People's minds, once interests are involved, will become very complicated. Chasu City Hospital directly sent a consultation letter to the affiliated hospital, general hospital, and provincial hospital of Bird City.

This kind of invitation is honestly ineffective. There is a clear fee for this kind of consultation. For online consultation, the deputy high is 20 yuan once, and the main high is 30 yuan once. The maximum consultation fee between hospitals is 1,000 yuan.

Therefore, science and technology are becoming more and more developed, and various communication conditions are getting better and better, but network consultation and inter-hospital consultation cannot be developed. The hospital consultation system, which had been built at great expense, was left idle.

Higher-level hospitals enforce the number of online consultations that each chief physician has to deal with within a specified time. This kind of consultation is generally a relatively complex or special disease, which is a waste of time.

The number of compulsory consultations by the superiors and the withholding of part of the consultation costs are the largest part of the consultation. Then, the chief physicians of various major hospitals began to act perfunctorily or arrange for young doctors in the department to replace him for consultation.

If the disease required by the lower and lower level hospitals for consultation is relatively simple or the lower level hospitals do not handle it very reasonably, there will be ridicule if the guarantee is not complete.

Immediately after that, the doctors in the lower hospitals were also out of motivation. If the local area is not good, he will go to the hospital or transfer to the hospital, and he can't afford to be ridiculed by others for the sake of his illness. As for whether there are subordinate doctors, they are suffering from all kinds of uncomfortable applications for online consultations for patients.

Yes, but not much. There are no senior doctors who are very kind and serious, and there are, but they are not in the majority. And the consultation between hospitals is even more bizarre. It is definitely not the authority of the hospital department that can come, and it is just a certificate for the lower-level hospital in the name of the hospital.

What Chasu City Hospital wants is this name, and what it wants is this officially recognized certificate. Within two days, the patient's medical record was complete.

Zhou XX, due to a drunken accidental fall, resulting in a fracture of the right humerus. In Chasu City Hospital, incision and internal fixation were performed. Before admission, the patient had poor glycemic control due to type 2 diabetes.

Chief Physician Chen Qi, director of the Third Department of Orthopedics, violated the principles of treatment because he was a friend with the patient, and before the formal treatment of diabetes, he ...... Our hospital actively invited Dr. XX from the Bird City Superior Hospital to come to our hospital for consultation.

The doctor in charge of the bed wrote a medical record into a book, as long as it was what happened, the situation at that time, the postoperative events, and the pulling out of the hair, he had to recall it. It's not just about the treatment and identification of the patient in the future.

Moreover, it is about his job. A doctor in a tertiary hospital, to be honest, if you threaten people with the establishment of the hospital, it is estimated that they are not very afraid. There is no place to stay here, there is a place to stay here.

However, if you want to say that the revocation of the practice certificate can probably scare him to death. This is the ultimate ultimate, and it usually doesn't come out, but once it does, it's a big deal.

Zhou XX and his family members stopped talking. Ouyang came down with a combination of punches, and Chen Qi was stunned. The relationship with Zhou XX that was originally as close as a brother and as a brother-in-law was also completely broken.

Chen Qi's acceptance of red envelopes before the operation was also reported by Zhou XX's wife. Chen Qi is not a mud, he is still handled casually.

He actually had a mobile phone recording at the time, and the two of them bit the hair anyway. Zhou XX inquired about it, and finally knew who was the best in the orthopedic department of the city hospital, which young assistant was the best!

In the end, he didn't leave, and had to do follow-up treatment in the city hospital. As long as he is willing to cooperate, Ouyang is not willing to make too much trouble, after all, this is a hospital, not a court.

Of course, Chen Qi's director couldn't do it, and he was warned by the hospital's internal red-headed documents, and was also fined for salvation.

He can't go back to the second orthopedic department, so he can only be an outpatient doctor, a doctor who has been in the outpatient clinic for a long time, prescribes a sick note, and prescribes a long-term outpatient prescription for chronic diseases, which can be regarded as a pension.

This punishment is not too heavy, and Chen Qi's future path is also very obvious, unless there is an unconventional leadership change in the hospital, otherwise, if you want to have surgery, you can only change places.

For Ouyang and Zhang Fan, Chen Qi is about to hate to death, and taking away people's wealth is tantamount to killing their parents. But on the surface, I can't see at all that he is not angry.

Go to work on time every day, get off work on time, smile at everyone, and take the initiative to say hello when you see Zhang Fan, without a little mustard.

Orthodontics, about 2 million patients with long bone fractures are treated in the United States every year, and about 100,000 of these 2 million patients have nonunions.

Moreover, the cost of nonunion treatment is about twice that of a normal fracture. And there is a very high disability rate, and the experts from the higher-level hospitals come to the Chasu Hospital, that is, to make a diagnosis, and want them to have surgery, but none of them are willing.

There is too much unpredictability in this kind of surgery. It is estimated that the patient also went to other hospitals before coming to such a sudden. If something happens in the hospital, it needs to be solved.

As Zhang Fan, who is in charge of surgery, he has to come forward to find a way, and Zhang Fan in the past can only make arrangements in their group, and he also has to consider Wang Yanan's mood.

It's different now," I would like to inform Dr. Zhou Chengfu of the Third Department of Orthopedics, Xu Xian of the First Department of Orthopedics, and Dr. Wang Pingshan of the Second Department of Orthopedics that I am going to have surgery for nonunion tomorrow. ”

Zhang Fan was in the office of his administrative building, explaining the task to the office director.

"Are you in charge?"

"Well, I'm the main knife. Zhang Fan replied, these are the best young doctors in orthopedics, and Ouyang directly handed over the task of selecting the director of the third orthopedic department to Zhang Fan.

Zhang Fan currently has two people in his mind, one is Zhou Chengfu, although this person is a little more utilitarian, but he is a good hand in business, and the second is Wang Pingshan of the second orthopedic department, and the business is also quite good, but his personality is a little wooden.

Both of them are attending doctors who are immediately promoted to deputy high, and Zhang Fan has to consider and weigh the pros and cons. Bringing Xu Xian is just a disguise.

After processing some documents that must be approved, Zhang Fan has to go to the third orthopedic department again, because the director has been dismissed, the new director has not been appointed, and Zhang Fan has to worry more about the work of the department.

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

"There are very, very many causes of nonunion, and to put it honestly, it's not clear, but through evidence-based medicine, it is certain that smoking is a very significant trigger. ”

After seeing Zhang Fan, Zhou Chengfu insisted that Zhang Fan say a few words, "I can't speak well, let Zhang Yuan tell us a few words." Zhang's lecture was as wonderful as his surgery. ”

The hospital should take the path of combining medical education and scientific research, and the education of young doctors, rotation doctors, and interns has gradually begun to pay attention to it.

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

"To say that the bones are not connected, we must first talk about the bones. If the bones of the human body are subdivided, there are many classifications, which are all in textbooks, which must be mastered as a doctor.

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

Doctors who can ask questions during surgery are almost all doctors who have been doctors for many years, and what they lack is a little trick or thinking problem, but when facing interns, they can't talk about it in general.

It is necessary not only to tell the knowledge points, but also to talk vividly and interestingly, which has much higher requirements for the lecturer, otherwise the things in the textbook are very comprehensive, and what do you need the teacher to do.

"The components of bone are all in the textbooks, and I will not repeat them, today because there is a disease number, let's talk about bone nonunion, if you want to say bone union, you must first talk about the healing of fractures.

There are four main types of bone healing. Osteoprogenitor cells, osteoblasts, osteocytes, osteoclasts.

When a long bone is fractured, osteoclasts will first break down the bones at the end of the fracture into various primitive components, such as bone cells, bone salts and other components.

Then, osteoblasts come to the field, and through genetic regulation, it will allow free bone cells, bone salts, and various nutrients ingested by the human body, so that bone progenitor cells can reconstitute cartilage, and then calcify, and finally form a finished bone. ”

Zhang Fan said that the doctors below, whether they were interns or in-service doctors, were all bowing their heads and taking notes, and even Zhou Chengfu was sitting in the back row and bowing his head to take notes. He estimated that the component of pretense was greater than the component of learning, but the attitude of others was expressed.

"The morphology of bones is not constant. A mature bone is not static, it changes every day as if it were dressed with you. Through hormonal and nutritional conditions, osteoclasts are constantly destroyed, and osteoblasts are constantly rebuilt.

Normally, bone loses 0.5% of the total amount of bone per year." Older women, because of the lack of estrogen, will lose a greater amount, which is why older women are prone to fractures.

This is also the reason why adults should take calcium supplements when they enter the age of forty-five. When the absorbed nutrients are not enough to keep up with the body's lost components, bone becomes more brittle and bone strength decreases.

Calcium supplementation cannot be corrected simply by taking medications. First of all, vitamin D should be supplemented in time, lack of vitamin D, especially in early childhood, rickets will occur.

Vitamin A deficiency causes variations in osteoblast and osteoclast velocity, which means deformities.

With a lack of vitamin C, the collagen fibers synthesized by cells decrease, resulting in increased bone fragility.

Moreover, under low stress, although the bone is absorbed, the density cannot reach the normal density. In particular, patients who have been bedridden for a long time are very prone to fractures.

Therefore, in order to ensure the health of bones, it is necessary to get more sunlight, moderate physical exercise, and ensure adequate food, which is the most important.

Taking calcium tablets in Australia and calcium tablets in the Americas is not as good as having a healthy lifestyle after you eat some ordinary calcium tablets.

There are two main ways of nutrition for bones, the first is the outermost layer of the tight periosteum, which has a large number of blood vessels, nerves, and bone progenitor cells.

The second place is the lining of the femora, the innermost layer of the bone, where the blood vessels are also walking. Note that the blood vessels here are all tiny blood vessels. In other words, if a large amount of periosteal soft tissue is removed from the bone surface during surgery, then the bone will be malnourished.

If the patient has diabetes, smokes, and has an irregular life, then there will be nonunion!" Zhang Fan did not start with the nonunion.

Medicine is a discipline with one link on the other, and without one link, the knowledge is incomplete, and the understanding of the disease is specious, and the reason for knowing it is not known.

Zhang Fan said this, and the following internship students were very clear and clear.

"The form of nonunion is divided into three ......" At this time, it is the beginning of the eight classics to explain the nonunion and explain the treatment of nonunion.

For more than forty minutes, Zhang Fan crushed and decomposed a lecture to the students below, as long as you listen carefully to this class, you will definitely have a complete grasp of this disease. All that's left is to go to the clinical internship and practice.

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

"No wonder, other people's surgeries are flying, you listen, this lesson is about bringing in a non-medical professional who can understand, it's too strong!" said one resident to another.

"Nonsense, can't you be the dean!"

Zhang Fan finished the lecture, and the students below looked at Zhang Fan with warm eyes, not knowing if it was the aura of the assistant dean, or if Zhang Fan really convinced them. However, Zhang Fan was still satisfied with this lecture.

I don't know how many times I've had my liver, and if I can't even teach a class, it's better to find a tofu to die.

"Zhang Yuan, it's 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 we will be taught every week, and it is estimated that the treatment level of the doctors in the department can go up several steps. Zhou Chengfu said to Zhang Fan with a smile.

He was also helpless, if he had known that Zhang Fan could rise so fast, what else would he run, don't talk about anything else now, even Lao Gao was dissatisfied with him, one wrong step and one wrong step!

"Self-study is still the most important thing. Zhang Fan was telling the truth, but Zhou Chengfu's face stiffened. However, Zhang Fan didn't pay attention, "Will I have surgery tomorrow morning, has the medical department notified me?"

"I've been informed, I've been informed. Zhou Chengfu hurriedly nodded and said.

"Well, you have the instruments you need for the surgery. Zhang Fan explained.

"Okay, okay. Zhang Yuan, don't worry, I will be properly prepared. The stiff smile has become wonderful again. He was afraid that his superiors would forget him, and he was willing to struggle lonely, saying that it was very simple, and there were few people who could really do it.

After dealing with the matter of the third orthopedic department, Zhang Fan still had to go to the general surgery to help with the operation. There are too many patient numbers, doctors can't turn around, Zhang Fan has no good way, and the training cycle of a qualified surgeon is too long.

In terms of a more local language, the current Zhang Fan is a local tyrant: I want to do general surgery, I want to do general surgery, I want to do general surgery, I want to do cardiothoracic surgery, I want to do cardiothoracic surgery.

If there is less administrative business, Zhang Fan will love this position to death, as long as he wants, the hospital surgery is casual. The general experience of the system, from the slow growth of a snail, began to become visible to the naked eye.

This is a welcome thing to celebrate.