top student at medical school

Chapter 151 Personal Abilities and Adaptability (Please Subscribe)
The trauma center has a total of five senior professional titles and three chief physicians with the title of full professor: Zhang Mingcan, the ward director; Wu Guonan, the group leader; and Hong Du, the former director.

Then, the associate chief physician titles are held by Xue Tao from Wu Guonan's group and Huang Kai from Hongdu's group.

Director Zhang Mingcan's team did not appoint himself to an associate senior professional title; he simply mentored several junior doctors.

Xue Tao immediately realized the ambiguity in her wording and explained, "It's not the kind of collapse you understand; it's just a digestive disease caused by an imbalance of water and electrolytes due to overwork."

Upon hearing this, Fang Ziye blinked, thinking to himself, what's the essential difference? It's just that he didn't hang up, right?

Fang Ziye didn't complain and followed Xue Tao into the deputy senior's office.

Sure enough, without Huang Kai's presence, there was no one inside. After Xue Tao came in, he told Fang Ziye to close the door behind him, and then said, "Ziye, there are three computers here. Before Li Yuanhong was promoted to associate professor, one of them will always be empty. They are all connected to the intranet."

"If you can't find a computer over there in the future, just come here. This is also Director Zhang's idea."

"Besides Huang Kai and me, the director usually doesn't come into the deputy senior director's office casually." Xue Tao seemed to be setting rules for Fang Ziye, but also breaking those rules.

Being able to avoid having to fight with others for a computer in the ward is naturally a very friendly thing, but Fang Ziye is still considering whether this exception can be made indefinitely.

It's not about being aloof, but about considering whether you might stand out from the crowd in the eyes of junior doctors and attract their hatred.

After considering for a few seconds, Fang Ziye still thanked him, "Thank you, Brother Tao. And thank you, Director Zhang."

What's the point of thinking about this now? I have seven or eight beds under my care in the ward, and I'll be busy with the medical records and doctor's orders for those patients.

Fang Ziye had not made any prior preparations, so he could not slowly figure out the current medical orders by consulting literature. For the time being, he simply wrote out the routine medical orders that Wu Guonan and Xue Tao had given during their ward rounds.

Most of them are three-piece sets.

It reduces swelling, relieves pain, and has anticoagulant properties. It is a preoperative medication.

Fang Ziye carefully checked the prescription, verifying the dosage, frequency, and usage of the medication.

Then he asked, "Brother Tao, what area is our Director Wu usually most proficient in? I see that our department has quite a few sub-diseases."

Although the hospital in Enshi Central Hospital is labeled as a trauma medical center, it actually treats a wide variety of conditions, including trauma, hand surgery, joint surgery, sports medicine, and minimally invasive spinal surgery.

To find the key points, you should ask your team leader what they are good at.

Xue Tao said, "Director Wu Guonan was previously a subspecialist in hand surgery, so his current focus in the ward is trauma and hand surgery. You can think of it as treating fractures and tendon repairs."

"As for Director Hongdu, in the past, spinal surgeons followed the route of trauma surgery plus sports medicine and minimally invasive spinal surgery, while Director Zhang Mingcan mainly focused on trauma and joints."

"The sub-diseases in our department are definitely not as detailed as those at Zhongnan Hospital. Just focusing on one direction isn't enough to make a living," Xue Tao joked.

It's not that Enshi Central Hospital is a bad platform, but rather that Enshi People's Hospital and Minzu University Hospital had already been very good at trauma surgery, so much so that in previous years, most of the development of Central Hospital was focused on joint and spinal surgery.

Currently, the hospital has the highest level of expertise, handling about 50% of joint and spinal surgeries. The other two hospitals share the remaining 50%.

As for the subspecialty of trauma surgery, the other two hospitals account for 70% of the patients, and Enshi Central Hospital is now working to fill this gap.

Xue Tao then smiled wryly and said, "Of course, Dr. Fang, your timing is just right. Our department currently has a lot of trauma patients, and we are very specialized in treating them. It will take a long time to handle them all."

Fang Ziye nodded.

He then asked, "Brother Tao, how many surgeries can our team usually handle in a day?"

"Three to four machines is the limit. We can't do it as quickly as Zhongnan Hospital," Xue Tao replied.

Fang Ziye's heart tightened upon hearing this—

No wonder, there are more than 30 patients in the group who have not yet undergone surgery. With four surgeries a day and working non-stop for a week, they still can't eat.

This doesn't even include the regular trauma patients. The three groups are in similar situations right now. If we don't find a way to deal with it, we might not see any other types of illnesses within half a month, and the patients and their families will definitely be very frustrated.

How can I not be worried when I've been waiting for so long and it's still not my turn for surgery?
“Actually, it’s not a small amount,” Fang Ziye replied, smiling as he spoke.

At Zhongnan Hospital, a team can only handle a maximum of three or four surgeries per day. However, the difficulty of the surgeries performed at Enshi Central Hospital cannot compare with that at Zhongnan Hospital.

In terms of sheer numbers, Zhongnan Hospital may not have as many as Central Hospital.

It's just quite difficult.

If it's really just about fractures, whether simple or complex, Professor Deng Yong's team could easily do ten or eight a day.

After all, whether it's Deng Yong, Xie Jinyuan, or Yuan Weihong, they can freely set up separate tables. Even for a simple fracture patient, it wouldn't be a problem to have Qin Geluo lead a team to set up a separate table.

If we divide it into tables like this, we can easily handle more than a dozen tables throughout the day.

However, for prefecture-level city hospitals, there isn't such a strong resource allocation. Even if Wu Guonan wanted to allocate resources, there wouldn't be enough manpower.

The team currently consists of five people, including Fang Ziye, which is the maximum number if divided into two groups.

"Sigh, take your time."

"Ziye, you've never managed so many beds before, have you?" Xue Tao suddenly stood up and quickly walked towards Fang Ziye.

He forgot one thing: he forgot to guide Fang Ziye step by step in writing medical prescriptions and establishing medical records.

This is Enshi Central Hospital. The medical record system and doctor's order system are inconsistent with those of Zhongnan Hospital.

The medical records and prescriptions at Zhongnan Hospital are in the same system as those at Enshi Central Hospital. I don't know who took the money, but the system is incredibly difficult to use, and there's still no sign of updating or replacing it.

However, seeing that Fang Ziye could already operate the medical order system and medical record system proficiently, Xue Tao didn't make a fuss, but was secretly amazed by Fang Ziye's really fast learning ability.

Oh no, his learning attitude was also very fast, because Fang Ziye had, without anyone noticing, already recorded the account passwords for the medical record system and the medical order system in his notebook, and had also noted down some key points.

"Dr. Fang, I'm not trying to be sarcastic, but with your attitude towards learning, even pigs could fly." Xue Tao praised him generously after reading it.

"Brother Tao, can I reply with a question: how much stationery do poor students have?" Fang Ziye didn't have the airs of a genius.

Whether he's a genius or not, whether he has a good memory or not, Fang Ziye likes to record things in his notebook and check them carefully one by one. Moreover, when he reads literature, he prefers to print it out and read the paper version.

Although it would cost more, it would look more impressive, and Fang Ziye liked to take notes in his books, making them densely packed, whether necessary or not, he maintained this habit.

"Bullshit." Xue Tao lightly patted Fang Ziye.

"By the way, Ziye, after you finish writing the medical orders, first create a template for manual reduction and plaster fixation of fractures in the patient consultation and signature system."

"Director Wu is not particularly interested in the types of trauma surgery. He said this morning that he was going to find Dr. Huang to come and help perform manual reduction of fractures on the patients in the department."

"Those who can be discharged immediately after repositioning should be treated directly." Xue Tao said, touching his nose.

Looking at Fang Ziye's notebook, and then at my own A4 sheet of paper that looked so pathetic, I felt a little ashamed.

Fang Ziye's notebooks probably still contain his previous medical records even a month after a patient's discharge, but he's not even sure if he'll have any notes left tomorrow to know what medical orders were given today.

Fang Ziye had just finished writing the prescription for the second patient, and after checking it, he clicked submit.

Turning to Tao, he asked, "Brother Tao, what kind of miracle worker is Dr. Huang that Director Wu went to see? How can he manually reduce fractures that shouldn't have been done?"

Manual reduction and surgical reduction each have their own indications, and in some cases, these indications are complementary.

Whether a patient's fracture type can be resolved through manual reduction is a question involving both cognitive and practical aspects. However, Fang Ziye's recollection doesn't seem to recall a suitable patient who could be treated with manual reduction combined with plaster cast immobilization. How to assess this is related to the principles of fracture treatment.

There are three main principles in the treatment of fractures: reduction, fixation, and rehabilitation.

Rehabilitation procedures are largely similar, but each person's experience is different. The most important aspects are repositioning and immobilization.

The methods of reduction can be broadly divided into manual reduction and surgical reduction. The indications for these two methods are different. Generally speaking, patients with contraindications to manual reduction must undergo surgical reduction.

For patients with certain contraindications to surgical reduction, manual reduction is the best option.

It sounds like a paradox, but in reality, patients who are generally contraindicated for manual reduction are those for whom plaster cast fixation cannot achieve the desired fixation effect after manual reduction. Therefore, surgical reduction is necessary, and internal fixation with plates, screws, or intramedullary nails can be used to achieve the desired fixation effect.

Patients with contraindications to surgery are those who cannot tolerate the impact of surgical treatment. The surgery is extremely risky, and in most cases, it is fatal. In such cases, if you do not perform manual reduction, you can only let the patient lie down and allow the recovery to proceed at its own pace.

That basically means they're confined to bed and will die. In such cases, manual reduction and plaster cast immobilization are palliative treatments—they try their best to treat the condition, but recovery depends on fate. Surgery is not an option; if they did, they'd be in serious trouble.

Upon hearing this, Xue Tao's thick eyebrows relaxed, and he chuckled, as if enjoying the thrill of finally hitting a blind spot in Fang Ziye's knowledge.

"Ziye, you didn't know this, did you?"

"You really shouldn't disbelieve me. This Dr. Huang is a deputy chief physician who is a very good friend of Director Wu. He originally came from a traditional Chinese medicine background, but now he is the deputy director of the Department of Trauma Surgery at Minzu University Hospital."

At this point, Xue Tao slightly cupped his hands and said, "Director Huang studied under Dr. Chen, the most renowned TCM master in Enshi. Although Dr. Chen is no longer in Enshi, Director Huang has learned the essence of Dr. Chen's treatment of sprains and bruises."

"In the treatment of fractures, within the scope of our modern medical understanding, fractures that cannot be manually reduced can actually be resolved through manual reduction, achieving functional or even anatomical reduction. After reduction, external fixation with plaster casts can achieve a fixation effect."

Fang Ziye remembered two unfamiliar names.

Director Huang, Dr. Chen, and traditional Chinese medicine practitioners.

Is this the powerful figure his master mentioned before going to the countryside? A powerful figure he couldn't afford to offend.

“Oh, oh, oh…” Fang Ziye nodded with some admiration.

He doesn't understand traditional Chinese medicine and hasn't studied it systematically, but he still admires it greatly.

There was no other reason than that Fang Ziye's own grandfather had been saved by an old traditional Chinese medicine doctor in Enshi, and his uncle had also received good treatment from traditional Chinese medicine doctors.

Traditional Chinese medicine (TCM) is real, but good TCM doctors are hard to find. Most of the TCM practitioners you see on the market are just quacks selling cheap, unreliable remedies that only cause skin infections. Fang Ziye has seen these patients frequently at Zhongnan Hospital; their skin ulcers are so severe that Fang Ziye feels sorry for them…

Xue Tao returned to the computer and continued, "Director Wu and Director Huang have a very good personal relationship. I heard they were good friends back then, but they took different paths. Naturally, their personal relationship hasn't suffered."

"The reason why the Department of Trauma Surgery at Minzu University Hospital has been able to develop rapidly in recent years is thanks to Director Huang. However, because he has not produced any outstanding scientific research results, he is still a little short of being promoted to senior chief physician."

"Of course, Director Huang is relatively young, so his professional title won't be promoted that quickly."

"When I first started working here, I didn't believe it either. I thought to myself, how could you possibly control the surgical indications and manual reduction indications that so many top experts and professors have set?"

"But I later learned that the upper limit of manual reduction techniques in modern medicine is the relative limitation of surgical and manual indications."

"I remember during an annual meeting some year, a professor mentioned this. He said that the contraindications and indications for manual reduction are individual. If you don't have it, then even if it's a type A fracture, it's a contraindication for manual reduction and an indication for surgical reduction."

"But if you know how, then type B2.3 fractures, and even type C fractures, can be resolved through manual reduction."

"However, the reason why manual reduction is difficult to promote seems to be that the diagnostic methods of traditional Chinese medicine are difficult to match with the X-rays of modern medicine. Moreover, some people have done experiments and found that the same type of fracture, treated by the same doctor, yielded very different results, which is very strange."

"It's quite funny that a simple manual repositioning technique has hampered both traditional Chinese medicine and modern medicine."

Fang Ziye listened quietly, pondered carefully, and felt that Xue Tao's words made sense.

Upon closer examination, however, it seemed that the professor's statement, which Xue Tao had relayed, was somewhat unreasonable!

If the indications for surgery and manual reduction cannot be uniformly reflected in the guidelines, then trauma surgeons in modern medicine will have no choice but to go home and farm.

There's no way around it. First, it's hard to learn. Second, I've learned surgery, so I can treat it surgically. Your guidelines mention manual reduction, but I don't know how. So I can only push it outwards; otherwise, it's just a matter of lacking the ability.

Isn't that nonsense?

If a technology cannot be learned by everyone, then it lacks broad applicability.

Why are guidelines necessary? First, they provide guidance for experts and medical professionals on disease recognition and treatment. Second, they serve as a blueprint for relatively evaluating whether a doctor has committed medical malpractice.

Following the guidelines will generally ensure you don't go wrong; this is a widely accepted principle.

Individual ability is one thing, but how can you guarantee that everyone's individual ability is so strong?

The revision of the guidelines is related to the national average level of medical care, rather than the local level, if the guidelines were formulated based on the average level of Peking Union Medical College Hospital and West China Hospital.

That would mean clearing out all the staff from rural health clinics and county hospitals across the country; doing so would be wrong and certainly doesn't reflect the reality.

"I'm kind of looking forward to Director Huang coming over to give some lessons soon," Fang Ziye said.

The ability to broaden one's horizons is the accumulation of worldly experience.

The world is vast, filled with all sorts of impossibilities that outsiders cannot understand.

For example, a doctor like Fang Ziye doesn't even know how to give an injection. Can you imagine an ordinary person doing that? But Fang Ziye really doesn't know how; he has never given an injection to a patient.

Puncture and local anesthesia are excluded.

Then the two stopped chatting. Everyone had a heavy workload. Even though Fang Ziye shared some of the tasks, there were still seven or eight beds whose admission records needed to be written.

There are also various necessary procedures and signatures, such as the admission interview signing form and the out-of-pocket payment disclosure form for trauma patients.

Why do trauma patients have to pay out of pocket? This is a regulation stipulated by medical insurance, not by the doctor. Fang Ziye cannot explain it in great detail. He simply tells the patient and their family that if they need more information, they should go to the medical insurance window below.

Around noon, Fang Ziye finally finished writing the medical records and hospitalization records for eight patients, but had not yet started the consultation and signing process.

But the meal had already arrived, and Xue Tao said, "Ziye, have you finished writing the doctor's orders?"

"Don't worry about the medical records for now. Let's eat first. Director Wu ordered some boxed lunches to be brought to the director's office."

"And Director Wu and Director Huang have already started eating." Xue Tao stood up and rubbed his stomach.

"Director Wu is eating boxed lunches with Director Huang?" Fang Ziye asked, slightly surprised as he stood up.

To be honest, this is not how you treat a director of the foreign language department. Fang Ziye had never learned to treat guests like this from any other teacher.

Whether they are teachers from higher-level hospitals who have come from afar, colleagues from hospitals at the same level, or visiting scholars from lower-level hospitals, they are all treated with great care.

"Brother Tie, eating boxed lunches is nothing. I even saw them making something in the office with peanuts and a few dollars' worth of liquor," Xue Tao said with some envy.

"Down-to-earth, true brother."

Fang Ziye could imagine the strange scene: two senior professionals, both in their forties, hiding in the department, drinking ordinary peanuts and a few dollars' worth of wine.

This is no longer just about drinking alcohol; it's about the warmth of human connection.

(End of this chapter)