Summary of the work of the attending doctor in 2019

Dear Academy Leader: Hello!

2010-1-5, after finishing the whole year of study and study, in accordance with the work arrangement in the hospital, I served as the responsible doctor for the first half of the year in the second ward. The completed work is as follows:

1. Responsible for the first round of ward rounds of newly admitted patients, instructing residents and trainee doctors to complete the initial diagnosis, treatment and formulation of the next treatment plan for the patient, and prepare for the ward round of the department.

2. Independently solve the diagnosis and differential diagnosis of general difficult and complicated cases, the initial setting and adjustment of the diagnosis and treatment plan; answer the questions of the lower level physicians; cooperate with the department heads of the department, or invite the professionals of relevant departments to work together for the typical, Case discussions and consultation rounds of difficult and complicated cases.

3. Responsible for the trainee doctor assigned to me in the teaching center to help him familiar with and master the basic skills of the newly admitted patients, such as consultation, consultation, physical examination, medical record writing, and medical advice, as well as daily ward rounds and medical orders for inpatients. , process records, procedures for handling discharges, etc.

4. Independently manage patients and participate in the rotation of the department.

5, accept the invitation of other departments of the consultation, complete the coordinated treatment or transfer treatment between departments.

6. Cooperate with Beijing cardiovascular experts to complete the special needs clinic and to check the ward in each ward.

7. Assisting complex patients in completing referral and transfer.

8. Help the head of the department to coordinate the relationship between doctors and doctors, and to resolve conflicts. The treatment and care of the ward can be carried out smoothly.

The following is a report on the specific completion of the above work and some of my feelings:

1. First round of investigation:

The first round of ward rounds is critical to the initial diagnosis and diagnosis of new patients. Especially in the current situation of our hospital, almost all of the patients with income are diagnosed as "coronary heart disease", despite hypertension, hypertensive cardiomyopathy, primary cardiomyopathy, valvular heart disease or even rheumatic heart disease, pulmonary heart disease The symptoms of heart failure or myocardial insufficiency of blood supply can be alleviated by nitrates, but this does not mean that all heart disease is equal to coronary heart disease. I remember that Director Zhi Zhimin of the Department of Foreign Affairs had a very classic saying: "The diagnosis is strict, the treatment is wide", and it is said that in the primary hospitals , due to the lack of more accurate means of diagnosis, experimental treatment can be taken expeditiously. But that is a helpless move. If we stay at this level, it will inevitably be misdiagnosed or even mistreated.

2. Through the organization of discussions and consultations, solve the problems in diagnosis, differential diagnosis and treatment:

The first is to diagnose the problem. We know that treatment can be broadly divided into treatment and symptomatic treatment. The former is the best policy and the latter is the best policy. As big as a hospital , as small as a doctor, the level of the level, the level depends on whether you are the former or the latter. The premise of determining the level of treatment is your level of diagnosis. From a variety of perspectives, large hospitals , senior doctors are to see people, small hospitals , low-level doctors are to treat people. Realistically, in the current medical market, the most valuable resource is outpatients, because no matter what "insurance", it can make the hospital open to "eat" and "insurance" does not hurt, it is the cost of the insured in the clinic. Then there is the medical examination crowd. If you are not sick, check your health every year. You can't manage your insurance! It is necessary to treat sick people, give physical examinations without illness and do health guidance. In the hospital , it is to fight equipment and spell check; in the case of doctors, it is to spell the diagnosis level! If we can adjust our role positioning in time, and grab the big "cake" of outpatients and medical examination groups in time, we can greatly improve the efficiency of all equipment and the efficiency of all personnel, and will be our living space. Expanded to the secondary prevention of more patients, even the primary prevention field of the whole people. Now that we have digital gastrointestinal angiography, electronic gastroscope, advanced color ultrasound and multi-row ct, we have gynecology, stomatology, ophthalmology, otolaryngology and dermatology, as the hospital leader called to mobilize: we are fully capable Provide regular medical examination services. Especially our multi-row ct, it can help us see cerebrovascular, coronary vessels, pulmonary vessels, renal blood vessels and almost all the peripheral arteries and veins you want to see, highlighting that we are a veritable cardiovascular and cerebrovascular Hospital . Next, our doctor will appear. Mao Zedong said: "The best weapon, leaving people, is a pile of scrap copper!" So you are a qualified doctor? Resident physician, attending physician, chief physician, how to distinguish who is high and who is low? Just look at your diagnostic level! By the way, here is a good doctor. His purposeful examination is to provide evidence support for his judgment, and it is by no means a "machine gun shot"! What is the expectation of a higher-level physician by a lower-level physician through case discussions and consultations? Didn't you tell me if this medicine is 0.1 or 0.2, I want you to tell me what this disease is! At least you have to tell me what diseases I can currently check and cure. Some of our superior doctors have not been able to guide the diagnosis, but they have put all their attention on the treatment of the lower-level physicians. What's worse, these changes are often completely contrary to the Guide. "North"! I remember our dean said: "Now is the "Guide" era, if anyone insists on adhering to the non-standardized 'personalized' treatment, they will eventually be held liable!". So worse than the worse, this behavior will expose our entire team and hospital to legal risks. The way to overcome this "one-word" model has always existed, that is, case discussions and consultation rounds. In the past six months, as we insisted on organizing case discussions and timely convening consultations, the level of diagnosis and treatment in the two wards has been improved. This is reflected in the fact that we can initially determine coronary heart disease, cardiomyopathy, valvular disease, pulmonary vascular disease or hypertension based on medical history, symptoms, signs, and auxiliary examinations, and then carry out further examinations in a targeted manner. Formulate standard treatments such as expanding the crown, reversing myocardial remodeling, improving valve function, reducing pulmonary arteriovenous pressure, and reducing cardiac load; this is reflected in the clear expansion of nitrate esters and the reduction of cardiac load effects in angina and heart. The different mechanisms of action in patients with aging are reflected in the understanding of the rate of heart drop and the reduction of myocardial oxygen consumption, which is crucial for patients with angina pectoris. For patients with heart failure, they may be “quantified to zero” due to excessive intervention. Heart failure is caused by the self-regulating mechanism of less pulling and running. The most important thing is that our doctors learn and are accustomed to independent thinking. Therefore, there is such a sentence in the second ward, saying: Fan Wei will be stunned by Zhao Benshan, and everyone will be reminded of the hypertensive cardiomyopathy by the "tough" of the electrocardiogram fixed t wave inversion. This is also a portrayal.

3. Is it taught? Or "catch"?

This is indeed a problem! According to my feelings, a group of small doctors who came to our hospital at first, because of the situation at the beginning, will soon be able to stand on their own. Today, we see that not only the growth rate of the new small doctors has slowed down significantly, but also the early “old” little doctors who grew up very quickly, and the pace of progress has obviously slowed down. If we still have to train our trainee doctors to call ourselves to be mixed, then when will they be independent, from your students to your partner? So you should teach them how to work as quickly as possible. From step by step, I walked to go alone, from hands-on to brainstorming, from mechanically consciously to consciously following process operations, from process compliance to participation. When he managed the patient from admission to discharge completely independently from beginning to end, when he passed the patient and expressed his gratitude to him when he was discharged from the hospital, and then asked him to return to the clinic, he really became a witness. "The real practitioner." The one-person ward round, a group of people "listening, writing" the old routine, will not only hinder the growth of the small doctor, but also will hinder the development of the department and even the entire hospital !

4. Patient and shift:

I like to manage bed patients separately and like to go to night shifts. This allows me to have more opportunities to accumulate, accumulate experience, accumulate information, and accumulate resources. We know that even in many public hospitals , even the director of the department will manage the bed alone. Otherwise, I should have said the sentence: "It doesn't matter if the director doesn't come for a few days. If the little doctor who can control the bed and shift is not coming, then it will be messed up!"

5, consultation, transfer, is a collaborative battle between different professional doctors, is the full use of hospital resources:

In the past six months, I have been invited to the Department of Surgery and Cerebrovascular Ward to make a diagnosis for patients with cardiovascular disease, to propose treatment plans or to transfer to the Department of Cardiology for further treatment. As far as the current specialty characteristics of our hospital are concerned, no matter the age of the patient, the disease factor or the characteristics of the disease itself, it is determined that a considerable number of patients will suffer from diseases of the heart, brain and even internal and surgical systems. The patients who manage themselves have their own medical conditions outside the profession. Please consult other relevant professional doctors, which will not only benefit the patients' correct diagnosis and treatment, but also benefit our own practice safety and the full utilization of hospital resources. We know that in the Law of Practitioners, there is also a strict definition of the scope of practice of practicing physicians.

6, experts are also divided:

What kind of experts are meaningful for a grassroots hospital like ours? The answer is Zhang Jian, Yan Zhimin, and Wan Yungao. Because they can not only help us solve the patient's diagnosis and treatment problems, but more importantly, they can teach us the correct and constantly updated ideas! It is a new concept and a new method that is in sync with the level of international development!

7. Referring patients in a timely and correct manner:

Due to the limitations of the current access system, the internal medicine department of our hospital can not carry out interventional treatment for a period of time. Therefore, patients with cardiovascular diseases who need vascular interventional or even surgical treatment should be promptly assisted to transfer to higher-level hospitals to solve the patient's problems. So that we can avoid medical disputes and even legal responsibilities, and this is also an important way for us to communicate with higher-level hospitals . In the past six months, I have referred more than 10 patients to Beijing Fuwai Hospital . Patients with coronary artery disease who have coronary stents, renal vascular hypertension patients with renal artery stents, and permanent intracardiac pacing. Patients with arrhythmia, patients with supraventricular tachycardia and atrial fibrillation who underwent radiofrequency ablation, and patients with pulmonary thromboembolic pulmonary hypertension who underwent pulmonary vascular intervention. They all received correct and timely medical treatment, and their subsequent regular follow-up visits were conducted in our hospital . I think that even if we can never carry out interventions that represent the most advanced level of today, we should also see that the basic drug treatment and routine monitoring following interventional therapy are more, not less. Because after the patient puts the metal tube or the small box, the medicine he wants to eat is not reduced but more. In short, for patients to refer to the timely and correct, the benefits also include ourselves!

8. Resolve contradictions between medical care and doctors and patients:

This is the best I have done! Because I concentrated all the contradictions on me. I am not bothered by this. The king became a victory and shouted: "Cow me!", so he became a hero after his death. But why do I open fire to me for the health of the patient, for the progress and improvement of each of us, and even for the entire department and hospital , regardless of personal gains and losses? Is it not that I am glorious, will I be remembered as a hero like Wang Cheng? Of course not! Because I know: If I am really dead, I really die for the benefit of patients and hospitals . It is also as light as a feather. Because, some people's face is more important than Mount Tai! ! !

The first work report ends here.

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