Author: Travel around
At 23:00 on the night of February 16, In Manila, Philippines, I was about to fall asleep.
Suddenly, the sleeping two-year-old baby next to him wakes up from breathlessness, cries, difficulty inhaling with laryngeal ringing, abdominal pain, and a bulging abdomen that touches the abdomen for about 15 minutes.
As an ophthalmologist, I was so ashamed that I didn't even see what the disease was! While packing up my things and preparing to go to the hospital, I contacted my college roommate and pediatrician on WeChat. But there was no contact because it was too late.
Hospital emergency
The hospital was close to home, and within 10 minutes we were in the Philippines' top 10 private hospital, The Medical City, which has a separate pediatric emergency building.
After arriving at the pediatric emergency room, the baby's breathing improved significantly, and his stomach was no longer bulging and soft. The receiving doctor asked if we had a regular pediatrician in the hospital.
In the Philippines, families tend to have a regular doctor. As a result, when a child gets sick, the usual procedure is for the receiving doctor to call the private pediatrician and then transfer it directly to the doctor.
But I considered that the doctor's specialty was newborns, which was not right, and the child's situation was more urgent, and I was afraid that with the Filipinos not in a hurry, the back and forth phone calls and the doctor's coming back might be wasted.
So I said I forgot the name of the pediatrician (Filipinos have a very long name, I really forgot).
The hospital gave us a paediatrician on duty, a young, mild-mannered female doctor who looked to be in her twenties.
After seeing the child, I did not hesitate to ask for a long period of medical history, and my husband said anxiously, "Do you want to check it first?"
She took the baby's temperature, ear temperature: 38.7.
It's strange, I don't feel hot when I touch my head and body?
In our doubts, another pediatrician who looked young came over to continue to ask about the medical history, and also watched a few videos of the baby's symptoms during the attack, and did a retest:
Body temperature: repeated measurements of body temperature are normal;
Blood oxygen: normal, heart rate: 140;
The stethoscope listened to the lungs and said it was okay, and the examination of the abdomen also said it was okay.
The doctor didn't seem to know what the disease was, and after checking it, he went to write the medical records. After a few minutes he said, "It can be observed."
Because when the baby was sick, I touched her stomach bulging, so I suggested to the doctor to do an abdominal examination.
The doctor said, Then do an exam, take the stool, and see if there's anything abnormal.
I refused because the baby had normal bowel movements during the day, and the two times of defecation were normal, and there was no vomiting, abdominal pain, and now the baby's stomach is also soft, and there is no more stomach pain.
I usually play with the baby's fingers, ears, nose, stomach and other whole body organs, so the baby can basically accurately identify and point out where the pain is.
The doctor said, "Then look up a flat abdominal tablet."
Courtesy of the author
Then there is a special person to push the wheelchair to take the baby to do the examination, after the flat film results come out, the doctor's final diagnosis is: constipation.
Is it really just constipation...?
Although I can't confirm it, out of the doctor's sensitivity, I always feel that the baby's laryngeal sound is abnormal when the baby is sick, so I put a newly recorded video in the hospital to the pediatric resident doctor to confirm the condition and diagnosis.
But she still did not find anything unusual, and finally gave half a month of lactulose and fever reducer, and let us go home.
Finally paid, a look at the bill, startled.
Going to the emergency department did two things: the doctor asked for medical history, a simple physical examination, and a flat abdominal film, which cost almost 800 yuan.
Diagnosed
When I got home, I didn't sleep because I was worried that my baby would get sick again. Just in case, staying up until after 7 a.m., I sent messages to my fellow doctors, the pediatricians at my hospital, and the doctors in the departments I thought were related to the baby's disease to help diagnose them.
Nine hours before the baby's onset, my college roommate diagnosed her with acute laryngitis through a video I sent her and a description of the baby's symptoms.
At the same time, the chief pediatric physician of our hospital also gave a unanimous answer through video.
Courtesy of the author: Chat history of domestic pediatricians
When I heard that it was acute laryngitis, I was immediately startled into a cold sweat. This disease onset is fast, the disease is serious, and it cannot be delayed, thanks to the baby's own strength, it survived.
Pediatric acute laryngitis is a common acute respiratory infection that is most common in children aged 6 months to 3 years, with the onset occurring between October and March of each year.
When acute laryngitis occurs in children, local edema of the larynx leads to narrowing of the respiratory tract, and if not treated in time, it will lead to difficulty breathing or even suffocation.
After my roommate's guidance on medication, budesonide suspension nebulized + oral prednisone tablets. The baby got better after taking it, and now he is bouncing around again.
forgive
The two pediatric residents in the emergency department of the Philippine hospital did not diagnose the baby's illness, but I chose to forgive.
Misdiagnosis was a fact, but fortunately it did not cause a catastrophe.
After all, I once came from the hospital, and I don't think any doctor dares to say that every patient I have met in my medical career can be 100% diagnosed.
What's more, my senior attending doctor is also not skilled in learning, so how can I blame others?
Two days before the baby's onset, he opened his mouth to say that he was in pain, which may be a precursor to acute laryngitis. I didn't care, ignored it.
In this case, leaving aside the mother's guilt for not being able to find out the child's illness in time, as an ophthalmologist, my medical qualification certificate actually includes the scope of ENT practice, but I did not see it.
I have also worked as an intern in a Philippine hospital, and I also know that their medical system is very different from that in China, and the doctor training mechanism and doctor promotion are basically based on the United States.
Usually, the night shift is an intern, internship or low-senior resident, and the senior doctor will visit the patient at a fixed point, and if there is a patient who cannot be determined by the low-senior doctor, or a patient who needs surgery, they will directly take over. However, in general, the first diagnosis is handled independently by the former.
The two emergency department doctors I met were most likely junior doctors with little clinical experience.
I think that the lack of diagnostic experience, the lack of medical and nursing manpower under the influence of the epidemic, and the mistakes made by doctors in busy and chaotic situations are also understandable.
Grow through trial and error
In addition to this experience, in addition to being vigilant, I also lamented the difference between the Philippines and the domestic medical environment.
On the one hand, I deeply feel that the access to medical resources for domestic patients and the government's support for hospitals are far superior to those in the Philippines, and they are inexpensive.
Private hospitals in the Philippines have a good environment and advanced machinery, but the cost of doctors' consultations is also very expensive.
The baby's visit this time, the doctor's examination fee is more expensive than the examination fee. If you are hospitalized, the doctor's bill and hospitalization cost are separated when you are discharged, assuming that the total cost of hospitalization is 100,000 yuan, the doctor's diagnosis and treatment cost may account for 10,000 to 20,000 yuan.
Courtesy of St. Luke's Hospital
Top private hospital in the Philippines
In China, when encountering an experienced pediatrician or an otolaryngologist, for acute laryngitis, you only need to spend a registration fee and a drug fee, and usually the first diagnosis is 30 or 50 yuan to get it done. Even if you take an X-ray, it is only a few dozen dollars in the country, and in the Philippines, it is often thousands.
In China, departments such as emergency departments, especially pediatrics, which are extremely short of people, may have to work night shifts.
Although the Philippines has mandatory social insurance for working employees, according to Philippine authorities, only more than 30 million of Manila's 100 million people have access to health care services, and most of the unemployed or unemployed do not have access to any health care services.
On this basis, many people can only go to public hospitals. The philippines' free public hospitals are far less equipped and equipped than private, and only one of its top ten hospitals is a public hospital.
Source: Visual China
Although there are many unsatisfactory aspects of equipment and hygiene in state and public hospitals, doctors' consultations and examinations are free of charge, at least to provide basic medical protection for those in need.
The overall level of public hospitals is not as good as that of private ones. Free medical care, coupled with the implementation of the medical separation system, the hospital has no revenue.
The Philippine government budgets 9.7 billion pesos ($176 million) a year for 72 state-level public hospitals, but because most of the funds are used for daily expenses, many public hospitals are unable to make ends meet, resulting in many equipment overdue services being backward and dilapidated, and some hospitals are in an environment comparable to that of field hospitals.
On the other hand, although the overall medical level of Philippine public hospitals is not too good, I am still envious of the Philippine doctor training mechanism.
Because doctors in the Philippines have more valuable trial and error opportunities that domestic doctors lack from the probationary and internship stages. Their training mechanism may be cruel to patients, but it is very beneficial to the growth of doctors' business.
During the training period, their own growth will be relatively fast, especially in surgery, and after the training, basic common surgeries can usually be passed.
I myself had rotated in public hospitals in the Philippines because of my poor language and low efficiency, but I had never received a complaint from a single patient about it. Even in the emergency department, unless a particularly urgent patient arrives, everyone will quietly line up in a long line and wait for the call.
In private hospitals, the health care system also assigns patients to interns and residents. Patients can pay part of the cost of treatment with their knowledge and consent.
From the education of the school to the concept of the hospital's emphasis on practice, including the tolerance and recognition of patients, I felt the patience of this country for the cultivation of doctors. Hospitals in the Philippines are undoubtedly the cradle of good training for residents.
The profession of a doctor is a job that needs to be practiced. For surgery, first aid or skill departments that need to be used, only by accumulating the amount of surgery can they slowly change from quantity to quality.
Finally, special thanks to my 4317 dorm roommates: pediatrics, gastroenterology, cardiology, emergency department, ultrasound, and neurologists, who will always be the first to appear whenever and wherever, day or night, whenever I need to. (Curator: Beatrice, Producer: Gyouza)
Acknowledgements: This article has been professionally reviewed by Feng Ye, deputy chief physician of the Department of Pediatrics of Harbin Acheng District People's Hospital
Title image source: Visual China