Chapter 251: Even if you lie down, you will get shot. The benefits of cultivating both inside and outside
After checking the patients in these beds, Zhou Can went to the ward where the patient in bed 71 was. Yesterday, the patient had undergone an esophageal to jejunal anastomosis surgery and fistula repair surgery.
The effect of the surgery cannot be seen for the time being. It will take about five to nine days for the patient's surgical site to heal basically before he can start trying liquid food.
Such as millet porridge, milk and so on.
"How is it? No abnormal reaction after the operation?"
Zhou Can asked the family members.
"Thanks to the hospital for clearing the fistula and repairing it for my dad, everything is going well. We are looking forward to the feeding test in a week."
The family members were very friendly towards Zhou Can.
Tuya Hospital performed this surgery for the patients and they were very satisfied.
But this is only temporary.
Only when the patient can really drink water and eat food will the family members be truly satisfied.
If the patient's problem is still not solved, it is just another painful experience.
After checking bed 71, Zhou Can still had three new patients to manage.
There were seven patients in total, and it took him more than half an hour just to make rounds.
He also needs to adjust the doctor's orders in a timely manner according to the patient's condition, changes in physical signs, and new symptoms. Then he needs to write medical records and course of disease. No patient has been discharged yet.
Otherwise, he would have one more thing to do, which is to discharge the patient.
Fortunately, none of the seven patients he was treating were in critical condition.
At about seven forty, Director Shang came to work.
Normally, Director Shang doesn't come so early.
I arrived at the hospital nearly twenty minutes early today, and the only thing I had to do was to make rounds.
According to the hospital's requirements, the chief physician conducts ward rounds at least once a week.
When it comes to ward rounds, the chief physicians are surprisingly consistent and try to be lazy whenever possible. Many of the better chief physicians lead a medical team and are in charge of multiple inpatients.
A ward round takes at least an hour.
This is subject to the fact that there are no difficult or critical cases, otherwise it will take even longer.
Therefore, the most common practice of chief physicians is to give full play to the three-level ward round system. First, let the interns and trainees in the group carefully manage the patients, and report any problems to the resident physician in charge of the bed.
Sometimes, if there are not enough residents in the group, trainees will be used instead.
Many of the trainees are regular doctors in county and city hospitals. They not only have certificates, but are also excellent doctors in their original units. It is completely fine to use them as residents.
If you encounter a problem that the resident physician cannot handle, report it to the attending physician.
Generally, they can reach the level of attending physician, and their level and experience are not bad, which is enough to be half of a chief physician.
The attending physicians can basically solve any problem, big or small.
If you encounter a problem that cannot be solved, report it to the chief physician for processing.
Only with this arrangement can the chief physicians handle their work.
Director Shang is the number one boss in the Department of Gastroenterology and has a lot of patients to take care of.
"Everyone, get ready. The directors will be checking the wards soon."
Huang Xinggui notified the doctors in the group.
The doctor in charge of the patient needs to prepare the patient's examination information, physical sign records, medical records and other materials, and place them at the head of the bed so that the chief physician can review them during rounds.
In addition, the attending physician must be familiar with the patients he is in charge of. When the chief physician finds the bed, the attending physician needs to quickly introduce the patient's basic condition in concise language.
If you have any problems that you cannot solve, you can also take this opportunity to consult the chief physician.
Zhou Can quickly sorted out the information of the seven patients in his care and placed them at the head of the beds. He quickly sorted out the conditions of several patients in his mind.
Just as we were getting ready, Director Shang and several chief physicians of the department, as well as the head nurse, deputy chief physicians, and attending physicians, totaling nearly 20 people, formed a very large ward rounds team and walked into the ward.
The director’s ward rounds are generally called major ward rounds.
The specifications and numbers of doctors and nurses dispatched are often the largest.
The specific day chosen for ward rounds is not fixed and depends on the chief physicians' own arrangements.
In the first ward, Zhou Can was already standing next to the third bed waiting.
The patient in bed 3 is a patient with enteritis, and he is a new patient who was just assigned to Zhou Can's management yesterday.
When Director Shang led the team to bed 3 for rounds, he calmly and briefly introduced the patient's condition and the examinations he had undergone during hospitalization.
Patients in internal medicine usually undergo more biochemical tests.
Enteritis is mostly acute. If it is chronic, few patients are willing to go to the hospital for treatment unless the condition is particularly serious.
The patient's enteritis was not particularly serious. He just ate at a roadside stall and then had persistent abdominal pain and diarrhea, so he rushed to the hospital for treatment. After analgesia, antidiarrhea, and electrolyte supplementation, his condition has improved.
To be honest, with Tuya's level, this kind of simple enteritis patient is rarely admitted to the hospital.
The cases admitted here are basically somewhat challenging.
Either the condition is serious or the cause is complicated.
"Director Shang, this is the medical prescription I wrote for the patient this morning. Please help me check if there is anything I missed!"
Zhou Canji made some revisions to the medical advice based on the patient's condition.
As the patient's condition improves, doctors will generally reduce the dosage of the medication. If the patient's condition worsens, the dosage may need to be increased or even other medications may be added.
Patients with high fever may need ice packs to cool down.
"I feel very relieved by the medical advice you gave me!"
Director Shang highly praised Zhou Can's medical skills in front of so many doctors, nurses, family members and patients, which instantly made Zhou Can the focus of everyone's attention.
In fact, from the first day Zhou Can entered the Department of Gastroenterology, he has attracted the attention of many doctors in the department because he saved a serious medical accident that could have been fatal.
"I have read the doctor's instructions. The prescription, dosage, and method of administration are all very accurate and precise."
After Director Shang praised Zhou Can, he still read the doctor's instructions carefully.
Then gave a high score evaluation.
"Director Shang seems to have special trust in this young intern! The young man looks very handsome and energetic." A short and fat male doctor seemed to have something else to say.
It sounds like there is a lot of innuendo.
This person is one of the chief physicians of the Department of Gastroenterology, named Zheng Hongtao. He has his own team and it is said that his ability and level are no worse than Director Shang.
The two sides have been competing fiercely.
This time when Zhou Can entered the Department of Gastroenterology, he was directly asked to leave by Director Shang, which caused Zheng Hongtao to complain.
Under the psychological effect of saying that grapes are sour because you can't eat them, Zheng Hongtao is not friendly to Zhou Can.
At least in the past two days, whether Zhou Can met Zheng Hongtao in the office or other places, the other party was lukewarm and the atmosphere was weird.
"Dr. Zhou is steady and down-to-earth, and his medical skills are outstanding. He is trustworthy. Isn't Dr. Huang Liang under Director Zheng also very reassuring? Excellent young doctors are everywhere."
Director Shang responded with a friendly smile.
As the head of the department, you must find ways to maintain unity and harmony within the department.
Zheng Hongtao was quite dissatisfied with him for taking Zhou Can away, but there was nothing he could do about it. Before Zhou Can entered the Department of Gastroenterology, Vice President Ye had hinted that Zhou Can had entered the regular training of various departments of the Department of Internal Medicine, and everyone should train and help him as much as possible.
The fact that Vice President Ye personally greeted him at a physician meeting of the Department of Internal Medicine shows that Zhou Can is at least a key training target selected by Tuya Hospital.
Later, Director Tan from the Department of Internal Medicine privately talked to Director Shang about Zhou Can's matter.
Unlike Vice President Ye's hint, Director Tan said it directly.
After all, we are all 'one of us'.
Director Tan greeted Zhou Can directly and said that there would be some flexibility in the time Zhou Can entered the Department of Gastroenterology. Then after Zhou Can entered the Department of Gastroenterology, he hoped that Director Shang would personally take care of him.
The two leaders have greeted him one after another, how can Director Shang not do as he is told?
If he lets Zheng Hongtao take care of Zhou Can, how will he answer when Director Tan asks him about this?
Although Director Tan is amiable and never speaks harshly, he holds a very high position in the Department of Internal Medicine. Everyone respects him from the bottom of their hearts.
Director Shang specifically emphasized that there are young and excellent doctors everywhere, and he hoped that Zheng Hongtao would not care about this matter anymore.
Unexpectedly, after hearing this, Zheng Hongtao raised the corner of his mouth.
"Oh, Huang Liang is going to be promoted to attending physician soon. Director Shang compares Dr. Zhou with Dr. Huang Liang. I guess Dr. Zhou Can is really outstanding."
Zheng Hongtao praised Zhou Can verbally, but he must have been full of disdain in his heart.
I guess he is thinking, how can a resident trainee be compared with Dr. Huang Liang who works for me?
"Doctor Zhou is much better than me. He writes clear instructions for patients with enteritis. When I was a resident intern, I didn't have such courage. Even if it was just the simplest admission order, I had to think about it for a long time and then ask the senior doctor to review it before I dared to write it out."
A young man with a crew cut, about thirty-four or thirty-five, stood behind Director Zheng Hongtao and took over the conversation.
His tone was highly consistent with Zheng Hongtao's. On the surface he was praising Zhou Can, but secretly he was mocking Zhou Can for being reckless and rash.
The resident trainee wrote the medical prescriptions without even checking them with the senior doctors.
Zhou Can could naturally hear the weirdness in the two people's tone.
He really died unjustly. He could get shot twice even when he was lying down.
Didn't provoke these two people.
All I can say is that the grudges among adults often come from conflicts of interest and have nothing to do with anything else.
As long as you touch the interests of others, even if you have not provoked anyone, you will be criticized. You may even be subjected to cold words and hostile emotions.
Zhou Can said nothing and just did his own thing.
I believe that it won't be long before these two people will have to silently accept his excellence and rise.
The ward rounds continue.
What a coincidence.
Huang Liang was in charge of three patients in the second ward. One of the patients in beds 6 and 8 was undergoing intestinal polypectomy, and the other was suffering from duodenal ulcer. Both were in serious condition.
The patient in Bed 7 came in with abdominal pain and was initially diagnosed with intestinal infection.
After admission to the hospital, Dr. Huang Liang prescribed anti-infection drugs for the patient, as well as fasting and fluid rehydration treatment and kept him in the hospital for observation.
Huang Liangguan's three patients all suffered from intestinal diseases.
This means that his area of expertise is the intestines.
"After my initial observation and diagnosis, the patient in bed 7 should be suffering from acute gastroenteritis and stress-induced hyperglycemia. This is the patient's examination report, including abdominal ultrasound, upright abdominal plain film, biochemical test and various auxiliary tests, all of which show that the patient has acute gastroenteritis."
Dr. Huang Liang is very efficient in his work and, like Zhou Can, he has prepared all the patient information long ago.
Zheng Hongtao took the patient's examination records and flipped through them casually.
"What treatment plan is Dr. Huang currently prescribing for the patient?"
"The patient had abdominal pain when he was admitted to the hospital. After initial treatment, he still had frequent and severe abdominal pain last night. At around 6 o'clock this morning, the patient vomited due to worsening abdominal pain. The current treatment for the patient is volume expansion and fluid replacement. In addition, the patient started to have a fever in the morning. During the morning rounds, I prescribed him oral antipyretics and ice packs for physical cooling."
Huang Liang described some treatment measures implemented for the patients.
Overall, these treatment measures are satisfactory and there is nothing wrong with them.
However, in Zhou Can's opinion, it is a bit conservative.
Moreover, seeing that the patient's face was twisted in pain and his body was bent like a shrimp, it showed that the treatment measures taken by Dr. Huang Liang did not have much effect.
Although abdominal pain is not as dangerous as chest pain, patients with frequent and severe abdominal pain like this are very likely to get into trouble if they delay treatment.
Zhou Can studied under Director Jia in the gastrointestinal surgery department for three months and became particularly familiar with some dangerous symptoms of gastrointestinal diseases.
The patient's condition now appears to be very critical.
However, with so many chief physicians leading the ward rounds on site, it was naturally not his turn as a junior intern to express his opinions.
What's more, Zheng Hongtao and Dr. Huang Liang both had prejudices against Zhou Can. If he dared to say in front of so many people that Huang Liang's treatment was problematic, it would definitely offend Huang Liang to death.
In Zheng Hongtao's opinion, it would be more of a show of showing off one's skills.
Zhou Can decided to listen to what the chief physicians had to say first.
"I think the measures taken by Doctor Huang are very safe. Director Shang, what do you think?"
There are several chief physicians in the Department of Gastroenterology .
Zheng Hongtao thought that the only person who could rival him was Director Shang.
He didn't ask for the opinions of other directors, he just wanted to hear Director Shang's ideas.
"From a treatment perspective, we have achieved symptomatic treatment. But seeing that the patient is in so much pain, wouldn't it be too conservative to just give fluids and expand the volume?" Director Shang reminded tactfully.
This patient's disease is more of a surgical one, and it seems that the chief physicians of the internal medicine department are not aware of the seriousness of the disease at all.
Zhou Can looked anxious.
"Both abdominal ultrasound and abdominal plain film indicate that the patient's condition is relatively optimistic. Director Shang, what additional treatment measures do you think would be better?"
This time, Zheng Hongtao really asked for advice humbly.
Because according to his understanding, these treatments should be enough. As for the follow-up treatment, he can only take it one step at a time and decide based on the changes in the condition.
This is also the most commonly used treatment procedure in internal medicine.
After the patient is admitted, we first treat the symptoms and provide a certain level of life support. Then, we make continuous adjustments by observing the effectiveness of the treatment and changes in the condition.
From this point of view, internal medicine has great similarities with ancient Chinese medicine.
"It's hard to say what specific treatment measures should be added. Just the fact that he's in so much pain means we must take it seriously. Show me the examination data and medical records."
Director Shang did not dare to jump to conclusions.
Decided to take a closer look at the patient's condition first.
The director's ward rounds are meant to identify any possible safety hazards or omissions or errors in diagnosis and treatment.
"Doctor Zhou is also here to help with the advisory!"
Director Shang waved to Zhou Can who was standing near the door.
There was no way. Zhou Can was just a resident intern. With so many directors, associate chief physicians, and attending physicians on the scene, it was a good thing that he was not squeezed out.
"He didn't ask his associate chief physicians or attending physicians for advice, but instead asked Dr. Zhou, a resident intern, to help. It seems that Dr. Zhou's status in Director Shang's mind is even higher than I thought!"
Zheng Hongtao said with emotion.
Deputy Director Shi, Director Shang's subordinate, attending physician Huang Xinggui and others looked a little unhappy when they heard this.
They were very optimistic about Zhou Can's abilities, but they would never admit that Zhou Can's abilities were superior to theirs, even if they were beaten to death.
Zhou Can walked to Director Shang honestly and said to Zheng Hongtao, "Director Zheng misunderstood. It's not that my status is so high, but Director Shang wants to help me, a novice doctor, and take this opportunity to let me expand my horizons. Usually in the group, Deputy Director Shi, Doctor Huang and others also take good care of me. I am extremely lucky to meet so many enthusiastic senior doctors."
With just one sentence, Zheng Hongtao's attempt to sow discord was perfectly resolved.
When Huang Xinggui, Deputy Director Shi and others looked at Zhou Can, there were smiles on their faces.
Senior doctors all like this humble young doctor.
Zhou Can's way of speaking and doing things makes people feel comfortable.
Zhou Can took some inspection materials from Director Shang and began to look through them carefully, especially some key inspection data.
For acute gastroenteritis like this, blood count is a very important reference data.
After looking at the patient's blood test report, Zhou Can's face changed drastically.
Director Shang noticed the change in his expression.
"Zhou Can, what's wrong? Are there any major problems with the patient's examination?" Director Shang had seen Zhou Can's abilities in all aspects, but had never seen Zhou Can's expression so serious and solemn.
As the manager of a small department, his biggest worry is patients getting into accidents in the hospital.
So when he saw Zhou Can's expression, his nerves immediately tensed up.
"The situation is very bad, let me take another look at the urine test report!"
Zhou Can quickly flipped through the urine test form, and after reading it, his brows were as solemn as a mountain. It was as if the army was already at the gates of the city, and the city would fall at any moment.
"Doctor Xiao Zhou, please don't be so exaggerated. You will cause the family members and patients to be extremely nervous."
Huang Liang said to Zhou Can with some dissatisfaction.
Instead of calling him Dr. Zhou or Zhou Can, he was called Dr. Xiao Zhou in front of everyone. This in itself was a form of contempt and insult.
Zhou Can didn't bother to pay attention to this person.
Instead, he kept a close eye on each parameter in the urine test report.
"Director Shang, this patient's condition is extremely dangerous. I suggest that we ask a general surgeon to come in for a consultation right away. If we delay, the consequences could be very, very serious."
Zhou Can has always been very measured in what he said and did. He used two "very"s in a row, which was enough to show how serious the patient's condition was.
