Chapter 62: Dispute!
“Then definitely no surgery. If you go for surgery when surgery isn’t necessary, you’re just asking for trouble, aren’t you?” the youth said naturally.
Lu Cheng thought for another moment and then said, “Of course, there are a few prerequisites for not having surgery.”
“First, you need to have enough self-control. You can’t take off the forearm sling, not even for showering or sleeping.”
“Are you sure you can do it?”
The youth thought for a moment and nodded, “It’s already like this, I can only listen to you doctors, right?”
“Then that’s fine. Come with me. We need to have a talk and get a signature. If you move around and the fracture keeps rubbing, it will prolong the recovery time, and you’ll be in unbearable pain yourself. That’s when you’re truly asking for trouble…”
“You must have self-control…” Lu Cheng said patiently as he led the patient out.
…
About an hour later, Tian Zhuang walked into the doctor’s office. Lu Cheng was eating and chatting with Tian Duoduo and Deng Zhouzhou.
“Brother Lu, Doctor Tian from Orthopedics called. I couldn’t explain it clearly over the phone, do you want to take it?” Tian Zhuang, aware of his limited communication skills, apologized profusely.
However, even if you can’t communicate well, you still have to be a good doctor. You can only continuously improve your cognitive abilities and practical skills.
Lu Cheng ate faster than Tian Duoduo and the others. He was nearing the end of his meal and quickly finished the remaining food, then stood up and threw his lunchbox into the trash can.
“Brother Shan,” Lu Cheng said heartily after taking the phone.
Tian Shan asked on the phone, “Lu Cheng? I heard from Tian Zhuang that you let a fracture patient go?”
“What’s going on here?”
Lu Cheng considered for a moment and then nodded calmly, “Brother Shan, this is a simple fracture of the radial head! I checked, and there are no surgical indications.”
Tian Shan chuckled and retorted, “For radial head fractures, our department usually performs surgery.”
“You’ve been here for so many years, don’t you know? I thought it was an avulsion fracture.”
Lu Cheng walked out the door and replied, “Yes, Brother Shan, our department usually performs surgery, but there are specific classifications for radial head fractures.”
“Mason type I and type II fractures are special and can be treated non-surgically.”
“In fact, for Mason type II fractures of the radial head, our fundamental treatment goal is to achieve painless, stable flexion, extension, and rotation function of the elbow joint.”
“For type II fractures of the radial head classification, if there is no associated elbow dislocation and flexion and rotation function are not limited, the effectiveness of surgical treatment is equivalent to non-surgical treatment.”
“Of course, the effectiveness of surgical treatment is not inferior to non-surgical treatment,” Lu Cheng added.
Lu Cheng did not boast about how detailed his theory was, nor did he feel proud of it.
However, not all fractures require surgical treatment.
Radial head fractures cannot be treated with manual reduction; they can achieve equivalent therapeutic effects without surgery.
This is a matter of cognition.
Tian Shan said, “What if you recommend the patient not be hospitalized for surgery and let him go, and he causes trouble for you later?”
The County People’s Hospital is not a top-tier teaching hospital. Patients will instinctively doubt your treatment level. If anything goes wrong, they might accuse you of misdiagnosis and mistreatment, delaying their condition.
Even though Lu Cheng provided sufficient reasons, for diseases that can be treated surgically or non-surgically, Tian Shan leaned towards surgery.
Lu Cheng replied, “Then let the patient choose for himself and clearly explain the consequences of not having surgery.”
“If the patient chooses surgery, that is his voluntary decision. If he chooses non-surgical treatment, he should also bear the corresponding consequences.”
“Furthermore, with conservative treatment for radial head fractures, the biggest limitation is only a slower recovery and healing. I assessed beforehand that his flexion and extension function is not impaired.”
Lu Cheng’s theoretical knowledge and corresponding structured theories confirmed that even if this patient was not treated and just went home with a forearm sling, he would achieve the same therapeutic effect as surgery.
But as always, this was only a theory recognized by Lu Cheng, not the definitive answer.
Even if it were the definitive answer, Lu Cheng would not dare to make promises to the patient.
The patient’s right to choose always supersedes the doctor’s recommendation. If the patient requests surgery, that is their own choice.
The Emergency Department requested a consultation and called Tian Shan. Since no one from Orthopedics came to see the patient, the Emergency Department had the right to internal consultation, and Lu Cheng was an attending physician.
As one of the attending doctors, Lu Cheng naturally prioritized trusting his own abilities and believed he could handle the emergency shift well.
Therefore, Lu Cheng did not feel there was anything wrong with sending the fracture patient back without surgery.
Tian Shan took a deep breath and said, “Xiao Lu, to put it broadly, this patient falls under the first-visit responsibility system. You in the Emergency Department were the first to receive him, and you were the primary attending doctor.”
“Although you called for a consultation, our advice was to admit him to the orthopedic ward, but you did not comply.”
“If the patient causes trouble later, you will have to bear the consequences yourself.”
Tian Shan could not say that Lu Cheng’s choice was wrong, nor could he force Lu Cheng to call the patient back.
If he didn’t come for the consultation himself, he was already in the wrong. Even with influence, certain rules must be followed.
Currently, Lu Cheng had not encountered any brainless colleagues; they were just rather cold-hearted.
Lu Cheng nodded, “That’s for sure, Director Tian. If the patient really comes looking for trouble, I won’t say it was your idea.”
“My name is also on the patient’s medical record book.”
【Trauma Surgery（Proficient 9/10）（+1）】This level of theory is sufficient for Lu Cheng to memorize the knowledge points in the Orthopedics textbook.
Lu Cheng did not misremember, and the guidelines did not make specific recommendations on whether to operate on radial fractures. Therefore, even if the patient caused trouble, Lu Cheng could justify that he did not ‘make a mistake’ by following the textbook.
Tian Shan clearly wasn’t calling to make Lu Cheng take responsibility, but rather said, “Xiao Lu, you know the specific situation of our department. The patient volume isn’t very high, so…”
Lu Cheng interrupted Tian Shan, “Director Tian, I didn’t deliberately send the patient away. He genuinely doesn’t need surgery. If you need it, I can take a picture of the textbook’s original text for you.”
“If I’ve remembered incorrectly, I’ll call the patient immediately, apologize to him, and have him come to Orthopedics for admission.”
“If the textbook is also wrong, then I’ll just have to accept it!~”
Tian Shan was indeed a Deputy Chief Physician, but what was the relationship between his position as Deputy Chief Physician and Lu Cheng’s current position as an Attending Physician in the Emergency Department?
“That won’t be necessary.”
“Xiao Lu, you carry on with your work… Actually, you know, I primarily focus on sports medicine.”
“It’s just that if you send patients away like this, Director Peng and Director Xiang will have opinions. They both primarily handle trauma fractures,” Tian Shan said. He understood Lu Cheng’s point and felt awkward about dwelling on it further.
Tian Shan was also a shrewd person; by not offending anyone, he instead gave Lu Cheng a favor under appropriate circumstances.
There are four Deputy Chief Physicians in the Orthopedics Department.
Peng Haibo handles spine and trauma, Xiang Kuihua handles trauma, Luo Changwu handles spine, and Tian Shan has carved out a niche in sports medicine.
“Thank you for the reminder, Brother Shan. We are all here to do our jobs. Personally, I believe that what is best for the patient is the most important thing,” Lu Cheng expressed his stance.
Aren’t they all legitimate orthopedic doctors?
If you don’t want to take responsibility as a doctor, you should change careers…
“That’s right, Xiao Lu.”
“If there’s anything you need help with, remember to call your Brother Shan anytime,” Tian Shan said with a sense of camaraderie before hanging up.
Lu Cheng was stunned for a moment, then suddenly understood.
Tian Shan was playing the spectator, hoping that Lu Cheng and Deputy Chief Physician Xiang Kuihua from Trauma Surgery would clash, ideally resulting in mutual destruction, while he would add fuel to the fire indifferently.
