medical simulator

Not all patients are lucky enough to meet you, and not everyone can be like you.

Keep your eyes open, because in the future, Zhou Cheng will not only become an expert group of the Hunan Provincial Medical Association, but may also become a member of the expert group of the Huaguo Medical Association when dealing with medical malpractice dispute appraisals in other top hospitals.

At that time, the more cautious you have to be, if you don't handle it properly, the impact will be even greater.

Generally, the medical accidents that involve cross-provincial medical accident appraisal and the expert team drawn from the Huaguo Medical Association are usually reported in the news, and the results of the processing will also become a reference for other similar accidents, and even a reference for modifying the French.

If such an impact is large, it may affect the diagnosis and treatment of a wider range of colleagues.

One hair will affect the whole body. At this time, how to explore and how to coordinate the overall situation are also issues that Zhou Cheng should slowly explore.

When Jin Kaishi came here, it was equivalent to passing a word to Zhou Cheng. In the future, Zhou Cheng would not only live in the three-acre land in Hunan Province, but also like the international Professor Zhang from the Department of Vascular Surgery of the Second Affiliated Hospital of Hunan University. To the country and even the world.

Therefore, this hearing of medical malpractice identification is actually only the first stop for Zhou Cheng to reach such a high level, and it is a reserve of resumes in the early stage.

Based on Zhou Cheng's previous experience and reserves, many people no longer simply regard Zhou Cheng as a simple department doctor, but really regard Zhou Cheng as a heavyweight who may have an impact on the overall situation figure.

At least that's the talent pool.

Zhou Cheng suddenly found that he seemed to have grown a little overnight, unconsciously, with a higher horizon and more things to think about.

Patients, doctors in lower-level hospitals, the direction of medical development, whether the handling of medical accidents can be more standardized, whether it will chill the hearts of medical staff, and whether it will involve the rights protection of patients and their families.

Chapter 473 Special Status

When Zhou Chengcai rushed back from Chen City after completing the medical malpractice appraisal hearing, he received another call from Ning Ling.

It is said that the Shashi Third Hospital has invited a foreign aid consultation operation. He and Li Neng from the trauma surgery department have already rushed there, and are now discussing the preoperative general consultation.

And now, neither Professor Ding Changle nor his teacher Professor Chen Tingye will be free, and Yang Yifeng is also undergoing surgery, and Lei Zhong is not convenient to attend, so I hope Zhou Cheng can go and have a look.

Zhou Cheng didn't even take a break here, he just got off the high-speed train.

"Okay, Professor Ning, I'll be right over." Although Zhou Cheng felt a little tired, he replied like this.

After hanging up the phone, An Ruo, who had finally asked for leave to pick up Zhou Cheng, frowned: "You just landed, where are you going?"

"Third Hospital, it's hard work for you to send me there."

"Professor Ding and Professor Chen Tingye are both busy. It is estimated that the patient's situation is quite troublesome."

"Professor Ding helped me a lot when I was in the Eighth Hospital." Zhou Cheng explained to An Ruo in this way, hoping that An Ruo would not blame Ding Changle for this.

That's what a job is, especially in the medical industry.

Now that they are giving themselves so many opportunities, they must want to promote their professional titles to the deputy high school in advance.

A deputy high school is an associate professor. After the associate professor, there must be countless such things.

Moreover, it was only when the Trauma Center was handed over to him at the sub-high school that it became more justifiable. All the previous preparations had to be done in place.

However, because Zhou Cheng had a counterpart support plan to a prefecture-level city hospital before, he didn't need to go to the countryside again. Considering his support resume, he could take the exam and be directly promoted now.

"Stop pouting, pouting is prone to mouth lines."

"Medicine is like this. If you make an extra trip, if you can save one more person, it's not a loss. At most, you're just a little tired." Zhou Cheng explained to An Ruo in this way.

His current work status is indeed a bit busy. After reaching a certain level, besides treating diseases and saving lives, he will have more tasks, which cannot be shirked.

"Liu Wei Wei, you workaholic." An Ruo made a face for Zhou Cheng, and then laughed cutely again.

"Aren't you also a workaholic?" Zhou Cheng replied with a grin.

After An Ruo is working now, the work tasks and on-duty tasks are much heavier than before, but she has survived.

Never complained to Zhou Cheng.

……

"Xiao Zhou, the situation is like this. One of the patients I met this time was an old woman, 82 years old, who suffered a fracture in a car accident and was admitted to the hospital. I originally planned to arrange surgery today."

"However, the results of the last preoperative examination today showed that the other party's blood coagulation function and respiratory function were not good, so the operation was temporarily suspended. We are currently discussing whether the operation is suitable and what kind of treatment method to use..."

"Of course, the fracture indication of this patient is in line with the indications for surgical treatment, and conservative treatment is ineffective. However, the patient's physical condition cannot tolerate surgery, which is a contraindication to surgery."

"Also, the patient had paralysis of the right lower limb before the operation. If the specific condition is introduced, we will go in and learn about it slowly."

Ning Ling's tone of voice was relatively honest and slightly respectful.

"Okay, Professor Ning, I hope I can help you." Zhou Cheng politely followed Ning Ling and entered the doctor's office with him.

There is no guarantee that it will be helpful.

In the doctor's office, a chair was reserved for Zhou Cheng in advance. In the middle was a square table made of two square red lacquered wooden tables, surrounded by a dozen people!There are both men and women, and Zhou Cheng doesn't know any of them.

After entering, one of them was expressing his opinion, while Zhou Cheng followed Ning Ling and sat in a corner.

Around the office, there are several nurses and a group of white coats, all of whom are quite young.

Seeing this, Zhou Cheng didn't intend to sit down, but Ning Ling took the initiative to pull Zhou Cheng's wrist, motioning him to sit down.

In front of Zhou Cheng was a case presentation about the patient.

This case presentation is quite level——

Zhou Cheng read it carefully and wrote it like this.

"The current diagnosis of the patient is considered to be Evans type III intertrochanteric fracture of the right femur, muscle paralysis of the right lower limb, coagulation dysfunction (exogenous), chronic obstructive pulmonary disease with type II respiratory failure, and mild respiratory acidosis... "

"According to the current diagnostic grade fracture classification, conservative treatment is ineffective. According to the patient's current physical condition, it is a relative contraindication to surgery. Considering the patient's right lower limb muscle dysfunction before surgery, the benefit of surgery is quite small."

"However, the patient is currently in an advanced age. Considering that conservative treatment will greatly affect the patient's quality of life and life expectancy, experts from various departments are invited to give comprehensive consideration and assist in readjusting the treatment plan..."

The case introduction can be regarded as clearly explaining the patient's current difficulties and diagnosis points.However, the more critical point is that if the patient does not undergo surgery, then lying down, it is foreseeable that the life span will not be long.

It is estimated that it will only take a few years, and if a thrombus occurs, or if the thrombus falls off, the time of death will be earlier.

And if the fracture cannot be treated, then for the elderly, it is equivalent to announcing the death line of life experience——

The speaker did not know who he was, but Zhou Cheng heard that his speech was very interesting.

"The identity of this patient is quite special, so I hope that all the directors can treat it with caution and discuss the most suitable and best treatment plan."

"The family members of the patient have high expectations for the operation and the quality of life of the patient after surgery. And because of their special status, if our decision this time cannot meet the actual situation, it will definitely be more troublesome in the future."

"Special matters..."

Zhou Cheng had heard the words "special status" five times since he came in.It can be expected that he said it at least five times.

Moreover, Zhou Cheng also noticed that Associate Professor Ning Ling, who was sitting next to him, frowned slightly every time he heard the words "special status".

Finally, after 2 minutes, the blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah blah, and then I asked Ning Ling: "Professor Ning, how do you think about the current patient's situation?"

"Director Huang, I don't think we should specifically emphasize the identity of the patient, but just treat it as a very common case." Ning Ling's first sentence was to express diss to him directly!

And Ning Ling's words did indeed make the opponent's face flicker several times.

Then he smiled awkwardly and said, "As doctors, we still have to consider the actual situation."

The opponent did not directly confront Ning Ling, but he also said something that Ning Ling could not refute.

Ning Ling roughly summed up the patient's situation: "I just listened to the opinions of the directors of the specialties and Director Huang of the medical department. I think that is what we already know about this patient."

"Currently, block patients are operated on mainly two categories: blood coagulation function and respiratory function. Among them, the problem of respiratory function suppression, Director Jiang of the Department of Respiratory Medicine also said that general anesthesia can be abandoned and spinal anesthesia can be chosen."

"In terms of coagulation function, Director Zhou of the Department of Hematology also said that the patient's coagulation factor is not the lack of key coagulation factors. This means that the patient's coagulation function is not in a state of absolute contraindication."

"After the operation, infusion of blood coagulation factors as appropriate can avoid the occurrence of postoperative massive bleeding."

"With reference to the opinions of the directors of other specialties, there are no other additional diseases that affect the operation."

"From the perspective of our specialty, the patient's current fracture situation requires surgical treatment. Director Xue of the Department of Traumatology also supports this point. This is also the Trauma Surgery Society of our Department of Orthopedics. Intertrochanteric fracture EvansIII Cognitive general knowledge in the treatment of type fractures."

"However, another doubtful point to continue the operation is that the patient has muscle dysfunction in the right lower limb before the operation, so if the patient's fracture recovers after the operation, the patient still cannot recover the activity function."

"Then the meaning of this operation is open to question."

"However, among the results of our many preoperative examinations, whether it is Director Ling of the Spine Surgery Department or Director Su of the Neurosurgery Department, they have also said that the current MRI results do not support intracranial or spinal canal. nerve damage."

"That is to say, it is not a central nerve function injury, but a peripheral nerve injury is more considered. According to the results of our preoperative examination, we also found that the patient's nerve EMG results were not obviously abnormal."

"In this way, how to characterize our diagnosis of right lower limb muscle dysfunction is also a very troublesome thing."

"Professor Li, you think so too, right?" Ning Ling handed over the initiative of the question to another professor.

Li Neng's figure is quite tall and strong, with thick eyebrows, big eyes, and a high nose bridge, which is very in line with the outside world's perception of orthopedic surgeons: "The fracture surgery of this patient is not difficult to treat."

"But if, after surgery, you still can't move normally, then the surgery is of little reference value."

"However, if no surgery is currently performed, the current examination results of the patient do not support the diagnosis of paralysis of the right lower limb, and then the muscle function recovers after the operation, but due to thrombosis, muscle atrophy, and bone atrophy due to the fracture, the operation is lost. In terms of timing and recovery timing, I would like to have additional surgery."

"Maybe based on the patient's current physical condition, there is no such opportunity."

"Therefore, the problem we have now is not the lack of coping skills, but the lack of cognition, that is, what is the reason for this patient's muscle loss before the operation, that is, before this car accident? Impaired function.”

"If there is no way to understand this point, no matter how much we think about the significance of more operations, or the prognosis of patients, it is actually not comprehensive."

"Everyone should also know that the family members of this patient are very hypocritical. Basically, if it weren't for our medical workers to ask, they would not take the initiative to inform the patient's condition."

"This seems to be a special test of our doctor's working ability, so based on this comprehensive consideration, my suggestion is not to operate." Li Neng said so.

While Li Neng was talking, Zhou Chengcheng found that Ning Ling, who was sitting next to him, was extracting the main points of Li Neng's speech.

Among them, the two keywords of cognition and skill preparation are circled.

Moreover, Ning Ling also classified cognition into the rest: "Professional cognition, diagnostic cognition, and prognosis cognition."

This classification is very interesting.

Then, after Li Neng finished speaking, Director Zhang of the medical department spoke again. He had a Chinese face and a more official tone: "Director Xue, Director Chen, I still say the same thing, this patient's diagnosis is not good enough." If there is treatment, it must be treated with caution.”

He didn't say the four words of special status, but he never left them.

Moreover, he didn't seem to dare to diss Professor Li Neng and Professor Ning Ling, so he could only take the two directors of his own hospital.

Chen Xuehua, Xue Guoqing, the two divisions are the Ward Director of Microhand Surgery and the Ward Director of Trauma Surgery.

Xue Guoqing is quite short, about one meter tall, and not fat, but he looks very shrewd: "Director Zhang, you heard it just now, our current opinion is that the problem of surgical contraindications is not a big problem .”

"It's about the diagnosis. You need to be more cautious. Well, it's getting late now. The directors of other departments and Director Zhang have worked hard. I would like to invite Director Su from the Department of Neurosurgery and Ling from the Department of Spine Surgery. The director will stay here for the time being, and we will work on the diagnosis together.”

"Director Zhang and other directors, please go back to rest first, how about we contact later?"

"This time I'm really bothering the directors." Although Xue Guoqing was small, he spoke very generously, and it was indeed getting late.

Director Zhang and others didn't speak, but the director of the Department of Respiratory Medicine said: "Director Xue, if you still have to decide on surgery, remember to tell me when the time comes, so that I can think about it with Director Zheng from the anesthesiology department." There is also a plan for postoperative respiratory management during the operation.”

Director Zheng also nodded: "When the time comes during the operation, Director Xue will indeed need to come to the operating room to take care of him."

……

After that, Director Xue, as the host, sent the other directors out of the ward together.

However, when Director Zhang of the medical department left, he still said: "Director Xue, the patient has a special status, so we must treat it with caution."

The voice was not low, Ning Ling clenched his fist slightly when he heard it, obviously wanting to hit someone, and he was tortured by this sentence for countless times!

After everyone else was gone, everyone who remained was relieved.

Spine surgery itself is an orthopedics department, and neurosurgery is half an orthopedics department, so there are quite a lot of exchanges between everyone.

Xue Guoqing went to send someone off. Chen Xuehua from the Trauma Surgery Department is actually the chief director of the Department of Orthopedics. He also shook his head slightly and said: "Professor Li, Professor Ning, this fracture patient I met this time really caused you a lot of trouble. ?”

Both Li Neng and Ning Ling came to do consultation surgery, just to do some surgical problems that cannot be done, and there is no need to spend time on such complicated patients.

Whether the operation can be performed or not is decided by the people in this hospital, and all preparations before the operation must be done.

But now they are asked to participate in the preoperative discussion.

Li Neng didn't speak, but Ning Ling said with bright eyes: "Director Chen, this kind of case is only interesting. Always perform surgery mechanically, so it must not be as interesting as this case."

"Professor Li, Director Su, and Director Ling. Now that we have invited our Dr. Zhou, we can almost sit down and think about gnawing on such a hard bone!"

"The significance of this conference is actually to allow Director Zheng of the Department of Anesthesiology to spare our department and accommodate the relative contraindications of anesthesia." Ning Ling began to take a stack of A4 papers while talking, full of fighting spirit.

Ning Ling was tall and thin, but his voice was thick and thick. With the blessing of his fighting spirit, he looked like a surgical madman.

Li Neng smiled. He looks tall and big, but his voice is relatively peaceful: "Professor Ning's interest in surgery is still deeply passed down by Professor Chen?"

Professor Chen Tingye is the director of the Department of Hand Surgery of Xiangya Hospital and currently the leader of the Hand Microsurgery Group of Xiangya Hospital.

Ning Ling smiled when he heard the words: "Professor Li, don't laugh at me. Compared with my teacher, I am still far behind."

Chapter 474 Is this TM okay?