Every Friday, the medical record discussion is very lively, this is an opportunity to learn and show ability, as long as there is no rescue, emergency surgery or ongoing surgery, all doctors come back to participate, because there are many people, so the venue is located in the large conference room of the administrative building.

Yang Ping glanced at the venue slightly, the directors of the departments have basically arrived, some doctors have something to delay and can't be on time, and now they are rushing to the venue one after another, anyway, this kind of meeting does not punch in and attend, does not register the name, it is all up to the individual to participate independently, everyone has no pressure, very free.

Director Tan, the case of cobalt poisoning, if you haven't been diagnosed or don't spoil it in advance, it must be more exciting to take it out for everyone to discuss.

It's a pity that Director Tan took it out and explained it directly, which was less interesting than peeling off the cocoon, but it was also in line with the straightforward character of the surgeon.

If you find an internist to explain this case, you will definitely not be so straightforward, if you let some department directors talk about it, it can tell you the taste of a suspenseful blockbuster.

"Lao Tan, I watched the American drama "Dr. House", Dr. House took a lot of effort to crack this kind of case, you came to our cardiology department for consultation, it seems that the diagnosis was made in a few minutes, you are a little out of the script."

The director of the cardiology department quipped.

Director Tan said on stage: "No way, the director asked Dr. House to do that, and I didn't have the director's arrangement, so I could only play at will." ”

Unexpectedly, the two directors were quite humorous, and the doctors at the venue were amused.

Director Tan took the microphone on the stage: "In fact, it must be very difficult for other doctors to diagnose this case, and it will be very simple for us orthopedic surgeons to diagnose, not how high our level is, but that this case falls in your knowledge blind spot, but in the center of our field of vision, do you think we can diagnose?" ”

"Let's listen to it, next time we encounter this kind of case, we won't be able to think of it, so we will ask you to consult and spread the net all over the sky, anyway, if the patient has any problems, we will ask which department, and no one will be missed." The director was interested.

Director Tan also intends to talk about it, he still has feelings about this case, and now the professional knowledge of each doctor is only limited to his own specialty, once he is out of the scope of his specialty, he is blind and deaf, and he doesn't know anything.

"Let me tell you why this case is easy for orthopedic surgeons to diagnose, but difficult for other doctors to diagnose, which involves the problem of blind spots. In fact, our hospitalist general suspected cobalt poisoning at the first consultation, and then called me, hoping that I could go and have a look, and after I saw it, I asked the patient's medical history, and I felt that it was cobalt poisoning nine times out of ten. ”

Yang Ping also deeply felt that all doctors have blind spots in knowledge, and once they enter the blind spots, they are completely incapacitated.

For example, the common low back pain in orthopedics, if it belongs to the scope of orthopedics, the general orthopedic surgeon is very powerful, the diagnosis and treatment are clear, if one day a disease similar to the symptoms of lumbar disc herniation in other departments is admitted to the orthopedic department, the orthopedic surgeon checks and checks, can not jump out of their own specialty range, how can it be possible to figure out the disease outside the range.

The three-year course can play a certain role in "literacy" after graduation, but it is only when you have just graduated, and with the increase of work years, the knowledge obtained in the three-year course is basically forgotten.

Director Tan said on the stage: "This patient had a left artificial hip replacement ten years ago, and I asked about it, and it was still metal-to-metal artificial hip replacement for the large femoral head. ”

"You ask us for a consultation, we must be most concerned about this, the others are not very related to our department, we are concerned about the left artificial hip replacement surgery, we must see the latest X-ray of this area, even if it is the orthopedic surgeon who has just worked."

"With an X-ray, we can identify that this is a metal-to-metal hip prosthesis, and we can easily identify the wear and tear of the prosthesis."

"Seeing the wear and tear of the hip prosthesis, as long as the doctor usually reads a few books and papers, or goes out to attend a few academic conferences, he will definitely be able to think that the cobalt ions in the patient's blood may exceed the standard according to the wear and tear of the prosthesis."

"Next, the orthopedic surgeon will ask for heavy metal ions in the blood."

"The results of the heavy metal ion test are out, and all the truth is revealed."

Director Tan told the story, it seems that it is indeed very simple, not so complicated, it seems to be done according to the process, and everything falls into place.

"It's not difficult, is it? In fact, cobalt poisoning is a rare disease for others, and for orthopedic surgeons, especially doctors who do artificial joint replacement, cobalt poisoning is a sensitive word, which will be mentioned in monographs, papers, and academic conferences. Although Director Tan said so much, it did make sense.

"Therefore, it is very important to read books and papers frequently, so that you can update your knowledge in time and constantly expand the depth and breadth of your knowledge." Director Zhao of the medical office added at this time

Director Zhao played the role of organization and coordination at the meeting, and came out from time to time to say a few words.

"Young doctors here, the source of our knowledge is nothing more than a few sources – books, teachers or other people, our own experience."

"The concept of books is very broad, including monographs, journal articles and online knowledge carriers, any knowledge carrier can be regarded as books, so books are our main source of knowledge, and other sources are not so extensive and durable."

"Everyone must read more books, Dean Xia has proposed to establish a library of our hospital, we will build the largest hospital library in the world, order all medical journals, and also buy members of various medical e-reading platforms to create a good reading conditions for everyone."

"This fee will be sponsored by social forces and will not cost our hospital a penny."

"Soon this matter will be voted on at the staff meeting, and I hope that everyone will actively support it, and doctors who are not active in learning will fall behind, and hospitals that are not active in learning will also fall behind."

Director Zhao's words immediately aroused warm applause from all the doctors in the audience, and everyone had already heard the rumors that the hospital was going to build a large library combining tradition and the Internet, but I didn't expect it to be true, and it would be much more convenient for everyone to write papers and check literature in the future.

Since Guo Jingyao had two surgeries, he not only injected funds into Yang Ping's scientific research fund, but also attached great importance to the hospital's overseas Chinese fund, becoming the leader of the overseas Chinese fund, making the hospital's overseas Chinese fund active and quickly accumulating a large amount of funds.

He took the money and began to work drastically, improving the hardware conditions of the hospital, improving the welfare of medical care, and arranging for doctors to go abroad for training.

With the help of Robert, Takahashi and Auguste, the hospital now has a large number of doctors who are formally and systematically trained in Europe, the United States and Japan.

"Anyway, everyone will study hard and work hard in the future, and the hospital will create the best conditions for everyone." Director Zhao's speech was very encouraging.

"Director Zhao, the hospital should also take care of the matter of marrying a wife and help create the best conditions, right?" Dr. Wen from the pathology department shouted.

You're doing everything!

Director Zhao was separated by several rows of seats, and glared at Wen Ruzheng from a distance on the podium.

You write like a terrorist threat letter, and you talk about marrying a wife.

Director Zhao recalled Wen Ruzheng's love letter that caused a sensation in the hospital: What do I want to cut your heart into pieces, put it under the microscope, and take a lifetime to read.

This live terrorist threat letter, who would dare to fall in love with you.

"We also considered this, and decided to change the hospital's annual blind date meeting to twice a year, take out your courage to run naked, and I promise you to hold your son next year." Director Zhao replied angrily.

"The topic is far away, continue the discussion!" Director Zhao pulled back the topic and put down the microphone.

Director Ouyang of the Department of Orthopedics raised his hand and stood up, straightened his black and white hair and said: "I have also watched "Doctor House", about the cobalt poisoning case in it, I remember that the patient had two hip surgeries, the first surgery was a ceramic-to-ceramic prosthesis, and when the second hip replacement surgery was done, the doctor used a metal-to-metal prosthesis, but when the doctor took out the ceramic prosthesis, the ceramic fragments in the joint cavity were not completely removed, and the residual ceramic fragments became a hidden danger. Later, the surface of the metal joint is constantly worn, which eventually leads to the release of heavy metal ions in the cobalt-chromium-molybdenum alloy, resulting in cobalt poisoning. ”

"Actually, the doctor who operated on the second operation made two mistakes, he should have removed the ceramic fragments in the joint cavity, and he should not have used metal-to-metal."

"We have an empirical rule for artificial hip replacement - once ceramic, lifelong ceramic, that is, if the first artificial hip replacement surgery uses a ceramic head, then the second operation must also use a ceramic head. In this way, it is possible to avoid the fine ceramic debris left after the wear and tear of the first operation, which will cause wear and tear on the metal head of the second operation, causing heavy metal ion poisoning, Director Tan, isn't it? ”

Director Tan took over: "That's right, metal to metal prostheses are rarely used now, doctors used to like to use them, especially metal-to-metal large femoral head prostheses, Union Hospital also liked to use them for a while. ”

"Why would you use this metal-to-metal prosthesis when you know there is a risk of heavy metal poisoning?" A neurosurgeon asked.

Interlaced like a mountain, Director Fang of the Department of General Surgery raised his hand to ask questions.

"This involves the question of the advantages and disadvantages of artificial joints, and the artificial hip prostheses we currently use are ceramic-to-ceramic, ceramic-to-polyethylene, metal-to-polyethylene, metal-to-metal, and metal-to-metal are the least used."

The director of the cardiology department said: "Lao Tan, we are internists, and we don't know much about your surgery, so take this opportunity to tell us a little more about which kind of hip prosthesis is the best?"

Director Tan said: "Every hip prosthesis has its advantages and disadvantages, but from the perspective of all aspects, at present, ceramics are the best for ceramics, and metals are the least recommended for metals."

"What do you mean to what?" A newly working doctor in pediatrics asked.

"Oh, it's that our artificial joints are divided into two parts, far and near, such as the hip joint, the distal femoral head ball, and the proximal acetabular fossa, which combine into one joint."

Ceramics to ceramics, spheres are ceramic, and nests are also ceramic; Ceramic to polyethylene, the ball is ceramic, and the nest is polyethylene; metal to polyethylene, the ball is metal, and the dimple is polyethylene; Metal-to-metal, balls are metal, and dimples are metal. ”

Director Tan said as he used his hands to make the shape of the ball and the socket to help explain.

"Ceramics to ceramics, its biggest advantage is that the friction coefficient is small, so it is particularly wear-resistant, if it is broken or loosened by accident, it can be used for twenty or thirty years."

"Secondly, it does not have the negative effect of heavy metal ion release relative to the metal head."

"The disadvantage is that it is brittle, and it is more likely to shatter when hit by violence than metal."

"Metal-to-metal, now rarely used, his biggest disadvantage is that the heavy metal ions released after wear and tear are harmful to the human body, the advantage is that it is not easy to crumble, in the current medical conditions, its advantages can not cover up the biggest disadvantages, so the scope of metal-to-metal use is getting smaller and smaller."

"Metal-to-polyethylene, it's between the above two artificial prostheses, it's cheaper than ceramic-to-ceramic, and it reduces the financial burden on patients. Compared with metal-to-metal, it will wear much lighter and is not easy to release a large number of metal ions as easily as metal-to-metal. ”

The director of the Department of Cardiovascular Medicine said: "Then what you mean is that ceramics are advantages for ceramic artificial joints except for the greater risk of fragmentation."

"It can be understood in this way, but he also has a big disadvantage, that is, the cost is relatively expensive, which is the most expensive of these types." Director Tan said with a smile.

"The main reason is that medical ceramic materials are expensive and difficult to process, so ceramic artificial hip prostheses are naturally very expensive."

Director Han also joined in and said a few words.

"However, at present, our state-owned enterprises have developed a very good ceramic, called soft ceramic, which overcomes the shortcomings of ceramics that are easy to break, if used for medical treatment, both the friction coefficient is small, and it is not easy to break, which will be the best artificial hip joint."

This kind of hospital-wide discussion of cases has many benefits, allowing each doctor to learn across disciplines and make up for the blind spots in their own knowledge.

For example, if the cardiovascular physician has basic orthopedic knowledge, he will pay attention to the patient's past history of left hip replacement, and then complete an X-ray of the hip joint.

If the doctor in charge had basic knowledge of reading films, he would have been able to see significant wear and tear on the hip prosthesis on the x-ray.

If he doesn't have the basics of reading films. It doesn't matter, he can ask the orthopedic surgeon to come and have a look, and it won't take too much time to diagnose.

Yang Ping feels that even if the participants listen to this kind of meeting, they will increase their knowledge and improve some basic knowledge.