System Came When the Doctor was Thirty

”Well, definitely no surgery. If it can be avoided, why go through the hardship unnecessarily?” the young man said naturally.

Lu Cheng thought again, then said, ”Of course, not having surgery comes with certain conditions.”

”First, you need enough self-control; you can’t remove the sling on your forearm—not for bathing or sleeping.”

”Are you sure you can do that?”

The young man thought for a moment, then nodded, ”Given the situation, I definitely have to follow the doctors’ advice, right?”

”Alright, come with me. We need to have a signing and consultation. If you move the fracture constantly, it will prolong recovery time and cause unbearable pain, which really would be unnecessarily self-inflicted hardship...”

”You really have to have self-control...” Lu Cheng said while patiently guiding the patient out the door.

...

About an hour later, Tian Zhuang walked into the doctor’s office while Lu Cheng was chatting with Tian Duoduo and Deng Zhouzhou during lunch.

”Brother Lu, Dr. Tian from orthopedics called. I couldn’t explain clearly on the phone; could you take the call?” Tian Zhuang knew his limited communication skills and apologized.

Being unable to communicate well meant continuously improving one’s abilities and skills to be a good doctor.

Lu Cheng ate faster than Tian Duoduo and Deng Zhouzhou, nearing the end of his meal. He quickly finished the remaining food and threw the box in the trash.

”Brother Shan.” Lu Cheng greeted energetically after taking the phone.

Tayama asked on the phone, ”Lu Cheng? I heard from Tian Zhuang that you let a fracture patient leave?”

”What’s going on?”

Lu Cheng paused to consider and calmly nodded, saying, ”Brother Shan, it’s just a simple radial head fracture! I’ve checked; there’s no surgical indication.”

Tayama laughed and challenged, ”Radial head fractures—we routinely operate on those in our department!”

”You’ve been here so long, you know that, right? I thought it might be an avulsion fracture.”

Lu Cheng stepped out and replied, ”Yes, Brother Shan, we do routinely operate, but radial head fractures have specific classifications.”

”Type I and II Mason fractures are special; non-surgical treatment can be an option.”

”Actually, our main goal in treating Mason Type II radial head fractures is to achieve pain-free, stable flexion, extension, and rotational function at the elbow.”

”For Type II radial head fractures without elbow dislocation, where flexion and rotation functions aren’t impaired, surgical and non-surgical treatments have equivalent outcomes.”

”Of course, surgical treatment is not inferior to non-surgical treatment,” Lu Cheng added.

Lu Cheng didn’t boast about the detail in his theory, nor did he act overly proud.

But not all fractures necessitate surgical treatment.

Radial head fractures don’t require manual reduction; they can achieve similar efficacy without surgery.

It’s a matter of understanding.

Tayama said, ”What if you advised the patient against admission for surgery and let them go, and they cause trouble later?”

Renmin Hospital isn’t a top teaching hospital; patients naturally doubt your treatment level. Any slight issue might lead to accusations of misdiagnosis or mistreatment, believing you delayed their condition.

Even though Lu Cheng provided sufficient reasoning, with conditions amenable to surgery or non-surgery, Tayama leaned towards surgery.

Lu Cheng responded, ”Then let the patient choose, explaining the consequences of non-surgical treatment.”

”If a patient opts for surgery, it’s voluntary. If they choose non-surgical treatment, they must accept the corresponding consequences.”

”Furthermore, with conservative treatment for radial head fractures, the greatest impact is merely slower recovery and healing. I’ve pre-assessed that their flexion and extension functions aren’t impaired.”

Lu Cheng’s theoretical background and structured theory assured that the patient could gain similar outcomes even without treatment, merely using a forearm sling.

But still, this is Lu Cheng’s understanding, not a definitive answer.

Even if it’s standard, Lu Cheng doesn’t promise patients anything.

Patient autonomy outweighs any doctor’s advice. If a patient requests surgery, it’s their choice.

The ER requested a consultation, called Tayama, and with no orthopedic response, the ER naturally has internal diagnostic rights. Lu Cheng is also an attending physician.

As one of the receiving doctors, Lu Cheng naturally trusts his capabilities first, believing he can manage the ER shift well.

Therefore, Lu Cheng doesn’t think there’s anything wrong with sending the fracture patient back for non-surgical treatment.

Tayama took a deep breath and said, ”Xiao Lu, for this patient, broadly speaking, as the first point of contact under the primary diagnosis responsibility system, your ER is the lead receiver.”

”Even though you called for a consultation, my advice was for the orthopedic ward, but you didn’t comply.”

”If a patient causes trouble later, you’ll be responsible.”

Tayama couldn’t outright say Lu Cheng was wrong, nor could he force Lu Cheng to call the patient back.

His failure to personally consult was already a disadvantage; even with support, rules must be followed.

Currently, Lu Cheng hasn’t encountered mindless colleagues, just ones less emotionally invested.

Lu Cheng nodded, ”Of course, Director Tian, if trouble arises, I won’t claim it’s your idea.”

”The patient’s medical record has my name.”

[Trauma Surgery (Skilled 9/10) (+1)] This level of theory is enough for Lu Cheng to remember key points from orthopedic textbooks.

Lu Cheng remembered correctly, and the guidelines didn’t specify detailed suggestions for surgical treatment of radial fractures. If a patient does cause trouble, Lu Cheng has reason to avoid being seen as ’wrong’.

Tayama clearly didn’t call to hold Lu Cheng accountable but said, ”Xiao Lu, you know our department’s situation; we don’t have many patients, so...”

Lu Cheng cut off Tayama, ”Director Tian, I didn’t intentionally send the patient away; he really doesn’t need surgery. If you need, I can send you the textbook excerpt.”

”If I remembered wrong, I’ll immediately call the patient to apologize and have them return to the orthopedic department.”

”If the textbook is wrong, I’ll accept the blame!”

Tayama, although an associate chief physician, is irrelevant to Lu Cheng’s current status as an attending ER physician.

”That’s unnecessary.”

”Xiao Lu, keep busy... you already know I primarily deal with sports medicine.”

”It’s just that sending the patient away might concern Director Peng and Director Xiang, who are mainly in trauma fracture areas,” Tayama understood Lu Cheng’s message, hesitating to argue further.

Tayama is wise, avoiding conflict. Instead, in suitable contexts, offering Lu Cheng a favor.

Orthopedics has four associate chief physicians.

Peng Haibo handles the spine and trauma, Xiang Kuihua manages trauma, Executive Luo works on the spine, and Tayama uniquely occupied sports medicine.

”Thanks, Brother Shan, everyone focuses on work. Personally, I think what’s best for the patient is most important,” Lu Cheng expressed his attitude.

After all, who’s not a proper orthopedic doctor?

Responsibility is key; if a doctor doesn’t want it, it’s better to change professions...

”Yes, Xiao Lu.”

”If you need any assistance, remember to call Brother Shan anytime.” Tayama hung up with a touch of camaraderie.

Lu Cheng was taken aback but then understood.

Tayama watched from the sidelines, almost hoping for a conflict between Lu Cheng and Trauma Orthopaedics’ Xiang Kuihua, ideally with mutual damage, while he added fuel impartially.