The Enhanced Doctor

Chapter 1274: Chapter 1274: What Should We Do with Patients Who Refuse Examination?

"What’s with the look in your eyes, you two? It’s the New Year, can’t you act a little normal?"

When they got downstairs and he found the two girls still sneaking glances at him from time to time, Liu Banxia was a bit helpless.

"Well... I still feel kind of unconvinced. Why can’t we look at a problem from multiple angles? Whatever we’re staring at is what matters, right?" Xu Yino asked.

Liu Banxia shrugged. "Who can say for sure about this kind of thing? Maybe in your hearts the safety of the tetanus patient is more important. I don’t really see it that way."

"There’s only so much treatment you can do against tetanus. What we can do is meticulous nursing and dealing with whatever comes up. But our nursing can only reach a certain level; most of the real monitoring still depends on his wife."

"Seeing his wife lose so much weight in just two days, I’m worried she won’t hold up. By then the patient will be even more upset, and his recovery will be even slower."

"Didn’t you say yourselves that a patient’s prognosis has a lot to do with their mood? So we have to rack our brains to create a good mood for him, right?"

The two girls nodded. Put that way, it did make sense.

"Quit staring. A female patient just came in—go take the case." Liu Banxia said.

The two girls looked up. A family of three was walking over. The woman didn’t look very well; her husband was holding her up.

"How is it, have you done some serious research into liver transplantation?" Wang Chao came over.

"I went home and thought it through carefully last night, but we still have to see how their test results look, and whether they’ll ultimately agree to let me do the surgery for them." Liu Banxia said.

"The more you think about it, the higher the difficulty level is. It really is much harder than a hemihepatectomy. With a hemihepatectomy you don’t have to think about anything else; with this you have to explant and then transplant."

"Which day of the holiday are you planning to do it?" Wang Chao asked outright.

"At the earliest, not until after the tenth day of the first lunar month. The patient’s physical condition is a bit poor, so for now we’ll adjust and observe. If the body isn’t prepared, the operative outcome will actually be worse, with a higher risk of complications."

"Come on, you’ve got this. Anyway, you’re just constantly taking on high-difficulty cases. Little by little you’ll complete the full set—pretty awesome." Wang Chao said with a squinting smile.

"What baffles me is why all of you have so much drive. I don’t have as much drive as you do." Liu Banxia said.

"Well, see, we’re still very confident in you. At most you’ll do it a bit slowly. Your technique is so solid, you’ll be fine." Wang Chao said.

Liu Banxia was quite helpless. Maybe this was also a side effect of system enhancement—seemed like everyone had slightly exaggerated his actual ability.

It was, after all, the third day of the New Year, and the current intake wasn’t that busy yet, so Liu Banxia and the others huddled together, openly chatting.

Most of what they talked about was still the potential upcoming liver transplant. After all, this operation wasn’t just technically difficult; for Liu Banxia it also carried extraordinary significance.

At the moment, in the whole emergency center only Zhou Shuwen could do liver transplants. If Liu Banxia could really challenge above his level and pull this off, that would be a solid achievement.

It had to be said that in recent years there really were a lot of patients needing liver transplants. Liver issues caused by all kinds of reasons, and in the end the solution for all of them is liver transplantation.

Some patients are lucky and have relatives who can donate; some are very unlucky and die without ever getting a liver available for transplant.

Honestly, a lot of the time treating disease really does come down to luck. You need methods that can treat it, and you also need the opportunity to actually receive that treatment.

Take the patient Liu Banxia was handling: his situation at the moment was actually pretty good. Both his son and his daughter are willing to donate liver tissue.

That’s really rare. Don’t be fooled by the fact they’re all blood relatives—having worked in the hospital for so long, what kind of situation hasn’t he seen?

In the hospital, what you see is the most real side of people. You can’t stand on some moral high ground and condemn them, because donating or not donating is everyone’s personal right.

No one can guarantee that after a very successful transplant the patient will improve dramatically. Nor can anyone guarantee that the donor providing the organ will be free of complications and danger.

But everyone else was honestly like Wang Chao—extremely confident in Liu Banxia.

"Teacher Liu, my patient has a tiny bit of a situation."

Right in the middle of the conversation, Xu Yino ran over.

"Perfect, everyone’s here. Tell us about it." Liu Banxia said.

"The patient came in with fever, cough, and chest tightness. Recently she’s been dieting to lose weight—for about half a year now, I think. She’s lost 5 kilos." Xu Yino said.

"I ordered bloodwork and a chest CT. The lungs show multiple nodules. The radiology department’s suggestion is that we can’t rule out the possibility of metastatic tumors."

"What about blood sugar?" Liu Banxia asked.

Xu Yino wrinkled her nose. "Why is it that whenever I try to set up a workup, I don’t do it right? Shouldn’t we be focusing more on the possibility of a malignant tumor?"

"A weight loss of five kilos over six months—for that patient we were just talking about, I don’t think it’s realistic to attribute that solely to dieting." Liu Banxia said.

"The blood sugar is a bit high, 16.2. Then we did HbA1c, it’s 12. But the patient also has fever, cough, and chest tightness, and there are multiple nodules in both lungs," Xu Yino said.

"With this situation, we can’t rule out the possibility of a malignant tumor with suppuration, right? That could also explain the patient’s weight loss. More or less?"

"Then just do an enhanced CT, isn’t that the easiest? A combined chest–abdominal enhanced CT. If it really is a malignant tumor, the primary lesion might be in the abdominal cavity."

Xu Yino gave a thumbs-up. "As expected of Teacher Liu. That’s exactly what I told the patient too, but the patient wouldn’t agree. Can you guess why?"

"Good grief, are you here to test me?" Liu Banxia grumbled.

The people nearby all laughed along; only Xu Yino dared talk to her like that.

"Just take a guess, I want to see if you get it right," Xu Yino said.

"Worried about the effect of the contrast agent," Liu Banxia said.

Xu Yino’s expression instantly turned gloomy. "A relative in the patient’s family had an enhanced CT before, developed contrast-induced nephropathy afterwards, and later progressed to uremia."

"Although that’s indeed possible, I’ve already ordered liver–kidney function tests and tumor marker screening. For patients whose liver and kidney function are basically intact, the incidence is still extremely low, right?"

"Telling me is useless, you have to tell the patient," Liu Banxia said.

"The patient has this concern, and it’s not some made-up worry—it really is something that could happen. We have to find a way to work with the patient’s thinking,"

"That’s why we came to you. Qingqing and I have been persuading them for over ten minutes. All three in the family are against it; the child has just started junior high and doesn’t want this kind of exam either," Xu Yino said.

"Alright then, looks like we really do need Director Liu to step in," Wang Huan said.

"Although in general malignant tumors don’t usually cause fever, what if there’s a suppurative area? That’s very possible too. Anyway, for now we can’t rule out malignancy."

"And for malignancy, relying only on tumor markers isn’t that reliable; enhanced CT is still safer in terms of diagnosis. If it were me, I wouldn’t have any better options either—otherwise you go straight to biopsy."

"I basically think the chance of them agreeing to an enhanced CT is very low. If it were just anxiety, it’d be manageable. But they’ve actually had a similar case in the family, so the resistance is very strong," Liu Banxia said.

"Alright then, we can only resort to a flanking maneuver. Based on our judgment, even if these are metastatic lesions, the probability that the primary is in the abdomen is relatively high, so let’s start with a non-contrast abdominal CT scan."

"If there really is a primary lesion, we should still be able to pick it up. Then we can compare it with the tumor marker screening results; otherwise we genuinely have no other way."

"Teacher Liu, you really won’t try talking them into it again?" Xu Yino asked.

"What’s there to try? No point wasting time," Liu Banxia shook her head.

"Let’s schedule it now; there aren’t many patients today. We should have the results by lunchtime. Then we’ll see how to plan the next step. That’s all we can do,"

"Tsk tsk, I thought when Teacher Liu stepped in she’d count for two people. I’ll go tell the patient the updated plan. But judging from their attitude, as long as it’s not an enhanced CT, they’ll agree to any exam."

Leaving that sentence behind, Xu Yino ran off.

"Patients like this are really hard to talk into anything," Liu Banxia sighed.

"Yeah, actually there are many similar cases. Non-invasive tests are easier; with invasive tests there’s always a chance something could go wrong," Chen Xuehai said.

"But for many conditions, only invasive tests give the best diagnostic yield. Back when I was an intern, I encountered a patient who had already agreed to coronary angiography, and we’d clearly explained everything."

"Then what? As soon as he saw that we still had to do an allergy test, he chickened out. When he was a kid, a child from his village had a false-negative penicillin skin test; although they saved him, he was left with sequelae."

"So we really have a long way to go, and we also need to understand why these patients resist examinations," Wang Chao said.

"If they simply thought our hospital was ordering random tests just to make money, we could still try to work around that. But when they’ve got this kind of psychological shadow, that hurdle is really hard to clear."

"Just like Director Chen said, even if they’ve signed the consent form, there’s still a chance they’ll back out at the last minute. Taking patients nowadays really does put us to the test."

"It’s also because diseases are more complex now, and there are more testing methods. We just have to work on them slowly; if we can’t find a compromise, we can only try empirical treatment," Wang Huan said.

The topic kept everyone talking for a while. It was really because there are too many patients who resist examinations; some people even refuse blood tests, convinced it’s all a scam to make money.

This is one of those old, oft-discussed problems. Everyone’s had the experience of waiting for a patient who never comes back.

It’s the same kind of situation, just like whether to donate or not—it’s equally a patient’s right.

As for the patient we were just talking about, now it all depends on what the abdominal CT shows. We’ll have to decide the next diagnostic step based on that.

If they still refuse enhanced CT, then we’ll have no choice but to do a biopsy.

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