When the Doctor Uses A Hack

Tao Zi intended to use the patient as a case for a clinical teaching session for everyone.

Many students were not very familiar with constrictive pericarditis, as most cardiothoracic patients had cardiovascular diseases and valvular heart diseases. This type of chronic pericarditis, which was protracted and not cured, was relatively rare.

Therefore, Tao Zi had a thought and decided to treat it as a teaching round.

…

Qian Lin, along with the graduate students beside him who were curiously observing the patient, took out paper and pen and began taking notes.

Clinical teaching is about cultivating the ability to think clinically about the diagnosis and treatment of diseases.

The other doctors and students gathered behind, while Zhang Wenfu stood in front asking about the patient’s history.

Zhang Wenfu was a bit nervous!

After all, previous teaching rounds had a script, with the patients’ conditions memorized by heart.

But this time, it was real action.

It put anyone on edge.

All the more so due to facing a patient with constrictive pericarditis, a condition rarely seen in clinical practice!

Thinking of this, Zhang Wenfu muttered to himself, “Just don’t embarrass yourself…”

Behind him were all the doctors from the department and a group of students… and most importantly, Director Tao Zi was right behind watching everything unfold.

If anything went wrong… that would be a tragedy!

With this in mind, Zhang Wenfu began a detailed collection of the patient’s history.

It had to be said that Zhang Wenfu indeed was an experienced doctor, collecting patient information comprehensively, quickly obtaining some meaningful clues.

But then!

After inquiring about the medical history, Zhang Wenfu became even more anxious…

Because the symptoms seemed more like COPD! (Chronic Obstructive Pulmonary Disease).

Zhang Wenfu panicked a little. To diagnose constrictive pericarditis solely through physical examination was quite challenging and tested a clinician’s grasp of the signs of this disease.

Could it be… a misdiagnosis by the emergency physician?

As this thought struck him, Zhang Wenfu’s eyes lit up. After all, such cases weren’t uncommon in clinical practice, and the emergency department, being a transfer department, often saw unclear diagnoses.

But then, he personally called the director, and the diagnosis should indeed be constrictive pericarditis!

Well then, let’s proceed with the assumption of constrictive pericarditis.

He conjured up all the signs of constrictive pericarditis in his mind, set his determination, and went through the examination step by step.

He wouldn’t backtrack, nor could he afford to second-guess, right?

With that thought, Zhang Wenfu picked up the stethoscope and began to listen. Upon listening, hmm, there indeed were some abnormalities in the heart sounds,

Next was the percussion of the heart, and it seemed off too, hmm, the dullness border was a bit large!

Then came the physical examination…

Until finally, Zhang Wenfu had a moment of clarity: this should indeed be a case of constrictive pericarditis!

At that moment, Zhang Wenfu couldn’t help but admire the emergency department doctor.

He had some difficulty even with clear evidence of constrictive pericarditis, but how challenging must it have been for them to make the diagnosis?

With this in mind, Zhang Wenfu became curious, who was that impressive physician?

Could it be Director Li Baoshan?

Zhang Wenfu asked curiously, “Do you know what illness you had before?”

Wu Yushu shook his head, “I don’t know. Just like Dr. Chen said, I might have had this chronic condition before but never paid attention to it. It wasn’t until Dr. Chen diagnosed me with constrictive pericarditis that I realized it.”

Tao Zi was curious about how little Chen made the diagnosis.

Thinking of this, Tao Zi asked, “How did the emergency department doctor diagnose you?”

Wu Yushu thought for a moment, “In the morning, there were quite a few patients, so Dr. Chen just listened to my heart, checked my blood pressure, felt my abdomen and said that I might have constrictive pericarditis… It all took less than five or six minutes.”

Everyone around was stunned.

Tao Zi swallowed, what on earth was Meng Xi capable of, to allow someone to improve so quickly?

Tao Zi said, “Didn’t they do an electrocardiogram?”

Wu Yushu nodded, “Yeah, no, Dr. Chen told me to come up here and get a comprehensive check-up after being admitted.”

Tao Zi responded, “Xiao Zhang, give the medical order to complete the relevant examinations as soon as possible, and we will continue to discuss this case tomorrow morning.”

Zhang Wenfu nodded, ordering the relevant examinations for the patient; chest X-rays, echocardiogram, abdominal ultrasound, electrocardiogram… as well as various physiological and biochemical tests.

…

…

The next day during the shift change, Tao Zi looked at Wu Yushu’s reports, all signs indicating that the patient indeed had constrictive pericarditis.

Tao Zi was somewhat emotional, and said to the crowd, “Bed 19’s Wu Yushu has been diagnosed with constrictive pericarditis, but… this serves as a wake-up call for us.”

“The emergency room doctor could make a clear diagnosis without any auxiliary examination, but ask yourselves, everyone, could you have been certain just with a physical examination and questioning?”

With that, everyone fell silent.

Zhang Wenfu also couldn’t help but blush. To be honest, without prior knowledge of the constrictive pericarditis, could he have diagnosed it clearly?

It wasn’t just Zhang Wenfu. The surrounding crowd also couldn’t help but reflect.

Maybe they could…?

Tao Zi, with a serious expression and tone, said earnestly, “As clinical doctors, if you go to grassroots level, to rural areas, where there’s not even an ultrasound or X-ray machine, let alone CT or MRI, and a patient comes to you, with only a blood pressure cuff and a stethoscope, can you make a judgement? Can you give the patient a relatively accurate response?”

Tao Zi even felt somewhat disappointed as he spoke.

Many doctors today had already lost the ability to think independently, reliant on equipment, dependent on tests for diagnosis. If that’s all it took to diagnose, who couldn’t be a doctor?

“I’m not saying you’re not good enough. I think every doctor, since you’re involved in clinical work, must develop yourself. Instrumental examinations are good, they can help us make clearer diagnoses, but you must not forget some basic clinical operations.”

“Otherwise, patients will laugh at us. Without instruments, can you still practice medicine?”

When Tao Zi reached the last sentence, his voice rose noticeably!

In everyone’s minds echoed that question, lingering long after.

“Without instruments, can you practice medicine?”

Doctor after doctor couldn’t help but clench their fists, the words piercing their hearts like a needle.

The entire office was deathly quiet.

Tao Zi looked around, then suddenly said loudly, “Starting next week, we will have a small ward round once a week, starting with cardiac auscultation. I need you to remember the auscultation sounds for every type of disease!

A stethoscope can tell us a lot, these are experiences you must learn. Now take a look at yourselves, how many of you wear your stethoscope every day? Some people don’t even bring a stethoscope on rounds, do you even look like a cardiologist?”

After that, Tao Zi left with a dark face, saying, “Alright, meeting dismissed!”

He walked out without paying attention to the crowd.