life.

As for master's students, unless they are very capable, they will end up in tears if they talk too much.

Master students who graduated from 985 and 211 colleges and universities, are they awesome?At least they crossed the single-plank bridge with thousands of troops and managed to fight their way out.

Li Jingsheng's master's degree is not from a prestigious school and is even less competitive.

I don't even have the conditions to do it.

In the early days of my career, I cried at least a few buckets of tears.

It is conceivable that the road to career advancement for doctors is so difficult and costly.Which doctor is willing to gamble his future and career?
Is it really worth it to save an unknown patient?
In fact, there are many such 'stupid' doctors.

Whether it is due to reverence for life or sympathy for patients, there are only a very small number of doctors who refuse to save patients.

"Your illness shouldn't be a minor problem. You still need to do the necessary examinations."

"Dr. Li, I actually understand the truth. It's just that the financial situation at home is really not good. My husband's monthly income is only about 3000, and after paying social security, he only has more than [-] left. My income is even less, only [-]. Eight, two children at home. Seven years ago, my father-in-law suffered from cirrhosis of the liver. He spent a lot of money on treatment, but he was finally diagnosed with liver cancer.

The person behind was not cured, and all the family’s savings were wiped out.

My mother-in-law passed away last year, and she spent nearly 3 yuan on treatment. She also spent a lot of money on funeral arrangements and a cemetery.The family has not paid off the debt yet.

They say that your medical skills are excellent. Can you just prescribe some medicine directly from me without doing those examinations?
Don't worry, I won't blame you even if it doesn't work. "

She said in an almost pleading tone.

"It's really difficult for your family."

Li Jingsheng sympathized with this patient very much, and even more admired her willingness to silently contribute to her family.

It was obvious that I had been ill, but my father-in-law and mother-in-law were treated.

Such a filial daughter-in-law is hard to find even with a lantern.

Since there are no abnormalities in the patient's chest, abdomen, armpits, and other parts of the body, and there is no edema in the legs, where will her tumor appear?

Judging from the patient's blood test results and symptoms, Li Jingsheng is still more inclined to think that her disease is a tumor.

There was no hematoma in her footsteps, and there was no jaundice on her skin or sclera, which indicated that the possibility of liver and kidney problems was relatively small.

The heart and lung sounds are also normal, indicating that the heart and lungs should also be healthy.

……

He began to use his extraordinary experience to analyze her disease.

Eliminate everything that can be eliminated.

Also, she has had this disease for more than eight years and has no pain, which is also a good thing.

If it is a malignant tumor, it will definitely be accompanied by cancer pain.

And in the later stages, cancer pain can be very severe.

"Have you been feeling any pain lately?"

"No. It's just that... I feel uncomfortable somewhere."

Her eyes were a little averted, and her face showed embarrassment.

"Don't shy away from medical treatment when you're sick, and you can tell me directly if you feel uncomfortable. This will be of great help to my diagnosis."

Li Jingsheng looked serious.

In fact, not only female patients, but also some male patients are hesitant when talking about the location of the disease.

Everyone has their own dignity.

Some diseases that are difficult to describe are indeed shameful to mention.

"It's just that the roots of my thighs seem to be a little uncomfortable, especially when walking."

She finally found the courage to speak out.

When Li Jingsheng heard this, his eyes brightened slightly, but he ignored an important part of the physical examination.

(End of this chapter)