godfather of surgery

The medical record discussion every Friday is very lively. It is an opportunity to learn and demonstrate abilities. As long as there is no rescue, emergency surgery or ongoing surgery, all doctors come back to participate. Because there are many people, the venue is located in the administrative building. large conference room.

Yang Ping took a brief look at the venue. The directors of each department had basically arrived. Some doctors were delayed and could not be on time. Now they are rushing to the venue one after another. Anyway, this kind of meeting does not require attendance or name registration. It is entirely up to individuals to participate. There is no pressure on everyone. , very free.

Director Tan's case of cobalt poisoning would have been more exciting if it had not been diagnosed or spoiled in advance and it had been brought up for everyone to discuss.

It's a pity that Director Tan explained it directly, which lacked the fun of peeling off the cocoons, but it was also in line with the straightforward character of the surgeon.

If you ask a physician to explain this case, it will definitely not be so straightforward. If you ask some department directors to explain it, they can tell it like a suspense blockbuster.

"Old Tan, I have watched the American TV series "House". Dr. House went through a lot of effort to solve this kind of case. You came to our cardiology department for consultation, and it seemed that the diagnosis was made within a few minutes. You are a bit Don’t follow the script.”

The director of the Department of Cardiology joked.

Director Tan said on the stage: "There is no way. The director asked Dr. House to do that, but I don't have the director's arrangements, so I can only do whatever I want."

Unexpectedly, the two directors were quite humorous, and the doctors at the meeting were made to laugh.

Director Tan held the microphone on the stage: "Actually, it would be very difficult for other doctors to diagnose this case, but it would be very simple for us orthopedic surgeons to diagnose it. It's not about how good we are, but that this case falls into your blind spot of knowledge." , but it falls in the center of our field of vision, do you think we can diagnose it?"

"Let's talk about it. Next time we encounter a case like this, we won't think twice about it and can't figure it out. Just asking you for consultation is casting a net all over the sky. Anyway, if the patient has any problem, we will call whichever department, and no one will do it. Leak." Director Guan was very interested.

Director Tan also wanted to talk about it. He still had feelings about this case. Nowadays, the professional knowledge of each doctor is limited to his own specialty. Once he goes beyond the scope of his specialty, he is blind and deaf and knows nothing.

"Let me tell you about this case. Why is it easy for orthopedic doctors to diagnose, but difficult for other doctors to diagnose? This involves the problem of blind spots in knowledge. In fact, our hospital always suspected cobalt poisoning during the first consultation, and then called Give it to me, I hope I can go and have a look. After I looked at it, I asked about the patient’s medical history and felt that it was most likely cobalt poisoning.”

Yang Ping also felt deeply that all doctors have blind spots in knowledge. Once they enter the blind spots, they will be completely disabled.

For example, low back pain, which is common in orthopedics, belongs to the scope of orthopedics. Generally, orthopedic surgeons are very skilled and have clear diagnosis and treatment. If one day a patient from other departments with symptoms similar to lumbar disc herniation is admitted to the orthopedics department, the orthopedic surgeon will check it out. If you can't go beyond the scope of your own specialty, how can you possibly figure out diseases outside the scope?

The three-year wheel course you just graduated from can play a certain role in "literacy", but it is only when you first graduate. As your working years increase, the little knowledge you gained from the three-year wheel course is basically forgotten.

Director Tan said on the stage: "This patient had a left artificial hip replacement ten years ago. I asked whether it was a metal-on-metal large femoral head artificial hip replacement."

"If you ask us for consultation, we must be most concerned about this. The other areas have little to do with our department. We are concerned about the left artificial hip replacement surgery. We must see the latest X-ray of this part, even if it is an orthopedic surgeon who has just started working. Also like this."

"By taking an X-ray, we can identify from the X-ray that it is a metal-on-metal hip prosthesis, and we can also easily identify the wear and tear of the prosthesis."

"Seeing the wear and tear of the hip joint prosthesis, as long as the doctor reads a few books and reads a few papers, or goes out to attend a few academic conferences, he will be able to guess that the cobalt ions in the patient's blood may exceed the standard based on the wear and tear of the prosthesis."

"Next, orthopedic surgeons will ask to check the heavy metal ions in the blood."

"The results of the heavy metal ion test came out and all the truth came out."

Director Tan talked about it and it seemed that it was indeed very simple, not that complicated. It seemed that just follow the process and everything would fall into place.

"Isn't it difficult? In fact, cobalt poisoning is a rare disease for others. For orthopedic surgeons, especially those who perform artificial joint replacement, cobalt poisoning is a sensitive word and will be mentioned in monographs, papers, and academic conferences." Although Director Tan said so Full, but it does make sense.

"So it is very important to read and read papers regularly so that you can update your knowledge in a timely manner and continuously expand the depth and breadth of your knowledge." Director Zhao from the Medical Department added at this time

Director Zhao plays the role of organizer and coordinator in meetings and comes out to say a few words from time to time.

"Young doctors sitting here, the sources of our knowledge are nothing more than a few channels - books, teachers or other people's teachings, and our own experience."

"The concept of books is very broad, including monographs, journal articles and online knowledge carriers. We can regard any knowledge carrier as a book, so books are the main source of our knowledge, and other sources are not so extensive and lasting."

"Everyone must read more books. Dean Xia has proposed to build a library in our hospital. We will build the largest in-hospital library in the country and the world, order all medical journals, and purchase various medical e-reading platforms. Members, create a good reading condition for everyone."

"This fee will be sponsored by social forces and will not cost our hospital a penny."

"This matter will be put to a vote at the staff meeting soon. I hope everyone will support it enthusiastically. Doctors who are not active in learning will fall behind, and hospitals who are not active in learning will also fall behind."

Director Zhao's words immediately aroused warm applause from all the doctors in the room. Everyone had heard the rumor for a long time that the hospital was going to build a large library that combines tradition and the Internet. Unexpectedly, it was true. It would be much easier for everyone to write papers and search literature in the future. .

The so-called "not spending a penny" is actually funded by the overseas Chinese fund of the hospital. Since Guo Jingyao had two surgeries, he not only injected funds into Yang Ping's scientific research fund, but also attached great importance to the hospital's overseas Chinese fund and became an overseas Chinese. As the leader of the fund, he made the overseas Chinese fund of the hospital active and quickly accumulated a large amount of funds.

Money makes it easier to do things. Dean Xia is not merciless and is willing to spend money. As the saying goes, "without desire, you are strong." He used the money to start doing things in a big way, improving the hospital's hardware conditions, increasing the welfare benefits of medical staff, and arranging for doctors to go abroad for training.

With the help of Robert, Takahashi and August, the hospital now has a large number of doctors receiving formal systematic training in Europe, America and Japan.

"Anyway, everyone will study hard and work hard in the future, and the hospital will create the best conditions for everyone." Director Zhao spoke very encouragingly.

"Director Zhao, the hospital should also take care of our marriage and help create the best conditions, right?" Dr. Wen from the pathology department shouted. You make trouble!

Director Zhao glared at Wen Ruzheng from a distance across several rows of seats on the podium.

Your love letter is written like a terrorist threat letter, and you even talk about getting a wife.

Director Zhao recalled Wen Ruzheng's love letter that caused a sensation in the hospital: I want to cut your heart into pieces and put it under a microscope. It will take me a lifetime to read it.

Who would dare to fall in love with you if this is such a threatening letter?

"We have also considered this and decided to change the hospital's annual external dating party to twice a year. If you have the courage to run naked, I guarantee that you will hold your son next year." Director Zhao replied angrily.

"The topic has strayed, let's continue the discussion!" Director Zhao brought back the topic and put down the microphone.

Director Ouyang of the Department of Orthopedics stood up, straightened his black and white hair, and said: "I have also watched "House". Regarding the cobalt poisoning case in it, I remember that the patient had two hip joints. During the first surgery, the prosthesis used was ceramic-on-ceramic. During the second hip replacement surgery, the doctor used a metal-on-metal prosthesis. However, when the doctor took out the ceramic prosthesis, he did not remove it from the joint cavity. If the ceramic fragments are completely removed, the remaining ceramic fragments will become a hidden danger. In the future, the surface of the metal joint will continue to wear away, eventually causing the release of heavy metal ions in the cobalt-chromium-molybdenum alloy, causing cobalt poisoning."

"In fact, the doctor who performed the second operation made two mistakes. He should have removed the ceramic fragments in the joint cavity, and he should not have used metal against metal."

"We have a rule of thumb for artificial hip replacement - ceramic once, ceramic for life. That is, if the first artificial hip replacement surgery uses a ceramic head, then the second surgery must also use a ceramic head. This way it is possible to avoid The fine ceramic debris remaining after the wear and tear of the first surgery caused wear and tear on the metal head of the second surgery, causing heavy metal ion poisoning, is that right, Director Tan?"

Director Tan took over: "Yes, metal-on-metal prostheses are rarely used nowadays. Doctors used to like to use them, especially metal-on-metal large femoral head prostheses. Union Hospital also liked to use them for a while."

"Why do we still use this kind of metal-on-metal prosthesis when we know that there is a risk of heavy metal poisoning?" a neurosurgeon asked.

Across the rows, Director Fang from the Department of General Surgery raised his hand to ask a question.

"This involves the issue of the advantages and disadvantages of artificial joints. The artificial hip prostheses we currently use are ceramic-on-ceramic, ceramic-on-polyethylene, metal-on-polyethylene, metal-on-metal, and metal-on-metal are the least used."

The director of the Department of Cardiology said: "Old Tan, we are physicians and don't know much about your surgery. Please take this opportunity to tell us in detail, which hip prosthesis is the best?"

Director Tan said: "Each hip prosthesis has its advantages and disadvantages, but looking at all aspects, ceramic-on-ceramic is currently the best, and metal-on-metal is the least recommended. "

"What exactly do you mean by "what"?" asked a doctor who had just started working in pediatrics.

"Oh, our artificial joint is divided into two parts, the distal and proximal parts, such as the hip joint, the femoral head ball at the distal end, and the acetabular socket at the proximal end. The two are combined into one joint."

Ceramic versus ceramic, the ball is ceramic, and the socket is also ceramic; ceramic versus polyethylene, the ball is ceramic, and the socket is polyethylene; metal versus polyethylene, the ball is metal, and the socket is polyethylene; metal versus metal , the ball is metal, and the nest is also metal. "

As Director Tan spoke, he made ball and socket shapes with his hands to help explain.

"Ceramic versus ceramic, its biggest advantage is that its coefficient of friction is small, so it is particularly wear-resistant. If it doesn't break or become loose accidentally, it can be used for twenty or thirty years."

"Secondly, compared to metal heads, it does not have the negative impact of heavy metal ion release."

"Its disadvantage is that it is relatively brittle. Compared with metal, it is more likely to shatter when violently impacted."

"Metal-to-metal is rarely used now. Its biggest disadvantage is that the heavy metal ions released after wear are harmful to the human body. Its advantage is that it is not easily broken. Under current medical conditions, its advantages cannot cover up its biggest disadvantage, so Metal-on-metal is currently used less and less widely.”

"Metal-to-polyethylene is between the above two artificial prostheses. Compared to ceramic-to-ceramic, it is cheaper and reduces the financial burden on patients. Compared to metal-to-metal, it wears much lighter and is not as easy to wear as metal-to-metal. It is easy to release large amounts of metal ions.”

The director of the Department of Cardiovascular Medicine said: "Then what you are saying is that except for the greater risk of fracture of ceramic artificial joints, there are other advantages."

"It can be understood that way, but it also has a big disadvantage, that is, it is relatively expensive. It is the most expensive among these types." Director Tan said with a smile.

"The main reason is that medical ceramic materials are expensive and difficult to process, so ceramic artificial hip prostheses are naturally very expensive."

Director Han also joined in to say a few words.

"However, our state-owned enterprises have developed a very good ceramic called soft ceramics, which overcomes the shortcomings of ceramics being easily broken. If used for medical purposes, it has a small friction coefficient and is not easy to break. This will be the best Good artificial hip.”

This kind of hospital-wide case discussion has many benefits. It allows various doctors to conduct interdisciplinary learning and make up for their own blind spots in knowledge.

For example, for this patient with cobalt poisoning, if the cardiovascular physician has basic orthopedic knowledge, he will pay attention to the left hip replacement in the patient's past history, and then complete an anteroposterior and lateral X-ray of the hip joint for the patient.

It would be better if the doctor in charge had basic knowledge of reading X-rays, and he would be able to see obvious wear and tear on the hip prosthesis from the X-rays.

If he does not have basic knowledge of film reading. It doesn't matter, he can ask the orthopedic surgeon to come and have a look, and it won't take too much time for diagnosis.

Yang Ping felt that even if the participants listened to this kind of meeting, they would gain some insights and improve some basic knowledge.