I'm really an intern

Chapter 47 You want to cheat my money

There were five patients in total, one was discharged and four had accidents.

Brother He was also shocked when he heard the news, and hurried to see the patient together, and then the three of them walked to the ward together.

The patients with fever yesterday included the 82 beds managed by Zhang Tianyang, and the 51 beds and 77 beds managed by Sister Chen.

Bed 59 did not return to the ward all night.

In fact, the doctors on duty have given emergency treatment to several patients, but as a bed doctor, he must always find out what caused the fever.

Bed 77 is an 82-year-old man who looks thin and pale.

According to the medical records written by the last batch of doctors, he has been suffering from fever for two months.

The old man felt a little bit like strangers should not enter. When he saw the doctor coming in, he only glanced at it, and then continued to drink porridge on his own.

"doctor."

There were two family members, a young man and an old lady, who were sitting by the hospital bed. At this time, they turned their heads and didn't intend to stand up.

The young man didn't speak, but the old lady gave orders.

"Doctor, please show me what happened to our old man. He fainted outside early this morning."

The three white coats frowned slightly, but did not answer right away.

Brother He stepped forward and gave the patient a set of physical examinations, and Zhang Tianyang followed suit.

"Well, any ideas?"

After all, Senior Sister Chen managed the bed, and Senior Brother He asked Chen Shishi what he said.

"It feels like it's related to the fever, but I can't tell."

Chen Shishi shook her head, "I read the medical records, and the patient's fever lasted for two months, with a maximum temperature of 39.1 degrees Celsius. But because the patient always took Merrill Lynch to cool down, we couldn't observe the heat pattern of the fever."

Zhang Tianyang also shook his head secretly, secretly saying it's a pity.

In fact, many problems can be seen in the law of fever.

The duration of fever, the temperature of fever, whether there is a cycle and regularity of fever, etc.

For example, long-term low-grade fever and night sweats in the afternoon should highly suspect the possibility of tuberculosis.

Another example is flaccid fever. If the body temperature is often above 39°C with large fluctuations, and the temperature fluctuation range exceeds 24°C within 2 hours, but it is above the normal level, it is necessary to suspect the possibility of sepsis.

Unfortunately, this patient seems a little disobedient.

Zhang Tianyang glanced at the impatient family members next to him, and secretly kept his eyes open.

Sister Chen flipped through the medical records and continued to report.

"Both infection indicators are normal, and no infection was detected.

In terms of blood system diseases, the bone marrow biopsy did not report any obvious problems.

In terms of cancer, several markers are high, but these indicators are high in patients with liver cirrhosis, and there is no specificity.

As for the circumstances of his fainting this morning, I have no idea. "

After finishing her statement, Senior Sister Chen said she was helpless.

"Intractable diseases."

Brother He sighed.

In fact, this situation is the norm in the hospital.

Not all diseases have a clear pathogenesis, and not all diseases can eventually find an explanation.

What's more, Dongfang Hospital, as a relatively well-known comprehensive tertiary hospital, will receive many patients who cannot be diagnosed or treated by lower-level hospitals.

In the current situation, doctors need to rely more on their rich clinical experience to "guess" what kind of disease the patient is.

Then try to find evidence to prove it.

So, sometimes, treating a disease is like solving a case.

Senior Sister Chen shook her head helplessly, "The last doctor has been looking for half a month and still can't figure out the cause of the disease. I just took over, and I can't figure out the cause of the disease either."

I don't know what the disease is, so how can I guess the syncope caused by the disease?

"Sister, have you done PET-CT?"

Zhang Tianyang interrupted suddenly, Senior Sister Chen froze for a moment, "No."

"Unexplained fever does not rule out a hematologic disorder, nor does a normal bone marrow picture and biopsy.

I think it is necessary to do PET. "

When no useful evidence can be found in other directions, PET-CT, that is, positron emission computed tomography examination, has become the key to diagnosis.

"Yes, junior brother."

Senior Brother He raised his eyebrows, "I think so too. I suspect blood system diseases, and it will be more likely to be diagnosed if I can do PET."

"What do you mean?"

The family members couldn't sit still, the old lady stood up abruptly, "Why do you need to be checked again?"

"I have been in your hospital for less than half a month, and have done so many checks, why do I need to do it?"

The old lady opened her arms, making an exaggerated metaphor, all the facial features on her face were wrinkled together, she suddenly stared at Chen Shishi and began to question.

"Hey, are you the doctor of our old man? What's going on? Huh?"

After all, Senior Sister Chen is an old fritter who has been in the clinic for several years, and she is true. She explained to her family members that "the purpose of the examination is to find out the cause of the disease. If the cause is not clear, how can I treat the disease?"

"Do the inspection, do the inspection, I think you are cheating money!",

The old lady didn't look like a good match either, she seemed to have accumulated anger for half a month.

Seeing the conflict, Senior Brother He came over with a "vicissitudes" and "reliable" face to talk to each other.

"If you have something to say, let's talk about this patient. The situation is more complicated. These examinations are necessary. This PET-CT is"

"Don't fool me!"

The old lady interrupted Senior Brother He directly and rudely, "Don't think I don't understand anything, I checked, this PET-CT is the most expensive test, you just want to cheat us of money!"

The old man on bed 77 also snorted coldly, expressing his approval to the old lady.

The atmosphere suddenly froze there.

The patient is an old man, and the family member is an old lady. Both of them are very old, so it is not easy to speak harshly to them.

Don't accidentally get angry and make troubles. ,

There was only one young man, who hid and played with his mobile phone without saying a word, with a face that had nothing to do with him, and seemed unreliable.

Zhang Tianyang sighed silently.

"Old lady, do you know that in fact, I am not afraid of not knowing anything, but I am afraid of only knowing a little bit."

Just as the old lady was about to continue having an attack, Zhang Tianyang opened his mouth and blocked her back.

"Old lady, do you know what the full name of PET-CT is?"

The family members opened their mouths, "I, how would I know! I don't need to know! I knew you were going to lie to us!"

Zhang Tianyang silently felt the effect of "reliability +2", and explained.

"The Chinese name of PET is positron emission computed tomography, and CT is called computer X-ray tomography.

PET-CT is to combine these two technologies together and use the same machine to do it.

Compared with other examinations, it can make an early, safe, accurate and rapid diagnosis. "

A bunch of proper nouns stunned the old lady, but the patient was still stubborn.

"I don't understand your stuff, but I know it. I was in another hospital before, and they didn't let me do this!"

Zhang Tianyang smiled, "Have those hospitals diagnosed your illness?"

""

The patient and his family were at a loss for words.

"PET-CT is not available in any hospital. The current situation is that other examinations have been done, but there is no evidence that can explain your persistent fever.

As a doctor, I will give you advice from a professional point of view. This examination still needs to be done. "

Brother He nodded silently beside him.

The Hematology Department of Dongfang Hospital regards PET-CT as a must-check item for admission, just to make a clear diagnosis and ensure that no misdiagnosis is missed.

It cannot be found by other examinations, and there are many patients who are finally diagnosed through this examination.

The patient and family members fell silent, and Zhang Tianyang's tone slowed down.

"Besides, I also read your information just now. The family should not be short of money, right? It's better to find out, health is more important."

The old lady of the family finally relented, but she still muttered in a low voice.

"Yes, there is no shortage of money, my son treats us well, yes"

"We suggest doing it, but the final decision is still in your hands. If you really don't want to do it, you can just sign it, and you don't have to force it."

Brother He made the final summary, and the old man and lady said that they would consider it.

"Okay, temporarily solved, let's check the next one."

Senior Sister Chen breathed a sigh of relief, turned around and was about to leave.

"It may not be resolved."

Zhang Tianyang sighed silently, and walked to the side of the young man who had been silent all this time.

"Can you show me your phone?

In hospitals, recordings are generally not allowed. "

　Should I not write the protagonist so black?

　　Why does my patient have to come 10 minutes before closing time?

　　Ah!

　　

　

(End of this chapter)