"Director Liang, look at the patient first." Wu Mian smiled and stood in the corner.


    The clinic has always been very busy. Mr. Wu doesn''t come to talk about things. Talking about things can''t be here. Director Liang understands.


    "The examination is back." director Liang stood at the table and reached for the B-ultrasound report and blood routine.


    He watched it for 2 minutes, very carefully, looked at all the important points, and even took a special look at the B-ultrasound images.


    The gallbladder wall of the patient is a little rough, which can barely diagnose cholecystitis.


    "Little girl, sit down and talk." director Liang was very gentle without any impatience. He said with a smile, "your situation is very clear. Now it''s considered cholecystitis."


    "Director, is the situation serious?" the little girl asked in a low voice, her face a little white.


    "It''s not serious. You have tenderness in your right upper abdomen, but there is no rebound pain and muscle tension. The gallbladder wall on B-ultrasound is a little rough, but it''s not very heavy. There''s no problem in diagnosing cholecystitis. Surgery... I don''t think it''s necessary. Take antibiotics orally for a day or two."


    "What if it''s not good?" the little girl continued to ask timidly.


    "You can go to the community hospital for a drip, but I don''t think there is a possibility of a problem." director Liang tried to have some affinity, smiled and said to the patient.


    After all, Mr. Wu stood aside, probably to dig people. Whether you go or not, you should always be friendly, and you can''t let Mr. Wu underestimate your clinical skills.


    "Thank you." the patient said very hard, with a small voice and full of pain. "Director Liang, why don''t you just drip it? The drip can be faster. I can''t stand the pain."


    The patient said pitifully, "I can''t stand the pain every night these two days..."


    Then she pointed to Murphy on her right upper abdomen and said distressedly, "every time I hurt, I can''t help coughing, especially uncomfortable."


    "Direct drip is OK." director Liang said, "but I suggest you still..."


    Just then, director Liang saw Wu Mian winking at himself.


    Wrong diagnosis? Director Liang thought carefully. No. Is it because I have too much drama in my heart and misunderstood Miss Wu''s meaning?


    What should I do now? Director Liang was stunned.


    Wu Mian turned and went out, his hands behind him, and his fingers seemed to move slightly.


    "Wait a minute, I have a stomachache and go to the bathroom," director Liang said to the patient.


    "Well, I''m not in a hurry." the patient was very cooperative and understood, whispered.


    Director Liang was a little nervous. Although he didn''t want to show his face, don''t show his ass.


    While running away, director Liang recalled the patient.


    The positive signs of physical examination were obvious. There was tenderness in the gallbladder area. Although there was no rebound pain and muscle tension, it proved that cholecystitis was not too serious, but it was not the reason to deny cholecystitis.


    It''s strange. What did Mr. Wu call himself to do?


    Director Liang came out with Wu Mian. Wu Mian didn''t go far and stopped in the corridor. "Director Liang, can I see the eye examination results?"


    "Oh, look." director Liang handed Wu Mian the inspection results in his hand.


    Wu Mian quickly glanced at the list. His eyes hardly stopped on any line. A few seconds later, he said, "director Liang, I see the double lung breathing sound written in your outpatient medical record is clear. Have you really listened?"


    "..." director Liang was stunned.


    In general, non specialist physical examination is written casually. The patient has a stomachache or is a young female patient. If he has to auscultate her, he is waiting to be complained.


    It''s not uncommon in hospitals every year.


    Mr. Wu is a professional in the profession. If you don''t check your body, the doorway involved should be very clear. Director Liang thought of the lightning flash and immediately recalled the patient''s signs, main complaints and relevant conditions.


    After thinking again, director Liang still didn''t find any problems.


    "Miss Wu." director Liang was just stunned, then smiled and bowed his head and said, "seriously, I didn''t auscultate. You know that."


    "Well, I know." Wu Mian nodded. "The patient''s tone is a little weak. She can vaguely hear the sound of airway spasm. In addition, she has a cough when she says she has abdominal pain. Check the imaging examination of her lungs."


    "You think so..." director Liang was stunned.


    "Why don''t you listen to the patient''s breathing sound? If the right side is weakened, do an examination." Wu Mian said, "the patient is not epigastric pain induced by cholecystitis, but a large amount of pleural effusion on the right side, which involves radioactive pain caused by pleura."


    "..." director Liang was speechless. He glanced at Wu Mian and knew that he was serious and indisputable. He nodded and turned back.


    "Miss Wu, did you hear it with your ears?" Xue Chunhe asked.


    Xue Chunhe also came from gastroenterology. He knew that director Liang''s level was not bad. He had just witnessed all this with his own eyes. He didn''t think director Liang did anything wrong.


    If you really say that director Liang''s medical record says that the breathing sound of both lungs is clear, but in fact there is no physical examination, this is indeed a mistake.


    However, the vast majority of outpatient medical records are written like this. A patient with appendicitis should check it from head to foot according to the medical record writing standard. Is that possible?!


    Mr. Wu didn''t say anything for this reason, but he might as well say something for this reason.


    Does the ear hear the patient''s breathing sound?


    Xue Chunhe thought it was incredible.


    "Dean Xue, have you observed the patient?" Wu Mian asked with a smile.


    "Yes, there are several main manifestations of tuberculosis patients, night sweats, dry cough, chest pain and fever. The patients are not consistent. How do you judge?"


    "The patient''s sitting posture is very normal. There is no arched back and chest, isn''t it?"


    Xue Chunhe recalled the patient''s situation and nodded.


    "But when the patient comes in, he can see the left deviation of the trachea, which is a very obvious sign."


    “……”


    "In the test sheet, the blood routine white blood cells are normal and the lymphocytes are on the high side. Although the change of blood routine in patients with pulmonary tuberculosis is not obvious, combined with the left deviation of trachea, we can begin to doubt whether there is right pleural effusion."


    "Er... Is it too far fetched?"


    "If you work in ICU or respiratory medicine for several years and listen to wheezing every day, you should be able to determine the patient''s condition soon." Wu Mian said, "wait and see. Director Liang can determine it soon after auscultation."


    Just then, the young woman came out with a confused face.


    "Hurry up, but don''t be too anxious when walking. Slow down. Don''t exercise violently. It''s nothing. You don''t have to worry." director Liang kept telling me.


    He watched the young woman leave the outpatient corridor. Then he turned and walked to Wu Mian with confusion and gratitude in his expression.


    "Mr. Wu, the breathing sound on the right side of the patient is very weak and almost disappears."