"Director Liang, you look at the patient first. Wu Mian smiled and stood in the corner.

The outpatient clinic has always been very busy, and Mr. Wu is not here to talk about things, and it is impossible to talk about things here, Director Liang understands.

"The check is back. Director Liang stood at the table and reached out to take the B-ultrasound report and the list of blood routines.

He looked at it for 2 minutes, quite carefully, looked at all the important points, and even glanced at the B-ultrasound image in particular.

The patient's gallbladder wall is vaguely rough, and cholecystitis can barely be diagnosed.

"Little girl, sit down and talk. Director Liang was very gentle, without a trace of impatience, he said with a smile, "Your situation is very clear, now it is considered to be cholecystitis." ”

"Director, is the situation serious?" the little girl asked in a low voice, her face was a little pale.

"It's not serious, you have tenderness in your right upper abdomen, but there is no rebound pain and muscle tension. The gallbladder wall on ultrasound is somewhat rough, but not very heavy. Diagnosis of cholecystitis is no problem, surgery ...... I don't think it's necessary, just take antibiotics orally for a day or two. ”

"What if it's not good?" asked the little girl, timidly.

"You can go to the community hospital for a drip, but I don't think it's likely that there will be a problem. Director Liang tried his best to make himself have some affinity, and said to the patient with a smile.

After all, Mr. Wu stood aside, probably to poach people. Don't say whether you go or not, you have to be kind and angry, and you can't let Mr. Wu underestimate his clinical skills.

"Thank you. The patient said very hard, his voice was a little small, full of pain, "Director Liang, why don't you drip directly, the drip can be faster, I really can't stand the pain." ”

The patient said pitifully, "I can't stand the pain every night for the past two days......

As she spoke, she pointed to the Murphy dot in her right upper abdomen, and said distressedly, "Every time it hurts, I can't help coughing, it's very uncomfortable." ”

"It's okay to just drop it. Director Liang said, "But I recommend that you still ......."

As he was talking, Director Liang saw Wu Mian blinking slightly at him.

Did you make a mistake in your own diagnosis? Director Liang thought about it carefully, no. Could it be that he has too many scenes in his heart and misunderstands what Mr. Wu meant?

What should I do now? Director Liang was stunned for a moment.

Wu Mian turned around and walked out, his hands behind his back, and his fingers seemed to move slightly.

"You wait a minute, I'll have a stomach upset, go to the bathroom. Director Liang said to the patient.

"Well, I'm not in a hurry. The patient was very cooperative and understanding, and whispered.

Director Liang was a little apprehensive in his heart, although he didn't want to show his face, but don't show his buttocks.

As he walked out, Director Liang recalled the patient.

Positive signs on physical examination are obvious, tenderness in the gallbladder area, and although there is no rebound tenderness or muscle tension, this proves that cholecystitis is not too severe and is not a reason to deny cholecystitis.

Strange, what did Mr. Wu tell himself to do?

Director Liang walked out with Wu Mian, Wu Mian didn't go far, and stopped in the corridor, "Director Liang, can I see the results of the eye examination?"

"Oh, look. Director Liang handed the test results in his hand to Wu Mian.

Wu Mian quickly glanced at the list, his gaze barely stopped on any line, and said after a few seconds, "Director Liang, I see that your outpatient medical record says that your lungs breath sound is clear, did you really listen to it?"

"......" Director Liang was stunned.

Under normal circumstances, non-specialist physical examinations are written casually, the patient has a stomachache, or a young woman, if he has to auscultate her, isn't he waiting to be complained.

It's not uncommon for this to happen in hospitals every year.

Mr. Wu is a professional in the profession, whether he checks the body or not, the doorway involved in the middle should be extremely clear. Director Liang's mind flashed, and he immediately recalled the patient's signs, complaints, and related conditions.

After thinking about it again, Director Liang still didn't find any problems.

"Teacher Wu. Director Liang was just stunned for a moment, then smiled and bowed his head and said, "Seriously, I didn't auscultate, you know this." ”

"Well, I know. Wu Mian nodded, "The patient's tone is a little weak, and she can vaguely hear the sound of airway spasm, plus she has a cough when she reports abdominal pain, check an imaging examination of the lungs." ”

"...... are you considering?" Director Liang was stunned for a moment.

"Why don't you listen to the patient's breath sounds, and if the right side is weakened, do a check-up. "The patient is not epigastric pain induced by cholecystitis, but a large pleural effusion on the right side, which is radiating pain caused by pulling the pleura." ”

"......" Director Liang was speechless, glanced at Wu Mian, knew that he was serious, and did not argue, nodded and turned back.

"Teacher Wu, did you hear it with your ears?" asked Xue Chunhe.

Xue Chunhe is also from the Department of Gastroenterology, he knows that Director Liang's level is not bad, and he has witnessed all this with his own eyes just now, and he doesn't think Director Liang has done anything wrong.

If it is more serious, Director Liang's medical record says that the breathing sound of both lungs is clear, but in fact there is no physical examination, this is indeed a mistake.

However, the vast majority of outpatient medical records are written in this way. For a patient with appendicitis, according to the medical record writing specifications, you have to check it from head to toe, is that possible?!

Mr. Wu didn't use this reason to talk about things, but what he said might as well use this reason to talk about things.

Is there a problem with the patient's breath sounds?

Xue Chunhe felt a little incredible.

"Dean Xue, have you observed the patient?" asked Wu Mian with a smile.

"Look, there are several main manifestations of tuberculosis patients, night sweats, dry cough, chest pain, and fever. None of the patients match, how do you judge?"

"The patient sits in a formal position, without a hunched back and chest, right? ”

Xue Chunhe thought back to the patient's situation and nodded.

"But when the patient comes in, he can see the left side of the trachea, which is a clear sign. ”

“......”

"In the laboratory test list, the blood routine white blood cells were normal, and the lymphocytes were high. Although the changes in the complete blood count in patients with tuberculosis are not significant, combined with the left tracheal deviation, the presence of a right-sided pleural effusion can be suspected. ”

"Uh...... Wouldn't it be too far-fetched?"

"If you've been in the ICU or respiratory medicine for a few years and you've been listening to wheezing every day, you should be able to determine the patient's condition very quickly. Wu Mian said, "Wait and see, Director Liang can quickly determine after the auscultation." ”

As she spoke, the young woman walked out with a confused expression.

"Hurry up, but don't be in a hurry when walking, take it slow. Don't be strenuous about it, it's fine, you don't have to rush. Director Liang kept admonishing.

He watched the young woman leave the outpatient corridor, and then turned around and walked in front of Wu Mian, with a confused and grateful expression.

"Mr. Wu, the patient's right breath sound is extremely weak and almost disappears. ”