All routine clinical examinations of the patient were normal, including imaging data. It is simply not practical to do all the inspections from beginning to end.
"What about bipolar disorder caused by changes in thyroid function?" Su Yun asked.
"In your words, there is still no way to explain Wang Canlan's existence." Zheng Ren continued to slide the mouse wheel bit by bit and looked down at the large medical record carefully.
Bipolar disorder is only a possibility, and Zheng Ren thinks it is unlikely.
"Boss, why are you reading the medical records so carefully?" Su Yun asked.
"The medical records were written by Zhong Min. She is more detailed." Zheng Ren said simply.
Clinicians write long medical records. In the past, a standard long medical record took at least an hour to write by hand.
Now with electronic medical records, many options are available, which are much more convenient than handwritten medical records.
But precisely because of this, doctors will not read or fill in many of the default options carefully. After all, time is limited every day, there are too many things to do, and there are not enough clinical manpower, so we can just mess around with unimportant areas.
Zhong Min is a standard internist. Because in the past, internists did not perform surgeries and spent "much more" time writing medical records and seeing patients than surgeons, so the medical records were written in relatively more detail.
In addition, her personality is still kind of delicate, especially after being frightened by the disappearance of the magic pen signature incident, she became serious to the point of harshness.
When it came to writing medical records, Zheng Ren thought he could never keep up with Zhong Min, let alone Chang Yue.
"Both eyes have normal light reflection, but the conjunctiva is slightly yellow. Does this make sense, boss?" Su Yun asked.
I have already seen the laboratory test sheets, and the bilirubin and other tests are all normal, which can basically rule out jaundice.
Moreover, hepatic encephalopathy may also cause mental symptoms, but the patient's situation is very different from hepatic encephalopathy.
"Just one is meaningless. There is 1mm redness and swelling in the corner of the eye, accompanied by peeling." Zheng Ren then saw another patient's signs described by Zhong Min.
Su Yun did not quarrel with Zheng Ren, but seriously sat aside and read the medical records written by Zhong Min with Zheng Ren.
Lin Yuan was very puzzled. Generally speaking, grassroots hospitals are faced with the diagnosis and treatment of common diseases. Although she had never been to Haicheng, she thought she would only undergo some minor surgeries.
The description of the medical record is so detailed, as if a realist literary giant is describing a passerby in concise language. It is completely meaningless!
But Boss Zheng and Brother Yun both looked at the medical records in silence. Lin Yuan had an illusion that he must have missed something.
At this moment, she seemed to feel a solemn atmosphere.
The conjunctiva and sclera are yellow, and there are small redness and swelling at the corners of the eyes. What is the problem
She also began to read the medical records with concentration. Occasionally, Boss Zheng's hand would pause slightly, but the relevant issues were just some minor problems that were very common and not worthy of attention at all.
For example, the lips may be pale, and the gums may bleed from time to time.
This medical record says... Suddenly, Lin Yuan had a very bad premonition.
She has read Sister Yue's medical records, which are even more detailed than the one in front of her. It can even be said to be a detailed description.
I won’t have to write medical records like this in the future!
She vaguely saw that her future was dark. She didn't want to sit in the office and write medical records every day. She wanted to do surgery and become a world-famous surgeon.
Nausea, no vomiting, progressive weight loss, weight loss of 2.3kg within 1 year.
This description was so detailed that Lin Yuan's head started to hurt.
Lin Yuan even recalled that he had seen the doctor from Haicheng write down how the patient had oral ulcers and several ulcers, and how he treated them.
The patient suspects a mental illness. What does it mean when writing about oral ulcer? ! Lin Yuan cursed in his heart.
Are all the people under Boss Zheng perverts? They are so strict when writing a large medical record.
No, it’s not strict, it can already be described as harsh.
Immediately, Lin Yuan saw the words "Medical history of dietary changes for 3 months" in the medical record summary. She was extremely speechless about this. If she had to describe it in every medical record like this, she would rather go home in a few days.
"Su Yun, ask Zhong Min what the change in diet means." Zheng Ren said suddenly.
"Well, it's very clear. I guess Mr. Wang has never encountered a similar patient." Su Yun said softly, picked up the mobile phone, and directly dialed a mobile phone number without looking in the phone book.
Clear? What is clear!
The hair on the back of Lin Yuan's neck suddenly stood up.
How did it become clear? What exactly did you see that made Wang Canlan’s existence clear
Small redness and swelling at the corners of your eyes? Oral ulcers? Or a change in diet.
For a moment, Lin Yuan felt a sense of powerlessness deep in his heart. Things that I was once proud of collapsed so quickly in front of these two monsters, Boss Zheng and Brother Yun, that it was almost unacceptable.
"Zhong Min, the medical record that Mr. Wang sent just now was written by you, right?"
"The medical record of the patient named Han Cuijuan."
"I see you wrote about dietary changes. What do you mean?"
"Okay, tell Mr. Wang that there are already some clues here. I will discuss it with the boss again and I will tell you the diagnosis right away."
After saying that, Su Yun hung up the phone.
"Zhong Min said that the patient started having a heavy mouth three months ago and the food he ate was too salty," Su Yundao said.
"Well, then the diagnosis is very clear. Carbamazepine cannot be stopped, and olanzapine is taken orally once a day at 10 mg. Vitamin B12 is injected intramuscularly at 1mg/d for the first 6 days, then 1mg intramuscularly every week for the next 6 weeks, and then 1mg intramuscularly every month. ." Zheng Ren said directly about treatment.
"Boss, that's too lax."
"The inspection still needs to be done. Does this need to be said?"
"Let's check vitamin B12 and homocysteine." Su Yun asked.
"Well, the positive rate of blood vitamin B12 test is not high, so homocysteine must be checked." Zheng Rendao, "Check now, tell Mr. Wang and we will wait for the results."
Lin Yuan watched silently as Su Yun called again, recalling the diagnostic criteria for vitamin B12 deficiency in his mind.
"Boss Zheng, vitamin B12 deficiency generally manifests as giant cell anemia, glossitis and neuropsychiatric symptoms." Lin Yuan questioned in a low voice.
"Well, there are some small details. Not every patient with vitamin B12 deficiency will have glossitis and megaloblastic anemia." Zheng Rendao.
“…”
"For example, glossitis is the most common, but the diagnosis is inflammation of the mucous membranes of the tongue, oral cavity, and digestive tract. If conditions permit, a gastroscopy can be performed on the patient, which is ideal."
"Ah?" Lin Yuan was startled.
"Gastroscopy is most likely to show gastric mucosal atrophy and chronic inflammation, and 50%-60% of the biopsy epithelium has intestinal metaplasia."