Path of Medicine With a System

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Once the human mind is involved in interests, it will become very complicated. Chasu City Hospital sent a consultation letter directly to the Affiliated Hospital, General Hospital, and Provincial Hospital of Bird City.

To be honest, this kind of invitation letter has no effect. There are clear charging standards for this kind of consultation fee. Online consultation, sub-high 20 yuan a time, high 30 yuan a time. The consultation fee between hospitals is up to 1,000 yuan.

Therefore, technology is becoming more and more advanced, and various communication conditions are getting better and better, but online consultation and consultation between hospitals cannot develop. The hospital consultation system, which was built with huge sums of money, was just left idle.

The higher-level hospital forces each chief doctor to deal with how many online consultations within the specified time. This kind of consultation is generally a relatively complicated or special disease, which is a waste of time.

The higher-ups enforced the number of consultations, and withheld part of the consultation fees, and most of them were withheld. Then, the chief physicians of various major hospitals began to act perfunctorily or arrange young doctors in departments to replace him for consultation.

If the disease that the upper-level hospital requires consultation is relatively simple or the lower-level hospital handles it unreasonably, there will be cases of ridicule if the guarantee is not complete.

Immediately afterwards, the doctors in the lower-level hospitals lost their motivation. The local area is not good, or he will be transferred to another hospital. He can't afford to be ridiculed by others because of his illness. As for whether there are any subordinate doctors, they are suffering from various discomforts and apply for online consultation for the patient number.

Yes, but not many. Are there any superior doctors who are very kind and serious? There are, but they are not in the majority. And the consultation between hospitals is even more bizarre. The ones who can come are definitely not the authority of some hospital departments, and they can only use the name of the hospital to provide a certificate for the lower-level hospitals.

What Chasu City Hospital wanted was this name, and what it wanted was this official certificate. In two days, the patient's medical records were completed.

Zhou xx suffered a broken right humerus due to an accidental fall after being drunk. In Chasu City Hospital, he underwent incision and internal fixation. Before admission, the patient had poor blood sugar control due to type 2 diabetes.

The chief physician Chen Qi, director of the third orthopedic department, violated the principle of treatment because he was a friend with the patient, and before the formal treatment of diabetes... Our hospital actively invited Dr. xx from the superior hospital of Bird City to come to our hospital for consultation.

The doctor who manages the bed has written a medical record into a book. As long as it is something that happened, the situation at that time, and the postoperative thing, he will recall it even if he plucks his hair. This is not only related to the treatment and identification of patients in the future.

Moreover, it is related to his job. A doctor in a tertiary hospital, to be honest, if you threaten someone with the establishment of the hospital, they probably won't be too scared. There is no place to stay here, but a place to stay.

However, if it is said that the practice certificate is revoked, it may scare him to death. This is the ultimate big move, and it is usually not released, but once it is released, it is a big deal.

Zhou xx and his family members stopped talking. When Ouyang came down with a combination of punches, Chen Qi was stunned. The original relationship with Zhou xx, who was as close as brother and brother-in-law, was completely broken.

Chen Qi's acceptance of red envelopes before surgery was also reported by Zhou xx's wife. Chen Qi is not a muddleheaded person, he can still handle it casually.

He even had a cell phone recording at that time, anyway, the two of them bit their hairs. Zhou xx inquired, and finally found out that in the orthopedics department of the city hospital, who is the best is the young assistant!

In the end, he didn't leave, and he was about to undergo follow-up treatment in the city hospital. As long as he is willing to cooperate, Ouyang is not willing to make things too big. After all, this is a hospital, not a court.

Of course, Chen Qi's director couldn't do the job. He was warned by the red-headed document inside the hospital and imposed a rescue fine.

He can't go back to the second department of orthopedics. He can only be an outpatient doctor. A doctor who has been in the outpatient clinic for a long time can issue a sick leave note and a long-term outpatient prescription for chronic diseases.

This punishment is not too heavy, and Chen Qi's future path is also very obvious, unless there is an unconventional change in the leadership of the hospital,

Otherwise, if you want to have surgery again, you have to change places.

For Ouyang and Zhang Fan, Chen Qi almost hated him to death. Taking money from people is tantamount to killing their parents. But on the surface, he couldn't see at all that he was unhappy.

He goes to get off work on time every day, leaves work on time, and smiles at everyone, and even greets Zhang Fan when he sees him, without any grudges.

Bone nonunion, about 2 million patients with long bone fractures are treated in the United States every year, and among these 2 million, there are about 100,000 nonunion patients.

Moreover, the cost of nonunion treatment is about twice that of normal fracture healing. And there is a very high rate of disability. Experts from higher-level hospitals come to Chasu Hospital to make a diagnosis and want them to perform surgery, but no one is willing.

There is too much unpredictability in this kind of surgery. The patient probably came here after going to other hospitals. If there is an accident in the hospital, it must be resolved.

As Zhang Fan, who is in charge of surgery, he had to come up with a solution. In the past, Zhang Fan could only make arrangements in their group, and he also had to consider Wang Yanan's mood.

It's different now, "Let Zhou Chengfu from the third department of orthopedics, Xu Xian from the first department of orthopedics, and Dr. Wang Pingshan from the second department of orthopedics be informed that they are going to have nonunion surgery tomorrow."

Zhang Fan was in his office in the administration building, explaining tasks to the office director.

"Are you the chief surgeon?"

"Well, I'm the chief surgeon." Zhang Fan replied, these are all young orthopedic doctors, and Ouyang directly entrusted Zhang Fan with the task of selecting the director of the third orthopedic department.

Zhang Fan currently has two people in his mind, one is Zhou Chengfu, although this person is more utilitarian, but he is good at business, the second is Wang Pingshan from the Second Department of Orthopedics, his business is also quite good, but his personality is a bit dull.

Both of them are attending doctors who are about to be promoted to deputy high school. Zhang Fan has to think about it and weigh the pros and cons. Bringing Xu Xian along was just a cover.

After processing some necessary documents, Zhang Fan went to the Third Orthopedic Department again. Because the director was dismissed and the new director had not yet been appointed, Zhang Fan had to worry more about the work of the department.

As soon as he arrived at the door, he heard that Zhou Chengfu was giving lectures to residents and rotation doctors in the department.

"There are many, many reasons for nonunion. To put it bluntly, it is not clear, but through evidence-based medicine, it is certain that smoking is a very significant inducement."

After seeing Zhang Fan, Zhou Chengfu insisted on Zhang Fan saying a few words, "I can't speak well, let Zhang Yuan tell us a few words. Zhang Yuan's lecture is as wonderful as his operation."

The hospital is going to take the path of combining medicine, education and scientific research, and gradually begins to pay attention to the education of young doctors, rotating doctors, and interns.

Just because of this case, Zhang Fan didn't say much, and went directly to the stage to start talking.

"When we talk about nonunion, we must first talk about bones. If the bones of the human body are subdivided, there are many classifications, all of which are found in textbooks. This is what a doctor must master.

If roughly classified, it can be divided into two categories, cartilage and bone. "Lectures, especially for young doctors and interns, are no better than explanations during surgery.

Almost all the doctors who can ask questions during the operation have been doctors for many years. What they lack is a little trick or a problem in thinking, but when facing interns, they can't speak in general.

It is necessary to explain the knowledge points, but also to speak vividly and interestingly. This requires much higher requirements for the lecturers. Otherwise, the textbooks are very comprehensive, so why do you need a teacher?

"The components and tissues of bone are found in textbooks, and I won't repeat them. Today, because of a patient, let's talk about nonunion. If we want to talk about nonunion, we must first talk about fracture healing.

Bone healing depends mainly on four types of cells. Osteoprogenitor cells, osteoblasts, osteocytes, osteoclasts.

When a long bone is fractured, osteoclasts will first decompose the broken bone into various original components, such as bone cells, bone salt and other components.

Then, osteoblasts come into play. Through gene regulation, they will allow free bone cells, bone salt and various nutrients ingested by the human body to allow osteoprogenitor cells to reconstitute cartilage, then calcify, and finally form a complete bone mass. . "

Zhang Fan said that the doctors below, no matter they are interns or on-the-job doctors, are all bowing their heads and taking notes. Even Zhou Chengfu is sitting in the back row bowing his head and taking notes. He guessed that the element of pretentiousness was greater than the element of learning, but his attitude was shown.

"The shape of bone is not constant. A mature bone is not static. It changes every day just like you wear clothes. Through hormones and nutritional conditions, osteoclasts are constantly destroyed, and osteoblasts are constantly destroyed. Stop rebuilding.

Under normal circumstances, %". Elderly women, because of the lack of estrogen, the loss will be greater, which is also the reason why elderly women are prone to fractures.

This is also the reason why adults need calcium supplementation when they enter the age of forty-five. When nutrients absorbed are not enough to keep up with what the body loses, bone fragility increases and bone strength decreases.

Calcium supplementation cannot be corrected simply by taking drugs. First of all, vitamin D should be supplemented in time. If vitamin D is deficient, rickets will appear especially in early childhood.

Lack of vitamin A will cause changes in the speed of osteoblasts and osteoclasts, that is to say, deformities will appear.

In the absence of vitamin C, cells synthesize less collagen fibers, resulting in increased bone fragility.

Moreover, under low stress, although the bone is resorbing, its density cannot reach the normal density. Especially long-term bedridden patients are very prone to fractures.

Therefore, in order to ensure the health of bones, it is most important to get more sun exposure, moderate physical exercise, and sufficient food.

Taking calcium tablets from Australia or American calcium tablets is not as good as eating ordinary calcium tablets and having a healthy living habit.

There are two main nutrition pathways for bones. The first is that the outermost layer is the dense periosteum, which contains a large number of blood vessels, nerves, and bone progenitor cells.

The second place is the femoral intima, the innermost layer of the bone, where there are also blood vessels running. Note that the blood vessels here are all small blood vessels. In other words, if a large amount of periosteal soft tissue on the surface of the bone is stripped during the operation, the bone will suffer from malnutrition.

If the patient has diabetes, smokes, and lives irregularly, then there will be nonunion!" Zhang Fan didn't directly talk about the nonunion.

Medicine is a discipline with one link within another. If one link is missing, knowledge will be incomplete. The understanding of diseases is specious, knowing what it is but not knowing why it is.

After Zhang Fan said this, the next intern students will be very clear and clear.

"There are three forms of nonunion..." At this time, it is time to start explaining nonunion and its treatment.

For more than forty minutes, Zhang Fan crushed and disassembled a bone and explained it to the students below. As long as you listen carefully to this class, you will definitely have a complete grasp of this disease. The rest is to go to the clinical practice, to practice.

At the beginning, most of the doctors in the Department of Orthopedics were pretending, but following Zhang Fan's explanation, most of them began to listen carefully.

"No wonder, people's surgery is so good. Listen, this class is so powerful that even a non-medical professional can understand it!" A resident doctor said to another resident doctor.

"Nonsense, can you be the dean if you are not strong!"

After Zhang Fan finished his lecture, the students below looked at Zhang Fan with enthusiastic eyes. They didn't know whether it was the halo of the dean's assistant or Zhang Fan really convinced them. However, Zhang Fan was satisfied with this lecture.

I’ve been so mad I don’t know how many times, if you can’t even teach a class well, it’s better to find a tofu and kill it.

"Zhang Yuan, you are too old-fashioned. I have gained a lot of knowledge. It seems that my knowledge reserve is still not enough. You are too busy. Otherwise, if you give us a class every week, it is estimated that the treatment level of the doctors in the department can be several times higher. a step." Zhou Chengfu said to Zhang Fan with a smile.

He was also helpless, if he had known that Zhang Fan could be promoted so fast, why would he run away, let alone other things now, even Lao Gao was full of dissatisfaction with him, he made a wrong step!

"Self-study is the most important thing." Zhang Fan was telling the truth, but Zhou Chengfu's face froze. But Zhang Fan didn't pay attention, "I will have surgery tomorrow morning, have you been notified by the medical office?"

"Notified, already notified." Zhou Chengfu nodded hurriedly.

"Well, prepare the instruments needed for the operation." Zhang Fan explained.

"Okay, okay. Zhang Yard, don't worry, I will definitely prepare properly." The stiff smile became wonderful again. He is afraid that his superiors will forget him, and he is willing to fight alone. It is very simple to say, but few can really do it.

After dealing with the third department of orthopedics, Zhang Fan has to go to the general surgery department to help with the operation. There are too many patients, doctors can't be transferred, and Zhang Fan has no good way. The training period for a qualified surgeon is too long.

Zhang Fan is still very happy to have surgery. Now he is an assistant to the dean. To put it in a rather rustic way, Zhang Fan is now a local tyrant: I want to do general surgery, so I do general surgery. I want to do it. For cardiothoracic surgery, we do cardiothoracic surgery.

If there were a little less administrative work, Zhang Fan would love this position to death. As long as he wanted, he could do any surgery in the hospital. The general experience of the system, from the slow growth of snails, has become visible to the naked eye.

This is a gratifying thing. ps: Book friends, I am Zang Fusheng, and I recommend a free novel app that supports novel downloads, listening to books, zero advertisements, and multiple reading modes. Please pay attention to the WeChat public account: dazhuzaiyuedu Book friends, please pay attention!

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