After hanging up the phone, Li Jingsheng still felt heavy.
However, he still had many patients waiting for treatment, and he quickly got back into intense work.
It was busy until one o'clock in the afternoon, and I finally finished handling all the waiting patients.
"Boss, hurry up and go to the office to eat. The food may be cold by now!"
Tang Ping felt helpless and a little distressed when she saw her boss missing the meal.
"It's okay, as long as there are people who stutter! There are indeed a lot of patients today, and several of them have quite complicated conditions."
When he encounters patients with more complicated conditions, he is often more cautious.
Because of fear of misdiagnosis.
The benefits of working so hard are not small, and it will definitely help greatly in improving one's medical skills.
Even he can feel this.
"In the future, we should not limit the number of patients. If we can handle thirty patients in the morning, we will limit the number of morning numbers to thirty. The rest can only wait until the afternoon for diagnosis and treatment. Otherwise, after the patient is cured, the doctor will be tired and fall ill. It definitely won’t work!”
Tang Ping made a suggestion.
She is very concerned about her boss's health, and their relationship is very delicate.
Not lovers, more like close comrades-in-arms.
"Let's see the day after tomorrow! If there are still so many patients, I'm afraid we can really only limit the number of patients. When we move to the new address, what I'm most worried about is that the original patients can't find us here. Now it seems that my worries are unnecessary of."
Li Jingsheng handled nearly fifty patients in total this morning.
This is almost as much as many doctors do in a whole day.
Fracture patients and patients with complex conditions require a lot of time. Sometimes when you have a difficult patient, just explaining can be maddening.
He came to the office to eat, and only then did he have time to check the messages received on his mobile phone.
"Have you eaten? I miss you a little!"
Ou Qinglan sent him a message at twelve o'clock.
I also took a photo of eating in the hospital cafeteria.
"Come to my clinic in the evening and take you shopping."
Li Jingsheng usually spends his evenings reading or practicing surgical skills. Now that you are in love, you must spend more time with your girlfriend.
"Oh my god...you don't eat until this hour! I won't allow you to torture your body like this."
"receive!"
"Don't be duplicitous. Take a photo while you are eating tomorrow and send it to me. Work is important, but your body is even more important."
"Okay! There are a lot of patients today. If we don't handle them all, there will be trouble. If there are a lot of people next time, I will limit the number of patients to solve the problem."
Li Jingsheng did not expect that the number restriction would begin so soon.
Judging from today's situation, the maximum processing capacity cannot exceed one hundred patients a day, and in fact it may be even less.
This requires practice slowly to know.
And as his reputation continues to grow, the probability of receiving various difficult cases will also increase significantly.
At present, only Dr. Wang can share a small part.
When Dr. Wang grows up, he should be able to share more responsibilities. Han Siying does not have a certificate, so she mainly works as an assistant and as an intern. It was impossible for her to attend a consultation, let alone prescribe a prescription.
If Li Jingsheng is present, she can properly exercise her independent diagnosis and treatment abilities.
When people call him master, she can't let her call him in vain.
"I'm going to be busy. I'll see you tonight!"
She sent a message back and got no response.
There must be a patient to deal with. Especially some emergencies.
Li Jingsheng looked down at the messages sent by others.
It’s really not that he values sex over friends. The main thing is that he’s not completely single yet, so he must be more considerate.
Director Mu sent a message praising him.
"Good boy, it's really you, and you have successfully diagnosed the real cause of the disease again! Next time I have a difficult case, I will ask you for help!"
Director Mu would never ask him for advice. He couldn’t save face!
After all, he is an old expert.
"no problem!"
Li Jingsheng readily agreed.
There are also two messages from Zhang Chao from the Cardiac Surgery Department of the People's Hospital, asking if he is busy? Let’s have a potluck dinner together when you have time!
Just looking for something to talk about.
Li Jingsheng has seen through this kind of relationship between classmates after experiencing the ups and downs of the world.
He ignored it and continued to scroll down.
Lian Tao from the People's Hospital also sent him a message.
You must pay attention to the message sent by Brother Lian Tao.
"Jingsheng, last time I was asked to pay attention to the second-hand equipment in the operating room. If you are not in a hurry, just wait. Our hospital may have a batch of good operating room equipment to be updated, most of which are imported. I will do my best to help you get it. .”
Lian Tao was actually very busy and could still take what Li Jingsheng told him to heart.
This man kept his word and was very popular with Li Jingsheng.
"Okay, Brother Lao Liantao, please take the trouble."
Most of the funds he currently has on hand have been spent on renovations and renting out houses. Just take it slow.
If he doesn't keep two to three hundred thousand yuan in his hand now, he will not be at ease at all.
By next month, Modu Youyao should be able to refund him 200,000 yuan for the renovation.
The premise is that good pharmaceutical sales performance must be maintained.
Then the 200,000 yuan was returned to him in the form of payment for goods, which could only be realized by purchasing goods.
If the performance is good, you may be able to get more than 200,000 yuan in about a month.
Therefore, based on this calculation, it will take at least two months for the 200,000 decoration subsidy to actually be credited to his bank card.
Nowadays, the net profit per day is more than 15,000, which refers to the money that falls into his personal pocket.
I have never received such a high income, and I am afraid I will have to pay a lot of money to make up for the tax.
No way, who calls him a law-abiding citizen?
"Jingsheng, there is a complicated case here. I will send you the information and help with the consultation."
Lian Tao replied almost instantly.
"send it!"
Li Jingsheng had no confidence at all, and a case that even Tao couldn't handle was definitely not a simple case.
However, he has now accumulated a lot of health points, and has a certain level of diagnostic and medical skills, so he is not afraid of challenging difficult cases.
Sent quickly.
The patient is an old man over 60 years old. His symptoms include weight loss and recurring rash on his lower limbs, which has lasted for nearly four years. Recently, I have developed fatigue, even to the point where I cannot walk independently.
So I ran to the People's Hospital for treatment.
There was treatment before, but it was only in a small local hospital, and it was always treated as a wet clinic.
Recurrent.
Many treatments have been used but failed to achieve good results.
Not to mention cutting off the roots.
Skin diagnosis is actually quite torturous. The itching and psychological pressure caused by it cause great distress to the patients.
Ordinary wet diagnosis is unlikely to cause the patient to be so weak that he cannot walk.
After examination, it was found that one of the symptoms was an oral ulcer, which was the same as the skin ulcer on the lower limbs and had been recurring for nearly four years.
And my tongue always hurts, and it has been hurting for four years.
It seems that this patient's disease is not a simple digestive tract disease. It's more like there's something wrong with the immune system.
The patient has been eating normally for the past four years.
Since I eat normally, why do I still experience continued weight loss and become emaciated?
Lian Tao has prescribed clotrimazole to the patient and asked him to hold it in his mouth to relieve tongue pain.
But this is a method that treats the symptoms rather than the root cause.
And the patient’s symptoms are not limited to oral ulcers.
The medical records sent showed that the patient was 1.75 meters tall and weighed 49kg. He must be on the thin side.
Cardiopulmonary examination revealed no abnormalities.
The patient had mild tenderness about 3cm below the right costal edge of the liver in the abdomen, and there was no moving dullness in the abdomen.
There were scattered dark erythema on the front of both shins, and there was a flaccid bulla with a diameter of nearly 1cm on the erythema on the right front of the shin.
You can also see scattered bullae that are ruptured, lightly eroded, and some have scabs.
Some skin lesions even showed obvious lichenification.
Judging from the erythema, bullae, and superficial erosion on the legs, they are very similar to eczema and tinea pedis.
Li Jingsheng has treated some patients with tinea manuum and pedis, some of which have lasted for more than six years and are very stubborn.
Because tinea manuum and pedis is a fungal infection, its biggest feature is that it is difficult to cure and easy to relapse.
The main attack site is the skin, which will cause intense itching, cracking, blisters, and erosion. And applying ordinary dermatological ointments can be effective quickly, but it will not take long for it to relapse.
This is not the most evil thing.
After using an ointment many times, the fungus develops resistance, and the effect will be significantly reduced after repeated use.
Many patients will think that it cannot be cured when encountering this situation.
This patient had been ill for four years, and his symptoms on his lower limbs were identical to tinea manuum and pedis caused by fungal infection.
However, the patient also had oral ulcers and weight loss, which seemed to rule out tinea manuum and pedis.
Tinea manuum and pedis commonly occur on the hands and soles of the feet, but it is highly contagious and may spread to other parts of the body if left untreated.
For example, the perineum, neck and other parts.
Lian Tao has checked the patient's urine routine and stool routine, both of which are normal.
Sudan stain is negative.
Blood in the stool can basically be ruled out.
The patient's food intake has not decreased, and there are no obvious gastrointestinal symptoms such as blood in the stool, so why does he continue to lose weight?
Lian Tao initially suspected that he might have diabetes, but the urine routine results were normal.
Then, in order to avoid misdiagnosis, the patient was tested for fasting blood glucose.
The first time it was 4.9mmol/l.
Maybe they were worried that the results were inaccurate, or they still suspected that the patient might have a pancreatic problem, so they took another test.
5.7mmol/l.
Fasting blood sugar levels of 3.9-6.1mmol/l are within the normal range.
Although this patient's fasting blood sugar fluctuated a bit, it was within the normal range.
At this stage of diagnosis, it is basically time to shift the diagnostic target. You can't hang yourself on the pancreas tree.
However, Lian Tao has the same character as Li Jingsheng. He likes to get into trouble when encountering difficult cases and likes to be confident in being confused.
He asked the patient to measure his blood sugar again two hours after the meal, and this time the result was 8.3mmol/l.
Lian Tao still refused to give up and gave the patient oral glucose for a tolerance test.
The blood glucose test was 5.2 0 minutes after taking it, 12.7 after half an hour, 18 after one hour, 15.6 after two hours, and 8.0mmol/l after three hours.
The patient appears to have mild diabetes.
However, the patient's blood routine, urine routine, and stool routine were basically normal, and his fasting blood sugar was also normal.
Although the blood glucose tolerance test fits the diabetes curve, it is difficult to determine how severe a patient's diabetes is.
And the patient never developed ketosis or acidosis.
It is precisely this strange condition that puts Director Lian Tao, the chief physician of the Department of Gastroenterology, into trouble.
It can be seen that the patient's liver was checked later. The patient had never had hepatitis, but according to the patient's self-report, he had had liver hemangioma.
Lian Tao checked the patient's liver function, which was normal.
The kidney function was checked again and it was still normal.
Moreover, the patient's body temperature is also normal.
I can eat and drink, my food intake has not decreased, my three basic routines are normal, and my liver and kidney functions are also normal. So where does the energy go?
The patient also did not have hematochezia.
Once you catch the symptom of weight loss, you can pursue it and find out the real cause.
But how can it be so easy in actual diagnosis?
The diagnosis of this patient has been in trouble, and everything that can be checked has been basically checked. All normal.
It means that there is continuous weight loss for no apparent reason.
At the same time, skin examination of lower limbs and oral ulcers were also present.
Li Jingsheng didn't have a clue for a while. His gastroenterology diagnosis was currently at the Xiaocheng level, and he was only two hundred years away from Dacheng.
It just so happened that he had saved a lot of life points.
And now, whether in a clinic or a hospital, you can earn a lot of life points every day. So he no longer uses it as petty as before.
Directly upgraded gastroenterology diagnosis to Dacheng.
I thought to myself, should I be able to diagnose it this time?
As a result, I still have no clue.
It seems that when encountering such difficult cases of top difficulty, blindly improving the proficiency of diagnostic medical skills does not seem to have much effect.
Maybe some other assistance is needed.
Such as doctor level, surgical diagnosis experience, etc.
When diagnosing such difficult cases, it is most likely to encounter areas where the lesions are not targeted.
For example, this patient seems to have a disease in the digestive tract. Li Jingsheng just upgraded the diagnosis of gastroenterology.
But the lesions may actually be in other areas, such as the liver, gallbladder, kidneys, etc.
He is only good at the gastrointestinal field. If the lesions are in other parts, he will naturally have no clue.
"It's a bit difficult. I'll tell you when I find out."
Li Jingsheng replied a message to Lian Tao, and then went to work in the reception hall.
Compared with the morning, there are still some patients coming in the afternoon.
There seems to be quite a lot of them.
Li Jingsheng even wondered if he had snatched away the patients from the health station?
Because the patient base in Chengnan Old Street is so large, it does not exist because the Sunshine Clinic moved to a new location, the venue became larger, and then the number of sick patients increased.
If this were the case, Li Jingsheng's clinic should be destroyed.
The most likely reason is that the rising reputation of Sunshine Clinic has attracted a large number of patients from Chengnan Old Street.
Patients who originally wanted to go to Kuai Kang Clinic or health station felt that the medical skills of Sunshine Clinic were better, so they went to Sunshine Clinic for treatment.
He has been busy, constantly dealing with patients who can eat one after another.
Some diseases are too serious or beyond the scope of his diagnosis and treatment, so he can only give up decisively and advise the patient to go to a large hospital.
It was close to five o'clock in the afternoon, and Li Jingsheng's cell phone seemed to have received two messages.
But he didn't have time, so he didn't check it.
Then after a while, the call came directly.
"Dr. Li, you must be busy!"
It was Director Hua's gentle voice.
"Director Hua, please tell me if you have any instructions."
Li Jingsheng's tone became respectful.
"Haha, you don't need to be so serious. You are a member of our orthopedic surgery department. You can relax in front of me! The patient with paralysis of the lower limbs followed your diagnosis and took the bone marrow fluid for testing. It was initially confirmed that there is indeed a parasite. Infection. We are currently undergoing further investigation and confirmation, and the cause has been basically found. You have made another contribution to our orthopedic surgery department."
Director Hua smiled and praised him.
As expected, Li Jingsheng took a taxi to the Second Hospital at his own expense last night and worked hard until after one o'clock in the night before returning to the clinic to sleep.
Two difficult cases have been solved, which is really good news.
The meaning of studying medicine is well reflected.
These difficult cases may have been solved by other doctors without Li Jingsheng's participation, but the meaning to him personally is definitely different.
If you conquer it yourself, you will feel a great sense of accomplishment.
It is also a great growth for me personally.
"I didn't expect it to be a parasitic infection. No wonder the patient's bones felt so strange. No wonder the vertebrae were obviously healed and the nerves were normal, but the patient kept complaining of lumbar pain and could not stand in his lower limbs."
All doubts are well explained at this moment.
It's like doing a math problem. There are many ways to solve the problem, but there is only one correct answer.
"If you come to pick up Xiao Ou from get off work later, come to my office. Let's talk. It doesn't matter if you don't have time today. You will come to work tomorrow anyway. You can come to my office after work or at noon. I."
Director Hua didn't know what else he wanted to see him for.
Judging from the tone, it must be a good thing.
The promotion to primary care has been resolved, what good thing would that be?
Li Jingsheng couldn't guess.
(End of chapter)
