In fact, in Sun Lien's view, there is still a huge difference between diagnosis and examination. At least in his eyes, it seems a bit ...... to use this set of cases to test a few new colleagues Lack of difficulty. The reason why Sun Lien made this judgment is also very simple - Professor Zhang will use this case to teach several doctors who are about to work in the comprehensive diagnosis center, which means that this patient's disease must belong to one of the "incurable diseases". His condition is by no means as simple as the medical records show, and there must be some material to dig up in it.

This directional cue is often the most important in clinical diagnosis. The status bar belongs to this kind of directional prompt - once the content of the prompt does not match the patient's symptoms, Sun Lien can react that he has stepped on the thunder. While the status bar is of course more detailed and more sensitive to indicators, it is essentially a clinically significant thing that is not very useful otherwise.

Oh yes, prompting the patient's name can be very powerful to help Sun Lien avoid the embarrassment of not being able to call the other person's name.

Several doctors exchanged glances with each other, and they all seemed to be a little surprised. However, since it is the question given by Professor Zhang Zhifu, it still has to be done.

"The patient history collection is good. When the three of them saw this medical record, the first thing they noticed was the medical history collection and description of the course of the disease, and Dr. Ma Yongfang made comments while looking at it. The course of the disease written by Sun Lien is based on the model of "the king of internal medicine writes like a god". The logic is smooth, the organization is clear, and most importantly, he tries to reflect reality rather than judge it.

This habit is more difficult to understand directly...... For example, if the same is "chest discomfort and fatigue after exercise", other doctors may directly mention "pain in the anterior chest area", while Sun Lien wrote that "I feel uncomfortable in the third to sixth ribs of the sternum, and I feel weak when I move my limbs again, and it is difficult but surmountable".

In the eyes of outsiders, this may be a small trick that Dr. Guipei is racking his brains to count words. But Sun Lien wrote like this, but it already reflects his work habits.

The same is chest pain, which may be pain in the anterior chest area due to myocardial ischemia, acute myocardial infarction, acute pericarditis, or aortic dissection, or it may be stomach pain, spontaneous pneumothorax, or pulmonary embolism, pneumonia, or even lung cancer. For the symptoms presented, the history should reflect the patient's condition at the time, rather than the first judgment and reaction of the attending physician.

An objective and accurate record of the course of the disease can not only facilitate the verification of the doctor's diagnosis, but also facilitate the examination, which is a benefit that Sun Lien did not think about.

The three doctors quickly finished reading the entire case and looked at each other, as if they wanted to exchange opinions.

"You can discuss it, you can also consult the information - check Baidu. Professor Zhang sat in his seat, carefully took a sip of warm water, and said with a smile, "There is no limit to the means, as long as you don't ask other doctors in the diagnostic center." ”

That's a very broad approach. Ma Yongfang began to look down at the test results again, while Wang Guonan and Chen Xuerong simply took out their mobile phones and began to search. Professor Zhang Zhifu was still sitting in his seat, smiling at the three young doctors in his group. Only Chen Tianyang was left silent in his seat, he looked at the list in front of him and asked, "The patient is stable now?"

"I'll answer that later. Professor Zhang Zhifu interrupted Chen Tianyang's question, "You are suspected of inducing them." ”

"I'm a surgeon, I can't do any of this. Chen Tianyang shook his head very indifferently, "I just want to know, has this person done a bridge?"

"I'll tell you later. Not answering can also be seen as one of the answers in some cases. Professor Zhang obviously had no experience with this kind of struggle, and he still didn't realize that Chen Tianyang was helping the three young doctors for advice.

Chen Tianyang handed Sun Lien a very meaningful look, and then fell silent with a wicked smile.

Although Chen Tianyang assisted, it was still a very difficult task to make a diagnosis in this situation - the information provided by Professor Zhang Zhifu did not contain the most critical information that Sun Lien asked.

"Does the patient have a family history, has he ever had Kawasaki disease?" Chen Xuerong first began to ask, as a cardiologist, he has seen many such patients. In his experience, he has not seen such patients with normal lipids but coronary artery stenosis. The most common are people with Kawasaki disease. As a disease with a self-limited course, a small number of patients with Kawasaki disease may have sequelae such as coronary artery disease. This is one of the main causes of acquired heart disease in children, especially coronary artery stenosis.

The cause of Kawasaki disease is still unknown, but if Kawasaki disease was diagnosed in childhood, it is completely understandable and explainable that Wang Ge now has coronary artery stenosis.

In addition to Kawasaki disease, family history is a risk factor for coronary artery disease. For cardiology, if a patient with normal lipids presents and only presents with coronary artery stenosis, these two relatively common factors should naturally be considered first.

The patient does not show symptoms of the immune system, or there is no such suspicion. Therefore, the first thing Chen Xuerong asked about were the two most common situations.

"The patient did not provide a family history and had no previous history of Kawasaki disease. After getting Professor Zhang's consent, Sun Lien replied.

"I don't have any ideas...... It's not like an autoimmune disease. Chen Xuerong sighed, turned his head to Wang Guonan on the side, "Brother Nan, do you have any ideas?"

"Why can't it be an autoimmune disease?" Wang Guonan's answer was a rhetorical question, "This patient is not very old and has normal blood lipids, but he has three lesions - isn't this situation exactly in line with the characteristics of vascular lesions caused by autoimmune diseases?"

"But he didn't have any other symptoms. Chen Xuerong is very confident in his diagnosis, and he argues with reason, "Autoimmune diseases with cardiovascular symptoms as the first ...... It's all too rare. ”

"He also has proteinuria and abnormal kidney function, didn't you look at the later examinations?" Wang Guonan continued to ask rhetorically, "If it is an autoimmune disease, it is easy to understand that abnormal kidney function is the first symptom, right?"

"He had an imaging before he had abnormal kidney function. And because of coronary artery stenosis, the amount of fluid given to him has not been enough. It's most likely contrast nephropathy, not some immune system disease......" Chen Xuerong argued with his colleagues, "I would like to ask you, on what basis do you think that his abnormal kidney function is a symptom of an immune system disease and not a contrast nephropathy?"

The two people were arguing louder and louder, and at this time, Dr. Ma Yongfang, who had been silent, suddenly said, "It's not contrast nephropathy." ”

It can be seen that in this improvised group, Dr. Ma Yongfang's speech carries more weight than Wang Guonan and Chen Xuerong - as soon as she spoke, the two immediately stopped arguing and turned to look at Dr. Ma.

"The first urinalysis was done forty minutes after the end of the angiogram. She picked up the report in her hand and said, "Contrast nephropathy won't be so fast." His abnormal kidney function was symptomatic, not the result of medical treatment—at least not at the time. ”

With Ma Yongfang's judgment being very accurate, Wang Guonan and Chen Xuerong quickly nodded and agreed with Ma Yongfang's judgment.

Professor Zhang Zhifu, on the other hand, sighed softly, he had been looking at his watch under the table, and it was clear that he was not very satisfied with the performance of the three doctors in his group.

They still spent more than 40 minutes discussing the condition even when it was clear that "this patient has a problem", and so far they have only narrowed it down to "the patient is likely to have an autoimmune disease". Although compared to other doctors, they are already very efficient. But...... There is still a big gap between this and Sun Lien's performance.

When Sun Lien received an "ordinary" patient with chest pain, it took less than 15 minutes to determine that Wang Ge had an immune system disorder and prescribed relevant tests to confirm his diagnosis. This time is evidenced by a checklist.

"Have you discussed the results?" Professor Zhang Zhifu waited patiently for another five minutes, and then interrupted the heated group discussion, "There are still patients waiting for treatment, what is your diagnosis?"

"Suspicion of an autoimmune disorder. Wang Guonan replied, "We suspect systemic lupus erythematosus, Wegener's granulomatosis, or lymphomatous granulomatous disease. ”

Professor Zhang Zhifu put away his "gentle and kind" smile, and then continued to ask, "Why do you continue to discuss it when it has been narrowed down to three diseases?"

"Because we haven't been sure ...... yet," Chen Xuerong was explaining, but Professor Zhang Zhifu suddenly slapped the table.

"This is a patient with three diseased coronary artery stenosis, and he is lying in a hospital bed, and he is in danger of having a heart attack at any time! You have spent forty-five minutes discussing three possible autoimmune diseases, why don't you immediately come up with tests to confirm the diagnosis? What is the point of continuing the discussion?" he angrily said to his teammates, "Which of the diagnoses and disease history records that are now available is likely to further narrow the scope of the diagnosis?"

Chen Xuerong was calmed by Professor Zhang's roar, and he subconsciously explained, "It will definitely take time for the consultation and discussion...... It's only been more than forty minutes......"

"It only took fifteen minutes for Dr. Sun to diagnose!" Professor Zhang Zhifu looked really angry, "I have long emphasized to you that the Fourth Central Hospital is a major emergency center, and most of the patients who come here for consultation are emergencies - the diagnosis must not only be accurate, but also fast!"

The three of them were silent, and of course, it would be a miracle that they could be convinced—it would not be easy to tell in forty minutes that a patient might have an autoimmune disease, and even more so to narrow down the list of suspicions to three. After all, none of these three were from rheumatology and immunology, and the closest to this field was Dr. Ma Yongfang.

"Take away all your arrogance and take a good look at what people are doing!" Professor Zhang Zhifu threw the complete examination report and medical records on the table, "Remember clearly, you are now in the front line of clinical practice in the major emergency center, not in the Affiliated Hospital of Tongde Medical College! No one will stare at your diagnosis and wait to see your jokes - only the patients who are about to die are waiting for you to save their lives! The diagnosis does not need to be 100% correct, but the treatment and accuracy must be balanced—— So many inspection methods are just to help you try and make mistakes!"