Come on, Dr. Wu

Chapter 422: Guidelines, urgent

The latter operation was performed by Wu Xiaofu.

Duodenectomy plus subtotal gastrectomy with gastrojejunostomy.

The operation was perfect, but the patient had severe duodenal perforation, diffuse inflammation in the body, and a large area of ​​peritonitis with obvious signs of inflammation.

Even if anti-inflammatory treatment is given after the operation, the inflammation will not go down for a while, and even the wound will be red and swollen. There is a fear of infection if the dressing is changed every day.

Coupled with the two operations in a short period of time, the patient was further exhausted.

There was no other way. It had already reached this stage and the patient had to continue with the treatment. Corey was also very concerned about the situation, and the treatment lasted for two months and cost more than $300,000.

Yuna had to transfer wards eighteen times almost every day.

"It has already happened, so let's just take it as a warning. I don't want the same thing to happen again, but every failure is a learning experience.

There are a few points that patients with abdominal pain, including those I treat, must pay attention to.

First, the medical history from outpatient clinics in other hospitals must not be trusted completely and can only be used as a reference. You must inquire about the medical history in detail and conduct physical examinations to obtain first-hand information.

After obtaining first-hand information, what is more important is thinking, especially for some old doctors.

Because they are old doctors with clinical experience, they can often determine what disease the patient has after taking a brief medical history.

It’s all too easy to miss something in this situation.”

Having said that, Wu Xiaofu looked at Yuna again.

Time passed quickly. Yuna was actually an old doctor at this time. The busy work in Area F had made Yuna grow up.

At this time, Yuna can take on most of the work in Area F and can be said to be able to handle it on her own.

This time, Yuna also made the mistake of having preconceived ideas about this patient. After you have diagnosed the patient with gallstones, unless there is sufficient evidence to support the diagnosis later, this preconceived diagnosis will not change.

This time Yuna did not lower her head again. She met Wu Xiaofu's gaze and stood up directly.

"Boss, I take full responsibility for what happened this time. I will bear any punishment. I admit my mistake, and I promise that I will never make such a mistake again. I promise."

Yuna's words were very firm. In fact, everyone had seen Yuna's attitude over the past two months. Not only was she dedicated to this patient, she was also much more cautious with other patients. Not to mention major illnesses, she had basically never had any minor ones.

However, in Wu Xiaofu's opinion, this is a bit of an overreaction. If Yuna really continues like this, she will be exhausted in a few years.

The effect is also significant. The patient was not concealed in the department, nor could he be concealed. He came to the hospital with stomach pain, and originally thought it was just a gallbladder problem.

Now, my gallbladder and stomach intestines are all in trouble.

The medical expenses definitely cannot be given to the hospital. In addition, the patients and their families are also demanding compensation.

This is also the reason why Wu Xiaofu started with "two months, three hundred thousand". It is not realistic to ask the patient for three hundred thousand because of the surgical accident, and the treatment cannot be stopped just because the medical expenses are not enough.

Therefore, these three hundred thousand yuan can only be paid by the department. If the department pays, Wu Xiaofu and his team will have to pay for it.

No matter how much performance bonus is calculated this month, the more than 300,000 yuan will have to be deducted before it can be paid to Wu Xiaofu and others.

Undoubtedly, this month, next month, and even the month after, the performance of Wu Xiaofu and his entire department will drop significantly.

This is also one of the reasons why Wu Xiaofu held this meeting. Yuna wants to bear the cost, but Wu Xiaofu cannot really let her bear it, and most of the doctors in the department cannot agree.

But disagreeing doesn't mean that you don't have any thoughts in your mind, so it is necessary to hold a meeting and talk things out, and the main thing is to let them all learn a lesson.

"Then I will bear half of the three hundred thousand as the department director, and the rest will be deducted from your performance every month until it is all deducted."

"No, this won't work. Just deduct my money. Boss, this is my mistake. It's because you helped me clean up the mess that it didn't get to the point where it's irreparable. How can I cause you to be deducted money? No, this is absolutely not possible."

Hearing Wu Xiaofu's words, Yuna quickly waved her hand and others also hurried to stop him.

"Boss, we are all from the same department. It is normal for problems to occur. We may also have problems. Besides, we are a whole. If there are problems, we have to bear the responsibility together."

"Yes, Boss. If you want to deduct money, let's deduct it together. We will share the burden. It will only be tight for a few months and it will be over in no time."

"Yes, we should buckle them together."

……

Everyone spoke up at this point, and they were not just saying it for the sake of face. No one likes to be deducted from their salary. After working hard for a month, their hard-earned money is deducted. It would be strange if they felt comfortable about it.

However, these doctors all have a sense of collective honor in the department, especially when the department has just been established for a few months and is thriving, the sense of collective honor is even stronger.

From the moment they said these words, they no longer cared about the money, and they thought more about the patient that Yuna met. If they encountered the same patient, they might not be able to avoid this pitfall perfectly.

If Yuna and the others don’t take care of it this time, what will they do if they encounter similar things in the future?
Are you also responsible for it?

Wu Xiaofu looked at the expressions of the crowd and couldn't help but smile. "Okay, it's good that everyone has this intention. Then let's do it together. We usually calculate the performance, and we will deduct according to the proportion. Let's get through this difficult time together."

The deduction of money is not the main issue, Wu Xiaofu can use the money from the department's public account, but this is a rare opportunity to gather the department's sense of honor, which cannot be missed.

As for the deductions, they will be deducted proportionally, with more being deducted from those who earn more and less being deducted from those who earn less. If the deductions are spread over several months, it will not be that obvious and will not affect everyone's living needs.

Faced with everyone's help, Yuna could only express her gratitude.

“As I said, if you have abdominal pain that doesn’t match the symptoms, you must think twice and do further examinations. Even if you feel something is a little wrong, you can’t let it go.

It's easier to say and do anything beforehand, but it's difficult to make up for it afterwards.

Also, you must be careful when using tramadol or pethidine to relieve pain, and be sure to distinguish whether it is an effective pain reliever or an ineffective pain reliever.

We need to know that if patients stop crying out in pain, it does not mean that their illness is gone. On the contrary, for us, it means that we have lost an indication for diagnosing the disease.

Then there are the conditions discovered during the operation. If there is any discrepancy between the conditions and the preoperative abdominal pain, it will be a greater test for the surgeon.

We have encountered many similar cases, including one where someone felt something was wrong after an appendectomy and found that it was a small perforation of the duodenum.

Last time, the painkiller injection in the emergency department before the operation covered up the abdominal pain symptoms, and the gallbladder had already adhered and blocked the perforation site, covering up the abdominal signs. Fortunately, we discovered it during the operation, otherwise we might have the same problem as now. Abdominal pain is easy to solve, but it is also the most challenging for us doctors. Ordinary differential diagnosis is really an endless pitfall.

As surgeons, we have a heavy baggage to carry. We must never perform surgery without identifying the specific cause of the disease.

You should not have surgery just for the sake of having surgery.

Remember, after eliminating all possibilities, what remains is the truth.”

Speaking of this, Wu Xiaofu frowned. The guidance work must be completed as soon as possible.

After a period of hard work, Wu Xiaofu and his team not only gathered together general surgery experts and professors to formulate general surgery diagnosis and treatment guidelines, but also mobilized other departments and specialties.

However, this is a huge project after all. Even with more people, more strength, it cannot be completed in a short time. Two months have passed, and only the general surgery department has made a slightly faster progress, while the others have been slower.

According to Wu Xiaofu's estimation, if everything goes well, it will probably take another year to complete the diagnosis and treatment guidelines for general surgery.

In fact, as the formulation process began, people felt that the guideline was very good. After all, the previous diagnosis and treatment guidelines were too old. There were slight adjustments every year, but everyone had their own opinions. Many local hospitals are still using guidelines from ten years ago.

For example, propranolol, used in cardiology, is basically no longer used in major tertiary hospitals, but it is still widely used at the grassroots level, and even the textbooks have not been changed.

Medication is still the main recommendation.

To be honest, Wu Xiaofu is not exaggerating when he imagines that once the new generation of treatment guidelines are completed, it will directly advance China's medical level by more than several years.

Thinking of this, Wu Xiaofu felt that the progress should be accelerated.

In the ward.

After the meeting, Wu Xiaofu brought Yuna and others to the ward. After two months of treatment, the patient, Old Sun, had almost recovered.

The process was tortuous, but fortunately the result was still controllable. Wu Xiaofu chose to hold the meeting at this time because the patient could be discharged from the hospital.

Now that issues such as cost have been resolved, we can give patients an explanation.

"Old Sun, how are you today?"

At this time, there were a lot of people surrounding the patient's bed. At the beginning, the patient was accompanied by only two family members for the operation, but as problems arose later, more and more family members of the patient gathered together. As of today, the number of family members of the patient has reached more than a dozen.

Whether it is to take care of patients or to build up momentum, Wu Xiaofu and others have no objection. Now the First Affiliated Hospital has implemented a no-family system in the wards.

Except for seriously ill patients, patients' families are not allowed to stay in the hospital at night. There are special nurses in the wards, and no extra charges are made, all for the professional management of the hospital.

But sometimes patients insist, like this patient. The hospital originally gave people a chance to talk, but now the patient's family wants to stay in the hospital, saying that they are worried about the hospital and want to watch him. The hospital has no choice but to let the patient's family stay.

However, there are more and more family members of this patient, and Wu Xiaofu is also having a headache. He is not worried about the lack of care but the uneven distribution of care. Other patients have complained about this many times. Fortunately, Old Sun can finally be discharged from the hospital.

"I feel fine today. I'm almost pain-free. I even walked twice."

Old Sun hurriedly spoke after hearing this, but his smile didn't last long as a woman rolled her eyes at him. Old Sun quickly shut up and just gave Wu Xiaofu an embarrassed expression in response.

In fact, Old Sun didn't make any fuss. His only wish was to be discharged safely from the hospital. This woman was the patient's sister-in-law, and she actually brought all these family members here.

Now it is this eldest sister-in-law who is in charge of the ward.

"That's good. You've recovered well and can be discharged from the hospital today."

Old Sun was even more delighted when he heard this. His thought was simple. Being able to be discharged from the hospital meant that he was cured. This was better than anything else. It had been two months and he was tired of the torment.

But the patient's sister-in-law squinted her eyebrows and said, "Discharged? What's the explanation?"

statement!

This is also what the patient's family has always insisted on. The other families are also right, and they really should be given an explanation.

Just in time, the medical department also arrived.

"As for the explanation, Chief Chen from our Medical Department is here. You can go to the Medical Department to talk with her."

After saying that, Wu Xiaofu asked Chief Chen from the Medical Department to come over, and then he came in front of Lao Sun and began to explain the precautions after discharge, as well as the elements of follow-up visits.

As for discussing matters, professional matters should be left to professionals. Doctors are there to treat illnesses, and these conversations are not what they are good at. In fact, a large part of the existence of the medical department is to deal with this matter.

Now that the department has reached a conclusion, it will be easier to discuss with the medical department. The most important thing is that the patient has recovered well and can be discharged from the hospital. This is the basis for discussion.

If the patient is well, everything is easy to talk about; if the patient is not well, nothing is easy to talk about.

Yuna wanted to leave her contact information to Lao Sun, but Wu Xiaofu stopped her and gave his own contact information instead. One reason was that he would be personally responsible for the patient's recovery, and the other was that he was afraid that the patient's family would contact Yuna later.

Yuna felt guilty and was afraid that she would be caught and would not be able to concentrate on her medical treatment. It would be better for her not to have any contact with him again.

This was actually just an episode in the ward. That's how the management department is. How could everything go smoothly? It is impossible for Wu Xiaofu to pay attention to everything and check everything.

Wu Xiaofu basically doesn't watch minor operations like Lao Sun's now, and he won't pay much attention to it in the future because of this incident. There are too many things to do and he really can't handle it.

This incident cannot be said to be a bad thing for Wu Xiaofu and others. At least after this incident, Corey will not make such a mistake easily again.

After dealing with Old Sun's matter, Wu Xiaofu went straight into surgery. Just one operation. After this operation, Wu Xiaofu had to attend a meeting.

This is a patient introduced by Wu Xiaofu's aunt Wu Nanqing. They are relatives, so Wu Xiaofu has to do the treatment himself. The patient's condition is not actually serious, but it is quite interesting.

It's the end of the year and all units are organizing physical examinations. This patient was also diagnosed during the physical examination. After the abdominal CT scan revealed the problem, he also came to the hospital for an enhanced CT scan.

Masses occupy the outer edge of the right liver lobe and the lower edge of the spleen, and the bilateral renal artery branches supply blood. The sizes are: 8*5cm and 5.5*2.8cm respectively. Consider: benign tumor lesions, hemangioma? Epithelioid hemangioendothelioma?

Both conventional CT and enhanced CT showed benign tumors, but no one can be at ease once a tumor is involved, no matter whether it is benign or malignant.

So, they asked Wu Xiaofu to help cut it off.

(End of this chapter)