System Came When the Doctor was Thirty

The girl listened, furrowed her brow slightly, and asked, ”Dr. Lu, can you really find out so much just from a physical examination?”

”Well... some conditions can be detected through a physical examination, while others may not be. Your situation is rather special, so it’s possible to make guesses by gathering shallow information.”

”It’s not a definitive diagnosis either.”

After finishing, Lu Cheng washed his hands with sanitizer and walked over to the computer to review the films, asking again, ”Why do you ask? Are you in the industry too?”

”My wife works at Longfeng Maternity Hospital!” the man said with a somewhat reserved expression.

The girl immediately said, ”Dr. Lu, I’m a nurse.”

Lu Cheng quickly responded, ”You’re in the nursing field, which makes communication easier. Physical examination is speculative, confirmation requires comprehensive information.”

”Let’s talk after we look at the films! Please give me your medical record booklet.” Lu Cheng’s voice sounded more mature and stable.

The patient nodded, indicating her boyfriend to pass the medical record over: ”Okay.”

Yet, her eyes darted around again, blinking as she asked, ”Doctor, isn’t joint dislocation something that orthopedic doctors look at? You’re an emergency room doctor; do you handle this as well?”

The girl took a seat on the chipped yellow wooden stool, feeling dubious and slightly furrowing her brows.

”I was previously trained in orthopedics; joint dislocation is an emergency type, not specifically classified under any department.”

”Of course, we’ve also called orthopedics. The orthopedic doctor on duty today said he couldn’t handle your joint dislocation.”

”Certainly, after my diagnosis, you can opt for a transfer to another hospital, like the Traditional Chinese Medicine Hospital or State People’s Hospital,” Lu Cheng said.

Patients have the right to informed consent and refusal, and especially those within the industry need to have their rights respected.

Tian Zhuang had already retrieved the patient’s films, but his skill only allowed him to detect the dislocation; being less articulate, he didn’t say much...

The plain films are mainly used for initial screening to determine if a fracture is present and if bone alignment is normal.

It’s a relatively simple auxiliary examination.

Lu Cheng took about a minute and a half to scan the films, focusing on the critical parts, and then explained to Tian Zhuang: ”Tian Zhuang, look, the humerus and the radius and ulna are intact, with no fracture lines or deformities.”

”The alignment between the humerus and the glenoid cavity is separated, with the humerus located under the coracoid process, indicating anterior dislocation.”

”You can see that the joint capsule is not dislocated, the acromioclavicular joint space is narrow, and this is not a second-degree injury, but falls within the category of a first-degree injury.”

”In this situation, after reduction, we can perform an auxiliary physical examination to diagnose the presence of rotator cuff damage.”

Lu Cheng’s words were logical and professional, yet the subspecialty span rather overwhelmed Tian Zhuang, leaving him bewildered and conflicted.

He didn’t understand orthopedics well, let alone a subspecialty like joint dislocation.

But lack of understanding aside, he patiently followed Lu Cheng’s explanation, reading as much as he could.

Lu Cheng, however, focused purely on his tasks, writing the medical records immediately after speaking.

...

Halfway through writing the medical records, a voice interrupted: ”Xiao Lu, what do these English terms you wrote mean?”

Upon hearing this, Lu Cheng quickly raised his head: ”Director Lin, what brings you here?”

He realized his reaction was naïve; of course, the orthopedic colleagues called Director Lin over?

Upon hearing Director Lin mentioned by Lu Cheng, the girl and the man brightened up again, explaining their ”basic medical history” to Lin Qianlong!

Lin Qianlong smiled and explained, ”I don’t handle orthopedic cases; our Dr. Lu Cheng specializes more in orthopedic cases, and he’s much more skilled at treating joint dislocation than I am.”

”Please wait outside for a bit; Dr. Lu and I will carefully discuss your diagnosis and treatment, and we’ll inform you of the results shortly.”

Upon hearing this, the girl froze, somewhat afraid, ”Director Lin? Is my case very troublesome?”

Lin Qianlong said, ”Not necessarily troublesome, but it mainly depends on whether we can handle it.”

”We will have a thorough discussion among ourselves.”

The girl and the man reluctantly exited the room, their expressions mingled with confusion.

...

After the patient left the room, Lu Cheng carefully explained to Lin Qianlong: ”Director Lin, the shoulder joint Apprehension test tends to diagnose anterior shoulder dislocation.”

”If symptoms are alleviated during the Relocation test, anterior shoulder dislocation can be confirmed.”

”The Release test is based on the above Relocation test, and if shoulder symptoms reappear, it can double-confirm the diagnosis… This is a handy diagnostic technique for anterior shoulder dislocation without X-ray checks.”

Lu Cheng continued, ”A square shoulder deformity, abduction position, limited mobility, and pain suggest a shoulder dislocation; palpation of the humerus under the coracoid process qualitatively confirms anterior shoulder dislocation under the coracoid.”

”The three major tests are vital signs for diagnosing anterior shoulder dislocation through physical examination; palpation of the acromioclavicular joint and joint capsule position determines injury grading.”

”Grading guides treatment; a detailed record, even if we fail to reposition, is due to skill issues, not diagnostic issues!” Lu Cheng responded with meticulous care.

”Plain films can initially exclude accompanying fractures.”

”If there are hidden fractures, plain films might not reveal them.”

Although Lu Cheng was unaware of why Lin Qianlong came, he explained his actions thoroughly to Lin Qianlong with professional acumen.

Listening to Lu Cheng’s words, Lin Qianlong felt his scalp tingling.

Lu Cheng was undeniably a professional surgeon; his firm grasp of basic surgical skills confirmed this.

However, what’s the typical diagnostic mode for surgeries? It’s simple and forceful—look at the films; if it’s there, it is; if not, cut...

And how did Lu Cheng approach it?

He started by suspecting based on symptoms, then divided types, and identified specific symptoms before confirming the diagnosis multiple times, followed by grading.

This should be what all medical departments do, yet ninety-five percent of surgeons don’t do it so meticulously and cautiously.

Seeing a part of something can reveal the whole picture.

”Xiao Lu, so do you mean you can handle not only tendons but also joint dislocation?” Lin Qianlong rubbed his short chin, squinting his small eyes.

Lu Cheng’s theoretical explanation style and depth had a hint of formal training.

Perhaps Lu Cheng was indeed ’very ordinary’ in his previous internships and training hospitals, but here he was in a county hospital, especially one in a remote county!

You can’t generalize.

Lu Cheng earnestly explained, ”Director Lin, I wouldn’t say I can do it, but given the right diagnosis and classification, I can handle it.”

”Previously, I lacked experience, so I just had to work stupidly.”

Before gaining expertise, Lu Cheng knew some of these points, and he’d treated joint dislocation independently, but definitely not as meticulous, thorough, or professional as now.

These are indeed dull workflows; experienced individuals wouldn’t need to be so cumbersome; one glance usually suffices for identifying the issue and determining treatment.

Of course, though the method is naive... it indeed works well, minimizing the risk of diagnosing patients!

”Then let’s proceed! If orthopedics doesn’t handle it, we will!” Lin Qianlong’s lips curled into a playful arc.