Chapter 64: The Real Attending Physician!
“Brother Lu, is Doctor Tian from Orthopedics still not coming? Tian Shan said it’s Tian Hongjian’s emergency shift today. Joint dislocations are handled by Doctor Tian Hongjian.”
Wrinkles furrowed Tian Zhuang’s brow, making his already not-so-pleasant face appear even more troubled.
Lu Cheng listened to Tian Zhuang, and took a deep breath.
Thinking that Professor Chen Song and Professor Tong Yuan’an had temporarily returned for the Qixi Festival, the brothers in Orthopedics immediately revealed their true colors. Then he looked at his own panel, his expression growing more solemn—
【 Comprehensive Level: Attending Physician.】
In the real world, he was an attending physician. Even if his panel previously showed he hadn’t reached the “attending physician” level of strength, others still treated him as an attending physician.
And after Lu Cheng’s efforts to identify and fill gaps during this period, his strength as an attending physician finally caught up—
【 Basic Theory: Surgery （ Proficient 10/10）（ Skill Points -1）, Orthopedics （ Proficient 10/10）（ Skill Points -2）, General Surgery （ Proficient 10/10）（ Skill Points -1）, Trauma Surgery Basic Theory （ Proficient 10/10）（ Skill Points -1）, Emergency Medicine （ Proficient 10/10）（ Proficient 10/10）（ Skill Points -2）……】
For the theory part, Lu Cheng increased some proficiency by reading books, and the rest was entirely done by using skill points to raise his proficiency to （ Proficient 10/10）.
【 Basic Surgical Skills: X-ray Interpretation （ Proficient 9/10）（ +1）, CT Interpretation （ Proficient 9/10）（ +1）, MRI Interpretation （ Proficient 9/10）, Surgical Instrument Operation Experience （ Proficient 9/10）（ +1）, Physical Examination （ Mastery 2/20）（ +1）, Auxiliary Examination Reading Skills （ Proficient 10/10）（ +1）】
All basic surgical skills improved naturally.
【 Basic Surgical Operations: Incision （ Proficient 10/10）, Debridement （ Proficient 10/10）（ Skill Points -1）, Suturing （ Mastery 14/20）, Knot Tying （ Proficient 10/10）（ Skill Points -1）, Puncture （ Proficient 10/10）（ Skill Points -2）, Hemostasis （ Proficient 10/10）（ Skill Points -2）.】
For basic surgical operations, Lu Cheng used a small number of skill points to complete most abilities to （ Proficient 10/10）, mainly for practical use, otherwise, no matter how high the skill level, it would be useless.
However, apart from the surgeries in General Surgery, the proficiency in Orthopedics surgeries hadn’t changed for a long time, remaining the same as before, only not decreasing.
【 Basic Surgical Procedures: Open Reduction and External Fixation for Fractures （ Proficient 1/10）, Fracture Manual Reduction （ Proficient 2/10）, Open Reduction and Internal Fixation for Fractures （ Proficient 0/10）, Closed Reduction of Joint Dislocations （ Proficient 1/10）……】
【 Current Skill Point Balance: 43.3 points!】
The daily skill point income was only six points. Because some points were used to upgrade Spleen Preservation Surgery and Gallbladder Preservation Surgery, Lu Cheng had painstakingly saved up 31 skill points, originally intending to use them for basic skills and theory to participate in competitions and earn money.
But now, he realized that reality would not give him the opportunity to save skill points for competitions.
“Brother Zhuang… I’ll take a look.” Lu Cheng replied, and with a thought, skill points began to drain rapidly.
【 Orthopedics （ Mastery 0/20）（ Skill Points -10）, Trauma Surgery Basic Theory （ Mastery 0/20）（ Skill Points -10）, Closed Reduction of Joint Dislocations （ Mastery 4/20）（ Skill Points -23）】
After the emergency skill point allocation, Lu Cheng felt two currents of cool and warm qi rising. The cool qi entered his brain, and the warm flow returned to his hands, bringing a comfortable sensation as he turned before disappearing without a trace.
Tian Zhuang replied straightforwardly, “That’s right, Brother Lu, you were an orthopedic doctor before, you can definitely do it.”
Lu Cheng glanced at Tian Zhuang, not explaining much.
He used to be on call under the name of Orthopedics. If there were patients he couldn’t handle, he could ask for help from his superiors.
Now, the meaning of being on call was different. If he asked for help from his superiors again, he could only ask Lin Qianlong, and Lin Qianlong would also be at a loss.
The patient and his companion quickly returned after getting the X-rays. They appeared young, around twenty-four or twenty-five years old.
The girl wore a white sleeveless long dress, holding her left hand with her right. Her emaciated body and the distinct shoulder deformity on her left side were evident.
At this moment, she was clearly angry, her pretty face ashen. The man was softly apologizing, and upon returning to the clinic, the man said, “The place that took the X-rays said we can’t get the films for another two hours.”
“My wife is in so much pain, can you please think of a way?”
When the man said “wife,” the girl’s expression flickered slightly, but she didn’t argue. She just nervously looked at Lu Cheng and Tian Zhuang, her face tight with pain.
Lu Cheng replied, “It takes time to get the printed films, but we can see the results on the computer as soon as you finish the X-rays.”
“However, we need to perform a physical examination first before looking at the films. We’ll make a comprehensive diagnosis.”
“Please tell Doctor Tian the last six digits of your wife’s ID number so he can pull up the X-rays.”
As Lu Cheng spoke, he walked towards the girl and said very rigorously, “Stand still. The physical examination for the shoulder joint doesn’t require you to lie down! I need to perform a detailed examination.”
The man was quite attentive. After providing the number, Lu Cheng found the X-rays and then turned to look at Lu Cheng and his girlfriend, his eyes full of worry.
“Don’t be nervous, try to move your left hand first, move it yourself,” Lu Cheng instructed.
For a patient with a closed shoulder joint injury, the first consideration is a fracture, then a joint dislocation, and finally sports medicine conditions like rotator cuff tears.
Whether there is a fracture can be definitively diagnosed through a physical examination. If there is a fracture, there will definitely be signs of fracture, such as pain on longitudinal percussion, local deformity, crepitus of fracture ends, and complete limitation of movement.
Lu Cheng didn’t examine the local area first because if the patient could move their limb, it indicated active movement, which could basically rule out a “major fracture”!
It’s important to know that Lu Cheng’s physical examination technique was originally the most proficient and the medical skill he had access to the most. It had long since reached the ‘Mastery’ level!
Fracture patients cannot have much normal movement, not at all.
“Ouch, no!~” The girl’s left hand had only been raised about thirty degrees when her face turned ashen.
“It hurts so much… I can’t move!”
Hearing this, Lu Cheng reached out and held her injured limb at the wrist, saying, “Okay, if you can’t move it, don’t move it. Next, I will perform a few passive examinations. Please relax and cooperate…”
Limited range of motion but with some range of movement, a fracture can be ruled out without reviewing the X-rays.
Diagnosing patients is like solving a case. For beginners, it’s like cracking a puzzle, finding clues step by step, and not overlooking any detail…
Orthopedics has a professional physical examination, and a professional sequence, called inspection, palpation, movement, and measurement.
However, the order of the physical examination cannot be too rigid and requires improvisation.
The moment the girl entered the room, Lu Cheng had already completed the inspection. The patient exhibited a rather typical “shoulder joint square shoulder deformity”!
The most likely diagnosis is a shoulder joint dislocation.
However, Lu Cheng, who had worked at Hanshi University Zhongnan Hospital, had heard professors mention many pitfalls. When diagnosing, one must not let the most obvious signs mask other key diagnoses.
If a dislocation is accompanied by a fracture, and you fail to diagnose it, it’s not just the patient who suffers; they will sue you for being unprofessional!
……
Lu Cheng slowly and meticulously performed the procedure for nearly four minutes before lowering the patient’s arm: “Alright, thank you for your cooperation. My physical examination is complete. Based on the results of the examination, I preliminarily suspect an anterior shoulder dislocation.”
“It’s a simple dislocation, subcoracoid dislocation, and the grade is very low. It should be treatable with manual reduction.”
“However, the specific situation will be determined after we review the X-rays. The physical examination can only provide a guess; the X-rays will reveal more information, allowing for a definitive diagnosis and treatment selection,” Lu Cheng’s voice was calm and firm.
