Six Hundred and Forty-Seven Impressive

"Zhang Yard has finally made a house round!"

"Boss is going to check the room!"

"The director of the Department of Gastroenterology has almost peed his pants these days, and finally Boss Zhang is going to make a ward round!"

When Zhang Fan was about to make a ward round, the female doctors in the internal medicine department seemed to be taken aback, one by one they almost took melon seeds!

However, Zhang Fan's rare visit to an internal medicine department every day this week made other people feel that something was wrong. This time, not only the leader at home came, but even the meatball expert from the intestinal surgery department also applied to participate in the big rounds.

"Finally remember the Department of Internal Medicine, if you don't care about the Department of Internal Medicine, from now on, the Chasu Hospital will be the Chasu Surgery Hospital.

Do you think this flower is sick, why did it lie down? Not enough water? Or lack of fertilizer? "Ouyang looked at the cactus in front of him tangled, it was straight yesterday, but why is it crooked today?

She has nothing to do these days, and she waters the flowers when she is bored.

"Ouyuan, are you going?" Lao Chen pretended not to hear Ouyang's words.

"I won't go. I'm too busy all day to touch the ground!" Ouyang said arrogantly. The old lady is very happy these days.

Because GlaxoSmithKline Mishima has built a factory in Chasu, the Chasu government is not confident enough to face such a giant. I want to make the other party pay more, but I am also afraid that they will dislike the ugly tea and stop playing.

Therefore, in order to make everyone more harmonious, Ouyang was invited by the tea government to communicate with Ms. Zeng from GSK Mishima.

The Chasu government and Ms. Zeng from GlaxoSmithKline actually wanted Zhang Fan to be the middleman, but Zhang Fan recently ordered internal medicine, so he ignored them. So as a last resort, Ouyang was invited.

Ouyang just likes the big projects of this kind of people.

On Monday morning, the weather was good. It rained more at night than during the day. Because of the snowy mountains, the temperature was too high during the day, and there was often a light rain or moderate rain at night. The next morning, the air was full of oxygen. ion.

Moreover, the opening of various flowers in summer makes the air of tea more fragrant. In the frontier, in the northwest, where almost half of the territory is the Gobi, such a city is really different.

Of course, I don't know how the other doctors are feeling in Chasu Hospital today, but the doctors in the Department of Gastroenterology are very nervous up and down.

"Are there any patients with sick numbers, and are there any patients whose drugs exceed the standard?

Is there anyone who stays in bed, why are you still writing medical records, my God, the dean has already called the door, you still want to do it or not. "The director of the Department of Gastroenterology was so anxious that his hair was about to jump up and stand on end.

An hour before work in the department, not only were all the staff in place, but they were also in a panic. One is more hurried than the other.

The head nurse led the nurses to check the ward over and over again, "Pick up all the extra things, the ward should be tidy, whoever's rice cooker, take it away for me immediately, next time you see it, don't come to the hospital for hospitalization.

Old man, what trouble are you making, hurry up and change the blanket you are wearing into a hospital quilt. "

When it was time to go to work, I heard footsteps in the corridor, and there were quite a few people. The director of Gastroenterology was sweating in the doctor's office. "Are you here?" he asked softly.

"Here we come! We're all here!" The nurse said immediately after taking a sneak peek at the door.

Zhang Fan came to check the room!

The leadership of the hospital, except for Ouyang, who was doing important things, did not come, and all the other leaders came.

The middle-level leaders, Lao Ju and a group of department directors also came.

In the laboratory, doctors and masters who have something to do with digestion also came.

It can be said that this ward round is estimated to be the largest and most complete team of talents in Chasu's history.

When Zhang Fan came to the internal medicine building in the morning and saw a group of people waiting in the lobby on the first floor of the internal medicine building, he saw a team of no less than thirty people waiting.

"Everyone is not busy today!"

Zhang Fan glanced at Xiao Chen.

"It's been a long time since there was a big round of ward rounds. This time, Yuan Zhang has spoken, and everyone is very enthusiastic. We can't decouple business studies!" Lao Chen quickly answered.

"Hehe, why did I remember the ward round of the Department of Gastroenterology?" Yan Xiaoyu asked.

She was worried that Zhang Fan was dissatisfied with internal medicine, but she didn't say anything about it. It was the most frightening thing if he didn't say anything.

"It's been a long time since the internal medicine department came to make rounds. It just so happens that they are not busy these days! Since everyone is not busy, let's go up and do rounds. Everyone should be prepared to be hungry today." Zhang Fan said with a smile. Just stepped into the elevator first.

All eight elevators were on standby, and Zhang Fan couldn't even smile anymore. "Don't take it as an example. It's outrageous for a patient to climb stairs!"

Although Xiao Chen is not in the leadership, she wants to follow the leaders, so after several leaders got into the first elevator, Zhang Fan said something to Xiao Chen.

Xiao Chen stuck out his tongue and quickly agreed.

About thirty people entered the internal medicine office.

The director of the Department of Gastroenterology looked at Zhang Fan, meaning that the leader was speaking!

Zhang Fan waved his hand to signal him to continue.

"Today's big ward round starts from the first bed. Doctors, please turn off the phone and be responsible for preparing various cases and materials of the patients who manage the bed in advance. Now start the ward round."

After finishing speaking, the chief of internal medicine rushed to Zhang Fan and asked Zhang Fan to go first.

This is the rule.

In any department, when making ward rounds, the subject leader must be at the forefront, followed by the next three levels. Hurrah, the leader brought number 30 people, the original doctors in the department plus the interns are almost 30 people, and then there are more than 30 nurses, a team of about a hundred people smaller.

"Three beds, female, forty-five years old. He has a history of liver cirrhosis for more than ten years. This time, he was admitted to the hospital due to hematemesis, melena and shock ascites. After admission, he was given active treatment to correct the shock, improve hemoglobin, and control the bleeding... "

In the first room, there was a seriously ill patient.

After the bed doctor seriously reported the condition, he looked at the big bosses of the ward rounds.

At this time, there are generally three types. Non-professional leaders will nod their heads, look at the patient from a distance, and then ask: "The windows must be closed on time, and attention should be paid to ventilation and warmth, so as not to let the patient catch a cold!"

Then, holding the patient's hand, the reporter of the hospital newspaper took photos immediately, and the ward round ended. The doctors didn't really care about him at all.

The second type is professional leadership but non-professional leadership. During the ward rounds, I don’t ask too many questions, but I will read the doctor’s orders, and occasionally let the patient lie down to check the individual. After the physical examination, after reading the doctor's orders, he hardly asks questions. Hua Guo's leaders are very good at hiding the clumsy way.

And the last one is the leader of this profession. This kind of leader makes ward rounds, and doctors and nurses are worried.

After the bed doctor finished his report, Zhang Fan didn't look at the medical records, and went straight to the physical examination, "Hehe, I'm the director of Chasu Hospital. I'll do the ward rounds today. I'll give you a physical examination. You lie down."

Zhang Fan said to the middle-aged woman in front of him with a smile, and then lifted the patient's shirt.

The patient was trembling a little. She was not in good health. Seeing that the bed doctor who was usually taller than a big cock looked like a quail, she was also nervous. She didn't know what was wrong, what she was going to do.

"It's nothing, they are all experts. You are lucky this time. There are so many people consulting you. It is usually difficult to find all these experts." Seeing that the patient was a little nervous, Lao Chen explained slowly with a smile.

"Oh!"

The patients in the other beds heard that they were experts or the dean, and hurriedly lay on the bed, opened their clothes to reveal their stomachs, and waited for the experts to touch them.

...

"The liver is palpable under the ribs, and the quality is hard..." Zhang Fan reported his own data while checking. The gastroenterology doctor, regardless of the bed, took out his notebook to record. Anyway, I don't know what he wrote. , but the posture is put out.

"Is there a primary prevention lecture for patients before bleeding?"

"Yes, Zhang Yuan."

"Did you cerclage the patient after hemorrhage?"

"Cerclage, it's almost a year now."

"After one year, what is the bleeding rate?"

"Yes..." The doctor in charge couldn't answer!

"60%!" The doctor in charge of the bed doctor hurriedly stood up and answered.

Zhang Fan didn't say anything, but the doctor in charge of the bed was already blushing.

"Have you checked your kidney function regularly?"

"Already checked regularly!"

Zhang Fan asked very detailed, very detailed questions.

Specifically, Ren Li and Yan Xiaoyu looked at each other. "I'm afraid this level is at the deputy high school of internal medicine. Doesn't it mean that the internal medicine of Zhangyuan is just a reluctance?"

Yan Xiaoyu was shocked, could it be that this is really the legendary pretending to be a pig and eating a tiger? So young, oh my god, with such a heavy heart, Yan Xiaoyu thought about it, and quickly thought about whether she had made any mistakes in business since she came to Cha Su Hospital.

"Why not add isosorbide mononitrate?" Zhang Fan had already taken the medical records and ordered the doctor.

The doctor in charge of the bed was stunned, yes, why isosorbide mononitrate?

The senior doctor was also stunned.

Internal medicine, how should I put it, is like a lottery. Before the lottery is drawn, everyone is confused, but once the lottery is drawn, everyone suddenly realizes that it is so.

It seems that everyone can understand it, but in fact, this is to start taking medicine according to the symptoms, signs, and the development of the disease.

In the textbook, it is well written, and this medicine is used for this disease. It seems irresponsible at all. To be honest, if it is really that simple, just pull out two high school students and let them familiarize themselves with internal medicine books. People went to see a doctor and took medicine.

"Oh? Didn't you think of it? Octreotide is very effective!" Zhang Fan clapped the case in his hand.

"Come on, Director Li, tell me why you don't use isosorbide mononitrate!" Zhang Fan said to the director of the Department of Gastroenterology with a smile.

Today, if the director doesn't even know why isosorbide mononitrate is added or why it isn't added, Zhang Fan is determined to take him down.

The director, who was sweating, didn't know Zhang Fan's target at this time, whether he was here to catch the expensive drug octreotide, or to catch the quality of the cases!

"Although the patient has had cerclage for nearly a year, the current bleeding is not obvious, and the patient's liver function is poor. In order to protect the liver, we did not consider using isosorbide mononitrate at first!"

When Zhang Fan heard this, he looked at the director of the Department of Gastroenterology, "The level is up, but the heart is not here!"

There are still directors of gastroenterology.

"Then when do you think it's appropriate to add it? There's a 60% chance of recurrence, and she's already bleeding again. If you can't vomit blood, just give octreotide. If the bleeding stops, don't worry about it. My chief director, can you use some snacks?" "

Zhang Fan handed the medical records to the director of the Department of Gastroenterology, but he didn't let go. The director of the Department of Gastroenterology, Lao Li, looked ashamed.

The time is only tens of seconds, as if a long time has passed.

The people who made the ward rounds, especially the head of the surgery department, looked at Zhang Fan with horror in their eyes.

"Zhang Yuan is going to practice internal medicine?"

Zhang Fan ignored them, let go of the case, and said, "Continue with the ward rounds."

Turn around and continue.

Everyone looked at Zhang Fan.

It seems to be like the more popular saying, I am standing here, you see how much I look like back then!

Zhang Fan checked the system in his mind while making ward rounds. Compared with surgery, internal medicine is actually more complicated.

For some treatments, in the short term, it is good to face the left, and it is also right to face the right, but it is different in the long run.

Maybe there are too few doctors who look at the long-term.

So Zhang Fan brought the treatment plans into the system and compared them one by one.