top student at medical school

Chapter 293 Master, I Want to Show Off (Please Subscribe)
"Master!" Fang Ziye calmly took off his rubber gloves, folded them inside out, and threw them into the yellow trash can, calling for help.

Knowing that Yuan Weihong was in a bad mood, he quickly continued to explain, "Master, these joint dislocations and fractures are relatively simple, not the kind that may have additional damage."

Fang Ziye had to explain to Yuan Weihong; Yuan Weihong had warned him about this last time.

You can disregard what others say, but if your master, Yuan Weihong, misunderstands that you are two-faced, it will cause a big problem.

If a person doesn't have the assistance and guidance of a mentor, and has fallen out with or had a misunderstanding with their mentor, their future prospects are unlikely to be very bright, unless the mentor is really too unreasonable.

Yuan Weihong took a deep breath and calmed himself down before saying, "Tell me the truth, how many patients did you see this morning?"

Medicine is not child's play!

Even the emergency department of Peking Union Medical College Hospital wouldn't dare to use the term "assembly line."

In hospitals, only laboratory tests and auxiliary examinations are done in an assembly-line manner!
In real clinical practice, each patient is treated individually, from start to finish, before the next patient is moved on.

But when it came to Fang Ziye, good heavens—

Line up and get manual repositioning done together!

Do you think you're having a reset party?
Upon hearing this, Fang Ziye quickly confessed honestly: "Master, I have only treated five patients so far. One of them had a joint dislocation, and three had fractures. However, one of the three fracture patients had both a fracture and a joint dislocation!"

"Of the other two fracture patients, one is very likely a closed fracture, but there is a combined chest and abdominal injury. There is currently no absolute indication for emergency surgery, and only a small local debridement is needed."

"The other two fractures, one is a simple fracture, which I reduced and immobilized with a plaster cast. He should need to be hospitalized for further treatment. The other fracture..."

Fang Ziye explained it in great detail.

Fang Ziye had no choice. The patients arrived one after another, not all at the same time. He couldn't check the vital signs and other conditions of each patient in a short period of time!
In other words, he must find time to see the next patient between seeing the previous one! To avoid the need for emergency surgery on the next patient, there must be an absolute indication.

After confirming that the next patient was out of danger, Fang Ziye went back to check the previous patient's examination results. By then, the previous patient had almost finished their examination as well. Based on the results, Fang Ziye could assess whether manual reduction was feasible.

Or they could offer other treatment options and advice.

At the same time, we also need to receive new emergency patients. In such cases, we temporarily set aside patients who have already been diagnosed and whose treatment plans we have already decided on.

Prioritize tasks for newly arrived patients whose life-threatening condition or potential illnesses is unknown.

First, check for life-threatening situations, then treat the symptoms. That should definitely be the right approach.

With all this piling up, it's no wonder that we've ended up with the long queues we see now.
However, Yuan Weihong had come specifically for this reason, so after listening for a while, he interrupted, saying, "Wait a minute."

"You said you had a patient you wanted to admit. Well, then I have to ask you something. Fang Ziye, when have you ever seen a patient with a simple fracture admitted to our hospital?"

"Are there any empty beds in the department for him? If you want him to stay in the department and occupy a bed, do you, Fang Ziye, have more face or more dignity?"

Yuan Weihong felt a bit annoyed after hearing Fang Ziye's explanation!

Not to mention, after taking on a patient individually, one must pay attention to the first-visit responsibility system, which is a principle of the medical system. In fact, whether it is an emergency patient or any other patient, once they enter the hospital, you must take full responsibility for them.

The behavior of someone like Fang Ziye, who saw the patient halfway through, sent them away, and then continued seeing them while uniformly arranging for repositioning, is somewhat irresponsible.

Fang Ziye's current queuing system is unscientific. It cannot treat so many patients at the same time, and you cannot admit such patients to hospitals.

There's no such procedure, and there's no available bed for a minor fracture.

Upon hearing this, Fang Ziye hesitated for a moment, then said, "Uh...!"

Immediately afterward, Fang Ziye thought of something: "When Jin Hongzhou and Brother Nuo were chief residents, didn't they admit patients into the wards?"

Upon hearing this, Yuan Weihong immediately replied, "That's only when they haven't been treated properly or the emergency room can't handle the situation, and the danger is extremely high, that they need to be admitted to the ward so that the professors can finish their treatment!"

"I glanced at the one you just took in and I can tell that it has neither bone defects nor lower limb defects!"

"Third, there are no signs of shock, so where are you going to take him?"

Upon hearing this, Fang Ziye looked up in confusion: "Then what should we do?"

Fang Ziye was confused at that time.

“There is more than one Zhongnan Hospital in Seoul. There are other places in Seoul besides Zhongnan Hospital to deal with trauma surgery emergencies.”

"If there is no bed available, the condition is not life-threatening, and it is not an absolute emergency, the patient can be transferred to another hospital as appropriate."

"If you insist on receiving treatment at our hospital, you'll likely have to go through the standard outpatient treatment process. Did no one teach you this?"

So you're not going to ask?

“You know everything anyway…” Yuan Weihong seemed to have found a loophole and began to frantically pour out his ideas, which were all the complaints that many people on the Internet had about emergency consultation doctors in large hospitals.

There's only one reason: there are no beds available for hospitalization. If you want to have surgery here, you'll have to wait. Go to the less desirable hospital next door and don't waste our hospital's beds.

Many people think that this is the hospital selecting patients because they don't have enough money.

In reality, they are selecting diseases.

"Master, what about the ones I dealt with today?" Fang Ziye was not convinced, but he had no choice but to admit defeat.

At least there was room for a joke when Yuan Weihong came to negotiate with him.

If it were Professor Deng Yong asking me, as Yuan Weihong said, "Fang Ziye, are you really going to arrange the types of diseases our group will be treated for?"

Fang Ziye was completely unable to reply.

"Alright? Now that it's all been dealt with, the X-ray after repositioning needs to be properly evaluated, and we need to take full responsibility." Yuan Weihong sighed, not to pursue accountability, but simply to give Fang Ziye a warning.

"What about that patient who might need to be hospitalized?" Fang Ziye asked Yuan Weihong again, asking how to handle the situation.

Yuan Weihong patted Fang Ziye on the shoulder and said, "Watch me."

Fang Ziye nodded, then watched Yuan Weihong approach the middle-aged man from Sichuan Province, whom Fang Ziye had previously mentioned had surgical indications.

No more than three minutes later, the middle-aged man's cursing voice came from behind: "Why are you still doing this?"

"We clearly agreed that I would have surgery."

"Yes, you need surgery. Surgery is a treatment, but in our hospital, it takes about half a month to schedule a surgery like yours."

"With a two-week waiting period, your fracture may have already healed abnormally. There's nothing we can do about that; some emergencies aren't what you think of as emergencies," Yuan Weihong explained.

“Look over there, those people. As soon as they appear, our orthopedics department immediately admits them to the ward. There’s no other way.”

"Is that so?"

“If we took on every kind of emergency, our orthopedics department would be overflowing with patients. We probably wouldn’t even be able to get into the real emergency rooms,” Yuan Weihong said, appealing to the public’s emotions.

"What do I do now? You guys..."

"Go next door? Which next door?" Yuan Weihong gave him a hint, and he asked again.

"It's all fine, it's your choice. I can't give you hints or explicit suggestions, otherwise you'll feel like I'm recommending hospitals to you and then I'm making a referral fee for recommending you to a hospital." "I won't do that kind of unethical thing. You can go to any hospital except ours, as long as you can contact them in advance to find a bed and they're willing to accept you. But I suggest you don't contact Tongji or other big hospitals..."

"Can't you really arrange the surgery?" the middle-aged man from Sichuan Province still refused to give up.

"You're kidding me!" Yuan Weihong probably had a wide circle of experience in the world, so he could still speak a few words of Sichuan dialect.

Upon hearing this, the other party found it believable, sighed, and rolled their wheelchair aside.

"Let's go check on the reset." Yuan Weihong stopped worrying. After giving Fang Ziye a preliminary demonstration, he wanted to be as reliable as possible to ensure Fang Ziye's success.

My student, after falling in love, seemed to have completely forgotten that he had a mentor. Before taking over as chief resident, he didn't ask any of the important questions.

In fact, everyone thought that the review of the results after the resetting was just a procedure!
But that's not actually the case. Observing whether the situation after repositioning is appropriate is the true reflection of a person's skill level.

Fang Ziye and Yuan Weihong went back into the consultation room, where the people inside were discussing the matter animatedly.

"I really learned something new today. I had only ever heard that when you come to the hospital, you have to go through a lot of tests and then be hospitalized. I never thought I would actually see a scene like the one in the short video where the body is immediately repositioned without injections, medicine, or surgery."

"Yes, we may all be a bit one-sided, thinking that only traditional Chinese medicine practitioners perform manual reduction. We all think that Western medicine is just about surgery."

"..."

As they were discussing, Fang Ziye and Yuan Weihong came in. The person near the door greeted Fang Ziye, "Dr. Fang, do we need to go for a follow-up examination?"

“Yes, we need to have a follow-up examination first, so that we can be more at ease with the results.” Fang Ziye’s gaze was sincere, and his tone was relatively more amiable.

After all, we'll have to arrange for you to not be hospitalized in our hospital later, so we need to build a good relationship in advance.

The re-examination and evaluation of the results are important, but the process is not complicated.

There are several main ways to assess the effect after repositioning.

First, check if the symptoms have improved.

Second, check if the deformity has disappeared.

Third, observe whether active and passive movements have recovered after joint dislocation reduction.

Fourth, check whether the joint is in place on the X-ray, and whether there is soft tissue compression or false reduction. If none of these are present, it proves that the reduction is of high quality.

Fifth, check for any complications during the reduction process, such as fractures.

Yuan Weihong reviewed the X-rays, while Fang Ziye was responsible for the post-reduction physical examination, observing active and passive movements, etc.

Yuan Weihong believed his film-viewing skills were superior to Fang Ziye's! At least, that's what Yuan Weihong thought.

Therefore, Yuan Weihong could see that the patients treated by Fang Ziye not only had their deformities disappear and their mobility restored, but also the four patients in this batch who had their deformities repositioned.

Not a single patient had any 'additional symptoms'!
What is 'additional complication'? It refers to the pre-existing complications that are likely to occur after repositioning.

Generally speaking, during reduction, there may be slight tearing of the soft tissue in the joint cavity, bleeding, or edema after impact. These are the most common problems that beginners in manual reduction of joint dislocations may cause.

These symptoms are not serious and will recover with rest.

Moreover, these symptoms, such as bleeding, are often undetectable by orthopedic surgeons who lack sufficient skill.

But Yuan Weihong himself could see it, because this was the greatest source of confidence he had after his film-reading skills improved, stemming from his own strength.

But?

Yuan Weihong looked for more than 20 seconds and couldn't find these common mistakes made by novices. This proves that Fang Ziye not only performed manual reduction well throughout the entire diagnosis and treatment process, but also made extremely accurate assessments when assessing the indications for manual reduction.

If there are suspected or obvious additional symptoms, these are relative indications for manual reduction. You need to carefully consider whether to perform manual reduction before deciding. These are also relative indications for surgical reduction, and are at the borderline.

This all demonstrates Fang Ziye's skill level and basic abilities in repositioning.

Yuan Weihong couldn't find these things, so he suppressed his inner thoughts of "going all out" to teach and explain to Fang Ziye!

Yuan Weihong glanced at Fang Ziye several times.

Fang Ziye's physical examination is almost complete.

"Master, there shouldn't be any problem, right?" Fang Ziye didn't dare to send the patient away directly when Yuan Weihong didn't speak.

When the master handles the disposal of ownership in person, it no longer belongs entirely to oneself.

"Let's go." Yuan Weihong had prepared many arguments, but none of them came in handy at this moment, so he could only watch from the sidelines.

One after another.

Fang Ziye reviewed the follow-up results of almost all four patients, and following Yuan Weihong's example, he also sent another patient who might need to be hospitalized for antibiotics to the emergency department or another community hospital.

Only then did he walk back into the consultation room.

Looking at Yuan Weihong's complicated expression, he said, "Master, the pre-operative and post-operative examination films of the previous patients can also be accessed in the film viewing system. Master, I would like to learn from you carefully."

Yuan Weihong stood up, shrugging and stretching, and said irritably, "Alright, stop pretending when you've reached a certain point. Do you think I'm checking your homework?"

Fang Ziye immediately laughed and said, "Master, that's not what I meant."

"Oh, so you're going to check my homework?" Yuan Weihong asked, his eyes widening in feigned anger.

"Master, I dare not do that at all." Fang Ziye's head bobbed like a rattle.

“I don’t think you’re afraid; you’ve been doing it all along. Just now, when I was watching the video, you kept looking at me while I was looking at you. What do you mean? Are you afraid that your master won’t understand?” Yuan Weihong asked.

Fang Ziye seemed to be deep in thought and was unable to give the correct answer immediately.

Seeing Fang Ziye's hesitation, Yuan Weihong immediately lost his composure: "You actually dare to think that way? Let me tell you, your master is me!"

"I really didn't quite understand it either," Yuan Weihong said, immediately deflated.

Fang Ziye's mindset also became much more relaxed.

"However, I still want to advise you: never make things difficult for yourself."

"Did you hear that?"

Fang Ziye nodded. He looked around and then spotted his junior brother, Jie Han, who was pacing back and forth at the door, not daring to come in.

It's unclear whether they didn't want to see Yuan Weihong reprimand Fang Ziye, or they didn't want to see Yuan Weihong embarrass himself in front of Fang Ziye.

Children grow up and can't stay at home; students become independent and their cages are too small to hold them all.

Jie Han was already used to it.

After the senior apprentice finished showing off, the junior apprentice followed suit, and then the master asked him to show off as well. He could only quietly observe who was the best at it all...

(End of this chapter)