People's minds become very complicated once interests are involved. Chasu City Hospital directly sent consultation letters to the affiliated hospitals, main hospitals, and provincial hospitals in Bird City.
To be honest, this kind of invitation letter has no effect. There are clear charging standards for this kind of consultation. Online consultation costs 20 yuan for a deputy consultation and 30 yuan for a full consultation. The maximum consultation fee between hospitals is 1,000 yuan.
Therefore, technology is becoming more and more developed and various communication conditions are getting better and better, but online consultation and inter-hospital consultation cannot develop no matter what. The hospital consultation system, which was established at a huge cost, was left idle.
Higher-level hospitals force each chief doctor to handle how many online consultations he or she must handle within a specified time. This kind of consultation usually involves complex or special diseases, which is a waste of time.
The superiors mandated the number of consultations and withheld part of the consultation fees, and the majority of the fees were withheld. Then, the chief physicians of various major hospitals began to act perfunctorily or arrange for young doctors in the department to take his place in consultations.
If the lower-level hospital requires consultation for a relatively simple disease or the lower-level hospital handles it unreasonably, there will be instances of ridicule.
Immediately afterwards, doctors in lower-level hospitals also lost motivation. If the local situation doesn't look good, he will be transferred to another hospital. He can't afford to be ridiculed by others because of his illness. As for whether there are lower-level doctors who are suffering from various discomforts and applying for online consultation for their patients.
Yes, but not much. Are there some superior doctors who have a very kind and serious attitude? There are some, but they are not the majority. And the consultations between hospitals are even more bizarre. Those who can come are definitely not the authorities of any hospital department, they just use the name of the hospital to provide a certificate for the lower-level hospital.
What Chasu City Hospital wants is this name and this officially recognized certificate. In two days, the patient's medical record was completed.
Zhou XX suffered a fracture of his right humerus due to an accidental fall while drunk. In Chasu City Hospital, incision and internal fixation were performed. Before admission, the patient suffered from type 2 diabetes and poor blood sugar control.
Chief Physician Chen Qi, director of the Third Department of Orthopedics, violated the treatment principles because he was friends with the patient. Before the diabetes was formally treated... our hospital actively invited Dr. XX from the higher-level hospital in Bird City to come to our hospital for consultation.
The doctor in charge of the bedside wrote a medical record into a book. As long as it was what happened, the situation at that time, and the postoperative events, he had to pull out all his hair to recall it. This is not only related to the treatment and identification of future patients.
Moreover, it concerns his job. For a doctor in a tertiary hospital, to be honest, if you threaten people with the hospital's staff, they probably won't be too scared. I don’t want to leave you here, I have my own place to stay.
However, the revocation of his practicing certificate would probably scare him to death. This is the ultimate ultimate move. It is usually not released, but once it is released, it is a big deal.
Zhou XX and his family members also stopped talking. Ouyang came down with a combination of punches, and Chen Qi was stunned. The relationship with Zhou XX that was as close as brothers and as good as brother-in-law was completely broken.
Chen Qi's acceptance of red envelopes before surgery was also reported by Zhou XX's wife. Chen Qi is not a fool, someone who can be manipulated casually.
He actually had a cell phone recording of that time. Anyway, the two of them had a mouthful of hair. Zhou XX inquired about it and finally found out who was the best in the Orthopedics Department of the city hospital, that young assistant!
In the end, he didn't want to leave and had to undergo follow-up treatment at the city hospital. As long as he is willing to cooperate, Ouyang is not willing to make the matter too big. After all, this is a hospital, not a court.
Of course, Chen Qi's director couldn't do it. He was warned by red-headed documents within the hospital and was even given a life-saving fine.
He can't go back to the Department of Orthopedics, and can only be an outpatient doctor. A doctor who visits outpatient clinics for a long time, issues a sick leave note, and writes long-term outpatient prescriptions for chronic diseases, which is regarded as a retirement.
This punishment is not too severe, and Chen Qi's future path is also very obvious. Unless there are unconventional leadership changes in the hospital, otherwise, if he wants to have surgery again, he will have to change places.
Chen Qi almost hated Ouyang and Zhang Fan to death. Taking away people's wealth was tantamount to killing their parents. But on the surface, there was no hint of any dissatisfaction on his part.
He goes to work and gets off work on time every day, smiles at everyone, and greets Zhang Fan proactively without any grudges.
Nonunions: About 2 million patients with long bone fractures are treated in the United States every year. Among these 2 million, there are about 100,000 patients with nonunions.
And the cost of treating a nonunion is about twice as much as normal fracture healing. And the disability rate is very high. Experts from higher-level hospitals come to Chasu Hospital to make a diagnosis and want them to operate, but no one is willing.
There is so much unpredictability in this kind of surgery. The patient probably came here all of a sudden after going to other hospitals. If something goes wrong in the hospital, it needs to be solved.
As the person in charge of surgery, Zhang Fan had to step forward and find a solution. In the past, Zhang Fan could only make arrangements within his team, and he also had to consider Wang Yanan's mood.
It's different now. "Let me inform Dr. Zhou Chengfu from the Third Department of Orthopedics, Xu Xian from the First Department of Orthopedics, and Dr. Wang Pingshan from the Second Department of Orthopedics. We are going to do nonunion surgery tomorrow."
Zhang Fan was in his office in the administrative building, explaining tasks to the office director.
"Are you the surgeon?"
"Yes, I'll be the surgeon." Zhang Fan replied. These were all top young doctors in the orthopedics department. Ouyang directly gave Zhang Fan the task of selecting the director of the third department of orthopedics.
Zhang Fan currently has two people in mind. One is Zhou Chengfu. Although this person is more utilitarian, he is good at business. The second is Wang Pingshan from the Department of Orthopedics. He is also quite good at business, but his personality is a bit dull.
Both of them were attending doctors who were about to be promoted to deputy senior positions. Zhang Fan had to think about it and weigh the pros and cons. Bringing Xu Xian along is just a cover.
After processing some documents that needed to be reviewed, Zhang Fan had to go to the Department of Orthopedics No. 3 again. Because the director had been dismissed and the new director had not been appointed, Zhang Fan had to worry more about the work of the department.
As soon as I arrived at the door, I heard Zhou Chengfu giving lectures to the resident doctors and rotating doctors in the department.
"There are many, many causes of nonunion. To put it bluntly, it is unclear. However, through evidence-based medicine, it is certain that smoking is a very significant cause."
After seeing Zhang Fan, Zhou Chengfu insisted on asking Zhang Fan to speak a few words, "I'm not good at speaking, so let Zhang Yuan tell us a few words. Zhang Yuan's lectures are as exciting as his surgeries."
The hospital wants to combine medicine, education, and scientific research, and it has gradually begun to pay attention to the education of young doctors, rotating doctors, and intern doctors.
Just because of this case, Zhang Fan didn't say much and went directly to the stage to start talking.
"When talking about non-union, we must first talk about bones. If the bones of the human body are subdivided, there are many classifications, which are all found in textbooks. This is something that a doctor must master.
If roughly classified, it can be divided into two major categories, cartilage and bone. “Lectures, especially to young doctors and interns, are no better than explanations during surgery.
Doctors who can ask questions during surgery are almost all doctors with many years of experience. What they lack is some tips or ideas, but when facing interns, they cannot speak in general terms.
It is necessary to not only teach knowledge points, but also to teach in a lively and interesting manner. This requires much higher requirements for lecturers. Otherwise, if the textbooks are very comprehensive, why would a teacher be needed?
"The components and tissues of bone are all in the textbooks, and I won't repeat them. Today, because there is a patient, let's talk about bone nonunion. To talk about bone nonunion, we must first talk about fracture healing.
Bone healing mainly relies on four types of cells. Osteoprogenitor cells, osteoblasts, osteocytes, osteoclasts.
When a long bone is fractured, osteoclasts first break down the bone at the broken end into various primitive components, such as bone cells, bone salts and other components.
Then, osteoblasts come on stage, and through genetic regulation, they use free bone cells, bone salts, and various nutrients taken in by the human body to allow osteoprogenitor cells to rebuild cartilage, then calcify, and finally form a complete bone. . "
Zhang Fan said that all the doctors below, whether they were interns or working doctors, were taking notes with their heads down. Even Zhou Chengfu was sitting in the back row, taking notes with his head down. He estimated that there was more of pretentiousness than study, but his attitude was shown.
"The shape of bone is not constant. A mature bone is not static. It is changed every day just like the clothes you wear. Through hormones and nutritional conditions, osteoclasts are constantly destroying, and osteoblasts are constantly destroying them. Stop rebuilding.
Under normal circumstances, bone elements will lose 0.5% of the total amount every year. In older women, due to the lack of estrogen, the amount of bone loss will be greater, which is why older women are prone to fractures.
This is also the reason why adults need calcium supplements after they reach the age of forty-five. When the nutrients absorbed are not enough to keep up with the nutrients lost by the body, bone brittleness will increase and bone strength will decrease.
Calcium supplementation cannot be corrected simply by taking medication. First of all, vitamin D must be supplemented in time. A lack of vitamin D, especially in early childhood, will cause rickets.
Lack of vitamin A will lead to variations in the speed of osteoblasts and osteoclasts, which means deformities will occur.
Lack of vitamin C reduces the amount of collagen fibers synthesized by cells, leading to increased bone fragility.
Moreover, under low stress, although bone is resorbing, its density does not reach normal density. Especially patients who are bedridden for a long time are very susceptible to fractures.
Therefore, in order to ensure the health of bones, it is most important to get more sun, exercise appropriately, and ensure adequate food.
Taking calcium tablets from Australia or America is not as good as having a healthy living habit after taking some ordinary calcium tablets.
There are two main nutritional pathways for bones. The first is the outermost layer of dense periosteum, which contains a large number of blood vessels, nerves, and osteoprogenitor cells.
The second place is the femoral intima, the innermost layer of the bone, where blood vessels also run. Note that the blood vessels here are small blood vessels. In other words, if a large amount of periosteal soft tissue on the bone surface is stripped away during surgery, the bone will become malnourished.
If the patient has diabetes, smokes, and has an irregular lifestyle, nonunion will occur! "Zhang Fan did not start directly from the non-union.
Medicine is a discipline with links within it. Without one link, knowledge will be incomplete. The understanding of diseases will be specious, and we will know what is happening but not know why.
After Zhang Fan said this, the following intern students became very clear and clear.
"There are three forms of non-union..." At this time, the serious explanation of non-union and the treatment of non-union began.
For more than forty minutes, Zhang Fan crushed and decomposed a broken bone and lectured it to the students below. As long as they listened carefully to this lesson, they would definitely have a complete grasp of this disease. All that's left is to do clinical internships and practice.
At first, most of the doctors in the Department of Orthopedics were pretending, but as Zhang Fan explained, most of them began to listen carefully.
"No wonder, people are so good at surgeries. Listen, even a non-medical professional can understand what this class is about. It's so powerful!" One resident said to another resident.
"Nonsense, how can you be the dean if you are not strong?"
After Zhang Fan finished his lecture, the students below looked at Zhang Fan with enthusiastic eyes. They didn't know whether it was the aura of the assistant dean or whether Zhang Fan really impressed them. However, Zhang Fan was still satisfied with this lecture.
I have become angry countless times. If I can't even teach a class well, I might as well find a tofu to kill me.
"Zhang Yuan, you are so experienced. I have gained a lot of knowledge. It seems that my knowledge reserve is still not enough. You are too busy. Otherwise, if you give us classes every week, the treatment level of the doctors in the department will probably be improved several times." A step." Zhou Chengfu said to Zhang Fan with a smile.
He was helpless. If he had known that Zhang Fan could be promoted so quickly, why would he have run away? Forget about other things, even Lao Gao was dissatisfied with him. Every step he took was wrong!
"Self-study is still the most important thing." Zhang Fan told the truth, but Zhou Chengfu's face froze. But Zhang Fan didn't pay attention, "I'm going to have surgery tomorrow morning. Have you received any notification from the medical office?"
"Notified, already informed." Zhou Chengfu nodded quickly and said.
"Well, prepare the instruments needed for the surgery." Zhang Fan explained.
"Okay, okay. Don't worry, Zhang Yuan, I will be well prepared." The stiff smile became wonderful again. He was afraid that his superiors would forget about him and would rather struggle alone. It was easy to say, but few could actually do it.
After dealing with the matters in the third department of orthopedics, Zhang Fan still had to go to the general surgery department to help with the surgery. There were too many patients, and doctors couldn't turn them away. Zhang Fan had no idea. The training period for a qualified surgeon was too long.
Zhang Fan was very happy to undergo the surgery. Now he is the assistant to the dean. To put it in a more crude way, Zhang Fan is now a rich man: If I want to do general surgery, I will do general surgery. I want to do it. For cardiothoracic surgery, just do cardiothoracic surgery.
If there were less administrative duties, Zhang Fan would love this position so much. As long as he wanted, he could perform any surgery in the hospital. The general experience of the system has grown from a snail-like slowness to one that can be seen with the naked eye.
This is gratifying.
