Hope to touch and knock listening to is the doctor's special skill out of date

Hope to touch and knock listening to, is the doctor's special skill out of date
Hope to touch and knock listening to, is the doctor's special skill out of date
Staff reporter Kong LingMin Having lived in the hospital of Anhui Province a county for one week, Mr. Zhang is more and more puzzled: "I tell the doctor in charge of the bed each time where is uncomfortable, doctors will turn on again big piles of laboratory test reports let the inspection, what whether even to touch patients? " Patient Xiao Wang of the Inner Mongol has the same doubt. Having treated in more than half a year in the local hospital, her endocrine regulation has never taken a favorable turn, ask someone to find a familiar doctor of phase in a large hospital of Beijing, doctor can require her to do some first relevantly to check. "Present doctor needn't look the patient in bloom to check singly? " As continuously newer instrument and equipment are being applied to clinic constantly, the results of the number value, image checked are more and more accurate, but more patients feel farther and farther from the doctor, can not find out more and more finally the machine is seeing the doctor or the doctor is diagnosing the illness, is traditional palpation really out of date? It is that the first step diagnosed coordinate the clinical diagnostics teacher of medical college to hope to touch and knock hearing forever as Beijing, Jiao Li that it has ever been the doctor of hematology of BJ Union Hospital can't forget to meet a pair of rural father and son that examined by oneself all the time. A face of father is anxious, because his teenaged son is diagnosed as leukemia by the doctor of the native place. "Leukemia? " The inspection result of the local hospital that Jiao Li has looked, the number value of the leucocyte is really higher, have, bleed some really too on the child, but he is of pink and healthy-looking, energetic, touch the lymph node, press the spleen of liver again, it is not unusual. After making detailed inquiries, have known what's what in the burnt centre of force. Originally, child have anaphylactic purpura just, have, bleed some naturally on one's body, and it is hormone of use to treat the most regular method of purpura. Under the function of hormone, patient's bodies will be released to store leucocytes in the pool in a large amount, check the leucocyte at this time, the number value will inevitablely be a little higher. In case of not doing any auxiliary examination, Jiao Li certainly tells the child's father: "I think it should be leukemia, but in order to let you rest assured, we do the blood routine examination of 15 yuan once again. " When getting and measuring all normal reporting to the form of result, the child's father is nearly paralysedly glad to fall on the ground. "Which doctors will intend to misdiagnose, just some doctor understanding of disease is more superficial, the basic training of clinical diagnosis is relatively deficient too. " Jiao Li says, " mainly there are two purposes of auxiliary examination: One is got rid of, one is confirmed. No matter how advanced the auxiliary examination means is, hope to touch and knock and hear a initial step diagnosed, because what it offered to doctor is the direction of disease and thinking of the diagnosis. " Jiao Li says, for a good doctor, as the patient comes into the consulting room, see he (she) After one, there should be certain feelings in the heart. Because people are a whole, different diseases, patients will demonstrate different states of mind, through palpation, doctors should have a preliminary judgement on the patient's condition in the brain, then prove by objective result of auxiliary examination one's own judgement is right or wrong. "Hope to touch and knock and listen to the essential means to diagnose with auxiliary examination, who substitutes either whom. " Jiao Li says, to an impatient, an intact case history must include medical history, physical examination, auxiliary examination and plan to examine and discuss, and final definite diagnosis is coming from such a diagnosis procedure that none of them can be dispensed with. The doctors, while diagnosing patients, what has been in fact done is two jobs: Impression diagnose and confirm, diagnose, only through inquiries test and palpation, collect the material diagnosed, and then select the final cause of disease through auxiliary examination. People are alive, the laboratory test report is likewise alive "Must the result of auxiliary examination be correct? " Doctor Zhang of a large hospital internal medicine department in Beijing can't help proposing such a query to the young doctor of emergency department of front. Early in the morning, a patient found doctor Zhang. Patient have a fever on evening before that day coming, watching emergency calling because of cold, blood result revealed her serious anaemia conventionally, the emergency call doctor demands to transfuse blood at once, but the patient thinks that does not need blood transfusion oneself, but is in suspense, have to sit down in the corridor of the outdoor emergency call for one night totally. Doctor Zhang has looked at patients, is stewing the patient's lower eyelid again, has looked at conjunctiva. Invite the blood screening test lab to reply patient's blood sample on the previous day to examine once specially subsequently, everything was normal finally, there is not anaemia. Division chief of education department of BJ Union Hospital, Wang Zhong of Deputy Director of emergency department think too, some doctors have believed in auxiliary examination very much. In fact, the machine will make a mistake too, what's more machine or people operate, so not every inspection result has come, the doctors should all meet the trick. In clinic, the doctor should realize, the patient is alive, the laboratory test report is alive too, when the inspection result does not conform with the patient's physical sign, will prove soon finally the problem happen to people, the instrument checked the problem happened. "It is limited too that auxiliary examination is more advanced. " Attending physician of BJ Union Hospital dept. of orthopedics Yu KeYi says, dept. of orthopedics is a lot of soft tissue diseases such as ligament inflammation, it is unable to reveal to shoot the film, do the nuclear magnetism, can only press most basic physical diagnosis such as the sore spot. Can it studies many first accuracy diagnosed as image to be and that physical sign does not accord with when, many one means of palpation in patient. "Only doctor's technology is really up to the mark, could reduce unnecessary instrument inspection. " Jiao Li thinks, do few this kinds and check and save the medical expenses to actually save small for the patient, the bigger one is the recessive injury of avoiding auxiliary examination causes to patient's body sparingly. Say to higher level, palpation can let the patient experience doctor's more cultural and educational care too. The most important one " The apparatus " It is doctor's burnt strength that says, a lot of are medical the older generation especially value one's own hands, because they think hands are fellows that the doctor had a meal. A good doctor can find the clue of disease only according to a pair of hands, thus guide the direction checked. When auxiliary examination is much, the doctor needs such a direction sign. "The stroking more accurately of the doctor, cross the X-ray machine? " A doctor newly participating in job says to reporters, he and classmate will often discuss this question, "nobody think hope, touch, knock, hear important, in the intersection of monitoring device and so advanced, that out patient have more visitors or business than one can attend to today, hope that it is still as important as before to touch and knock hearing? " "Big to three study the intersection of clinical diagnosis and class hour, teacher say, hope, touch, knock, hear really, but things that learn forget the light mostly. " Have been just admitted to the young Section that Beijing has coordinated the graduate student of medical college and told reporters, she knows too that hopes to touch and knock the importance listened to, but the classmates all really practise, prepare for the postgraduate qualifying examination, look for a job busily, in addition, diagnostics is a course with extremely strong practicality, so " there are not several persons who will really see the doctor with hands " . "Is the young doctor right to look? �, dyke of ��, make a noise, faint fat Zhai ChenDun �� particularly! Castor Chuo lay down, hold in the mouth the intersection of ���� and ring rectify Chi and the intersection of leech and �� see eye Fu, uncut jade of Ba, braise Ping Does the ring of flat stone with ropes attached at the sides of �� of the stem rectify Xie Wan's mother of rifle of Bi's larva of a tapeworm or the cercaria of a schistosome and work for Huan 5 ���� dyke �� corridor alcohol of midge's horsefly's eye of emperor and Huan Cuo and smelt nine shanks? In the medical treatment in the heavy earthquake of Wen Sichuan was rescued, once a lot of doctors found shockedly, there is not a seismic zone of any auxiliary monitoring device, some young doctors will not see the doctor. Wang Zhong says: "The doctor should practise medicine under any circumstance, in the basic unit, it is the larger to hope to touch and knock the function listened to. It is prove whether best in one's own thinking doctor not to if you can't there is be instrument and equipment, help,but can't because there is apparatus doctor even ' examine ' have. " In order to cause the young doctor to touch and knock the attention listened to in looking, young minister of work office, physician Wu Dong of BJ Union Hospital has initiated in the institute has offered " Physical diagnosis is really out of date " Discussion. He thinks, emphasizes the function of traditional physical diagnosis again, neither out of date, but just in time. Hope not to touching can't be abandoned to knock the skill listened to, should strengthen constantly instead. So, only emphasize importance of physical diagnosis is not enough, must reform the teaching of physics diagnostics, inject the new vitality into this traditional course. "In the face of out patient of overload, want, make one hoping, touching, knocking, it hears to be unrealistic really intact for every patient every day. " Jiao Li thinks, but the specialist should try hard to check the body especially for the patient, for example the heart physician should pay attention to heart auscultation, digests department's doctor and pays attention to touching the stomach even more. But even a training doctor, every basic training of checking the body should be mastered, because having only had basic training, the doctor could go to a field specially. The reporter has also interviewed medicine of location village such as Jiangxi, Heilongjiang and Shandong, they tell reporters, except that the stethoscope is waited for " third kind " Outside, in the village clinic, the most important " apparatus " It is doctor. 60 -year-old the intersection of Shandong and Li Guang of village clinic the intersection of friend and doctor Zhu, town of village, Cao, county of Linshu, tell reporters this year, up till now, it was the skill on hand that he practised medicine and depended on in 38, " the present young doctor has competent theory, it is not good enough to practise " .


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