top student at medical school

Chapter 9 Taking the Initiative (Please add to your favorites and read on)

Zhongnan Hospital is a very large institution. You are only a junior master's student because of its existence, not because of its existence that it is the affiliated Zhongnan Hospital of Wuhan University.

There's really not much that a master's degree holder can do!
The most basic thing is to do your shift well and manage the beds properly: write up medical records, change medications properly, and organize discharge summaries. That's all.

You just need to do these things. You can ignore everything else and just relax. Whether it's surgery or assistants, if you're not needed, someone else can step in at any time.

So another week has passed.

All Fang Ziye could do was fulfill his duties, spend time in the training room, and reasonably allocate some time to read more books, diligently serving as a little assistant, occasionally glancing at literature, just as usual.

Even if new patients arrive, it is almost impossible for Fang Ziye to make any new discoveries.

Emergency patients in trauma surgery are under the care of the chief resident, and by the time they are brought to the ward, they have already finished their treatment.

Elective patients are referred by associate professors and professors to their clinics. They have already been thoroughly examined by professors, doctoral students, and other students, so there is no need for you to advocate for any new diagnoses or discoveries.

Once something has been chewed thoroughly, it's almost impossible to find another place to eat it.

Therefore, Fang Ziye's progress in gaining knowledge points was still quite slow. It wasn't until the following Tuesday, after a surgery, that his knowledge point balance increased from 9 points to 12 points.

There's no other way; the surgeries performed at Zhongnan Hospital are all of a very high level. In the trauma surgery department, apart from the chief resident, no one else can handle cases and surgeries with a difficulty level below level three.

Such a complex surgery was extremely difficult even for his own teacher, Yuan Weihong, to handle alone. He was still learning and practicing on his own, so it was impossible for him to request more surgeries for Fang Ziye to perform.

He had already requested suturing last Friday, but Fang Ziye's suturing skills are not the best in the group, and he is even inferior to other PhDs in terms of fine details, so naturally, he cannot be given another chance.

Just messing around aimlessly, as an assistant, you can earn anywhere from 0.2 to 0.4 knowledge points.

Even a small mosquito is still meat, better than soaking in the training room.

It was 4:27 PM.

Seeing that 47 patients had been seen at the outpatient clinic, Fang Ziye knew that his teacher only opened fifty appointments a day.

After patiently explaining to the patient where to schedule an MRI appointment, Fang Ziye closed the door.

"Are there no more patients outside?" Yuan Weihong's eyes flickered slightly when he saw Fang Ziye's little gesture.

Fang Ziye touched the tip of his nose through his mask, then squinted and carefully poured his teacher a cup of hot water: "Master, why don't you rest for a bit and watch me take care of these two patients?"

"Is this alright? There are only three patients left, and we still have an hour before we get off work..." Fang Ziye's eyes looked almost like they had been deliberately made up.

Making such a request is not unreasonable.

First, since it's just an outpatient clinic, even if mistakes occur, Yuan Weihong can correct them.

Secondly, there was plenty of time; there was still an hour before the end of the workday, and only three new patients remained.

Third, it provides sufficient assurance; the patient only needs to take medical history and conduct a physical examination, and Yuan Weihong will control the quality afterwards, which is harmless to the patient.

Naturally, Fang Ziye had been working in the ward for two years, and he was already very familiar with the most basic things, so he wouldn't appear to be an amateur or at a loss.

Making diagnoses for patients, earning some knowledge points, and getting a benefit for oneself without affecting the patient's interests, while also allowing the teacher to rest—Fang Ziye felt this was a win-win-win situation.

"Dong dong dong."

The patients waiting outside started knocking on the door.

Yuan Weihong waved to Fang Ziye, then stood up with his cup in hand and began to twist his waist.

Upon hearing this, Fang Ziye was overjoyed. He opened the door and, before the patient could speak, explained, "I'm sorry, my teacher was just a little tired. He drank some water and rested for a bit."

"Please come in first. I'll ask about the basic situation for my teacher. The teacher is listening in right next to me."

Fang Ziye's way of speaking and his methods of inviting patients in were both exceptionally skillful.

When the patient came in, she saw that Yuan Weihong was indeed sitting upright with his back straight. The woman nodded and said, "Thank you for your hard work, doctor."

She wasn't so scared if Yuan Weihong didn't leave.

Fang Ziye politely said, "Auntie, what's wrong? Please sit down and tell me slowly." Fang Ziye sat down on the stool, took her medical record, and spoke half with humanistic concern and half directly to the topic.

"It hurts here." The woman walked with a normal gait, but she rubbed her buttocks.

Then he sat down.

Fang Ziye quickly glanced at the aunt's age and asked, "Auntie, how long have you been in pain?"

Actually, this aunt is over fifty years old and walks normally, but she complains of pain in her groin. He has seen many patients like this in the clinic and knows that it is sacroiliitis.

But this is just a suspicion, a first guess made from a high-probability perspective based on 'epidemiology' and 'statistics'. This is the benefit of having more experience and knowledge.

"That's been quite a few years."

"How severe is the pain? Does it affect your sleep?" Fang Ziye first routinely inquired about the patient's medical history.

In conclusion, the patient is a middle-aged woman who had experienced left hip pain for 5 years, which worsened over the past six months. The pain was exacerbated by carrying heavy loads, and could be slightly relieved by rest or pain medication. She had been seeking treatment at a traditional Chinese medicine clinic for over two years without significant improvement.

I occasionally experience morning stiffness, but it doesn't last long and can be relieved after activity.

"Auntie, we've asked about most of your symptoms. Let me do a physical exam for you first!"

"Please lie flat on the examination table, without taking off your shoes, facing your left side." In clinical practice, both medical history taking and physical examination are very important, serving as key evidence before imaging and laboratory tests.

"Okay!" The aunt stood up again. There was no obvious impact, but the persistent dull pain was still there.

Because it was a woman, even an elderly woman, Fang Ziye did not conduct a visual examination due to the inconvenience of her position. He only assessed whether there were any skin defects or depressions by observing the outer curvature.

I didn't see the empty feeling in the buttocks that comes with gluteal muscle contracture.

Visual and tactile examinations are conducted in the order of physical examinations in orthopedics, which differs from the order of visual, auditory, and percussion examinations in ordinary medical examinations.

After skillfully performing the tender point test, Piedallu sign test, and counter-hip abduction test, Fang Ziye said, "Auntie, your current condition is likely sacroiliitis, which is a chronic, progressive osteoarthritis."

“You can’t carry extra weight anymore,” Fang Ziye said as she helped her stand up.

As they spoke, Fang Ziye glanced at Yuan Weihong, who nodded in approval.

Regardless of whether he possesses orthopedic expertise, Fang Ziye's physical examination skills alone demonstrate that he is a highly professional orthopedic doctor.

"I can't carry heavy loads, but I have to carry things on my back. I sell vegetables..." The aunt hesitated slightly.

"Then reduce it as much as possible, and try to choose other methods, otherwise, your pain will become more and more intense."

"We need to do another X-ray to confirm the diagnosis, and then we'll probably prescribe some medication. You can go home and rest for a while."

"The most important treatment is actually to avoid heavy lifting!" Fang Ziye knew that the first priority for this disease was to eliminate the triggering factors.

"How much does a checkup cost?" Her eyes darted around.

"The X-ray should be 54 pieces per area. The X-ray is very fast. You can basically go down and have it done, and then come back up immediately after. You don't have to wait for the results. We can check them directly here."

"Okay then." The aunt felt relieved; a few dozen yuan wasn't too expensive.

"..."

The first patient's case was closed. After Fang Ziye finished writing the diagnosis and treatment recommendations in the outpatient medical record and handed the examination form to the patient, the knowledge points column jumped up again.

"+2!"

nice!

Fang Ziye smiled and said, "Alright, go downstairs for your checkup. After you're done, come straight to the clinic for your follow-up appointment, and I'll prescribe some medicine for you then."

"Remember the key point: carry less weight. Otherwise, it's like wearing a cotton-padded coat in the summer, complaining about the heat while the air conditioner is on. You have to consider your own body."

(End of this chapter)