Practicing Medical Skills in a Small Clinic-Chapter 62: Extremely Difficult Diagnosis

"About two or three months ago, I started feeling a heaviness in my chest, and after taking a few extra steps, I’d become short of breath. Also, my body gets easily fatigued, even sitting feels tiring, and once I’m lying in bed, I don’t want to move."

The elderly man said this while glancing at the two family members.

The woman replied somewhat guiltily, "During that time, my brother and I really couldn’t understand dad, always thinking he was lazy. A healthy person lying around all the time can easily become ill; I thought life is about movement, you know, so I made time every day to take dad out for a walk. He couldn’t go far before he complained of being tired and wanted to go back... sigh! I should have thought he might be sick back then."

The son didn’t say anything, but there was a hint of guilt in his expression as well.

"My children are actually very filial; they urged me to exercise more because they were worried my body would have issues from lying around too much. During that period, I often woke up drenched in sweat in the middle of the night, and felt particularly fatigued."

In front of outsiders, the elderly man was very protective of his children, not blaming them for their lack of understanding at that time, and instead praised them for being filial.

Li Jingsheng observed that loving families tend to raise more filial children.

It is indeed rare to see both children accompanying their parents to see a doctor when they fall ill.

After all, once children become adults, they have to work and deal with various family chores after getting off work.

Unless the parents are critically ill or have a severe condition, they generally go to the doctor by themselves.

Being able to help parents pay for medical expenses is already considered very filial.

Really, when Li Jingsheng worked at the hospital, he often saw elderly people fall ill, and their children would find excuses to shirk responsibilities and refuse to cover medical expenses.

But when a child gets sick, parents are willing to sell their house and car, borrow money everywhere, and do whatever it takes to get their child treated.

Heartbreaking, isn’t it?

This is the most real human nature.

"You’ve been sick for three months, and you haven’t gone to the hospital?"

Li Jingsheng looked at this family and they didn’t seem like they were from a disadvantaged background.

It’s not a situation where they wouldn’t dare go to the hospital because of financial difficulties.

"Uh... we did go, but it wasn’t cured. Didn’t they say your medical skills are excellent? We thought we’d come over and take a look."

The elderly man’s eyes were evasive.

The children remained silent.

Seeing this, Li Jingsheng immediately understood a bit more.

No wonder, after he listened to the elderly’s heart and lungs in the infusion room and said their condition was a bit serious, the children showed calm expressions.

When the elderly man praised his medical skills at that time.

Now it can be basically confirmed that the elderly man has been examined in a major hospital and diagnosed with a serious illness.

Cough, night sweats, fatigue, low-grade fever for nearly three months, what serious illness could it be?

Li Jingsheng was suddenly startled, most likely lung cancer.

Damn!

These two family members are really not honest, they’ve already been examined at the hospital but deliberately concealed it without mentioning anything.

If Li Jingsheng’s diagnostic skills hadn’t improved significantly in Pulmonary Medicine, he might have made a fool of himself.

It’s unlikely people would make fun of him to his face.

But going out and telling friends and family that Dr. Li at Sunshine Clinic isn’t competent and is just after reputation would be certain.

This made Li Jingsheng deeply realize once again, the core competitiveness of a clinic is the medical skill if you want to grow your business.

Medicines, software and hardware, those are not core competitiveness.

They can at best add some flair.

The magical attribute panel that can enhance medical skills and doctor levels is his strongest trump card.

"What was diagnosed at the large hospital?"

Li Jingsheng asked directly.

"Dr. Li, it’s not that we’re intentionally hiding it from you, could you please diagnose my father first, then we can compare your diagnosis with the hospital’s result. We understand the rules, we won’t bargain with you over the consultation fee."

Faced with this kind of request from the family, Li Jingsheng was speechless.

Actually, there are quite a few such patients.

Sometimes a disease has to be examined at seven or eight hospitals before picking the most reliable one.

"Then how about this, let’s do a B-ultrasound here first, then an X-ray to check the lungs. These two tests are 100 yuan each, does that work for you?"

Since the patient requests this, Li Jingsheng had no reason to refuse earning the money.

The two pieces of equipment can’t just sit there gathering dust, I’ve got to find a way to earn back the capital quickly, then buy two higher-resolution pieces of equipment.

"Two hundred yuan isn’t much, can we take the pictures now?"

"Yes. There’s basically no queue at our small clinic."

"Can I scan the code to pay you?"

"Sure. Just scan one of these codes and pay 200 yuan."

Li Jingsheng pointed at the two codes on the table.

Alipay and WeChat are the two most commonly used mobile payment methods, which indeed bring great convenience to people’s lives.

You basically don’t need to carry cash when going out, a cellphone can handle everything.

"Brother, let me pay this!"

The sister rushed to pay.

She was rejected by the brother.

The sibling relationship seemed pretty good.

Two hundred yuan into the account, feeling great.

He then took the elderly man to the examination room for the checkup, allowing one family member to accompany them.

Very soon, the examination results came out.

From the B-ultrasound scan, multiple nodular shadows in the lungs could be seen.

The bilateral lung X-ray showed local small patchy shadows, with more obvious diffuse shadows.

Seeing this, Li Jingsheng’s heart sank directly to the bottom.

It was indeed a lung tumor.

Most likely lung cancer.

Calming himself, he linked the patient’s symptoms and medical history with the ultrasound and X-ray results, then pondered repeatedly.

"Doctor, is my dad’s condition serious?"

The female family member asked.

The old man’s son stayed outside the examination room, not coming in.

Li Jingsheng glanced at the old man, somewhat hesitant to speak.

Generally, when suspected of cancer, the patient is not informed directly. This could worsen the patient’s psychological burden and risk aggravating the condition.

The benevolence of a doctor isn’t just empty words.

Always considering the patient’s well-being, even if faced with endless hardships, they remain steadfast in their mission.

"Young man, it’s okay, say whatever you need, I can handle it. That’s what I told the doctors in the big hospital during the examination."

"This is the lung ultrasound taken earlier, showing multiple nodular shadows. Then the bilateral lung X-rays also show patchy shadows. Initially, it appears that borders are unclear, and there are multiple occurrences with varying shapes. If this could be followed up with a biopsy in a large hospital, it might be more accurate."

Li Jingsheng said subtly.

Having been a doctor for so long, he knew well how to mitigate risks during patient conversations.

Even if it’s clearly lung cancer now, you can’t tell the patient and family "According to my examination, you have lung cancer and should urgently begin treatment."

Instead, offer a vague diagnostic conclusion.

I suspect it might be some sort of illness.

People who check examination sheets in big hospitals will often notice a question mark after the diagnostic results in the diagnosis conclusion section.

Then the recommendation section will say, suggest further examinations.

This is a form of self-protection for doctors.

Really scared of being sued by those troublemakers.

"Is my illness lung cancer?"

The old man stared intently at Li Jingsheng.

One could feel a trace of hope deep in the old man’s eyes, hoping Li Jingsheng would dismiss this answer.

"Have you done a lung lesion biopsy in a big hospital?"

"No, I don’t agree to undergo this examination."

The old man answered directly.

"Could you tell me about your experiences before the onset? The more detailed, the better."

Li Jingsheng examined and pondered over the old man’s test results and symptoms repeatedly, always feeling there were some differences from lung cancer.

But both the ultrasound and X-ray results pointed towards lung cancer.

He had worked in the pulmonary medicine department at a big hospital before, although he was only handling bed management, he had managed quite a few lung cancer patients.

"I remember before the onset, I went to a flower and bird market and bought a green parrot home. Within two days, I felt my throat was always itchy and wanted to cough. At first, it was okay, clearing my throat and it would be fine. Later, the cough worsened. Thinking I was drinking less water, I deliberately drank two more cups than usual. Two full cups of the 500ml thermos. It still resulted in coughing, and the cough got worse, followed by some fever.

Thinking that age brought old ailments, I went to a pharmacy to buy some cough suppressant.

After taking the medicine, I didn’t cough as much, but after a few days, it started severely again. Knowing a bit about traditional Chinese health preservation, I bought some lung-nourishing herbs to brew tea, thinking it would improve over time.

But after dragging for a month, it still didn’t improve, and I would sweat a lot during sleep. I knew then, this illness wasn’t simple.

That’s about it."

After listening to the old man’s account, Li Jingsheng fell into deep thought again.

After a while, he looked up and asked the old man.

"Did you often cough before the illness?"

"Occasionally, my throat would feel itchy, and I would cough a couple of times, but it was never this severe."

"This is only a small clinic, and conditions are limited, some examinations can’t be done. I’m sure you’ve had a lung CT in a big hospital, right?"

"Yes, I’ve had a CT scan."

"Could I take a look at the films?"

Li Jingsheng received two hundred yuan from the family, did two examinations, and spoke cautiously.

Family members might think he was just aiming to earn examination fees, and dispute with him, which would have a very bad impact.

Regarding clarity and precision, CT is superior to ultrasound and X-ray.

But each examination has its strengths and weaknesses, and diagnostic reference significance also varies.

Additionally, CT isn’t a routine examination.

"Sure, my brother should have brought them."

The female relative said.

They returned to the examination desk, and after inquiring about the situation, the old man’s son took out the CT films from the bag for Li Jingsheng to review.

"The tumor shapes are varied, the edges are not clear, micro-blurring signs, vascular convergence signs, and cystic signs are visible..."

After viewing the CT films from the big hospital, Li Jingsheng’s expression grew more serious.

Indeed, these are typical imaging features of lung cancer.

He compared the CT films with his clinic’s ultrasound films and X-rays.

The patient and family members dared not breathe, waiting for the final judgment.

From Li Jingsheng’s serious expression, they already sensed an unfavorable outcome.

Visiting this small clinic was merely hearing praises from friends about the skills and ethics here, hoping for one last diagnosis.

At this moment, the old man’s daughter started coughing again, covering her mouth.

Since they came in, the old man’s daughter had coughed no less than five times.

It seemed quite strenuous.

Li Jingsheng’s gaze turned to the old man’s daughter, who seemed a bit embarrassed.

"Has your cough started recently?"

Li Jingsheng asked.