In the past few years, the medical trust has long evolved, and it is no longer the stupid whirring like before, guarding the outpatient hall and pulling people at the entrances and exits like pimps. Because the news reports about medical trusts deceiving patients into small hospitals and private clinics for treatment, the money has long been deeply rooted in the hearts of the people.

Ordinary people are not fools either.

When you encounter the kind of accosting for no reason, enthusiastically introducing the 'miracle doctor', the medical trust of a cheap hospital, you will immediately be vigilant.

In order to improve the success rate, the medical trust has long learned various disguises.

It can not only evade the crackdown of hospital security, but also better deceive the trust of patients and their families.

It is unclear whether the family member asked to be transferred to another hospital or was persuaded to do so. Zhou Can will not inquire about these privacy of patients.

What he has to do now is to straighten out the patient's entire progression from the onset of the disease to the present, and what treatments have been undertaken. What are the symptoms now?

"Did I notice that he looks quite thin now, not fat before he got sick?"

"It's okay! My son must have been fatter than he is now before he got sick, he used to be close to seventy pounds, and now he is only fifty-nine pounds. ”

The family replied.

I lost eleven pounds in just over two months, which is another very bad sign.

Persistent low-grade fever also indicates that there is something wrong with the patient's body.

For example, the most common leukemia and most cancers basically appear with persistent low-grade fever.

Zhou Can once again read the patient's various examination materials from beginning to end, and formed a complete pathological mechanism in his mind.

"Little friend, uncle will give you a physical examination first, good!"

Zhou Can stood up and took Ji You to do a physical examination of the patient. When others look at a case of headaches, he wants to challenge it.

Du Leng just looked at the examination data and pushed the patient out.

Zhou Can couldn't do such a thing.

First, carefully follow the reception process, examine the patient, and improve the medical record information.

Blood pressure, heart rate is not a big problem.

The body is thin, with a low-grade fever of 37.9 degrees, and his legs can't help but tremble when he stands. It should not be caused by pain in both knee joints, but may be caused by physical weakness or even nervous system problems.

Nerves are not just narrow neurons in the brain, but all kinds of nerves around the body. Including motor nerves, pain nerves, sympathetic nerves, and so on.

"Is there pain or swelling in these areas of the neck?"

Zhou Can asked the patient while touching it.

Palpation is one of the most basic physical examination skills.

"Nope!"

The patient shook his head.

Zhou Can did not feel a lump on his neck. In a rigorous attitude of not letting go of any details, he touched one of the patient's armpits.

"Huh?"

His eyes lit up slightly.

The patient, however, was itching a little unbearable, giggling, and avoiding his hand.

"Don't move, don't move, bear with me, I feel like I've touched a lump."

Zhou Can had a serious face.

On palpation, he found that the patient had nodal masses of varying degrees in both axillas. Many people only know that the neck is rich in lymph, but they don't know that the armpits are also rich in lymph.

If you guessed correctly, the patient's bilateral axillary lymph nodes were already enlarged.

This is a new and important discovery.

3 plus urine protein, swollen lymph nodes in the armpits, weight loss of more than 10 pounds, and persistent low-grade fever...... Taken together, these symptoms are by no means powerful for ordinary diseases.

Zhou Can diagnoses diseases for patients, never according to conventional thinking to distinguish syndromes, but likes to jump out and look at problems from some special angles.

Although there is no examination data to indicate that the patient has a malignant disease, he directly labels the patient as a malignant disease patient in his heart.

It must be a serious disease such as leukemia and cancer.

Of course, this kind of thinking must not be said to the family until it is clear. Otherwise, the family thought that they were cursing their son and would definitely curse.

"Let's do a CT scan of the chest, abdomen and pelvis! Judging from his current symptoms, the situation is not optimistic. ”

Zhou Can looked at the family.

"Yes!"

The family now just wants to find out the cause of their son's illness as soon as possible and do a few more tests, and they are not rejected.

Not long after, the patient came back from the CT scan.

Zhou Can checked the results of the examination, and sure enough, he made a new major discovery.

The patient has bilateral axillary lymphadenopathy and bilateral pleural effusion.

Splenomegaly.

In fact, the patient has always had an enlarged spleen. This was the result of the first examination at the county maternity and children's hospital.

Thick bladder wall, bilateral renal pelvis, bilateral ureteral dilation effusion.

There is also a pelvic effusion and thickening of the left colon wall.

Seeing that there were so many lesions in the patient, and the lesions were serious, Zhou Can was worried that the patient's heart was also wrong. For the sake of the patient's safety, the family members took the patient to do an echocardiogram.

This test uses the special physical properties of ultrasound short waves to examine the anatomy and function of the heart and large blood vessels.

It is a non-invasive test.

It is an advanced inspection technology.

Xinxiang Women's and Children's Hospital can do these examinations, which is enough to make it clear that its foundation is very thick.

It's just that the strength of a hospital is never complete with hardware facilities. No matter which hospital, the most important thing is still talent, to put it bluntly, the level of doctors directly determines the level of diagnosis and treatment of a hospital.

Echocardiography showed an LVEF of 48% and a pulmonary artery pressure of 34 mmHg.

This pulmonary artery pressure is significantly higher than normal by 12 to 20 mmHg.

Now that everything should be checked, it is time to diagnose the specific cause and location of the lesion.

Don't look at the patient's illness now, but Zhou Can knows in his heart that there is probably only one cause. Moreover, it is a major malignant disease among chronic diseases.

Ureteral dilation, protein in the urine, and weakened heart function along with pulmonary hypertension were the first symptoms that came to his mind, and urinary tuberculosis was the first thing that popped into his mind.

Coupled with the fact that the patient has been urinating urgently and frequently, he is even more suspicious in this regard.

He took the results of the urine routine test done by the patient at the hospital and carefully examined them.

Pro 0.3g/L。

The WBC of the blood routine is only 2.2*10 to the 9th power per liter, which is obviously low. Normally, an adult's white blood cells should be 4.0*10 to the 9th power or more per liter.

EOS % 15.1%, eosinophil values were significantly higher than normal.

The data of Hb and PLT are normal.

Looking at these examination data, Zhou Can's diagnostic thinking at the moment was also like that expert from the Provincial Children's Hospital, and he entered a pit thinking.

Urinary tuberculosis?

Parasitic infections?

These two diseases were coiled around his brain.

"Doctor Zhou, may I ask what kind of disease my son has?"

The boy's father seemed to have lost some patience.

A lot of examinations have been done, and Zhou Can is so young, but the diagnosis has not come out for a long time.

The family's trust in Zhou Can is decreasing little by little.

His situation is very similar to the day when Du Leng was pointed at and scolded by his family.

"Wait a minute, our Dr. Zhou is diagnosing your son! The diagnosis of this ultra-difficult and difficult disease is very difficult, and the difficulties and medical theories that require reasoning, syndrome differentiation, and consideration are extremely complex. Please be patient and try not to interrupt Dr. Zhou's diagnostic thoughts. ”

Ji You, who was sitting next to Zhou Can, gave full play to the role of 'virtuous helper'.

explained two sentences for Zhou Can to appease the emotions of the family.

For her to stand up and explain, the effect is much better than Zhou Can himself coming forward to explain.

If Du Leng had such a caring nurse to help him, he would not have been scolded by his family.

calmed the family and had no worries, Zhou Can immersed himself in the diagnosis.

I saw him frowning, his eyes were deep, and his eyes occasionally rolled a few times, indicating that he was thinking deeply.

Diagnosing a disease is more mind-consuming than solving a problem.

In particular, the solution of such difficult cases is more consuming.

"Check the urine acid-fast stain again!"

Zhou Can thought for a long time and put forward a new application for examination for the patient.

The family was a little emotional this time.

"Haven't you checked your urine routine several times? Why do you want to check it again? ”

The family began to question the tests prescribed by the doctors, which did not bode well.

It means that if Zhou Can does not make significant progress in the next diagnosis, he will completely lose the trust and cooperation of his family. This patient's illness is basically impossible to continue to diagnose and treat.

Because it was only a diagnosis, the family had already raised doubts.

If a patient is prescribed medication or a surgical plan, the family will be even more uncooperative.

The doctor himself is paid a salary, and it will be a little uncomfortable to meet such family members. Treating one more, treating one less, it really doesn't matter to the doctor.

The end result is the removal of family members and patients.

"The test I gave your son is a urine sediment test, which is a different test from the urine routine! The causes targeted are also different. The urinalysis is just a common routine examination, which mainly checks the red blood cells, protein, glucose, nitrite, white blood cells and other indicators in the urine. Urine sediment testing is a method of examining urine sediment with a microscope after centrifugation of urine using a centrifuge. It is mainly used to diagnose diseases of the urinary system. ”

"Just now, after careful analysis and further diagnosis, I believe that your son's disease needs to be screened for urinary tuberculosis."

Zhou Can patiently explained and communicated with the family.

In communication, he has a sincere look in his eyes and a friendly and sincere attitude.

This undoubtedly increased the favorability of the family.

"I'm sorry, we misunderstood you! You give my cub this check-up, and we'll pay to do it right away. ”

The patient's mother hurriedly stepped forward to play the round.

The boy's father did not speak, but an apologetic expression appeared on his face.

Between people, when they communicate and talk with their hearts, they can feel each other's sincerity.

Zhou Can's sincerity touched the family, making them naturally ashamed of themselves and guilty.

Soon, the urine sediment results came out.

WBC 118.1/ul, epithelial cell count 72/ul, bacterial count 8317.6/ul......

Zhou Can did not give up, and gave the patient a PPD skin test, blood TB-AB, and the results were negative.

At this point, urinary tuberculosis can be basically ruled out.

What kind of disease could it be?

He couldn't help but pick up the patient's CT film again to look at it.

A tumor was found at the Provincial Children's Hospital and surgically removed.

However, this does not rule out the possibility that there are other malignancies lurking in the patient's body.

Many cancerous tumors are less than 5 mm in size and are generally difficult to detect.

In medicine, tumors with a diameter of less than 1 cm are called microtumours. The doctor's attitude towards microscopic tumors is somewhat similar to that of ants on the ground, but they don't pay much attention to it.

It's about humanity and a lot of clinical experience.

The harm of malignant tumors in the early stage is very small and controllable. Only when it is enlarged to a certain extent will it have obvious adverse effects on the body.

If the tumor is too small, it is difficult to determine whether it is benign or malignant.

A pathologic biopsy is required to confirm this.

The doctor's practice is generally to instruct the patient to have regular check-ups and pay close attention to the growth of the tumor.

Why is humanity involved?

Because the tumor does not occur in the doctor himself after all, when the tumor is still small, it is completely in line with the medical rules to observe whether it continues to worsen. But without knowing the nature of the case, it was cut.

What if the surgery turns out to be a false tumor?

Also, a pathological biopsy means that a sample is taken, which will definitely irritate the tumor.

Some tumors are inherently difficult to sample.

Having a doctor take a big risk to do this can end up being thankless. Naturally, no doctor wants to do it.

Zhou Can frowned, thinking hard.

The diagnosis has reached a deadlock.

Director Zhang finished dealing with the patient in his hand at this time, stood up and walked over.

She had been secretly paying attention to Zhou Can's side for a long time.

also knew that Zhou Can encountered an ultra-difficult and difficult illness that was kicked by Dr. Du and Director Dai.

Zhou Can dares to take responsibility, not afraid of being embarrassed if he can't be diagnosed, this kind of adventurous spirit and courage in order to treat patients is very valuable.

"Dr. Zhou, if this patient's disease is really difficult to diagnose, he can be admitted to the hospital for observation before diagnosis, maybe there will be gains! After all, this patient has been treated in the Provincial Children's Hospital for a long time, and even the experts of the Provincial Children's Hospital can't cure the disease, and the difficulty must be hellish. ”

Zhang Bihua not only has the intention of helping Zhou Can say good things, but also instructs Zhou Can not to worry when he encounters such patients.

You can be hospitalized first and solve it slowly.

Haste makes waste.

Even if it is a hospital with a cow B, it is impossible to say that the cause of all the patients can be found in the outpatient clinic.

Many difficult cases that cannot be detected are first arranged for hospitalization for observation. If you can find out, it's best, if you can't, then you can only tell the family and the patient, we did our best.

"Thank you Director Zhang for your concern, I'll try again, if I really can't find out, I'll discuss hospitalization observation with my family." Zhou Can nodded gratefully to Zhang Bihua.

He stood up and showed the inspection materials to Zhang Bihua for review.

Director Zhang came over, so he naturally helped him with the consultation.

There is no need to say anything about this kind of thing.

"At first, I thought the patient had urinary tuberculosis, but after extensive screening, it was basically ruled out. The possibility of parasitic infection is also largely ruled out. ”

Zhou Can told Director Zhang about his diagnostic ideas.

Director Zhang read all the examination materials, combined with Zhou Can's diagnostic ideas, and pointed out to Zhou Can, "The cause of this child is confusing, and it is indeed extremely difficult to diagnose. You can try to start with the two initial symptoms of vomiting and diarrhea, and let the patient be hospitalized first. ”

can sit firmly in the top position of the director of the Department of Obstetrics and Gynecology of Tuya Hospital, Zhang Bihua's diagnostic level is naturally beyond doubt.

Her words made Zhou Can's eyes light up.

That's right, they are all used to taking the sword off the rails and not diagnosing diseases according to conventional diagnostic ideas. Why do you ignore the first two symptoms?

The road to simplicity.

Martial arts masters often say that there are no tricks to win.

All the laws in the world are the same, and the truth is the same.

The medical diagnosis is the same as the cultivation of martial arts tricks. At the beginning, I drew a scoop according to the gourd, and after learning other people's moves, practicing them, and being proficient, I could start to integrate them into my own things, and I could be flexible.

In diagnosis, Zhou Can often goes off the rails and uses different diagnostic angles and ideas to diagnose cases, which is almost equivalent to the second stage in martial arts.

Once you are proficient and proficient, start incorporating something into yourself.

The result is a unique way of diagnosis and a different way of thinking.

Now, Director Zhang's words woke up the dreamer, making him feel empowered.

It's like all of a sudden there's a greater realization.

It is not the accumulation of diagnostic experience, nor the deeper understanding of a certain disease, but a major breakthrough in diagnostic thinking and methods.

This is a realm ascension.

His pathological diagnostic skills have already started the first step into the 'road to simplicity'.

[Your pathological diagnosis thinking and way have undergone a qualitative leap improvement, pathological diagnosis experience value +10000, congratulations to Ling's pathological diagnosis technique for being promoted to level 5. ] The current experience value is 1/100000 of level 5, and the junior level of deputy chief physician. 】

The last time he was rewarded with 1000 experience points, he felt that it was a historical precedent.

Because in many cases, the maximum reward for medical experience points is 100 once.

Unexpectedly, the upper limit of the reward was broken by him again.

The fundamental improvement of diagnostic thinking has directly promoted his pathological diagnosis to a higher level.

This should be an unprecedented medical advancement.

Despite his diagnostic experience, he may not have met the standard of Level 5. But the system has forcibly pushed him to level five.

This kind of epiphany is hard to come by.

It should be hard to have it again next time.

Zhou Can believes that medical skills and martial arts are really becoming more and more similar, and they have a lot in common. In ancient Chinese medicine, many of them were born from martial arts families.

Martial arts are divided into moves and mental techniques.

His diagnostic thinking has made a major breakthrough, which is somewhat similar to the comprehension of martial arts and mental methods to a new level.

After the pathological diagnosis was promoted to level five, Zhou Can found that when he rediagnosed the child's disease, he obviously had a different experience. Looking back at the patient's illness, some of the original obscurities became clear.

(End of chapter)