Zhongnan Hospital was an enormous institution. It was because of its existence that being just a lowly master's student was possible, not the other way around - the hospital didn't owe its status as Hanshi University's Zhongnan Hospital to a single student.
There really wasn't much a mere master's student could do!
The most basic duties were to handle shifts well and manage the ward: write proper medical records, change medications, and organize discharge summaries. That was enough.
One could just do these tasks and coast on everything else, lying flat[1] when it came to surgeries, being an assistant, etc. If missing, someone else could easily fill in at any time.
And so, another week passed.
All Fang Ziye could do was fulfill his basic responsibilities, then spend time in the training room, reasonably arrange some time to study more, diligently serve as a minor assistant, and occasionally read some literature, just like always.
Even when new patients came in, it was nearly impossible for Fang Ziye to make any novel discoveries.
Emergency trauma patients were handled by the chief resident. By the time they were sent to the ward, treatment was already complete.
Elective patients all came through the outpatient clinics of associate professors and full professors. They had already been thoroughly examined by the professors, PhD senior fellows and other students. Everything was crystal clear - there was no need for you to propose any new diagnoses or findings.
When something has been chewed to bits, it's almost impossible to find a place to take another bite.
Therefore, Fang Ziye's accumulation of Knowledge Points remained quite slow. It wasn't until the following Tuesday, after a surgery day, that his Knowledge Point balance increased from 9 to 12 points.
There was no helping it. The surgeries at Zhongnan Hospital were all very high-level. In the trauma surgery department, aside from the chief resident, no one else could handle cases or surgeries below level 3 difficulty.
For such high-difficulty surgeries, even Fang Ziye's teacher Yuan Weihong found it extremely challenging to tackle them alone. He was still slowly learning the ropes, so naturally there was no way he could take on extra surgeries to let Fang Ziye operate.
Last Friday, Fang Ziye had already proactively asked to do some suturing. But his suturing skills weren't the best in the group - in fact, he was even inferior to some of the PhD students in terms of fine details. So of course, he wouldn't be given more opportunities.
Just muddling through as an assistant, he could gain between 0.2 to 0.4 Knowledge Points.
Even a tiny bit of meat from a mosquito was still meat[2] - it was better than just hanging out in the training room.
In the afternoon, at 4:27 PM.
Seeing that the number of outpatient visits had reached 47, Fang Ziye knew his teacher only scheduled 50 appointments per day.
After patiently explaining to the current patient where to go to schedule an MRI, Fang Ziye went ahead and closed the door.
"No more patients outside?" Yuan Weihong noticed this small action, his gaze flickering slightly.
At this moment, Fang Ziye rubbed his nose through his mask, then squinted his eyes and carefully poured a cup of hot water for his teacher. "Master, why don't you rest for a bit and watch me see two patients?"
"What do you think? There are only three patients left, and we still have an hour before closing time..." Fang Ziye's eyes almost sparkled.
Making such a request was not excessive.
Firstly, it was just an outpatient clinic. Even if mistakes were made, Yuan Weihong could still correct them.
Secondly, there was plenty of time. There was still an hour before closing, with only three new patients left.
Thirdly, it was sufficiently safe. Fang Ziye would only take the medical history and perform examinations. Yuan Weihong would still be there to control the quality afterwards, so there was no harm to the patients.
Naturally, Fang Ziye had been working in the ward for two years already. He was thoroughly familiar with the basics and wouldn't appear inexperienced or at a loss.
Diagnosing patients would earn Knowledge Points. Under the premise of not affecting patients' interests, getting himself a benefit while letting his teacher rest - Fang Ziye felt this was a win-win-win situation.
"Knock knock knock."
The patient waiting outside started knocking on the door.
Yuan Weihong waved his hand at Fang Ziye, then stood up holding his cup and started twisting his waist.
Hearing this, Fang Ziye was instantly overjoyed. He opened the door and, without waiting for the patient to speak, explained: "I'm sorry, my teacher was just a bit tired and took a sip of water to rest for a moment."
"Please come in. I'll help my teacher by asking about your basic situation. He'll be listening from the side."
Fang Ziye's manner of speaking and the way he invited the patient in were particularly practiced.
The patient came in and saw that Yuan Weihong was indeed standing straight, supporting his lower back. The auntie nodded, "You must be tired, doctor."
With Yuan Weihong not leaving, she wasn't so afraid.
Fang Ziye politely said, "Auntie, where are you feeling unwell? Please sit down and tell me slowly."
Fang Ziye sat down on the stool, and after taking her medical record book, half of his words were showing humanitarian care while the other half directly addressed the main topic.
"It hurts here." The auntie's gait was normal as she walked, but she was clutching her hip area.
Then she sat down.
Fang Ziye quickly glanced at the auntie's age, then asked, "Auntie, how long have you been feeling this pain?"
Actually, given this auntie's age of over fifty, normal gait, but complaining of pain when striding, Fang Ziye had seen many such patients in outpatient clinics and knew at a glance it was likely sacroiliac joint inflammation.
But this was just a suspicion, a first guess based on epidemiology and statistics from a probabilistic perspective. This was the benefit of having more experience and knowledge.
"Oh, it's been quite a few years."
"How severe is the pain? Does it affect your sleep?" Fang Ziye first routinely inquired about her medical history.
Finally, he summarized as follows: Middle-aged female, left hip pain for 5 years, worsened in the past 6 months, aggravated after bearing weight (when carrying things), slightly relieved by rest or taking painkillers, self-treated at a traditional Chinese medicine clinic for over two years with no obvious improvement.
Occasional morning stiffness, not lasting long, relieved after activity...
"Auntie, we've asked about your symptoms pretty thoroughly. Let me do a physical examination for you now!"
"Please lie down on the examination bed, no need to take off your shoes, facing your left side." In clinical practice, both inquiry and physical examination were very important, serving as key references before imaging and laboratory tests.
"Alright!" The auntie stood up again, with no obvious impairment, but the persistent dull pain was still present.
Because she was female, even though elderly, due to the inconvenient location, Fang Ziye did not perform a visual inspection. He only assessed for any skin defects or depressions based on the external contours.
He didn't see any gluteal muscle atrophy or that sunken feeling in the buttocks.
The order of orthopedic examination was inspection, palpation, range of motion, and measurement, different from the usual medical examination order of inspection, auscultation, percussion, and palpation.
Fang Ziye very skillfully performed tests for tender points, Piedallu's sign[3], and resistive hip abduction, then said, "Auntie, based on your current condition, we're considering sacroiliac joint inflammation. This is a chronic, progressively developing osteoarthritis."
"You shouldn't bear extra weight in the future, okay?" Fang Ziye said this as he helped her stand up.
As he spoke, Fang Ziye glanced at Yuan Weihong. Yuan Weihong nodded at Fang Ziye, indicating approval.
Leaving aside whether the rest of the inquiry demonstrated orthopedic expertise, just Fang Ziye's examination skills alone showed that he was a very professional orthopedic doctor.
"I can't bear weight? But I need to carry things. I sell vegetables..." The auntie hesitated slightly.
"Then you should reduce it as much as possible. Try to find other ways. Otherwise, your pain will get worse and worse in the future."
"We need to do an X-ray to confirm the diagnosis, and then we'll probably prescribe some medication. You'll need to go home and rest for a while."
"The main treatment, actually, is to avoid weight-bearing!" Fang Ziye knew that for this type of disease, the primary approach was to eliminate the triggering factors.
"How much does the examination cost?" Her eyes darted about restlessly.
"An X-ray should be 54 yuan for one area. X-rays are quick, you can basically go down and have it done right away, then come back up after it's finished. No need to wait for the results, we can check them directly here."
"Alright then." The auntie felt relieved; a few dozen yuan wasn't too expensive.
"..."
The first patient was thus concluded. As Fang Ziye finished writing the diagnosis and treatment recommendations on the outpatient medical record and handed the examination form to the patient, the Knowledge Points column jumped sharply once again.
[+2!]
Nice!
Fang Ziye smiled: "Alright, please go downstairs for the examination. After the examination, come directly back to the clinic and queue for a follow-up consultation. We'll prescribe some medication for you then."
"Remember the key point: reduce weight-bearing. Otherwise, it's like wearing a cotton jacket in summer, blasting the air conditioner and still complaining about being hot. You need to weigh the pros and cons for your own body."
Translation Notes:
[1] "Lying flat" (躺平) is a Chinese neologism referring to doing the bare minimum to get by, often in protest of societal pressures.
[2] This is a Chinese idiom meaning "every little bit helps."
[3] Piedallu's sign is a medical test used to diagnose sacroiliac joint dysfunction.