MTLNOVEL I can see the status bar
Chapter 228 Misdiagnosis
Chapter 228 Misdiagnosis
In Sun Lien's view, there was nothing special about Cao Jianguo's situation—the gastroenterologist at the Fourth Central Hospital who saw him must have been working for a short time, so he made this mistake.
When specialists see patients, they tend to have a fixed idea that "the disease the patient suffers from must be the systemic disease that I am responsible for".And this kind of fixed concept is prone to misdiagnosis when encountering autoimmune system diseases or other diseases with multiple organ symptoms.
Yes, Cao Jianguo was misdiagnosed.At least Sun Lien believes that what Cao Jianguo suffers from is not just "reflux esophagitis".He did have reflux esophagitis, and if it continues to develop, it may deteriorate into esophageal cancer.But the disease itself is not simple.It builds on a disease that has a wider impact and causes problems in more organs - systemic sclerosis (SSc).
Cao Jianguo's symptoms of systemic sclerosis are actually very typical. The thickened skin and thickened skin fibers on the finger joints are the decisive symptoms for diagnosing systemic sclerosis.In the latest diagnostic guidelines for systemic sclerosis, immunology experts and medical experts from various countries have jointly determined after discussion that only this one symptom can be considered as a patient with a score greater than nine points and diagnosed as systemic sclerosis.You know, the positive report score of systemic sclerosis blood immunology test is only three points - which is far lower than the nine points required for diagnosis.
If it were an experienced physician, the moment he saw Cao Jianguo's hands, he might have already determined that he had systemic sclerosis and requested a rheumatology and immunology doctor for consultation.And obviously, the physician who treated Cao Jianguo didn't even look at his hands.Only based on the content of Cao Jianguo's self-report and the results of the additional esophagoscopy, he came to the judgment that "this is reflux esophagitis".Famotidine was subsequently prescribed for treatment.
And this is where it makes people feel a little helpless—Cao Jianguo does have reflux esophagitis.However, if only from the perspective of a specialist doctor, it is believed that the patient has and only this disease, then misdiagnosis cannot be avoided.
One of the main causes of reflux esophagitis is the decline in the anti-reflux function of the patient's digestive tract.Stomach contents regurgitate easily and burn the esophagus causing damage.But as a doctor, you must ask a few more whys.The diagnosis of the receiving doctor stopped here, but did not go into the details of why Cao Jianguo's anti-reflux function declined.And this was his last chance to make a correct diagnosis.
The muscarinic acetylcholine receptor M3 is the key receptor of the enteric nervous system controlling intestinal peristalsis, and they can convert the peristaltic command of the enteric nervous system into the motor command of the smooth muscle and sphincter in the digestive system.In patients with systemic sclerosis, the expression of the M3 antibody, which blocks the binding of this neurotransmitter, was significantly increased.This will lead to the inability of the enteric nervous system to fully execute the instructions for intestinal peristalsis, resulting in insufficient movement range of sphincter and smooth muscle, sphincter insufficiency and so on.This can trigger gastrointestinal symptoms.With the further increase of M3 antibody, the patient's gastrointestinal damage will continue to deepen, and symptoms such as smooth muscle damage, severe fibrosis, and collagen deposition will appear immediately.These injuries and insufficient range of smooth muscle movement can lead to swallowing obstruction in patients, and endoscopic manifestations such as esophagitis and esophageal contracture.
Sun Lien explained his point of view and called Dr. Pascal for consultation.At the same time, Cao Jianguo, who heard that he was "misdiagnosed", was very happy.Even a little happy.
"Second Uncle, what are you laughing at?" Cao Yanhua scratched his face and asked curiously.
"You are still a doctor, do you know that stomach problems are not easy to cure?" Cao Jianguo grinned, "Just now I heard from Dr. Xiao Sun that I am not a stomach problem, but some sclerosis, so it can be cured easily! It's okay to have a harder hand. , and then prescribe some softening medicine, I’ll be fine if I take some!”
Sun Li'en glanced at Cao Yanhua with a strange expression, and sure enough, as he guessed, Cao Yanhua showed a bitter and distorted expression as if he had eaten poop.
A doctor is most afraid of encountering a patient like Cao Jianguo.Most of these patients do not have any medical knowledge or even a reserve of biological knowledge.For this kind of patients, the focus of judging their disease is mainly based on the name of the disease.What "tumor" or "cancer", then you can go home and lie down to prepare for the funeral.For other diseases, keywords are randomly selected, and then combined with life experience, the keywords are "analyzed", so as to draw the wrong conclusion that "this disease is easy to manage".
To put it simply, this kind of patients are used to judging something that they don't know at all through imagining.And I will be very persistent in thinking that my judgment is correct.And then, no matter what the doctor explains, they insist, "I'm not sick, you're trying to scam me out of money."
Fortunately, Cao Jianguo is Cao Yanhua's second uncle.
Nephew will never lie to uncle!
Taking advantage of Dr. Cao Yanhua's spare time to supplement his uncle's knowledge of biology, Sun Lien welcomed Dr. Pascal with a tired face.
"This patient may be a SSc." Sun Li'en explained his judgment concisely, then stepped aside to turn on the computer and asked Dr. Pascal to sit down. "I want to hear your opinion."
Dr. Pascal glanced at the screenshot of the esophagoscope on the computer screen, and then took a look at Cao Jianguo's hands. "Your diagnosis is fine."
"That's good." Sun Li'en nodded, and wrote his diagnosis on the computer.Seeing that Cao Jianguo's make-up class was not over yet, he asked Dr. Pascal, "Recently...very busy?"
Dr. Pascale nodded with a wry smile, "I think if I can change my income from a fixed amount to a sharing system, I will be able to buy a house in Ningyuan by this time next year."
The housing price in Ningyuan is not low. It is close to the Fourth Central Hospital, and it costs almost [-] per square meter.
Sun Lien was overjoyed when he heard the words, it is a good thing that Lao Pa is willing to buy a house in Ningyuan.This shows that he has plans to take root in Ningyuan.If Old Pa can really take root, at least he won't have to worry about being skinned and stuffed by Dean Song, right?He pretended to be concerned and asked, "Have you gone to see the house? Decided where to buy?"
"I don't have time to look at it." Dr. Pascal continued to smile wryly, but changed from nodding to shaking his head. "My wife is doing research recently. She said that there is a newly built villa area nearby that is not bad. At least there is a yard for Panny and Todd to play."
The living habits of Americans are quite different from those of Chinese.For a medical professional like Dr. Pascale, a house with a yard is a livable "home."As for the buildings in the residential areas in the urban area - those are for bachelors and those who have no children but need to work in the urban area.
After pondering for a while, Sun Li'en asked, "Have you contacted the academy? I remember that there are housing subsidies for the introduction of experts."
Dr. Pascal continued to shake his head, "The college hasn't told me about this matter, why don't you ask Dean Song for me tomorrow? After all, you are my boss!"
"...Okay." Sun Lien took another job for himself.However, this matter is not too difficult for him. Anyway, it is Dean Song's request to keep Lao Pa. If the housing subsidy can be approved, at least it means that he has fulfilled Dean Song's request.
Sun Lien chatted with Pascal here, and the phone on the desk had to ring every 2 minutes—there were dozens of expert numbers in the Department of Rheumatology and Immunology waiting for Dr. Pascal to deal with it.Dr. Pascal, who was bombarded by phone calls, had to hastily ended the chat and rushed back to the consulting room to see patients.On the other hand, Sun Li'en also reported his discovery to Zhou Jun - there was a misdiagnosed case in the Department of Gastroenterology of the Fourth Central Hospital.
"Understood. You transfer the patients to the Department of Rheumatology and Immunology, and let them be admitted to the hospital for treatment." Zhou Jun pondered for a moment and made a decision. "I will report the misdiagnosis to the medical department. The patient's condition is not dangerous, right?"
"It has not been found so far. His systemic sclerosis should still be in the early stage." Sun Lien glanced at the top of Cao Jianguo's head again, except for the addition of "systemic sclerosis" in black letters, the status bar did not change.It shows that at least systemic sclerosis has not invaded other organs.At present, only the digestive tract is involved. "I continued to prescribe famotidine to control his reflux esophagitis, and the immune shock treatment was handed over to the Department of Rheumatology and Immunology."
"Don't discuss misdiagnosis with other doctors." Zhou Jun had no objection to Sun Lien's treatment plan, and his focus was on another direction. "For this kind of disease, misdiagnosis in the digestive tract is also excusable. And the patient did not cause additional damage due to misdiagnosis. This kind of misdiagnosis, which is not considered medical negligence, is unnecessary. Everyone knows-you understand what I am talking about?"
Of course, Sun Li'en knew that internal medicine had opinions about him.And he found out a case of misdiagnosis in the digestive system, which is actually quite a big thing in the hospital's operating system.It may require a suspension investigation of the doctor, while also reviewing his past diagnosis cases.Given the delicate relationship between the internal medicine system and Sun Lien, this incident might be interpreted as Sun Lien's deliberate provocation.
No one likes a misdiagnosis, and especially for doctors, it can be a nightmare.Once a misdiagnosis is confirmed, it means that someone has to take responsibility for it and pay the price.And the life and health of the patient will be threatened as a result - no one wants to see the occurrence of misdiagnosis.
"It's fine on my side, and I'll pass it on to Dr. Cao." Sun Lien suddenly thought of an important question, "But...Dr. Pascal just came for a consultation, and I'm worried that he might..."
"There will be no problem with Dr. Pascal." Zhou Jun laughed twice, "Just in time, there is a meeting invitation in two days, you can take the members of your treatment team with you." He paused, He emphasized, "It's the whole treatment group, but you can also take Xiao Hu with you. The meeting location is Sanya, Hainan, so it's just that you guys are going to play and give yourself a vacation."
Promote the book "Night Walk of Police Doctors"
The story of dual systems, dual heroes, a doctor and a policeman
The author is quite sincere, at least the medical content is not nonsense, and the information has been checked.As far as this point is concerned, it is already considered good.
The new book is still young, please help me.
(End of this chapter)
In Sun Lien's view, there was nothing special about Cao Jianguo's situation—the gastroenterologist at the Fourth Central Hospital who saw him must have been working for a short time, so he made this mistake.
When specialists see patients, they tend to have a fixed idea that "the disease the patient suffers from must be the systemic disease that I am responsible for".And this kind of fixed concept is prone to misdiagnosis when encountering autoimmune system diseases or other diseases with multiple organ symptoms.
Yes, Cao Jianguo was misdiagnosed.At least Sun Lien believes that what Cao Jianguo suffers from is not just "reflux esophagitis".He did have reflux esophagitis, and if it continues to develop, it may deteriorate into esophageal cancer.But the disease itself is not simple.It builds on a disease that has a wider impact and causes problems in more organs - systemic sclerosis (SSc).
Cao Jianguo's symptoms of systemic sclerosis are actually very typical. The thickened skin and thickened skin fibers on the finger joints are the decisive symptoms for diagnosing systemic sclerosis.In the latest diagnostic guidelines for systemic sclerosis, immunology experts and medical experts from various countries have jointly determined after discussion that only this one symptom can be considered as a patient with a score greater than nine points and diagnosed as systemic sclerosis.You know, the positive report score of systemic sclerosis blood immunology test is only three points - which is far lower than the nine points required for diagnosis.
If it were an experienced physician, the moment he saw Cao Jianguo's hands, he might have already determined that he had systemic sclerosis and requested a rheumatology and immunology doctor for consultation.And obviously, the physician who treated Cao Jianguo didn't even look at his hands.Only based on the content of Cao Jianguo's self-report and the results of the additional esophagoscopy, he came to the judgment that "this is reflux esophagitis".Famotidine was subsequently prescribed for treatment.
And this is where it makes people feel a little helpless—Cao Jianguo does have reflux esophagitis.However, if only from the perspective of a specialist doctor, it is believed that the patient has and only this disease, then misdiagnosis cannot be avoided.
One of the main causes of reflux esophagitis is the decline in the anti-reflux function of the patient's digestive tract.Stomach contents regurgitate easily and burn the esophagus causing damage.But as a doctor, you must ask a few more whys.The diagnosis of the receiving doctor stopped here, but did not go into the details of why Cao Jianguo's anti-reflux function declined.And this was his last chance to make a correct diagnosis.
The muscarinic acetylcholine receptor M3 is the key receptor of the enteric nervous system controlling intestinal peristalsis, and they can convert the peristaltic command of the enteric nervous system into the motor command of the smooth muscle and sphincter in the digestive system.In patients with systemic sclerosis, the expression of the M3 antibody, which blocks the binding of this neurotransmitter, was significantly increased.This will lead to the inability of the enteric nervous system to fully execute the instructions for intestinal peristalsis, resulting in insufficient movement range of sphincter and smooth muscle, sphincter insufficiency and so on.This can trigger gastrointestinal symptoms.With the further increase of M3 antibody, the patient's gastrointestinal damage will continue to deepen, and symptoms such as smooth muscle damage, severe fibrosis, and collagen deposition will appear immediately.These injuries and insufficient range of smooth muscle movement can lead to swallowing obstruction in patients, and endoscopic manifestations such as esophagitis and esophageal contracture.
Sun Lien explained his point of view and called Dr. Pascal for consultation.At the same time, Cao Jianguo, who heard that he was "misdiagnosed", was very happy.Even a little happy.
"Second Uncle, what are you laughing at?" Cao Yanhua scratched his face and asked curiously.
"You are still a doctor, do you know that stomach problems are not easy to cure?" Cao Jianguo grinned, "Just now I heard from Dr. Xiao Sun that I am not a stomach problem, but some sclerosis, so it can be cured easily! It's okay to have a harder hand. , and then prescribe some softening medicine, I’ll be fine if I take some!”
Sun Li'en glanced at Cao Yanhua with a strange expression, and sure enough, as he guessed, Cao Yanhua showed a bitter and distorted expression as if he had eaten poop.
A doctor is most afraid of encountering a patient like Cao Jianguo.Most of these patients do not have any medical knowledge or even a reserve of biological knowledge.For this kind of patients, the focus of judging their disease is mainly based on the name of the disease.What "tumor" or "cancer", then you can go home and lie down to prepare for the funeral.For other diseases, keywords are randomly selected, and then combined with life experience, the keywords are "analyzed", so as to draw the wrong conclusion that "this disease is easy to manage".
To put it simply, this kind of patients are used to judging something that they don't know at all through imagining.And I will be very persistent in thinking that my judgment is correct.And then, no matter what the doctor explains, they insist, "I'm not sick, you're trying to scam me out of money."
Fortunately, Cao Jianguo is Cao Yanhua's second uncle.
Nephew will never lie to uncle!
Taking advantage of Dr. Cao Yanhua's spare time to supplement his uncle's knowledge of biology, Sun Lien welcomed Dr. Pascal with a tired face.
"This patient may be a SSc." Sun Li'en explained his judgment concisely, then stepped aside to turn on the computer and asked Dr. Pascal to sit down. "I want to hear your opinion."
Dr. Pascal glanced at the screenshot of the esophagoscope on the computer screen, and then took a look at Cao Jianguo's hands. "Your diagnosis is fine."
"That's good." Sun Li'en nodded, and wrote his diagnosis on the computer.Seeing that Cao Jianguo's make-up class was not over yet, he asked Dr. Pascal, "Recently...very busy?"
Dr. Pascale nodded with a wry smile, "I think if I can change my income from a fixed amount to a sharing system, I will be able to buy a house in Ningyuan by this time next year."
The housing price in Ningyuan is not low. It is close to the Fourth Central Hospital, and it costs almost [-] per square meter.
Sun Lien was overjoyed when he heard the words, it is a good thing that Lao Pa is willing to buy a house in Ningyuan.This shows that he has plans to take root in Ningyuan.If Old Pa can really take root, at least he won't have to worry about being skinned and stuffed by Dean Song, right?He pretended to be concerned and asked, "Have you gone to see the house? Decided where to buy?"
"I don't have time to look at it." Dr. Pascal continued to smile wryly, but changed from nodding to shaking his head. "My wife is doing research recently. She said that there is a newly built villa area nearby that is not bad. At least there is a yard for Panny and Todd to play."
The living habits of Americans are quite different from those of Chinese.For a medical professional like Dr. Pascale, a house with a yard is a livable "home."As for the buildings in the residential areas in the urban area - those are for bachelors and those who have no children but need to work in the urban area.
After pondering for a while, Sun Li'en asked, "Have you contacted the academy? I remember that there are housing subsidies for the introduction of experts."
Dr. Pascal continued to shake his head, "The college hasn't told me about this matter, why don't you ask Dean Song for me tomorrow? After all, you are my boss!"
"...Okay." Sun Lien took another job for himself.However, this matter is not too difficult for him. Anyway, it is Dean Song's request to keep Lao Pa. If the housing subsidy can be approved, at least it means that he has fulfilled Dean Song's request.
Sun Lien chatted with Pascal here, and the phone on the desk had to ring every 2 minutes—there were dozens of expert numbers in the Department of Rheumatology and Immunology waiting for Dr. Pascal to deal with it.Dr. Pascal, who was bombarded by phone calls, had to hastily ended the chat and rushed back to the consulting room to see patients.On the other hand, Sun Li'en also reported his discovery to Zhou Jun - there was a misdiagnosed case in the Department of Gastroenterology of the Fourth Central Hospital.
"Understood. You transfer the patients to the Department of Rheumatology and Immunology, and let them be admitted to the hospital for treatment." Zhou Jun pondered for a moment and made a decision. "I will report the misdiagnosis to the medical department. The patient's condition is not dangerous, right?"
"It has not been found so far. His systemic sclerosis should still be in the early stage." Sun Lien glanced at the top of Cao Jianguo's head again, except for the addition of "systemic sclerosis" in black letters, the status bar did not change.It shows that at least systemic sclerosis has not invaded other organs.At present, only the digestive tract is involved. "I continued to prescribe famotidine to control his reflux esophagitis, and the immune shock treatment was handed over to the Department of Rheumatology and Immunology."
"Don't discuss misdiagnosis with other doctors." Zhou Jun had no objection to Sun Lien's treatment plan, and his focus was on another direction. "For this kind of disease, misdiagnosis in the digestive tract is also excusable. And the patient did not cause additional damage due to misdiagnosis. This kind of misdiagnosis, which is not considered medical negligence, is unnecessary. Everyone knows-you understand what I am talking about?"
Of course, Sun Li'en knew that internal medicine had opinions about him.And he found out a case of misdiagnosis in the digestive system, which is actually quite a big thing in the hospital's operating system.It may require a suspension investigation of the doctor, while also reviewing his past diagnosis cases.Given the delicate relationship between the internal medicine system and Sun Lien, this incident might be interpreted as Sun Lien's deliberate provocation.
No one likes a misdiagnosis, and especially for doctors, it can be a nightmare.Once a misdiagnosis is confirmed, it means that someone has to take responsibility for it and pay the price.And the life and health of the patient will be threatened as a result - no one wants to see the occurrence of misdiagnosis.
"It's fine on my side, and I'll pass it on to Dr. Cao." Sun Lien suddenly thought of an important question, "But...Dr. Pascal just came for a consultation, and I'm worried that he might..."
"There will be no problem with Dr. Pascal." Zhou Jun laughed twice, "Just in time, there is a meeting invitation in two days, you can take the members of your treatment team with you." He paused, He emphasized, "It's the whole treatment group, but you can also take Xiao Hu with you. The meeting location is Sanya, Hainan, so it's just that you guys are going to play and give yourself a vacation."
Promote the book "Night Walk of Police Doctors"
The story of dual systems, dual heroes, a doctor and a policeman
The author is quite sincere, at least the medical content is not nonsense, and the information has been checked.As far as this point is concerned, it is already considered good.
The new book is still young, please help me.
(End of this chapter)
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