Chapter 368: Chapter 368: Without Equipment, Can You Still Treat Patients?
Wu Yushu was quickly admitted to bed 19 of the cardiothoracic surgery ward, and the attending physician was Zhang Wenfu, a senior attending doctor.
Tao Zi intended to use the patient as a case for a clinical teaching session for everyone.
Many students were not very familiar with constrictive pericarditis, as most cardiothoracic patients had cardiovascular diseases and valvular heart diseases. This type of chronic pericarditis, which was protracted and not cured, was relatively rare.
Therefore, Tao Zi had a thought and decided to treat it as a teaching round.
â¦
Qian Lin, along with the graduate students beside him who were curiously observing the patient, took out paper and pen and began taking notes.
Clinical teaching is about cultivating the ability to think clinically about the diagnosis and treatment of diseases.
The other doctors and students gathered behind, while Zhang Wenfu stood in front asking about the patientâs history.
Zhang Wenfu was a bit nervous!
After all, previous teaching rounds had a script, with the patientsâ conditions memorized by heart.
But this time, it was real action.
It put anyone on edge.
All the more so due to facing a patient with constrictive pericarditis, a condition rarely seen in clinical practice!
Thinking of this, Zhang Wenfu muttered to himself, âJust donât embarrass yourselfâ¦â
Behind him were all the doctors from the department and a group of students⦠and most importantly, Director Tao Zi was right behind watching everything unfold.
If anything went wrong⦠that would be a tragedy!
With this in mind, Zhang Wenfu began a detailed collection of the patientâs history.
It had to be said that Zhang Wenfu indeed was an experienced doctor, collecting patient information comprehensively, quickly obtaining some meaningful clues.
But then!
After inquiring about the medical history, Zhang Wenfu became even more anxiousâ¦
Because the symptoms seemed more like COPD! (Chronic Obstructive Pulmonary Disease).
Zhang Wenfu panicked a little. To diagnose constrictive pericarditis solely through physical examination was quite challenging and tested a clinicianâs grasp of the signs of this disease.
Could it be⦠a misdiagnosis by the emergency physician?
As this thought struck him, Zhang Wenfuâs eyes lit up. After all, such cases werenât uncommon in clinical practice, and the emergency department, being a transfer department, often saw unclear diagnoses.
But then, he personally called the director, and the diagnosis should indeed be constrictive pericarditis!
Well then, letâs proceed with the assumption of constrictive pericarditis.
He conjured up all the signs of constrictive pericarditis in his mind, set his determination, and went through the examination step by step.
He wouldnât backtrack, nor could he afford to second-guess, right?
With that thought, Zhang Wenfu picked up the stethoscope and began to listen. Upon listening, hmm, there indeed were some abnormalities in the heart sounds,
Next was the percussion of the heart, and it seemed off too, hmm, the dullness border was a bit large!
Then came the physical examinationâ¦
Until finally, Zhang Wenfu had a moment of clarity: this should indeed be a case of constrictive pericarditis!
At that moment, Zhang Wenfu couldnât help but admire the emergency department doctor.
He had some difficulty even with clear evidence of constrictive pericarditis, but how challenging must it have been for them to make the diagnosis?
With this in mind, Zhang Wenfu became curious, who was that impressive physician?
Could it be Director Li Baoshan?
Zhang Wenfu asked curiously, âDo you know what illness you had before?â
Wu Yushu shook his head, âI donât know. Just like Dr. Chen said, I might have had this chronic condition before but never paid attention to it. It wasnât until Dr. Chen diagnosed me with constrictive pericarditis that I realized it.â
Tao Zi was curious about how little Chen made the diagnosis.
Thinking of this, Tao Zi asked, âHow did the emergency department doctor diagnose you?â
Wu Yushu thought for a moment, âIn the morning, there were quite a few patients, so Dr. Chen just listened to my heart, checked my blood pressure, felt my abdomen and said that I might have constrictive pericarditis⦠It all took less than five or six minutes.â
Everyone around was stunned.
Tao Zi swallowed, what on earth was Meng Xi capable of, to allow someone to improve so quickly?
Tao Zi said, âDidnât they do an electrocardiogram?â
Wu Yushu nodded, âYeah, no, Dr. Chen told me to come up here and get a comprehensive check-up after being admitted.â
Tao Zi responded, âXiao Zhang, give the medical order to complete the relevant examinations as soon as possible, and we will continue to discuss this case tomorrow morning.â
Zhang Wenfu nodded, ordering the relevant examinations for the patient; chest X-rays, echocardiogram, abdominal ultrasound, electrocardiogram⦠as well as various physiological and biochemical tests.
â¦
â¦
The next day during the shift change, Tao Zi looked at Wu Yushuâs reports, all signs indicating that the patient indeed had constrictive pericarditis.
Tao Zi was somewhat emotional, and said to the crowd, âBed 19âs Wu Yushu has been diagnosed with constrictive pericarditis, but⦠this serves as a wake-up call for us.â
âThe emergency room doctor could make a clear diagnosis without any auxiliary examination, but ask yourselves, everyone, could you have been certain just with a physical examination and questioning?â
With that, everyone fell silent.
Zhang Wenfu also couldnât help but blush. To be honest, without prior knowledge of the constrictive pericarditis, could he have diagnosed it clearly?
It wasnât just Zhang Wenfu. The surrounding crowd also couldnât help but reflect.
Maybe they could�
Tao Zi, with a serious expression and tone, said earnestly, âAs clinical doctors, if you go to grassroots level, to rural areas, where thereâs not even an ultrasound or X-ray machine, let alone CT or MRI, and a patient comes to you, with only a blood pressure cuff and a stethoscope, can you make a judgement? Can you give the patient a relatively accurate response?â
Tao Zi even felt somewhat disappointed as he spoke.
Many doctors today had already lost the ability to think independently, reliant on equipment, dependent on tests for diagnosis. If thatâs all it took to diagnose, who couldnât be a doctor?
âIâm not saying youâre not good enough. I think every doctor, since youâre involved in clinical work, must develop yourself. Instrumental examinations are good, they can help us make clearer diagnoses, but you must not forget some basic clinical operations.â
âOtherwise, patients will laugh at us. Without instruments, can you still practice medicine?â
When Tao Zi reached the last sentence, his voice rose noticeably!
In everyoneâs minds echoed that question, lingering long after.
âWithout instruments, can you practice medicine?â
Doctor after doctor couldnât help but clench their fists, the words piercing their hearts like a needle.
The entire office was deathly quiet.
Tao Zi looked around, then suddenly said loudly, âStarting next week, we will have a small ward round once a week, starting with cardiac auscultation. I need you to remember the auscultation sounds for every type of disease!
A stethoscope can tell us a lot, these are experiences you must learn. Now take a look at yourselves, how many of you wear your stethoscope every day? Some people donât even bring a stethoscope on rounds, do you even look like a cardiologist?â
After that, Tao Zi left with a dark face, saying, âAlright, meeting dismissed!â
He walked out without paying attention to the crowd.