This miracle doctor just wants to be fired!

Chen Yu's proposal was only twelve pages long, making it much simpler compared to the previous two.

The title is also straightforward and doesn't use complicated technical terms; it's simply titled "A Study on Medication Adherence and Influencing Factors in Patients with Chronic Heart Failure After Discharge."

She plans to recruit heart failure patients from the ward and follow them up one month, three months and six months after discharge to record their medication, weight monitoring, diet control and readmission.

We also need to understand the impact of age, education level, family support, and medication dosage on adherence.

Li Mingyuan opened the plan and asked, "There must have been many studies like this before, right?"

"Yes," Chen Yu said, "but we have many heart failure patients who are repeatedly hospitalized in our ward, and I want to see why they can't follow the doctor's orders after they go home."

Zhao Sisi also reviewed it: "Just conducting questionnaires and follow-ups may not be innovative enough. In the end, it's highly likely that it's related to older age, lower education level, multiple types of medications, and poor adherence."

Chen Yu pursed her lips; she knew these questions herself.

Compared to animal experiments and artificial intelligence models, her research topic does seem quite ordinary.

Without new technologies or complex algorithms, the final conclusions may have already appeared in other studies.

"Right now, I just want to figure out the reason first," Chen Yu explained. "We often say that patients have poor compliance, but the medical records usually only say one sentence: 'They didn't take their medication regularly.' Doctors rarely ask in detail why they didn't take it."

"Even if you find out the details, it's still difficult to publish high-quality articles," Zhao Sisi said.

He didn't mean to belittle Chen Yu; he was just used to judging solutions from the perspective of research output.

Nowadays, hospitals evaluate candidates based on papers, research projects, and impact factors. A follow-up study that lacks technological highlights is indeed unlikely to attract attention.

Li Mingyuan also said, "We could add some intervention measures, such as smart pillboxes or mobile phone reminders, to make it more complete."

Chen Yu nodded, wrote down the two people's opinions, but looked somewhat downcast.

After all three proposals were presented, everyone looked at Zhou Cheng.

They originally thought Zhou Cheng would comment on each one individually, or directly determine which plan could be implemented.

Zhou Cheng closed the documents in front of him and asked, "How many patients have you seen in the past week?"

Li Mingyuan said, "I mainly worked on organizing calcification cases; I followed up on four of them."

Zhao Si thought for a moment: "Six, all of them are patients who have undergone interventional procedures."

Chen Yu, who spends the longest time making rounds each day, replied, "Eleven heart failure patients."

Do you know how they live after being discharged from the hospital?

None of the three spoke; they knew quite a bit about the situation in the ward.

The patient's medical records contain information about the medications used, test results, and adjustments made to the treatment plan.

As for who takes care of the patient after they return home, where the medication is kept, how they take it every day, and what difficulties they encounter during follow-up visits, very few people actually follow up on these matters.

Zhou Cheng glanced at the time: "Your plan will remain unchanged for now. Starting tomorrow, each of you will select ten patients and follow up with them for a week."

Zhao Sisi asked, "Is it necessary to standardize the disease categories?"

"No need. Select patients whose cases are relevant to your research. Mingyuan will follow up on patients with severe calcification or complex interventions, Siyuan will follow up on patients after PCI, and Chenyu will continue to see patients with heart failure."

"What exactly should be recorded?" Li Mingyuan asked.

"Don't rush to apply the questionnaire," Zhou Cheng said. "Accompany the patients through their examinations, treatments, and discharge preparations, and talk to them. If you can contact their families, ask them too. Come back in a week and revise the research questions."

Zhao Sisi asked, somewhat puzzled, "What can change in a week?"

Zhou Cheng returned the three plans to them: "Most of the questions you've raised come from the literature and your own assumptions. First, see if the problems the patients are facing are the same as what you've thought."

This concludes the group meeting.

After leaving the meeting room, Zhao Sisi was still pondering her data solution.

Li Mingyuan then began calculating the animal experiment time, considering whether the follow-up points could be shortened, or whether a small-sample preliminary experiment could be conducted first.

Chen Yu walked at the back, carrying the documents, feeling somewhat uncertain.

She was well aware that her proposal lacked any highlights.

If the study only proves that older patients and those taking more medications have lower adherence rates, then it is not very meaningful.

But the longer she stayed in the ward, the more she felt that the phrase "poor compliance" was too simplistic.

Many patients are repeatedly hospitalized, and doctors usually attribute the cause to not taking medication on time, not restricting water intake, and not weighing themselves every day.

As for why they can't do it, usually no one goes on to ask.

The next morning, Chen Yu screened out ten heart failure patients from the ward.

One of the elderly men, surnamed He, is 74 years old and has been hospitalized five times in the past two years.

Each time I was admitted to the hospital, I had shortness of breath and lower limb edema. The symptoms were relieved after diuresis, but I would come back not long after being discharged.

The medical record repeatedly stated "poor adherence to medication outside the hospital," and the nurses also mentioned during the handover that the elderly patient often couldn't remember the names of the medications.

When Chen Yu first went to the bedside, Old He was tidying up the bedside table.

There were several plastic bags in the cabinet, each containing a different medicine box.

Some of the pills were taken before this hospitalization, some were taken from the last time I was discharged, and a few medicine boxes have been opened with pills scattered inside.

"Grandpa He, do you usually take these medicines?" Chen Yu asked.

The old man looked at the cabinet, somewhat embarrassed: "Food."

"What should I eat every day?"

"Eat it once in the morning and once in the evening."

Chen Yu picked up one of the medicine boxes; it contained spironolactone.

"How many times a day?"

The old man glanced at it and said, "Eat it both morning and night."

In fact, the discharge instructions stated once a day.

She then picked up sacubitril valsartan: "What about this one?"

"It seems like this is also once a day."

The medical record states that the treatment plan is twice a day.

Chen Yu thought the old man just had a bad memory, so he rearranged the medicine box according to morning, noon and evening, and took out a piece of paper to write a clear medication schedule for him.

The old man watched her write for a while, then suddenly took out a stack of folded papers from the bottom of the bedside table.

"Doctor, I still have these at home."

Chen Yu took them and found that they were all the medication prescriptions the elderly man had received when he was discharged from the hospital several times in the past.

On the first chart, furosemide is taken twice daily, and spironolactone is taken once daily.

The second prescription was issued due to changes in kidney function, with furosemide dosage reduced and sacubitril and valsartan dosage discontinued.

The third prescription reverted to sacubitril/valsartan, and the metoprolol dosage was also adjusted.

A recent case from a community hospital showed that the doctor added another antihypertensive drug to the original treatment plan, but did not specify whether the original drug was discontinued.

The names, dosages, and frequencies of the medications on the several prescriptions kept changing.

The hospital's printing format was different, with brand names and generic names mixed together. Some of the medications had already been discontinued, but the elderly person kept them.

Each time he was discharged from the hospital, he would take the new medication home and put it in the same drawer as the old medication.

"Which prescription do you usually follow?" Chen Yu asked.

The old man stared at the papers for a while, then shook his head.

"I don't know which one is the current one. Sometimes I take the one from last time, sometimes I look at what's written on the medicine box. When my daughter comes back, she'll give me a few days' worth. When she's not here, I just take it based on my memory."

"The doctor said you weren't taking your medication on time. Why didn't you tell them you couldn't understand it?"

The old man rubbed his hands together, his voice lowering slightly: "The doctor is always very busy and speaks very quickly. I'm afraid if I ask too many questions, they'll find me troublesome. Besides, I recognize all these characters, but when I get home and put them together, I can't distinguish them."

Chen Yu looked down at the row of medicines on the table.

The elderly man did not refuse treatment, nor did he deliberately take less medication.

Every time he was hospitalized, he listened carefully to the doctor's instructions.

Every time I was discharged from the hospital, I brought all the medicine home with me.

Just a few constantly changing medication prescriptions stacked together would take even a young person time to check, let alone a seventy-year-old living alone.

She originally planned to research why patients were unwilling to take medication.

At this moment, she realized that she had asked the wrong question from the very beginning.

It wasn't that Mr. He was unwilling.

He just didn't know which slice he should eat today...