Chapter 422 Guide, without delay
The latter operation was performed by Wu Xiaofu.
Duodenectomy plus subtotal gastrectomy plus gastrojejunostomy.
The operation was perfect, but the patient's duodenum was severely perforated, inflammation was widespread in the body, and large-scale peritonitis had formed, with obvious inflammation.
Even after the operation, anti-inflammatory treatment was given, but the inflammation did not go away for a while. Even the wound was red and swollen, and I was afraid of infection if I changed the dressing every day.
Coupled with two operations in a short period of time, the patient's vitality was even more damaged.
There is no other way. It has reached this level and can only be continued with treatment. Corey is also very concerned about it. This treatment lasts for two months and costs more than 300,000 yuan.
Yuna has to go to the ward almost eighteen times a day.
“Things have already happened. It’s good for everyone to take a warning. I don’t want the same thing to happen again in the future, but you will always learn a lesson after learning from it.
Abdominal pain patients , including those I treat, there are a few things you must pay attention to
First, the medical history of outpatient clinics must not be fully relied on and can only be used as a reference. You must inquire about the medical history in detail and conduct a physical examination to obtain first-hand information.
After getting first-hand information, it is more important to think, especially for some veteran doctors.
Because old doctors have clinical experience, they often prejudge the patient's disease after a brief medical history.
Under such circumstances, it is too easy to miss something. ”
Speaking of this, Wu Xiaofu glanced at Yuna again.
Time flies by very quickly. At this time, Yuna is actually an old doctor. The busy work in Area F has long made Yuna grow up.
At this time, Yuna can take on most of the work in Area F, and she can be considered to be in charge.
This time with this patient, Yuna is not guilty of preconception. After you have diagnosed the patient with gallbladder stones first, unless there is sufficient diagnostic evidence to support it later, otherwise, this preconception will The diagnosis will not change no matter what.
This time Yuna did not lower her head again, and stood up directly to meet Wu Xiaofu's gaze.
"Boss, I take full responsibility for what happened this time. I will bear any punishment. I admit my mistake, and I promise that I will never make such a mistake again in the future. I promise."
Yuna's words were very firm. In fact, after two months, everyone has seen Yuna's attitude. Not only is she dedicated to this patient, but other patients are also much more cautious. Let alone a serious problem, the little one is I basically never made any mistakes.
However, in Wu Xiaofu's view, it was somewhat overkill. If Yuna continued to do this, she would be exhausted within a few years.
The effect is also remarkable. The patient did not hide it from the department, nor could he hide it. He came to the hospital with a stomachache, thinking it was just a gallbladder problem.
It’s better now, my gallbladder and gastrointestinal tract are moving all over.
Medical expenses must not be given to the hospital. In addition, patients and their families are also demanding compensation.
This is also the reason why Wu Xiaofu started with "two months, three hundred thousand". Three hundred thousand and the patient are no longer realistic. Because of the surgical accident, treatment cannot be stopped because the medical expenses are not enough.
So, the 300,000 yuan can only be paid by the department. The department pays the bill, and Wu Xiaofu and the others pay the bill.
The more than 300,000 yuan will be deducted from this month’s performance calculation, and then it can be paid to Wu Xiaofu and the others.
Undoubtedly, this month, next month, and even the next month, the performance of Wu Xiaofu and his entire department will drop significantly.
This is also one of the reasons why Wu Xiaofu held this meeting. Yuna has to bear the cost, but Wu Xiaofu can't really let her bear it, and most of the doctors in the department can't agree.
But disagreeing does not mean that you don't have ideas in your heart, so it is necessary to hold a meeting to talk things out, and then the main thing is to let them all learn a lesson.
"Then as the department director, I will bear half of the three hundred thousand, and the rest will be deducted from your performance every month until the deductions are exhausted."
"No, how can this be done? , just deduct everything from me, boss, this is my mistake , it’s because you wiped my butt that it didn’t reach the point of irreversibility, how can I still drag you into deducting money, no, this is absolutely not okay.”
Hearing Wu Xiaofu’s words, Yuna quickly waved her hands and said, "Others." People also rushed to stop it.
"Boss, we are all in the same department. It is normal for problems to arise. We may also have problems. Besides, we are a whole body. If there is a problem, we have to bear it together."
"Yes, boss, if you want to buckle, buckle it together. Let's share it together. It only lasts for a few months, and it will be over soon."
"Yes, buckle it together if you want it."
......
Everyone also spoke at this time, and it was not for the sake of face. No one was happy to have money deducted. After a month of busy work, the hard-earned money was also deducted, so I felt comfortable. Strange.
But these doctors also have a sense of collective honor in the department. Especially when the department has just been established for a few months and is booming, the sense of collective honor is even stronger.
From the time they said these words, they no longer cared about the money, and they also thought about more. As for the patient Yuna met, if they encountered it, they might not be able to perfectly avoid this thunder.
Yuna and the others don’t care this time, what should they do if similar things happen to them in the future?
Do you have to bear it yourself?
Wu Xiaofu couldn't help but smile when he looked at everyone, "Okay, as long as everyone has this childlike attitude, that's it, we all shoulder the responsibility together, we usually calculate the performance, and we will decide what the ratio is. Deductions will be made according to the proportion, and we can overcome this difficulty together.”
The deduction is not the main thing. Wu Xiaofu can use the money from the department’s public account, but this is a rare opportunity to build up the department’s sense of honor, so he cannot miss it. .
As for the deductions, they will be deducted in proportion. Those who earn more will be deducted more, and those who earn less will be deducted less. If the deduction is spread over several months, it will actually not be that obvious, and it will not affect everyone's daily needs.
Faced with everyone’s help, Yuna could only keep thanking her.
“Again, when the symptoms are not consistent with abdominal pain, you must think twice and conduct further examinations. Even if you feel something is wrong, you must not let it go.
No matter what you do beforehand It's easy to say, but it's difficult to make up for it afterwards.
When using tramadol and pethidine for pain relief, you must be careful to distinguish whether it is an effective pain relief or an ineffective pain relief. < br>
We need to know that just because patients stop complaining about pain, it does not mean that their disease is gone. On the contrary, for us, we have lost an indication for diagnosing the disease.
Then there are the conditions discovered during the operation. Once the abdominal pain is inconsistent with the preoperative abdominal pain, it will be even more challenging for the surgeon.
We have encountered many similar situations, including those who felt something was wrong after appendectomy and found out that there was a small perforation of the duodenum.
Last time, wasn’t it because the preoperative painkiller injection in the emergency department covered up the symptoms of abdominal pain? The gallbladder had been adhesions and blocked the perforation site, covering up the abdominal signs. Fortunately, we found it during the operation, otherwise it might have happened like this now. problem. Abdominal pain is easy to solve, but it is also the most difficult test for our doctors. Ordinary differential diagnosis is really full of pitfalls.
As a surgeon, we carry a heavy baggage, and we must not operate easily without clearing the specific cause of the disease.
Do not perform surgery for the sake of surgery.
Remember, after eliminating all possibilities, what remains is the truth. ”
Speaking of this, Wu Xiaofu himself frowned. The guide work must be completed as soon as possible.
After this period of hard work, Wu Xiaofu and the others not only gathered experts and professors of general surgery The guidelines for diagnosis and treatment of general surgery have been formulated, and other departments and specialties have also been mobilized
However, this is a huge project after all. Even if there are many people and strength, it cannot be completed in a short time. Two months have passed, which means that the progress of general surgery has been advanced a little faster, and everything else has been slower. .
According to Wu Xiaofu's estimation, if everything goes well, it will take another year to complete the diagnosis and treatment guidelines for general surgery.
In fact, as the formulation began, people felt that this guideline was very good. After all, the previous diagnosis and treatment guidelines were too old. There were slight adjustments every year, but they all insisted on their own opinions. Many local hospitals now The ones I use are from ten years ago.
For example, propranolol in the cardiology department is basically no longer used in major tertiary hospitals, but it is still widely used at the grassroots level, and even the textbooks have not changed.
Medicine is still mainly advocated.
To be honest, Wu Xiaofu is no exaggeration in imagining that once the new generation of treatment guidelines is completed, it will directly advance China's medical level by more than a few years.
Thinking of this, Wu Xiaofu felt that the progress should be accelerated.
In the ward.
After Wu Xiaofu finished the meeting, he took Yuna and others to the ward. After two months of treatment, the patient, Sun, had almost recovered.
The process was tortuous, but fortunately the result was still controllable. Wu Xiaofu chose to hold the meeting at this time because the patient could be discharged.
Now that issues such as cost have been decided, patients can also be given an explanation.
"Old Sun, how are you today?"
At this time, many people gathered around the patient's bed. At the beginning, the patient and two of his family members accompanied him during the operation. But as subsequent problems arose, more and more patients' family members gathered. To this day, the number of patients' family members has been mentioned as more than a dozen.
Whether it’s taking care of patients or building momentum, Wu Xiaofu and the others don’t have any objections. Now the First Affiliated Hospital has implemented a family-free ward system.
Except for seriously ill patients, family members of patients are not allowed to stay in the hospital at night. There are dedicated nurses in the ward and they will not charge more. This is all for the professional management of the hospital.
But sometimes patients insist, just like this patient. Originally, the hospital gave people a chance to talk, but now the patient's family members want to stay in the hospital, saying they don't trust the hospital and want to watch. The hospital has no choice but to let the patient's family members Leave.
It’s just that the number of family members of this patient is increasing, and Wu Xiaofu also has some headaches. He is not worried about scarcity but inequality. Other patients have had this reaction many times. Fortunately, Lao Sun can finally be discharged from the hospital.
"It's pretty good today. It doesn't hurt at all. I even went to the ground twice."
Lao Sun said quickly after hearing this, but the smile on his face didn't last long before it was replaced by a woman Rolling his eyes, Lao Sun quickly stopped talking and just gave Wu Xiaofu an embarrassed expression.
Actually, Lao Sun has never made any fuss. His only thought is to be discharged safely. This woman is the patient's sister-in-law, and she actually brought these family members here.
Now it is this sister-in-law who calls the shots in the ward.
"That's good, I'm recovering well, and I can be discharged from the hospital today."
Lao Sun was even more happy when he heard this. He thought simply, if he can be discharged from the hospital, it means he's fine. This is better than anything else. For two months, he has been tortured and scared.
It’s just that the patient’s sister-in-law squinted her eyebrows, “Discharged? What’s your explanation?”
An explanation!
This is something that the patient's family has always insisted on, and other people are right, and they should be given an explanation.
Just in time, the people from the medical department have also arrived.
"As for the explanation, Chief Chen of our Medical Department happened to be here. Just go to the Medical Department with her to talk."
After saying this, Wu Xiaofu asked Chief Chen of the Medical Department He came closer, and then came to Lao Sun, and began to explain the precautions after discharge, as well as the elements of follow-up consultation.
As for talking about the Dharma, professional matters, leave them to professionals. Doctors are there to treat diseases. These conversational matters are not what they are good at. In fact, a large part of the existence of the medical department Just to deal with this matter.
Now that the department has come to a conclusion, it is easier for the medical department to talk. The most important thing is that the patient recovers well and can be discharged. This is the basis for the discussion.
It’s easy to talk about anything good about a patient, but it’s hard to talk about anything bad about a patient.
Yuna wanted to leave her contact information for Lao Sun, but Wu Xiaofu stopped her and gave her her contact information. First, he would be personally responsible for the recovery later, and he was no longer afraid that the family members of the patients would come to Yuna later. .
Yuna feels guilty and is afraid that she will be taken advantage of. She will not be able to see a doctor with peace of mind in the future, so it is best not to have any contact with her again.
This is actually an episode in the ward. The management department is like this. How can everything go smoothly? It is impossible for Wu Xiaofu to take care of everything and check everything.
Wu Xiaofu basically doesn't do minor surgeries like Lao Sun's now, and he won't pay too much attention to it because of this incident in the future. There are too many things, and he really can't handle them.
For Wu Xiaofu and the others, this incident cannot be said to be all bad. At least after this incident, Corey should not make such mistakes easily again.
After finishing the matter of Lao Sun, Wu Xiaofu went directly to the operation, just one. After the operation, Wu Xiaofu had to go to a meeting.
This is a patient introduced by Wu Xiaofu's aunt Wu Nanqing. She is considered a related household, so Wu Xiaofu has to do it himself. The patient's condition is not actually serious, but it is quite interesting.
It is the end of the year, and all units are organizing physical examinations. This patient was also diagnosed by physical examination. After the abdominal CT revealed problems, he came to the hospital for an enhanced CT.
The outer edge of the right lobe of the liver and the lower edge of the spleen occupy space, and the branches of the bilateral renal arteries supply blood respectively. The sizes are: 8*5cm and 5.5*2.8cm. Consider: Benign neoplastic lesions, hemangiomas? Epithelioid hemangioendothelioma?
Normal CT and enhanced CT suggest benign tumors, but as long as they are stained with tumors, no matter whether they are benign or malignant, no one can rest assured.
No, I asked Wu Xiaofu to help cut it off.
(End of this chapter)