Back in 2002 as a doctor

Page 920

Zhou Congwen remembered this scolding for two lifetimes.

"Generally, nephritis or other messy diseases will be diagnosed." Zhou Congwen said, "Give nephritis rehabilitation tablets, Bailing capsules, caffeic acid, cefixime and other drugs for treatment."

"Hahaha, what you said seems to be true." Shen Lang laughed.

Zhou Congwen sighed, this is the doctor's order he gave the patient in his previous life.

As a result, after taking the medicine for a period of time, the disease did not improve at all.

Looking back now, Zhou Congwen would always feel ashamed.

Sometimes when he is tired and tired from surgery training, he will think of his countless misdiagnoses, so the tiredness is swept away, and he continues to struggle like chicken blood.

"So, I told you everything. A layman sees the excitement. You are a doctor and an expert, so you have to look at the way." Zhou Congwen said to Shen Lang very seriously, not thinking about his misdiagnosis in his previous life.

"Well, I think I can see the way now." Shen Lang said.

"Nutcracker syndrome is a typical rare disease. In the future, if you encounter a boy with blood in the urine, take a look at the spermatic vein." Zhou Congwen said, "If the left spermatic vein has varicose veins, it can basically be diagnosed."

"Basic?"

"There are other conditions, but other conditions are rare." Zhou Congwen said, "That is the real rare disease."

"Like what?"

Zhou Congwen told Shen Lang sixteen kinds of rare diseases that could cause hematuria, proteinuria, and varicocele with his fingers.

Shen Lang was dumbfounded.

There are so many possibilities... there are so many possibilities!

"But these are rare diseases." After Zhou Congwen finished speaking, he waved his hands, "Don't remember, and you can't remember either."

"How do you remember?" Shen Lang asked unconvinced.

Zhou Congwen chuckled, this is his rich clinical experience, but Shen Lang can't just say this.

"Let's go, let's eat." Zhou Congwen pulled Shen Lang and finally left the emergency department, "Shen Lang, you said you too, a nutcracker syndrome and you still put yourself into it, and suffer with the patient and the patient's family, you said Are you very promising?"

"Hey." Shen Lang turned his head and smiled embarrassedly.

"Take your time, don't worry." Zhou Congwen and Shen Lang left 912 and found a restaurant to sit down.

"Congwen, why did you go today?" Shen Lang asked, "I saw you leave early in the morning without doing the operation, and even pulled Dean Deng back to watch the operation."

Zhou Congwen recounted what happened today.

Shen Lang was dumbfounded.

"Congwen, the viral load is high, so it's wrong to take entecavir?" Shen Lang asked suspiciously.

Zhou Congwen talked about the relevant knowledge again, which was very detailed.

Shen Lang's problem is a mistake that many grassroots doctors often make. Zhou Congwen did not blame Shen Lang, but patiently explained the pathophysiological process of the disease and when is the right time for treatment.

"So that's how it is..." After hearing this, the light in Shen Lang's eyes disappeared, and he was a little dazed.

"Did you miss it?" Zhou Congwen knew why Shen Lang was depressed at a glance, so he asked.

Chapter 1582 The Gap

The two randomly found a restaurant to sit down and have a meal.

Shen Lang was still immersed in the shock of Nutcracker Syndrome, he was not as "smart" as usual, and was a little dazed.

"Shen Lang, what are you thinking?" Zhou Congwen asked.

"Congwen, I didn't think there was much difference between a hospital and a hospital before." Shen Lang said in a low voice with concentration.

Zhou Congwen frowned slightly, "Shen Lang, after all, you are also a person who went from Jianghai City to the provincial capital, and then came to the imperial capital from the provincial capital. You have personally experienced the domestic medical level from the middle to the highest level, so why can't you feel the difference. "

"The diseases are all those diseases. The Third Hospital of Jianghai City can't understand them, and neither can the provincial capital." Shen Lang shrugged.

Zhou Congwen scratched his head and looked at the sky.

It is true that the level of diagnosis and treatment of the Third Hospital of Jianghai City is a certain distance from that of the provincial capital, but it is definitely not to an astonishing level.

There are even some old doctors in Jianghai City who are better than the provincial capital in some special fields, which Zhu Jun and the others have always been proud of.

But compared with 912, the top three public hospitals in the country, the gap can be said to be stark.

"Hehe." Zhou Congwen smiled, "The Third Hospital of Jianghai City is newly established. There is a group company behind it, and the equipment is all new. Some equipment is not even comparable to that of the provincial capital. Of course you don't think so."

"But when it comes to surgery, diagnosis, etc., the Third Hospital really doesn't care enough. Let's not talk about Nutcracker Syndrome. For aortic dissection, 10% of the doctors in the Third Hospital now know that the diagnosis is good."

"Is it that exaggerated?" Shen Lang asked.

"I... a few years ago, I had a rib fracture. I was injured in a car accident and broke two ribs. It's nothing wrong. The alignment and alignment are pretty good." Zhou Congwen said, "The patient pulled the I asked if I was going to die."

"Ah!" Shen Lang experienced, "Congwen, what did you say to the patient."

"The other injured person who was in a car accident with him didn't believe our Jianghai Third Hospital. He went to the People's Hospital, where he was at Zhu Jun's. The initial diagnosis was nothing, it was all rib fractures, but he suddenly passed away in the early morning."

Shen Lang was astonished.

What Zhou Congwen said is simple - people are gone.

If the cancer is in the advanced stage, it will be gone if it is gone. It is unavoidable with the current medical level and methods.

But if a rib is broken, the person is gone?Can the family accept it?

"How is the family?" Shen Lang asked vaguely.

"The family doesn't take people away, I want Zhu Jun to give an explanation." Zhou Congwen said, "Don't talk about this, let me ask you, what kind of disease is this?"

"There is a high possibility of aortic dissection." Shen Lang said habitually.

"Yes." Zhou Congwen said, "You think it's a normal disease, and you will glance at it when you watch the film, but the front-line doctors in the People's Hospital don't understand it at all."

"..." Shen Lang didn't expect that he would grow up so fast inadvertently, he pondered Zhou Congwen's words.

"If you accepted a patient with a broken rib, what would you do with it?" Zhou Congwen continued to ask.

"It's usually a chest X-ray." Shen Lang thought about it carefully, and replied, "But I'm used to doing a CT scan for patients, and it's not too troublesome. I'll take a look at the aorta and pericardium by the way."

"Although ordinary CT can't see clearly, you can see some clues to some extent. It is unreasonable to give a patient an enhanced CT simply because of a rib fracture, and it is impossible to do an enhanced CT at night."

"That's right." Zhou Congwen nodded in relief.

Although Shen Lang didn't know about Nutcracker Syndrome, it wasn't in the scope of cardiothoracic surgery at all. It could be said that it was in the scope of vascular department, which was a thousand miles away from cardiothoracic surgery.

But Shen Lang's diagnosis and treatment of the simplest rib fracture in thoracic surgery is correct. (Note)

There is nothing wrong with being cautious.

"Look, Shen Lang, there is a gap between your level of diagnosis and treatment and that of primary hospitals." Zhou Congwen said with a smile, "Seeing more, thinking more, this is inevitable."

"But that little boy just now, you didn't even see the patient!" Shen Lang emphasized.

"Didn't I say it all? There is no family genetic history. Boys with a slender body in junior high school and high school have signs such as hematuria, proteinuria, and left varicocele. They are generally nutcracker syndrome. Others are rare diseases. For the time being Not considered."

"Tsk tsk." Shen Lang clicked twice and fell into deep thought.

"Do you see the difference between the Cardiothoracic Surgery Department of 912 and the Third Hospital of Jianghai City and the Second Hospital of the Provincial Medical University?" Zhou Congwen asked.

"Our side is full of undergraduates, half of them are undergraduates and half of them are postgraduates in the provincial capital, 912... are all doctors." Shen Lang suddenly swears, and then looks at Zhou Congwen pitifully.

"Congwen, when will you recruit doctoral students?"

"Hahaha." Zhou Congwen laughed, "Dean Deng recruited a doctor, I thought you were not interested in this."

"Well, I used to see undergraduates around me, and I thought my education was okay, so I didn't think so much. When I was in the provincial capital, at least half of them were undergraduates, and graduate students were not very good, so I didn't think too much about it."

"I don't think it's right to come to 912."

"En." Shen Lang nodded.

"Hurry up." Zhou Congwen said, "Now 912's doctorates are barely spread out. Wait another ten years, and Dean Deng's doctorate will not be able to stay after graduation."

"I go!"

"Really." Zhou Congwen said, "Moreover, there will be many requirements for promotion in the future, and it will definitely not be as simple as a lower-level hospital."

Although Shen Lang felt that Zhou Congwen's words about lower-level hospitals were harsh and his role hadn't been changed yet, the facts proved that no matter whether it was the Third Hospital of Jianghai City or the Second Hospital of Medical University, they were all younger brothers in front of 912, and they were all lower-level hospitals.

"Then what will you ask for in the future?" Shen Lang asked.

"The attending physician needs a national natural science foundation project to be promoted to a deputy high school."

"!!!" Shen Lang's eyeballs almost fell out.

"You have to know that 912 is at least the top three in the country. Xiehe, Huaxi, followed by 912, Xiangya, Ruijin and so on." Zhou Congwen said, "There are too many talents, and it is not easy for us to enter this year. "

"Congwen, if you won't be able to come in after a few years?" Shen Lang was a little puzzled.

"Ah?" Zhou Congwen's eyes were a little teasing, "I'm talking about you, and we just said the word "we" casually, making it seem closer. I'm number one in the world, so why can't I get in?"

Shen Lang burst into tears.

……

……

Note: I don’t know if it’s my habit. It may be because I’m very timid. Every patient with a fracture, especially a patient with high blood pressure, will carefully perform a CT scan.

In those years of thoracic surgery, several dissections were screened out.

Be careful, it is indeed difficult to walk on eggshells.The key is that the chest CT is really hard to see clearly, and sometimes it takes an hour to see each other in front of the film.

Bitter.

Chapter 1583 The Gap

"Congwen, do you think it is difficult to apply for the National Natural Science Foundation of China?" Shen Lang asked.

"Of course." Zhou Congwen said with a smile, "there is a big gap between hospitals and hospitals, and between doctors. I heard from the boss that at the annual neurosurgery conference in China, there was a big gap between the top ten hospitals. "

"Huh?" Shen Lang frowned, looking at Zhou Congwen.

"In the top five hospitals in the country, in the medical records produced by the doctors, meningiomas do not surround the bilateral internal carotid arteries, and they are embarrassed to talk about it." Zhou Congwen said, "This disease occurs in almost all cases in the top five hospitals. A group of professors can do it, but in 5-10 hospitals, only the director can do it, and it may not be possible to do it.”

"What you said is a rare situation." Shen Lang retorted habitually.

"With a population base of more than one billion, there are no diseases that are too rare. Otherwise, Nutcracker Syndrome would be a common disease in the eyes of doctors on 912." Zhou Congwen said.

"Yes! What you said is so right!" Shen Lang didn't shy away from it, he always said something, especially when chatting with Zhou Congwen, "I don't even talk about Sister Pang from the emergency department, even the one from the CT room. The doctor knew it was Nutcracker Syndrome at a glance!"

"That's right." Zhou Congwen smiled, "As long as you've seen it, and you've seen it a lot, that's it. By the way, I heard from the boss that he organized a national annual meeting of cardiothoracic surgery when it was just re-opened."

Shen Lang pricked up his ears and listened to Zhou Congwen's gossip.

"Esophageal cancer radical surgery data presented by a director from a small county in Henan shocked even the boss."

"Really?" Shen Lang knew that Huang Lao was powerful, so hearing Zhou Congwen's words, he subconsciously thought it was an exaggeration.

"Really." Zhou Congwen said, "The boss didn't believe it either, so he found a patient to go on stage with the director of that small county."

"It turned out that what they did was really good. The boss basically only worked as an assistant on one side, and couldn't find any major problems. You know, how awesome are the surgeons who the boss can't find fault with." Zhou Congwen said.

"So powerful? Why?" Shen Lang was a little confused.

"That side is an area with a high incidence of esophageal cancer. It is said that their clinical junior doctors have done more radical resections for esophageal cancer than the professors in the 912 group."

"!!!"

"The boss later organized professors from 912 and Imperial Capital to study advanced technology locally." Zhou Congwen said, "However, this is an extremely rare situation and cannot be regarded as a common case."

"So amazing!" Shen Lang sighed again.

"Of course." Zhou Congwen said, "For the same disease, even hospitals in the imperial capital have different levels of classification. Our 912's cardiothoracic and rheumatic immunity are very strong, but when it comes to orthopedics, it is relatively average."

"I think our 912 is very good, the top in the country, it's really not bragging." Shen Lang said.

"Who said that." Zhou Congwen scorned, "The boss told me an example. A patient with a deformity in his left ankle came to the doctor. After the MRI, our 912 did not give an exact diagnosis, so he told the patient not to wear high heels, but to wear as much as possible." Flat shoes, less exercise."

"As a result, the patient went to Jishuitan. They did a set of examinations, and the diagnosis was that the ankle ligament was completely torn. The drawer test was not obvious, and the structure was fine, but the strength was too weak. It is recommended to perform surgery."

"I'll go, the gap is so big!"

"Yeah." Zhou Congwen said, "So, student Shen Lang, you have to work hard."

"I……"

"You are no longer a small doctor in a primary hospital." Zhou Congwen earnestly said, "There is really no way for a primary hospital. Doctors in small cities can often browse new literature, update their old medical experience, and learn the latest medical technology.