Medical road

Once a person's mind is involved in interests, it will become very complicated.The Chasu City Hospital directly issued consultation letters to the Affiliated Hospital, General Hospital and Provincial Hospital of Bird City.

To be honest, this kind of invitation letter has no effect.There is a clear fee standard for such consultation fees.Online consultation is 20 yuan per sub-high and 30 yuan per orthodox.The highest consultation fee between hospitals is 1,000 yuan.

Therefore, science and technology are becoming more and more advanced, and various communication conditions are getting better and better, but network consultations and consultations between hospitals have not been developed.The hospital consultation system, which was built with huge sums of money, was left unused.

Higher-level hospitals force each chief doctor to handle how many network consultations within a prescribed time period.This kind of consultation is usually for more complicated or special diseases, which is a waste of time.

The superiors force the number of consultations, and withhold part of the consultation fees, which are mostly large.Then, the chief physicians of various major hospitals began to act perfunctorily or arrange young doctors in the department to replace him.

If there is a relatively simple disease that the lower-level hospital requires consultation, or the lower-level hospital handles it unreasonably, there will be cases of ridicule wherever the protection is not complete.

Immediately afterwards, the doctors in the lower-level hospitals lost their motivation.The local is not good, or go to the transfer hospital, he is not guilty of being ridiculed by others for the sake of sickness.As for whether there are lower-level doctors, who suffer from various discomforts, apply for online consultation for the sick number.

Yes, but not many.Are there any superior doctors who have a very kind and serious attitude, but they are not in the majority.The consultation between hospitals is even more exotic.The one who can come is definitely not the authority of any hospital department, and the name of the hospital is just a proof for the lower-level hospital.

What the Chasu City Hospital wants is this title, and what it wants is this officially recognized certificate.In two days, the patient's medical record was completed.

Zhou XX suffered a fracture of the right humerus due to a fall accidentally after being drunk.In the Tea City Hospital, the treatment was performed by incision and internal fixation.Before admission, the patient had poor blood sugar control due to type 2 diabetes.

Chief Physician Chen Qi, the director of the Third Department of Orthopedics, because he is a friend of the patient and violates the principle of treatment, before the formal treatment of diabetes... Our hospital actively invited Doctor XX from the Bird City Superior Hospital to our hospital for consultation.

The bed doctor, wrote a medical record into a book, as long as it is the thing that happened, the situation at that time, the thing after the operation, and the hair is pulled out.This is not only about the treatment and identification of patients in the future.

Moreover, it's his job.A doctor in a tertiary hospital, to be honest, if you threaten someone with the hospital's establishment, you probably won't be very scared.There is no place to stay here.

However, if the practice certificate is revoked, it is estimated that he will be scared to death.This is the ultimate big move, generally not issued, but once it is issued, it is a big deal.

Zhou XX and his family did not speak anymore.Chen Qi was beaten dumbfounded by Ouyang's combination of punches.The relationship with Zhou XX who was as close as a brother and brother-in-law was also completely broken.

Chen Qi's acceptance of red envelopes before surgery was also reported by Zhou XX's wife.Chen Qi is not muddy, he still handles it casually.

He actually had the phone recording at the time, anyway, the two bit the hair.Zhou XX inquired, and finally knew who was the best in the Orthopedics Department of the Municipal Hospital, which was the young assistant!

In the end, he did not leave anymore, and had to undergo follow-up treatment at the city hospital.As long as he is willing to cooperate, Ouyang is not willing to make things too much. After all, this is a hospital, not a court.

Of course, the director of Chen Qi couldn't do it. He was warned by the hospital's internal red-head document, and he even imposed a rescue fine.

He can't go back to the second department of orthopedics. He can only become an outpatient doctor. A doctor who visits the clinic for a long time, writes a sick leave slip, and writes a long-term outpatient prescription for chronic diseases.

This punishment is not serious, and Chen Qi's future path is also very obvious. Unless there is an unconventional leadership change in the hospital, otherwise, if he wants to perform surgery, he can only change places.

For Ouyang and Zhang Fan, Chen Qi is about to hate them to death, and taking money away is tantamount to killing his parents.But on the surface, he couldn't tell at all that he was angry.

I go to work on time and leave work on time every day. I smile at everyone. When I see Zhang Fan, I will take the initiative to say hello, without any grudge.

For nonunion, approximately two million long bone fractures in the United States receive treatment each year. Among these two million, there are approximately 100,000 cases of nonunion.

And the cost of treatment of nonunion is about twice that of normal fracture healing.And there is a very high rate of disability. Experts from higher-level hospitals came to the tea hospital to make a diagnosis and wanted them to undergo surgery, but none of them were willing.

This kind of surgery is too unpredictable.It is estimated that the patient came here all of a sudden after going to other hospitals.An accident in the hospital must be resolved.

Zhang Fan, who is in charge of surgery, has to come up with a solution. Previously, Zhang Fan could only make arrangements in their group, and he had to consider Wang Yanan's mood.

Now it’s different. “I’d like to inform Zhou Chengfu from the Third Department of Orthopedics, Xu Xian from the First Department of Orthopedics, and Dr. Wang Pingshan from the Second Department of Orthopedics. We are going to have nonunion surgery tomorrow.

Zhang Fan is in the office of his administration building, explaining the tasks to the office director.

"Are you in charge?"

"Well, I'm in charge." Zhang Fan replied. These are the top young orthopedic doctors. Ouyang directly handed over the task of selecting the head of the three departments of orthopedics to Zhang Fan.

Zhang Fan currently has two people in his mind. One is Zhou Chengfu. Although this person is a bit more utilitarian, he is a good player in business. The second is Wang Pingshan from the Second Department of Orthopedics. His business is quite good, but his personality is a bit dull.

Both were the attending doctors who were immediately promoted to vice-high, Zhang Fan had to consider and weigh the pros and cons.Bringing Xu Xian is just a cover.

After processing some necessary documents, Zhang Fan has to go to the Third Department of Orthopedics again. Because the director has been removed and the new director has not been appointed, Zhang Fan has to worry about the work of the department.

As soon as I arrived at the door, I heard that Zhou Chengfu was giving lectures to the resident doctor and the rotating doctor in the department.

"There are many reasons for nonunion. To put it honestly, it is not clear, but through evidence-based medicine, it can be determined that smoking is a very significant cause."

After seeing Zhang Fan, Zhou Chengfu insisted on Zhang Fan to say a few words, "I'm not good at what I said. Let Zhang Yuan tell us a few words. Zhang Yuan's lectures are as exciting as his surgery."

Hospitals have to take the path of combining medical education and scientific research. The education of young doctors, rotating doctors, and interns has gradually begun to pay more attention.

Just because of this case, Zhang Fan didn't say much, so he went on stage and started talking.

"Speaking of nonunion, we must first talk about bones. If the bones of the human body are subdivided, there are many classifications, which are available in textbooks. This is what a doctor must master.

If it is roughly classified, it can be divided into two categories, cartilage and bone."Lectures, especially for young doctors and interns, are no better than explanations during surgery.

Doctors who can ask questions during surgery are almost all doctors for many years. What they lack is a little trick or thinking problem, but when facing interns, they can't say it in general.

It is necessary to tell the knowledge points, but also to speak vividly and interestingly. This requires much higher requirements for the lecturer, otherwise the textbooks are comprehensive, and the teacher needs to do it.

"Bone's composition and organization are included in the textbooks, and I will not repeat it. Today, because of a disease number, let's talk about nonunion. To talk about nonunion, we must first talk about fracture healing.

Bone healing mainly depends on four kinds of cells.Bone progenitor cells, osteoblasts, bone cells, osteoclasts.

When a long bone is fractured, osteoclasts will first decompose the fractured bone into various primitive components, such as bone cells, bone salt and other components.

Then, osteoblasts come into play, and through genetic regulation, it will allow free bone cells, bone salt and various nutrients taken by the human body to rebuild the bone progenitor cells into cartilage, then calcify, and finally form a completed bone. ."

Zhang Fan said that the doctors below, whether they were internships or working doctors, were all bowing their heads to take notes. Even Zhou Chengfu sat in the back row and took notes.He estimated that the element of pretense is greater than the element of learning, but the attitude of others is manifested.

"The shape of bone is not constant. A mature bone is not static. It is like wearing clothes with you. It changes every day. Through hormones and nutritional conditions, osteoclasts are constantly destroyed, and osteoblasts are not Stopped rebuilding.

Under normal circumstances, 0.5% of the total amount of bone elements will be lost every year.” Elderly women, because of the lack of estrogen, the loss will be greater, which is also the reason why elderly women are prone to fractures.

This is also the reason why calcium supplements are needed when adults reach the age of 45.When the absorbed nutrients are not enough to keep up with the loss of the human body, the bone will become more brittle and the bone strength will decrease.

Calcium supplementation cannot be corrected by simply taking medicine.First of all, vitamin D should be supplemented in time. If vitamin D is lacking, rickets will appear especially in early childhood.

Lack of vitamin A will cause the speed of osteoblasts and osteoclasts to mutate, which means deformities will appear.

Without vitamin C, collagen fibers synthesized by cells decrease, leading to increased bone fragility.

And under low stress, although bone is being absorbed, the density is not up to the normal density.Especially patients who are bedridden for a long time are very prone to fractures.

Therefore, in order to ensure the health of the bones, it is necessary to get more sun, moderate physical exercise, and ensure adequate food, which is the most critical.

Eating calcium tablets from Australia and calcium tablets from America is not as good as having a healthy lifestyle after eating ordinary calcium tablets.

There are two main ways of nutrition for bones. The first is that the outermost layer is a dense periosteum with a large number of blood vessels, nerves, and osteoprogenitor cells.

The second place is the intima of the femur, the innermost layer of the bone, where blood vessels are also walking.Note that the blood vessels here are all small blood vessels.In other words, if a large amount of periosteal and soft tissue on the surface of the bone is stripped during the operation, the bone will become malnourished.

If the patient has diabetes, smokes, and lives irregularly, then there will be bone nonunion!"Zhang Fan did not directly start with nonunion.

Medicine is an interlocking discipline. Without a link, knowledge is incomplete, and the understanding of diseases is specious, knowing what is happening and not knowing why.

Zhang Fan said this, the following intern students are very clear and clear.

"There are three types of nonunion..." At this time, Zhenger Bajing began to explain nonunion and the treatment of nonunion.

For more than forty minutes, Zhang Fan, who had broken bones, crushed and decomposed it to the students below. As long as he listened carefully to this lesson, he would definitely have a complete grasp of the disease.The rest is to go to clinical practice and practice.

In the beginning, most of the doctors of the three departments of orthopedics were pretending, and following Zhang Fan's explanation, most of them began to listen carefully.

"No wonder, the operation is flying, you listen to it, this lesson is that a non-medical professional can understand it. It's too strong!" A resident said to another resident.

"Nonsense, can't you be strong enough to be the dean!"

After Zhang Fan finished the class, the students below looked at Zhang Fan with enthusiastic eyes, not knowing whether it was the aura of the assistant dean or Zhang Fan really impressed them.However, Zhang Fan was still satisfied with this lecture.

I don’t know how many times I’ve lost it. If I can’t even teach a lesson well, it’s better to find a tofu to kill me.

"Zhang Yuan, too old. I have gained a lot of knowledge. It seems that my knowledge reserve is still not enough. You are too busy. Otherwise, you will teach us every week. It is estimated that the treatment level of the department doctors can be improved. A step." Zhou Chengfu said to Zhang Fan with a smile.

He was also helpless. If he had known that Zhang Fan could rise so fast, what else would he run, let alone other things now, even Lao Gao was dissatisfied with him, one step was wrong!

"Self-study is the most important thing." Zhang Fan was telling the truth, but Zhou Chengfu's face was stiff.But Zhang Fan didn't pay attention either. "Did the medical office inform you about the operation tomorrow morning?"

"It's been notified, it's already been notified." Zhou Chengfu nodded hastily.

"Well, you are ready for the equipment needed for the operation." Zhang Fan confessed.

"Okay, okay. Don't worry, Zhang Yuan, I must be properly prepared." The stiff smile became wonderful again.He was afraid that his superiors would have forgotten him, and he was willing to fight lonely. It was very simple, and there were not many that could be done.

After dealing with the three departments of orthopedics, Zhang Fan will go to the general surgery department to help with the operation.There are too many cases, the doctors can't turn them on, and Zhang Fan can't do anything about it. The training cycle of a qualified surgeon is too long.

Zhang Fan is still very happy to undergo surgery. Now he is the assistant to the dean. To put it in a more rustic way, Zhang Fan is a local tyrant: I want to do general surgery, so I do general surgery. I want to do For cardiothoracic surgery, do cardiothoracic surgery.

If there is less administrative business, Zhang Fan will love this position, as long as he is willing, the operation of the hospital will be carried out.The general experience of the system, from the slow growth of a snail, began to become visible with the naked eye.

This is a gratifying thing.