In Sun Lien's view, there is nothing special about Cao Jianguo's situation - the gastroenterologist at the Fourth Central Hospital who received him must have worked for a short time, so he made this mistake.

When treating patients, specialists tend to have a fixed belief that "the patient's disease must be the systemic disease for which I am responsible". And this fixed concept is easy to misdiagnose when encountering autoimmune diseases, or other diseases with multi-organ symptoms.

Yes, Cao Jianguo was misdiagnosed. At least Sun Lien believes that Cao Jianguo's suffering from is not simply "reflux esophagitis". He does have reflux esophagitis, which may progress to esophageal cancer. But the disease itself is not alone. It occurs on the basis of a more widespread disease that causes more organ problems – systemic sclerosis (SSc).

Cao Jianguo's manifestations of systemic sclerosis are actually very typical, and the thickening of the skin and skin fibers on the root joints are the decisive symptoms for diagnosing systemic sclerosis. In the latest guidelines for the diagnosis of systemic sclerosis, immunology experts and medical experts from various countries have jointly determined that a patient can be considered to have a score greater than nine points and be diagnosed with systemic sclerosis for this symptom alone. Keep in mind that a positive blood immunology test for systemic sclerosis reports only three points – well below the nine required for diagnosis.

If it were an experienced internist, the moment he saw Cao Jianguo's hands, he might have already decided that he had systemic sclerosis and asked a rheumatology immunologist to come for consultation. And it was obvious that the physician who received Cao Jianguo's treatment did not glance at his hands at all. Based only on the content of Cao Jianguo's self-complaint and the additional esophagoscopy results, the judgment that "this is reflux esophagitis" was reached. Famotidine was then prescribed for treatment.

And this is where people are a little helpless - Cao Jianguo does have reflux esophagitis. However, if it is only from the perspective of a specialist that the patient has and is the only one of these diseases, then misdiagnosis cannot be avoided.

One of the main causes of reflux esophagitis is the decreased anti-reflux function of the digestive tract. Stomach contents are prone to reflux and damage to the esophagus from burning. But as a doctor, you have to ask a few more whys. The attending doctor's diagnosis stopped here, without delving into why Cao Jianguo's anti-reflux function declined. And this was his last chance to make a correct diagnosis.

Muscarinic acetylcholine receptor M3 is a key receptor in the enteric nervous system that controls intestinal motility, and they are able to convert peristaltic instructions from the enteric nervous system into motor instructions for smooth muscle and sphincter muscles in the digestive system. In systemic sclerosis, the expression of M3 antibodies, which hinder the binding of this neurotransmitter, is significantly increased. As a result, the enteric nervous system cannot fully carry out the instructions for intestinal peristalsis, resulting in insufficient amplitude of movement of the sphincter and smooth muscles, insufficiency of the sphincter, and so on. This triggers gastrointestinal symptoms. With the further increase of M3 antibodies, the patient's gastrointestinal damage will continue to deepen, and smooth muscle damage, severe fibrosis, collagen deposition and other symptoms will appear immediately. These injuries and the lack of smooth muscle range of motion can lead to swallowing obstruction and endoscopic manifestations such as esophagitis and esophageal contractures.

Sun explained his point of view and called Dr. Pascal for a consultation. At the same time, Cao Jianguo, who heard that he was "misdiagnosed", was very happy. There is even some meaning of joy.

"Second uncle, what are you laughing at?" Cao Yanhua scratched his face and asked curiously.

"You're still a doctor, do you know that stomach problems are not easy to treat?" Cao Jianguo grinned, "I just heard from Dr. Xiao Sun that this is not a stomach disease, but some kind of hardening, then it will be easy to cure!

Sun Lien glanced at Cao Yanhua with a strange expression, and sure enough, as he guessed, Cao Yanhua showed a bitter and distorted expression as if he had eaten stool.

What doctors are most afraid of encountering is probably a patient like Cao Jianguo. Most of these patients do not have much medical knowledge or even biological knowledge. In this kind of patient's mind, the focus of judging his disease is mainly based on the name of the disease. What kind of "tumor", "cancer", then you can go home and lie down to prepare for the future. For other diseases, keywords are randomly selected, and then "analyzed" the keywords based on life experience, so as to come to the wrong conclusion that "this disease is easy to manage".

To put it simply, it is the habit of this patient to judge something that he or she is completely unaware of through imagination. And they will be very persistent in believing that their judgment is correct. Then, no matter what the doctors explained, they would insist, "I'm not sick, you want to scam me out of money." ”

But fortunately, Cao Jianguo is Cao Yanhua's second uncle.

My nephew won't lie to my uncle!

Taking advantage of the gap between Dr. Cao Yanhua and his uncle's biological knowledge, Sun Lien ushered in Dr. Pascal with a tired face.

"This patient may be an SSc. Sun Lien explained his judgment succinctly, then moved away from the computer and asked Dr. Pascal to sit down. "I want to hear from you. ”

Dr. Pascal glanced at the screenshot of the esophagoscope on the computer screen, and then took Cao Jianguo's hands and looked at them. "Your diagnosis is fine. ”

"That's good. Sun Lien nodded and wrote his diagnosis on the computer. Seeing that Cao Jianguo's make-up class was not over yet, he asked Dr. Pascal, "Recently...... Busy?"

Dr. Pascal smiled wryly and nodded, "I think if I can change my income from a fixed amount to a system, I will be able to buy a house in Ningyuan by this time next year." ”

Ningyuan's housing prices are not low, close to the boundary of the Fourth Central Hospital, and one square meter is almost 40,000.

Sun Lien was overjoyed when he heard this, it was a good thing that Lao Pa was willing to buy a house in Ningyuan. This shows that he has plans to take root in Ningyuan. If Lao Pa can really take root, at least he doesn't have to worry about being skinned and stuffed by Dean Song, isn't he?" He pretended to be concerned and asked, "Have you gone to see the house?"

"I don't have time to look at it. Dr. Pascal continued to smile wryly, but changed from nodding to shaking his head. "My wife has been researching recently, and she said that there is a new villa complex nearby, which is not bad. At least there's a yard for Parney and Todd to play with. ”

Americans' living habits are not quite the same as those of Chinese. For medical experts like Dr. Pascal, a house with a yard is a good place to live. As for the buildings in the residential areas of the city, they are for bachelors and people who have no children but need to work in the city.

After pondering for a while, Sun Lien asked, "Have you contacted the academy? I remember that there is a housing subsidy for the introduction of experts. ”

Dr. Pascal continued to shake his head, "The academy hasn't told me about this, so you can ask Dean Song to help me ask tomorrow, right?"

“...... All right. Sun Lien gave himself another job. However, this matter is not too difficult for him, anyway, it is Dean Song's request to keep Lao Pa, and if the housing subsidy can really be approved, it will at least mean that he has fulfilled Dean Song's request.

Sun Lien had a few words with Pascal here, and the phone on the desk had to ring every two minutes—there were dozens of experts waiting for Dr. Pascal to deal with on the rheumatology and immunology department. Dr. Pascal, bombarded by phone calls, had to hurriedly end the chat and rush back to the office to receive the patient. On the other hand, Sun Lien also reported his discovery to Zhou Jun - there was a misdiagnosis case in the Department of Gastroenterology of the Fourth Central Hospital.

"Understood. You refer the patient to the rheumatology and immunology department and admit them to the hospital. Zhou Jun pondered for a moment and made a decision. "I'll report the misdiagnosis to the medical department, and the patient's condition is not in danger, right?"

"At present, it has not been found, and his systemic sclerosis should be in the early stages. Sun Lien glanced at the top of Cao Jianguo's head again, and the status bar did not change except for the black font of "systemic sclerosis". This means that at least systemic sclerosis has not invaded other organs. At present, it only affects the digestive tract. "I continued to prescribe famotidine to control reflux esophagitis, and the immune pulse treatment was handed over to the rheumatology and immunology department. ”

"Don't talk to other doctors about misdiagnosis. Zhou Jun has no objection to Sun Lien's handling plan, and his focus is on another direction. "This kind of disease, the misdiagnosis of digestion is also understandable. And the patient didn't have any collateral damage due to the misdiagnosis, which isn't a medical negligence, and everyone knows about it—you know what I'm talking about, right?"

Internal medicine has opinions about himself, and of course Sun Lien knows about this kind of thing. And he found out a case of misdiagnosis in digestion, which is actually a big deal in the hospital's operating system. It would be necessary to suspend the doctor from his job and review his past diagnoses. The delicate relationship between the internal medicine system and Sun Lien's current situation, if this matter is not good, it will be interpreted as Sun Lien's deliberate provocation.

No one likes misdiagnosis, especially for doctors, and misdiagnosis is a nightmare. Once a misdiagnosis is identified, it means that someone is held accountable and pays the price. And the patient's life and health will be at risk as a result – no one wants to see a misdiagnosis happen.

"It's okay on my side, and I'll convey it to Dr. Cao. Sun Lien suddenly thought of an important question, "But...... Dr. Pascal just came in for a consultation and I'm worried he might ......"

"There's no going to be a problem with Dr. Pascal's side. Zhou Jun laughed twice, "It's just right, there is a meeting invitation in two days, you can bring the members of your treatment team with you." He paused and emphatically said, "It's the entire treatment group, but you can also take Xiaohu with you." The venue of the meeting was chosen in Sanya, Hainan, so you should take a trip and give yourself a vacation. ”