This ability to diagnose hidden diseases in advance by visual observation and intuition was extremely popular in ancient times. Clever Chinese medicine practitioners, almost all of them can do it.

This is called a visit.

Traditional Chinese medicine (TCM) is the four most basic methods of diagnosis, such as looking, smelling, asking, and cutting.

Visits come first.

It is the eldest of the four methods of diagnosis in traditional Chinese medicine.

By observing the patient's complexion, skin color, nails, tongue coating, body shape, etc., the most intuitive first diagnostic impression is given. The types of diseases can be roughly delineated, which is convenient for subsequent diagnosis of lesions and pathological dialectic.

Zhou Can's three-month training in the intensive care medicine department has exceeded imagination.

At first, I didn't think that it was a huge help to his medical practice, but now that he has entered other departments, he has found that the three-month study in the intensive care medicine department has been of immeasurable help to his medical practice.

Whether it is in rescuing critically ill patients, or in pathological diagnosis, encountering emergencies during surgery, etc., it can make him more confident than others.

Vice President Ye personally extended his training time in the intensive care medicine department by two months, which can be described as well-intentioned.

For example, not long ago, I followed the ward round, and the patient in the third bed, even Director Jia didn't find out that the person had cancer, but Zhou Can did.

Of course, it is only Zhou Can's preliminary diagnosis.

It can also be called speculation.

Whether the patient really has cancer needs to be further verified and verified.

It is impossible for Zhou Can to tell Director Jia directly without evidence that the patient may have cancer, right?

It was the first time for the two to deal with each other today, and Director Jia's trust in him was still very limited.

If you want Director Jia to approve his diagnosis, you must give a reliable basis for diagnosis, and it is best to point directly to the area where the lesion is located.

According to Zhou Can's experience, diagnosing this recessive disease with high difficulty is likely to be rewarded with an additional reward of 100 experience points for pathological diagnosis.

"Dr. Zhou, I guess your girlfriend must be very beautiful! It's very attractive! Qiu Hong suddenly smiled and said something confusing to Zhou Can.

"Why do you say that?"

Zhou Can asked her puzzled.

If Su Qianqian is not beautiful, I am afraid that there is no woman in this world who can use the word beautiful.

"You look like you're out of the way, I guess, you're thinking about your girlfriend, right?"

Qiu Hong quipped in a joking tone.

She was not malicious, but full of kindness.

Because when Zhou Can answered Director Jia just now, he seemed a little perfunctory. Director Jia's face was actually a little unhappy.

She has followed Director Jia for five years and knows Director Jia's temper and personality very well.

It can be regarded as deliberately helping Zhou Can explain.

also reminded Zhou Can not to desert.

"Hehe, Senior Sister Qiu is so humorous. I was not thinking about my girlfriend, I was thinking about the patient in bed 3, and I didn't feel like a simple duodenal ulcer. ”

Zhou Can is also a smart person, and he knows what's going on as soon as he hears it.

Secretly glanced at Director Jia's slightly cold face, and quickly explained the reason for his absent-mindedness.

"That patient's duodenal ulcer was really serious. They have a history of nearly 20 years, so it's easy! ”

She responded.

"No, no, no, I mean the patient may have other diseases!"

Zhou Can could only say his doubts in advance.

Director Jia can't be misunderstood that he is a person who is a fool and does not concentrate on studying.

A small thing that seems inconsequential.

However, it may lead to a great damage to his image in Director Jia's mind.

You may not be able to see through a person in your life, but one thing can really look down on a person.

"Other diseases? Liver cirrhosis and chronic superficial gastritis, Director Jia has already been diagnosed! ”

She asked, confused.

Qiu Hong just met Zhou Can, and he didn't know that he was deliberately making an excuse to explain to Director Jia the reason for the desertion just now. Or is it true that the patient is diagnosed with other diseases.

She prefers the former.

thinks that Zhou Can is just making an excuse, so as not to give Director Jia a bad impression.

After having such an idea, her perception of Zhou Can suddenly deteriorated a lot.

People who like to play clever are generally not very likeable.

"I'm talking about other diseases, like cancer!"

Zhou Can is really speechless, and he is endless.

This time, even Director Jia looked at him again.

Qiu Hong pursed her lips, and there was a hint of disdain on her pretty face. She didn't expect Director Jia's new student to be so pompous, you said that it would be okay to make an excuse, but now in order to sensationalize, she actually directly said that the patient had cancer.

Fortunately, the family members are not here, otherwise there would have been a quarrel.

"Director Jia, can I ask you for a twenty-hour leave? I'd like to go and see the patient's report. If the patient does have cancer, I am afraid that the feasibility of surgical options will need to be re-evaluated. The patient is so old that there is an extremely high risk of surgery. I see that the operation time you set for the patient is 1 p.m., and I will wait until noon to check, I am afraid that it will be too late. ”

Zhou Can explained the reason in detail.

The tone is sincere and the expression is sincere.

Qiu Hong almost didn't laugh out loud, as if it was true, it was a pity that this new doctor Zhou didn't act.

Her good impression of Zhou Can is also gone.

"Let's go!"

Director Jia readily agreed.

Zhou Can didn't talk nonsense anymore, quickly returned to the inpatient department, and went to the third bed to check the patient's examination report.

The patient had a smoking history of nearly 50 years, his father died of "typhoid fever" 20 years ago, and his mother died of a lump in his abdomen 10 years ago. Because no pathological examination was done, the nature of the mass is unknown. ”

That is, it is likely that the patient's mother also died of cancer.

The patient himself was hospitalized and had X-ray barium swallow examination, gastroscopy, blood and stool tests and other routine examinations.

In addition, an ultrasound examination of the liver was performed.

"6 intercostal spaces at the upper boundary of the liver, oblique diameter of the right lobe 13.5cm, thickness 2cm and length 1.5cm under the midcostal margin of the clavicle, thickness of the left lobe 7cm and length of 8cm, thickness of 4cm under the xiphoid process, length of 3cm, thickening and enhancement of intrahepatic light spots, echo distribution is still uniform, and the vascular line is not clear......"

Ultrasound is mainly a test of the liver.

At present, the possibility of liver cancer cannot be ruled out.

Because the liver does not have pain nerves, it is called the most silent organ.

Many liver cancer patients are diagnosed with advanced liver cancer.

Until then, there were hardly any noticeable symptoms.

Zhou Can squinted his eyes and carefully examined this B-ultrasound film.

It is undeniable that the diagnostic basis of the Western medical system is mainly based on the comprehensive dialectic of various examination results.

At this point, a wave of Chinese medicine must be blown.

Experienced TCM practitioners can quickly get a clear picture of the patient's condition by simply pressing the ruler on the patient's wrist. It is comparable to Western medicine giving a patient a full body physical examination.

Now why are people reluctant to enter the hospital, as soon as you enter, whether you are sick or not, routine examinations will go up first.

If you are going to be hospitalized, you will need to do more tests.

It's a few hundred yuan, and thousands of dollars are gone.

As a result, I waited in line for a day, and I was lucky to get the test results before the attending doctor left work.

In the past, TCM also required a consultation fee for medical treatment, but it was often very cheap.

There are many traditional Chinese medicine practitioners, who are even more noble in medical ethics, and when they encounter poor people to see a doctor, they even pay for their own medicines.

Looking at the current Western medical system, if you don't have money, you can basically wait for death.

Don't be naïve enough to think that public hospitals can pay for arrears anyway, treat first and pay later.

Those are all emergency patients.

And not all emergency patients are in arrears.

Because in case the patient and his family are in arrears, it is the medical staff of that department who is unlucky.

It is difficult to tell whether the patient has liver cancer from this ultrasound video alone.

At least at Zhou Can's current level, after reading it, I feel that the possibility of a patient getting liver cancer is very small.

If it's not liver cancer, what kind of cancer could it be?

There are too many cancers.

Liver cancer is excluded, and if there is a cancer tumor in another part, the patient will feel pain and abnormality.

Zhou Can looked at the patient's symptoms again.

Patients are then asked simple questions such as if they have pain elsewhere.

When the patient responds to the onset of the disease, there is sometimes pain in the back, which should be considered radiating pain.

At this point, liver cancer, abnormalities or severe pain in other parts of the country are basically ruled out, and only the last case remains.

The symptoms caused by this cancer site are combined with duodenal ulcers.

The gastroscopy has been checked, and gastric cancer has been basically ruled out.

At this time, Zhou Can suddenly realized, could it be that there is a problem with the gallbladder?

There are two reasons, the liver and gallbladder are originally brothers, and the liver is cirrhosis, and the gallbladder will be affected to some extent. However, there is no direct link between cirrhosis of the liver and gallbladder cancer.

The duodenum is very close to the gallbladder, which is equivalent to a cousin relationship.

If there is a problem with the gallbladder, abdominal pain will occur. Jaundice is also common.

However, patients with cirrhosis of the liver can also develop jaundice.

It is equivalent to the high degree of overlap of the symptoms very accidentally.

It is precisely this coincidence that even Director Jia, an old doctor with extremely rich experience in diagnosis and treatment, has lost his eyes.

Zhou Can carefully checked the B-ultrasound film again, and the gallbladder had good sound transmission and no abnormal reflexes.

However, because the gallbladder was not specifically illuminated, Zhou Can could not see the condition of the cyst wall and common bile duct very clearly.

The idea of having the patient do an ultrasound is tempting, but the family will be skeptical.

Moreover, Zhou Can himself did not give patients the right to apply for examinations.

You have to find Director Jia or a doctor in this matter.

"I'll take the film to Director Jia to see again, and we will give you feedback in time if there are any problems."

Zhou Can took the patient's B-ultrasound sheet to Director Jia.

Maybe with Director Jia's level, he can find the abnormalities in it.

At least for now, look at the shape of the gallbladder with a slight abnormality.

Back in the outpatient room, Director Jia had already begun to receive patients.

Although his special needs expert number is available in limited quantities, it is very famous, and there are too many people who come to see him.

In order to avoid patients waiting for a long time, or even looking for scalpers to buy high-priced numbers, he often tries to add a few more patient numbers.

In addition, he often sits in the morning and performs surgery in the afternoon, which makes his time very tight.

Zhou Can took the film, stood behind Director Jia, and patiently waited for the patient who was being treated to see the doctor, and then showed the B-ultrasound order to Director Jia.

"Director Jia, just now I went to the ward to carefully check the patient's condition, and the patients have both symptoms of jaundice and abdominal pain, and they have already been expressed. He had a visible lump on his abdomen, but he didn't say anything about it. I suspect that the patient may have gallbladder disease or even cancer. It's just that it coincides with the symptoms of duodenal ulcer and liver cirrhosis, so it was not detected. ”

Zhou Can didn't dare to say too much.

Because there is too little basis for diagnosis.

Medical diagnosis requires at least one strong diagnostic basis.

For example, B ultrasound, MRI, CT, blood routine, urine routine and so on.

In the actual diagnosis and treatment process, doctors often need to have more than two excellent diagnostic bases before they dare to give preliminary diagnostic opinions.

What is a first opinion? It's the kind that puts a question mark after the diagnosis.

"Gallbladder cancer?"

Director Jia took the B-ultrasound order and looked at it seriously twice.

Then his face became slightly solemn, and he picked up a magnifying glass and began to examine it carefully.

Qiu Hong, a young beautiful doctor standing next to her, was disdainful of what Zhou Can said about gallbladder cancer at first. Because she had a preconceived opinion, she thought that Zhou Can was still acting.

However, when she found that Director Jia's face became serious little by little, and even took a magnifying glass to carefully check the B-ultrasound order, she began to mumble in her heart.

Could it be that there is a real problem?

Isn't this trainee acting?

"The gallbladder looks like there's something wrong. Qiu Hong immediately called the B-ultrasound examination room to see if the patient's B-ultrasound film was clearer in the gallbladder. ”

In general, the results of the examination are archived.

It's not that after printing it out to the patient, the hospital doesn't have it on file.

In some large hospitals, doctors in the medical technology department may even have multiple records. The actual print to the patient may be one sheet, or it may only be a part of the better.

Qiu Hong hesitated for a moment: "Is your outpatient work suspended?" ”

"If this patient does have gallbladder cancer, that's a big deal. It's okay for outpatient patients to be postponed a little. Big deal, I don't take a break at noon, I work overtime. ”

The work of a doctor is inherently more active.

When encountering problems, the safety of the patient's life must be the top priority.

"Okay! I called right away to ask. ”

After she finished speaking, she looked up at Zhou Can.

"Doctor Zhou, inform the guide outside, don't call the number yet."

Qiu Hong's tone of voice had obviously changed, and Zhou Can could feel it.

He opened the door, explained to the nurse outside, and returned to the outpatient room.

Guides are also nurses, and their status and salary are lower than those of department nurses.

Generally, the guide takes 4K a month, and the department nurse gets at least 5K.

In terms of status, the guiding nurse is also full of sadness.

In fact, it is similar in any unit, such as the auxiliary police, and the treatment and status are also worse than the formal staff.

After Qiu Hong contacted the B-ultrasound department on the list, the other party quickly sent all the patient's B-ultrasound films.

Sure enough, there was a very clear film of the gallbladder area.

Director Jia hurriedly checked it with an excited expression as if he had obtained a treasure, and looked at it very carefully.

"There is a real problem with the gallbladder, and there is a great possibility of malignancy. You should immediately notify the treating doctor and communicate with the family to see if you can do a multi-detector spiral CT and, if necessary, an endoscopic ultrasound. The patient's surgery schedule has been cancelled for the time being. ”

Director Jia is aware of the seriousness of the problem.

The patient's condition was not very good, but now after Zhou Can's reminder, it was discovered that the patient may have gallbladder cancer.

The surgery must be cancelled first.

It must be re-evaluated.

"The treating doctor of this patient seems to be Dr. Tang, and I will tell him about it right away." Qiu Hong called on the spot to communicate, but did not mention it.

After the communication is completed, notify the outside guide to continue to call the number.

Many of these patients have taken special leave, or even traveled thousands of miles to seek treatment.

Surely their registration cannot be canceled.

If you should finish reading it, you must read it all on the same day.

This is the professional ethics and sense of responsibility that doctors should have.

After experiencing this incident, Zhou Can's status has obviously risen a lot.

Director Jia's eyes became more cordial when he looked at him.

Qiu Hong's attitude towards him has also changed subtly.

Strength is really a good thing, which can help Zhou Can quickly establish his position in the new department again and again.

At this moment, a young woman with a slightly pale face walked into the outpatient room.

The special needs expert number costs a few hundred yuan for registration, and the general patient, if it is not an incurable disease, will choose a more economical general doctor when registering this kind of number.

The woman came alone, without an escort.

"Hello Mr. Jia, I heard that you are particularly good at treating gastrointestinal diseases, and you came from other provinces to see you."

"Beauty, sit down and talk, when you get here, Director Jia will definitely help you take a good look!"

Qiu Hong comforted her gently.

The girl should look like she was twenty-four or five years old, quite young, and dressed very fashionably.

The complexion looks very bad.

"Thank you!"

After she sat down, she began to talk about her condition.

"I don't know what's going on lately, I've been having diarrhea lately, and it was even worse yesterday, I vomited when I ate, which was very uncomfortable. I had a check-up at the local hospital and said that I might have enteritis, and I was prescribed some medicine, but it didn't work. ”

She showed the checklist to Director Jia for inspection.

Basically, the patients who come to see a special needs specialist have already been examined in other hospitals, and may even be treated.

So, they basically have a common feature, they come to the clinic with the examination report of another hospital.

After Director Jia took it, he carefully looked at them one by one.

"Did you have any long-term discomfort before diarrhea?"

Freezing three feet, not a day's cold.

Some of the more serious diseases do not occur instantaneously. Rather, it slowly accumulates and eventually erupts like a volcano.

Her condition is vomiting and diarrhea, and a cold can also trigger these symptoms.

When experienced doctors diagnose and treat patients, they will check them one by one.

Rather than jumping to conclusions right up.

The more skilled the expert, the more comprehensive the consideration. So, don't question the level of the specialists.

Maybe he's just thinking a little more about you.

"I didn't have any other symptoms, but I had constipation for a long time. Maybe more than two years. I searched Baidu myself, and said that eating more vegetables and fruits could alleviate it, so I used dietary therapy. It did get some relief, but constipation persisted. ”

When she talked about constipation, she was somewhat embarrassed.

After listening to this, Director Jia nodded and carefully recorded it in the medical record book.

Zhou Can began to think about what kind of disease this female patient had?

(End of chapter)