top student at medical school

Was there a misdiagnosis in Chapter 168? (Please subscribe)

Fang Ziye had finished dealing with his own matters and stood up immediately, but instead of leaving, he asked, "Brother Lei, were the emergency consultations at our hospital handled by the on-call doctors before?"

If Fang Ziye heard correctly, this should be the model.

Guo Yunlei obtained his medical license last year and officially started working on duty after registration. If this model is followed, Guo Yunlei must have handled emergency consultations.

"Yes, Brother Ye." Guo Yunlei nodded, slightly shifting the keyboard towards Fang Ziye to show his respect.

"Any things to be aware of when making this emergency consultation? If not, I'll just head over there." Fang Ziye asked casually, not wanting to waste any time.

Guo Yunlei's eyes flickered slightly, and after thinking for a moment, he said, "If the patient has been treated before, Brother Ye, you might need to be a little more careful."

"Because whether it's Enshi People's Hospital or Minzu University Hospital, the patients transferred here are likely to be difficult cases, but if it's their first visit, it's relatively simpler."

“Normally, emergency patients are called directly to the ward by the emergency department. Such emergency consultations are mostly multidisciplinary joint injuries. If there are indications for treatment in our department, we will recommend consultations with other specialties to assess vital signs and then admit the patient for treatment.”

In fact, Fang Ziye's inquiry surprised Guo Yunlei quite a bit, but considering that Fang Ziye had previously worked at Zhongnan Hospital, it was basically very difficult for junior doctors to obtain such authority.

Let alone a master's or doctoral degree holder like Fang Ziye, even experienced doctors who have completed advanced training would not be allowed to work shifts, and even the opportunity to perform on stage would have to be waited for and fought for.

"Okay, thanks, Brother Lei. If I have any questions, I might call you again. Brother Lei, don't try to fool me. When I say we're learning from each other, I don't mean empty flattery. I really will ask you questions." Fang Ziye said this before walking out.

Fang Ziye learned something from Jie Han and Luo Tingzhu: if you don't understand something, just ask. So what if you're shameless? You can learn something, why care about saving face?

Fang Ziye glanced at his chest. He hadn't had time to get his name tag yet, but it didn't matter. He was going to see a doctor with the necessary license, so a name tag wasn't always required. Even if he did wear one, he would only be a resident physician.

Fang Ziye was very familiar with Enshi Central Hospital; he had been to the emergency department once before. Although it was a bit far from the inpatient building, it was alright.

The elevator couldn't speed up, so Fang Ziye quickly jogged after getting off.

In case of an emergency consultation, the consulting doctor must arrive within fifteen minutes. There may not be such an absolute requirement, but if possible, Fang Ziye will try to arrive as quickly as possible to save time.

What if it's a large hematoma or trauma?

Then we need to call the operating room immediately and ask our superiors to take the patient there when they have time.

However, before seeing the patient, Fang Ziye could only make inferences based on the general procedure.

Fang Ziye arrived at the emergency department quickly, which was still somewhat disorganized.

Family members supporting patients, patients themselves, trolleys, wheelchairs, patients covering their hands and small cuts, nurses pushing trolleys, and white coats rushing in and out—it's hard to see everything at a glance…

Fang Ziye quickly ran to the entrance of the surgical emergency room and asked inside, "Teacher, which patient is the one requiring an emergency consultation in orthopedics?"

The surgical emergency room is about 20 square meters in size, slightly larger than a ward. There is a worktable directly in front of the door, and gurneys on both sides.

There were two patients lying on the left and three on the right, each with a doctor in a white coat handling their patients, reviewing X-rays, or writing emergency medical records.

Fang Ziye inquired about the doctor in the white coat sitting at the doctor's workstation as he approached.

"Orthopedics? Urgent consultation?" He was stunned for a moment, clearly not recognizing which of the five beds outside required an orthopedic consultation.

"Oh!~"

"Orthopedics, come with me."

"Brother Yu, can you take a look for me..." he said to the distance after standing up.

Although there was no verbal response, Dr. Yu, who was cleaning the patient's wound, nodded.

"Teacher Du, did she go to the operating room?" Fang Ziye's heart tightened slightly upon hearing this.

When Fang Ziye saw the doctor in front of him, whose head was very oval, named Du Gaozhong, he politely called him Teacher Du.

Wearing a mask and hat, Du Gaozhong shook his head upon hearing this: "No, this patient and his family are a bit difficult to deal with. They were transferred from Minzu University Hospital, and the medical record already has a treatment plan."

“We would definitely give priority to the opinions of the other hospital if this patient was transferred from another hospital. We hoped that he would have an MRI scan first, and then ask your orthopedics department to come and take a look. But the patient disagreed and insisted that Minzu University Hospital had called to make arrangements and that we were in cahoots.”

"They were making a ruckus in the emergency room earlier, so our head doctor took them aside."

"You need to be careful," Du Gaozhong kindly advised, seeing that Fang Ziye was young.

He was probably in his thirties, calm and composed.

Having worked in the emergency room, I've witnessed a significant number of deaths and injuries. If you panic, you definitely won't be able to stay still.

"Thank you, Professor Du. I understand now." After listening, Fang Ziye followed Du Gaozhong to a deputy director's office that looked rather private.

Just as Du Gaozhong reached the door and was about to knock, a voice came from inside: "Director Ning, please stop speaking up for those doctors from Minzu University Hospital."

“Just tell me what’s wrong with them. I just twisted my ankle, and they made me do X-rays and MRIs. They even said that they wouldn’t treat me without an MRI and suggested that I be hospitalized.”

"What kind of doctors are these?"

Du Gaozhong's hand froze slightly, but after a three-second pause, he knocked on the door with his left hand and pushed it open with his right: "Director Ning, the orthopedic consultant has arrived, so I brought him directly here."

Fang Ziye was right next to Du Gaozhong and didn't linger. After Du Gaozhong opened the door, he went straight inside.

Orthopedics and emergency medicine are parallel departments, and there is no such thing as an upstream or downstream department. Moreover, Fang Ziye's first lesson in trauma surgery at Zhongnan Hospital was that when you encounter a patient, go see them first, and decide whether you can do it or not. Don't hesitate or be indecisive.

This is an art of getting along.

"Hello, who is the patient? What's wrong?" Fang Ziye smiled at Director Ning as he entered the office, then asked the two people directly opposite Director Ning at the desk.

A man and a woman, probably in their forties, were likely a married couple.

"Sigh, see for yourself. Every time someone comes in, they ask this question. What's wrong with your hospitals these days?"

The injured man used his right, healthy arm to push against the medical record book on the table.

His hand was still carefully protecting his shoulder joint.

Director Ning immediately said, "Dr. Fang, the injured person is this gentleman, and the family member next to him is his wife. It should be a shoulder dislocation."

“I visited the Minzu University Hospital before, and they suggested that after an MRI, surgery might be necessary. You are a professional orthopedic doctor, could you take a look at me as well?”

Director Ning ignored Du Gaozhong, who brought Fang Ziye over, and instead conveyed a huge amount of information to Fang Ziye with a seemingly ordinary sentence.

The patient and their family are both very difficult to deal with. I had previously seen a doctor at Minzu University Hospital, and they wanted to perform examinations and surgery.

Fang Ziye's voice and tone were gentle as he carefully examined all the data and medical records, saying, "You saw a doctor at Minzu University Hospital before, why didn't you choose to have it treated there?"

"The trauma surgery department at Minzu University Hospital is excellent."

Fang Ziye didn't say that his hospital's trauma center was bad, nor would he dare to say such a thing.

"That's all just talk. They treat people differently based on their connections. Those with connections get their parts fixed and leave, while ordinary folks like us, without any connections, are left to have surgery."

"They are the same problem, but the solutions are completely different."

At the same time, Fang Ziye saw the signature on the medical record and his heart tightened again.

Wu Xuanqi.

Then he quickly scanned the medical records written by Wu Xuanqi, which could be described as concise and skillful.

It's been two hours since the injury. Dr. Wu meticulously recorded the time of the medical record entry, noting it was 9:50 AM, but the entry itself was written thirty minutes ago. The diagnosis given was moderate posterior shoulder dislocation and rotator cuff tear?
Shoulder dislocations are most commonly anterior dislocations, followed by inferior dislocations, while posterior and superior dislocations are the rarest.

The reason it's so rare is because the trauma is so severe. Usually, such trauma results in fractures, not dislocations. Only in extremely rare cases can it manifest as a posterior dislocation, but even then, the likelihood of rotator cuff injury is over 95%.

A 95% probability is probably still a relatively conservative estimate.

There was no need for a physical examination; there was definitely a dislocation complex. Fang Ziye only glanced at it and already roughly understood what was going on.

He then asked, "Uncle, you just mentioned that Minzu University Hospital also reduced a dislocation. Can you confirm that the patient who underwent manual reduction at Minzu University Hospital had the same moderate posterior dislocation injury as you?"

"It seems I'm ignorant; I've never heard of a moderate posterior dislocation being able to be manually reduced!"

First of all, Fang Ziye can confirm that complications from posterior dislocation are 100% certain. The reason why there is a few percent chance of no accompanying symptoms is simply because he doesn't want to make any definitive statements.

Secondly, Wu Xuanqi is a professional doctor, and his professional skills in manual reduction and diagnosis are definitely better than mine. The fact that he did not perform reduction and pain relief immediately, but instead suggested an MRI, indicates that there is definitely a significant problem.

"What do you mean? You think I'm lying to you?" The middle-aged man turned his head, his tone and expression somewhat fierce.

He knew that if he wasn't fierce, he would face the doctor's indifference.

"No, that's not it. It's just my personal understanding. You have a posterior shoulder dislocation, which is a rare type of dislocation. It's very difficult to completely resolve the problem with manual reduction. At most, it can only provide temporary pain relief."

"To solve the problem, surgery is definitely the only option," Fang Ziye explained slowly.

Just as I was about to ask if there were any more movies...

The man roared again: "You know everything? You don't even look at me, how do you know what kind of repositioning I am? Did you come here for a medical checkup or to read a book? Whatever he writes, you believe it?"

Fang Ziye wasn't angry, knowing that it was best not to add fuel to the fire at this time: "Uncle, you're wronging me. I wanted to ask you directly right away, but you said you were too lazy to explain and told me to just look at it."

"Right? My aunt can make that decision for me too."

"You only show me your medical records, so I can't just give you a physical exam and all that, can I?"

The middle-aged woman glanced at Fang Ziye, whose eyes were smiling and who seemed rather approachable.

He said, somewhat angrily, "Doctor, stop rambling on and on. Just tell me, when is the treatment?"

“My husband has been injured for almost two hours now. No one has come to deal with it yet. How are we going to resolve this problem? If your hospital is going to be so perfunctory and avoid the important issues, then I will have no choice but to report you.”

Upon hearing this, Fang Ziye's eyes flashed, and he suppressed his anger, remaining calm and composed: "This is a matter of treatment, and it should be done after an accurate diagnosis. From the time I received the urgent consultation call until now, it hasn't been more than fifteen minutes."

"It took eleven or twelve minutes to get there. Right?"

“I don’t even know what the diagnosis is, so how can I deal with it? I can’t even offer advice.”

“If you don’t even give me a chance to diagnose, then it’s unreasonable and illogical for you to complain about our hospital. We’re not unreasonable people, we wouldn’t do such a thing, right?” Fang Ziye had only been inside for about a minute.

"Of course we can't be unreasonable," Fang Ziye's flattery had a slight effect.

"I'm here for treatment, not to complain. I'm still in a lot of pain here, I don't have time to complain. Can you take a look and tell me what to do?" The man's affected left shoulder trembled slightly, clearly in pain.

"Ok."

As Fang Ziye approached, he gently touched the skin a few times and asked a few questions about the patient's medical history and the course of the injury. Then he asked, "Have you printed out the X-rays you took before? Or can you check the results on your phone?"

"Based on the initial assessment from the physical examination, a posterior dislocation of the shoulder joint is definitely present; otherwise, you wouldn't be in so much pain. However, the extent of the dislocation is..."

"Can it be reset?" The man ignored Fang Ziye's numerous explanations.

"That depends on the situation. I don't know the extent of the damage, so I don't know if it can be reduced. If you want me to trust the medical records, then I'll tell you that it can be reduced surgically, but not manually," Fang Ziye replied flawlessly.

"Hey, who are you? Don't you have any senior doctors in your department? Where's your head doctor?"

"Isn't the director coming for a consultation?" The middle-aged woman didn't notice any flaws in Fang Ziye's words and was slightly annoyed.

Director Ning immediately chimed in: "Sister, this is really true."

“For emergencies like yours, the chief physician does not directly participate in emergency consultations unless it is a problem that a junior physician cannot solve, in which case the junior physician will request a senior physician to come and inspect the situation.”

"Then please! He can't handle it, it's obvious he can't." The woman gently patted the table.

Director Ning's tone faltered instantly.

Fang Ziye then took over the conversation: "How about this, given your situation, you go back to the orthopedic ward first, and then I'll call our director. After the surgery, the director will come over to take a look. This process may take one or two hours."

"Because of the director..."

"One or two hours? Are you kidding me? You want us in the emergency room to wait one or two hours? What's the point of being an emergency room then?" Upon hearing this, the man seemed to think that Fang Ziye was an oddball.

"Uncle, the emergency room is not the emergency room you understand."

“Our hospital has more than just an emergency room; we also have outpatient and surgical services. The head doctor is currently performing surgery, and the patient on the operating table needs our head doctor to perform surgery to resolve the issue. Therefore, according to the priority of the cases, yours will be placed further down the list.”

“It’s impossible for the director to step down and come directly to see a patient just because of an emergency case of shoulder dislocation.” Fang Ziye also showed a bit more temper.

"I don't care. If you can't solve it, call your director over. Otherwise, I'll complain about you. What kind of bullshit rules are these? Surgery here, surgery there, is your hospital the busiest place?" The man started to act shamelessly, turning his head away as if he had Fang Ziye cornered.

"Then there's nothing I can do. If you want to file a complaint, there's nothing I can do either."

"Then I'll write it down: you refused to cooperate with my suggestion. You strongly demanded that a senior professional title be awarded for treating patients. Is that what you mean? Right?" Fang Ziye was also decisive, picking up his pen to start writing.

When did I refuse?

"Young man, don't talk nonsense, okay?" The woman wouldn't let Fang Ziye write anything and snatched the medical record away from him.

"If you can't solve the problem, call your superiors. Do I have to teach you something this simple?"

Fang Ziye said, "Thank you, but no need. I don't know how to make phone calls either. None of my teachers taught me that patients with dislocations should call their superiors directly."

"You only have a few options right now. First, let me diagnose you and give you a reliable suggestion based on my qualifications."

"Second, you can go to another hospital for treatment. Third, you can just wait for a senior doctor to come and examine you."

"These are the only ways to solve the problem. No matter which option you choose, you have the greatest right to decide."

“You don’t listen to my advice or my opinions, and you want me to call my superiors? That’s absolutely impossible. Our superiors won’t come either. They’ll just make you wait in the ward. I’ve already analyzed the approximate waiting time for you.”

"Do you have any other questions?" Fang Ziye asked patiently again.

"You really think I wouldn't dare to report it? Do you believe I'll go right now?" the middle-aged man said to Fang Ziye, his face hardening.

"Whether you go or not is your freedom. If you choose to go, I cannot restrict your personal freedom. I have already fulfilled my duty. It's just that you rejected my diagnosis and advice. What else can you report?"

"You're reporting me for not agreeing to your unreasonable demands?"

"Also, I still need to use your emergency room medical record book. I need to write down my suggestions clearly." Fang Ziye explained in this way, without exploding, remaining relatively calm.

Hearing Fang Ziye say this, the middle-aged man finally managed to utter a single sentence: "Give me a straight answer, did Minzu University Hospital misdiagnose you or not?"

This revealed their true intentions.

(End of this chapter)