Chapter 190 You keep acting, it turns out he is not acting
This ability to detect hidden diseases in patients in advance through visual observation and intuition was extremely popular in ancient times. Almost every skilled Chinese medicine practitioner could do this.
It's called the art of diagnosis by observation.
When Chinese medicine treats patients, the four most basic diagnostic methods are observation, auscultation, questioning and palpation.
Observation comes first.
It is the eldest of the four diagnostic methods in Traditional Chinese Medicine.
By observing the patient's complexion, skin color, nails, tongue coating, body shape, etc., the most intuitive first diagnostic impression can be given. The type of disease can be roughly identified, which is convenient for subsequent lesion diagnosis and pathological dialectics.
What Zhou Can gained from his three months of training in the Department of Critical Care Medicine was beyond his imagination.
He didn't realize it at first, but now that he has entered other departments for regular training, he found that the three months of study in the Department of Critical Care Medicine has been of immeasurable help to his medical practice.
Whether it is in rescuing critically ill patients, or in pathological diagnosis, encountering emergencies during surgery, etc., he can be more confident than others.
Vice President Ye personally extended his critical care medicine training time by two months, which can be said to be a well-intentioned move.
For example, when I went to make rounds not long ago, even Director Jia didn’t realize that the patient in bed 3 had cancer, but Zhou Can did.
Of course, this is just Zhou Can’s preliminary diagnosis.
It can also be called speculation.
Whether the patient really has cancer needs further verification.
There was no way Zhou Can could just tell Director Jia that the patient might have cancer without any evidence, right?
This was the first time the two of them had dealt with each other today, and Director Jia's trust in him was still limited.
If he wants Director Jia to approve of his diagnosis, he must provide reliable diagnostic evidence, preferably directly pointing to the area where the lesion is located.
According to Zhou Can's experience, diagnosing this highly difficult hidden disease will most likely result in an additional reward of 100 pathological diagnosis experience points.
"Doctor Zhou, I guess your girlfriend must be very beautiful! And very charming!" Qiu Hong suddenly smiled and said something confusing to Zhou Can.
"Why do you say that?"
Zhou Can asked her puzzledly.
If Su Qianqian is not considered beautiful, then there is probably no other woman in the world who can be described as beautiful.
"Seeing that you look distracted, I guess you must be thinking about your girlfriend, right?"
Qiuhong joked in a joking tone.
She had no ill intentions, but was full of kindness.
Because Zhou Can seemed a little perfunctory when answering Director Jia just now. Director Jia's face was actually a little unhappy.
She has followed Director Jia for five years and knows Director Jia's temper and personality very well.
It was considered as a deliberate explanation for Zhou Can.
He also wanted to remind Zhou Can not to be absent-minded.
"Haha, Senior Sister Qiu is really humorous. I was not absent-minded just now because I was thinking about my girlfriend, but because I was thinking about the patient in bed 3. I don't think that patient has a simple duodenal ulcer."
Zhou Can is also a smart man. He knew what was going on as soon as he heard it.
He secretly glanced at Director Jia's slightly cold face and quickly explained the reason for his absent-mindedness.
"That patient's duodenal ulcer is indeed very serious. He has had the disease for nearly 20 years. How can it be simple?"
She responded.
"No, no, no, I mean the patient may have other diseases!"
Zhou Can could only express his doubts in advance.
He couldn't let Director Jia misunderstand that he was a lazy person who didn't focus on his studies.
A very small thing, seemingly insignificant.
But it might cause serious damage to his image in Director Jia's eyes.
You may not be able to see through a person in your entire life, but one incident can really make you look down on a person.
"Other diseases? Cirrhosis of the liver and chronic superficial gastritis. Director Jia has already diagnosed them!"
She asked puzzledly.
Qiu Hong had just met Zhou Can, and she didn't know whether he was deliberately looking for an excuse to explain to Director Jia why he had just been absent from work, or if he really diagnosed the patient with other diseases.
She prefers the former.
I think Zhou Can was just making an excuse to avoid giving Director Jia a bad impression.
After having this thought, her impression of Zhou Can suddenly became much worse.
People who like to be clever are generally not very popular.
"I meant other diseases, like cancer!"
Zhou Can never stops until he makes a shocking statement.
This time even Director Jia looked at him again.
Qiu Hong curled her lips, and a trace of contempt appeared on her pretty face. She didn't expect that Director Jia's new student was so boastful. It would be fine if he just made up an excuse, but now he actually said that the patient had cancer in order to attract attention.
Fortunately, the family members were not here, otherwise there would probably have been a quarrel.
"Director Jia, may I ask for twenty minutes' leave? I want to check the patient's medical report. If the patient really has cancer, I'm afraid we need to re-evaluate the feasibility of the surgical plan. The patient is so old that there is a very high risk of surgery. I see that you have scheduled the patient's surgery at 1pm. I'm afraid I won't be able to make it in time if I wait until noon to check on him."
Zhou Can explained the reasons in detail.
The tone is sincere and the expression is genuine.
Qiuhong almost sneered out loud, it sounded like the truth, it would be a shame if the new doctor Zhou didn't go to act.
Her good impression of Zhou Can also disappeared.
"You go ahead!"
Director Jia agreed very readily.
Zhou Can didn't waste any more time and quickly returned to the inpatient department and went to bed 3 to check the patient's examination report.
"The patient has a history of smoking for nearly 50 years. His father died of typhoid fever 20 years ago, and his mother died of a lump in her abdomen 10 years ago. Because no pathological examination was done, the nature of the lump is unknown."
In other words, the patient's mother was likely to have died of cancer as well.
The patient himself underwent routine examinations such as X-ray barium meal examination, gastroscopy, blood and stool tests during hospitalization.
In addition, an ultrasound examination of the liver was also performed.
"There are 6 intercostal spaces above the liver, the oblique diameter of the right lobe is 13.5cm, the thickness is 2cm and the length is 1.5cm below the costal margin of the midclavicular line, the thickness of the left lobe is 7cm and the length is 8cm, the thickness is 4cm and the length is 3cm below the xiphoid process, the light spots in the liver are thickened and enhanced, the echo distribution is still uniform, and the blood vessels are not clear..."
B-ultrasound is mainly used to examine the liver.
At present, the possibility of liver cancer cannot be ruled out.
Because the liver has no pain nerves, it is called the most silent organ.
Many liver cancer patients are already in the advanced stage once confirmed.
Before this, there were hardly any obvious symptoms.
Zhou Can squinted his eyes and looked at the ultrasound film carefully.
It is undeniable that the diagnostic basis of the Western medicine system is mainly based on comprehensive dialectical analysis of various examination results.
At this point, we must praise traditional Chinese medicine.
An experienced Chinese medicine practitioner can quickly understand the patient's condition by simply pressing the Cun, Guan, and Chi points on the patient's wrist, which is comparable to a full-body physical examination performed by a Western doctor.
Why are people reluctant to go to the hospital nowadays ? Once they go in, no matter whether they are sick or not, they will go for routine check-ups first.
If you need to be hospitalized, more tests will be done.
Hundreds or even thousands of yuan were gone just like that .
After waiting in line for a whole day, I was lucky enough to get the test results before the doctor went off work.
Although Chinese medicine practitioners did charge a consultation fee in the past, it was often very cheap.
There are many traditional Chinese medicine practitioners who have high medical ethics. When they see poor people they even pay for the medicine out of their own pocket.
Look at the current Western medical system. If you don’t have money, you can basically just wait to die.
Don’t be naive to think that public hospitals can handle unpaid bills and pay later.
Those are all emergency patients.
And not all emergency patients are paid in arrears.
Because if the patient and his family refuse to pay, the medical staff in that department will be the ones who will suffer .
It is difficult to tell whether the patient has liver cancer from this ultrasound film alone.
At least with Zhou Can's current level, after examining the patient, he feels that the possibility of the patient having liver cancer is very small.
Since it is not liver cancer, what kind of cancer could it be?
There is too much cancer.
Excluding liver cancer, if there are cancer tumors in other parts of the body, the patient will feel some pain and discomfort.
Zhou Can reviewed the patient's symptoms again.
The patients were then asked simple questions such as whether they had pain in other areas.
Patients report that they sometimes experience pain in the back when the disease strikes, which should be considered radiating pain.
At this point, liver cancer, abnormalities in other parts of the body, or severe pain have basically been ruled out, leaving only the last possibility.
The symptoms caused by this cancer site are merged into the duodenal ulcer.
I have done a gastroscopy and gastric cancer has been basically ruled out.
At this time, Zhou Can suddenly realized that maybe there was something wrong with his gallbladder?
There are two reasons. The liver and gallbladder are close relatives. If the liver is cirrhotic, the gallbladder will be affected to some extent. However, there is no direct correlation between liver cirrhosis and gallbladder cancer.
The duodenum and gallbladder are very close, almost like cousins.
If there is a problem with the gallbladder, abdominal pain will occur. Jaundice is also common.
However, patients with cirrhosis of the liver may also develop jaundice.
This means that the symptoms overlap to a high degree by chance.
It was precisely this kind of coincidence that caused even Director Jia, an experienced doctor with extremely rich clinical experience, to make a mistake.
Zhou Can carefully checked the B-ultrasound film again and found that the gallbladder was transparent and had no abnormal reflections.
However, since the gallbladder was not specifically photographed, Zhou Can was unable to clearly view the condition of the cyst wall and common bile duct.
It is tempting to ask the patient to have another B-ultrasound, but the family members may have doubts.
Moreover, Zhou Can himself did not give the patient the authority to apply for examination.
You have to consult Director Jia or the attending physician about this matter.
"I'll take the film to Director Jia for another look. If there are any problems, we will give you feedback in a timely manner."
Zhou Can took the patient's ultrasound report to see Director Jia.
Perhaps with Director Jia's level of expertise, he could discover the abnormality.
At least for now, the shape of the gallbladder is slightly abnormal.
Back in the outpatient department, Director Jia had already started seeing patients.
Although his special expert appointments are limited, he is very famous and has many patients seeking treatment.
In order to avoid patients having to wait for a long time or even have to find scalpers to buy high-priced appointments, he would often try his best to add a few more patient numbers.
In addition, he often sees patients in the morning and performs surgery in the afternoon, which makes his schedule very tight.
Zhou Can stood behind Director Jia holding the film, patiently waiting for the patient to finish his examination before showing the ultrasound report to Director Jia.
"Director Jia, I just went to the ward and carefully examined the patient's condition. The patient had both jaundice and abdominal pain, and he had already expressed them. There was an obvious mass in his abdomen, but he didn't express it. I suspect the patient may have gallbladder disease or even cancer. It just happened to overlap with the symptoms of duodenal ulcer and liver cirrhosis, so it was not found out."
Zhou Can didn't dare to say anything too decisive.
Because there is too little evidence for diagnosis.
A medical diagnosis requires at least one solid diagnostic basis.
For example, B-ultrasound, MRI, CT, blood routine, urine routine, etc.
In the actual diagnosis and treatment process, doctors often need more than two solid diagnostic evidences before they dare to give a preliminary diagnosis.
What is a preliminary opinion? It is the kind that has a question mark after the diagnosis.
“Gallbladder cancer?”
Director Jia took the ultrasound report and took a careful look at it.
Then his expression became slightly serious, he picked up a magnifying glass and began to look at it carefully.
Qiu Hong, a young and beautiful doctor standing next to him, was disdainful of Zhou Can's talk about gallbladder cancer at first, because she had a preconceived notion that Zhou Can was still acting.
However, when she noticed that Director Jia's expression gradually became more serious, and he even took a magnifying glass and carefully checked the ultrasound report, she began to have doubts in her heart.
Is there really a problem?
Isn't this trainee acting?
"It looks like there's something wrong with the gallbladder. Qiuhong, call the ultrasound room immediately and see if there's any ultrasound film of this patient with a clear gallbladder."
Generally speaking, the imaging results of the examination are archived.
It doesn’t mean that the hospital will lose its archives after printing it out for the patient.
In some responsible large hospitals, doctors in the medical technology department may even keep multiple copies on file. The one actually printed out for the patient may be just one copy, or just a portion of the better copies.
Qiu Hong hesitated for a moment and asked, "Are you going to suspend your outpatient work for a while?"
"If this patient really has gallbladder cancer, then it's a big deal. It doesn't matter if the outpatients are delayed a little bit. At most, I won't take a lunch break and work overtime."
A doctor's job is inherently dynamic.
When encountering a problem, the patient's life safety must be given priority.
"Okay! I'll call and ask right away."
After she finished speaking, she looked up at Zhou Can.
"Doctor Zhou, notify the guide outside and don't call out numbers yet."
Qiu Hong's tone had obviously changed, and Zhou Can could feel it.
He opened the door, said something to the nurse outside, and returned to the outpatient room.
The guide is also a nurse, and his or her status and salary are lower than those of the department nurse.
Generally, a medical guide earns 4K a month, and department nurses earn at least 5K.
In terms of status, the guiding nurses are also full of sadness.
In fact, it is almost the same in any unit. For example, the treatment and status of auxiliary police are also worse than those of regular staff.
After Qiuhong contacted the ultrasound department on the list, they quickly sent her all the ultrasound films of the patient.
Sure enough, there were very clear films of the gallbladder area.
Director Jia was overjoyed and looked at it very carefully with an excited expression.
"There is indeed a problem with the gallbladder, and it is very likely to be malignant. We must immediately notify the attending physician and communicate with the family to see if a multi-slice spiral CT scan can be performed. If necessary, an endoscopic ultrasound examination can be added. The patient's surgery schedule is temporarily canceled."
Director Jia realized the seriousness of the problem.
The patient's condition was not very good to begin with, and now after Zhou Can's reminder, it was discovered that the patient might have gallbladder cancer.
The surgery must be canceled first.
Must be re-evaluated.
"The patient's attending physician seems to be Dr. Tang. I'll talk to him right away." Qiuhong didn't mention the phone call she made on the spot.
After the communication is completed, notify the guide outside to continue calling numbers.
Many of these patients took special leave and even came from far away to seek medical treatment.
Their registration must not be cancelled.
Everything that needs to be watched must be watched on the same day.
This is the professional ethics and sense of responsibility that a doctor should have.
After this incident, Zhou Can's status obviously improved a lot.
Director Jia looked at him with a more friendly look.
Qiuhong's attitude towards him also changed subtly.
Strength is a good thing. It can help Zhou Can quickly establish his position in the new department time and time again.
At this time, a young woman with a slightly pale face walked into the outpatient clinic.
The registration fee for a special specialist appointment is several hundred yuan. Most patients, unless their disease is difficult or complicated, will choose a more economical ordinary doctor appointment when making this appointment.
The woman came alone and had no one to accompany her.
"Hello, Mr. Jia. I heard that you are very good at treating gastrointestinal diseases. I came all the way from another province to see you."
"Beautiful lady, sit down and talk. When we get here, Director Jia will definitely help you to look good!"
Qiuhong comforted her gently.
The girl looked to be about twenty-four or twenty-five years old, quite young and dressed very fashionably.
You look very bad.
"Thanks!"
After she sat down, she began to talk about her illness.
"I don't know what happened recently. I've been having diarrhea a lot lately. It was even worse yesterday. I vomited every time I ate. It was really uncomfortable. I went to the local hospital for a checkup and they said I might have enteritis. They prescribed some medicine for me, but it didn't work."
She took the examination form to Director Jia for review.
Basically, patients who come to see special specialists have already been examined and possibly treated in other hospitals.
So, they basically have one thing in common, that is, they come for treatment with examination reports from other hospitals.
After Director Jia took it, he looked at it carefully one by one.
"Did you have any prolonged discomfort before the diarrhea?"
It takes a long time for the ice to freeze three feet thick.
Some serious diseases do not occur instantly, but accumulate slowly and eventually erupt like a volcano.
Her condition is characterized by vomiting and diarrhea, and a cold may also cause these symptoms.
Experienced doctors will check each case one by one when treating patients.
Rather than jumping to conclusions right away.
The more skilled the expert is, the more comprehensive their considerations will be. Therefore, never question the expert's skill level.
Maybe he is just thinking more comprehensively about you.
"I didn't have any other symptoms, except for constipation which lasted for a long time. Maybe more than two years. I searched on Baidu and found that eating more fruits and vegetables could help relieve the symptoms, so I tried the food therapy. It did help to some extent, but the constipation persisted."
She was somewhat embarrassed when she talked about constipation.
After listening to this, Director Jia nodded and carefully recorded it in the medical record.
Zhou Can began to wonder what disease this female patient had.
