In Sun Lien's opinion, there was nothing special about Cao Jianguo's situation. The gastroenterologist at the Fourth Central Hospital who treated him must have been working for a short time, so he made this mistake.
When specialists treat patients, they tend to have a fixed idea that "the disease the patient suffers from must be a systemic disease for which I am responsible." However, this fixed idea will not apply when encountering autoimmune system diseases or other multi-organ symptoms.
When you are sick, it is easy to get misdiagnosed.
Yes, Cao Jianguo was misdiagnosed. At least Sun Lien believed that what Cao Jianguo suffered from was not simply "reflux esophagitis." He did have reflux esophagitis, and it might worsen into esophageal cancer if it continues to develop.
.But the disease itself is not simple. Its occurrence is based on a disease that has a wider impact and can cause problems in more organs: systemic sclerosis (ssc).
Cao Jianguo's symptoms of systemic sclerosis are actually very typical. The thickened skin and thickened skin fibers on the root joints of his fingers are the decisive symptoms for diagnosing systemic sclerosis. In the latest diagnostic guidelines for systemic sclerosis, immunology in various countries
After discussion, experts and medical experts jointly determined that for this symptom alone, the patient can be considered to have a score of more than nine points and be diagnosed with systemic sclerosis. You must know that the positive report score of systemic sclerosis blood immunology test is only
Just three points, which is far less than the nine points required for diagnosis.
If it were an experienced internist, the moment he saw Cao Jianguo's hands, he might have concluded that he had systemic sclerosis and requested a rheumatology and immunologist to come for consultation. Obviously, Cao Jianguo's
The internist didn't even look at his hands. Based only on Cao Jianguo's self-report and the additional esophagoscopy results, he concluded that "this was reflux esophagitis". Then he prescribed famotidine.
Carry out treatment.
And this is where people feel a little helpless. Cao Jianguo does have reflux esophagitis. But if only from the perspective of a specialist, it is believed that the patient has and only has this disease, then misdiagnosis is inevitable.
One of the main causes of reflux esophagitis is the decline in the anti-reflux function of the patient's digestive tract. Gastric contents are prone to reflux and burn the esophagus, causing damage. When you are a doctor, you must ask more questions about why. See the doctor
The diagnosis stopped here without delving into why Cao Jianguo's anti-reflux function declined. But this was precisely his last chance to make a correct diagnosis.
Muscarinic acetylcholine receptor m3 is the key receptor in the enteric nervous system to control intestinal peristalsis. They can convert the peristaltic instructions of the enteric nervous system into movement instructions of smooth muscles and sphincter in the digestive system. In patients with systemic sclerosis,
, the expression of m3 antibodies that can hinder the binding of this neurotransmitter is significantly increased. This will cause the intestinal nervous system's instructions for intestinal peristalsis to be unable to be fully executed, resulting in insufficient movement range of sphincter and smooth muscle, incomplete sphincter closure, etc.
.This will trigger the occurrence of gastrointestinal symptoms. As m3 antibodies further increase, the patient's gastrointestinal damage will continue to deepen, and symptoms such as smooth muscle damage, severe fibrosis, collagen deposition, etc. will appear immediately. These injuries and smooth muscle movement amplitude
Insufficiency will lead to swallowing obstruction in patients, and endoscopic manifestations such as esophagitis and esophageal contracture.
Sun Lien explained his point of view and called Dr. Pascal to come for consultation. At the same time, Cao Jianguo, who heard that he had been "misdiagnosed", was very happy. He was even a little happy.
"Second uncle, what are you laughing at?" Cao Yanhua scratched his face and asked curiously.
"Thank you for being a doctor. Do you know that stomach problems are difficult to cure?" Cao Jianguo grinned, "I just heard Dr. Xiao Sun say that I don't have a stomach problem, it's some kind of sclerosis. Then it can be cured! It doesn't matter if you have tougher hands.
, prescribe some more softening medicine, I’ll be fine if I take some!”
Sun Lien glanced at Cao Yanhua with a strange expression. As expected, Cao Yanhua showed a bitter and twisted expression as if he had eaten shit.
What doctors are most afraid of encountering are patients like Cao Jianguo. Most of these patients have little medical knowledge or even biological knowledge. For such patients, the key to judging their disease is mainly based on the name of the disease.
.What is "tumor" or "cancer"? Then you can go home and lie down to prepare for the funeral. For other diseases, keywords are randomly selected, and then the keywords are "analyzed" by combining life experience, so as to draw the conclusion
The wrong conclusion that "this disease is easy to treat".
To put it simply, this kind of patients are used to judging something that they know nothing about through imagination. And they will be very persistent in thinking that their judgment is correct. Then, no matter how the doctor explains, they will insist that, "I
It’s okay, you want to cheat me out of money.”
Fortunately, Cao Jianguo is Cao Yanhua's second uncle.
A nephew would never lie to his uncle!
Taking advantage of Dr. Cao Yanhua's spare time to supplement his uncle's biological knowledge, Sun Lien welcomed Dr. Pascal who looked tired.
"This patient may be an SSC." Sun Lien explained his judgment concisely and concisely, then stepped away from the computer and asked Dr. Pascal to sit down. "I want to hear your opinion."
Dr. Pascal glanced at the screenshot of the esophagoscope on the computer screen, then took Cao Jianguo's hands and took a look. "Your diagnosis is fine."
"That's good." Sun Li'en nodded and wrote his diagnosis on the computer. Seeing that Cao Jianguo's tutoring class was not over yet, he asked Dr. Pascal, "Been...very busy lately?"
Dr. Pascal smiled wryly and nodded, "I think if I can change my income from a fixed amount to a share-sharing system, I will be able to buy a house in Ningyuan by this time next year."
Housing prices in Ningyuan are not very low. Located close to the Fourth Central Hospital, one square meter costs almost 40,000 yuan.
Sun Lien was overjoyed when he heard this. It was a good thing that Lao Pa was willing to buy a house in Ningyuan. This showed that he had plans to take root in Ningyuan. If Lao Pa could really take root, at least he wouldn't have to worry about being skinned and stuffed by Dean Song, right?
? He asked pretending to be concerned, "Have you gone to see the house? Have you decided where to buy?"
"I don't have time to take a look." Dr. Pascal continued with a wry smile, but his head turned from nodding to shaking his head. "My wife is doing research recently, and she said that there is a new villa area nearby that is pretty good. At least there is a yard for Pani.
Have some fun with Todd."
The living habits of Americans are different from those of Chinese people. For medical experts like Dr. Pascal, a house with a yard is considered a livable "home". As for buildings in residential areas in urban areas, those are
It is suitable for singles and people without children who need to work in the city.
Sun Lien thought for a while and then asked, "Have you contacted the college? I remember that the introduction of experts is provided with housing subsidies."
Dr. Pascal continued to shake his head, "The college hasn't told me about this. Why don't you ask Dean Song for me tomorrow? After all, you are my boss!"
"...Okay." Sun Lien took another job for himself. But this matter is not too difficult for him. Anyway, it is Dean Song's request to keep Lao Pa. If the housing subsidy can be approved,
, at least it shows that he has fulfilled Dean Song’s requirements.
Sun Lien chatted with Pascal for a few words. The phone on the desk rang every two minutes. There were dozens of expert numbers in the Department of Rheumatology and Immunology waiting for Dr. Pascal to deal with. It was miserable to be bombarded with phone calls.
Dr. Pascal had no choice but to end the chat in a hurry and rush back to the clinic to see the patient. On the other hand, Sun Lien also reported to Zhou Jun his discovery that there was a misdiagnosed case in the Gastroenterology Department of the Fourth Central Hospital.
"I understand. You transfer the patients to the Rheumatology and Immunology Department and let them be admitted to the hospital for treatment." Zhou Jun pondered for a moment and made a decision. "I will report the misdiagnosis to the medical department. The patient's condition is not dangerous, right?"
"We haven't found anything yet. His systemic sclerosis should still be in the early stages." Sun Lien glanced at the top of Cao Jianguo's head again. Except for the addition of "systemic sclerosis" in black font, the status bar had no changes. This means that at least he has systemic sclerosis.
It has not invaded other organs. At present, it has only affected the digestive tract. "I will continue to prescribe him famotidine to control reflux esophagitis, and the immune shock treatment will be handed over to the rheumatology and immunology department."
"Don't discuss misdiagnosis with other doctors." Zhou Jun had no objection to Sun Lien's treatment plan. His focus was on another direction. "With this kind of disease, misdiagnosis in the digestive system is excusable. And the patient did not suffer from misdiagnosis.
It leads to additional injuries. This kind of misdiagnosis that is not considered medical negligence is unnecessary. Everyone knows. You understand what I am talking about, right?"
Of course Sun Lien knew that the internal medicine department had opinions about him. And he found out a case of misdiagnosis in the digestive tract, which was actually a big deal in the hospital's operating system. Maybe the doctor needed to be suspended for investigation.
At the same time, we also need to review his past diagnosis cases. Given the current delicate relationship between the internal medicine system and Sun Lien, this matter might be interpreted as Sun Lien's deliberate provocation.
No one likes misdiagnosis, especially for doctors. Misdiagnosis is simply a nightmare. Once a misdiagnosis is determined, it means that someone has to take responsibility and pay the price. Moreover, the patient's life and health will be threatened, and no one wants to see it.
Misdiagnosis occurs.
"There is no problem with me, and I will convey it to Dr. Cao." Sun Lien suddenly thought of an important question, "But... Dr. Pascal just came for consultation, and I am worried that he may..."
"There will be no problem with Dr. Pascal." Zhou Jun laughed twice, "Just in time, there will be a meeting invitation in two days. You can bring the members of your treatment team with you." He paused.
Emphasized, "It's the entire treatment group, but you can also bring Xiao Hu with you. The meeting location is in Sanya, Hainan. Just think of it as a trip for you to have fun and give yourself a vacation."