medical simulator

"Forty hours of limb salvage surgery after trauma, isn't this another extremely rare case?" Ning Xihua said in an extremely excited tone.

Although this patient has gone through twists and turns, he was able to successfully salvage his limb after so long a delay. This will lead the hand surgery department to re-understand the timing of replantation of severed limbs.

"Professor Ning, this case is a special case with many subjective conditions, so we can't make inferences like this."

"The optimal time window for limb replantation and limb salvage surgery is still determined to be within 24 hours, and it should not exceed 36 hours at the latest, otherwise the chance of futile work will be greater." Zhou Cheng replied cautiously. Ning Xihua.

I hope that Ning Xihua will not think about changing the deadline for replantation of amputated limbs so far away because of such a special case.

Some things currently recognized by the medical community are still not so easy to break. Even after you break it, someone needs to have strong surgical skills to copy it.

Concepts and cognitions that cannot be replicated by most of the peers cannot be promoted as theories.

At most, it is just bragging, and it has no universal applicability. Otherwise, it will mislead other colleagues, thinking that the real time window can be extended to that long.

As a result, cognitive errors occur, which is not the original purpose of doing academics and doing projects.

Ning Xihua said: "However, Xiao Zhou, our hospital can now cautiously extend this time window. The future time window for limb salvage will definitely be extended even further than this!"

Ning Xihua spoke very cautiously, specifying the scope to the hospital.

But Zhou Cheng still decided to pour cold water on Ning Xihua: "Professor Ning, although this is true, it still requires our hospital to be able to carry out a relatively large-scale routine."

"Currently, the technology of limb transplantation after amputation is not particularly mature. As long as it is not a surgery that can be copied by many people, it is not a mature surgery. Therefore, I still think we should not take too big a step forward."

"After all, we don't have that much time and energy." Zhou Cheng was telling the truth.

I really don't have that much time. The last time it was Chen Tingye who called for emergency, Zhou Cheng was free and could go there.

In case, I don't have time, wouldn't that be screwed up?

To make it a routine, at least one hospital, at least one-third of the people, can handle it.

Zhou Cheng's current regular route is not hand surgery, nor is he omniscient.

It is necessary to have a field and scope that belongs to one's own label, so that one can better gain a foothold in the arena of orthopedics.

That is Zhou Cheng's own trauma surgery department, Diabetic Foot.

After cultivating these two aspects to maturity, and having a reserve of talents who can routinely carry out such surgeries, Zhou Cheng will decide to develop the next subspecialty.

Surgical methods and diagnosis and treatment plans that cannot be promoted, let alone applicability.

Medicine is a science, an industry, not a person, a person is called a doctor.

Ning Xihua knew that Zhou Cheng had refused to cooperate with him on the project again in a more subtle manner, so he said, "Okay, I understand, Xiao Zhou. I will carefully consider this matter."

Zhou Cheng heard that Ning Xihua's tone was a bit lonely, but he didn't give much hope. He just hung up the phone, kept silent, and then thought about how to deal with this medical accident.

Although it is just a trip to do odd jobs, it also has certain responsibilities.

My current identity as a representative is a team of experts, a member of the Orthopedic Branch, and every word I say may affect the appraisal result of this medical accident.

Moreover, for the identification of medical malpractice, we should not simply start from our own point of view, but should objectively evaluate the average level of the local hospital and combine it with the current law to make a corresponding judgment.

This is not an easy task either.

……

Time passed, and it was Sunday again.

This morning, Zhou Cheng was not woken up by his colleagues in the orthopedics department of Chen City People's Hospital, but was woken up by Yang Yifeng's phone call.

It was still early, it was only after five o'clock, but Yang Yifeng seemed to have just had the operation, and he said in a high voice, "Zhou Cheng, you're a bitch, don't you?"

"The symptoms of this patient with polymyosteitis vera have been relieved so much?"

"Tell me, it's not cheating. How do you quantify it?"

Zhou Cheng took a deep breath and cursed angrily: "You called to tell me this? Brother, what time is it?"

"It's not until five o'clock, do you still want to sleep?"

"sleep?"

"I just stepped down. Do you think I slept or not? If I hadn't taken the time to look at the medical records written by Fang Yun, I wouldn't have had the time to make rounds. This weekend is also a wicked one. There was a series of car accidents, and it was still near the hospital. , a lot of surgery."

"It was you who was forced to be on duty, but now he ran away."

"Hey, don't play the opposite game with me, I'll ask you a question." Yang Yifeng said wittily.

Zhou Cheng sighed, secretly thinking that Yang Yifeng was too sensitive, so he asked back: "Then, with your skills, are you also using it? Why can't it be because I have good aptitude and strong understanding?"

"You ass!"

"My technology and level are all existing in reality. I have repeated other people's operations and the peak level of treatment plans. You have broken this blockade time and time again. Where did you get so much energy and data?" Yang Yifeng didn't believe in evil, and his voice was cursing, but he was very calm.

"Maybe you don't know anything about the world of geniuses. Before Einstein proved the theory of relativity, he didn't have the theory of relativity."

"Okay, let's not talk, I really need to squat for a while, I didn't sleep until after one o'clock yesterday, and I almost fell asleep." Zhou Cheng forcibly ended the topic.

But Yang Yifeng seemed to come over, and he didn't really want to ask about Kaihang.

Instead, he said: "I went to a prefecture-level city hospital with a team of experts to investigate medical accidents. The process was quite exciting, right? If you have any experience or knowledge, I will adopt a style and write it in the novel, okay?"

"The more detailed the better..."

"Paralyzed, you..." Zhou Cheng was drunk, what was it, and he was still picking up the wind.Zhou Chengcheng hung up the phone directly, then looked left and right, but did not find Yang Yifeng with a camera.

Chapter 472 People Who Affect the Height of the Structure

Zhou Cheng was really worried about Yang Yifeng, what time was it, and he was still doing this.

To be honest, this time Zhou Cheng would follow the medical association and the forensic team to Chen City to hold a hearing, which was beyond Zhou Cheng's expectation.

However, after Zhou Cheng checked some relevant documents, he realized that he had already been classified as a member of the medical malpractice appraisal expert group by the Hunan Provincial Medical Association, and these application procedures seemed to be carried out by Professor Ding Changle or Lei Feng. Professor Zhong, in order to increase his qualifications, filled in the materials.

So, Zhou Chengcheng followed.

According to Article [-] of the "Regulations on the Handling of Medical Accidents", a medical accident refers to a medical institution and its medical personnel who, in medical activities, violate medical and health management laws, administrative regulations, departmental rules, and diagnosis, treatment and nursing norms and routines, and negligently cause personal injury to patients. ACCIDENT.

Here it refers to the personal injury caused to the patient. If the negligence only increases the hospitalization expenses, the number of days in hospital, and the pain, it does not constitute a medical malpractice.

For medical malpractice, the expert group of the medical association should be invited to conduct hearings and identification of medical malpractice, which requires proper procedures.

When a medical accident is suspected, the patient should immediately seal up the medical records, related drugs, and medical equipment, whether they are paper or electronic, whether they are still in hospital or have been discharged (or died), they should be sealed as soon as possible, and the evidence should be fixed as soon as possible to avoid The hospital tampered with the medical records to cover up the mistakes in diagnosis and treatment, which made it difficult for the patient to produce evidence.

If it is the hospital and the patient, after reporting to the local health committee, the local health committee will organize the local medical association or higher-level medical association to conduct a medical malpractice appraisal report. If they are not satisfied, they can apply for a higher-level medical association. Expert group, come to another hearing and conduct identification of medical malpractice.

This time, Zhou Cheng and others came to Chen City because the patient refused to accept the medical malpractice appraisal of the local medical association——

Even if the patient dies, the medical institution only bears a slight responsibility.

In fact, there are three conditions that must be met to constitute a medical malpractice: 1. The medical institution or medical staff is at fault, that is, it violates laws, regulations, and routine diagnosis and treatment; 2. The patient has suffered personal injury; 3. The patient’s personal injury is caused by these faults of.These three conditions are indispensable.

Although the patient died, according to the appraisal opinion of the local medical association, Chenzhou No.1 Civilian Hospital had fulfilled its obligation to provide the maximum level of medical care during the patient's treatment, and the rescue failed in the end, which did not cause medical accidents. But in the spirit of humanitarianism, it was determined that the hospital had a certain responsibility.

Zhou Cheng continued to look at the patient's diagnosis and treatment process:

The patient was admitted to the hospital due to trauma, and underwent surgical treatment in the hospital. After the examination, during the operation, a large area of ​​myocardial infarction and pulmonary infarction suddenly occurred, and the patient died on the operating table at that time.

What the patient means is that they pushed people to the hospital to save lives. No matter what aspect, as long as there is a problem, the hospital is responsible and failed to fulfill its obligation to save lives.

However, the opinion of the hospital is that when the patient was admitted to the hospital, the signs of trauma were obvious, and emergency surgery must be planned as soon as possible, instead of continuing to waste time to check for hidden risks such as thrombus and thrombus dislodgement, otherwise, the patient would have to wait for the check-up. In the process of waiting and waiting, there is a great possibility of shock and death.

After trauma and during surgery, there is a certain chance of special unexpected complications such as shock, myocardial infarction, and arrhythmia. This is an inherent complication of surgery and operation, and it is not due to the medical staff's medical fault. cause.

This is naturally recorded in the medical records, and the operation records are also well written.

But in fact, after reading the corresponding emergency rescue process, Zhou Cheng discovered a problem, that is, the emergency department only called the surgery doctor to the emergency room for consultation, and then immediately pushed it to the operating room, and did not send the internal medicine doctor to the emergency room. People called over to take a look.

In fact, if you have to follow a particularly strict emergency diagnosis and treatment system, the consultation system is the core system. When encountering suspicious patients, it is best to call all relevant departments.

But the word “suspicious” is too broad. If you call each patient next to each other, it will actually waste medical resources and increase the burden on patients to a certain extent. After all, you need to pay for consultation, even if The other party came to take a look and said that there is no problem, and you have to pay for the consultation fee.

Besides, there really wasn't that much time.

However, in the operating room, there is an opportunity to make up for a consultation. If people from the relevant department come to see it and write a consultation opinion, then the hospital will not be at fault if they send related questions. risks of.

It's just that if there is no such link at present, the patient will hold on to this point.

Of course, Zhou Cheng did not think in a fixed way and decided that this was definitely the fault of the patient and had nothing to do with the hospital, because the medical records and medical history data were all written by the hospital and clinical medicine, which may be biased.

Now that I am recommended to be a member of the Medical Malpractice Appraisal Expert Group of the Hunan Provincial Medical Association, I must be objective and fair.

Because from the patient's point of view, if they all have pre-positioned support, then they really don't know how to work hard to protect their rights and interests.

According to the determination of the local medical association, in fact, it is only recognized that the hospital bears part of the responsibility, which is no problem and complies with the law and the corresponding provisions of the Huaguo Medical Association.

Moreover, another problem is that in Zhou Cheng's vision, this accident can be completely avoided. When Zhou Cheng performed amputated limb transplantation before, he had considered this situation and installed a filter in advance.

It is necessary to have such a risk awareness, but there is no guideline for such a complicated emergency surgery, and his standard diagnosis and treatment procedure——

The standard of medical malpractice identification is not based on the individual's technical level, or the top medical standards in the province and the country. If this is the case, most doctors will be laid off.

Standards are vast medical monographs, textbooks, guides, norms, authoritative documents, etc., as well as some administrative regulations, but medical knowledge is relatively flexible, and it is not as simple as black and white. One, two, three, four, different analysis angles, different conclusions.

In particular, there are many "medical disputes" clinical evidence is actually not sufficient, and the results of the auxiliary examinations that should be available are all missing, which provides a huge space for wrangling.

Therefore, on the day of the appraisal hearing tomorrow, Zhou Cheng had to think carefully about how to speak tomorrow in order to be more fair and just, and not to do such ambiguous things.

"Boom, boom, boom!" While Zhou Cheng was still thinking like this, there was a knock on the hotel door.

Zhou Cheng went to open the door, and then saw Jin Kaishi, a professor of vascular surgery at the Affiliated Hospital of Shonan University, stepping in: "Xiao Zhou, I knew you were still up."

"Professor Jin, sit inside, you haven't rested yet?" Zhou Cheng greeted Jin Kaishi to drink some mineral water while welcoming Jin Kaishi. There was really nothing else to entertain.

"I don't sleep well when I'm old, and I have something to do. I want to talk to Dr. Zhou." Jin Kaishi sat down and looked Zhou Cheng up and down.

"Professor Jin, please advise." Zhou Cheng's attitude immediately became better. He knew that Jin Kaishi must have come for tomorrow's hearing.

Although Zhou Cheng is very good at being a doctor, Zhou Cheng also has such confidence.

However, this is the first time that he is firm in medical malpractice, and his experience this time is different from that of the previous inspection team.

But you must not blame good people by mistake, and you must not express your opinion casually.

Jin Kaishi said: "Xiao Zhou, let's get rid of the surgeon first. This relationship is from our brother hospital. What we mean is that it depends on the local level of diagnosis and treatment and the upper limit of the service that can be provided."

"Based on this, it is most appropriate to make such a determination."

"Of course, Professor Jin, I think so too." Zhou Cheng nodded hastily.

"Of course, when I say that, I'm definitely not here to call you to get mixed up at the hearing, but I also know that Dr. Zhou, you have a solid foundation of medical knowledge, and you must have a lot of reserves when you quote scriptures."

"If you think about it seriously, I think there are still some problems with the consultation process this time. That's for sure."

"Even, the entire operation process may be full of loopholes in your eyes, Dr. Zhou. I don't know if you, Dr. Zhou, can break out of your own set of thinking." Jin Kaishi said slowly.

Then he stated: "I'm not a lobbyist. In fact, to be honest, although our hospital and Brother Hospital seem to be brothers, there is still quite a lot of internal competition. If there is a chance, I definitely want to be the big brother of brothers. Not being a brother to Big Brother."

"It's just that we can't do such a thing, we need to be upright."

"Of course, this is also what Dean Lei Zhong meant. I hope that you, Dr. Zhou, can separate your medical work from the current work of the expert team to a certain extent."

If Zhou Cheng were to find faults, Zhou Cheng could even find faults in Professor Jin Kaishi and Professor Lei Zhong. After all, it is impossible for anyone else to have the same perfect skills as him!

Based on this, Zhou Cheng has to jump out of his own perfect thinking, and don't compare pennies and pennies.

You can't really come here, and if Zhou Cheng is too fussy and makes this kind of thing too formative and standardized, then next time, who will dare to see patients.

A dead person must have responsibilities and shortcomings, so it is better to go wherever you like, and in the process of pushing some patients who may be saved, unnecessary damage or even death will be caused.

Lei Zhong asked Zhou Cheng to practice to increase his social experience, not to let Zhou Cheng kill this industry.

Jin Kaishi continued: "One more thing, we must pay attention to that we can be stricter when conducting internal inspections, but we must not be too strict when conducting external inspections. Otherwise, it will appear that our hospital is too ostentatious. "

When Jin Kaishi said this, Zhou Cheng wondered in his heart whether this Jin Kaishi was really arranged by the people from Chen City No. picture.

"Professor Jin, what do you mean? Should we continue to recognize the relevant medical malpractice appraisal report of the Chen City Medical Association?" Zhou Cheng asked.

"Yes and no." Jin Kaishi said.

"Because there are some problems, which are actually established problems. If the corresponding provisions are not changed, then it is correct."

"However, if the provisions are to be changed, then the general environment must change. For example, the average medical level in our country has been improved to a relatively high level before we can consider modifying some things to take care of more people."

"We can simply go back to this case..."

After talking for another half an hour, Zhou Cheng sent Professor Jin Kaishi out of the room.

Then Zhou Cheng stood at the window and looked out, the strange city, the strange scenery, the night scene of the strange place.

The arrival of Jin Kaishi made Zhou Chengcai see clearly again. As a professor at the Affiliated Hospital of Shonan University, if you have to compare pennies and pennies, the premise is to make the whole world a better place.

Otherwise, your personal thoughts and personal abilities are at most dazzling stars, although they are high above, they are far away.