"Last night her child sneezed and started bleeding again. She came to my clinic in the middle of the night. After examination, I found purple ecchymoses on the back of the child's hands and feet. I then checked the child's mouth and found sublingual and oral Mucosal blood blisters, I think, are most likely to be acute ITP. Because the child is still young, only 5 years old, the possibility of innate T cell defects is low. In the end, my initial diagnosis was acute ITP caused by viral infection."
Li Jingsheng explained his diagnostic ideas in detail.
Dr. Wang couldn't get involved in such a difficult case.
That means Dr. Shao can participate.
Internal medicine actually tests clinical experience, clinical diagnostic thinking, basic medical knowledge, and case knowledge.
Only a doctor with the above four advantages can become an excellent physician.
If you want to become a top physician, you need to have a high level of prescription and medicine on this basis, as well as be bold, careful, thoughtful, and good at careful observation. If you can also communicate well with patients and family members, that would be even better.
The breakthrough of many difficult cases may be due to a small thing or a symptom that is difficult to talk about when communicating with patients or family members.
"I really learned a lot today! I didn't think about it at the time. I was always worried that the child would break a deep artery and cause intracranial bleeding. Who would have thought that it could be ITP!"
Dr. Shao looked at Li Jingsheng with a hint of admiration.
It has only been a few days since I came to Sunshine Clinic.
However, Li Jingsheng has already performed more than a little better than his old doctor in many fields of internal medicine.
He is young, knowledgeable, and has top-notch clinical diagnostic thinking. The potential of such a young doctor is limitless!
"Doctor, can you please check my child's ears? Recently, the teacher said that she can't concentrate in class and is always distracted. I called her from behind, but she couldn't seem to hear her. I'm worried that there is something wrong with her hearing?"
A mother in her thirties came to see a doctor with an eight or nine-year-old girl.
Basically, there are only a few types of patients who come to the clinic for treatment.
One type is those who are greedy for cheap, have poor or average financial conditions, and are afraid of spending too much money to go to the hospital.
The second category is for convenience, living close by and not having to queue up for medical treatment at the clinic.
In fact, before the Sunshine Clinic recruited doctors, people had to queue up for a long time to see a doctor.
But now there are three doctors on site, and the situation has been greatly improved.
Some elderly people don't know how to register, let alone where blood is drawn here or where examinations are done in big hospitals, and they are afraid of entering the hospital. My children were not around, so I came to the clinic for treatment.
Not to mention it’s cheap, and there aren’t that many complicated procedures.
The third category, out of trust, may also be for reasons of convenience and benefits.
Basically these are the three types of patients.
This mother probably brought her daughter to the clinic to see a doctor in order to save time and money.
"Girl, please close your eyes!"
Li Jingsheng said to the girl.
She closed her eyes.
"How old are you this year?"
"Nine years old!"
"What grade are you in?"
Li Jingsheng deliberately lowered his voice.
"I didn't hear you clearly, please speak louder."
"I asked you what grade you are in?"
"In third grade."
"What's your name?"
Li Jingsheng deliberately asked from her right side this time.
no response.
"May I have your name?"
This time it was changed to the left side.
"Wang Chunlan!"
She can hear clearly.
Li Jingsheng felt confident.
"Okay, open your eyes! Have you felt any discomfort in your ears recently?"
"No! It's just that my right ear feels a little itchy sometimes."
"Have you ever dug your ears?"
"Picked it with my fingers."
"Are you feeling uncomfortable anywhere else in your body?"
"No."
At this point in the consultation, Li Jingsheng basically concluded that there was something wrong with the little girl's right ear.
"Come closer and I'll show you your right ear."
He took a small flashlight and looked at the child's right ear. He could see that the ear was basically blocked by a black substance.
It doesn't look like blood, it feels like cerumen.
"Go lie down on the bed over there! There is a foreign object in your ear. I will use tweezers to help you take it out."
Two treatment plans quickly appeared in Li Jingsheng's mind.
Use tweezers to take it out, or put 5% sodium bicarbonate solution into the ears to let the cerumen swell, and then wait a few days before letting the child come over to flush the external auditory canal.
The first method is efficient, fast and less expensive.
Children suffer less.
After letting the child lie down, he turned to Han Siying and called, "Siying, come here and help this little girl's head."
Now whenever she has time, she will go to the medicine sales area to sell medicines.
It's really busy over there.
Of course, what makes her so active is the considerable commission from selling drugs.
After she received the customer, she hurried over to help.
"I'm going to remove the cerumen from the child's ears. You have to hold her head steady and don't let her turn."
"clear!"
She nodded in agreement.
If the foreign body in the ear is pinched, the child will feel itchy or painful and will move around.
This can easily injure the external auditory canal and even the interior of the ear canal, including the eardrum.
Safety is an issue that cannot be ignored.
After Han Siying held the little girl's head, Li Jingsheng carefully helped her remove the foreign object from the ear canal.
It feels extremely hard and tight.
It may have something to do with the little girl picking her ears with her fingers.
This will only cause the cerumen to get stuck deeper and tighter.
Because the ear canal will automatically secrete 'earwax', especially oily ears, it will be more serious.
Normally, the ear canal has a self-cleaning mechanism.
It will continue to move as we talk, chew food, etc., and automatically expel dirt from the ears.
It can be understood that it is a spiral movement mechanism.
It is precisely because of this special ability of the ears that we can ensure that our ears will never be blocked by earwax.
When the ear canal is blocked, the garbage inside cannot be transported out, and new earwax is continuously produced, which accumulates and eventually turns into this huge cerumen.
After a lot of effort, a huge piece of cerumen with a length of more than two centimeters was removed.
The little girl looked extremely comfortable.
"Don't move, don't move, I'll show you again."
Li Jingsheng checked her again and found out some tiny cerumen, and finally the cleaning was completed.
Next, she checked her left ear and found a large piece of cerumen.
It's just not as blocked as my right ear.
"Don't pick your ears with your fingers anymore. Our ears will automatically clean up the garbage."
Li Jingsheng said to the little girl.
"Wow, I feel like my ears can hear sounds so clearly!"
The little girl's face was filled with joy.
"Did you hear what Dr. Li said? I asked you not to pick your ears with your fingers again."
"I know, I know!"
At this age, the little girl no longer likes to listen to her parents’ nagging.
In the end, Li Jingsheng collected 20 yuan.
After sending this patient away, a new patient came over.
This time it was a young man in his twenties with a cyan tattoo on his arm, only part of which was exposed.
It seems to be a dragon.
Her hair was dyed light yellow and kept very long, covering her ears.
Her ears are pierced and she wears earrings.
The skin looks quite fair.
Wearing ripped jeans and a floral shirt. The people accompanying him should be his parents, both of whom seemed to be very honest ordinary workers.
The wrinkles on their foreheads were extremely deep, and their faces were full of sad expressions.
What parent wouldn’t worry about educating his son like this?
The education of children must start from an early age. After the age of eleven, it becomes difficult to educate them again. They already have their own thoughts and opinions, and they will not listen to many of their parents' words.
If you reach the youthful rebellious period of fourteen or fifteen years old, it goes without saying.
Sometimes, it really depends on what you sow and what you get.
When I was a child, I was neglected in discipline. When I grow old, I can only watch and worry, secretly wiping away tears.
"Doctor, look at it for me, there seems to be a bump here."
The young man spoke first.
The part pointed to is the cheek.
You can see that the left cheek is swollen to the size of half an egg, as if there is a piece of candy in the mouth.
"smokes!"
After explaining his condition, the young man took out a pack of cigarettes from his pocket and handed one to Li Jingsheng.
Place it directly on the consultation table.
"Thank you, I don't smoke."
Li Jingsheng quickly declined politely.
After hearing this, the young man didn't mind, picked up the cigarette and put it in his mouth.
His parents behind him looked on silently, as if they had long been used to it.
"Smoking is not allowed in our clinic, please cooperate."
Li Jingsheng said to the young man.
"So many rules!"
The young man took out the cigarette and clamped it to his ear. The movements are so skillful, they are really amazing.
"Do you want to eat betel nut?"
He always felt that he had to treat Li Jingsheng to something to treat him properly.
"Thank you, I don't eat betel nut!"
Li Jingsheng has been treating patients for so long, and this is the first time he has seen such a top talent.
The young man took out a piece by himself, deftly peeled off the black medicine in the middle of the betel nut, threw it into his mouth and chewed it.
Snapped!
His mother saw it and without saying a word, she hit him hard on the back of the head.
"Hey, why did you hit me?"
The young man hurriedly blocked it with his hands.
"People say that eating betel nut causes cancer. Your mouth is swollen, but if you still eat it, don't you think your life will be longer?"
The boy's mother scolded people very harshly.
It's also very hard to hit someone.
The slap on the back of the young man's head just now shocked Li Jingsheng.
There are many important acupuncture points, blood vessels, and nerves on the back of the head.
Hitting the back of the head and crotch is prohibited in Sanda and fighting competitions.
This mother was probably so disappointed in her son that she took such a harsh step.
"So many people are eating, aren't they all fine? Look, this cigarette box says that smoking is harmful to health, why don't everyone still smoke? Can you please stop hitting people every now and then?"
The young man was beaten by his mother. Although he was very angry, he did not fight back.
From this point of view, at least it is not hopeless.
At least he knows how to respect his mother.
"If someone else smokes it, it's someone else. If I see you chewing betel nut in the future, I will beat you."
With that said, my mother snatched away the bag of betel nuts.
The young man was so frightened by his mother's big slap that he had no choice but to spit out the betel nut in his mouth.
He spit it out, first caught it with his hands, and then threw it hard.
Accurately flew into the trash can a few meters away.
People who are used to being mixed up in society basically have this habit.
Li Jingsheng said nothing during the whole process, and did not stop the young man's mother from beating him.
"Doctor, please check on my son. I'm afraid he has some kind of oral cancer on his mouth. One of my relatives got oral cancer from eating betel nuts. Half of his tongue was cut off and his face was also cut off. Part of it.”
the young man's mother pleaded.
When I hit my son just now, that was love.
On the contrary, the young man's father didn't speak a word the whole time, standing behind like a piece of wood.
Sometimes, there must be a reason why a family fails to educate its children.
"Let me take your temperature first."
Li Jingsheng took the young man's forehead temperature, which was 36.5 degrees, which was normal.
Then he reached out and touched the mass on the young man's cheek. The texture was soft and did not look like a malignant tumor.
"Open your mouth and let me see."
I took a flashlight and saw obvious redness and swelling on my left cheek.
No suppuration.
"How old is this lump?"
"About a month or so! I felt a little pain at the beginning, so I thought it was a fire, so I ignored it. A bump slowly grew in the back, and it didn't subside for a long time, so I told my mother."
"You should have told me immediately."
His mother started yelling at him again.
Educating children by yelling and threatening them at every turn is actually not good at all.
It will only make the child feel scared, and he will be even more afraid to say anything next time.
Li Jingsheng checked it carefully again.
"Let me take a picture for you first! If the problem is not particularly serious, you can choose to have surgery here or in other hospitals."
When the examination fee was paid, the father who never said a word paid the bill.
After a B-ultrasound, the tumor had clear borders and a large diameter.
Li Jingsheng believed that he was sure to complete the operation.
It depends on whether the family and the patient agree.
"You need surgery to remove the tumor. The cost is about two thousand. If you do this surgery in our clinic, you don't need to be hospitalized, but you need to follow doctor Cong's instructions."
It's not a major surgery.
It can be done directly in the clinic.
If you go to a hospital that is short of inpatients, you may keep the patients in the hospital for surgery.
In a large hospital, the surgery must be performed directly in the outpatient department.
"Is it so expensive? I have to ask my mother to get the money. Doctor, do I have oral cancer?"
The young man only asked this question in the medical laboratory.
In front of his parents, he really has a fearless attitude.
It's as if he doesn't care about his body at all.
"We can't say for the time being. After the procedure is completed, we will do a pathological biopsy on you. When the results are available, we will tell you. You can also come to our clinic on the third day after the operation to get the pathological biopsy results."
Li Jingsheng brought another business to the Second Hospital.
His clinic is temporarily unable to perform biochemical tests before surgery.
Because it is an outpatient surgery, there is actually no problem without routine blood tests.
All I can do are minor surgeries.
If you really encounter a high-risk surgical patient and after evaluation, he feels that it is necessary to complete the preoperative examination, he can contact the community health station for cooperation.
It's also close.
Just draw the patient's blood and send it over.
“Why do we still eat betel nut if we are worried about oral cancer?”
Li Jingsheng asked him.
"Betel nut and smoke have boundless power. If you hang around outside and don't invite anyone to smoke or eat betel nut, who cares about you? I didn't like smoking or chewing betel nut at the beginning, but I gradually got used to it. . Now I just feel uncomfortable if I don’t chew betel nut, and I always feel like something is missing.”
The young man is quite solid.
Li Jingsheng nodded, "Go and discuss with your parents and ask for their opinions. Your tumor is getting bigger, so the sooner the surgery is done, the better. If it is a malignant tumor and it metastasizes to lymph nodes and other organs, it will be very difficult." It’s hard to clean up.”
I really didn’t want to scare this guy.
The cheeks and neck are next to each other.
There is very dense lymph under the cheek. If it is not surgically removed in time, it is very easy to metastasize.
"That man is not my dad! He is my stepfather!"
the man said.
"No matter what, they are your elders. Go and discuss it with them! I saw that your stepfather paid for the inspection fee just now."
Li Jingsheng finally understood why the young man's father didn't speak.
It’s hard to be a stepfather!
Just look at the young man's attitude towards his stepfather.
I don't recognize this father at all in my heart.
After the young man went out, he went to discuss it with his mother.
His stepfather sat in the rest area and watched from a distance, not daring to go over at all.
Li Jingsheng continued to receive other patients.
More than an hour later, the young man's mother came over and said, "Doctor, the surgery fee is still a little short. Can I wait until next month's salary is paid before paying it to you?" The woman begged in a low voice with a smile on her face.
"I'm afraid this won't work. Our clinic has clinic regulations."
Clinics are unlike other industries.
You can't do this kind of thing on credit.
Because patients may feel grateful to the clinic before treatment. However, after being cured, some patients will keep their promises and make up for the outstanding fees. Most patients will 'forget' this matter.
He even said that the clinic failed to treat him well and some new problems appeared after the operation.
This is also the reason why hospitals rarely pay arrears to patients now.
Some patients don’t have any money with them, or they can’t raise so much money at once, but they are in a hurry to save their lives. The doctors at the hospital kindly settled the outstanding bills for him. After efforts to save him, the patient ultimately failed to be saved and died.
It is difficult to recover the arrears at this time.
Even if the hospital doesn't issue a certificate and the family can't get the body, they still can't take it back.
And legally, it is not supported for hospitals to seize corpses to demand medical fees owed by patients.
Li Jingsheng's small clinic can provide some support when it encounters patients who really need emergency treatment, but it will definitely not agree to such patients who owe surgery fees.
The purpose of opening a clinic is to make money, not charity.
He also has no ability to do charity.
At most, when you meet someone who needs help, you can help as much as you can.
"Does he have to do this surgery now?"
"In view of the fact that his mass has been getting bigger and affecting his normal eating, it is definitely better to have surgery sooner. To put it bluntly, if it is malignant and it takes a while to cause metastasis, wouldn't it be a pity? Is that so? Two thousand yuan is not much, and it is definitely worth it compared to a human life. Please think about it again."
Li Jingsheng believed that as long as the family's credit was not bankrupt, they could raise two thousand from relatives and friends.
If relatives and friends wouldn't even lend them two thousand, it would be even more impossible for Li Jingsheng to agree to let them owe money.
It shows that the integrity of this family is not good.
"I've paid for it, let him do it!"
The young man's stepfather stood nearby and listened.
This was the first thing he said after being here for so long.
Simple and direct.
The cost of the surgery was borne by him alone.
In a second-marriage family like this, because they are a half-way couple, the money earned by the two people is usually kept separately.
The man may take on more responsibility in life.
"If you don't take out the money early, you are stingy!"
The young man muttered.
"Shut up! Have you ever spoken to your father like this? If you dare to say that again, I will slap you loudly."
The woman scolded her son and then looked at the man.
"Old Liu, I lent you this money, and I will pay it back to you when I get paid."
"Need not."
Men should be the type who are not good at words.
He took out a plastic bag directly from the inner pocket of his clothes, and then counted two thousand yuan out of it.
"Give!"
He handed it to Li Jingsheng's reception desk.
The money was all the man's hard-earned money, and he used it to perform surgery on the young man without much hesitation.
Li Jingsheng looked at the young man and found that the guy still had a disgusted expression on his face, with a hint of dissatisfaction.
Sometimes, people's feelings are so complicated.
The man had obviously paid so much for this unrelated son, but the young man refused to acknowledge it.
Raising other people's children is tiring both mentally and physically.
It's really hard to get their approval.
(End of chapter)
