Chapter 460： congratulations

Chapter 460

Once people's minds are involved in interests, they will become very complicated. The Chasu City Hospital directly sent consultation letters to the Affiliated Hospitals, General Hospitals and Provincial Hospitals of Bird City.

This invitation letter, to be honest, has no effect. There are clear fees for this consultation. For online consultation, the vice high is 20 yuan once, and the high is 30 yuan once. The maximum consultation fee between hospitals is 1,000 yuan.

Therefore, science and technology are becoming more and more developed, and various communication conditions are getting better and better, but online consultations and consultations between hospitals cannot be developed. The hospital consultation system that was built with huge sums of money was left idle.

The superior hospital forces each chief doctor to handle how many online consultations should be handled within the prescribed time. Such consultations are generally more complicated or special diseases, which is a waste of time.

The number of consultations compulsory by the superiors, and some of the costs of the consultations were intercepted. Then, the chief physician of each major hospital started to act perfunctoryly or the young doctor in the department of the clinic replaced him for consultation.

If a lower-level hospital requires a simpler consultation or the lower-level hospital does not handle the disease reasonably, there is a case of bluntness.

Immediately afterwards, the doctors at the lower hospitals also lost their motivation. The local area is not good, otherwise he will go to the hospital, he can't afford to be ridiculed by others for his illness. As for whether there are subordinate doctors, they are suffering from various uncomfortable cases and apply for online consultation for the patient number.

Yes, but not much. Are there superior doctors who are very kind and serious, but they are not the majority. The consultation between the hospital and the hospital is even more amazing. It is definitely not the authority of any hospital department that can come, and it is just the name of a hospital that gives a certificate for a lower-level hospital.

The Chasu City Hospital wants this name, what it needs is this officially recognized certificate. Within two days, the patient's medical records were complete.

Zhou XX, suffered a right humerus fracture due to accidental fall after being drunk. In Chasu City Hospital, incision and internal fixation were performed. Prior to admission, the patient had poor glycemic control due to type 2 diabetes.

The chief physician of the third department of orthopedics, Chen Qi, was a friend with the patient and violated the principle of treatment. Before the formal treatment of diabetes ... Our hospital actively invited the doctor XX of the bird's superior hospital to the hospital for consultation.

The bed doctor wrote a medical record into a book, as long as it happened, the situation at that time, the postoperative thing, and the hair was plucked. This is not just about the treatment and identification of patients in the future.

Moreover, it matters to him. A doctor in a tertiary hospital, to be honest, if you threaten others with the establishment of the hospital, they are probably not too scared. There is no grandfather here.

However, to say that revoking his practising certificate may scare him to death. This is the ultimate move and it is not usually issued, but once it is issued it is a big deal.

Zhou XX and his family stopped talking. When Ouyang put down a set of punches, Chen Qi was snoring. The relationship between Zhou and XX who were close to each other like brothers and brothers-in-law was also completely broken.

Chen Qi's acceptance of the red envelope before the operation was also reported by Zhou's wife. Chen Qi is not muddy, but people still take it easy.

He even had a cellphone recording at the time, anyway, the two bite their hair. Zhou XX inquired, and finally knew who was the best at the orthopedics department of the city hospital, which was the young little assistant!

In the end, he didn't leave, and he was going to do follow-up treatment at the municipal hospital. As long as he is willing to cooperate, Ouyang is not willing to make things too big, after all, this is a hospital, not a court.

Of course, Chen Qi's director couldn't do it. He received a warning from the hospital's internal red-headed documents and said he had also delivered a rescue fine.

He could not go back to the second department of orthopedics. He could only be an outpatient doctor. The doctor who had been in the clinic for a long time, prescribed a sick leave, and prescribed a long-term outpatient prescription for a chronic disease.

This punishment is not heavy, and Chen Qi's future is also very obvious. Unless there is an unconventional leadership change in the hospital, otherwise, if you want to have surgery, you can only change places.

For Ouyang and Zhang Fan, Chen Qi is about to hate death, and stealing money is tantamount to killing parents. But on the surface, he couldn't see anything, and he didn't hesitate.

Every day I go to work on time and get off work on time, everyone smiles, and I will greet Zhang Fan on my own initiative.

Bone nonunion. In the United States, about 2 million patients with long bone fractures are treated each year. Of these 2 million, there are about 100,000 patients with nonunion.

And the cost of treating nonunion is about twice that of a normal fracture. And with a very high disability rate, experts from higher-level hospitals came to Chasu Hospital to make a diagnosis, and no one wanted them to undergo surgery.

This operation is too unpredictable. The patient is estimated to have come here all the time after going to other hospitals. There is something wrong with the hospital and it needs to be resolved.

Zhang Fan, who is in charge of surgery, has to find a way out. Before, Zhang Fan could only make arrangements in their group, taking into consideration Wang Yanan's mood.

Now it ’s different, "Come to Zhou Chengfu of the third department of bones, Xu Xian of the first department of orthopedics, and Dr. Wang Pingshan of the second department of orthopedics to inform him that the operation for nonunion will be prepared tomorrow."

In the office of his administration building, Zhang Fan explained the task to the director of the office.

"Are you the master?"

"Well, my main knife." Zhang Fan replied, these are the best among young orthopedic doctors, and Ou Yang directly gave Zhang Fan the task of selecting the three orthopedic masters.

Zhang Fan currently has two people in his mind. One is Zhou Chengfu. Although this person is more utilitarian, he is a good player in business. The second one is Wang Pingshan of Orthopedics. The business is also very good.

Both were promoted to the deputy high doctors at once, and 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 went to the Department of Orthopedics, because the director was removed and the new director had not been appointed. Zhang Fan had to worry about the work of the department.

As soon as I arrived at the door, I heard that inside the department, Zhou Chengfu gave a lecture to the resident doctor and the rotating doctor.

"There are many, many reasons for bone nonunion. To be honest, 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 asked Zhang Fan to say a few words, "I can't speak well, let Zhang Yuan tell us a few words. Zhang Yuan's lecture is as wonderful as his surgery."

The hospital has to follow the path of combining medical education with scientific research. The education of young doctors, rotation doctors, and interns has gradually begun to pay attention.

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

"When bones are not connected, we must first talk about bones. If the bones of the human body are subdivided, there are many classifications, which are on textbooks. This is what a doctor must master.

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

The doctors who can ask questions during the operation are almost all doctors for many years. What is lacking is a little trick or thinking problem. When facing an intern, you can't talk in general.

Both the knowledge points and the vividness and interestingness are required. The requirements on the lecturers are much higher, otherwise the textbooks are comprehensive and what the teacher wants to do.

"The components of bone are in the textbooks, and I won't repeat them. Today, because of a sickness, let's talk about bone nonunion. To talk about bone nonunion, we need to talk about the healing of the fracture first.

Bone healing mainly depends on four types of cells. Bone progenitor cells, osteoblasts, osteocytes, osteoclasts.

When a long bone is fractured, osteoclasts will first break down the bones at the fracture end into various original components, such as bone cells and bone salts.

Then, osteoblasts come on the field, and through gene regulation, it will make free bone cells, bone salts and various nutrients taken up by the human body, make bone progenitor cells reconstitute cartilage, then calcify, and finally form a completed bone . "

Zhang Fan said that the following doctors, both intern and in-service doctors, are taking notes while looking down, and even Zhou Chengfu is sitting in the back row and taking notes. He estimates that the pretend component is greater than the learning component, but the attitude of others is manifested.

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

Under normal circumstances, bone elements will lose 0.5% of the total amount every year. "Older women, because of the lack of estrogen, will lose more, which is why older women are prone to fracture.

This is why calcium supplementation is required when adults are forty-five. When the absorbed nutrients are not enough to keep up with the components lost by the human body, bone becomes more brittle and bone strength decreases.

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

Lack of vitamin A can cause variability in osteoblast and osteoclast velocity, which means deformities.

Lack of vitamin C reduces the collagen fibers synthesized by the cells, leading to increased bone fragility.

And under low stress, although the bone is absorbing, the density does not reach the normal density. Especially patients who are bedridden for a long time are very prone to fracture.

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

Eating Australian calcium tablets and American calcium tablets are not as good as eating ordinary calcium tablets and have a healthy lifestyle.

There are two main nutritional pathways for bones. The first is the outermost layer of dense periosteum, which contains a large number of blood vessels, nerves, and bone progenitor cells.

The second place is the innermost femoral membrane of the bone, which is also the walking blood vessel. Note that the blood vessels here are small blood vessels. That is to say, if a large amount of periosteal soft tissue on the bone surface is peeled off during surgery, the bone will be malnourished.

If the patient has diabetes, but also smokes and lives irregularly, then nonunion will occur! "Zhang Fan didn't start directly from the bone nonunion.

Medicine is an interdisciplinary discipline. Without it, knowledge is incomplete. The understanding of disease is paradoxical.

When Zhang Fan said this, the intern students below were very clear and definite.

"The forms of bone nonunion are divided into three types ..." At this time, it was the beginning of the Eight Classics of Zhenger to explain bone nonunion and the treatment of bone nonunion.

For more than forty minutes, a boneless Zhang Fan shattered and disintegrated and told the students below. As long as he listened carefully to this lesson, he would absolutely master the disease. The rest is to go to clinical practice and practice.

At the beginning, most of the orthopedic doctors were pretending to be pretending. With Zhang Fan's explanation, most of them began to listen carefully.

"No wonder, the surgeries performed by others, you listen, what this class is about is that it can be understood by a non-medical professional. It is too strong!" Said one resident to another resident.

"Crap, can't you be a dean!"

After Zhang Fan finished the lesson, the students below looked at Zhang Fan with warm eyes. I don't know if it was the dean's aura or Zhang Fan really convinced them. However, Zhang Fan was satisfied with the lecture.

I do n’t know how many times I ’ve had livers. If I ca n’t even speak a lesson, it ’s better to find a tofu.

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

He was helpless, if he had known that Zhang Fan could rise so fast, what else would he run, let alone the rest, even Lao Gao was dissatisfied with him, step by step!

"Self-learning is still the most important thing." Zhang Fan was telling the truth, but Zhou Chengfu's face froze. But Zhang Fan didn't notice, "I have surgery tomorrow morning. Has the medical office notified you?"

"Notified, already notified." Zhou Chengfu nodded quickly.

"Well, you have the equipment you need for surgery." Zhang Fan explained.

"Okay, okay. Zhang Yuan, rest assured, I must be properly prepared." The stiff smile became wonderful again. He was afraid that his superiors would forget him, and he was willing to fight lonely. He said it was very simple.

After finishing the orthopedics, Zhang Fan had to go to the general to help with the operation. There are too many patients, doctors ca n’t turn them on, and Zhang Fan has no good way. The training period for a qualified surgeon is too long.

Zhang Fan is still very willing to go to the surgery. Now he is the assistant to the dean. In a more local language, Zhang Fan is the local tyrant: I want to do a general surgery, I just want to do a general surgery, I want to do Cardiothoracic surgery, cardiothoracic surgery.

If there is a little less administrative work, Zhang Fan will love this position. As long as he is willing, the hospital's surgery will be casual. The general experience of the system, from a snail-like slow growth, has begun to become visible to the naked eye.

This is gratifying.

Can't comment anymore!

Lao Zang is very hard now!

Haha!

If you don't speak, you agree!

(End of this chapter)