"Based on my study of nearly 200 patients with right lower quadrant pain, I have come to a conclusion."

Facing the somewhat apprehensive Millers, John said seriously: "But one of the most important things I want you to know first, that is, for patients who have sudden severe abdominal pain and it lasts for a long time, many of their results are quite regrettable!" ”

If it is abdominal pain caused by nerve involvement, or abdominal pain caused by some other internal medical diseases, it is also possible that the symptoms will eventually be relieved and not reflected in the future, but if it is an acute abdomen such as abdominal infection, hollow organ perforation or hemorrhage, the prognosis will definitely not be better in the era when there are no antibiotics and abdominal surgery is backward, which John has already seen in the more than 100 cases.

"What?!"

After hearing John's words, the Millers screamed at the same time!

After seeing the Millers' reaction, John immediately understood that Mr. Wolfgang was not telling the truth to the two, or that the professor of internal medicine had not yet realized the dangers of such prolonged and severe abdominal pain......

Of course, the former is a bit more likely.

In a hurry, Mrs. Miller couldn't take care of her stern husband beside her, and stepped forward and asked anxiously, "Mr. Huntelaar, what do you mean?!" ”

Although Mr. Miller has such and such shortcomings, for a family, men are the pillars of everyone's lives, and Mrs. Miller and her three children depend on him to survive, so how can you not be anxious after hearing John's words?!

"I'm sorry, both of you."

Secretly ashamed in his heart, John's face was still calm and said: "Mrs. Miller, I am not talking about it, in fact, I have followed up nearly two hundred patients with pain in the right lower abdomen...... It was to send someone to investigate the situation after they left the hospital. In the end, nearly forty people died within six months of the onset of the disease! This is quite a staggering percentage when you consider that there are nearly 40 people who have not been able to find their addresses, and that some of them have recently become ill and continue to get sicker......

When he said this, John was also very sorry in his heart.

The communication conditions of this era were simply poor, and the records of medical records were not perfect. He couldn't find many patients at all, so the information was still a little incomplete, which was really a pity for him in his pursuit of perfection.

"Phew!"

But after hearing these words, the Millers finally couldn't help but gasp, and then their faces changed at the same time!

Two hundred people, more than thirty dead!

If you count those who have not been found and whose condition is worsening, isn't the death toll terrible?

"Mr. Huntelaar, this ...... Is this true? ”

Originally, he was still immersed in the satisfaction of smoking yapian, but at this moment, Mr. Miller's words were tinged with a trill. Obviously frightened!

"I'd like to have some good news for you, but alas, I have no reason to lie!"

Shrugging his shoulders, John said with a sympathetic face.

As a physician, it was not John's intention to intimidate his patients like this, but he knew very well in his heart that if he did not explain the consequences of Yan zhòng to the Millers, he would be diagnosed with Mr. Miller's illness later. I'm afraid this family will not be able to agree to do any surgery!

That's a worse option for them.

Although there is no physical examination yet. But judging by Mr. Miller's own description of his symptoms, it is very likely that he has appendicitis. Of course, it does not mean that acute appendicitis will definitely die, and it may become chronic, but even any ordinary person in the future may know the danger of acute appendicitis, right?

After getting John's confirmation. Mrs. Miller's legs began to tremble.

In contrast, Mr. Miller himself was even calmer, and his eyes immediately looked at the faces of the other two physicians beside him, especially Professor Bergman, who was the focus of his attention.

But it's a pity. Professor Bergman nodded silently.

If John had just made the request, Bergman would probably have categorically rejected this claim, because no one had ever counted these figures on a large scale before, and he only knew that the mortality rate of acute abdomen was relatively high. But John's arrival changed his mind, people's thoughts may not be correct, but counting jù is not deceiving, John and a few of them ran all over Berlin to collect the conclusion of the case, Bergman could not deny!

"Ahh

Seeing Professor Bergman nod, Mrs. Miller staggered and took two or three steps back.

Mr. Miller was also a little depressed, John's words and Bergman's acquiescence caused a huge blow to the man who had the strength to complain loudly when he first arrived, and he could not have imagined that it was just a stomachache, how could it become a serious illness that could kill people?

"He didn't mean to scare me, did he?"

A thought suddenly arose in his mind, and Miller immediately looked up at John.

But before Mr. Miller could question, John had already said with a smile: "Of course, we can't jump to conclusions until a final diagnosis is made, after all, there are some patients whose final results are still better...... So, Mr. Miller, the key is the next series of tests, if you don't meet some of the characteristics that we have summarized, you can go back and continue with the treatment according to Professor Wolfgang's protocol, but if the characteristics that we have summarized, I hope you will consider the possibility of surgical treatment......"

"So what are you waiting for? Let's start checking it out! ”

As soon as John's words fell, Mrs. Miller said impatiently.

After the psychological shock just now, Mrs. Miller is now full of worries about her husband's condition, and naturally wants John to start checking immediately to see if there are any "characteristics".

After a moment of silence, Mr. Miller said nothing.

"Hoo ......"

Seeing the reaction of the two, John secretly breathed a sigh of relief.

He really didn't mean to intimidate the two of them by saying this, in fact, he had appropriately underestimated the possible number of deaths. During such a long period of investigation and follow-up, John found that many people's conditions have actually reached a very serious point, and they may have developed diffuse peritoneal inflammation before coming to the hospital to see a doctor, so the mortality rate is scary!

By contrast, Mr. Miller is in a pretty good position right now.

Of course, this is also related to the family's economic conditions, although the Miller family is not rich, a test fee can make them hesitate, but after all, Mr. Miller also has a formal job, which can support the family, unlike many patients who are directly destitute, and come to the hospital to wait for death......

In this era, acute abdomen is already terrible, how can the mortality rate be low under such circumstances?

That's why John wanted the Millers to really take their illness seriously, instead of relying on any yapian to temporarily anesthetize themselves.

"Therefore...... The next physical examination is especially important! ”

Looking at Mr. Miller, who was ready, John's expression became solemn.

There was no CT, no MRI, no X-rays and the most basic blood tests, and the hospitals of this era had not even seen the first and most basic laboratories, and all diagnoses relied on a doctor's eyes, a pair of ears and two hands, which was undoubtedly an extremely heavy challenge for John, who was used to writing a bunch of orders when making diagnoses! John may have had unparalleled theoretical support compared to the physicians of his time, but the thought of the lack of instrumentation made John, a 21st-century physician, a little flustered......

For later generations of physicians, the diagnosis of instruments is their backbone.

People's subjective judgment is wrong, for example, John just "invented" the mercury sphygmomanometer not long ago, different people have different results when they measure, but the results given by the instrument are relatively objective. This is why many patients in later generations will often complain that they will be prescribed a bunch of examination lists as soon as they go to the hospital to see a doctor, and many years ago, doctors basically asked about the condition to see the tongue coating to check the pulse or something, which saved a lot of money......

In fact, it is not necessarily because of the level of the doctors, but because there are no conditions!

It is irresponsible for any physician to make a diagnosis based solely on his own medical experience, because people have subjective errors, and the results of the instrument will provide them with the necessary reference. This is also the reason why the more advanced medicine is, the more tests need to be done, because the doctors at that time were different from now, and the goals pursued were different. Of course, the most important thing is that the patients of later generations are not the same as the patients of today, and the requirements are higher I don't know how many times!

Of course, as for the fact that some physicians disregard professional ethics and over-medical treatment, it is another issue......

In summary, it does not mean that the results of the instrument do not need to be judged by the physicians themselves, after all, many diseases have the same symptoms, and the physicians need to use their professional knowledge to analyze, judge, and finally draw the best conclusion. If the symptoms are not very typical, it is difficult for doctors to make a judgment even with the help of equipment, and it is easy to make mistakes. John had similar experiences before, such as misdiagnosing urinary tract stones as acute appendicitis, and the experience was accumulated through lessons learned again and again.

"Today's inspection needs to be extra careful!"

Clenched his fist vigorously, under Bergman's expectant gaze, John nodded at Thomas first, and then turned his gaze to the direction of the patient: "Mr. Miller, the next examination is more complicated, I hope you can cooperate with me and patiently finish it......"

…… (To be continued......)

PS: To be honest, I'm a little annoyed with these chapters.

Pursue the plausibility in my mind, make the content long and boring, and then I will greatly simplify the diagnosis process and see how it works.