Chapter 459

Once people's mind involves interests, it will become very complex. Chasu hospital directly sent consultation letters to affiliated hospitals, general hospitals and provincial hospitals in niaoshi.

This kind of invitation, to be honest, has little effect. There are clear charging standards for such consultation fees. Online consultation, vice high 20 yuan a time, positive high 30 yuan a time. The maximum consultation fee between hospitals is 1000 yuan.

Therefore, science and technology are more and more developed, and various communication conditions are better and better, but network consultation and inter hospital consultation can not develop. The hospital consultation system, which has been established at a huge cost, is thus idle.

The superior hospital forces each chief doctor to deal with how many network consultations should be handled within the specified time. This kind of consultation is usually a complex or special disease, which is a waste of time.

The superior forces the number of consultations and withholds part of the consultation expenses, which is the largest part. Then, the chief doctors of major hospitals began to act perfunctorily or arrange young doctors in departments to replace him for consultation.

If the diseases required by the upper and lower level hospitals for consultation are relatively simple or the lower level hospitals do not handle them reasonably, there will be ridicule.

Then, the doctors in the lower level hospitals lost their motivation. The local people don't look good, or they will be transferred to another hospital. He can't afford to be ridiculed by others for his patient. As for whether there are lower level doctors who suffer from various discomfort, they apply for online consultation for patients.

Yes, but not much. Whether the superior doctors have a very kind and serious attitude, but they don't account for the majority. The consultation between hospitals is even more wonderful. What can come is definitely not the authority of any hospital department. It's just to top the name of a hospital and give a certificate for subordinate hospitals.

Tea vegetable city hospital wants this name and this officially recognized certificate. In two days, the patient's medical record was improved.

Zhou XX accidentally fell after being drunk, resulting in fracture of right humerus. The patients were treated with incision and internal fixation in chasu hospital. Before admission, patients suffered from type two diabetes and poor blood glucose control.

Director Chen Qi, director of bone three branches, is a friend of a patient and violates treatment principles. Before the formal treatment of diabetes, our hospital actively invited Dr. XX, a doctor of XX in a bird's hospital.

The bed doctor wrote a medical record into a book. As long as it was what happened, the situation at that time, the things after the operation, and pulling out his hair, he had to recall it. This is not only related to the treatment and identification of patients in the future.

Besides, it's about his job. A doctor in a third class hospital, to tell you the truth, if you threaten others with the establishment of the hospital, it is estimated that they are not very afraid. There is no master here, there is a master's place.

However, it is estimated that the revocation of his practice certificate will scare him to death. This is the ultimate trick. It's usually not sent out, but once sent out, it's a big deal.

Zhou XX and his family stopped talking. Ouyang's set of combined punches came down, and Chen Qi was stunned. The original relationship with Zhou XX was as close as brothers and as good as brother-in-law.

Chen Qi's acceptance of red envelopes before surgery was also reported by Zhou XX's wife. Chen Qi is not mud, and people still take it casually.

He even had a cell phone recording at that time. Anyway, they bit their hair. Zhou XX inquired and finally knew who was the best in the orthopedic department of the municipal hospital, that is, the young assistant!

Finally, he didn't leave, so he had to do follow-up treatment in the municipal hospital. As long as he is willing to cooperate, Ouyang is not willing to make things too big. After all, this is a hospital, not a court.

Of course, Chen Qi's director couldn't do it. He was warned by the red headed documents in the hospital and imposed a rescue fine.

He can't go back to the second Department of orthopedics. He can only be an outpatient doctor. A doctor who has been in the outpatient clinic for a long time will write a sick note and a long-term outpatient prescription for chronic diseases, which can be regarded as a pension.

This punishment is not heavy. Chen Qi's future road is also very obvious. Unless there is an unconventional leadership change in the hospital, if you want to have an operation, you can only change places.

Chen Qi almost hates Ouyang and Zhang Fan. Seizing people's money is like killing their parents. But on the surface, there was no sign that he was angry.

Go to work and leave work on time day by day. I laugh at everyone. When I see Zhang Fan, I will take the initiative to say hello without any resentment.

In the United States, about 2 million patients with long bone fractures are treated every year. Of these 2 million, about 100000 patients with bone nonunion.

Moreover, the treatment cost of bone nonunion is about twice that of normal fracture healing. And there is a very high disability rate. Experts from superior hospitals come to tea vegetable hospital, that is, to make a diagnosis and want them to have an operation. None of them is willing.

This kind of operation has too many unpredictability. It is estimated that the patient came after going to other hospitals. If something happens in the hospital, it needs to be solved.

As Zhang Fan in charge of surgery, he has to find a way. In the past, Zhang fan can only make arrangements in his group, and also consider Wang Yanan's mood.

Now it's different, "let's inform Zhou Chengfu of the third Department of bone, Xu Xian of the first Department of bone and Dr. Wang Pingshan of the second Department of bone that we're going to have an operation for nonunion tomorrow."

Zhang Fan is in the office of his administrative building and gives the task to the office director.

"Are you the master knife?"

"Well, I'm the main knife." Zhang Fan replied that these are the leaders among the young orthopedic doctors. Ouyang directly handed over the task of selecting the director of the third Department of orthopedics to Zhang Fan.

At present, Zhang Fan has two people in his mind. One is Zhou Chengfu. Although this person is more utilitarian, he is a good hand in business. The second is Wang Pingshan of the second Department of orthopedics. His business is also quite good, but his character is a little dull.

Both of them were attending doctors who were immediately promoted to the vice high school. Zhang Fan had to consider and weigh the pros and cons. Take Xu Xian, but it's just a cover.

After dealing with some necessary documents, Zhang Fan has to go to the third Department of orthopedics again. Because the director has been removed and the new director has not been appointed, Zhang Fan has to worry more about the work of the Department.

As soon as I got to the door, I heard Zhou Chengfu give lectures to residents and rotation doctors in the Department.

"There are many reasons for bone nonunion. In a big truth, it is not clear, but through evidence-based medicine, it can be determined that smoking is a very significant inducement."

After seeing Zhang Fan, Zhou Chengfu insisted that Zhang Fan say something, "I'm not good. Let Zhang Yuan tell us something. Zhang's lecture was as wonderful as his operation. "

Hospitals should take the road of combining medical education and scientific research, and pay more attention to the education of young doctors, rotating doctors and interns.

Just because of this case, Zhang Fan didn't say much, so he went straight to the stage and began to talk.

"To say that bones are not connected, we must first talk about bones. If the bones of the human body are subdivided, there are many classifications in textbooks, which must be mastered by doctors.

If roughly classified, it can be divided into two categories, cartilage and bone. " Lectures, especially for young doctors and interns, are no better than those in surgery.

Doctors who can ask questions during surgery are almost doctors for many years. What they lack is a little trick or thinking. When facing interns, they can't talk in general.

We should not only speak out the knowledge points, but also speak vividly and interestingly, which requires much higher requirements for the lecturers. Otherwise, the things in the textbook are very comprehensive, what do we have to do with the teacher.

"The composition and organization of bone are found in the teaching materials, and I will not repeat it. Today, because there is a patient, let's talk about bone nonunion. If we want to say bone nonunion, we must first talk about the healing of fracture.

Bone healing mainly depends on four kinds of cells. Bone progenitor cells, osteoblasts, osteoblasts, osteoclasts.

After long bone fracture, osteoclasts will first decompose the bone at the fracture end into various original components, such as bone cells, bone salt and so on.

Then, osteoblasts play. Through gene regulation, it will make free bone cells, bone salts and various nutrients ingested by the human body, make bone progenitor cells reconstitute cartilage, then calcify, and finally form a completed bone. "

Zhang Fan said that the following doctors, whether interns or in-service doctors, are lowering their heads to take notes. Even Zhou Chengfu sat in the back row and lowered his head to take notes. He estimated that the element of affectation was greater than that of learning, but others' attitude was shown.

"The shape of bone is not constant. A mature bone is not immutable. It changes every day as you wear clothes. Through hormone and nutritional conditions, osteoclasts are constantly destroyed and osteoblasts are constantly rebuilt.

Under normal circumstances, bone elements will lose 0.5% of the total amount every year. ". Elderly women lose more because of the lack of estrogen, which is also the reason why elderly women are prone to fracture.

This is also the reason why adults should supplement calcium when they reach the age of 45. When the absorbed nutrients are not enough to keep up with the lost ingredients of the human body, the brittleness of bone will increase and the bone strength will decrease.

Calcium supplement can not be corrected by simply taking drugs. First of all, vitamin D should be supplemented in time. Rickets will occur in early childhood due to lack of vitamin D.

Lack of vitamin A can lead to variation in the speed of osteoblasts and osteoclasts, that is, deformities.

Lack of vitamin C reduces collagen fibers synthesized by cells, resulting in increased bone brittleness.

Moreover, under low stress, although bone is absorbed, the density can not reach the normal density. Especially long-term bedridden patients are very prone to fracture.

Therefore, in order to ensure the health of bones, it is necessary to bask in the sun, exercise properly and ensure sufficient food.

Eating calcium tablets from Australia and America is not as good as having a healthy lifestyle after you eat ordinary calcium tablets.

There are two main nutritional pathways of bones. The first is that the outermost layer is a tight periosteum, which forms a large number of blood vessels, nerves and bone progenitor cells.

The second place is the innermost femoral intima of the bone, which also walks blood vessels. Note that the blood vessels here are small blood vessels. In other words, if a large number of periosteal soft tissue on the bone surface is stripped during the operation, the bone will suffer from malnutrition.

If the patient has diabetes, and he also smokes and lives irregularly, then there will be bone nonunion. " Zhang Fan did not start directly from nonunion.

Medicine is a discipline with links. Without one link, knowledge is incomplete. The understanding of disease is specious, knowing it and not knowing why.

Zhang Fan said this, the following internship students are very clear and clear.

"There are three forms of bone nonunion..." at this time, it is the beginning of the eight classics to explain bone nonunion and the treatment of bone nonunion.

After more than 40 minutes, Zhang Fan told the following students about a broken bone. As long as you listen carefully in this class, you will definitely master the disease. The rest is to go to clinical practice and practice.

At first, most of the doctors in the third Department of orthopedics were pretending. With Zhang Fan's explanation, most of them began to listen carefully.

"No wonder people's surgery is flying. Listen to it. What this class says is that a non-medical professional can understand it. It's too strong!" One resident said to the other.

"Nonsense, not strong, can you be the Dean!"

After Zhang Fan finished his lecture, the following students looked at Zhang Fan with warm eyes. They didn't know whether it was the aura of the dean's assistant or whether Zhang Fan really convinced them. However, Zhang Fan was satisfied with the lecture.

I don't know how many times I've lost my liver. If I can't even speak a class well, it's better to find a tofu and die.

"Zhang Yuan, it's too old. I have gained a lot of knowledge. It seems that my knowledge reserve is not enough. You are too busy. Otherwise, you will give us classes every week. It is estimated that the treatment level of doctors in the Department can rise several steps. " Zhou Chengfu said to Zhang Fan with a smile.

He was also helpless. If he had known that Zhang Fan could rise so fast, what else would he run? Now don't say anything else. Even Lao Gao was dissatisfied with him. He was wrong step by step!

"Self study is still the most important." Zhang Fan is telling the truth, but Zhou Chengfu's face is stiff. But Zhang Fan didn't notice, "have you been notified by the medical office to have an operation tomorrow morning?"

"Yes, I have." Zhou Chengfu quickly nodded and said.

"Well, you have the instruments you need for the operation." Zhang Fan explained.

"OK, OK. Zhang Yuan, you can rest assured that I will be well prepared. " The stiff smile became wonderful again. He was afraid that his superiors would forget him and was willing to struggle lonely. He said it was very simple. There were few things he could really do.

After dealing with the third Department of orthopedics, Zhang Fan has to go to general surgery to help with the operation. There are so many patients that doctors can't turn around. Zhang Fan doesn't have a good way. The training cycle of a qualified surgeon is too long.

Zhang Fan is still very happy to go to surgery. Now he is the assistant of the president. In a more rustic word, Zhang Fan is a local tyrant: if I want to do general surgery, I will do general surgery. If I want to do cardiothoracic surgery, I will do cardiothoracic surgery.

If there is less administrative business, Zhang Fan loves this position. As long as he is willing, he can go to the hospital for surgery. The systematic general foreign experience, from the snail like slow growth, began to become visible to the naked eye.

This is something to be congratulated on.