Practicing Medical Skills in a Small Clinic

After digesting the information he provided, Ou Qinglan asked, "Can you talk about the causes of hypotonic dehydration?"

"No problem. Clinically, there are approximately three common causes of hypotonic dehydration. The first is the continuous loss of gastrointestinal digestion, such as persistent vomiting and chronic bowel obstruction. This patient isn’t experiencing continuous vomiting, but chronic bowel obstruction is something to be vigilant about."

"The second cause is chronic secretion from large wound areas. I have carefully observed the patient’s surgical wound and haven’t found anything obviously abnormal yet. However, it’s crucial to closely monitor other symptoms, such as fever or severe pain at the surgical wound site, which may indicate wound necrosis.

Based on my personal experience, if necrosis of the surgical wound truly causes secretion, and it’s an external wound, a large amount of pus and yellow discharge can be visibly observed. This usually occurs more than two days post-surgery.

This patient can basically rule out the possibility of such a condition.

In future cases, you must consider the necrosis of the wound factor with similar patients."

She quickly took notes.

"What’s the third cause? You have such rich clinical knowledge! I used to think that after studying under Professor Wu for several years and engaging in quite a bit of clinical work, I had some experience. Now I realize that working under senior doctors to diagnose patients is a completely different concept from diagnosing independently."

Gazing at Li Jingsheng with eyes full of admiration.

Qin Fei and the other two interns on night duty also gathered around, even taking notes on the spot.

Initially, Qin Fei was a bit embarrassed.

Since he’s about to be promoted to attending physician, listening to Jingsheng’s lecture was fine, but taking notes on the spot seemed embarrassing.

After realizing that the knowledge Jingsheng shared was extremely practical and consisted of invaluable experiences potentially useful in clinic practice, he didn’t care about losing face. He decided to take notes first and slowly digest and memorize them later.

These are tangible benefits.

Once learned, they immediately enhance clinical skills.

Crucially, they can save patients’ lives.

"Aren’t you supposed to be working?"

Li Jingsheng noticed several people around him, looking up at them.

"Haha, isn’t it because Teacher Li’s talk is fascinating? We want to progress along with Dr. Ou. If there’s an emergency, the nurse will come to call us."

One intern said with a dry laugh.

"Come on, hurry up with the explanation! If something urgent happens in the ward, we won’t be able to continue listening."

Ou Qinglan urged him.

"The third cause is excessive renal excretion of water and sodium. This can be inferred through urine sodium analysis. Patients typically exhibit frequent urination, and urine volume will noticeably increase. I’ve seen severe cases where not only is urine volume large, but water metabolism is extraordinarily fast. Drinking a large glass of water usually takes us at least half an hour or longer to feel the urge to urinate.

Clearly, this patient’s urination volume is fairly normal, and their urine sodium levels are relatively okay, which can be ruled out."

Li Jingsheng explained the three main causes of hypotonic dehydration.

Then he asked Ou Qinglan, "Qinglan, what do you think is the most likely cause of hypotonic dehydration in this patient?"

"Is it even necessary to say? You’ve analyzed it for me so thoroughly. I’ll go check the patient in the ward later to see if there’s a history of chronic bowel obstruction."

She replied straightforwardly.

When it comes to talent and comprehension, the higher the IQ, the stronger these traits.

Ou Qinglan’s performance is outstanding; she is an excellent student.

At least Li Jingsheng finds it very agreeable, whether teaching her the principles of life or clinical knowledge.

She isn’t like some students who have no skills but enjoy constantly questioning the teacher.

Some even insist on doing something different just to feel unique.

With students like that, Li Jingsheng ensures to say goodbye by the next day.

Good doctors are never short of students.

Other attending physicians try their best to secure as many intern positions as possible because the more interns they have, the more workforce they have.

Li Jingsheng is never short of assistants.

Because his work is very specialized, as long as there’s a student with some medical knowledge available occasionally, assisting in repositioning some difficult cases or providing traction is enough.

Of course, if the doctors under him can quickly progress and share more work tasks, that’s even better.

"I should head back now. For that patient, start by balancing electrolytes through fluid and sodium replenishment. If there isn’t anything specific, don’t recklessly treat them. It may not necessarily be bowel obstruction; there are many causes of hypotonic dehydration, and the ones I’ve listed are just the most common clinical reasons."

Before leaving, Li Jingsheng advised her.

Concerned she might rush to conclusions, thinking Jingsheng’s guidance will effortlessly unravel the patient’s symptoms.

Acute bowel obstruction is already difficult to diagnose, and chronic bowel obstruction is even harder to diagnose.

"Dr. Li, next time you have time, please analyze more typical cases for everyone! After listening to your lecture today, I feel like everything I’ve read before was theoretical, and I’m nothing more than a bookworm."

"Haha, you really have quite the talent for flattery. There are plenty of skilled doctors in orthopedics like Director Hu, Director Chen, Director Hua, Director Ou. Their levels are much higher than mine. If you’re truly eager to improve, you should reach out to them to explain classic cases. I’m off, wishing you a less hectic evening."

Li Jingsheng waved goodbye to the doctors.

When he returned to the clinic, the employees had already left for the day.

Checking the sales data, offline sales have basically stabilized.

Even when he was trending recently, it didn’t significantly boost offline sales.

In the health medicine sector, the nationwide market share is substantial, but locally, there’s ultimately a limit.

Potential customers who are too far away might trust the Sunshine Clinic and have prescription needs, but expecting them to travel one or two hours, even several hours, to buy a couple of boxes of medicine is unrealistic.

Because Li Jingsheng isn’t the only Best Medicine vendor; they’re everywhere.

Prices between everybody don’t differ much.

Here, Jingsheng benefits from lower rental costs, which is an advantage, so the medicine prices are slightly lower.

But they can’t be reduced by too much, or it would disrupt the market.

Best Medicine won’t allow it, nor will other dealers agree.

If the price is too low, it might also lead people to suspect it’s counterfeit. So, Jingsheng never considered price wars.

He can at most discount a few cents or a dollar compared to others, making customers feel it’s most economical to purchase here.

Speaking of ordinary medicine, it’s not worth mentioning.

Market prices are quite similar.

Because the profit margin itself is very low.