What Does a Pediatric Orthopedic Surgeon Do?

In "How Doctors See Doctors" produced by Yuedu Ji in 2015, each article begins with a small story, which raises questions, then develops popular and interesting explanations, and popularizes relevant medical knowledge. Enable readers to understand some doctors' practices and communicate with doctors more effectively. ^[1]

How did the doctor see the doctor

What did the doctor think?

Let you do a bunch of inspections without asking

You have the same illness as XX

Just want to know, but the doctor put you in hospital

You lined up for the N-day team and wanted to be hospitalized, but the doctor didn't pay the bill

...

From the perspective of an obstetrician, this book tells readers how doctors see a doctor, what diagnostic logic doctors use when they see a doctor, how to judge the condition, how to decide what drugs to use, and what medical methods to use.

Wonderful storytelling and science. Obstetrician male doctors teach us to identify the most common over-medical pitfalls, and use cases to explain how to communicate with the doctor most effectively. ^[1]

Tian Jishun, a male doctor of obstetrics and gynecology who has been fighting for hundreds of years. Practitioner of the People's Republic of China: 110330000006611

The host of the first doctor's talk podcast in Chinese on the Internet. He has published clinical academic papers in official journals sponsored by the Australian and New Zealand Obstetrics and Gynaecology Society. Dedicated to the popularization of online medical science for a long time, he is the best answerer in the field of online health and medicine, with nearly 400,000 fans. He has also opened medical science columns on multiple online platforms. And accept an interview with "Public Health."

He is the author of "Practitioners Saying-Knowing Tian Jishun's Selected Works" and "Male Doctors in Obstetrics and Gynecology".

This is a popular science book for ordinary readers, but popular science is not a certain discipline, but a unique group of doctors. How do they make a series of medical decisions in the face of patients and conditions? The medical logic in the middle is what.

-Knowing the netizens silently

A very good book, which uses complex language to make everyone understand, using case-spoken language. Through case stories, we understand how doctors think when they see a doctor. They teach us to judge rationally. Listening to the doctor, you must enrich your medical knowledge.

-Douban netizen Mosca

Very practical. After reading this book, we can better understand some doctors' ideas and practices, communicate with doctors more effectively, and identify the most common over-medical traps.

Ms. Zhang, a patient of Medical College of Zhejiang University

Preface ... 3

Chapter 1 Doctors do not repair computers when they see a doctor ... 5

Doctors do not repair computers when they see a doctor ... 6

How is the disease diagnosed? 6

The cause is not simple ... 8

Oligohydramnios and postpartum hemorrhage ... 8

Side effects of medicines-Viagra is actually a failed product ... 9

Inflammation-a battlefield filled with smoke ... 11

Are there any surgical indications for Hua Yu for Guan Yu's bone scraping therapy? ... 12

Horrible side cut ... 14

The operating table is too narrow and nobody is nervous! ... 14

Anatomy Atlas May Be More Like an Art Photo ... 14

Doctors also get sick, but they just know better. 15

Chapter II It is impossible for a doctor to speak 100% ... 17

The doctor can't pack your tickets ... 17

The doctor can only say the range, not the standard value ... 17

Will you taste all the oranges? ... 19

Small probability is not equal to small risk ... 20

There is no small probability in the doctor's eyes ... 21

Diagnostics-Doctor's Secret to Solve Cases ... 22

There is a huge secret behind the symptoms ... 23

Symptoms can also lie ... 24

Don't you know you are pregnant? ... 25

Medical Examination-the "Simple" but Irreplaceable Method ... 27

Breast self-examination every month ... 28

The most valuable experience accumulated by doctors in actual combat ... 29

Chapter III Modern Instruments Can Only Provide Reference 25

How Doctors Write Medical Records ... 30

Take blood and urine tests seriously ... 31

How to read the test list ... 31

Please follow the doctor's diagnostic logic when seeing a doctor ... 33

Imaging examination, but not yet gold eyes ... 34

How to judge X-ray or B-ultrasound? ... 35

Don't go through the checklists without permission ... 36

Unjust and false cases caused by small probability incidents ... 36

Chapter 4 What makes a doctor make a diagnosis ... 37

Personal experience vs clinical thinking ... 37

How Doctors Make Diagnosis ... 40

Learn from the painful cases ... 41

The doctor first reasoned about the probable cause ...

Doctors prefer presumption of guilt ... 44

Good doctor's diagnosis is targeted, and doctors casting a net-type consultation continue to cheer ...

Make a diagnosis first, then make a cure ... 48

Facing the emergency, first save your life and then reason ... 50

Why did the doctor leave you to see someone else first? ... 52

Chapter V The Doctor Always Has a Skeptical Heart ... 53

The doctor will also tell the evidence ... 53

Evidence is also divided into three or six or ninety-nine ... 55

Don't take the theory too seriously ... 57

Randomized Controlled Trials-Both Belief and Not Belief ... 58

Tall meta analysis ...

For doctors, all clinical guidelines are a reference ... 60

The doctor always has a doubtful heart ...

There is no greater sin than self-righteousness ... 62

The informed consent is not a life and death instrument, nor is it a disclaimer ...

The principle of non-injury in modern medical experiments ...

Chapter 6 Each visit is a fate between doctors and patients ...

Life is actually an adventure ...

Helplessness behind high cesarean delivery rate ... 68

Data doesn't determine everything ...

"Study more, talk less about doctrine" ... 69

Problems to pay attention to when watching Chinese medicine ... 71

Don't take improper cadres and don't take improper treatments ...

Each visit is a fate between doctors and patients ... 74

Postscript ... 80

At the time of writing this book, I was just a dad. As an obstetrician and gynecologist who is used to childbirth and surgery, the thrill of my wife's birth is still vivid.

My wife has been talking to me, saying that she must be the most uncomfortable woman in pregnancy. From the third trimester of pregnancy, hepatic impairment was found. Liver enzyme indicators, stepping on the corpses of various treatment methods, are still rising, up to 10 times the normal value. Early pregnancy screening is at high risk, gestational diabetes, and polyhydramnios. In short, the whole pregnancy process is to give his wife a vivid high-risk pregnancy class. What she did most often during pregnancy was to widen her eyes and say, "Ah? There's this kind of problem!"

And all this did not go well, reaching the peak at the moment of delivery-postpartum bleeding!

My wife had a B-ultrasound for the last time during pregnancy, and found that the amniotic fluid was almost gone, and the baby was at risk of hypoxia in the belly, which made me surprised. So the emergency department had a cesarean section. Then, because the baby's head is too large and its position is high, it is difficult to give birth during the operation, so it was pulled out with forceps during the cesarean section. And then there was postpartum hemorrhage.

It doesn't have to be a hundred years ago, when our grandmother gave birth to our father, and women gave birth to children, just walking around the gate of the ghost door, one foot inside the door, and one foot outside the door. Even now, the leading cause of maternal death is postpartum hemorrhage. And it wasn't until my wife was sent to the ICU (Intensive Care Unit) because of excessive bleeding, and I was full of various tubes that I realized that the postpartum hemorrhage happened to me!

Very familiar rescue process, more familiar with patient rescue!

I started some treatments for my wife's postpartum hemorrhage. After changing the roles of doctor and husband several times, I found that my brain was gradually being emptied, and I did not want to consider the possibilities after rescue. In the end, all I can do is comfort my weak wife who is lying on the bed. A line from Wu Yanzu's "The Revenge of the Princess" was very relevant at the time: "I have saved many people, but if someone wants to ask at this moment, the person I want to save most is you!"

The wife's postpartum hemorrhage was due to weak contractions. At last, the method of uterine cavity packing was finally controlled. Packing the uterine cavity is to squeeze gauze into the uterus to oppress it. If it is still not controlled, then there is basically only the step of hysterectomy-this is the last step to save lives.

After a night of rescue, my wife's bleeding volume was more than 3000ml, which was equivalent to more than 70% of the blood in the body. After 3,000ml of blood was transfused, hemoglobin was only more than seven grams, at least eleven grams in normal people.

This is not the end of the story.

The gauze cannot be stuck in the uterus all the time, and it must be removed after 48 hours, and there is still the possibility of continued bleeding after the gauze is removed.

The day I took the gauze, it happened to be my night shift. After the gauze was taken out, the blood was still flowing, and another 300ml was discharged in a few hours, so the various tocolytic drugs continued. I don't know what will happen next, and I dare not think about what will happen.

At this time, my wife's girlfriend, also my high school classmate, called to ask about the situation. After listening to my brief description of the process, she kept asking on the phone: how could this happen? Aren't you an obstetrician? Aren't you taking care of your whole pregnancy? How could amniotic fluid suddenly disappear? Wasn't it in your hand? Why is there a major bleeding? How come the gauze is still bleeding? Have you ever used medicine?

These familiar questions were asked by many patients and family members in the past, and I would explain with a smile; but at that moment, my nerves that I had been nervous all the time could not be stretched. I was in the office, crying to the phone Out loud, kept answering a sentence: I don't know, I don't know, I don't know.

In the end, I was lucky, the most terrible scene did not happen, and the bleeding stopped. Now his wife has recovered.

After telling my own story, you see a powerless doctor, a doctor who only cries in front of his favorite woman. Unfortunately, in many cases, doctors are powerless.

Induction of labor was given to a patient with intrauterine infection. This is a 36-year-old IVF pregnant woman, twins, hospitalized to have a fetus because of bleeding. The patient is older, pregnant for the first time, and IVF, twins, so we are very active in trying to save the child. However, by 25 weeks, it was clear that intrauterine infection and blood culture were already positive, suggesting sepsis, and then continue to conceive, I am afraid that adults will also be infected with septic shock. So we advised her to give up and terminate her pregnancy earlier. After repeated persuasion, the pregnant woman finally agreed to give up. At this time, she was crying and said, "It's all my bad, it's all my fault, I'm sorry for my children! They are so pitiful, I'm sorry for them "I think I can understand how a expectant mother feels about the child in her belly, but I have to correct her:" It's not your fault, you are not at all wrong, and you are not sorry for your child. Continue pregnancy Go on, your own life is gone, you can only give up, but this is not your fault. It does not mean that all bad endings can find a person who makes a mistake. If no one makes a mistake, there will be a bad ending. There is an end to life, does not mean that someone must have made a mistake. People who have cancer or other terminal illnesses, what have they done wrong? They have done nothing wrong, but they will still get sick. If anyone must have done wrong, then Blame God or Blame them, they are wrong! "

The reason why I think that human illness and death is God's fault is because of a previous Caesarean operation. The mother had a cesarean section because of uterine malformations and was concerned about uterine rupture during delivery. It turned out that the baby's right leg and knee were long! That is to say, the patella of the knee has grown to the back, and the front has become the iliac fossa. The doctor next to me saw the situation and shouted, "God made a mistake! It reversed its legs when it was made!" This situation has not been seen before, so we consulted a pediatric orthopedist, They believe that this situation should be caused by the deformed uterine cavity, which restricts the fetal movement in the uterus and the knee joint caused by long-term compression. It should be possible to try manual reduction. You may think it s the mother s fault, but she does nt want her womb to be deformed, so this is really God s fault!

It is said that there is a debt and a debtor for injustice. When we encounter an unacceptable result, there is always an attribution, that is, someone must have made a mistake, otherwise how could there be such a bad result! If everyone can do their own thing, the result should be good. Therefore, there are two kinds of attributions when visiting a doctor. One is like the mother of the twin, who feels that he has made a mistake; the more is the attribution to the doctor. If the patient's illness is not cured or even died, then it must be a medical accident; if a misdiagnosis occurs, the doctor must be irresponsible and negligent. But why is it that someone has made a mistake because of a bad result? Everyone does their own thing, should the result really be good? What if God made a mistake? With human beings' smallness, how could it be possible to restore God's fault?

After experiencing a comprehensive education in atheism, we have the magnanimity of human beings, and we firmly believe that human beings are the masters of this world. I don't need you here to believe in God, just please keep human humility in the presence of nature. In the face of illness, doctors and patients are the same, and they are both weak humans!

For the time being, in fact, doctors' actual role is not great, they are just to help the body get back on track when the body runs out of order. For example, with medication, a certain part of the abnormality is corrected with drugs. However, the drug lacks self-recognition and coordination. It actually brings other abnormalities to the body when correcting the body's abnormalities. This is the side effect of the drug. Then we use the body's self-coordination ability to correct the original and drug-induced This effect puts the body back on track. Surgery is the same. Regardless of the size of the operation, the patient's self-healing and coordination capabilities ultimately help patients recover after surgery. Therefore, at the current level of medicine, it is not the doctor but your own body that ultimately makes you regain your health. The doctor is just the helper; most of the time, the doctor does not "treat" people, but "helps" people.

From the questioning of his wife and girlfriends, we can see the public's expectations of the doctor; but the epitaph of the first American doctor Dr. Trudeau who isolated tuberculosis (ELTrudean) tells you the doctor's helplessness: occasionally heal, often help, always To comfort sometimes; to relieve often; to comfort always.

There is always a huge gap between what a patient expects and what a doctor can do. There is a gap that can only be reduced as much as possible but never disappears. This book is to tell you what the doctor actually does.

The training of doctors is long, and a large amount of professional knowledge must be learned, including basic subjects such as physiology, pathology, anatomy, histology, and clinical subjects such as women and children. It is as if in the "Lu Ding Ji" starring Zhou Xingchi, Chen Jinnan is going to teach him peerless martial arts. The book called "Peerless Martial Arts" is actually just a catalog. There are a lot of real peerless martial arts secrets. Chen Jinnan watched for three years and practiced For thirty years. For the peerless martial arts of medicine, countless seniors have also spent decades of hard work, my little book is not even a catalog. Medical students have spent five or eight years studying medical knowledge, dozens of professional courses, and hundreds or thousands of pages of textbooks. Even if they simply introduce various medical terms, they can not be completed by a book or two. Moreover, even if you know those terms, they are just dead knowledge. Without a relevant knowledge framework, it is difficult to form a clear impression.

"The reporter must put it to the point, and the usurper must hook it." A better way to get involved in a field quickly is to start with the problems and events in this field, and combine the professionals in the field with specific Questions, make a summary of the outline, directly explain the main content, and readers can form their own knowledge of this field based on their existing knowledge. However, the content of medicine is complicated, and how to choose and choose among such vast contents is not an easy task. This book is not a popularization of medical expertise or medical terminology, but it wants to illustrate through some examples that every medical activity performed by a doctor and every medical decision made by him is based on where does the doctor come from How do you integrate this expertise when making medical decisions?

This book is divided into four parts. The first part introduces what doctors can do (more precisely, there is no way to do it), and some necessary concepts, such as some knowledge about drug treatment and surgical treatment. The second part introduces several related concepts of medical statistics and clinical diagnostics. These are the basis for doctors to integrate professional knowledge, especially clinical statistics. It is the source of data on which doctors make decisions. The absolutely accurate description of the facts determines that the doctor will always make mistakes. The third part introduces the relevant ideas and principles of diagnosis and treatment, which focuses on the principles of evidence-based medicine. The fourth part introduces the bio-psycho-social medical model and medical ethics. It is hoped that by reading this book, readers can have a general understanding of medicine, and at the time of consultation, they can understand some of the doctor's practices.