1. Dedication is the road to success for clinicians.
To be dedicated, we must have a strong sense of social responsibility. No matter how high a person's status and skills are, he is still a member of society, and the collective is a small part of society. The medical career of medical workers is only a part of social division of labor. Society has given us everything, and each of our medical workers must also serve the society. In this respect, many of our ancestors are examples for everyone to learn. Responsibility is the most important issue for a good doctor. Istonordback, director of surgery at the Affiliated Hospital of Tampere University in Finland, once said: When you have deep love for patients, you will try your best to solve problems. In clinical treatment, we will encounter many unsatisfactory results, so we have to summarize and study to improve the treatment effect. See more patients, contact more patients, read more literature, and sort out your own ideas in combination with reality. Regarding the sense of responsibility, Professor Qiu Fazu, honorary dean of Tongji Medical College of Huazhong University of Science and Technology and academician of Chinese Academy of Sciences, once told a short story about repairing watches by himself. One day 30 years ago, he went to the watch shop to repair the watch and asked a female comrade on duty: "This watch makes a noise when it is shaken. Would you please have a look? " She shook her hand and immediately said to him, "I can't fix it. There are no parts." He carefully repeated "Please open it and have a look". The female comrade on duty gave him an impatient white look and said, "As long as you can walk, there are no parts." He asked again, and the lesbian never spoke to Dr. Qiu again. He just needs to try another big watch shop across the street. He met a gay man, but he got the same reply and attitude. At this moment, he happened to find Comrade Khufu sitting in another corner of the shop. He is a patient of Dr. Qiu and an employee of our shop. He immediately went over and asked Comrade Khufu to find out the reason why the watch made noise when it vibrated. Comrade Hu opened the back cover of his watch and found a screw loose. He screwed the screw in place and the watch was repaired. Dr. Qiu was very happy, but very angry, pointing to say; "That comrade said it couldn't be repaired, and he didn't even want to take a look. I'm going to blame him. " Comrade khufu burst out laughing and said; "Doctor qiu, forget it, forget it! Is it not the same as your doctor? " Hearing this sentence, he couldn't help blushing a little, making a haha and saying goodbye. For decades, he has remembered this sentence: "Is it different from your doctor?" This sentence deeply inspired him and made his mood restless for a long time. In the future, he often asks himself whether we have an attitude and style of "no repair, no repair of parts" in our work, and the answer is "yes". As a master of repairing watches, you should think more from the standpoint of customers, and as a doctor, you should think more from the standpoint of patients. A responsible doctor often thinks more about his patients. Professor Wang Shiwen, director of the Institute of Geriatric Cardiovascular Diseases of the General Hospital of the People's Liberation Army and academician of the Academy of Engineering, once told a short story about how to obtain information, make a clear diagnosis and cure patients by re-inquiring the medical history. There was once a middle-aged male patient who had repeated fever for 9 months, and his temperature fluctuated between 37.8 and 39 degrees. No obvious positive symptoms were found in physical examination. During the 9-month hospitalization, 12 doctors were responsible for the treatment of patients. They have considered that patients may have various microbial infections and autoimmune diseases, and have done laboratory tests on various pathogenic microorganisms and immune system diseases, and the results are all negative. She is the 13 doctor in charge. After taking over, she carefully checked all the patient's medical records and re-inquired about the medical history, and learned that the patient had returned to his hometown in Inner Mongolia to contact the newborn lamb before the onset. At the same time, it is found in the reading literature that some authors believe that intravenous infusion of high concentration glucose can improve the detection rate of brucellosis. Sure enough, the laboratory examination was carried out again and brucellosis was diagnosed. After targeted treatment, the patient was quickly cured and discharged. First of all, it should be clear that serving patients as a doctor is the most fundamental problem. At present, many hospitals put forward the aim of "serving patients, facilitating patients and serving patients", the core of which is to serve patients. As Lu Shibi, an academician of China Academy of Engineering and the General Hospital of the People's Liberation Army, said: Doctors are a special profession. Because doctors directly serve people and patients, they come to see a doctor in the hope of getting help, so it is understandable that patients and society put forward some requirements and norms for the profession of doctors. The profession of doctor requires doctors to know not only natural science, but also some humanities, not only medicine, but also social science such as sociology, psychology and ethics. Chinese medicine stresses Confucianism and requires doctors to have certain literary literacy. It is no accident that Lu Xun, Guo Moruo and Sun Yat-sen all studied medicine. Doctors are a special profession. He should not only learn knowledge well, but also be a "person" and have good medical ethics. In addition to abiding by professional ethics, we must also be bound by public opinion and law. Doctors should respect patients, and patients and society should also respect doctors. It is not difficult to be a doctor, but it is not easy to be a good doctor. We often say: noble medical ethics, exquisite technology and satisfactory service are the basic conditions that an excellent doctor should have, but a doctor with noble medical ethics is almost unprofessional, and loving his post and dedication is the touchstone of noble medical ethics.
Diligence is the cornerstone of success.
"Diligence" enables you to continuously acquire knowledge from practice. "Diligence" can help you discover new problems and find out the regular things. "Diligence" can also be said to be an opportunity created by oneself. This opportunity is to increase knowledge, enhance the ability to solve problems, and even solve medical problems unprecedented, which will promote the development of medical science. This opportunity will make you famous and have a family. Behind fame and family background is hard work and superhuman efforts. Diligence is mainly reflected in the following three aspects of learning. An excellent doctor has been learning from books, patients, teachers and others all his life, which is the basic source for doctors to acquire knowledge and skills. As a young doctor, we should keep learning, master knowledge and form the habit of reading. Clinical medicine is an empirical science, and present medicine is the result accumulated by predecessors through thousands of years of scientific practice. Books and documents record the experiences and lessons gained by predecessors. Reading literature is to absorb the essence of its achievements to enrich and improve yourself. If you want to have profound knowledge, you must keep on studying and reading. In addition to mastering the basic theories, knowledge and skills of your own discipline, you must first understand the frontier knowledge of your discipline. Only in this way can we find something in our work and achieve something. Professor Han Qide, academician of China Academy of Sciences, vice chairman of the National People's Congress Standing Committee (NPCSC) and former doctoral supervisor of Peking University, chose molecular biology as the frontier basic discipline in his initial work, thus making important achievements in the basic research of cardiovascular system, especially in the research field of a 1-AR subtype. There should be a way to read. Many famous scholars often choose and synthesize special topics on the basis of browsing, understand the viewpoints, methods and development trends of a certain problem at home and abroad at that time, analyze its ideas, background and conditions, think carefully with their own experiences and cases, and draw conclusions. The second is to serve patients seriously and learn from them. It is not enough for a young doctor to grow up only by book knowledge. Medical students who just graduated from medical school are not doctors. Must go through the training process of residents and attending doctors. The process of understanding diseases is the process of practice and understanding again and again. Otherwise, it is impossible to improve the medical level. The third is to learn from teachers and others. There must be a teacher in a threesome, and the teacher may not be superior, and the disciple may not be inferior to the teacher. Wen Dao is orderly, and the book industry is specialized. That's all. Medicine is empirical medicine, and medical knowledge can only be truly learned after being tested by clinical practice. Teachers or superior doctors play the role of inspiration and training. This teacher has rich experience. He taught his own views and experiences in ward rounds and teaching, just like Haiyan fed a small Haiyan with half-digested sea fish in her stomach. Teachers often talk about the experience distilled through the tests of success and failure. These experiences cannot be found in books. Learning from the teacher is not only learning knowledge, but also learning his thinking in the process of diagnosis and treatment and the way he does research. The concept and way of learning is a key that can open the door to the treasure house of knowledge. The idea is that doctors can use their own medical knowledge to comprehensively analyze the condition from the patients' symptoms, signs, laboratory tests, imaging and other complex manifestations, and get the correct diagnosis and the best treatment plan. The most important content of learning also includes practice and accumulation.
3. Maturity needs to be honed, accumulated, pondered and summarized:
Knowledge lies in accumulation and ability lies in practice. There is no genius in clinical medicine. It is difficult to become a qualified doctor without more than 5 ~ 10 years of clinical training, because it takes time and experience to really understand clinical medicine. With the accumulation of experience, people's thinking activities will change qualitatively after a certain period of time, and they will not be afraid of the clinical manifestations and pathophysiological changes of patients, especially severe patients, and can make clear judgments and appropriate treatments in a short time. It seems that in a unit or a school, you can know many people, even dozens or hundreds, and you can basically distinguish them accurately. Why? Although you can't describe their characteristics, you can know who they are. This is a qualitative change caused by long-term accumulation, and so is seeing a doctor. With the accumulation over time, we can find something from the accumulation and gain something. Engaged in clinical and scientific research, only down-to-earth, hard work, can gain something. Let's take a look at Professor Yuan Longping, the winner of the highest national science and technology award. How did hybrid rice come out? Is squatting in the ground and observing, observing for a day, two days, months, adults! If we go to see Professor Wu Wenjun again, he will still be in the computer room on New Year's Eve! When domestic computer research is very tense, the person who spends the most time on computers is not a graduate student, but Wu Wenjun. Let's look at Professor Wang Xuan's laser typesetting. It took more than ten years to make laser typesetting of Chinese characters. Let's take a look at the life experience of Academician Wu, the winner of the highest national science and technology award in 2005, who wrote myths with both hands. Wu is only 1.62 meters tall and stands on a small stool every time he goes to the operating table. A professor in charge of graduation homework once sarcastically said to him, "Can you operate without looking at your height?" This strengthened his determination to be a surgeon, and he finally arrived at East China Hospital at that time. His career as a doctor can be said to be a lifelong operation. As long as Wu is not on a business trip, he has surgery almost every day. Sometimes one, sometimes two, at most three, 80-year-old people stand in the operating room until 3 pm for lunch. In his life, he has operated on more than 13000 patients, and this number has not stopped yet, and it is still rising at a rate of about 200 cases every year. Hard work leads to true knowledge and practice leads to results.
4, think carefully, in order to find and innovate.
Repeated practice, careful observation and serious thinking can lead to discovery. For example, Academician Wu Jieping observed a large number of renal tuberculosis in long-term practice, summarized and put forward the view that hydronephrosis would occur in the kidney opposite to renal tuberculosis, and rewritten the textbook at that time. Inspired by the disappearance or obvious decrease of urinary protein in patients with rheumatoid arthritis treated by tripterygium wilfordii, Academician Li Leishi developed a new tripterygium wilfordii immunosuppressant, which was widely used in clinic and attracted the attention of the international medical community. Professor Zhang Tingdong of Shanghai and Academician Zhu Chen of Shanghai were inspired by the effective cases of arsenic in treating cancer, and developed arsenic trioxide injection for treating leukemia, which had great influence at home and abroad. The photo of his experiment was selected as the cover of American science magazine. During the period of SARS in 2003, when some experts at home and abroad disputed whether hormones could be used in the treatment of SARS patients, Zhong Nanshan, based on his own clinical experience and lessons, thought that hormones played an obvious role in alleviating the inflammatory reaction of SARS patients, alleviating and preventing pulmonary fibrosis, relieving dyspnea and preventing respiratory failure, and explored and standardized its application indications, dosage and course of treatment, so as to improve the success rate of SARS patients' rescue and reduce the mortality and infection rate.
5. Science needs the spirit of seeking truth from facts.
Medicine is a natural science, science needs the spirit of seeking truth, and science needs the test of practice. Professor Zhong Nanshan, Director of Guangzhou Institute of Respiratory Diseases and Academician of China Academy of Engineering. He is a model of being scientific and realistic in China today, and he is also a respected excellent doctor. At the beginning of SARS in 2003, Academician Ceng Guang, the chief expert of China National Center for Disease Control and Prevention, officially announced that according to his experimental observation, the pathogen of SARS was chlamydia. This conclusion makes many people breathe a sigh of relief, because chlamydia is a known pathogenic microorganism and has a mature treatment method. However, based on his extensive clinical observation and experience in diagnosis and treatment, Zhong Nanshan disagreed with this conclusion, believing that if this conclusion is used to guide clinical practice, it will lead to serious consequences. At a meeting, he stood up and made it clear that he was arguing. Later, someone asked him, aren't you afraid that misjudgment will damage your reputation? Why not choose silence in front of authority? Zhong Nanshan said; "It's a matter of the patient's life, and I decide to prevent and treat it. I can't protect myself; In the face of facts, I can only respect science, but not "authority". On April 7th, 2003, they and HKU first isolated two strains of novel coronavirus from the tracheal secretions of SARS patients. Unfortunately, the release date is a few days later than that of the United States.
6. Training and thinking methods related to three basics and three strictness are the foundation of success.
6. 1 Three basics and three strictness training is very important for medical students. In this training process, they can master the correct learning methods, exercise keen observation, enhance understanding, form the habit of independent thinking and pursuing new knowledge, and their future development will be broad. Standardized training of residents is an important stage to acquire three basic knowledge. If medical college graduates can be assigned to teaching hospitals or other hospitals with better conditions, they can be residents for two or three years, be directly responsible for the diagnosis and treatment of patients under the guidance of superior doctors, learn to observe patients and be familiar with diagnostic techniques, and then be assigned to medical units when they are mature, laying a good foundation for future work. Why the students graduated from Union Medical College have a solid foundation is related to their long-term adherence to the standardized resident training system.
6.2 Professional training plays an important role in the growth of doctors. With the rapid progress of science, our knowledge needs to be updated in time and advanced technology needs to be introduced. Many famous experts in contemporary China have received good professional training, especially studying abroad. For example, Professor Hu Dayi, a famous cardiovascular expert in contemporary China, Academician Zhu Chen, a famous genetic engineer, and Professor Liu Zhihong, a famous nephrologist in Nanjing General Hospital of Nanjing Military Region, etc. They all studied abroad, mastered the latest knowledge and skills, and made professional achievements through hard work after returning home.
6.3 Only by understanding the pathogenesis and pathophysiology of the disease can we provide more reasonable medical services for patients. For example, in the treatment of diabetes, it is necessary to understand the insulin secretion characteristics of normal people and diabetic patients. Under normal physiological conditions, the two different secretory states of-fasting and postprandial cells are: fasting,? -Pulsed secretion of insulin by cells, about 65,438+0 U/h, about 24u in 24 hours, is called basic secretion, which mainly inhibits glycogen production and glucose output in the liver and maintains fasting blood glucose at a reasonable level; After eating, blood sugar rises and stimulates? -Cells secrete a lot of insulin to cope with the increase of blood sugar after meals. The insulin secretion of normal people without IR is 6-8u per meal, so the total insulin secretion after three meals a day is about 40u, of which the basic amount accounts for 40-50% of the whole day's secretion. In DM patients, if exogenous insulin replacement therapy is needed, the endogenous islet function often loses more than 80%; Or severe IR, although the endogenous islet function loss is not very serious, but the insulin is relatively insufficient. Therefore, for patients with type 2 diabetes who still have partial islet function, it is reasonable to take oral hypoglycemic agents and appropriate insulin or premixed insulin preparations twice before going to bed. Pathological study of acute cerebral hemorrhage showed that brain edema appeared after 3 hours, reached the peak on the 2nd-4th day, and decreased obviously after the 7th day, and the severe cases could be delayed to 7- 10 day. Therefore, the dosage, usage and duration of mannitol in acute cerebral hemorrhage should be determined according to the classification of diseases and the evolution of brain edema. For example, for severe patients (Grade III-IV), that is, moderate to deep coma, complete hemiplegia, unequal pupils, obvious changes in vital signs or aggravation of illness (in which coma deepens, knee reflex or muscle tension gradually decreases, and contralateral pyramidal tract sign or neuroticism appears). ), you can use high-dose mannitol 250ml/ time, 4-5 times a day, and you can use high-dose mannitol within 7 days of onset. When the systolic blood pressure is higher than 24KPq, furosemide should be used to adjust the blood volume first, and then mannitol should be used to avoid adverse reactions that lead to the increase of blood pressure.
6.4 Constantly update knowledge, adopt schemes or drugs suggested by evidence-based medicine or relevant guidelines and principles, and provide patients with more reasonable treatment. For example, in the prevention and treatment of systemic arteriosclerosis and hyperlipidemia, especially hypercholesterolemia or mixed hyperlipidemia, revolutionary statins should be recommended as the first choice. Re-evaluating drug-eluting stents and standardizing the use of interventional techniques have provided more convincing evidence and principles for the 2006 World Cardiology Congress and the European Cardiology Congress. At present, it is considered that the earlier the intervention for AMI, the better. Time is the heart muscle, and time is life. Unstable angina pectoris should be stratified first, and high-risk patients should be intervened as soon as possible, and antithrombotic drugs (clopidogrel, aspirin, low molecular weight heparin, statins and beta blockers) can be used first. Intervention within 72 hours is too radical, because it may increase the risk of myocardial infarction and death in non-high-risk patients, so we should pay attention to the recently introduced "early risk" phenomenon. The indications of stable angina pectoris should be strictly controlled, and interventional therapy should not be overused. For macrovascular diseases > 3mm, cheap BMS should be used, and DES can be used for diabetes, small blood vessels and long diseases, each accounting for about 50%. For patients with left main artery and multi-vessel diseases, especially those with diabetes, bypass surgery should still be considered first.