White armor

Chapter 603 Miao Youfang is a bit smart
“……”Miao Youfang was silent.

What Luo Hao said was simply too far-fetched. Although Miao Youfang felt that a similar problem might occur, the chances were slim.

"I'll leave this as a question for you." Luo Hao said calmly, "I want to see how you solve it."

"Teacher Luo?" Miao Youfang wanted to ask more, but Luo Hao had already turned around and sat back on the chair in the waiting area.

topic?

topic!

Miao Youfang thought about how when he first started to worship Professor Luo, he asked him a question, and he answered it perfectly that time, which led to the subsequent stories.

"Teacher Luo." Miao Youfang asked doubtfully, "The patient came to the hospital for treatment because of the lack of professionalism. The lawyer turned around and supported the unprofessional people to question the professional technology. Is this really a good thing?"

"No one in the hospital will debate with you. The question I leave for you is - if you encounter this kind of thing, how can you guarantee that nothing will go wrong." Luo Hao sat down and smiled slightly.

Miao Youfang was in a dilemma.

He knew that clinical work was difficult, but he didn't expect it to be this difficult.

And logically speaking, now that the patient and his family refuse hospitalization, if something happens in the future, shouldn't the patient and his family be fully responsible?

Luo Hao squinted his eyes and looked at Miao Youfang. He thought that this question was indeed a bit difficult for Miao Youfang.

Especially for young people, what they learn in school is completely different from what they encounter in society.

reason?

If you continue to think reasonably, you will probably fall many times in the future.

If you can't turn this corner, you may waste many years of your life.

Luo Hao looked at the academic master who had scored 425 points in the postgraduate entrance examination with great interest to see how he would deal with this matter.

The emergency surgeon finished explaining everything to the patient's family and walked out as he spoke.

Miao Youfang followed the emergency surgeon and listened attentively to the details.

While the emergency surgeon was about to communicate with the orthopedic department, Miao Youfang pulled the bottom corner of his white coat.

The two went to the duty room.

Luo Hao guessed that Miao Youfang was going to ask the emergency surgeon the question he had just asked.

After a few minutes, the orthopedic doctor arrived, took a look at the patient, asked the nurse, and then went into the duty room.

A full ten minutes later, the three of them came out. The emergency surgeon and the orthopedic surgeon had strange expressions on their faces. The emergency surgeon went to deal with the squeezed patient, while the orthopedic surgeon found the patient and his family.

But he did not communicate directly with the patient's family. Instead, he let Miao Youfang walk in front of him. It seemed that Miao Youfang was going to take the lead.

When he came in front of the patient's family, Miao Youfang looked reserved.

It was obvious that this was the first time he faced such a situation and he felt very guilty.

"Family of the patient, right?"

"Yes, hasn't it been signed? Is there anything else?" asked the patient's family member.

"We just did some research and found that we don't have much experience in outpatient treatment of penetrating injuries. We're afraid we can't do it."

Luo Hao pricked up his ears to listen to Miao Youfang's nonsense.

Hearing Miao Youfang say this, Luo Hao's eyes lit up. Although it was nonsense, Luo Hao understood what Miao Youfang meant.

"Just pull it out and it's over." The patient's family members were particularly disdainful.

"It's not that simple. What if there's a massive hemorrhage?" Miao Youfang said worriedly, "Here we are... Alas, all the experienced doctors have gone to the south in recent years, and the people working in the clinic are fresh graduates like me."

"..."

The patient's family was speechless.

The orthopedic surgeon behind him was a little embarrassed and was digging the ground with his toes.

After much hard work, he finally managed to buy a three-bedroom apartment.

"The signature you just signed is incomplete. You need to sign another one - if the bleeding does not stop during emergency surgery, you still need to be hospitalized. We can't do anything about it. We don't do many surgeries like this."

"Alas, we don't want to, but our skills are indeed limited."

When Miao Youfang talked about his limited level, he lowered his head and seemed a little shy. He said it with gritted teeth.

His youthful and naive energy was displayed to the fullest.

"Aren't you from the First Hospital of Medical University?" the patient's family member asked in astonishment.

"The main reason is that the patients admitted by the First Hospital of Medical University are from the provincial cities. Some senior professors can provide support for chronic diseases. We have never seen this kind of injury, and we don't see as many as the Second Hospital of Medical University."

"The Second Hospital of Medical University? Yes, yes, yes. I heard that the level of the Second Hospital of Medical University is higher than that of the First Hospital of Medical University." A patient's family member who had been silent suddenly said.

"Yes, especially for this kind of emergency injury, we are really unsure." Miao Youfang sighed, "We still recommend hospitalization, otherwise no one would dare to do it. If the bleeding does not stop after the removal, we will have to go through the hospitalization procedures. By then, we will be busy and nagging, and it will be bad if other things happen."

The more Miao Youfang spoke, the less confident he became, and the smaller his voice became. He even looked hunched over, with an embarrassed look on his face.

Even his temperament changed, which made Luo Hao almost laugh.

It is obvious that Miao Youfang's acting skills are also good.

"You have the nerve to call yourself the largest hospital in the province?!"

"Alas, it has not been like that for a long time. The Second Hospital of Medical University is of higher level than ours." Miao Youfang sighed deeply and said in embarrassment.

The orthopedic surgeon behind me was picking his toes so hard that he lowered his head and almost hit the ground.

"Really? What should we do?" asked a patient's family member.

"In fact, it is divided into different diseases. For chronic diagnosis, our levels should be similar." Miao Youfang seemed to be making a final and useless "quibble".

But his voice became smaller and smaller, softer and softer, as if he knew he was lying.

The patient's family members were a little angry and started cursing, especially because a hospital of the level of the First Hospital of Medical University actually admitted defeat and said that it was not capable of doing anything. They were also a little confused.

But what the young doctor said seemed to be true, and he even sought compensation for the First Hospital of Medical University.

There is no use in scolding, so after a brief discussion, the family decided to transfer the patient to the Second Hospital of Medical University.

The orthopedic surgeon lowered his head and kept picking at his toes, and had already touched the national defense optical cable.

When the emergency surgeon heard that the patient was going to be transferred to the Second Hospital of Medical University, he hurried out and began to explain some things to the patient's family.

Luo Hao guessed that the 120 ambulance fee would not be charged.

As for the issue of missed fees on this bus, each emergency department has a certain amount of missed fees allowed. In order to appease patients and their families, emergency surgeons use their own quota on this to avoid too much resentment from patients and their families.

After the patient with the rake got on the 120 ambulance and left, the emergency department finally became quiet.

Luo Hao smiled, waved, and came to the fire escape.

Miao Youfang lowered his head in frustration, "Teacher Luo, this is the best way I can think of to deal with the problem."

"What if the patient's family complains?" Luo Hao was not in a hurry. He sat on the stairs and patted the ground beside him.

Miao Youfang sat next to Luo Hao and said, "If you complain, I am not even an intern and cannot represent the First Hospital of Medical University."

"Why do you seem to be in a bad mood?" Luo Hao asked with a smile.

"Teacher Luo, I...I...I..."

Luo Hao didn't say anything, he just took out his mobile phone, found the "Cyber ​​Smoking" app and started to play it.

"I feel like I haven't done what a doctor should do." Miao Youfang finally sorted out his thoughts and said to Luo Hao.

After finishing speaking, Miao Youfang felt that his expression was still not clear enough, but he didn't know how to say it.

"Very good." Luo Hao said calmly, "There are some solutions to similar problems, but the solution you chose is quite standard, which is what we usually call passing the buck. Don't underestimate passing the buck, being able to do it well is also a skill."

Miao Youfang has some methods.

In his opinion, he had become the kind of person he hated the most within less than a month of entering the clinic.

"Do you think you have become the most annoying type of person?" Luo Hao asked with a smile, as if he could see into Miao Youfang's heart.

"Yeah." Miao Youfang was stunned, but still nodded.

"Don't be like that. After a long time in the clinic, you have to make choices." Luo Hao said, "If you can cure everything, you are not a doctor, you are a god."

"But this patient's injury can be cured."

Miao Youfang was a bit stubborn, which was completely different from his previous behavior when he gave in and brought shame to the First Hospital of Medical University.

"But the patient and his family said they didn't want to be hospitalized." Luo Hao advised, "This is still the simplest case. There are many other complicated cases. I will give you an example."

"For example, if an 80-year-old patient comes to the emergency department from a county hospital in a coma and his family knows nothing about his medical history, what are you going to do?"

Luo Hao's question is beyond the scope of the syllabus.

In theory, there are no such patients in the interventional department, and Miao Youfang may never need to know the answer in his entire life.

But after Luo Hao asked, Miao Youfang began to think seriously.

He sat next to Luo Hao, listening to people walking back and forth in the corridor outside, and the silent sound of the nurse pushing the IV cart with its wheels.

Luo Hao was not in a hurry either.

After about a minute, Miao Youfang asked, "Teacher, is it because of DRG that we can't accept it?"

Luo Hao smiled slightly, "There are two general considerations - first, the elderly are in a coma and have many underlying diseases, so the DRG limit is definitely not enough. If the amount exceeds the limit, the medical insurance will deduct the hospital, and the hospital will deduct the department, but it will deduct the individual's money, so we dare not collect it."

"Secondly, the patients' families had high expectations, hoping that the patients would recover or regain the most basic self-care abilities. The clinicians judged that this was not possible and it was completely unable to meet the expectations of the patients' families, so they did not dare to admit the patients."

Miao Youfang was a little depressed because he didn't dare to accept two in a row.

"Let's talk about the first one first. In some areas, eicu is fully self-funded and does not use medical insurance. It is common for patients to be placed in the emergency department and other departments for consultation and treatment at the same time."

"If we admit such patients, we will almost 100% lose money. If the department has a big surplus, it doesn't matter if we occasionally admit two patients. But if you always admit them, you will be deducted money every time, and not just your own money. Gradually, the nurses in the department will look at you with strange eyes, and you will have difficulty in carrying out your medical orders.

From now on, no matter what you do, you will feel insecure. If your level doesn’t deteriorate, let alone improve, it means you have a strong psychological quality.”

"..." "This has to do with the overall environment. Don't learn from them. They don't care about the overall environment. It's all nonsense to say that the strong can change it. It's right to go with the flow. Want to change the environment? That's nonsense."

"Teacher, what should we do?" Miao Youfang asked vaguely.

"How would I know?" Luo Hao laughed, pressed his fingers hard on the screen of his mobile phone, and seemed to be taking a deep puff of cigarette.

As his fingers moved away, Luo Hao patted Miao Youfang's shoulder vigorously, "This is the general environment, so you have to get used to it and adapt to it."

"Is there really no way?" Miao Youfang asked Luo Hao in a daze.

"Of course."

"???"

“The strong change the environment.”

Luo Hao had a boomerang hit him in the face, but he seemed not to feel it and said calmly, "How strong are you? Only when you can reach my level can you consider such a thing."

“……”Miao Youfang stared in amazement.

Is Mr. Luo praising himself?

Praising yourself so blatantly?

But after a period of contact, Miao Youfang was very clear about Teacher Luo's strength.

The diagnosis is clear and clear, especially for some "weird" diagnoses, Mr. Luo can always follow the clues to find the truth.

This personal ability is so strong that it is astonishing.

"I summarized it and generally speaking, there are three things that cannot be solved. Pay attention to them."

"Teacher, please go ahead." Miao Youfang took out a black notebook and a ballpoint pen with the name "Meng Liangren" written on it.

Luo Hao saw it and smiled, but did not say anything about ordering a custom ballpoint pen for Miao Youfang.

“The disease can’t be dealt with, the patients can’t be dealt with, and the medical insurance can’t be dealt with.”

Miao Youfang wrote down these three items one by one in his notebook.

His handwriting is ugly and very awkward.

"If you can't handle these three things, you must be careful. I'll talk a little more, don't think I sound too much like your dad."

"Teacher, tell me, why would I think that?" Miao Youfang quickly explained.

“First, the disease cannot be cured.”

Luo Hao counted on his fingers again and explained in a very scientific way, "For example, a few months ago, there was a patient who was poisoned by paraquat. The disease could not be cured. I immediately called Brother Che from Qilu and had a video consultation all the way, and the patient was cured."

"Ah? Isn't paraquat poisoning a sure death? Can it be saved?" Miao Youfang was stunned.

"What you said is all old news. Go back and ask Lao Meng to take you back to the beginning of the medical record."

"it is good."

"Similar situations are not uncommon. For example, I just encountered a mushroom poisoning incident at our Union Hospital. At that time, I called Brother Lou from Nanyun. They have a lot of mushroom poisoning patients and are very experienced."

Miao Youfang wanted to record it, but didn't know where to start.

"No need to remember, let's just chat. This is my first time teaching students, I usually teach my junior brothers and sisters, so I don't have much experience." Luo Hao smiled slightly, "Next, I will tell you about the situation where the patient can't handle it."

"Some of these cases involve patients' families having high expectations, and the clinical treatment effect is completely unsatisfactory, which may lead to medical disputes. Another reason is that people come to the hospital to blackmail them."

Luo Hao told Miao Youfang about the patient that Wen Youren was seeing.

Miao Youfang listened quietly. Luo Hao didn't think that he was not serious or did not actively give him feedback. Instead, he felt that this young man's brain was about to burn out the CPU.

After all, we may not understand the evil of human nature.

"Finally, the most troublesome thing is that medical insurance cannot be solved. This problem can only be solved in the process of development. From our current perspective, there is no solution. It is just like more than a hundred years ago, tuberculosis was an incurable disease; just like cancer is an incurable disease now."

"Of course, some cancers are now curable. I heard that the United States has developed a cure for cancer, but I don't know when it will be available."

"Ah? Shouldn't we enter the clinical trial stage after the research?" Miao Youfang asked in surprise.

This child is so naive, Luo Hao smiled.

"When did Dolly the cloned sheep appear? It's been almost 30 years. What about now? Can you still see any reports about cloning? There are only fragmentary and scattered reports. It is still a million light years away from entering the vision of ordinary people."

“It should involve medical ethics.”

"No, this part of the content was sealed up by powerful people as a technology that they enjoy alone." Luo Hao said firmly.

“……”Miao Youfang was speechless.

Luo Hao placed his hand on the screen of his mobile phone and took another deep puff of cigarette.

"Oh."

"Some things should be done this way under the current conditions. What you just encountered was the second type - a situation that the patient couldn't handle." Luo Hao concluded, "You handled it very well."

"Can……"

"The level of the Second Hospital of Medical University is poor? Not necessarily. Sending the patient there will not delay the patient's treatment. It's okay." Luo Hao laughed.

“But we can cure it.”

"Pushing the trouble to others is also a kind of attitude. Don't think too much. You did a good job today, especially some small details are worth recalling." Luo Hao praised, "Regarding the things here, you should think more about it when you go back and keep up the good work."

"..."

Miao Youfang never expected that Teacher Luo would give him such a high evaluation, which made him a little overwhelmed.

The strong conflict of three views made Miao Youfang a little confused.

"Oh, don't think too much. It's hard for people in the medical insurance industry to do their job, mainly because there are not many people who know the business." Luo Hao stood up and patted Miao Youfang on the shoulder. "In DRG, cerebral hemorrhage is given a quota of more than 2 yuan, and severe pancreatitis is also given more than 2 yuan. Isn't that nonsense?

For severe pancreatitis, it’s good to be discharged from the hospital after paying around 5 to 10 yuan on average.”

"In this case, the larger the tertiary hospital, the easier it is to do business. One of my seniors works in the oncology department of a hospital in the imperial capital, but he doesn't even know how to use painkillers."

"Ah?" Miao Youfang exclaimed again. What Luo Hao said was unimaginable to him.

"Because they only accept patients with mild cases, patients with advanced cancer are sent to local hospitals or subordinate medical alliances. They don't accept them at all and have never seen them."

"..."

"Don't think too much. You are busy. I'm going back." Luo Hao waved his hand and turned to leave.

Today Luo Hao had a new understanding of Miao Youfang. This young man looked honest, but once pushed to the limit, he would lie without blinking an eye.

Luo Hao felt that this child was becoming more and more interesting.

Furthermore, Miao Youfang’s final dilemma seems to be okay, which fits the image of a student who has just graduated from school and whose mind is full of thoughts about curing diseases and saving lives.

He had to do things "against his will" with the idea of ​​curing diseases and saving lives, and now he seems to be quite obedient.

Although Luo Hao had no idea of ​​PUA or obedience testing, his opinion of Miao Youfang became better and better.

I just hope that Principal Wang won't give me too many problems.

Luo Hao returned to the ward and prepared to change clothes and go to Hadong. The black-nosed sheep will be sent to Hadong in a few days and tourists will no longer be allowed to touch them at close range.

Fucking people are everywhere. Luo Hao couldn't even imagine how the metal rod was stuffed into the blacknose sheep's stomach.

As soon as he returned to the ward, Luo Hao saw Meng Liangren and Zhuang Yan standing at the elevator entrance.

"Huh?" Luo Hao was stunned. Why would Meng Liangren, the nuclear-powered donkey, leave so early?
"Professor Luo, I'm going to see a patient." Meng Liangren said apologetically.

"Well, it's time to get off work, so just leave. What patient?" Luo Hao asked.

"An old doctor in my previous department took good care of me when I first started working," Meng Liangren and Luo Hao explained. "But he had severe chronic bronchitis, and it got cold late this year, so he didn't go to Sanya. As a result, the temperature suddenly dropped in the past few days, and his chronic bronchitis suddenly flared up."

"Xiao Zhuang will drive you there?" Luo Hao smiled slightly.

"Well, I'll take Lao Meng there. It's not easy to get a taxi at this time. I'll send him back later and go home directly." Zhuang Yan explained generously.

"Okay, go ahead."

Luo Hao waved his hand and turned to change his clothes.

Before they got into the elevator, Zhuang Yan's cell phone rang.

It seemed like the call was from Zhuang Yongqiang, and Zhuang Yan felt a little embarrassed.

"You do your thing, I'll take Lao Meng back." Luo Hao said, "Lao Meng will take a taxi back later. By the way, Lao Meng, do you have a driver's license?"

"I bought my driver's license 15 years ago, but I never bought a car. Professor Luo, you know my past situation."

Meng Liangren glanced at Zhuang Yan.

"Then I'll leave first. My dad asked me to go home, saying that some relatives are coming to our house." Zhuang Yan turned and left.

Meng Liangren followed Luo Hao to change clothes.

"Take some time to learn how to drive. Having a car will be more convenient." Luo Hao and Meng Liangren chatted, "Having a car or not is two different worlds."

"Hey, yeah." Meng Liangren nodded.

"Does your old colleague usually go to Sanya?"

"Well, I guess he didn't go to Sanya this year not because the winter was warm, but mainly because the prices there were rising too fast. The price of health care apartments rose from 3000 yuan a month before the epidemic to 5000 yuan a month, and his retirement salary could no longer cover it."

"I have to go. There are many elderly diseases in Northeast China, and medical treatment costs a lot of money. It is better to go to Sanya and spend money on vacation than to spend money on medical treatment at home."

"Yeah, I heard that when Lao Xu went to Sanya for the first time, he stopped coughing after getting off the plane. It's really good for health there." Meng Liangren was a little yearning.

"Is it so obvious?" Luo Hao changed his clothes and took Meng Liangren to the garage to pick up the car.

"It's quite obvious. I didn't expect it to be like this. I didn't go this year. Old Xu has been sick so many times. I have to talk about him when we meet."

Sanya has a police station in the provincial capital. Every time the country boosts the Northeast economy, the housing prices in Sanya go up. These are facts.

The Northeast is bitterly cold and has many geriatric diseases. As a result, many people go to the South to retire. This is the general environment.

(End of this chapter)