Chapter 14 The opportunity to use diagnostic medicine has arrived
This is an examination room .
Tuya Medical College is actually a provincial medical institution that integrates medicine and education. It consists of Tuya Hospital and Tuya Medical University.
What’s more interesting is that the hospital and the campus are connected.
For example, this conference room that can accommodate 10,000 people is often used by the hospital to hold staff meetings.
At this moment, the room was packed with interns from our hospital and medical personnel from all walks of life.
Tuya is recruiting regular trainees. Anyone with a bachelor's degree or above and under the age of 35 can apply.
Including trainees in three areas: nursing, general practice and medical technology.
The training period is 36 months.
The medical skills here do not refer to surgical skills, but to the examination departments such as the laboratory, radiology department, B-ultrasound room, electrocardiogram room, electroencephalogram room, and gastrointestinal endoscopy room.
Why is Tuya’s regular training student quota so attractive?
Because as long as you complete 36 months of regular training here and meet the requirements in the final examination, you can obtain the regular training certificate of Tuya Hospital.
This is a very valuable document.
Even if you fail to obtain the qualification to stay in the hospital to work after completing the regular training, you will be in high demand as long as you return to your original hospital, or go to a municipal or county hospital.
The attending doctors and resident doctors in some county-level, prefecture-level city's Class II, Class III and Class III hospitals often regard the regular training in Tuya as a form of further study.
The examination room was very quiet, and all the candidates were answering the questions silently.
Regular training recruitment is divided into three parts: written test, interview and physical examination.
Now it’s just the written test stage.
Of the more than 7,000 candidates, more than half will be eliminated in the written examination.
Among the candidates, there are both interns in their twenties and social medical workers in their thirties.
Of course, there are also many outstanding people such as graduate students and doctoral students.
In terms of academic qualifications, Zhou Can's bachelor's degree is unremarkable.
As for comparing medical skills, hehe, I'm afraid it's enough to crush all the heroes.
"Please pause for a moment, all candidates. I have an important announcement to make."
Deputy Section Chief Hu held the microphone and spoke loudly.
The candidates all looked up at her standing on the stage, and Zhou Can beside her.
Some of Zhou Can's classmates or colleagues have already recognized him.
"Brother Chan, what happened?"
Several roommates were worried about him.
Class monitor Yang Chan prayed silently, "Rich kids are unreliable. Please don't get into trouble and bring shame to your alma mater."
In fact, she has always had a bad impression of Zhou Can.
"Let me introduce you first. The boy standing next to me is named Zhou Can, and he is also a candidate. When he rushed to the examination room in the morning, he met a patient who was suffering from chest tightness and angina pectoris. After a brief inquiry, he diagnosed that the patient was likely to have acute coronary heart disease and there was no family member accompanying him."
Deputy Section Chief Hu's voice echoed throughout the conference room.
She spoke with great emotion.
"Dr. Zhou Can was faced with two choices. Either he could abandon the patient and rush to the examination room to take the regular training examination. Or he could send the patient to the emergency department, save the patient's life, and then be late for the examination. Even if he abandoned the patient, he would not be held responsible. However, if he was late for the examination, he would be disqualified according to the regulations."
Everyone fell into a brief moment of thought.
If we put ourselves in their shoes, what would we choose? If we ask ourselves honestly, I'm afraid most people would put their own interests first.
Especially this kind of major interest decision that concerns the future and destiny.
Few people are capable of being selfless.
On the contrary, selfishness is human nature.
"But do you know? Dr. Zhou Can would rather lose his qualification to take the exam and resolutely chose to send the patient to the emergency department. In the end, thanks to his professional recommendation, the doctor on duty diagnosed the cause of the disease in time, which bought precious time for rescuing the patient."
The candidates were deeply moved and full of admiration for Zhou Can.
A gentleman carries the world with virtue.
People with great virtue are more likely to be respected from the bottom of their hearts.
"Zhou Can is just an ordinary intern in our Tuya Hospital, but he has demonstrated with his actions what great love is and what medical ethics comes first. I was very shocked when I learned about his heroic deeds just now. After consulting the hospital leaders, everyone agreed that this behavior should be highly praised. I hereby waive all penalties for Zhou Can's lateness for the exam and give him extra points for full medical ethics."
As soon as he finished speaking, the audience burst into thunderous applause.
A full score for medical ethics is definitely the highest honor given by Tuya Hospital since its regular training recruitment.
It will become a monument in Zhou Can's career.
An unprecedented smile also appeared on his face.
"Thank you for the hospital leaders' praise and recognition. I am not a hero, just an ordinary medical worker. Saving the dying and healing the wounded is the duty of a doctor. Thank you all."
Zhou Can's words "saving the dying and healing the wounded is a doctor's duty" touched every candidate present.
Yes, curing diseases and saving lives is the original intention of every medical worker and what they should pursue.
For them, it is more like a baptism of the soul.
The mind becomes pure and sublimated.
The whole audience burst into thunderous applause again, which lasted for a long time.
"Zhou Can, go to your seat and take the exam. You are allowed to hand in your paper late."
Deputy Section Chief Hu said to him with a smile.
"Thanks!"
Zhou Can just felt as if he was stepping on a ray of light, and realized that life could be so wonderful.
Good people live a peaceful life, and the world will not let them down in the end.
His seat is in the back.
When passing by squad leader Yang Chan, she smiled brightly and gave Zhou Can a thumbs up.
Zhou Can responded with a smile and a nod.
Following the number, I found my seat and sat down. On the table was a tablet provided by the hospital.
Simply enter the candidate's name and ID number, select the department to apply for, and you can start answering the questions.
The requirements for recruiting trainees in provincial top-level tertiary hospitals like Tuya are very high. Trainees in clinical medical departments are required to take a general theory exam.
In other words, the test questions include not only surgical questions, but also internal medicine, pediatrics, obstetrics and gynecology, ophthalmology, etc.
Theory has always been Zhou Can's strong point.
When answering the questions, he moved his fingers very quickly and solved the difficult medical questions quickly.
…
Although Zhou Can answered questions faster than most of the candidates, he still entered the examination room too late. Before he could finish answering the test paper, the loudspeaker announced that it was time to hand in the paper.
The candidates submitted their answer sheets one after another.
Zhou Can was given special consideration and was allowed to hand in his paper later. He continued to concentrate on answering the questions.
Not long after the candidates handed in their papers, Deputy Section Chief Hu took the microphone and began to announce the results.
"Thank you very much for the active participation of all candidates. The test results are now out. You can check your scores. Those with A or above can continue to stay for the interview. Candidates with scores below A, I regret to tell you, will be eliminated. You can leave in an orderly manner and continue to work hard after returning. You are welcome to continue to participate in Tuya's regular training recruitment next year."
Nowadays, papers are graded and scores are tallied up by computers.
Amazing efficiency.
It only takes a few minutes from the time candidates hand in their papers to the time their results come out.
The eliminated candidates stood up and left dejectedly.
After more than ten minutes, there were only about 3,000 candidates left out of the original 7,000 candidates.
Almost 60% were eliminated.
This is just the first step; the following interview phase is the most difficult.
"Now, please invite our judges to come in."
As soon as Deputy Section Chief Hu finished speaking, several doctors and nurses entered the examination room one after another.
There were three groups of judges in total.
Then workers brought in various props needed for the interview.
"Candidates for the medical technology department's regular training, please sit over here."
This department mainly performs various examinations and pathological tests on patients.
Most of the instruments carried in by the workers are for use by candidates studying medical technology.
There are quite a lot of candidates applying for the medical technology department, at least around 800.
All they have to do in the interview is to read B-ultrasound films, CT films, X-ray films, etc. Then complete the operation of the Doppler ultrasound machine and take a clear film on the spot.
Of course, the area to be filmed will be randomly selected by the examiner.
"Candidates for the Nursing Department, please come to the front."
Most of the female candidates flocked to the hospital, including some with extremely high looks. Tuya Hospital recruits a large number of nurses every year. Nursing is basically a profession that relies on youth.
Many nurses, when they get older, either return to their families or switch to other jobs, such as health managers, etc.
Only a very lucky few can be promoted to head nurse, or retreat to the second line and do relatively easier work.
For example, tasks like checking medical orders, typing into the computer, picking up medicines, managing the warehouse, and organizing documents.
Generally speaking, nursing is a job that requires youth.
There is a lot of turnover of people.
Basically all hospitals are similar and they often recruit nurses.
About 700 candidates applied for the regular training program in the Nursing Department.
Not all of them are girls, there are boys too.
But relatively speaking, the number of boys is very small.
The remaining 1,500 or so candidates applied for full-department regular training.
It can also be seen from here that the profession of doctor is still the most popular. Because as medical skills continue to grow and improve, the older the doctor is, the higher his income and status will be.
Doctor is a growing profession with a bright future.
The competition for general practice training is the most intense, far exceeding that for nursing and medical technology.
More than 1,500 candidates are ready to take the exam.
"Good morning, candidates. Now we will start the first part of the interview, pathological diagnosis. I will play the role of the patient and give a series of symptoms. You can use the tablet to prescribe a test plan. Remember, you must not prescribe a random test plan. If you prescribe too many tests or too few tests, you will lose points."
The hearts of the candidates tightened.
No one expected that the first question in the interview would be a real-person diagnosis.
Those social candidates who are in their thirties are better off. Many of them have worked as doctors in county or municipal hospitals for several years or even more than ten years and have relatively rich clinical diagnosis experience.
For interns, this is a bit terrible.
They have very little experience in clinical diagnosis, and have never seen patients on their own. They usually just talk about it on paper.
Now that they are asked to make a real-life diagnosis, they are naturally a little panicked.
"I suddenly felt chest pain and shortness of breath. I felt that my physical condition was not good, so I rushed to the hospital emergency room for treatment. You are the doctor on duty. What examinations will you perform on me? Please write out the examination list in order on the tablet. Please note that if the order of the examinations is reversed, the score will be halved."
There is a relatively strict process for what examinations a doctor should perform after seeing a patient.
The first thing is definitely a physical examination, such as palpation, inspection, etc.
The next inspection items are like peeling off silk threads from an onion.
For example, after doing a routine blood test, if you feel it is necessary to do an electrocardiogram (ECG) to check again, when applying for the examination, you should first do the routine blood test and then the ECG.
After careful consideration, all the candidates submitted their applications for examination.
"Time's up."
The examiner only gave about 10 minutes.
This undoubtedly increases the difficulty of the exam.
However, in actual consultations, when encountering emergency or critically ill patients, the doctor's response time will be shorter.
"Now you can view the scores and results of the inspection items."
Just at this time, Zhou Can finally completed the written test.
He submitted his answer sheet.
The results are available almost instantly.
A.
The score should be between 90-95.
If the score is 95 or above, the grade should be A+.
However, the test paper was so difficult, and the content covered almost all medical departments, including internal medicine, surgery, obstetrics and gynecology, pediatrics, etc. He was already very good to get an A.
He also listened roughly to the questions asked by the examiner just now.
Now that you have passed the written test, you can move on to the interview.
"The patient has chest pain and is short of breath?"
First of all, we must rule out heart disease. He quickly prescribed a physical examination, a blood test, and an electrocardiogram.
submit.
"Congratulations, you checked all the items correctly and got full marks."
Zhou Can smiled slightly.
At least his pathology diagnosis has been upgraded to level three, which is the level of a resident doctor. If he can still make mistakes when ordering an examination, then his level three pathology diagnosis must have been paid for.
He quickly checked the test results.
Physical examination showed heart rate 122 beats/min, blood pressure 97/49 mmHg.
The normal heart rate is within the range of 60-100 beats/minute, but the patient's heart rate is obviously too fast.
Normal people's systolic blood pressure is 90-140 mmHg, and diastolic blood pressure is 60-90 mmHg. The patient's blood pressure is obviously too low.
For an adult male in his thirties, who is in the prime of life, such low blood pressure is enough to cause shock. Moreover, if the blood pressure is too low, the organs of the whole body cannot get enough blood oxygen, and the cell function metabolism will be impaired.
Over time, the organs will be overwhelmed and stop functioning.
The patient died.
Next, read on to see the blood test results.
Wow, that troponin is so high.
Significantly higher than normal.
Zhou Can couldn't help but think of a terrible disease, acute myocardial infarction. The Mr. Cui he saved in the morning had a disease very similar to this one.
Acute myocardial infarction is also a type of coronary heart disease.
If not treated in time, the mortality rate is extremely high and the prognosis is poor.
It is difficult to make a conclusion based on the results of the first two tests. Then check the most important electrocardiogram.
It can be clearly seen that the electrocardiogram has changes similar to myocardial infarction.
Under normal circumstances, the human heart can discharge continuously. The electrocardiogram monitors its discharge and converts it into ripples for doctors to use for diagnosis.
When a piece of myocardium becomes necrotic or a blood vessel is blocked, the myocardium loses its vitality.
The ripple peak of the electrocardiogram will be clearly reflected.
Doctors can roughly determine which blood vessel is blocked based on the electrocardiogram.
"Damn, it really is an acute myocardial infarction."
Based on the results of the three tests, Zhou Can preliminarily concluded that the patient was most likely suffering from acute myocardial infarction.
But he vaguely felt that something was wrong.
What Dr. He said to him after the consultation yesterday echoed in his ears again.
"Medicine is a rigorous discipline, and I never jump to conclusions. Diagnosis must be based on the patient's medical history, condition, gender, and various examination data."
At this time, the examiner said expressionlessly, "I believe that after reading the diagnosis results, you have already made a judgment in your mind. Please fill in the diagnosis results."
Many candidates have begun to fill in their diagnosis results with confidence.
Zhou Can frowned, feeling that something was wrong.
But I can't find the reason.
