"Zhang Yuan finally has a ward round!"
"The boss is going to check the ward!"
"The director of the Department of Gastroenterology has almost wet his pants these days, and finally Boss Zhang is going to do a ward round!"
When Zhang Fan was about to make a ward round, the female doctors in the internal medicine department seemed to be frightened, and one by one they were barely holding melon seeds!
However, it was rare for Zhang Fan to come to the internal medicine department every day this week, which also made others feel that something was wrong. This time, not only the leader at home came, but also the expert from the intestinal surgery department also applied to participate in the ward rounds.
"I finally remembered internal medicine. I no longer care about internal medicine. From now on, Chasu Hospital should become Chasu Surgery Hospital.
Do you think this flower is sick? Why is it lying down? Not watering enough? Or is there not enough fertilizer? "Ouyang looked at the cactus in front of him in confusion. Yesterday it was all straight, but why is it crooked today?
She has nothing to do these days, so she waters the flowers when she is bored.
"Ouyuan, are you going?" Lao Chen pretended not to hear what Ouyang said.
"I won't go. I've been too busy all day without my feet touching the ground!" Ouyang said proudly. The old lady is very happy these days.
Because Mishima GlaxoSmithKline has built a factory in Chasu, the Chasu government does not have the confidence to face such a giant. I wanted to ask the other party to pay more, but I was also afraid that they would dislike the tea because of its ugly appearance.
Therefore, in order to bring harmony to everyone, Ouyang was invited by the Chasu Government to communicate with Ms. Zeng of Mishima GlaxoSmithKline.
The Tea Su government and Ms. Zeng from GlaxoSmithKline actually wanted Zhang Fan to be the middleman, but Zhang Fan had recently ordered internal medicine, so he ignored them. So as a last resort, Ouyang was invited.
Ouyang just likes this kind of big project where people are in front of others.
On Monday morning, the weather was good. It rained more at night than during the day. Because of the snow-capped mountains, the temperature was too high during the day, and there would often be light rain or moderate rain at night. The next morning, the air was filled with oxygen. ion.
Moreover, the blooming of various flowers in summer adds a delicate fragrance to the air. In the frontier, in the northwest, in a place where almost half of the territory is covered with Gobi, such a city is really very different.
Of course, I don’t know how the other doctors are feeling at Chasu Hospital today. The doctors in the Department of Gastroenterology are very nervous from top to bottom.
"Are there any sick patients, are there any medications that exceed the prescribed limit, are there any people who are lying in bed? Why are you still writing medical records? Oh my God, the dean has already called the door. Do you still want to do it?" Digestion The director of the internal medicine department was so anxious that his hair stood on end.
An hour before going to work in the department, not only were all the staff in place, but they were also in a panic. One is in a hurry than the other.
The head nurse led the nurses to check the ward over and over again, "Pack away all the extra things. The ward must be tidy. Whoever has the rice cooker, take it away immediately. Don't come to the hospital next time you see it."
Old man, what are you causing trouble? Hurry up and change the blanket you are wearing into a hospital quilt. "
When it was time to go to work, I heard footsteps in the corridor, and there were quite a few people. The director of gastroenterology was sweating in the doctor's office. "Are you here?" he asked quietly.
"Here it comes! All here!" The nurse said immediately after taking a sneak peek at the door.
Zhang Fan is here to check the ward!
Except for Ouyang, who was doing important things, all the other leaders of the hospital were here.
The middle-level leaders, Lao Ju, also came with a group of department directors.
Doctors and masters from the laboratory who have something to do with digestion also came.
It can be said that this ward round is probably the largest and most comprehensive in the history of Chasu.
When Zhang Fan came to the internal medicine building in the morning, he saw a group of people waiting in the lobby on the first floor of the internal medicine building. He directly saw a team of no less than thirty people waiting.
"Everyone is not busy today!"
Zhang Fan glanced at Xiao Chen.
"It's been a long time since we had a ward round. This time Zhang Yuan has spoken. Everyone is very enthusiastic. We can't decouple ourselves from professional studies!" Lao Chen quickly answered.
"Haha, why do you think of the gastroenterology department's ward rounds?" Yan Xiaoyu asked.
She was worried that Zhang Fan was dissatisfied with internal medicine, but she didn't say anything, which was the most frightening thing.
"It's been a long time since the internal medicine department has come to do ward rounds. It just so happens that we are not busy these days! Since everyone is not busy, let's go up and do ward rounds. Everyone must be prepared to be hungry today." Zhang Fan said with a smile. He entered the elevator first.
All eight elevators were on standby, and Zhang Fan could no longer smile. "It won't be the same next time. It's outrageous for a sick patient to climb the stairs!"
Although Xiao Chen was not a leader, she wanted to follow the leader, so after several leaders entered the first elevator, Zhang Fan said something to Xiao Chen.
Xiao Chen stuck out his tongue and quickly agreed.
About thirty people entered the internal medicine office.
The director of the Department of Gastroenterology looked at Zhang Fan, meaning the leader was speaking!
Zhang Fan waved his hand to indicate for him to continue.
"Today's ward round begins with bed one. All doctors are asked to turn off their phones and prepare various cases and information for the patients in their own beds in advance. The ward rounds will begin now."
After saying that, the director of internal medicine hurriedly ran to Zhang Fan and asked Zhang Fan to leave first.
This is the rule.
In any department, during ward rounds, the subject leader must be at the front, followed by three levels following. Wow, the leader brought in the number 30, the original doctors in the department plus the doctors who were interns and specialists were about the number 30, and then the nurses were number 30, which is almost a small team of 100 people.
"Bed 3, female, 45 years old. She has a history of liver cirrhosis for more than ten years. She was admitted to the hospital due to vomiting blood and melena and shock and ascites. After admission, she was given active treatment to correct the shock, improve hemoglobin, and control bleeding... "
In the first room, I encountered a seriously ill patient.
After the doctor in charge of the bed carefully reported the condition, he looked at the ward rounds.
At this time, there are generally three types. Non-professional leaders will nod, then look at the patient from a distance, and then ask: "The windows must be closed on time, and ventilation and warmth must be paid attention to, so as not to let the patient catch a cold!"
Then holding the patient's hand, the reporter from the hospital newspaper immediately took photos, and then the ward round ended. The doctors actually didn't care about him at all.
The second type is professional leadership but not professional leadership. During ward rounds, I don’t ask many questions, but I will read the doctor’s orders, and occasionally ask the patient to lie down for personal examination. After the physical examination and reading the doctor's orders, Hua Guo leaders are very good at asking questions and hiding their clumsiness.
And the last type is the leader of this profession. This kind of leader makes ward rounds, which makes doctors and nurses nervous.
After the doctor in charge of the bed completed his report, Zhang Fan went straight to the physical examination without looking at the medical records, "Haha, I am the director of Chasu Hospital. I will do a physical examination for you during today's ward round. You lie down."
Zhang Fan said to the middle-aged woman in front of him with a smile, and then lifted up the patient's top.
The patient was trembling a little. She was not in good health. Seeing that the doctor who usually raised her head higher than a big cock was acting like a quail, she was also nervous. She didn't know what was wrong and what she was going to do.
"It's okay, they are all experts. You are lucky this time. There are so many people consulting you. It is usually difficult to find all these experts." When Lao Chen saw that the patient was a little nervous, he smiled and explained slowly.
"oh!"
The patient in the other bed heard that he was an expert or the dean. He hurriedly lay down on the bed anxiously, opened his clothes and exposed his belly, waiting for the expert to touch him.
…
"The liver is palpable under the ribs and is hard..." Zhang Fan reported his data while checking. The doctor in the Department of Gastroenterology, regardless of whether he was in charge of the bed or not, took out his notebook to record. Anyway, he didn't know what he wrote. , but the posture is put on.
“Is there primary prevention education given to patients before bleeding?”
"Yes, Zhang Yuan."
"After bleeding, was the patient given a cerclage?"
"Cerclage, almost a year now."
“What’s the bleeding rate after one year?”
"Yes..." The doctor in charge of the bed couldn't answer!
"60%!" The superior doctor in charge of the bedside doctor quickly stood up and answered.
Zhang Fan didn't say anything, but the doctor in charge was already blushing.
"Has your kidney function been tested regularly?"
"Already checked regularly!"
Zhang Fan asked very detailed questions, very detailed.
In detail, Ren Li and Yan Xiaoyu looked at each other. "I'm afraid this level is equivalent to associate professor of internal medicine. Isn't it said that Zhang Yuan's internal medicine department is just a reluctant one?"
Yan Xiaoyu was shocked. Could this person really be the legendary pretender to eat the tiger? So young, oh my God, so thoughtful, Yan Xiaoyu thought about it, and quickly recalled whether she had made any mistakes in business since she came to Chasu Hospital.
"Why not add isosorbide mononitrate?" Zhang Fan had already taken the medical record and started giving instructions.
The doctor in charge of the bed was stunned, yes, why is isosorbide mononitrate needed?
The superior doctor was also stunned.
Internal medicine, how should I say it, is like a lottery. Before the lottery is drawn, everyone is confused. But once the lottery is drawn, everyone suddenly realizes that it is like this.
It seems that everyone can understand it, but in fact, it is based on peeling off the cocoons bit by bit and starting to take medicine according to the symptoms, signs, and progression of the disease.
In the textbook, it is well written that this medicine should be used for this disease. It seems irresponsible at all. To be honest, if it were really that simple, just pull out two high school students and ask them to familiarize themselves with internal medicine books, and they can give it. People get medical treatment and medicine.
"Oh? You didn't expect it? Octreotide is really useful!" Zhang Fan patted the case in his hand.
"Come on, Director Li, tell me why we don't use isosorbide mononitrate!" Zhang Fan said to the director of the Department of Gastroenterology with a smile.
Today, if the director doesn't even know why isosorbide mononitrate is added or not, Zhang Fan is determined to get him.
The director, who was wiping his sweat, didn't know Zhang Fan's target at this time. Whether he was here to capture expensive drugs like octreotide or to capture the quality of cases!
"Although the patient has been cerclage for nearly a year, the bleeding is not obvious at present, and the patient's liver function is poor. In order to protect the liver, we have not considered using isosorbide mononitrate!"
When Zhang Fan heard this, he looked at the director of the Department of Gastroenterology and said, "I have the skills, but my heart is not here!"
There is still a level of director of gastroenterology.
"Then what time is the right time to add it? There is a 60% chance of recurrence, and she has already started bleeding again. If you can't vomit blood, just give it octreotide. Once the bleeding is stopped, leave it alone. My chief director, can you give me some snacks?" "
Zhang Fan handed the medical record to the director of the Department of Gastroenterology, but did not let go. The director of the Department of Gastroenterology, Lao Li, looked ashamed.
The time lasted only a few dozen seconds, as if a long time had passed.
The people doing the ward rounds, especially the surgical leaders, looked at Zhang Fan with horror in their eyes.
"Is Zhang Yuan going to practice internal medicine?"
Zhang Fan ignored them, released the case, and said, "Continue the ward rounds."
Turn around and continue.
Everyone looked at Zhang Fan.
It seems like the popular saying, I'm standing here, you see I look a bit like I did back then!
While making rounds, Zhang Fan checked the system in his mind. Internal medicine was actually more complicated than surgery.
For some treatments, in the short term, facing to the left is good, and facing to the right is also correct, but in the long term, it is different.
Maybe there are too few doctors who take a long-term view.
So Zhang Fan took the treatment plans into the system and compared them one by one.
