Attended a lecture on Wednesday, where Chief Surgeon Wang Guang talked about the differential diagnosis of acute abdomen. I won’t get into the specific knowledge points but will record some key highlights.
Accurate
Teacher Wang first made us clarify the concept: what is acute abdomen? This point was emphasized throughout. For any confirmed diagnosis, it must meet the concept. Surgery doesn’t have so many cases pending investigation; there must be a diagnosis upon discharge.
Wide
Then the teacher asked a question that he asks every year when interviewing students: Now there is a young male patient with acute onset of upper abdominal pain. Whether internal medicine or surgery, what diseases can you think of?
The teacher prompted us to start from nerve distribution. Shamefully, I had already forgotten it all. The teacher sighed and turned to the next slide with his answers — a whole page full of disease names, at least twenty, from all aspects, many of which I couldn’t think of. And this was only part of it; the other half was not written on the PPT.
The teacher said: Each time during interviews, when students say a few words, I immediately know their level, whether they have a general approach — it’s obvious at once. Students, please think about this question well after class; if you can answer it fully, your internal medicine and surgery skills will have reached a certain level.
I hope that in three years, I can name fifty diseases.
Fast
The teacher said that many surgeries in surgery involve bleeding that sprays outward, and blood transfusion is too slow; the bleeding point must be found and stopped as soon as possible. This kind of hands-on experience makes every surgeon appear swift and decisive.
Last night, it rained in Beijing just as I exited the subway to go back to school. The rain was getting heavier — either hurry up and walk, delaying a second would make it harder to walk, or wait until the rain lessens before setting off. Gathering information, I checked the weather forecast: rain would continue and not lessen soon. Made the decision not to wait but to set off quickly. Calmly executed — since I was already out, even if my shoes and pants got wet, I had to hurry back, constantly watching for puddles and slopes. Although in a hurry, I had to be steady.
At that moment, I felt as if the chief was possessing me, proud of myself for swiftly deciding and acting calmly.
Confidence and Responsibility
The teacher told a case: for some patients, palpation and percussion give one impression, but test results show another. He asked, in this situation, what do we do? Trust yourself or the report?
Seeing our dilemma, the teacher told us to trust ourselves because the surgeon is the primary responsible person. If something happens, no one else, including the lab technicians, will take the blame for you. Your own matters, you are responsible; your judgment, you must believe in it.
It seemed clear when I heard it, but on Saturday at outpatient, I almost messed up — the clinic was busy, and the teacher asked me to handle a patient. As routine, I tried to pull up previous records to copy, which showed a fracture with no prior treatment — so no way to just copy. I asked a senior colleague what to do, but he was also busy, told me to proceed according to the joint injection process. I was confused but ultimately didn’t say it was a fracture and not arthritis; I wondered if the senior had seen the patient before. Finally, I wrote out a joint injection prescription. Before saving, the teacher came back, saw the mistake, and quickly corrected it.
Your own matters, you are responsible! That’s when it truly sank in.
Others
Teacher Wang also said:
Students in the future, when specializing, will have plenty of time to study and deepen knowledge, like me, who has been doing surgery for forty years. But now students have this chance to change specialties — in the future, there will be no such opportunities again.
Also, some internal medicine chief once said:
The biggest regret in my life is that I didn’t go to the surgical operating table when switching specialties; afterward, I never did.
Internal medicine taught me moderation; surgery taught me precision, decisiveness, and calmness. I hope everyone diligently seeks diverse knowledge and does not dislike a specialty based solely on others’ discussions or stereotypes.
Finally, you can also listen to a program we recorded a few days ago, hearing what the neurosurgery teacher thinks about traditional Chinese medicine and Western medicine.
Vol.6 Chat with Neurosurgeons in the Chinese Medicine Hospital about Traditional Chinese Medicine