You can't. Thesis is one of the important achievements of medical research and one of the important indicators to measure the level of medical scientific research and clinical practice. In the promotion of subtropical high schools, papers are one of the materials that must be submitted, and the quality and quantity of papers must meet certain standards. Discussion on difficult cases is one of the important methods to improve the level of clinical diagnosis and treatment. Through the discussion of difficult cases, we can promote clinicians' knowledge and understanding of diseases and improve their clinical thinking ability and diagnosis and treatment level. Although the discussion of difficult cases can be used as a part of medical research, it cannot replace papers. In the discussion of difficult cases, doctors only analyze and discuss the cases without systematic research and experiments, so they can't draw scientific conclusions. Therefore, the promotion of difficult cases in subtropical high schools cannot replace papers.