Chapter 1138: with translation of chapter title

There is a patient with a high-altitude fall injury, who jumped from the fourth floor, and the family does not want to be hospitalized. Yuan Li explained vaguely.

Zheng Ren's heart stirred; jumping off a building and not wanting to be hospitalized—these two keywords linked together, and he thought of several possibilities.

"Is it because of insurance?" Zheng Ren asked softly.

Wang Zong felt deeply moved and admiring.

Medical technology is medical technology, and what Doctor Yuan just said is another matter entirely.

In Di Du, he rarely dealt with insurance matters. Staying at 912 Hospital, the prepaid deposit was 50,000 yuan. In other words, without paying 50,000 yuan, one couldn't even get admitted to the hospital.

As for whether the patient could be reimbursed, that was not within Wang Zong's consideration.

But the situation in Hai Cheng was completely different.

Here, whether reimbursement is possible is absolutely a major factor for patients' families in choosing where to be hospitalized and what treatment to receive.

But Zheng Lao Ban could tell at a glance that it was about insurance—what the heck is this? Wang Zong also realized the problem.

Yuan Li was stunned, then nodded.

Zheng Ren smiled, "You guys continue chatting."

Having said that, he continued walking forward with Wang Zong.

"Zheng Lao Ban, what's going on?" Wang Zong asked.

"Jumping off a building counts as suicide, so insurance won't reimburse." Zheng Ren said, "Without insurance, many of the orthopedic steel plates can't be used. If cheap domestic plates are used, the injured mostly have lower limb injuries; later, bearing weight, the plates might break."

……

"This will always be a medical risk later on. So if the Emergency Department admits such patients, it's not very urgent and they can't be reimbursed, orthopedic doctors will be very unhappy. If it's truly urgent, then it wouldn't be."

But Doctor Yuan said earlier, for someone who jumped from the fourth floor, the injury is probably not severe—maybe a tibial fracture, or a trochanteric fracture, or femoral shaft fracture.

"These, as long as they're not disclosed, aren't a big deal. So changing hospitals and telling the doctor it was an accidental fall would just get past it."

"Um… is doing this really okay?" Wang Zong had been a doctor at the nation's top-tier tertiary hospital, had been in Hai Cheng for a few months, performed many surgeries, but had not grasped this kind of subtle thinking.

"I also don't know if it's good or not; even more seriously, this is insurance fraud." Zheng Ren said flatly, "But after all, we're treating people, which is better than those community small hospitals that daily milk insurance for cash. In Hai Cheng's community small hospitals, hospitalization costs nothing, and they even give out money every day."

"Give out money? That's impressive?"

"En." Zheng Ren nodded while walking, "I've heard people say it's about a hundred yuan a day. Hanging a bed and prescribing medicine, the hospital takes it to sell—that's one way of milking insurance. There are many methods; all can be done. The huge deficit in medical insurance is not in tertiary hospitals but in community clinics."

"This isn't…" Wang Zong felt indignant and resentful.

"Stay calm, at the grassroots level it's always like this. If supervision is strict, they restrain themselves; if supervision is lax, they rush to prescribe medicine." Zheng Ren chuckled, "Everyone benefits from these things, so no one wants to cause trouble. Actually, saying everyone benefits ends up with no one benefiting. But who knows how to do it?"

Zheng Ren put on an attitude of being just a doctor, only responsible for seeing patients and performing surgery; this matter is not his responsibility, and he cannot control it.

Wang Zong felt a sigh, there are so many loopholes below; he hadn't known before.

Walking to the rescue room door, Zheng Ren glanced inside.

His body tensed slightly, then he quickly strode into the rescue room.

In the rescue room, nurses were busy; the patient lay on the rescue bed, and the ECG monitor showed stable numbers.

Zheng Ren hurried in, drawing the nurse's attention.

She turned her head, delighted: "Chief Zheng, you're back."

But the delight was only momentary; when the little nurse saw Zheng Ren behind her, she immediately fell into boundless disappointment.

Zheng Ren knew the only person who could truly make the little nurse delighted was Su Yun. That guy, who knows if he's finished drinking with Chang Yue.

He nodded, Zheng Ren approached the patient, reached out, and said: "Stethoscope."

Wang Zong was somewhat doubtful, took out a fish-leap stethoscope from his white coat pocket, and handed it to Zheng Ren. The patient's blood pressure was 150/100 mmHg, heart rate 102/min, respiration 28/min, oxygen saturation 98%.

The ECG showed sinus rhythm; this was an emergency patient, but not a critical one.

The patient's injury matched Zheng Ren's judgment—in the calf; Wang Zong estimated it was a tibia-fibula fracture. However, the fracture was somewhat severe: the left calf was congested and edematous, the skin slightly shiny.

Compartment syndrome, very obvious, easy to recognize.

If Wang Zong handled this patient, he wouldn't discuss insurance with the family like Yuan Li, nor would he use a stethoscope to listen to the abdomen like Zheng Ren…

What the hell is Zheng Lao Ban listening to the abdomen for? This is utter nonsense, isn't it?

Vital signs are stable, so the abdominal organs are probably fine; otherwise Yuan Li wouldn't be leisurely chatting with the family about insurance.

Even if there were something, one shouldn't auscultate.

"Bedside ultrasound, call now!" Zheng Ren said solemnly; in an instant he had resumed his role as Inpatient Chief of Haicheng First Hospital Emergency Department, "Sodium nitroprusside, lower blood pressure, keep systolic under 120."

The little nurse was stunned; although Zheng Ren had been away for half a year, his authority remained, and her body instinctively obeyed rather than questioned.

She hurriedly called someone to make the phone call, while she herself quickly added medication.

"Zheng Lao Ban?"

"Suspected tear of the thoracic and abdominal aorta." Zheng Ren gave the diagnosis directly, "Go call Yuan Li in."

Zheng Ren had just glanced at the rescue room; the bright red System Panel background color drew him in. The Xitong Diagnosis was severe, making Zheng Ren dare not delay.

Auscultation is just a method, rarely used. Because the patient is thin, pressing hard on the stethoscope lets one hear the aortic blood flow sound. But there is a lot of noise; the real diagnosis is not done this way.

This is merely one way Zheng Ren reasons backward; others cannot learn it.

"……" Wang Zong looked at Zheng Ren in astonishment, then at the patient, utterly speechless. How does this even relate?

However, experience with P-J syndrome patients told Wang Zong that he must obey.

He hurriedly walked to the door and called Yuan Li in.

Yuan Li was a bit unhappy; he had just finished speaking vaguely with the patient's family, and although his own words were unclear, they still made the family understand what to do. This required deep skill, and he felt a bit proud.

The next step was to sign a form taking full responsibility for any consequences, then have the 120 emergency ambulance take the patient to another hospital in the city for treatment.

In Yuan Li's view, it was just a fracture; any hospital could treat it.

Zheng Ren, this guy, is he back to cause trouble for me?! He was getting angry.

……

……

Note: This is a patient I've been seeing for 10 years. My skill level is not high; I looked at the chest CT and didn't find the dissection. To put it simply, an early-stage dissecting arterial aneurysm is also relatively hard to discern. I just had doubts in my mind; the family wanted to leave, but I stubbornly waited until the next morning, then contacted the emergency Blood Vessel CT reconstruction.

Finally diagnosed with dissection, he was sent straight to the ICU. What happened afterward is also true: the person survived, but it cost a lot of money, and the family ended up in a huge argument. When he was discharged, his spouse looked at me with a wrong expression, fierce and vicious.

However, let's just leave it at that, with a smile.

Besides, Idle Talk, my constitution is the type that tends to attract dissecting arterial aneurysms. Patients with rib bone folding and aortic dissection—over the past ten or so years, the department has seen eight cases, all of whom arrived during my shifts.

This, I'm quite speechless.