Why do you think that this patient needs to be treated with such a super overbearing treatment?

In fact, Zhang Tianyang himself can't say clearly.

It can only be said that it is "intuition".

In fact, clinical practice is often a place of "intuition".

Experienced doctors, with their own "intuition", can roughly guess the cause of your illness by listening to the symptoms, and even the results of the tests you have not yet done.

This "intuition" may be more appropriate to call it "experience".

But in fact, in many cases, when the diagnosis and treatment is in a difficult situation, and the existing examination methods and instruments cannot help the diagnosis, it depends on the "intuition" of experienced doctors.

Zhang Tianyang just thinks that this uncle should use it.

Really have to investigate the reason.

"I feel like the patient's disease is progressing too fast. ”

Zhang Tianyang gave an ambiguous answer.

In the system space, he had seen many such patients.

If something goes wrong, there must be a demon, and if the disease progresses too quickly, there must be a problem.

He also once made a mistake in judgment and did not use a strong enough drug, which led to the uncontrolled progression of the patient's disease simulated by the system, and even produced death.

Based on those patients who "die" in the system, he must also be firm in his choice.

Zhang Tianyang did not give any effective evidence in the end, and the question was thrown back to the attending doctor.

To listen, or not to listen?

The attending physician frowned and recalled the data from the patient's examination in the emergency department.

In addition to the CT scan that was done two days earlier, the patient had an almost full blood test.

Including but not limited to blood routine, infection indicators, liver and kidney function, etc.

The attending physician pointed to the screen to confirm again.

"Xiao Zhang, if you look at this patient's infection index, it is actually not high. ”

The normal range for ProCT is 0-0.05 ng/ml, which is 1.5 in this patient.

The normal range of CRP is 0-5 mg/L, and this patient is 12.

Although they are all elevated, they do not appear to be severe.

Compared with the 78 beds, which is hundreds of times higher than the data and floats high in the sky, it even seems very light.

The attending doctor elaborated his opinion, "I don't think there is such a strong antibiotic for this kind of indicator, and the second echelon is more than enough." ”

But Zhang Tianyang still insisted on his opinion.

"This is data from two days ago, and it doesn't match the severity of the patient's symptoms now.

I suggested that I do an urgent blood test immediately, review the relevant indicators, I see that he just did another CT before he came, call to urge, and I will see the latest CT results tomorrow morning.

But this plan should be used now. ”

The voice fell, and there was some eerie silence around.

The two bigwigs are fighting, and the horror .jpg.

In fact, a few onlookers in white coats understood.

The attending physician's order is based on the patient's existing examination results, which is the basis for most doctors to judge the condition.

Because the patient's indicators are not outrageous, the attending doctor feels that a slightly weaker antibiotic can be used.

The basis for Zhang Tianyang's medical order is that he believes that the patient's performance does not match the examination indicators of two days ago, and the disease is progressing too rapidly.

So he felt that the most powerful antibiotics should be used.

In fact, in the final analysis, they are all using antibiotics, and the two people have the same goal.

The problem was that the two men disagreed on the severity of the patient's illness.

If the patient's condition is indeed critical, but weak antibiotics are used, there may be no way to contain the progression of the disease in time, which may lead to serious consequences.

But in the same way, if the patient's condition is actually just scary, but he is given too strong antibiotics, then he will develop a certain resistance to strong antibiotics in vain, and the effect will be much worse in case strong antibiotics are needed to control the disease in the future.

In both cases, it is possible to have a long-lasting impact on the patient's later life.

In fact, if you wait until tomorrow, the results of the blood test and the new CT results will come out, and it will be clear who is right and who is wrong.

The problem is that the patient needs treatment today.

Where can I wait for tomorrow?

So, who to listen to?

A few white coats always felt that what the two of them said made sense, and they didn't know who to believe for a while.

I simply gave up thinking and turned my eyes to the attending doctor.

In any case, Zhang Tianyang is just an intern, and he has no right to prescribe, only the right to make recommendations.

The final decision is still made by the attending doctor.

Of course, he also bears the responsibility.

The attending doctor frowned.

According to his usual character, here he has the highest title and the most experience, and when there is a disagreement, he should definitely stick to his own judgment.

But this little sheet ......

The performance in the past two days has made him put Zhang Tianyang on a parallel level to himself in his heart.

An intern jumps out and says, "Teacher, you're wrong," and he must have laughed it off.

But a peer of the same rank jumped out and said, "I think there may be something wrong with your judgment", and he had to think about it seriously.

After thinking about it, he still couldn't make up his mind.

"In this way, you first prescribe urgent blood routines to the patient, liver and kidney function, infection indicators, etc., and let the nurses draw blood first. ”

The attending doctor decided to implement the consensus between the two first, and then turned his head to look at Zhang Tianyang.

"I still insist on my own opinion on this patient's condition, but what you said is also reasonable, why don't we go to the director for advice?"

A new patient's doctor's order is going to the director's side, and there is no one.

But Zhang Tianyang could only nod helplessly.

He didn't want to confront the attending doctor.

However, in the spirit of being responsible for the patient, if you have an idea, you have to say.

Especially when there are disagreements.

Otherwise, the word "consultation" would not have appeared.

Isn't the consultation also a process in which everyone sits together, expresses their opinions on incurable diseases, and finally is persuaded by the most probable conjecture, and then unites the front?

......

The director of the ICU touched his half-La Mediterranean and listened to the opinions of the two people.

I carefully reviewed the results of the new patient's examinations in the emergency department on the computer.

Again, I asked the two about their performance when the patient had just sent them.

Finally, a pat on the head.

"I agree with you about the idea that this patient's lung infection caused an intracranial infection. ”

"What kind of antibiotics to use, Xiao Zhang makes sense. ”

The words of the director of the ICU made Zhang Tianyang's heart feel slightly relieved, but in the next second, the plot reversed.

The director of the ICU changed his tone, "But, there are index requirements for the use of antibiotics in our East Hospital, Xiao Zhang, you have also prescribed strong antibiotics, right?"

He even clicked on the doctor's order entry interface on the computer.

"You see, the background color of a normal doctor's order is light blue, but with a slightly stronger antibiotic, the background color will turn bright red. ”

And after clicking OK, you need to check the conditions of use, and you also need to enter the patient's examination indicators. ”

"The state has strict requirements for the use of antibiotics, and all use records will be reported, and if you want to check it in the future, you can turn it out at any time, so ......"

The director of the ICU dragged out the last note and did not say anything further.

But Zhang Tianyang already understood what he meant.

The current indicators of this patient are not enough to use the line of the mepine-Wangu combination regimen.

In this case, if the patient is not used, even if the patient's condition is more serious than expected, or even if the person dies in the end, and a lawsuit is required, the medication error will not be determined.

Because there are really no conditions for use.

However, if it is used, even if the bet is right, the patient's prognosis is good, but in case the family is not pure-minded, wants to rely on the medical expenses, and wants to file a lawsuit, then the hospital can only suffer this loss in vain.

Because even though you are taking the right medicine, you have no evidence that the patient needs to take the medicine now.

After all, strong antibiotics are still expensive.

From the perspective of the hospital, or even from the perspective of the doctor to protect his own safety, he should choose the attending doctor's plan and choose a more conservative medication.

What's more, the title of the attending doctor is more than a little bit higher than Zhang Tianyang.

On the surface, his experience is far beyond that of Zhang Tianyang.

Therefore, it is reasonable that the director of the ICU should not stand on the side of Zhang Tianyang, an intern.

Do you really want to insist on it because of your "intuition" that you can't produce evidence?

Zhang Tianyang frowned, and was about to speak.

Over there, the director of the ICU spoke first.

"But ......"