Practicing Medical Skills in a Small Clinic

In her clinical work, when she encountered problems, Professor Wu no longer guided her as attentively as before. People are like that.

Ou Qinglan’s office experience is still rather weak; there are just so many areas for her to improve.

"Ah, that’s how it is! Professor Wu is really nice to me!"

Although she lacks experience, luckily she’s smart as a whip, understanding things immediately.

She clearly already understood Li Jingsheng’s good intentions and changed her tune on the spot.

"Can you help me analyze this case now? Every time I encounter electrolyte imbalance or dehydration, I feel especially stressed. I have no idea where to start."

She sat down beside Li Jingsheng.

"No problem. Turn on your computer and pull up the patient’s information!"

Li Jingsheng readily agreed.

Perhaps still worried that his girlfriend didn’t understand workplace survival skills and might suffer losses, while Ou Qinglan was booting up, logging in, and retrieving patient information, he quickly sent her a text message from his phone.

"Make sure next time to control what you say; never speak ill about your superiors, colleagues, or anyone else."

She got the message, looked at her phone, and glanced over at Li Jingsheng.

Then, Li Jingsheng received her reply.

"Nanny Li!"

Li Jingsheng just felt a moment of breathlessness, this little spitfire even thought he was being long-winded.

"Good daughter!"

He quickly shot back a reply.

Now it was Ou Qinglan’s turn to breathe heavily.

Luckily, the two were not married yet; otherwise, Li Jingsheng might have had to kneel on a washboard at home or at least sleep on the couch.

"Help me find out the cause of this patient’s illness, then I’ll forgive you. Otherwise..."

She made a motion as if to pinch him.

"Girl, violence and intimidation are so out of fashion now. A woman’s greatest weapon is her tenderness, you know."

"As if! All the patient’s information is up, so get to work."

The two bickered a bit before focusing seriously on analyzing the patient’s condition.

"Giving someone a fish is not as good as teaching them to fish, let me teach you step by step!"

Li Jingsheng’s level now is not astonishing, but at least far exceeds that of Ou Qinglan.

"Monitoring the patient’s electrolyte balance is mainly about serum sodium, serum potassium, and chloride concentration. I trust I don’t need to elaborate on this; just follow the standard from the textbooks. What you need to do is pay attention to the patient’s symptoms, and then learn to make comprehensive judgments. For instance, today’s patient reported fatigue and a somewhat muddled mind; at this point, you should be vigilant about whether his body is experiencing some change.

Rather than assuming it was caused by lack of rest after surgery.

Then, my actual judgment that he probably has hyponatremia was made after noticing how he was drinking water, leading to this preliminary diagnosis.

Normally, patients shouldn’t experience prolonged thirst post-surgery.

I can’t say every patient who feels thirsty post-surgery has a problem, but at least, like this kind of prolonged thirst, nine out of ten patients will have issues."

He shared his diagnostic thought process with her earnestly.

"After discussing diagnostic awareness, let’s analyze the causes of electrolyte imbalance next. Treatment methods, I don’t need to say much; you can follow the textbook precisely. If necessary, I can lend you a clinical surgery handbook, just flip through it directly. However, be sure to summarize more often; the content in books is ultimately static, and many times you’ll need to flexibly adjust dosage, combine meds, or modify administration schedules.

These practical skills can’t be taught by any textbook."

The growth of a doctor indeed involves many facets.

Just blindly memorizing medical knowledge from books—that’s being a bookish fool.

Such people can’t diagnose causes nor treat illnesses.

Only doctors who are good at continuous summarization in practice, then gradually improving, will become stronger, turning into truly formidable experts.

She kept nodding, like a diligent student, conscientiously noting down the progress methods he taught.

For any young doctor, such a good mentor is vital to guide them on their path to improvement.

"Next, let’s analyze the types of electrolyte balance. If serum sodium results remain within normal values but blood volume decreases and extracellular dehydration occurs, it’s isotonic dehydration. The major concern with this is circulatory failure.

Isotonic dehydration is usually acute, progressing rapidly, demanding immediate decisive rescue action once detected.

The second type, when serum sodium levels exceed 150mmol/L, significant water loss occurs, even leading to more water loss than sodium, strongly suggesting hypertonic dehydration. Usually, this arises from diarrhea, excessive sweating, or diabetes. Since this patient’s serum sodium is below normal, it’s evidently not hypertonic dehydration, so it can be directly ruled out.

Then there’s only the last two types left, one being water intoxication.

Often caused by drinking large amounts of water in a short time, though this patient had increased water intake, symptoms were already present before his thirst, so water intoxication is ruled out.

The last is hypotonic dehydration, where the patient’s serum sodium is below 135. If you lack diagnostic experience under available conditions, further plasma osmolality tests can be done. If below 280mmol/L, it can be mostly confirmed."

Li Jingsheng first walked her through the types of electrolyte imbalances and explained how this patient was determined to have hypotonic dehydration.

She was rapidly taking notes.

Some experiential clinical knowledge is hard to glean from textbooks.

It’s akin to combining textbook knowledge with practice, making it a living guide.