This miracle doctor just wants to be fired!

Chen Yu originally only intended to record Old He's medication situation.

When she checked on the patients the next day, she discovered that things were much more complicated than she had imagined!

The first page of Mr. He's medical record states that he is married, and his daughter is listed as the primary contact person.

According to the information in the medical records, the elderly person does not seem to lack family care.

But after talking to him a few times, Chen Yu learned that his wife had passed away five years ago and his daughter worked in a neighboring city, returning home at most twice a month.

He usually lives alone, and he has to manage everything himself, from grocery shopping and cooking to taking his medication.

"Can't your daughter take you to live with her?" Chen Yu asked.

Old He shook his head: "Her house is small, and she has two children. Her son-in-law is also busy with work. If I move in, it will be inconvenient for everyone."

He spoke calmly, clearly having long accepted this kind of life.

His daughter would pick him up during holidays and often call him.

But while the phone can remind him to take his medicine, it can't help him identify the dozen or so medicine boxes on the table.

……

After asking carefully, Chen Yu learned that Old He's eyesight was also poor.

He was diagnosed with cataracts two years ago, and the doctor recommended surgery. However, he was worried about the cost and felt that he could still see, so he didn't seek treatment.

The large print on ordinary newspapers is barely legible, but the densely packed small print on medicine boxes can only be deciphered by holding them up close.

The medicine boxes in the bedside table looked very similar.

Two of the boxes came from different manufacturers and had completely different product names, but the actual ingredients were the same.

Mr. He always treated them as two separate medications, sometimes taking one tablet of each in the morning, which was equivalent to taking them repeatedly.

The other box of antihypertensive medication contained diuretics. The old man said that after he was discharged from the hospital last time, his daughter helped him divide up a week's worth of medication, and later the remaining pills were mixed together.

Seeing that the colors were similar, he casually put them into the empty box.

Upon hearing this, Chen Yu felt a chill run down her spine.

When the elderly patient was admitted to the hospital this time, he had mild hypotension and fluctuations in renal function. Initially, everyone thought it was due to insufficient effective circulating blood volume after the progression of heart failure.

It now appears that repeated use of antihypertensive drugs and diuretics outside of hospitals may also be contributing factors.

What's more troublesome is that he himself had no idea that he had taken the wrong medicine. Every time the doctor asked if he had taken it on time, he would seriously answer, "I take it every day."

From the old man's perspective, this statement was not a lie.

Every morning after he gets up, he sits at the dining table and opens the medicine boxes one by one.

If you encounter an unfamiliar medicine, try to recall what the doctor told you last time; if you really can't remember, guess based on the size and color of the pill.

He took a lot of medicine, but the dosage varied.

Sometimes I miss taking metoprolol for several days in a row, and sometimes I combine two similar antihypertensive drugs together.

Chen Yu recorded these details in the follow-up form and contacted Mr. He's daughter again in the afternoon.

When the call connected, the other person was at work. Upon hearing that the father had been taking the wrong medication for a long time, they remained silent for a while.

"I always divide it up for him every time I go back," said Mr. He's daughter, her voice filled with obvious self-reproach. "I even bought a seven-day medicine box with compartments for morning, noon, and night."

"Will he know how to use it?"

"I taught it."

"After you finish the medication, who put it in the next week?"

The other end of the phone went silent again.

The daughter sighed over the phone: "He puts it in himself. I can only remind him via video call. Sometimes when I see him holding the medicine box, I think there won't be any problem."

The seven-day pillbox solves the problem of short-term medication, but it does not address the issues of medication changes and declining vision in the elderly.

Each time medication is adjusted during hospitalization or outpatient visits, the old medications are not disposed of in a timely manner, while new medications are constantly added.

The prescriptions kept piling up, and the contents of the medicine box became more and more chaotic!

……

Chen Yu did not rush to finalize her research plan that day.

She checked all of Mr. He's current medications again, asked the attending physician to confirm the latest treatment plan, and then worked with the nurses to make a large-print medication schedule.

Next to each medicine was a picture of the pill, with the sun, moon, and bowls and chopsticks representing morning, evening, and after meals, respectively.

All the discontinued medications were packed into a separate bag for the daughter to take with her when she next visits the hospital.

The nurse glanced at the form and smiled, "This is much clearer than our discharge form."

"The discharge form is correct, but the print is too small, making it difficult to compare after the medication is changed."

"The forms in the hospital are for doctors to see." The nurse picked up Mr. He's medicine box. "Whether the patient can understand them or not is rarely taken into account."

Chen Yu listened without responding.

She added a line to her notebook: "Comprehensibility of medication information".

……

At the same time, Zhao Sisi was also tracking the ten patients she had selected after coronary intervention.

Her method of selecting patients aligns well with her research habits.

Among the ten individuals, there were elderly patients, diabetic patients, and patients with complex bifurcation and long lesions, indicating a very even distribution of risk levels.

She input each person's clinical data into her initial model, preparing to compare the model's predicted results with the actual follow-up situation.

For the first few days, everything went smoothly.

After variables such as age, blood pressure, kidney function, ejection fraction, number of lesions, and stent length are entered, the model can quickly generate a risk score.

Several patients with complex conditions scored higher, while patients with common lesions scored relatively lower, which generally aligns with clinical intuition.

The model first encountered trouble when she followed up with the fifth patient.

The patient, surnamed Wu, is 63 years old. He underwent emergency interventional treatment for acute myocardial infarction six months ago and was admitted to the hospital again this time due to chest tightness.

Follow-up angiography did not reveal in-stent restenosis, and cardiac function remained stable.

According to Zhao Sisi's model, the risk of patients experiencing another cardiovascular event within a year is not high.

However, upon reviewing his medical records, it was found that Mr. Wu had visited the hospital four times within the past six months.

Two emergency room visits, two hospitalizations.

Zhao Sisi initially thought that the patient's chest tightness might be due to anxiety, and that such a visit to the doctor might not necessarily be considered a cardiovascular event.

He continued to press for answers and discovered that Mr. Wu rarely had regular follow-up visits after being discharged from the hospital, had stopped taking antiplatelet drugs for more than ten days, and had also taken lipid-lowering drugs intermittently.

The reasons are neither complicated nor uncommon.

The patient and his wife run a breakfast shop. They get up at 3:30 a.m. every day. They are busy in the morning and often forget to take their medicine. After catching up on sleep during the day, they can't tell whether they have eaten or not.

Once, when he was about to go to the hospital for a follow-up visit, the store received a group order at the last minute.

After discussing it, the couple felt that they did not have any obvious discomfort, so they postponed their follow-up appointment for a month.

This information is not recorded in the medical record database.

The database only contains two sentences: "mediocre medication adherence" and "failure to attend follow-up appointments on schedule".

As for what time patients get up each day, their work rhythm, and why they forget to take their medication, there are no structured variables that can be presented.

……

After learning about these factors, Zhao Sisi tried to incorporate "poor compliance" into the model, but found that the hospital's past data records were extremely inconsistent.

Some medical records describe regular medication use, some describe basic medication use, some only record the name of the medication, and many medical records do not mention it at all.

Even if we manage to convert the text into variables, it is still difficult to guarantee that different doctors will have the same criteria for judging "patterns".