When the Doctor Uses A Hack

“I’m telling you, Chen Cang is an amazing lecturer. I’ve heard others talk about thoracic puncture before, but compared to Chen Cang, they’re far behind!”

“The key thing is, he’s also really handsome!”

“Really? Is it that exaggerated?”

“It’s even more than that. Yesterday, a group of us, maybe fifteen or twenty, asked him questions and he knew everything! I feel like, when it comes to thoracic puncture, Chen Cang is unrivaled!”

“I’ve heard Chen Cang is still single!”

“He’s on the staff at Xiehe Hospital, currently sent out to pursue graduate studies. Handsome, works at a good unit, and is a nice guy—go for it!”

…

A few trainee girls chatted merrily; they weren’t even supposed to attend today’s training but came back just to listen again, just like in college when everyone would flock to a class taught by a good-looking and popular teacher!

In fact, among those attending the residency training, many were already graduate students, but they hadn’t obtained their training certification at the time of their graduation.

Now, to be a doctor, one must have the training certification—just as important as the medical practicing license. Without it, you can’t advance to a mid-level professional title.

To put it plainly, without the training certification, you can’t be promoted to attending physician.

So, many people are participating in the training.

However, the gender ratio of medical students becomes apparent at this point.

Out of ten people, there are seven girls and three guys.

So, it’s relatively easier for guys to find a partner in medical school.

…

As a group of people pushed their way into the thoracic puncture room, they suddenly noticed a man already standing inside.

This man… his oily hair attempted to hide the reality of his balding scalp, and his new white coat struggled to contain his protruding belly, giving off a greasy appearance…

Immediately, those ready to sign in hesitated!

This person couldn’t possibly be Chen Cang, could he?

“This is Chen Cang? So… abstract?”

Even those who had come the day before were taken aback: “No way! Chen Cang is my classmate; I’d recognize him. Who is this guy?”

A few of them signed their names reluctantly, each one curiously eyeing Shi Qi.

They were already here; it’s not like they could just leave, could they?

Seeing almost everyone had arrived, Shi Qi opened his PowerPoint with a Wu Yanzu-like smile, “Well, welcome everyone to Xiehe Hospital. I’m Shi Qi. Today, I’m going to talk about the procedure and considerations of thoracic puncture.”

“Perhaps you’re not very familiar with me, but you’ll get to know me over time. I used to be the head of the thoracic surgery department in our hospital, and after continuous reforms, I was moved to the breast surgery department. When it comes to explaining thoracic puncture, I believe I’m probably the most suitable person in Xiehe Hospital, right?”

At this point, Shi Qi chuckled at his own perceived humor.

“Thoracic puncture is utilized a lot in clinical settings, and it’s very important for medical workers. Everyone here is the future of medicine, so mastering such a skill is quite necessary.”

“I’m normally quite busy, but when I received the invitation from the residency training center, I thought this was more important, so here I am, let’s get started…”

The materials Shi Qi was using were left behind by Li Shijian, who often trained with Chen Cang in thoracic surgery, so he had all the materials prepared.

Shi Qi now planned to become a director at the residency training center since he couldn’t move up in the breast surgery department — the old director wouldn’t retire, and besides… he didn’t really want to practice clinically anymore.

He had already served three years as the director of thoracic surgery; three years like a salted fish — who would choose such a hard life over that?

Being a director at the residency training center, in charge of hundreds of students, seemed much more comfortable and relaxed.

Shi Qi’s lecture was… by the book, just like a grading rubric, very standard, very official.

“`

Everyone seemed to be listening quite well.

However, those who had listened to Chen Cang’s lecture yesterday suddenly felt somewhat unsatisfied.

Without comparison, there’s no awareness of the disparity. Sometimes, the level of a clinician can be seen through their explanations—some are insightful, while others are just dry and bland.

But thinking that the person was the former head of thoracic surgery, everyone still felt he must be quite skilled, perhaps just not good at explaining.

So they listened patiently and, after the lecture, Shi Qi looked at the audience and asked, “Any questions?”

At that time, someone asked, “Teacher Shi, the 2010 British Thoracic Society guidelines for pleural diseases state: ‘For malignant pleural effusions, the volume of fluid to be removed during therapeutic thoracentesis should be based on the patient’s symptoms at the time, and a single session should not exceed 1500ml. However, you just mentioned that the initial removal should not exceed 700ml, and subsequently should not exceed 1000ml. Xiehe Respiratory Medicine believes the initial extraction should not exceed 600ml, and subsequently no more than 1000ml. Domestically, we’re more conservative on the initial volume; why is that?”

As soon as this question was out!

Most people in the room were stunned!

This question was impressive!

It was evident that the person was an expert!

Because editions five, six, seven, and eight of internal medicine texts all state that the initial extraction should not exceed 700ml, and subsequently no more than 1000ml, but it seems that no one has really asked why!

Shi Qi was taken aback; it was a good question. He pointed to a girl in the front and asked, “What do you think about this question?”

The girl hesitated, “I used… the eighth edition of ‘Internal Medicine’ to study…”

As soon as she said this, everyone around was taken aback and then burst into laughter.

Shi Qi also smiled and said, “Because extracting too much fluid too quickly can cause re-expansion pulmonary edema, so relatively speaking, we are more conservative than abroad.”

The girl was stunned, “Then aren’t they afraid of exceeding 1500ml for the first time abroad? Is the difference between our country and others just because we’re more conservative in our thinking?”

Shi Qi paused for a moment, “Every guideline is based on an understanding gained through a large number of case experiences and evidence-based medical research; I think we should respect the guidelines.”

At this time, a girl suddenly raised her hand and said, “Teacher Shi, actually, these values have a basis, and they are not fixed values.”

“Physiology tells us that the average total lung volume for an adult male is 5000ml, which includes a vital capacity of 3500ml + a residual volume of 1500ml. From this we can infer that the thoracic volume should also be about 5000ml, so one side of the thoracic cavity is approximately 2500ml.

For a patient with a large amount of pleural effusion, extracting 1000ml at once from one side, which is 2/5 of the volume, is quite significant. If 1500ml is removed at once (from one side), it would be 3/5 of the volume of the thoracic cavity, and this is basically a line that cannot be crossed.”

“Evidence-based medicine statistics show that Europeans and Americans are taller and bigger, which is an undeniable fact. Correspondingly, their thoracic volumes are also larger than ours, so it’s understandable that their upper limits for fluid extraction are higher.”

“And the true meaning of the guidelines is not to emphasize this numerical value; it is merely a threshold. In clinical practice, in fact, the ‘700ml, 1000ml’ cannot be immutable because each patient’s age, body type, and condition are different. We can’t rigidly adhere to these two numbers; more important is to constantly observe the patient’s condition. The same is true abroad; guidelines provide a broad range. Every physician should continuously observe the patient and adjust the volume accordingly.”

The girl’s voice was not loud, but it quieted the room.

Her words were crystal clear, plainly explaining the significance of the thoracentesis fluid extraction values, and suddenly everyone understood, feeling a sense of sudden realization.

So that’s why!

Even Shi Qi felt enlightened, appreciating the excellent explanation. So that was it.

Unable to hold back, Shi Qi praised, “This student, well said! You have a solid understanding.”

That girl actually didn’t intend to say it, but she slipped it out without restraint, naturally not expecting such a big reaction. Seeing everyone looking at her with awe, she blushed a bit.

“Actually… it wasn’t me who said it, it was Professor Chen who taught it,” the girl said shyly and then pointed to her classmates beside her, “Ask them, they know too!”

Several classmates nodded in agreement, “That’s right, Professor Chen has taught us that.”

Everyone was suddenly taken aback!

Who was this Professor Chen?

That Professor Chen?

Even Shi Qi was clueless, wondering who Professor Chen was. It sounded familiar.

“`

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