The door of the clinic slammed open, and the nurse poked her head in and asked the doctor directly: "Doctor Xin, 120 is calling for an ambulance. This is a patient in the internal medicine department. Are you going to go or is Doctor Dong going to go?"
"I have an urgent patient here. Please ask Dr. Dong if he can spare some time." Xin Yanjun replied.
Bang, the nurse closed the door and left. No need to respond. This is an emergency, and saying even a word more would be a waste of time.
This little episode left the patients and their families dumbfounded. The person was gone before they could even hear what had happened.
Only medical staff who have worked in the emergency department know that the emergency department can only be described in four words: like purgatory.
After the examination, the patient lay down and was no longer in pain as he had been sitting and bending over. It may also be that he felt more at ease after seeing the doctor.
"Which department do you think he should be admitted to?" Xin Yanjun whispered to the students around her.
It was obvious that Teacher Xin wanted to test her.
Here we have to talk about a common problem in the emergency department. Abdominal pain is the most difficult symptom to identify clinically. Some diseases can be treated by both internal medicine and surgery. For example, upper gastrointestinal bleeding, mild cases can be treated in the internal medicine department, and severe cases with surgical indications can be treated in the surgery department. In special cases, you may need to go to the ICU to stabilize the condition before surgery.
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The triage nurse cannot immediately determine whether the patient should go to the surgery department or the internal medicine department. As long as the patient does not vomit blood and does not have other emergencies that seem particularly scary at first glance, they will be arranged to go to the internal medicine department first. The internal medicine doctor will then examine the patient and make a decision whether to stay in the internal medicine department for treatment or go to the surgery department.
How each doctor judges is based on his or her own knowledge and medical experience. Therefore, although doctors' judgment standards are guided by medical guidelines, they vary from person to person. Especially for some diseases where the boundaries between internal medicine and surgery are relatively vague, when both internal medicine and surgery can be treated, the individual differences in doctors' choices will become more obvious.
This difference may be due to the doctor's personal habitual thinking about certain diseases, or it may be combined with other considerations of the patient. For example, if some patients want to undergo surgery, the first choice must be surgery. Some patients want to try conservative treatment first, and the doctor respects their choice and asks them to go to internal medicine.
If the patient and the patient have no objection, either the internal medicine or surgery department is fine. Then there may be another factor that makes the decision. Each department sends people to take shifts in the emergency department. In addition to being assigned by the hospital, each department has its own plans.
Even though the doctors on night duty in the ward seem to hate seeing emergency patients, every time the department director mentions the issue of department bonuses, they can only keep quiet. No one can resist money, including doctors. No patients means no income.
Basically, departments that compete fiercely with other departments for business will definitely instruct their emergency doctors to admit more patients.
Outpatient departments can accept patients, and emergency departments are also a source of patients. If you don't accept them, other departments will accept them all. Over time, you will have fewer patients, less money, and fewer opportunities to practice your skills. When hospital leaders see the indicators, they will also be unhappy that you like to refuse emergency patients.
Of course, doctors would not go against their conscience and treat patients in their own wards for diseases that are not treated by their own departments. That would be purely asking for trouble.
The patient in front of me had pain under the xiphoid process in the upper abdomen and reported coffee-colored vomitus. Upper gastrointestinal bleeding was initially suspected. This was definitely not a patient that the respiratory department could treat.
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