My Medical Skills Give Me Experience Points Chapter 1250 - 493: The Gap Between Director and Deputy Director, Solving It With Interventional Imaging

"Dr. Zhou, you are not only exceptionally skilled but your kind words are truly refreshing! Let us delve into the details of the patient’s status before the situation deteriorates further."

Director Shang possesses a notably impatient character.

Ignoring further pleasantries, he prompted Zhou Can to begin the formal consultation immediately.

It appears that even with the combined efforts of Director Shang and his pair of graduate students, the root cause of the patient’s ailment remains elusive.

In days past, he would have addressed Zhou Can as Xiao Zhou; however, after their time apart, his tone has shifted toward a more formal demeanor.

"Director Shang is correct. Although the patient’s fever has subsided slightly following the administration of medication, the underlying pyrexia persists. Our primary concern now is the potential for a major source of internal hemorrhage. We must prioritize locating the site of this bleeding immediately."

Deputy Director Han is also a man who prioritizes practical action over empty words.

The steadfast dedication these veteran physicians demonstrate toward their patients and the complexities of disease is truly a model for others.

The sentiment that a doctor possesses the heart of a parent is frequently reflected in precisely these kinds of minute details.

"After consulting with one another, have you both arrived at any definitive conclusions?" Zhou Can inquired with a humble tone.

"We have yet to confirm the exact nature of the illness. However, I suspect the symptoms merely mimic upper gastrointestinal bleeding. Having Doctor Ai withdraw gastric fluid for analysis was a prudent move, and that process is already underway. Furthermore, you noted the presence of dark red blood on your glove during the rectal examination. If this were truly a case of upper gastrointestinal hemorrhage, finding fresh, dark red blood during such an exam would be highly unlikely."

Director Shang had clearly conducted a thorough review of the patient’s prior diagnostic records and treatment protocols.

"Internationally, there exists a diagnostic technique used specifically to differentiate between upper and lower gastrointestinal bleeding. Clinical research indicates that elevated plasma urea levels are indicative of gastrointestinal hemorrhage, with the magnitude of the spike correlating to the volume of blood lost. By calculating the ratio of plasma urea nitrogen to plasma creatinine, one can effectively determine the site of the bleeding."

The expertise level of a Chief Physician is indeed formidable.

Zhou Can recalled reading about this identification method in medical journals previously.

Yet, he remained unfamiliar with its practical clinical implementation.

The primary sticking point was his inability to recall the necessary numerical threshold values.

Moreover, the reliability of this diagnostic test is not absolute, sitting at approximately 95 percent accuracy.

"If the calculated ratio exceeds 100, the likelihood of upper gastrointestinal bleeding is very high. Conversely, a ratio below 100 points strongly toward lower gastrointestinal bleeding."

The strategy proposed by Director Shang is certainly worthy of implementation.

By simply evaluating two distinct biochemical markers to determine the ratio, one can distinguish the source of the hemorrhage.

It is elegant, effective, and highly economical.

"The calculations indicate a high probability of lower gastrointestinal bleeding."

Director Shang is truly impressive and fully deserves his title as the director of Digestive Internal Medicine. His personal involvement in this consultation represents a significant honor for the Emergency Department.

"Given that the patient is suffering from lower gastrointestinal bleeding coupled with a fever, we must consider the potential for localized inflammation or malignancy. Since the onset was abrupt, intestinal tuberculosis is highly unlikely. Therefore, we should focus on inflammation as the leading cause."

The two graduate students promptly opened their notebooks to record these insights.

Zhou Can remembered following Director Shang and frequently doing the exact same thing.

"Dr. Zhou, you have been away from the department of Digestive Internal Medicine for quite a while now. Do you still retain your knowledge regarding intestinal inflammatory lesions?"

For reasons unknown, Director Shang felt compelled to test Zhou Can’s knowledge.

"Calling me Xiao Zhou as you once did is actually quite heartwarming."

Zhou Can understood clearly that Director Shang never viewed him as a mere subordinate.

During his tenure in Digestive Internal Medicine, he had always been the beneficiary of Director Shang’s guidance and support.

For instance, the consultation organized at the Xinxiang Women and Children’s Hospital was a specific arrangement made by Director Shang that eventually allowed Zhou Can to be inducted into Tu Ya’s pool of elite reserve medical staff.

"Haha, naturally. I was merely concerned that your current professional standing might make such an informal address detrimental to your reputation!" Director Shang laughed.

"In your presence, I shall always be that same Xiao Zhou."

This declaration from Zhou Can visibly pleased the director.

Few doctors could fail to appreciate a subordinate who remains grounded and loyal. Director Shang had put substantial effort into mentorship, and he had always held Zhou Can in high regard.

Three years later, Zhou Can’s continued gratitude and respect provided Director Shang with a deep sense of satisfaction.

"The lessons you imparted remain vivid in my memory. Inflammatory lesions are categorized into specific and non-specific types. Inflammatory bowel disease generally encompasses disorders like ulcerative colitis and Crohn’s disease, which are classified as non-specific chronic inflammatory conditions, typically presenting with abdominal discomfort, diarrhea, and unintentional weight loss."

Zhou Can had firmly mastered these theoretical concepts long ago.

"Impressive indeed!" Director Shang nodded with sustained approval.

"Given the patient's medical history, clinical symptoms, and the recent biochemical findings, we can effectively rule out bacterial dysentery and amoebic dysentery. I suggest we run a Widal test, as it has been five weeks since the onset of symptoms, making this the optimal window for detection."

"Are you suspecting the patient is suffering from enteric fever?"

Zhou Can’s gaze flickered with sudden realization.

The diagnostic intuition of a director-level physician is truly remarkable.

When compared to Director Shang, the disparity in their experience was undeniable.

Currently, his own pathological diagnostic proficiency sits at the level of a Deputy Chief Physician, and reaching the Director level will require further cultivation.

His recent focus on board examinations has limited his clinical hours, decreasing the total volume of patients seen and, consequently, slowing the accumulation of experience points for his diagnostic skills.