Practicing Medical Skills in a Small Clinic-Chapter 234 - 145: This Isn’t Bronchitis, My Status Seems to Be Rising
Some elderly people in their 60s who persist in exercising are even stronger than young men in their 30s.
"I’ve had this old problem for almost thirty years. It started as just a cough with a lot of phlegm, and later my breathing became somewhat labored. I’m an impatient person. When I was teaching, seeing students not listening, not studying seriously, and not completing their assignments properly, I’d get angry. The angrier I got, the worse the cough became, cough, cough..."
After speaking, the man began to cough violently again.
Unexpectedly, the man was a teacher, no wonder he had such a distinctive demeanor.
He gave off a clean, tidy, serious, and earnest feeling.
"Have you been to a hospital for a check-up?"
"Yes, they said it couldn’t be cured, just managed with some medication."
"Did they mention what disease it might be?"
"They said my lungs aren’t good. I heard that you have good technology and high medical ethics here, so I wanted to come and try some medicine. Previously, I got my medicine from a dedicated hospital."
The man is a teacher, so he’s definitely covered by medical insurance.
Moreover, he is at least fifty-seven or fifty-eight years old, and his insurance contributions are likely well over 25 years, so he can enjoy lifelong medical insurance.
Now he’s coming to Li Jingsheng’s small clinic for medication, but this place hasn’t qualified for dedicated medical insurance yet!
The patient can only pay out-of-pocket.
"I can prescribe some medication for you, but our clinic’s treatments are not covered by medical insurance. Can you accept that?"
"If it’s not too expensive, that’s fine. If it is, I’ll just go to the hospital, cough, cough..."
The man couldn’t speak too much.
Speaking too much would trigger a violent cough.
"Do you smoke?"
"I don’t smoke."
"Do you have chest pain, cough blood, chills, or any other symptoms?"
"No, I just feel short of breath and have to inhale forcefully."
From the time he entered, the man’s breathing was labored.
"Alright, let me listen to your heart and lung sounds, and measure your blood pressure and temperature."
Upon measurement, the man’s temperature was normal, with a respiratory rate of 19 breaths per minute.
The lung sounds were rough, but there were no obvious dry or wet rales.
The heart sounds were fairly normal as well.
His blood pressure was slightly elevated, but still acceptable.
The man was slender, with a noticeably barrel-shaped chest and rib spaces wider than usual.
After examining the man, Li Jingsheng initially diagnosed it as chronic bronchitis.
Chronic bronchitis is quite common clinically.
It’s a stubborn disease, difficult to cure and prone to relapses.
His small clinic couldn’t perform blood gas analysis, but through a comprehensive diagnosis, he judged the man’s condition to be not severe and felt capable of treating it himself.
The patient mainly exhibited shortness of breath and respiratory distress.
It should indeed be chronic bronchitis, so treatment will proceed as such.
At this point, the man coughed and expectorated phlegm.
He was very courteous, wrapping it in a tissue.
Li Jingsheng noticed the phlegm was yellow and viscous.
Strangely, it also contained serous foamy sputum.
It didn’t seem like a typical presentation of chronic bronchitis!
Considering the patient’s normal temperature and that the lungs’ sound, apart from being rough, was fairly normal.
It’s easy for acute bronchitis episodes to present with an elevated temperature.
"Let me listen to your lung sounds again!"
Suspecting it wasn’t bronchitis, Li Jingsheng decided to examine more carefully.
This time, he paid extra attention when listening to the lung sounds.
"The lung sound is peculiar, getting progressively coarser. This is somewhat different from bronchitis lung sounds."
If it’s not bronchitis, then what disease could it be?
Concerned about misdiagnosis, Li Jingsheng became extremely cautious immediately. 𝒻𝑟ℯℯ𝑤𝑒𝑏𝑛𝘰𝓋𝑒𝓁.𝒸𝑜𝘮
After all, his small clinic was recently troubled by a patient incident.
His respiratory diagnosis is at the Master Level for now.
Sufficient for diagnosing most Pulmonary Medicine diseases.
But when encountering subtle or ambiguous issues, and lacking various auxiliary examination methods, his Master Level in respiratory diagnosis was somewhat lacking.
The life points balance had 402 left, more than enough to upgrade the respiratory diagnosis.
This diagnostic skill is used almost daily, and very frequently.
The sooner the upgrade, the sooner the benefit.
With this mindset, Li Jingsheng decided to splurge.
Directly upgrading the respiratory diagnosis to the Minor Achievement level.
Pulmonary Medicine Minor Achievement 500/1000.
Respiratory diagnosis and treatment have always been Li Jingsheng’s forte.
Various other medical skills have already surpassed him using the attribute panel, leaving it behind.
Even his Gastroenterology diagnosis had long ago reached a level of Minor Achievement.
Finally, it caught up again.
His life points were almost exhausted again, with only 24 remaining.
Feeling the powerful upgrade of respiratory diagnosis, he believed it was worth spending more life points.
He tried using the Minor Achievement level respiratory diagnosis to reassess this patient.
"Wow, so powerful! It can analyze from nasal mucosa, sputum volume, concentration, color, and the degree of roughness and shortness of breath across many aspects."
During the diagnosis, Li Jingsheng experienced how exceptional the Minor Achievement level respiratory diagnosis was, with one symptom emerging, multiple diseases matching that symptom immediately popped into his mind.
Just like a computer, capable of automatic filtering.
Ranking the higher probability, consistent diseases towards the top.
"When did you start feeling shortness of breath?"
"Started suddenly worsening yesterday."
"Was it the same during previous episodes?"
"Yes, about the same. It seems a bit more severe this time."
The patient, being a teacher, cooperated highly with Li Jingsheng’s inquiry.
"The onset should be fairly acute, and the condition is still rapidly worsening. Manifesting mainly with rough, urgent breathing. If not bronchitis, then what disease could it be?"
