The Enhanced Doctor

Chapter 1115: Chapter 1115: What Did We Forget to Check?

Early the next morning, after Liu Banxia finished breakfast with Qiaoqiao, he gathered everyone together for a large-scale teaching consultation.

Rou’s performance was quite good, having stayed overnight in the hospital without any discomfort, looking rather energetic instead. After breakfast, she even volunteered to wash the dishes.

At her own home, she wouldn’t have the chance to do such chores, not because she didn’t want to, but because there was never an opportunity.

"You all have more opportunities to follow Dr. Shi, Dr. Wei, Dr. Xu, and Doctor Wang on rounds. Because I’m lazier and currently a bit busy, I don’t participate much," Liu Banxia said.

"This patient’s case is somewhat complicated. You all know the basic situation from yesterday’s admission. In a moment, when we enter the ward, watch how Xu Yino handles it."

"Although you are currently interns and resident doctors, before long, you’ll be taking on the roles of attending physicians. It’s not just us trying to ease our workload by letting you manage the cases; engaging with patients helps you grasp some skills."

After speaking, Liu Banxia nodded at Xu Yino.

Xu Yino adjusted her expression and led the group into the ward.

"Doctor, Ranran’s condition hasn’t improved; she’s still coughing up blood," the patient’s mother hurried over when they entered.

"Please don’t worry, our Director Liu and Doctor Xu are here. We’re conducting a consultation this time," Xu Yino reassured her.

"The patient is 33 years old, visited due to hemoptysis and fatigue yesterday. CT shows multiple ground-glass opacities in both lungs, primarily in the lower lobes. Blood tests reveal slightly elevated white blood cell count and hemoglobin count of 89. Stool test showed no occult blood."

"Tumor marker screening, gynecological ultrasound, acid-fast bacilli test, PPD test, and bronchoscopy all returned negative results, and culture results currently show no growth."

"Yesterday, we administered antibiotics and hemostatic medication for symptomatic treatment, but the hemoptysis symptoms have not improved. We took another blood sample this morning, and the latest results haven’t returned yet."

"Doctor, it’s not lung cancer or tuberculosis, is it?" the patient inquired from the bed.

Today, she seemed much less energetic than yesterday. However, perhaps due to her vanity, she even wore light makeup, despite her condition.

But that sickly appearance cannot be masked by makeup.

"Our tests from yesterday already ruled out those two possibilities. Currently, we mainly find it difficult to associate or differentiate your symptoms," Xu Yino explained.

"I’ll check your body again to see if there’s lymph node or thyroid swelling. The current medication isn’t working, indicating your symptoms are still developing and may reveal more," she continued.

The patient nodded.

Xu Yino drew the curtain, and female doctors followed inside, while the male doctors remained outside to give privacy.

"Check-up results show no thyroid or lymph node swelling, body temperature is 38 degrees," Xu Yino stated.

Listening to her words, Liu Banxia frowned, as this could be considered a new symptom.

Yesterday, the results were normal, and now after medication, the temperature climbed. It seems the disease is progressing to a new level, and action is needed soon.

Although the fever is mild now, with rapid symptom development, it could escalate to a high fever.

"Teacher Liu, Teacher Xu, should we continue medication today?" Xu Yino asked after opening the curtain.

"Suspend the antibiotics, only give hemostatic medication, and measure the temperature every half hour," Xu Hui replied.

"Doctor, could you prescribe me some watermelon frost? I’ve got a fever, and I found ulcers in my mouth this morning," the patient requested.

"Open your mouth and let me take a look," Xu Yino quickly asked.

The patient opened her mouth.

"The patient has two ulcers the size of sesame seeds on the lower left molar, and a rice-grain-sized ulcer near the lower right canine," noted Xu Yino after the examination.

"Record it, and after our discussion, we’ll update the medication order. Meanwhile, hold off on eating," Xu Hui instructed.

Discussions on the patient’s condition must continue but not in the patient’s presence to avoid burdening them.

This round of ward visits was meant to give students a clearer and more intuitive understanding of the patient’s condition, facilitating the subsequent teaching consultation.

Typically, most ward visits focus on cases with clear diagnoses. You can quiz students and directly issue medical orders.

"Comrades, the situation is critical. Here are the patient details recorded by Xu Yino, along with some symptom descriptions and related tests," Liu Banxia said upon reaching the meeting room.

"While I’m hosting this consultation, it’s Teacher Xu who is the responsible doctor. I’m just a substitute host, so everyone feel free to speak up."

"I can tell you that both Dr. Xu and I are also a bit puzzled by this patient’s condition. The symptoms are very vague, and the direction for diagnosis is hard to determine."

Xu Hui gave him a helpless glance, wondering why he had to be so honest.

However, the intern and resident doctors showed no signs of relaxation since this kind of consultation assessment is the most challenging.

It’s less about solving the patient’s condition and more about assessing your thought process during the consultation.

Occasionally, junior doctors solve what senior doctors can’t, but such cases are rare and often remarkable.

Everyone wants to make an impression, but things could go wrong, leading to quite a complex situation.

"Not very enthusiastic, are we, Cui Jia?" Liu Banxia began calling names.

"Then I’ll share my personal perspective," Cui Jia responded.

"Based on the latest results, the cause of the pneumonia is still a mystery. The hemoptysis and anemia cannot be effectively linked. Although we administered hemostatic drugs, the patient’s symptoms need two to three days to show improvement."

"Oral ulcers can be considered possibly related symptoms, and the low-grade fever can be identified as a new symptom. Should we consider blood disorders as a possibility?"

"That’s a good direction. What puzzles me and Teacher Xu is exactly that point," Liu Banxia nodded.

"The patient’s symptoms appear somewhat interconnected, but these connections are very weak. Theoretically, there could be some causal relations, but symptomatically, there’s no clear indication."

"My wife mentioned yesterday that doctors often guess when they can’t figure things out: it’s either this or that, or perhaps something else."

"I think she isn’t entirely wrong, but while we can make educated guesses, we need to identify the issue as soon as possible; otherwise, treatment might be delayed."

"It’s such a good opportunity to demonstrate your capabilities; you should try your best. Before the consultation, Dr. Xu and I quietly examined another possible direction worth exploring."

The attendees in the meeting room were a bit bewildered—what does this mean, there’s a direction?

This prompted their brains to engage faster. If they could align their thoughts with the teachers’, it would be a good opportunity to shine.

"Teacher Liu, could pneumonia be the main factor influencing the current symptoms, with the patient’s anemia being merely incidental?" the internal medicine intern Chen Jun asked.

"That’s a possible direction, but you need to convince everyone to support your view," Liu Banxia said.

"Well, my primary reasoning is that although the patient has anemia symptoms, it’s at a borderline level," Chen Jun pointed out.

"After examining the patient today, I noticed she maintains a great figure, so I suspect the anemia might result from nutritional deficiencies."

"The oral ulcers might be due to stress from the unknown cause of her hemoptysis, combined with dietary shortcomings."

"And the low-grade fever indicates a possible pneumonia exacerbation. Although we’ve used antibiotics, it was broad-spectrum, and the pneumonia-causing bacteria might be highly drug-resistant."

"If you were in charge of this patient, what would your approach be?" Liu Banxia asked.

"I think symptomatic treatment should be continued for now, waiting for culture results," Chen Jun replied.

"Clear thinking, regardless of this patient’s actual situation, your response was excellent," Liu Banxia commented.

"Now we have two viewpoints: a blood disorder causing these conditions and pneumonia being the primary cause with accompanying symptoms."

"Does anyone have a third opinion? The more perspectives, the better—it helps create more pathways. These clashing ideas might lead us to a clearer understanding."

Although he said this, the response was not very enthusiastic.

"In our current discussion, while we’ve made some progress, are we simply waiting on current results? Can’t we take some initiative?" Liu Banxia continued.

Chen Jun frowned, sensing from Teacher Liu’s comments that his idea might not align with the discussion Mr. Liu and Mr. Xu previously had.

Taking initiative means conducting further tests, but what further tests could be done?

This question was on everyone’s mind, not just his.

Given the patient’s current condition, it’s not easy to judge. But with Teacher Liu’s vast experience, participating in his consultations required critical thinking.

"You might feel like we’re missing something crucial in the consultation process. Or to be more precise, something was left unchecked," hinted Liu Banxia with a smile.

"I’ll give you ten minutes to discuss, and then Doctor Xu and I will listen to the results. Honestly, we’re guessing too, not sure if our guess is correct."

Hearing his remarks made the interns feel slightly worried.

As expected, Teacher Liu already had an idea.