The baby in his arms was so frightened that his crying stopped instantly. Then after two or three seconds, the child's little eyes saw that there was no movement, and then started crying, and the crying became even worse.
"Sister, don't scare the child!"
Li Jingsheng could only secretly help the poor daughter-in-law.
He cannot and will not interfere with other people's family affairs.
"Mother of the child, please go to the rest area and sit down and rest for a while!"
Li Jingsheng looked at Tang Ping over the counter.
In fact, the movement here has long been noticed by the customers over there.
Everyone is watching openly or covertly.
He and Tang Ping had worked together for more than nine months. It was impossible to say that they had the same mind or intentions. They could understand each other's meaning with just one glance.
Tang Ping said hello to the two customers he was serving, and then went straight to the young mother.
After taking her to sit on a bench in the rest area, he poured her a glass of water.
After a few words of comfort, she took the milk bottle from her hand and gave it to the child's grandmother. She helped stop the child from crying, and then returned to the counter to continue selling medicine.
Li Jingsheng knew very well that the best way to help this family resolve conflicts was to cure the child's disease.
This baby has been sick for more than a month and has been treated in many hospitals but has not been cured. The parents and grandmother of the baby must be mentally and physically exhausted. Moreover, the process of seeking medical treatment is time-consuming, laborious and expensive, which is even worse for this already unharmonious family.
After the child's disease is cured, the child's grandmother and parents are happy, and the sharp conflicts will naturally be eliminated.
The idea is good, but curing this child is not easy.
He subconsciously checked the properties panel.
Now he has become dependent on him. When he encounters a difficult patient, cannot find out the cause of the disease, or his surgical skills are too weak, he will subconsciously hug the 'Buddha's feet' of the attribute panel temporarily.
And it works every time.
The prerequisite is that you need to have sufficient health points, learn the corresponding medical skills, and practice your proficiency to the entry level.
If you can't even get started, there is nothing you can do with the cheat finger of the property panel.
This child's illness must be digestive disease.
Gastrointestinal diagnosis is key.
The examination data from the two major hospitals are sufficient and can provide him with a very good diagnostic reference.
The only difference is the level of gastrointestinal diagnosis.
Gastrointestinal diagnosis is now at the proficiency level, which has reached its peak. If you want to advance further, you must first upgrade your doctor level by one level.
There are many benefits to upgrading the doctor level.
It is equivalent to the internal strength of a doctor.
It can provide a broader and thicker carrier for all medical skills.
It is the basic platform for all medical skills.
Li Jingsheng is still benefiting from the benefits of being promoted from a junior resident to a senior resident last time.
Moreover, he also found that the higher the level of doctors, the stronger their learning ability, and their comprehension and understanding of medical knowledge, especially their comprehensive cognitive ability, comprehensive diagnostic thinking and even surgical understanding, can be comprehensively improved.
Li Jingsheng has long wanted to upgrade his doctor level to the attending level.
The limelight was so great recently that he was afraid of becoming the bird that was shot in the first place, so he tried his best to reduce his sense of presence.
It was his low profile that allowed Sunshine Clinic to enjoy a peaceful and prosperous life for more than half a month.
The rent was collected, the salary owed to Tang Ping was settled, and there was still a little balance left in hand.
No more borrowing money.
Now that his clinic is becoming less popular, the attention and jealousy of his competitors should have dropped a lot.
It's time to secretly upgrade your doctor's level and medical skills, and increase your strength to another level.
After reaching the level of attending physician, the upper limit of proficiency in various medical skills can be raised to a higher level, reaching the senior attending level. By then, his medical skills should be able to be used without fear of any opponent in the Chengnan Old Street area.
Including the three "bully men" at the community health service station, they will all be surpassed by him.
By then, more patients will be able to eat it.
Nowadays, we see more than a dozen patients every day, but not every one of them can be treated.
Some risks were too great, some causes were difficult to identify, and some were not his area of expertise, so he could only push them away.
The baby's illness was recurring, but it was not fatal in a short period of time, which gave Li Jingsheng the courage to try the challenge.
If it is really cured, it will not only enhance the reputation of the clinic, but also be very beneficial to alleviating the conflicts in the family. At the same time, his diagnostic and treatment capabilities in the field of digestive diseases will also be well exercised.
For any doctor, the only shortcut to improving his medical skills is to take on difficult cases.
For example, for a medical doctor who has just participated in the regular training, if he can get a chance to suture the skin once in the operating room, it will be more useful than pulling a hook a hundred times.
The courage developed by sewing patients' skin and the practical operations under high pressure and tension will be a leap forward in the level of medical skills.
After making up his mind, Li Jingsheng subconsciously checked the attributes.
Grade: Senior resident physician 692.5/1000.
Gastroenterology proficiency 131.7/500.
HP: 541.
Whether it is level experience or medical proficiency, the improvement is very slow.
To upgrade your doctor level and gastrointestinal diagnosis proficiency at the same time, you need 677 health points.
This is far from enough.
Even if all the health points are spent in one breath, there is still 136 points left.
"We can only try to raise the level first and see how it goes. If it doesn't work, we can only advise the family to take the child to a large hospital for treatment."
Li Jingsheng actually knew very well that neither the Children's Hospital nor the People's Hospital could cure the child's disease, and the difficulty must be at the ceiling level. Even if he upgrades his doctor level and gastrointestinal diagnosis by one level, he still may not be able to diagnose it.
After all, the attending physician in a large hospital is at least the deputy director level.
They couldn't diagnose it, but Li Jingsheng, a junior doctor in the clinic, diagnosed it. Are they just doing it for a living?
Competition in large hospitals is even more intense, and doctors without real talent and knowledge will not engage in clinical work even if they are awarded associate senior or senior professional titles.
Instead, they engage in scientific research and teaching.
Otherwise, if something happens and the hospital's sign is smashed, who will be responsible?
All of the chief physicians who are qualified to sit in outpatient clinics or lead teams in inpatient departments have real abilities. And it has a very high level in at least one field.
The opportunity was rare, so Li Jingsheng hesitated briefly before spending 308 health points to upgrade the doctor level.
Level: 1000.5/2000 for junior attending physicians.
To advance to the next level, you need 1,000 experience points, which is scary.
If he were down-to-earth and worked diligently in the hospital to accumulate experience, with his mediocre medical talent, he might not be able to even think about it for more than ten years.
Now, Li Jingsheng finally understands why some attending physicians, after working for thirty or forty years, are still the attending physicians even after retirement.
It’s extremely cold at high places.
Only when you reach the attending level can you understand how difficult it is to advance to the next level.
He is now a junior attending physician. To be promoted to the next level, he should be a senior attending physician. This already requires 1000 level experience points.
After being promoted to a senior attending physician, one can then be promoted to deputy chief physician.
It is estimated that the required experience points will be a more terrifying number.
Not to mention working hard to upgrade, even if he cheated, he would have to save thousands of health points, and his knees would feel weak.
I want to kneel down!
Now that I have successfully upgraded my level to the attending level, my first feeling is that I look like garbage when I look back.
That's really what it feels like.
Not arrogant at all.
There seems to be only one level difference between the attending physician and the resident physician. The understanding and application of medical knowledge, the height and breadth of diagnostic thinking, as well as the ideas for medication, surgical ideas, and understanding of surgery are really very different.
Even in large hospitals, you can only start outpatient service, take care of interns, independently preside over some diagnosis and treatment work, etc. after you have become the chief physician.
The number of attending physicians in large hospitals is very large, and their qualifications are also very high.
For example, a medical student who has studied for eight years with a bachelor's degree, a master's degree, and a Ph.D. can work for one year after graduation and be directly promoted to attending physician.
His thesis level and theoretical level may be very high, but his clinical practice level and clinical diagnosis and treatment experience may be a little better than those of ordinary trainees.
This is not a disparagement, this is the reality.
For example, Li Jingsheng used to work in a large hospital and had reached the level of senior resident doctor based on his working years.
The actual diagnosis and treatment level is only that of junior residents.
“It’s great to be promoted to the attending level!”
The 308 health points spent are so worth it.
Only when the doctor's level was upgraded to that of attending physician did he realize how beautiful the 'scenery' of attending was.
His health points were only 233 points left.
It was no longer enough to support him in upgrading his gastrointestinal diagnostic skills.
Life points are never enough!
When your medical skills improve, you will have the opportunity to receive banners and positive reviews from patients every day, and you will even have the opportunity to rescue critically ill patients every day, then your life points will be earned at an alarming rate.
All I can do now is take it slow.
He once again took the child's medical record information and tried to diagnose.
A doctor's level is equivalent to 'skill', and various medical skills are 'tricks'.
As your skill level increases, the simplest moves will become astonishingly powerful.
In the past, the level was only at the resident level, but gastrointestinal diagnosis has reached the junior attending level, which is equivalent to a calf pulling a cart, unable to exert its full power.
It's different now. His level is the same as his medical skills, and he can already perform 100% of his gastrointestinal diagnosis at the attending level.
His diagnostic thinking also opened up.
Since the cause of the child's persistent diarrhea cannot be found, can we start with other symptoms?
For example, edema of the legs.
Li Jingsheng thinks this is a good breakthrough.
Because the People's Hospital has checked her, her liver, kidney, and heart functions are all normal.
The most common clinical cause of lower limb edema is kidney problems.
Now that it is confirmed that there is no problem with the kidneys, what causes edema in the lower limbs?
The child is pale and his weight is below standard.
Moreover, according to family members, the child not only did not grow in more than a month, but actually lost about 0.7 kilograms.
It is a full 1.4 pounds lighter, which is very scary for a baby who is only seven months old.
Because his total weight is only more than ten kilograms.
Under normal circumstances, a baby is in an absolute period of rapid growth from birth to one year old.
Many baby boys weigh only about 3 kilograms at birth and can weigh more than 10 kilograms when they are one year old.
The child's weight when admitted was 4.9 kilograms, and it is estimated to be even lighter now.
The cause of weight loss must be related to nutrition.
Persistent diarrhea in a child can lead to poor nutrient absorption, ultimately leading to malnutrition.
So is the edema in his lower limbs related to malnutrition?
Li Jingsheng found that after he was promoted to the rank of attending physician, he could integrate a lot of theoretical knowledge and conduct a systematic and in-depth analysis of the causes of disease.
This ability was not available before.
Learning knowledge and applying it are two different things.
As junior residents, they can only initially apply medical knowledge to clinical practice. At the senior resident level, you can already apply the medical knowledge you have learned in practice more flexibly.
It's even more awesome now.
You can start to use medical knowledge together to form a systematic analysis and diagnosis.
Malnutrition causes lower limb edema, and the most common cause is hypoalbuminemia.
The baby's blood routine results showed anemia and low hemoglobin.
When combined with malnutrition and gradually worsening, it is normal for lower limb edema to occur.
The doctor at the People's Hospital must have diagnosed the cause of the edema of the lower limbs.
But if you want to treat lower limb edema, you must find out the causes of anemia and hypoalbuminemia.
Considering that the baby has had diarrhea for nearly a month, has diarrhea multiple times a day, and has watery stools containing mucus, this is one of the main causes of malnutrition.
There is also the continuous reduction in the amount of food consumed by infants, which is another major cause of malnutrition.
After going around in a circle, the real cause came back to diarrhea and reduced food intake.
Li Jingsheng now finally understands why the attending doctors at Children's Hospital and People's Hospital cannot get around the strange circle of fecal examination.
Because the final diagnosis direction pointed to diarrhea.
Diarrhea in infants under six months old is not a big deal, it is a common phenomenon. But normal babies do not have mucus in their loose stools.
Moreover, this baby is already half a year old and has diarrhea up to five or six times a day. The stool is watery and contains mucus, which makes people suspicious of intestinal diseases.
Imaging examination showed that the liver, heart, and abdominal cavity were all normal.
Then we can only suspect intestinal bacterial infection, flora imbalance, enteritis, physiological imbalance, and food problems. These are the reasons.
Li Jingsheng grabbed his hair hard and racked his brains to identify the real cause of the disease.
It felt like I was back in the university classroom where I was studying medicine.
Every time the teacher talks about the symptoms of some diseases, he always wonders if he also has the disease.
At this moment, he felt that the listed causes were all possible.
It’s really a headache.
Let’s start with the simplest troubleshooting.
"May I ask what brand of milk powder you usually give your children?"
"We are eating... brand of milk powder. It is a big domestic brand, so there will definitely be no problem. Because my nephew's child also eats milk powder of this brand. We bought it as a group."
The child's grandmother replied.
Because of the large quantities, group purchases often offer discounts on prices.
The brand mentioned by the child's grandma is indeed a well-known milk powder brand in China, and the possibility of problems is very small.
Li Jingsheng ruled out food problems and began to investigate the possibility of enteritis.
It can cause diarrhea in children for such a long time, and the medication has almost no effect, which makes people have to suspect fungal enteritis first.
For example, the most common candida albicans.
It's just that the attending physician at the People's Hospital has done three stool cultures, all of which were negative.
The possibility of fungal enteritis can basically be ruled out.
Considering that infants have a long treatment cycle and long-term use of antibiotics during treatment, they are prone to oral thrush and perineal and perianal fungal infections.
However, when the baby's oral cavity was examined before, the oral mucosa wall was smooth and oral thrush was basically ruled out.
Perineal and perianal fungal infection was also ruled out after Li Jingsheng's on-site examination.
Moreover, the stool culture is negative, which can also further rule out the possibility of fungal infection.
"Is it an imbalance of intestinal flora?"
After Li Jingsheng ruled out a variety of possible causes, he thought that long-term use of broad-spectrum antibiotics in large doses in infants could easily lead to the suppression of normal intestinal flora and the proliferation of drug-resistant bacteria, leading to severe diarrhea.
In particular, Staphylococcus aureus enteritis and pseudomembranous enteritis are most likely to occur.
This suspicion was also ruled out directly because the stool culture results were negative.
The attending physician at the People's Hospital was so obsessed that he did three stool cultures on this child. It was not without reason.
That leaves only the last possibility, physiological diarrhea.
Normal physiological diarrhea usually manifests as frequent, loose stools. However, appetite, eating, and growth and development are not affected.
This baby is eating less and less, is already half a year old, and is still malnourished. Together, these factors can completely rule out the possibility of physiological diarrhea.
At this stage of diagnosis, Li Jingsheng was already in trouble.
Limited abilities and limited levels.
That is to say, his doctor level has been upgraded to the attending level, and he has proficient gastrointestinal diagnostic skills, so that he can have so many diagnostic ideas and eliminate them one by one through syndrome differentiation.
Otherwise, we couldn’t even do this step before.
With his current level, even if he were thrown into a third-level hospital like the Second Hospital, he would already be a good player.
At least you can start to stand alone in the inpatient unit.
As long as you don't encounter a particularly difficult condition, you can basically take care of the chief physician's worries.
It is definitely much more advanced than a resident doctor.
"It would be great if I could have 136 more health points."
He felt very unwilling.
There has obviously been great progress in diagnosing the cause of this child's illness. But after ruling them out one by one, the diagnosis finally ran into trouble.
If gastrointestinal diagnosis can be upgraded to another level, he believes it will be possible to diagnose the real cause.
He may appear to be a gentle person, but deep down he has a fierce temper.
If he fails to do something, he is not afraid of setbacks, but keeps trying and must do it well.
If you were an ordinary person, after opening a clinic for half a year, you would lose so much money that you couldn't even pay your employees' wages, so you would bow to reality and sell the clinic directly. Then I honestly found a hospital to work again.
If he did that, his girlfriend might not run away.
Because at that time, the two of them just quarreled a lot, and their relationship gradually became estranged and became worse than before.
Later, it seemed that his girlfriend couldn't persuade him, and by that time, she probably had a new suitor. After all, Li Jingsheng has always been picky in choosing girlfriends, and he is not interested at all if they are too low-looking.
Beautiful women never lack suitors.
After his girlfriend became dissatisfied with him, it would be easy for other men to take her away as long as they were just a little better than Li Jingsheng.
that's the truth.
Li Jingsheng was worried, where could he earn so much life points in a short time?
(End of chapter)
