top student at medical school

Chapter 145 What Kind of Doctor Is This? (Third Update, Please Subscribe)

Outside the operating room, patients and their families continued to arrive, accompanied by muffled complaints.

It was the patients who joined the queue later who asked, "Why is it taking so long?"

"It's alright, this is for medical treatment, not for buying groceries. You didn't see that guy before, he was in there for more than half an hour before he came out," someone replied enthusiastically.

"There are only so many doctors, and only one operating room, so you just have to wait in line. I guess I'm just a little luckier than others since I didn't get injured." Some people offered this more optimistic advice…

There are too many people, so you can't push and shove. Everyone already has either a fracture or a dislocation, and if you push and shove, you'll bump into someone, which is just asking for trouble.

Who here isn't sick and in pain?
Zhang Jinchuan's broad shoulders and sturdy build give him a commanding presence befitting an orthopedic surgeon. Just by standing there with the door open, he naturally makes the patients closest to him instinctively shrink back.

Zhang Jinchuan is very strong. It's no joke to say that his arms are as thick as a girl's thighs. He doesn't look bulky at all. His voice was raised a few octaves: "Please take a moment to line up. We need to be responsible for every patient. Please come one by one and don't push or fall."

Then the patient brought in by Zhang Jinchuan was about forty years old, with his arms hanging limply. He was also a local and stood at the door saying in the local accent, "Quickly, quickly, give the doctor the X-rays, and I'll go in."

He was wearing leather shoes and a suit jacket over a shirt.

But at this moment, he had his wife cut off the sleeves of his shirt, leaving only half of his suit jacket with the sleeves hanging behind him, as he walked in like a monk's robe.

"Director, should I lie down or sit?" He immediately looked at Xue Tao, who was older, and also glanced at Fang Ziye next to him.

After all, Xue Tao was still chatting with Fang Ziye at this time, and her words showed a certain respect.

If you're middle-aged and don't even understand such basic social skills, then you're pretty much useless. The more unfamiliar the field, the more important it is to be able to read people and situations accordingly.

So after leaning against the bed, he also looked at Fang Ziye, who was wearing a mask.

He wasn't very tall, probably close to 1.8 meters, and he looked very energetic. Although he wasn't as big as Zhang Jinchuan, his muscles were quite well-defined...

As he looked Fang Ziye up and down, Fang Ziye walked over to him and said, "Uncle, what happened here? How did you get injured?"

In urgent situations, consultation and image review are conducted simultaneously, followed by a physical examination.

Otherwise, the normal consultation procedure is to first take a medical history, then perform a physical examination, and finally review the imaging results. But when necessary, time is the most important resource…

The middle-aged man was taken aback for a moment, but then took the initiative to continue the conversation—

"This is what happened after the car veered off course. I was holding onto something tightly with this hand. Even after it tipped over, I was still holding on. The doctor downstairs said it was lucky I was holding on tight enough, so it was just a dislocation, otherwise I would have been seriously injured." The middle-aged man joked with a touch of self-deprecation.

The patient's medical history and imaging findings are consistent with the characteristics of anterior dislocation...

However, Fang Ziye still dared not skip the physical examination. The busier the situation, the more important it was to make an accurate diagnosis to speed things up.

When Fang Ziye went to perform a physical examination on the patient, Xue Tao and Zhang Jinchuan, who were standing next to him, reviewed the X-rays and carefully confirmed the diagnosis to completely rule out occult fractures.

To diagnose a joint dislocation, a medical history, physical examination, and auxiliary examinations are all necessary.

Moreover, in addition to confirming the diagnosis, we also need to rule out other diagnoses. If a dislocation is accompanied by a fracture, then there is no need for manual reduction. Just perform skeletal traction and let the patient lie in bed.

If there's a fracture and dislocation, you can't possibly reset it.

After a basic diagnosis can be made.

Xue Tao then told the patient, "Your condition is an anterior shoulder dislocation. It requires manual reduction. Please sign here so we can perform the manual reduction and apply a cast, and then..."

The situation was urgent, and Xue Tao didn't have time to waste words with him. The normal medical procedure would have required a detailed discussion, but there were too many people, so she could do it if she wanted and leave if she didn't.

That's about all the stuff, and those are the risks. Talking about it any further would just be a waste of time.

When necessary, some steps can be omitted.

"Okay, why don't you ask my wife to sign it? My writing hand is useless now, I can't move it." The patient pointed to his right arm. Although he found signing the document quite troublesome, at least now that a professional doctor was taking care of him, he felt like he had met a savior.

This time, he really suffered. He waited a long time from the scene to the emergency room, then a long time in the emergency room, and then a long time at the entrance of the orthopedic trauma center.

He was on the verge of tears, because several of his friends who were anxious and thought they had connections had tried to pull strings, but the hospital wouldn't let them cut in line, had been taken away by the police. The middle-aged man had become much more obedient.

Using connections is something that happens occasionally in hospitals under normal circumstances.

But in the event of a major emergency, anyone who dares to cause trouble would be effectively fired from their position as the leader of Enzhou...

"Come this way, we won't be performing the repositioning in this operating room." After seeing the patient's wife had already signed the consent form at the door, Fang Ziye changed his hands from examining the patient to supporting the affected limb, and then pointed towards the door with his mouth.

Fang Ziye's words caught the patient off guard, and without thinking, the patient nodded, "Okay. Thanks!"

Naturally, Xue Tao, who was standing next to Fang Ziye, was also stunned after hearing Fang Ziye's words. Where was Fang Ziye going to take the patient?
Suddenly, just as the patient turned halfway around...

He suddenly felt a violent force coming from his right arm, which made him instinctively panic and let out a "Whoa!"

Immediately afterwards, his center of gravity became slightly unsteady, and he veered slightly backward.

"Click!" The sound almost followed the howl in quick succession.

Two voices rang out at the same time, and everyone in the room was stunned!

The middle-aged man seemed to feel a sharp pain in his right shoulder again, and immediately let out a painful cry.

However, this sharp pain lasted no more than two seconds.

A sudden feeling of emptiness, as if for a short time, my hands had detached from my body.

In medical examinations, this is called a phobia, which is accompanied by pain.

The sudden pain made him instinctively tilt his right side downwards. The brief pain immediately caused his forehead to be covered in a fine sweat, and the veins on his forehead stood up!
But in the next moment, all the pain was relieved. The rebound force of the upper arm muscles made his pain numb instantly, and he didn't even realize that the pain had disappeared.

She covered her right arm with her left hand, looking aggrieved and resentful, and glared angrily at Fang Ziye standing to her right, as if she had anger about to explode.

However, although Fang Ziye is not tall, he is considered strong and has considerable strength, while I currently only have one hand.

Can't beat it.

All I can do is yell, "You!"

He cursed inwardly: "You have no sportsmanship! Didn't we agree to go this way?"

At the same time, both Xue Tao and Liang Xueya were stunned.

I don't understand what's going on.

The burly Zhang Jinchuan slowly and stiffly turned his head toward Xue Tao, who had a large nose and thick eyebrows, his face full of question marks. He then noticed that Xue Tao's eyebrows were now tightly furrowed, as if drawn up like knives.

Xue Tao then looked at Fang Ziye—

Fang Ziye immediately released his hands and explained to the patient, "The repositioning is complete. Try moving this hand."

"Ouch, it hurts!"

"I can't move, I can't move. What am I supposed to do?" The middle-aged man's tone was rather unfriendly.

He cursed under his breath while thinking about reporting the incident.

If my hand weren't injured right now, would you believe me? I'd have to fight you. What kind of doctor are you? I'd definitely punch you.

"It's alright, sir. Move around a bit. It was dislocated before, but it's back in place now. The increased and persistent pain you felt earlier was a fear sign during the repositioning process. It's an academic term; it's temporary and will disappear immediately, and the original pain will also be relieved right away."

"Am I right?"

"The reason I sent you elsewhere was to distract you and speed up the repositioning process. If I told you I was going to trick you into a sudden repositioning, you'd beat me up," Fang Ziye said, laughing as he spoke.

Then, seeing the middle-aged man's skeptical expression, he said, "Come on, learn from my movements, slowly lift your right hand forward!"

At this moment, Fang Ziye paid no attention to anything else.

Because Level 3 manual reduction technique and Level 4 manual reduction technique are completely different in understanding and concept.

There were quite a few patients outside, and they were even queuing up.

Saving time is a necessary action. Even if I add manual reduction technique to level 4, I may only save time for one patient. What if I save time for two?

Saving even a little time means earning a little more.

Fang Ziye was now fully in character – because this simple reduction of anterior shoulder dislocation was far too easy.

Shoulder dislocation is an extremely common type of joint dislocation in clinical practice!

Anterior shoulder dislocation is the most common type of shoulder dislocation!
Having mastered the Level 4 Repositioning Technique, Fang Ziye had at least four or five ways to deal with it, making it seem effortless.

In addition, Fang Ziye possesses a level 4 ability to read medical images, which means his diagnosis is virtually flawless. If there are any loopholes, then Fang Ziye has already done his utmost.

Level 4 X-ray interpretation skills and Level 4 manual repositioning techniques represent preparations made to the best of my ability.

Although there might be a waste of knowledge points, Fang Ziye still dared not forget the oath he had made. He might have limited abilities, but he would do his best within his capabilities!
Naturally, the Level 4 manual reduction technique greatly benefited Fang Ziye.

In clinical practice, the most commonly used, widespread, and textbook-recorded technique for reducing shoulder dislocations is the foot-assisted hand-pulling method.

The scientific name is Hippocratic repositioning, but it is often referred to clinically as the foot-pull-hand method.

The surgical reduction method involves the surgeon placing their foot against the affected side's armpit and applying longitudinal traction while alternately rotating the humeral head internally and externally.

This technique is classic and simple, and its success rate in repositioning is acceptable. However, it carries a relatively high risk of brachial plexus traction injury and is quite laborious, so it is no longer commonly used.

Clinically, there are already other, less strenuous, and simpler reduction methods available, namely the external rotation reduction method. This is the choice of treatment approach.

The second type of promotion is about choosing the right time.

In general, after a joint dislocation, patients will subconsciously try to protect themselves and be on guard. This is equivalent to the sympathetic nervous system becoming tense, causing the muscles to contract involuntarily.

Under normal circumstances, if you want to perform a repositioning, you need to use the surgeon's strength to counteract the contractile force of this part of the sympathetic nerve excitation.

However, there are exceptions, namely, surprise attacks.

If you perform the repositioning before the patient realizes you are going to do it, you don't need to use too much force.

It saves effort and is fast.

Furthermore, such treatment procedures cannot be explained to the patient.

Explaining to Xue Tao and the others slowly would waste even more time; it would be better to perform a routine repositioning.

For conventional repositioning, it is necessary to resist the patient's stress-induced muscle contractions due to pain and the patient's defensive muscle contractions. This requires strong force or, with the addition of anesthesia or muscle relaxants, brute force traction to reposition the patient.

Clinical studies have shown that the protective contractile force generated by a patient's voluntary defense is greater than the stress-induced contractile force caused by pain.

Therefore, the best time to perform the repositioning is when the patient is unaware and completely unprepared.

Just then, the patient was talking to Xue Tao, and Fang Ziye was even 'pretending' to point him to a place, making the patient think that they really needed to go somewhere else.

It can definitely achieve a surprise effect.

This is about the grasp and timing of a disease.

Of course, only Fang Ziye knew these things; the patients didn't, and neither did Xue Tao and the others.

The patient looked at Fang Ziye with resentment, then glanced at Xue Tao, who looked older.

Are you going to do anything about it or not?

Otherwise, I'll file a complaint against you too.

Xue Tao also looked at Fang Ziye with suspicion, not quite understanding Fang Ziye's behavior.

Because he always felt that Fang Ziye's recklessness just now was somewhat inconsistent with his temperament and style of doing things, but he didn't know the specific reason.

Fang Ziye still didn't explain to Xue Tao, but continued, "Uncle, say something. If the pain gets worse, then I should apologize to you. If it's really as I said, then you can get a forearm sling and go home to rest."

"There are still patients seeking treatment after that, right?"

"If you don't say anything, I won't know whether it's good or bad," Fang Ziye explained calmly.

The middle-aged man immediately frowned.

Upon closer inspection, if the pain during the previous dislocation was the size of an egg, the pain just now suddenly became the size of a basketball, and now it's only the size of a grain of rice.

Fang Ziye was right about everything!

Fang Ziye can deceive himself, and even his wife can deceive him. But his own feelings certainly won't lie to him.

So the patient began moving his left hand with some skepticism!

Slowly lift it up.

Well, it's alright.

Outreach was alright.

It was raised, and it was raised.

Immediately, the patient's eyes lit up as he looked at Xue Tao and Fang Ziye, his tone becoming much better: "Director Xue, doctor, what about me? I'll get it right away?"

"All right?"

He personally witnessed how long it took for the previous patients to go from entering the operating room to leaving.

He has been in this room for a while now, and the time he has been staring at Fang Ziye for so long has only been two or three minutes. This includes the time Fang Ziye spent examining him and reviewing the medical images.

But for everyone else, it was usually around ten minutes.

Upon hearing this, Fang Ziye replied, "You had a joint dislocation before. The main symptoms of a joint dislocation are pain and limited mobility."

"As you can see now, the joint has been repositioned. If you feel significant relief from the pain, then the dislocation has been corrected. Go get an X-ray later to check the results."

"The reason I caught you off guard was to lower your guard and reduce the force of your defensive muscle contractions, just like..."

Fang Ziye then began to explain in detail, wanting to fully inform the patient and Xue Tao about his treatment process and approach.

First, it's about getting the patients involved in the entire diagnosis and treatment process so they can understand it; that's how you get the timing and intensity right.

Otherwise, if only the doctor has a precise understanding of the disease, but the patient doesn't quite understand it, then the communication process wasn't done well.

Secondly, it was a subtle way of telling Xue Tao that I actually had some skill in manual reduction techniques, and if he was willing, I could help him quickly deal with the patients outside, allowing him to recover some of the knowledge points he had spent.

Of course, it doesn't matter if you don't believe it.

I will not take the initiative to ask for orders to be obeyed.

Speak less, do more, promise less, ask less.

On his first day, Fang Ziye couldn't ask for too many opportunities, as that would seem foolish. However, he could appropriately showcase his abilities and let Xue Tao make her own choices.

Xue Tao was stunned when she heard Fang Ziye's words, and then she became a little dumbfounded.

Fang Ziye was probably talking to himself.

It's just a simple dislocation technique, but they've made it sound so mysterious. Is it real or fake? It sounds a bit far-fetched.

"Zhang Jinchuan, take the patient out to get the post-operative follow-up appointment order, and then put on a forearm sling. Dr. Fang and I will take care of the other patients." Xue Tao hesitated for a moment before speaking.

He had many doubts in his heart, but it was not the right time to ask them.

When facing a patient in person, resolving their pain is the top priority; everything else must take a backseat at this time.

Asking someone a question face-to-face is something that only happens in TV dramas.

Upon hearing this, the patient quickly thanked Fang Ziye, and his gaze towards Fang Ziye changed slightly.

"Next." Immediately afterwards, Xue Tao took the initiative to call in the next patient.

However, such a tactic might work the first time, but it's impossible to use it repeatedly.

Moreover, the patient seemed to have heard the previous repositioning sound, so he kept looking at Fang Ziye with great vigilance.

(End of this chapter)