He was obviously the one who took the lead in applying pressure, but now he was the first to run away.
A person who is shameless is invincible.
"I, I seem to have drank a little too much water!" Boss Liu from Fredo Drug Store followed closely and left, clutching his stomach.
This woman was particularly strong when she came, and now she is retreating for fear of falling behind others.
Li Jingsheng felt that this woman seemed to have a split personality.
When he scolded her to work on her brain, her eyes and expression made her want to rush forward and strangle Li Jingsheng to death.
But behind it all stopped.
Usually, women are very impulsive when angry and cannot be so rational.
Judging from her overall performance, she doesn't look like a very resourceful woman.
It felt like there was an invisible red line suppressing her.
"Oops, I was in a hurry to get out. I forgot to lock the store door. I have to go back and take a look."
Another weird reason.
Three of the seven drugstore owners left at once.
The rest were already stragglers, and no one dared to confront Li Jingsheng head-on.
Even Boss Cheng of Huimin Pharmacy just glared at Li Jingsheng fiercely, and then left with a heavy grunt.
No wonder Huimin Pharmacy has the worst business among the seven pharmacies.
Boss Cheng is thirty-seven or eighteen years old, but he is so impulsive in doing things. He is far inferior to Fatty Zhang.
In such a mixed place, those who can really live well must learn from people like Boss Zhao of Kuaikang Clinic and Fatty Zhang of Baixing Pharmacy.
To save face or suffer the consequences.
Boss Cheng knew clearly that he had become the leader among the seven, and was being used as cannon fodder. Before leaving, he did not seize the last chance to repair the relationship, but treated Li Jingsheng badly for the sake of worthless face.
This behavior is so stupid.
Li Jingsheng's face remained calm as he watched the seven drugstore owners come in a fierce manner, not fighting for two rounds, and finally leaving in disgrace.
In the confrontation just now, he could feel that he had really grown a lot and become a lot stronger.
When facing the attacks and coercion of these people, not only with ease, but at least with calmness and calmness, he could deal with it calmly.
If it had been a few months ago, so many bosses would have come to put pressure on him, he would have been extremely frightened.
"It's okay, let's go home from get off work!"
Li Jingsheng did not say any polite words such as gratitude or thank you, but looked at the three employees with extremely soft eyes.
Friendship is an extremely precious thing.
Li Jingsheng will develop even better in the future, and he will definitely not forget the friendship between the three of them.
"The boss was so handsome just now!"
Han Siying couldn't help but smile when she saw the dark clouds dispersing in the sky. When he looked at Li Jingsheng, his eyes were shining with starlight, which was the light of admiration.
"This isn't called handsome, it's called mighty!"
The adjectives for Xiao Gao are also not good enough.
"I think it's more appropriate to call them majestic! When the boss confronted them just now, he was really like an emperor in the TV series. He was full of momentum and unfathomable."
After Tang Ping finished speaking, she covered her mouth and smiled again.
"Or there's nothing wrong with being manly!"
"Are you guys praising me or hurting me? Get off work as soon as possible!"
Li Jingsheng was so praised by them that he really couldn't laugh or cry.
It is true that through this 'battle', his image in the minds of the three employees has become much taller and more powerful.
…
The next day, Li Jingsheng opened for business as usual.
People buying medicine and seeing doctors flocked in just like a morning market.
"Don't worry, everyone, line up. Those who want to see a doctor line up in front of the clinic over there, and those who want to buy medicine line up here at the counter."
Li Jingsheng sighed inwardly, looking at this situation, he might not be able to have breakfast again today.
However, he was very happy to see so many customers and patients as soon as he opened the door. It was another busy and fulfilling day.
Gone are the days when we saw less than one patient a day.
"Boss, I feel a lot of pain in my chest and it's very difficult to breathe."
A man in his forties took the first seat at the consultation table.
He seemed to know Li Jingsheng.
In fact, after experiencing several 'big events', Li Jingsheng has become somewhat famous in the south of the city.
Being on TV has made many people in Lijiang City know Dr. Li from Sunshine Clinic.
"Please sit down, I'll give them their number plates first."
Li Jingsheng took out the number box from under the consultation table and issued number tags to eight patients. Then he sat back at the consultation table and began to diagnose the patients.
This box was made by Han Siying using a box filled with medicine.
It is divided into 12 grids, and 10 number plates are placed in each grid.
There are numbers written on the partitions of each grid, 1-10, 11-20...
The girl's delicate mind and ingenuity are reflected in this simple cardboard box.
She even drew a red cross on the front of the carton and wrote the Sunshine Clinic number and some silk embroidery characters.
"Where does the chest hurt?"
Li Jingsheng asked the first male patient.
"That's it!"
The man was actually pointing to the left chest.
The left lung and heart are on the left side of the chest.
Li Jingsheng's expression became much more serious.
"I'll take your temperature first!"
The ear temperature is 38.5 degrees and the forehead temperature is 38.4 degrees.
There are obvious fever symptoms.
"When did you start feeling sick?"
"Yesterday at noon! I felt a little uncomfortable when I had lunch. After eating and taking a nap, I felt a little feverish and my chest was tight. I took a pack of Wujisan at night. When I got up this morning, I felt that it was very difficult to breathe. It felt like someone had covered my nose. My wife scolded me to find a doctor quickly. I thought I might have caught a cold and it was not a big problem."
The man described how he got sick.
Wuji San is a relatively common Chinese medicine prescription that has the effects of relieving surface temperature and internal heat, dispersing cold and dampness, regulating qi and activating blood circulation, and resolving phlegm and eliminating accumulation.
Many older people choose to take it to treat cold diseases after catching a cold.
The effect is not bad.
In addition, it is a traditional Chinese medicine prescription with few side effects and does not require much attention to your physical constitution.
"Come, let me listen to your heart and lung sounds. Try to relax and breathe normally."
Li Jingsheng motioned to the man to unbutton his shirt, expose his chest, and then pressed the probe of the stethoscope up.
The lung sounds were clear, but a little thick, and no wet or dry rales were heard.
But pericardial friction rub was heard.
Listening carefully, the pericardial friction sound is a scratchy rough sound, which is a triphasic friction sound.
The area...seems to be in the precordial area.
The patient began to cough at this time and instinctively leaned forward.
Li Jingsheng heard it more clearly this time.
When the patient finished coughing, Li Jingsheng tried to percuss the patient's heart and heard a dull sound.
And it increases to both sides.
Proficient cardiovascular medicine diagnosis immediately made him realize that the patient did not have a cold, but had a pericardial problem.
During heart percussion, he always felt that his auscultation level and diagnostic ability were still a little behind, and some key details were not grasped.
"If it's not a cold, what disease is it?"
Li Jingsheng felt that it was necessary to use the grandpa-level X-ray testing equipment for auxiliary diagnosis.
Now it is basically certain that the patient's lesion is in the pericardium.
He dared not treat most serious heart diseases.
You should try something with a smaller risk factor.
After all, now we have the efficacy and pharmacokinetics of medicines at the junior level, and the diagnosis of cardiovascular medicine at the proficiency level. We must apply what we have learned and exert their effectiveness.
The more you use medical skills, the more you become familiar with them, and the more you use them, the better you become.
After a brief communication, the patient agreed to have an X-ray examination.
To be honest, checking the heart with that grandpa-level X-ray testing equipment is not an ordinary task. It is best to have high-quality X-ray testing equipment to check the pericardium and lungs.
Naturally, he doesn't want to lose a piece of business easily.
After a lot of effort, the boss finally found out something.
X-ray chest X-ray showed that the heart shadow increased to both sides and the apical pulse was significantly weakened.
After checking this step, he could basically determine that the patient had pericarditis.
"Do you have any symptoms of chills?"
"Does it mean you're afraid of the cold?" the patient asked puzzledly.
"right."
"I don't think so. I just have a fever all over my body, my head is a little dizzy, and I don't have any strength."
"Your disease is probably caused by inflammation of the pericardium. Judging from the time of onset, it should be acute pericarditis. I suggest you go to a large hospital to see it, which is safer."
After Li Jingsheng found out that the patient had pericarditis, he was unable to confirm the type of pericarditis due to limited conditions.
If possible, an echocardiogram, electrocardiogram, blood routine, or even pericardial puncture biopsy can be done to accurately determine what type of pericarditis it is.
Then prescribe the right medicine.
"Can you treat it here? I know the medical skills here are very good. If you can treat it, give it to me. I can trust you."
A forty-year-old man is really not afraid of death.
In order to save some medical expenses, choose to be treated in a small clinic.
Of course, this is also related to the good reputation of Sunshine Clinic.
"Well... okay, I'll give you some medicine to try. If the effect is not obvious after taking it today, you don't need to come again and go to the hospital for treatment."
Li Jingsheng thought for a moment and then agreed.
I dare to agree because I am certain.
There are many types of pericarditis, with idiopathic pericarditis being the most common.
Tuberculous pericarditis is usually caused by direct spread of mediastinal lymph node tuberculosis, pulmonary, or pleural tuberculosis.
Clinically, there are systemic reactions and pericardial effusion of tuberculosis.
This disease generally does not have precordial pain and pericardial rub.
Therefore, tuberculous pericarditis can be ruled out directly.
The remaining neoplastic pericarditis generally progresses slowly and the fever symptoms are often long-term low-grade fever, which can also be ruled out.
There is also purulent pericarditis, which is most common with pneumonia, empyema, and sepsis. The pericardial exudate is mostly purulent. The course of the disease is long, and the onset is rarely so acute.
Finally, there is a syndrome caused by heart damage.
This often occurs in patients with high-fall injuries, post-surgery, and acute myocardial infarction, and can be ruled out directly.
The last thing that remains is viral pericarditis.
Caused by viral or bacterial infection.
The onset is more acute and progresses rapidly.
It is highly consistent with many of the symptoms of this patient.
The patient now only has difficulty breathing, and his heart rate and pulse are fine. It should be an early stage or mild disease, and Li Jingsheng is confident that it can be cured.
That’s why I agreed immediately.
The patient was prescribed ibuprofen extended-release capsules.
Fenbid mainly relieves pain, reduces inflammation and reduces fever.
I was originally going to prescribe ribavirin, which is very effective in the early treatment of viral pericarditis.
Ganciclovir has the same therapeutic effect.
After comprehensive consideration, Li Jingsheng chose the most commonly used ibuprofen sustained-release capsules.
"Is it enough to just prescribe one medicine?"
The patient asked in disbelief.
"It's three parts of the medicine that are poisonous, not too much. You can take the medicine home now, take it according to the dosage, and then have a good rest. I believe it will have a good therapeutic effect."
Li Jingsheng said confidently.
Medicine is more valuable than more.
Really smart doctors choose to use less medicine and use more medicine.
This good medicine does not refer to expensive medicine, but precise and symptomatic medicine.
"Well, I'll try it when I go home. If nothing else, your approach of not taking advantage of the opportunity to sell more medicine is much different from other clinics and pharmacies. If the treatment is effective, I will definitely help you die in the future. You do the propaganda. We need really good doctors with high standards and medical ethics here."
The man bought the medicine and left with satisfaction.
A total of 30 yuan.
Including the money for filming, it’s 130 yuan.
If you go to a big hospital, it will cost you at least 1,500 yuan to go up, and the queue time will probably last most of the day.
After the electrocardiogram, an echocardiogram will be done, and a pericardiocentesis will probably be performed, and then the specimen will be sent for examination. The laboratory will conduct bacteriological, biochemical, cell classification and other examinations on the extracted fluid.
After all the tests are done, the results will probably be available the next day.
Then in hospital outpatient clinics, most patients with pericarditis are admitted to the hospital.
Therefore, if a patient goes to a large hospital to treat this disease, the cost is only a little more than 1,500 yuan.
And the time cost will be very high.
For patients with mild symptoms like him, getting good rest and less queuing is more effective than any good medicine.
From this point of view, a good clinic brings great benefits to the people.
Diagnosing and treating this patient, the gains from the attribute panel are also considerable.
Doctor level experience +5, cardiovascular medicine diagnosis +10, drug efficacy and drug metabolism +5, health +11.
After taking a big job at the beginning, the next five patients all had common diseases.
He inquired and prescribed prescriptions one by one.
When the third patient was diagnosed, Han Siying finished her work at the counter and stood behind him to study.
Under normal circumstances, if you work in a large hospital, residents will only have the opportunity to study in outpatient clinics after three years. And there is often only one day of learning opportunity a week.
After being promoted to attending physician, outstanding doctors will have the opportunity to obtain outpatient clinic qualifications.
Han Siying has just graduated and only has one year of hospital internship experience.
Being able to study with Li Jingsheng in the outpatient clinic was of great help to her.
"Dr. Li, my child has a fever, cough, and pounding breathing. Can you please see if he can be treated here?"
A middle-aged woman with deeply tanned skin brought a six or seven-year-old boy.
Looking at the clothes of these two women, it can be basically seen that they are migrant workers in the city, and their economic conditions are not very good.
The middle-aged woman is about thirty-three or four years old, maybe a little younger in actual age.
Her hair was tied up casually on the back of her head, and a lot of loose hair was exposed on her temples.
Wearing a pair of black trousers and a cheap floral shirt, his skin was tanned.
And her hands are very rough, and you can even see some small cracks.
The body bones look quite thick.
The child was wearing a school uniform, and the shoes on his feet were cheap sneakers with serious wear and tear on the corners.
Today's parents treat their children like treasures. Even if their financial conditions are not good, they still choose the best food for their children to eat and wear.
Both the middle-aged mother and the child looked a little undernourished.
It is basically certain that her family's financial situation is relatively poor.
She was able to call out Li Jingsheng's surname, and she obviously knew Li Jingsheng.
"How long has the child been sick?"
Li Jingsheng motioned for the child to sit down.
Unexpectedly, the child was quite sensible. He looked at his mother beside him and said something in dialect.
It should mean asking mom to sit down.
"It's okay, it's okay. There are still chairs. Siying, please bring another one over."
When Li Jingsheng saw this scene, he didn't say anything, but in his heart he felt that this child was very sensible.
Children from poor families become parents early.
They see their parents struggling to make ends meet, so they can sympathize with their parents' difficulties even more.
The child was sick and unwell, but wanted to let his mother sit.
Really heartwarming.
"I'll just hold him! No need to trouble you!"
The child's mother quickly stopped Han Siying and sat on a chair with her son in her arms.
"My fourth child caught a cold last Monday. I bought some medicine at the drugstore and got better after taking it. But he kept coughing, and now he has a fever. Since last night, his breathing has been a bit heavy. This morning He didn't feel better when he got up, and his breathing became heavier, so I asked for leave from the construction site and brought him over for medical treatment."
There are several large construction sites nearby, and it is estimated that this middle-aged woman works there.
This child has had a cold for more than a week and is still coughing and has a fever. His breathing has worsened because of difficulty breathing.
It means the condition is getting worse.
"Dr. Li, do you think the medicine my son took was left behind by the pharmacy, and that's why the condition recurred?"
The woman didn't shy away from anything and asked directly.
"This possibility should be very small. Today's medicines are all packaged medicines. They are packaged by the manufacturer and go through strict multiple inspection procedures before they are released for sale. There is generally no problem with safety."
Li Jingsheng often hears patients mention that doctors deliberately leave the tail of their hands intact.
It is not ruled out, but it is generally unlikely to happen in a regular hospital.
Doctors are eager to cure the patient's disease at once, and there is no need for the patient to run to the hospital every three days.
'Revisit' cases are called follow-up visits in a nice way, but they are actually different from normal follow-up visits.
You may have heard the term return to factory.
Unqualified products are sent back to the manufacturer for repair or replacement.
If a product is returned to the factory many times, it means that the quality of that product is very poor.
In the same way, if a patient goes to a doctor for treatment and comes back for follow-up consultations every once in a while, it shows that the doctor's skills are impeccable.
If there are too many patients for follow-up visits, the doctor will be reviewed by the hospital’s quality control office and medical department, and his medical skills will be deemed to be substandard, and he will be removed from the outpatient service immediately. Be marginalized.
Therefore, no doctor in a regular hospital dares to joke about his future.
Moreover, follow-up visits bring very little benefit to the doctor and are completely unnecessary.
As for the small clinics that have so many patients and a high return rate, this is generally not a sign of being behind the scenes.
At most, the dosage is deliberately reduced to achieve a certain therapeutic effect, but it cannot cure the disease at once. The goal is to give the patient multiple infusions.
For example, the amount of medicine that could be infused in one time was deliberately divided into two or even three times.
This happens in the clinic.
Li Jingsheng has never done it anyway.
(End of chapter)
