This doctor has a system

Chapter 526 589. Let’s set some rules for everyone
The old lady refused exploratory surgery, but her family had high expectations, which put Bu Zhengyang in a difficult position.

Although I cannot accept the risks of surgery, I hope you can figure out our old lady's condition. This is the family members' simple idea.

It's a bit embarrassing.

"What should I do?" Bu Zhengyang asked with a frown, "I have no sense of direction at all now."

He didn't know where to look next.

"Why not set up an MDT?" Gao Feng suggested. To be honest, he couldn't see anything at the moment. It would be better to brainstorm and listen to what others have to say.

As the saying goes: Three people talking is better than one person complaining.

MDT is chaired by Yang Zhongyi from the Medical Education Department. Director Wang is getting old, so if nothing unexpected happens, he will take over.

Yang Zhongyi is 41 years old this year, at the prime of his life. He has currently taken over most of the daily work of the Medical Education Department and is a very hardworking person.

Some time ago, there was a large-scale random inspection of medical records. It was very strict, even harsh. If there was a mistake in punctuation, 100 yuan would be deducted.

If a Class B medical record is found, the Class III physician team will be directly warned and fined 2000 yuan. Junior doctors will need to leave their posts and study in the Medical Education Department for three months.

"The purpose is not to fine you, the purpose is to make you remember!" said Director Yang.

This caused a lot of complaints in the hospital, but Director Liu, who was in charge of medical care, supported his approach.

"I think it's a good idea to set some rules for everyone," said Dean Liu.

All subject demonstration classroom

The multidisciplinary discussion is scheduled for 10 a.m.
It was already 10:10 when Yang Zhongyi arrived. Gao Feng greeted him, and he nodded perfunctorily, looking unhappy. If you didn't know better, you would think his wife was cheating on him.

"Director Yang was promoted by Vice President Liu, and he has a rather arrogant personality." Li Youliang whispered to Gao Feng, "He seems to be quite hostile to clinical doctors."

"What?!" Gao Feng was stunned.

A director of a medical education department is hostile to clinical doctors???
It's a bit outrageous.

"Whose position is that?" Director Yang asked.

"Director Zhou from the Nephrology and Rheumatology Department just called and said that a patient was delayed and will need another 5 minutes." Bu Zhengyang replied.

"Being late is being late!" Director Yang was a little unhappy, "Don't put everything on the patients."

"The patients are not your doctors' scapegoats!"

Some people have a special skill, which is to offend a group of people with just one sentence, and Director Yang has done it successfully.

Everyone looked at each other, and several directors looked unhappy.

"Don't wait for him, let's start right away." Director Yang said.

Mao Wen stepped forward and started to present the PPT. As usual, he had to report the patient's detailed condition to everyone.

"That won't do!" Director Yang interrupted Mao Wen before he could finish his sentence. "Don't you think this paragraph is too long? Why write so much useless history of the present illness?"

"You need to be more concise and not write a lot of nonsense."

Mao Wen was confused. In fact, he felt that his medical record was well written. After all, it was going to be a multidisciplinary discussion, so he spent half a day polishing it and even made sure the punctuation marks were correct.

"That's what it says in the book." He retorted subconsciously.

"Is everything in the book correct?" Director Yang was very angry. "Young people should accept criticism with an open mind and not make excuses."

The scene was very quiet for a while, until someone couldn't help laughing.

"Director Cao! What are you laughing at?!" Director Yang became even angrier. What's wrong with this woman? She's embarrassing him!

"Excuse me, Director Yang." Director Cao of the Endocrinology Department said with a smile, "I just thought of a joke."

"This is a case discussion! I ask you to be more professional!" Director Yang said angrily, "Don't treat the patient's affairs as a joke!"

"I don't dare." Director Cao's face turned cold. "I work diligently every day, unlike some people who just shout slogans all day long."

Gao Feng, who was sitting next to him, felt a headache. He thought Director Yang must be sick.

It’s incredible to think that someone with this kind of character would become the head of the medical education department of a large tertiary comprehensive hospital in the future.

Aren't administrators all cunning and experienced? What's wrong with him?

"Who are you talking about!" Director Yang slammed the table, "If you have any objections to me, just say it!"

"I just have a problem with you." Director Cao said bluntly.

After these words were spoken, Director Yang's face turned red. Damn it, this old woman is rebelling!

"Director Cao, you have to be responsible for what you said today!" Director Yang was completely furious. Okay, okay, you really think I can't deal with you, right?
Just wait and see how I will make things difficult for you in the future.

He had already made up his mind that he would give the other party a good beating once he officially took office. This group of clinical doctors deserved to be punished!
Director Cao didn't say anything else, but her disdainful look once again deeply hurt Director Yang.

"you!"

"Director Yang, please calm down." someone said.

"Director Yang, don't be angry." A director advised, "Director Cao has always been so sincere, you will get used to it in the future."

"Yes, Director Cao is a straightforward person, but he doesn't have any bad intentions." Someone then said, "Director Cao, you should speak less truth."

"Yes, Director Cao, a smile can actually liven up the atmosphere. Director Yang, it's not appropriate for you to make a big deal out of it."

"Yeah, I also think that Director Yang is wrong."

"I suggest that both parties just apologize to each other. We are comrades in the same trench." A director of the cardiology department said with a smile.

Director Yang sensed something was wrong. It seemed like they were teaming up to bully him, so he couldn't help but turn his gaze to Director Wei of the Hepatobiliary Surgery Department.

Director Wei was in a bit of a dilemma at this time. He had a better relationship with Director Yang, so logically he should have spoken out to support him, but
Everyone said so, and if he were to say something different, it wouldn't seem appropriate if that got out.

"I really don't understand why you have such strong opinions about clinical doctors!" He felt a little resentful towards Director Yang. He hadn't even taken office yet, but he was already picking on the doctors.

Nearly half of all doctors were fined last month, which is too much.

It is definitely a good thing to tidy up medical records, but the method is too harsh. How can punctuation marks be included?
Also, he felt that Mao Wen's medical record was well written. It was not too lengthy at all. The medical record writing standards stipulated that the current medical history should be so detailed.

Oh, the book is wrong, you are right? You are nothing!
"Everyone please speak less, we are discussing the medical records." Director Wei said.

Gao Feng found it quite interesting. It seemed that Director Yang's prestige was not very good. So many people were singing a different tune, which was somewhat beyond his expectation.

Director Wang of the Medical Education Department may have done a great job. Over the years, he has always been very enthusiastic in clinical medical management. His professionalism and ability are very admirable. Director Yang's ability is obviously far behind him. He is ambitious and always regards himself as a leader. This comparison may make everyone feel disappointed.

Gao Feng felt that he had a big problem. As the future head of the Medical Education Department, although whether Director Yang could take the position was decided by the hospital leaders, the realization of his power was through the vast number of clinical doctors below him.

You only have the power if people are willing to listen to you.

If you really want to quickly establish your own authority, you can do so by winning over a group of people and attacking a group of people.

It is definitely not okay to stand against everyone.

Now it's not the one-man show that it used to be. If you make someone angry, they will really fight with you. Besides, how many of those who can become directors are simple?

In addition to having strong business capabilities, he also has a good background.

Besides, the head of the Medical Education Department is at the same level as the department director in terms of position, both are middle-level cadres, and he cannot directly interfere with the other's behavior.

Mao Wen continued to report the medical records, but everyone's mood was obviously affected by this incident. In the end, a few directors said a few words and then dispersed.

The multidisciplinary consultation was in vain.

"Director Gao, you must do a good job of preparation before carrying out MDT in the future!" Director Yang was obviously furious, "You did a very bad job this time!"

"I think the preparations are pretty good." Gao Feng said, "It's just that everyone is not in good shape today."

As for why you are not in good shape, don’t you know it yourself?

"Hmph!" Director Yang snorted coldly and turned away.

When he returned to the Medical Education Department, he called Secretary Cui.

"Do the quality control of the medical records of the endocrinology department and the general medicine department in the next two days." He instructed, "As soon as possible!"

Secretary Cui responded and frowned as he walked out the door. What does this Old Yang want to do? It's all about him every day.

"Zhou Qing, what's going on?"

Zhou Qing came back with Director Yang.

"What's the matter? He just got mad." Zhou Qing said with a smile, "Just now in the general practice department, Director Cao from the endocrinology department said something back to him, and his Yuyu syndrome came back."

"It's really frustrating." Secretary Cui said speechlessly, "He will offend everyone sooner or later."

I don't know what's going on in this leader's mind. He looks down on everyone. Some directors still want to have a good relationship with him, but Director Yang treats everyone equally, and his expression is: everyone here is garbage.

Those directors were usually spoiled by drug dealers and equipment vendors, so they couldn't stand this. They were unwilling to stick their heads in front of him.

"Then what does he mean? Is he looking for trouble?" Secretary Cui asked.

"It's obvious." Zhou Qing handed him a cigarette, "Just be perfunctory and don't do these annoying things."

"That's hard to explain, Director Yang."

"Can you explain after you've done your job?" Zhou Qing looked at him with strange eyes, "Is there any day when you don't get scolded?"

"Yeah." Secretary Cui suddenly felt relieved. That's right, since the treatment is the same whether you do a good job or a bad job, why should he bother?

"Oh, if only the director would not retire."

"Maybe Director Yang will be more at peace after Old Wang retires." Zhou Qing said, "He has put too much pressure on Director Yang."

Although today's multidisciplinary discussion started off well but ended badly, Gao Feng still gained something. Director Zhou from the Department of Nephrology and Rheumatology arrived last, but the opinions he expressed were the most valuable.

He proposed the possibility of histiocytic proliferative diseases: including Langerhans cell hyperplasia (LCH), hemophagocytic syndrome, malignant histiocytosis, etc.

"We really need to focus on ruling out Langerhans cell hyperplasia," Gao Feng told Bu Zhengyang and Mao Wen, "Communicate with the family members and ask them to be more patient."

The family members had long lost their patience, but there was no other way. Mao Wen had already told them that they could go to the big hospitals in Beijing or Shanghai for further check-up.

The most common clinical manifestations of Langerhans cell hyperplasia (LCH) are diabetes insipidus, bone and lung involvement, but this disease usually occurs in children.

Gao Feng thought about the old lady's situation and felt that it didn't quite fit.

"Could it be non-Langerhans cell hyperplasia?"

Non-Langerhans cell hyperplasia (formerly known as lipid granuloma) was first described by Jakob Erdheim and William Chester in 1930, hence the name Erdheim-Chester disease. It is an extremely rare non-Langerhans cell hyperplasia, formerly known as lipid granuloma.

The disease is more common in middle-aged and elderly people, with a median age of 55 to 60 years old, and is rare in children. There is no significant difference in the incidence between men and women.

It is also a histiocytic proliferative disorder.

The patient's bones, heart, lungs, nerves, etc. may be affected, resulting in pleural effusion, pericardial effusion, and dyspnea. The posterior pituitary gland may also be affected, manifesting as diabetes insipidus.

Looking at it this way, it does fit.

But where is the evidence?

Gao Feng consulted the literature and found that the laboratory tests for this disease are not specific. Inflammatory indicators may be elevated, such as erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein (hsCRP), platelets (PLT) and fibrinogen (Fbg); at the same time, cytokines may be elevated, such as IL-6, IL-8 and TNF-α.

Imaging studies are essential for the diagnosis and evaluation of non-Langerhans cell carcinomas (ECDs).

However, the gold standard for diagnosing the disease is still pathological results.

If non-Langerhans' tissue cells with foamy or eosinophilic cytoplasm are found, combined with imaging examinations, the disease can be truly confirmed.

The patients' families are quite positive about the examinations, after all, the expenses can be fully reimbursed. When a patient is no longer troubled by medical expenses, the conflicts between doctors and patients are reduced by 90%.
Mao Wen took the patient to do a PET-CT scan, and the results showed that there were varying degrees of radioactivity accumulation in the heart, lungs, and bones.

The testing of pleural effusion and pericardial effusion needs to be outsourced, and some projects at the Provincial Hospital have not yet been launched.

When Yue Penghui received this task, he was counseling a subordinate named Cao Bo.

"How many times have I told you that this girl is no good? She looks so vain."

"Now, I spent so much money and you didn't even kiss me! Are you stupid?"

"She said she was conservative and would wait until she met her parents before doing it," Cao Bo said dejectedly. "Who knew she was lying to me?"

He was beaten up for no apparent reason yesterday by a man who claimed to be his girlfriend's boyfriend.

"Then who am I?"

"You love whoever you want!" The other party was very angry at first, but later they both felt something was wrong, so they compared the information and finally the truth came to light.

"Split your legs! They've been chopped into centipedes!"

(End of this chapter)