Chapter 258 The old man is so shameless! (Mid-Autumn Festival, extra update)

"Professor Hu, the question you want to ask is actually from another section. It may be quite complicated to explain it in detail. I have a PPT summary copy here."

"Let's go over it. The topic of our discussion today is open reduction and internal fixation of small incision fractures. Professor Hu, what do you think?" Zhou Cheng replied generously.

Hu Xianhe was stunned for a moment and said, "Okay. You have to focus on the key points when doing things. There is an important point and theme in academic exchanges. I am wasting everyone's time."

Hu Xianhe had never thought that Zhou Cheng would be able to come up with an outline and summary of systematic fracture reduction techniques. He just asked casually and unexpectedly came up with such an explosive thing.

Zhou Cheng also opened another PPT in the USB flash drive, and then gave everyone a brief overview of the fracture classifications he understood, which ones can be reduced manually, which ones cannot, and which ones cannot be reduced.

Need to be treated surgically.

This may sound casual, but in fact, it directly targets the revision of the fracture guidelines.

Rule 1 of Surgery: Indications and Contraindications.

Any surgery has its indications and contraindications.

After Zhou Cheng completed the turning, when he was about to return to the small incision open reduction and internal fixation of the fracture, he saw that the faces of Professor Chen Jiwu and others also became solemn.

The indications and contraindications for fracture surgery and the principles of fracture treatment were compiled by the Trauma Surgery Group of the Orthopedic Branch of the Chinese Medical Association.

Compilation of guidelines requires top experts to sit together, discuss in detail, and then make standardized treatment recommendations. These people here are part of it, not all of them.

But they have always believed that the compilation of the guide must be based on the principles of comprehensiveness, detail, and safety, and it must also be advanced.

The existence of the guideline needs to be revised. After the revision, it will be published to academic websites or distributed, and printed and bound into a book for colleagues across the country to study. Moreover, many medical malpractice judgments are also based on the guideline.

of.

The stakes are high.

Professor Liu Zhibin raised his hand again: "Xiao Zhou, please slow down for a moment. You have a systematic theoretical outline for this method of fracture reduction. Have you done any clinical research? Is there any corresponding objective data?"

This is particularly important. What kind of fractures require manual reduction, and what kind of fractures require surgery? If this principle can be discussed more clearly.

It improves the overall medical quality in China and can also save a lot of medical resources.

(Note: The author’s contact is probably only in orthopedics. Thanks to the kindness of his mentor and master, he has been exposed to some things that ordinary people have never been exposed to. Therefore, the content in this book may be a little more detailed.)

(I look forward to all the book friends appreciating it. In fact, every thing has deeper social, academic and economic factors. I am willing to analyze these one by one for everyone, and try to use the way that everyone likes to read.

, if any colleagues or teachers read this article and find anything inappropriate, please correct me.)

The data was there, but it was not in reality, so Zhou Cheng could not show it, but he said realistically: "Mr. Liu, I'm very sorry about this. When I was doing manual reduction before, I only treated some patients in the Eighth Hospital."

"The number of cases is small and is still being tracked and data is being collected."

Zhou Cheng continued to say without being arrogant: "From a more cautious perspective, some of the patients I have come into contact with who fall into this category have very good short-term curative effects after manual reduction. The earliest batch of patients are already

I took off the cast and started normal functional exercises."

Zhou Cheng is very clear-cut now. If he does something, he does it. If he doesn't do it, he doesn't do it.

The manual reduction he performed at the Eighth Hospital was at the end of October and the beginning of November. It is now the beginning of March. The effect was indeed very good. Zhou Cheng also knew that the effect was very good, but it was in a simulated world.

The real-world data is quite limited. Zhou Cheng also knows that what Liu Zhibin and others are interested in must be what Zhou Cheng has listed now. In addition to the indications for manual reduction in the original guideline, it is within the indications for manual reduction listed by Zhou Cheng personally.

classification of these diseases.

Zhou Cheng's words made everyone fall into deep thought. Inside the box, you could hear a pin drop.

Liu Zhibin looked around for a while. Then he asked with an extremely serious expression: "Dean Xu, what do you think?"

Xu Dashan, the administrative director and vice president of the Jishuitan Trauma Surgery Department, is also the leader and main person in charge of the trauma surgery group of the Orthopedics Branch of the Kyoto Medical Association under the Chinese Medical Association. He has relatively more resources than Liu Zhibin.

leave.

Xu Dashan originally valued and paid a lot of attention to Zhou Cheng because of his acquaintance with Professor Chen Jiwu, but for now, it seems that Zhou Cheng himself has to let him express what he has expressed through him.

Slightly changed.

The more basic something is, the greater the relationship.

If it is said that even the indications for surgery have been changed, they are still studying the fracture classification that can be done without surgery, and how to make the surgery better, what do you think about it?

This is like, when you are thinking about how to fry vegetables to make them taste as delicious as meat, the price of meat is already the price of vegetables. But from a purely delicious and nutritional perspective, isn't it good to eat meat?

Xu Dashan felt a little restless, looked around, and said to a person at the door: "Please close the door."

Obviously, he planned to say something that was not convenient for outsiders to hear, and it was also very profound.

Chen Shengwu immediately went to lock the door.

Xu Dashan knocked on the table a little and said, "I'm sorry, professors, I'm sorry to bother you, but I would like to borrow a little bit of your precious time."

"Actually, we all know that our country has been discussing how to improve the quality of our medical care and how to improve the quality of our services."

"This is a long-term problem, and it will never stop. I am not in the leadership, so I don't have much publicity, so I just talk about some problems in our orthopedics. What I said today will come out of this door.

Forget it all and don’t spread it out again.”

Xu Dashan's words made everyone else smile and did not reply, interrupting Xu Dashan. At this moment, the attending physician Shen De gave Zhou Cheng a glass of water, and then motioned Zhou Cheng to sit down first and listen to what Professor Xu Dashan said.

"Each hospital is at a different level, so the contact areas are also different. Our country's current medical care is constantly sinking. What we can intuitively feel is that our current trauma surgery department has fewer fracture patients.

.”

"More are patients with complex fractures or hand surgery. This is a good thing. To a certain extent, it urges us to further improve our professional strength and professional capabilities. If we cannot handle cases and problems that cannot be solved by the hospitals below.

"

"We old guys should change careers or do more side jobs, because we won't be able to make a living anymore. The current circle of trauma surgery is only so big, and the volume of patients is only like this."

"Manual reduction is a relatively sensitive topic. The reason why not many people touch it is because doing it is thankless. I won't go into details about the specific reasons. Everyone knows it."

"But in fact, no matter what it is, it actually doesn't have a big impact on us, because we don't have simple fracture patients, just a few every year. If we relied on this for food, we would have starved to death long ago."

Xu Dashan's words are very hurtful. But they are also very true.

Where is the hospital he is in? Jishuitan, the place where orthopedics is apparently ranked number one in the country. Does he lack a source of disease? There is no shortage of it. There are basically no good sources of disease and a lot of bad ones.

Therefore, if the source of the disease is to be diverted, top hospitals in countries such as Jishuitan and Hexie must specialize in solving complex problems, and then leave emergency cases such as fractures and debridement to lower-level hospitals.

This is an ongoing issue.

However, if Zhou Cheng's project, once successfully completed, is distributed and implemented uniformly across the country, it will be good enough and favorable for patients, and another problem arises.

What about the doctors in lower-level hospitals? Do they still need to eat?

Fractures and trauma are the source of their illnesses. The source of illness in a hospital is their root cause. They are required to suddenly learn more difficult surgeries in depth and deal with more complex patients.

So why don't patients just go to a better hospital?

Doctors are human beings too. People should have emotions and desires, need to eat, and need to make money to support their families. But before the country implements a safety net system to ensure doctors' reasonable and legal income, how to eat is a fundamental problem.

A month's salary is more than 2,000, more than 4,000, and in Kyoto it is more than 5,000. You can eat, but you can't even eat shit!

However, Xu Dashan definitely does not look at the problem in such a simple way: "This is a phased issue, and it is also an issue that requires continuous development. If this thing is good, it must be done, but where to do it is a very worthy discussion.

question."

"You said that we can perform fracture reduction techniques in our hospital, but we won't see a few fracture patients at all in that year. What should we do?"

"Even the emergency center and the 120 command center know that we don't do fractures in Jishuitan, not because we don't do it, but because we have already filled up the beds when dealing with complex patients."

"We have to do it, so my suggestion is to put this clinical subject in prefecture-level city hospitals, where there are many patients, and there are also county hospitals that send some complex cases there, which can meet the needs of clinical development at the same time.

The conditions of the subject.”

"It will not harm the fundamental interests of our comrades."

Speaking of this, Xu Dashan scratched his head again: "At this time, there is a question, that is, who owns the ownership of this topic? Who will host it, who will carry it out, and then it is very difficult to please."

"But its upper limit is high. Once it is implemented, it will have a great impact on trauma surgery. We still need to study this in detail."

"That's all I have to say. Other professors, do you think you have any better suggestions?"

Zhou Cheng was slightly moved when he heard Xu Dashan's words. The depth of his thinking about the problem was very profound.

China is a big country with a population of more than one billion, which is no joke, and every idea and decision affects a large number of people.

Under better economic factors, more and more emphasis is placed on people-centeredness, but this people-centeredness cannot simply be people-centered, but must be everyone-centered and take all aspects of everyone into consideration.

Just simply consider the factors at the bottom and kill all the middle-level people?

How embarrassing the current situation of doctors is, you know how ridiculous this idea is. The salary of an orthodox doctor after graduation is almost the same as that of a master's degree in other majors.

Some people will definitely say that doctors become more popular as they get older, and they can still make money even when they are over 70 years old.

Think about it from another way, if you are over seventy and have to make money when you are old, you still have to make money, instead of enjoying your old age, with the same education and class, isn't it pitiful?

The first line of reading is at least relatively fair.

Most people don’t dare to accept this, and it’s not easy for them to accept it.

Professor Jingxing thought for a while, and when no one answered, he sighed and took over the conversation: "Professor Xu, your analysis has been very profound. But I think I still have to add something.

It’s just that this subject is not easy to do.”

"We have to do it, and it can't be done by just one or two people. We all need to use a certain amount of manpower and material resources to do it. This is realistic."

"If professors hadn't stood up to take the lead, ordinary prefecture-level city hospitals would not dare to take it on, and they wouldn't be able to take it on. If we are in this muddy water, if we want to do this, we can only do it together."

"There are no interests involved, and there is no need to compete for reputation. I will simply spread the subject from an academic perspective."
To be continued...