Great Doctor Ling Ran Chapter 38

38 Outpatient Consultation

The provincial hospital was a large-scale, tertiary, grade A general hospital that was on an equal footing with Yun Hua Hospital.

In other words, they were both reputable tertiary grade A hospitals.

Hospitals had a siphoning effect[1].

Everyone would think of going to the best hospitals. That also included those who held positions at the top.

So, the premium provincial hospitals would be able to get the best financial support from the province's health finance department. The city's tertiary grade A hospitals would be able to get the greatest financial support from the city's Department of Health Care Finance. County-level tertiary grade A hospitals would be able to get the greatest financial support from the county's Department of Health Care Finance. If this county-level city had a tertiary grade A hospital

Under such circumstances, the Matthew Effect[2] was particularly evident in hospitals.The strong would grow stronger, while the weak would grow weaker. Better hospitals would be able to obtain more advanced facilities and keep excellent doctors in their hospitals.

Among the 1,300 tertiary grade A hospitals throughout the entire country, there were only 44 government-funded hospitals such as Union, Xiangya, West China Center of Medical Sciences, Zhongshan, Fudan, and so on.

Based on that alone, Department Director Huo Congjun of Yun Hua's Emergency Department and Chief Physician Qi Zhenhai of a provincial hospital's Emergency Department were among the best in the medical field of Changxi.

Both of them were masters when it came to determining the degree of burn wounds, and they had 'communicated' with each other more than what other people would think.

However, procedures for formal outpatient consultation were complicated, and such events only became easier to organize if there were unique public incidents, such as factory explosions, or the entire medical cadre was required to perform health care assignments.

Qi Zhenhai was most eager for such an opportunity. He did a ward round and performed one surgery in the morning before he changed into his outfit for a journey and rushed straight towards Yun Hua Hospital.

He had been slated to become a chief physician when he was just forty years old. It was a young, early ageone that was full of promise.

He had also dressed himself in a way that made him look younger than he was. While the elder doctors donned white coats and fought to create their own empire, he got into T-shirts and dress pants whenever he left the hospital.

The only thing that worried him was the fact that the number of wrinkles on his face were increasing day by day. His body which slacked off from physical exercise had started packing on pounds. His belly would grow if he was not careful. If he wore the white coat like a department director, perhaps he could still try to cover it up. But Qi Zhenhai was not willing to fall to that.

It was too old-fashioned. He would not be able to show his young and promising side.

Currently, what troubled Qi Zhenhai the most was his department director.

Hospitals were unlike government agencies. The path to promotion was extremely narrow. A department director would remain in the same position until retirement arrived, unless he could get promoted to be the associate hospital director, or get transferred, or perhaps even get poached by other hospitals.

Some department directors were not willing to leave their positions as department directors, even once they have been promoted to become associate hospital directors. And so, some young and promising department directors remain in the same position for over twenty years, smothering the doctors beneath them to the point of suffocation.

Qi Zhenhai could not afford to wait for the Director of Emergency Department to retire. So, he had been aggressively promoting the founding of a Burn Center, thinking of stepping out independently to be his own boss.

This additional challenge was probably the reason his wrinkles ran so deep. Because of that, no one could actually tell that the age difference between him and Huo Congjun were only ten years apart.

"I was thinking of holding another case discussion when I received a consultation call from your Yun Hua Hospital. I have also brought cases from my hospital along with me. Let's have a look together." Qi Zhenhai was speaking about medical records that had been assigned to the provincial hospital.

The factory explosion incident was a tragedy to the wounded workers and a loss for the factory. For Qi Zhenhai, it was, in fact, a rare opportunity. If he could prove his position in the field of burn wounds, it would be easier for him to establish his Burn Center.

"We can discuss this in private if we still have time after the consultation."

Huo Congjin did not seem to be in the mood for politeness.

'Take a look together? That is probably him trying to show off, right?'

Huo Congjun glanced at Qi Zhenhai out of the corner of his eyes as he thought to himself. 'Let's see if you'll be this eager for our private conversation once I'm done.'

"Let's head in. It is almost time." Huo Congjun was not in the mood to talk. He only announced his arrival before he got back into the meeting room.

At that moment, the young doctors of the department were arranging chairs. Once they were done, they sat around the room, allowing the chairs around the meeting table in the middle of the room to be unoccupied.

Huo Congjun had picked the far corner that faced the door and sat down in a regal air.

The other two chief physicians and four associate chief physicians sat by his sides. The solemn atmosphere generated by a total of seven specialists in the department room started clouding up the room.

Qi Zhenhai casually picked a chair in the middle and sat down, completely unbothered by Huo Congjun's attack. Then he instructed the resident doctor who came with him to put the medical records right before him. He smiled and asked, "Hasn't Department Director Liu from the People's Liberation Army General Hospital arrived?"

"Something happened to a patient of his. But he's already on the way." Doctor Du was in charge of keeping the communication lines opened. He gave them the relevant information.

Qi Zhenhai laughed and said, "Then let's wait for a while. The factory incident is rather serious. It'll be like a three-judge trial[3]."

Huo Congjun did not make a sound. The other doctors remained silent. The atmosphere quickly became awkward.

Qi Zhenhai remained unconcerned as he straightened his clothes a little to cover up his bulging tummy and continued to wait quietly.

Hospitals the likes of Yun Hua and provincial hospitals were not fond of outpatient consultations in the first place. Naturally, no consultation session would be held in festive spirits.

Due to the difference in status of county or city level tertiary grade A hospitals as compared to provincial level tertiary grade A hospitals, outpatient consultations held by county or city level hospitals were actually organized due to their need for assistance, and it was more meaningful to them.

Of course, county-level tertiary grade A hospitals were also unwilling to engage in outpatient consultations through conventional means. They had been privately contacting and roping in foreign aid. If they were going to pay anyway, it would be much easier if fewer procedures stood in the way.

"Opps. Sorry. I'm late, I'm late." The sound of the doors flying open shattered the tense atmosphere in the office.

The person who came through the door was an old doctor with a square face. There was an old fashioned stethoscope hanging on his chest, and it seemed as if the doctor hung it there like an accessory, something like a pocket watch.

Huo Congjun stood up to greet him.

"Department Director Liu, have you handled the patient?"

"Declared him dead."

Department Director Liu's expression did not change.

Ling Ran sat in a small corner as he turned his head over and took a glance at Department Director Liu.

People dying in a big hospital was a normal occurrence. Only a handful of modern people would have their lives end quietly and peacefully in their own homes. They would usually only completely give up on hope for living after all treatments from hospitals failed.

However, Department Director Liu's casual manner of speech when it came to death was still rather uncommon, even by modern standards.

Among the doctors who were sitting in a circle with their backs facing the office table, the expressions of the attending physicians were the calmest. On the other hand, the expressions of the young resident doctors varied widely. Some of them were familiar with Department Director Liu's words, and those were the senior resident doctors. Others were unaccustomed to Department Director Liu's wordsjunior resident doctors who had just completed their housemanships. There were even some who were not even concerned with the conversation in the middle of the meeting room.

"Everyone is here. Let us begin then." Huo Congjun returned to his seat and opened up the medical records.

After years of improvement, the consultation system had become much more organized.

Especially when it concerned outpatient consultation. Its meticulousness was uncannily similar to the country's military education and training[5]. Its importance was also equal to the country's military education and training. Both were equally troublesome and appeared to be useful, but was in truth, completely useless. Nevertheless, the higher-ups still loved checking on how doctors conducted these outpatient consultations.

Doctor Du stood up and switched on the projector. Then he began reading the powerpoint slides.

Huo Congjun turned his chair around. His eyelids slid down while he listened. He appeared to be asleep, but was not. He paid no mind to how he appeared to others.

Qi Zhenhai was fueled with excitement. His eyes were wide open. He was relentlessly criticizing certain aspects of the medical cases in his heart.

Department Director Liu performed the routine. His eyes seemed to be both focused and unfocused, and his mind wandered. He seemed to be unconcerned, since this had nothing to do with him.

"So, this is the situation. The burn areas of the two critical patients were pretty substantial. But basically, everything is under control. The lesson of the day is to not repeat the same thing."

Huo Congjun sounded as if he was giving out medical advice to the doctors working under him.

That attitude established the tone for the outpatient consultation on that day.

Qi Zhenhai could not help but feel a little disappointed. How was he going to show off his talents if there were no critical cases?

"We still can't let down our guard when it comes to patients with 80% burns."

Department Director Liu paused for a moment before he gave his comment.

"Someone must be with the patients at all times. I suggest delegating some manpower into that."

"We have assigned Doctor Du to this case" Huo Congjun said.

"Too old, he won't keep up," Department Director Liu said bluntly.

"For a burn patient, complications can happen at any moment. To have burns on 80% of their bodiesheart failure, renal failure, shock, toxemia, anything can happen to the patients. Assign a younger attending physician, and it'll be best if he can keep his eyes on them twenty-four seven. Assign the person on duty for a full month. See if we can save both of them."

The factory explosion was the focal point of the entire city. The doctors needed to be handling the cases cautiously and take everything that could happen to the patients into consideration. Finances should be their secondary concern.

Huo Congjun was taken aback for two seconds before he nodded and said, "Alright, we shall see to it."

Huo Congjun and Qi Zhenhai were both experts in the Emergency Department. They both achieved greatness when it came to burn wounds. However, when it came to handling details, they were no match to Department Director Liu, who had firmly sat on the throne in the Trauma and Burn Surgery Department for many years.

Department Director Liu was very indifferent.

"As more patients give up their lives for our learning, our methods grow more innovative. Today, I discovered the pulmonary embolism[6] far too late. Otherwise, I would have straightaway applied heparin, regardless of the potential outcomes forget it, let's not talk about it now. Let's only talk about it again during the autopsy. Hmm, old Huo, if there's nothing left, I'll head back now, alright?"

"Don't mind it. It's not easy to come over here. Let's talk about another medical case." Huo Congjun let out a deliberate cough. Doctor Du picked up the remote control and started playing a video.

On the big screen, Ling Ran plunged his hand into a patient's abdomen.

Translator's Note:
1. Siphon effect: An effect where atmospheric pressure pushes the liquid up, and gravity pulls the liquid down. In the text, it means that the strong attraction of the host city (where there are hospitals) attract investment from other places, thus slowing down the development of other areas.
2. Matthew Effect: An effect where the rich get richer, and the poor get poorer.
3. Three-judge trial: A scenario where highest-ranking chiefs of three departments were handling the same case at the same time and the same location. Known as public security, procuratorial, and court based on today's department. It usually is held to handle significant cases, or conventional and sensitive parts, such as a case in a royal family.
4. Military education and training: Is a fundamental form of higher learning covering defense education as required by The Military Service Law of the People's Republic of China and The Decisions of the Central Committee of the Communist Party about Education System Reform.
5. Pulmonary embolism: Is a blockage of an artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream. Symptoms are like shortness of breath, chest pains, coughing up blood.