Practicing Medical Skills in a Small Clinic-Chapter 39: So It Was the Culprit

Diagnosis: General Surgery proficiency 10.1/100.

Awesome!

As long as the ’money’ is in place, dreams really do come true.

This diagnostic skill has instantly upgraded from entry level to proficient level.

He was pleasantly surprised to find that his diagnostic vision of general surgical diseases suddenly broadened. Actually, every medical student learns about the same clinical theoretical knowledge, so why are some stronger or weaker?

In the diagnostic process, the accumulation of experience is one aspect, and diagnostic thinking is equally important.

With diagnostic experience of various similar diseases, combined with patient symptoms, examination results, medical history, age, etc., comprehensive analysis and differential diagnosis are performed.

Ultimately eliminating the false and retaining the true, it is possible to derive the correct diagnosis result.

This can greatly reduce the probability of misdiagnosis and missed diagnosis.

The improvement of diagnostic thinking requires daily accumulation and diligence in thinking.

Once the vision is opened, it’s equivalent to enhancing diagnostic thinking.

The feeling for him is that after the general surgery diagnosis advanced to proficient level, diagnosing diseases in this domain feels like reaching a new high point.

Previously standing at the foot of the mountain, you could only see a small part of the view.

Now having climbed to halfway up the mountain, the height is different, and the vision is opened up, able to see more things.

Doubts and diagnostic clues previously unseen, and details easily overlooked before, are now fully captured.

There are many reasons for abscesses forming on the back.

Common ones include folliculitis, diabetes patients, local injuries and infections, long-term bedridden causing back pressure and poor hygiene...

This old man’s condition suddenly appeared, feeling back pain suddenly over a month ago, then after a while, a large red swollen lump appeared, then it started to fester.

Folliculitis and local injury infections can basically be ruled out.

The old man’s dressing was decent and clean, not like someone who neglects hygiene.

Li Jingsheng carefully sought clues, trying to find the real cause.

He observed the old man’s back abscess again, now seeing pink liquefaction flowing from the wound. A thread of yellow-white fluid was mixed in the middle, which would be easily overlooked if not particularly meticulous.

If it were still an entry-level general surgery diagnosis skill, even if he saw the yellow-white fluid mixed in the pink fluid, he wouldn’t care at all.

At this moment, with proficient-level general surgery diagnosis skills, it immediately caught his attention.

"Yesterday it was just debrided at the community service station, and anti-inflammatory antibacterial medication was used in the pus cavity. How could it fester so quickly?"

Because based on Li Jingsheng’s medical common sense, for an abscess to mature and liquefy, which is festering, it takes at least over three days.

He immediately got a cotton swab and picked up a bit of yellow-white fluid.

Those pink fluids are blood and body fluids, very bland.

But the yellow-white fluid he picked up was quite viscous.

Like nasal mucus, it can be drawn into a thread.

But it isn’t as thick as nasal mucus.

It can basically be concluded that this is mature pus.

What on earth is going on?

Could it be that debridement in the pus cavity was not done thoroughly, leaving infectious foci residues?

Li Jingsheng, having found a trace, seemed very excited.

As long as he cures this old man, his small clinic will also become famous in the field of general surgery. In the future, it will attract a continuous stream of surgical patients seeking treatment.

This is the type of patient he desires most.

Not only because he has spent a lot of life value and energy, learning and enhancing many surgical skills. Not just because surgery is very profitable.

Also because surgery is easy to learn but hard to master, let alone in clinics, even in most primary medical institutions, including community health service centers, surgical business development is basically barren.

Because the training of surgeons is too difficult.

Long cycle, high threshold, high risk, and large investment.

The key is, once trained, people switch directly to larger hospitals.

Just as water flows to low places, people go to high places!

Who doesn’t want a better life?

With greater skill, being able to enter larger hospitals, naturally one would choose to develop in a big hospital. Not only will there be greater space for development, but the working environment and learning environment will also be better.

The income will also be higher.

At the same time, social status and medical status will follow and rise.

The number of surgical patients in primary hospitals is pitifully small, which is also a reason why good doctors can’t be retained.

After all, small hospitals are only known for treating minor illnesses like colds and fevers, deeply ingrained in people’s minds.

"Old gentleman, I’m going to open the wound to look inside, it will hurt a little, do you need an anesthetic?"

Li Jingsheng asked the old man.

"It’s okay, this bit of pain is nothing, I can handle it."

In front of his wife, the old man demonstrated a steely resolve.

"Show off all you want! Don’t yell when it starts hurting later!"

The old lady sarcastically jabbed at her husband from the side.

Actually, it was also a form of implicit care. She surely hoped her husband would take anesthetic, but in front of others, she didn’t want to undermine her husband’s dignity.

So she gave a sarcastic reminder.

"Underestimating whom? Dr. Li, go ahead, open it up for examination! I promise I won’t cry out in pain."

Although the old man spoke assertively, he closed his eyes, clenched his molars tightly, the muscles on his cheeks bulging out.

Li Jingsheng held back a laugh and led the old man into the treatment room in the back.

"Do you need a piece of cork to bite on?"

"What do I need that thing for, just get on with it."

The old man said impatiently.

Li Jingsheng was mainly worried about him biting his teeth off.

The old man turned his head to see the treatment room door closed, seeing that his wife did not come in, his expression relaxed a lot.

He took a deep breath, then closed his eyes again, clenching his teeth.

Li Jingsheng used an aseptic swab to open the wound; the abscess was quite deep.

He shone a flashlight inside, searching for the source of the yellowish-white pus.

The old man’s body trembled slightly, clearly in pain.

Cold sweat continuously emerged from his forehead.

Yet he remained silent.

Primarily fearing his wife outside would hear and mock him.

After some effort, Li Jingsheng unexpectedly found the source of the pus at a superficial spot about 2cm to the left of the abscess.

"Strange, why is the pus coming out from here?"

He felt very excited about the discovery.

At the same time, he was puzzled; this spot was an easily operable location during surgical debridement, making poor cleaning unlikely.

Moreover, it had been cleaned three times, the second time even by Ding Wangshou, an experienced surgeon.

Leaving a small infected and purulent tissue uncleaned—how could that be possible?

When something unusual happens, there must be a hidden cause.

Li Jingsheng switched to a longer swab, trying hard to scrape the source of the pus.

"Ugh!"

The old man let out a muffled groan.

His teeth clenched tightly.

The tissue in that area turned slightly pale, and the pus stopped flowing.

"It hurts a bit, please bear with it! Once we find the cause, there’s a good chance your abscess can be cured."

Li Jingsheng observed the locked-in source of the pus.

After a moment, pale yellow pus flowed out again.

The amount was very little.

Only as thin as a hair strand.

If he hadn’t had a prior diagnosis and intentionally searched for the source, chances are he wouldn’t have made this discovery.

He simply checked the entire abscess carefully several times.

Determined that only that spot was continuously secreting pus.

"Could this be a hidden sinus tract?"

Li Jingsheng’s mind was struck with a flash of insight, knowing a major breakthrough in diagnosis had occurred.

The true cause was likely found.

Doctors at the health service station surely used alcohol or saline to wash the wound during debridement.

This would temporarily eliminate the source of pus.

Since both alcohol and saline are quite stimulating.

While washing the abscess, due to pain, the muscles automatically contract.

The sinus tract is thus temporarily closed, preventing further pus outflow.

By the time the patient seeks treatment several days later, the infection in the abscess has become quite severe, full of pus, making it extremely difficult to find the tiny sinus tract.

This also resulted in all surgeons at the health service station failing to discover the hidden sinus tract.

Sinus tract-induced stubborn abscesses are uncommon but encountered clinically.

Typically, sinus tracts are larger, directly forming a draining hole on the body surface. Experienced doctors can diagnose them at a glance.

This old man’s sinus tract is located on his back, and because he delayed seeing a doctor for a long time, combined with the skill level and limited equipment of the health service station, they never managed to identify the true cause.

Treated repeatedly, the illness showed no improvement.

Kept recurring.

Finding the sinus tract now is a good thing.

But it’s not time to rejoice too soon.

If the sinus tract is too deep, Li Jingsheng definitely couldn’t handle it.

Additionally, his small clinic only has an old X-ray machine and an ultrasound machine, lacking other diagnostic equipment.

Luckily, examining the sinus tract doesn’t require high-precision instruments like color Doppler ultrasound, CT, or MRI.

Ultrasound combined with X-ray can fully diagnose it.

Regarding large hospitals, they are more rigorous, often combining it with laboratory data for examination.

If it’s deep within the body, like the thoracic or abdominal cavity, they might perform a sinus tract angiography to ascertain it.

Li Jingsheng restrained his inner excitement and secret joy.

The opportunity for fame and fortune was right in front.

However, he must hold steady.

He must remain calm, otherwise, if he doesn’t cure the patient or even causes harm or death, it would truly turn joy into sorrow.

"Sir, there’s been a significant breakthrough in diagnosing your condition. I’ve found there’s likely a sinus tract present. Next, we’ll need to perform an ultrasound and X-ray examination. These two tests cost 200 yuan."

The old man didn’t seem short of money.

He should be able to afford the cost of these two tests.

Li Jingsheng’s diagnostic equipment may be old, but he needs to recoup costs.

"Wonderful. It was worth coming here; if you cure me, I’ll give you an extra 1,000 yuan as a bonus. No... 1,000 is too little, I’ll give you an extra 2,000 yuan as a bonus."

The old man was quite generous.

Bang, bang, bang!

The old lady outside heard her husband starting to splurge again and anxiously pounded on the door.

"Old man, let’s focus on treating the illness first. Hospitals now don’t allow doctors to accept bonuses; don’t harm the doctor."

The old lady was also somewhat quick-witted.

Her excuse was dignified, making sure not to upset Li Jingsheng, while preventing her husband from giving an extra 2,000 yuan bonus to him.

Men are generous, women are frugal, this almost seems innate.