Classical principles in the medical profession must not be forgotten

Classical principles in the medical profession must not be forgotten

1. Don’t do any harm first.

This is the classical principle of introduction of people’s medicine. If you have not treated the patient well, do not give more promotion to the patient for complications caused by medical staff, unintended accidents.

For example: broken left arm but right hand surgery, the patient was hospitalized for pneumonia but had more complications due to drug overdose.

2. If you don’t know what to do, it’s best not to do anything.

If you stand in front of a patient and don’t know how to handle it, then seek help from your colleagues through consultation, from books… Don’t handle it out of habit, according to feelings because it may cause further harm to the patient. Beware of violating rule number 1.

The important thing is to know what you’re bad at, don’t know yet. The bad thing is that many people don’t know but think they know.

For example, a patient hospitalized with a thrombotic stroke has high blood pressure; the sudden and severe lowering of blood pressure will make the area of ​​cerebral infarction more widespread; and do more harm than doing nothing.

3. A dangerous disease must be thought of before a less dangerous disease.

A dangerous disease, if detected early and treated promptly, has a good chance of being cured.

For example, looking at a complicated peptic ulcer, one must think of ulcerative gastritis before peptic ulcer disease.

4. One must think of a curable disease before an incurable disease.

Many doctors think that the disease can no longer be cured and then give up, no longer trying to treat it. Relatives, upon hearing such an explanation, also let go and took the patient home to wait for death. In fact, many patients are sent home from one hospital to die but are saved at another hospital.

Example: Before a multifocal lesion in the liver, multifocal liver abscess must be considered and ruled out before considering metastatic liver disease. Similarly, before a multifocal lung injury, staphylococcal pneumonia should be considered before lung metastases.

5. Think of a common disease before a less common one.

When you hear a neigh, think of a horse before a zebra because horses are more common, so the probability of being correct is higher.

Example: When you see a patient with right iliac fossa pain, think of appendicitis before thinking of diseases such as Crohn’s disease, ileocecal tuberculosis.

6. When things are going well, keep acting the same.

If the patient’s condition is improving, do not change the treatment.
In fact, there are still cases where the disease is progressing well, but for some invisible, tangible or subtle reasons, the doctor changes the drug, adds another drug, and finally has a problem.

For example: a patient with pneumonia is responding well to antibiotic treatment, even though the results of the antibiogram do not support the antibiotic being used, the doctor must continue to use the old antibiotic, do not change the antibiotic.

7. When things are doing, but there are unfavorable developments, they must change their actions immediately.

If the patient is being treated and the condition progresses adversely, the cause must be found and treated immediately. It is not possible to keep the same treatment and wait for it to get better on its own.

For example: The case of a schoolgirl with a broken leg in Gia Lai, the disease has progressed abnormally, but the hospital still keeps the cast, no other treatment. By the time the powder was removed, it was too late.

8. Personalization in diagnosis and treatment:

Ordinary doctors treat diseases. A good doctor treats patients.

Each patient has a different body, physical condition, tolerance threshold, resistance and comorbidities.

The same disease, but in different patients can show different symptoms, different severity.

The same drug, but in one patient can be used, in the other is contraindicated; In one patient, a high dose can be used, in the other, a low dose must be used.

For example: Due to the different location of the appendix, appendicitis has many different forms in different patients: common, subhepatic, retrocecal, pelvic…

9. Attention must be paid to special patients: the elderly, young children and pregnant women.

I want to separate this issue from Principle 8 for emphasis.

a. Old person:

Symptoms are often vague (less pain, less fever…), or there are many comorbidities (heart, lungs, kidneys, stomach, joints…), poor endurance, poor resistance, easy drug overdose due to Poor liver and kidney function, easy side effects of drugs, abnormal psychology (or hide illness or sometimes worry too much, easy guilt, fear of death…).

For example, when treating hypertension, the goal blood pressure to be achieved in young people is < 140/90 mmHg, but in the elderly it may be higher than that. There are elderly patients, when blood pressure drops below 140/90, patients are dizzy, uncomfortable and they quit treatment immediately.

b. Children:

Symptoms are also often vague, the child is too young to speak, or the disease is inaccurate, note congenital diseases or associated obstetric trauma, poor tolerance, poor resistance, and easy overdose. medication (non-pediatricians often suffer from this), prone to side effects of the drug.

The younger the child, the more difficult it is to diagnose and treat.

c. Pregnant:

Symptoms also change, there are specific comorbidities (eclampsia, thromboembolism), some diagnostic tools and drugs are contraindicated in pregnant women (can’t take X-ray …) .

Example: appendicitis in a pregnant woman without abdominal pain in the right iliac fossa.

Note that some patients do not know they are pregnant.

There are diseases caused by the fetus, there are patients who have had it before, but during pregnancy, the pregnancy will make the disease worse. For example: hypertension, bronchial asthma, diabetes, thromboembolism…

Many diseases, diagnostic means, therapeutic interventions, and medications can affect the fetus, so it is necessary to carefully consider and consult carefully with the patient in advance to avoid complicated lawsuits later.

Note: At each stage of pregnancy, there are always different problems: the first 3 months are easy to miscarry, the second 3 months are easy to cause birth defects, the last 3 months are prone to premature birth, there are complicated diseases during labor. (amniotic fluid embolism, acute pulmonary edema, etc.)

Personal experience for doctors who are not obstetricians: give obstetric ultrasound as soon as the patient is admitted to the hospital if possible to see how the pregnancy is, whether the fetal heart is still or not, and then invite an obstetrician to see an obstetrician as soon as possible. good.

BS. From Quoc Thanh

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