How to be a doctor with noble medical ethics ① Yu Zhuowei, former director of East China Hospital: "Little apprentice" of "great experts", today
[Editor's note]
A hundred years ago, the famous medical educator in China, Yan Fuqing, defined modern doctors as follows: "We believe that those who become doctors must have the spirit of sacrificing themselves and serving society, serving the medical industry, and not having the mentality of promotion and wealth. If someone studies medicine for the purpose of serving humanity and the public interest, this is the best."
For a hundred years, generations of white angels have protected the health of the children of China. Since the liberation, the average life expectancy of Chinese residents has increased from 35 years to 78.2 years, and the achievements in health are evident to all. Mr. Yan Fuqing's definition of a doctor back then was brilliant, but it still holds great significance today - to be a noble doctor, with the sole goal of promoting the health of the population. Starting from today, the Liberation Daily Shangguan News will successively publish medical experts and lifelong professors who possess both moral integrity and talent, telling the story of how doctors can establish a noble professional outlook in the new era.
Inside the dark canvas bag was a neat stack of folders, with slightly yellowed old newspapers and documents filled with handwriting; The medical history record printed in enlarged font size three is at hand, sometimes picked up to examine, and sometimes raised to encourage everyone to speak; Black pants and black running shoes conceal the inconvenience caused by long-term knee strain, but most of the time he refuses to be supported, let alone crutches.
This is an ordinary yet extraordinary elder. On the first Friday afternoon after the Teachers' Day, Yu Zhuowei, the former president of East China Hospital affiliated to Fudan University and the national model worker, went to the community health service center of Zhoujiaqiao Street, Changning District, and sat around with family doctors to analyze difficult cases and guide the writing of medical records. Two hours passed quickly, and towards the end of class, the family doctor took out a large bouquet of flowers that had been prepared early and handed it to Yu Zhuowei. "Thank you, Dean Yu, Teacher Yu!"
In 2013, Yu Zhuowei, who was then the director of East China Hospital, went to the grassroots level. At that time, Zhou Jiaqiao vacated a small room in a limited space, and a team of experts led by Yu Zhuowei signed a contract with family doctor Chen Hua, who was also a model worker. No matter how busy his job was, he always insisted on teaching and training at the Innovation Studio. In a blink of an eye for 10 years, even though he claimed to be "unleashing his potential", he still did not change his original intention. "Watching the level of family doctors getting higher and higher is my greatest comfort."
Thinking about Life in the "Imperfect" Lecture
The lecture notes for this time come from an unsuccessful case: Mr. Miao, who is 88 years old, was admitted to the Zhoujiaqiao Social Health Center due to pleural effusion. However, at the end of July, he had three episodes of bright red rectal bleeding. After conducting blood tests, the possibility of digestive tract tumors cannot be ruled out. It is recommended that family members transfer to a higher-level hospital for treatment. B-ultrasound shows that Mr. Miao has a mass in his upper abdomen and multiple enlarged lymph nodes in his groin. However, due to considerations such as advanced age, the family refused further examination, and the patient passed away 2 weeks later.
"We feel very regretful. This review is actually to trace back to where we can do better. If the family is willing to cooperate with the treatment, what further help can we provide?" After the attending physician Liu Can reported the medical history in detail, Yu Zhuowei nodded. "The patient's final condition can be discussed together, whether it is a digestive tract tumor or any other more fatal symptoms?"
As if returning to the classroom of his student days, Yu Zhuowei demanded that every family doctor who participated in the training speak up. The atmosphere gradually became lively, "blood like stool should not be directly related to tumors in the upper abdomen", "the patient's gastrin releasing peptide precursor index has been increasing", "his blood sugar is only 2.6, and his uric acid and creatinine indicators have also increased", "In addition to a large amount of pleural effusion, there is also serious renal dysfunction"
Most of the time, Yu Zhuowei played the role of quietly listening, until the summary section, like threading a needle through a thread, he shared his thoughts with everyone's analysis. "Everyone has explained it in great detail, but there is one small point: severe hypothyroidism can also cause pleural effusion, with a mortality rate of up to 30% to 50%, and can also lead to a decline in multiple organ function throughout the body. So, why is thyroid function declining? Tumors are one of the causes. Patients' lymph nodes may also be a manifestation of malignant lymphoma in the stomach."
"To be a doctor, one needs to delve deeper and constantly reason, have correct thinking, scientific examination, and accurate conclusions in order to provide patients with as much help as possible." Yu Zhuowei paused, "The examination indicators are our assistance. As considerate people at the doorstep of residents, our advantage is that we can spend more time understanding patients. Some necessary and unnecessary examinations may bring different outcomes."
Why are experts obsessed with dealing with communities
Being a grassroots helper, starting as a referral and recommendation person, and becoming a skilled diagnosis and treatment expert are often spoken by Yu Zhuowei, and they are also his requirements for his "little disciples". Wang Wenwen is now the Deputy Director of Huayang Street Community Health Service Center. When she worked as a family doctor in Zhoujiaqiao, her contracted resident Aunt Xu Lijun was a beneficiary of Yu Zhuowei's weekend teaching clinic. "Auntie was the last patient of the day, carrying a thick test report. Dean Yu first picked up a stethoscope and carefully examined her body. When describing the details of the disease, he never interrupted."
My heart is about to jump out, my blood pressure is very high, and I can't detect any problems, but I feel anxious and have chest tightness. A doctor has prescribed anti anxiety drugs for her, but there are many side effects, so Aunt Xu resolutely refuses to take them. What should we do? "I have a different idea," Yu Zhuowei said gently. "You know how to consider others and don't want to cause trouble for the elderly and children. When you get sick, you also go to see them alone, so the psychological pressure is still a bit high. I just heard that your heart rate is still a bit fast, just adjust the current medication first, and then observe for a period of time." Afterwards, he changed the patient's Betaloc to a sustained-release tablet with a longer duration, and the dosage only increased by a quarter. In just a few days, Aunt Xu's symptoms improved significantly. "In general practice, treating patients as a whole is a concept that Director Yu embodies every time he conducts ward rounds."
Ruijin Hospital has 18 years of deep cultivation, and East China Hospital has 13 years of leadership. Many people and even colleagues have been puzzled: why is this expert from Shanghai's top tier tertiary hospital obsessed with dealing with the community? "I have been working in Guizhou for 16 years and can be said to be the earliest general practitioner." Yu Zhuowei revealed the answer, "At that time, no matter what disease the people in the countryside and counties had, you had to see them. Later on, rescue consultations, medical management, and the construction of geriatric medicine also relied on a general practitioner mindset. Integrating medical resources vertically is the real way to benefit patients."
Be a good "doctor behind family doctors"
In recent years, Yu Zhuowei's knee joint disease has become increasingly severe, but he has never made up his mind to undergo replacement surgery. "It will take a long time for me to recover after a knee replacement, but my work won't be delayed for that long. I still want to do more while I have more energy and can barely move."
Being idle is the evaluation of many people and students around him. Yu Zhuowei's medical principles are clear and simple: adhering to public welfare, both inside and outside the hospital. In April 2006, under its leadership, East China Hospital took the lead in cooperating with neighboring grassroots healthcare institutions in Changning District. This not only filled the shortage of resources in tertiary hospitals in the area at that time, but also provided comprehensive technical and professional support. 67 experts with vice high or higher professional titles paired up with 10 communities, and Yu Zhuowei also took advantage of holidays to stay in the community and listen to the needs and difficulties of frontline family doctors.
In those years, "graded diagnosis and treatment, two-way referral" was still a trendy and fresh term, and residents still "couldn't figure it out" when they went to tertiary hospitals with appointment forms. How could they truly achieve referral? Yu Zhuowei gave everyone confidence: In 2013, East China Hospital took the lead in setting up a "community two-way referral office", dispatching dedicated personnel to receive referral patients to avoid residents having to spend too much trouble. Chen Xiaoyi, the director of the referral office, said that in 2017, the hospital established a green channel for referral fees and also opened a WeChat appointment platform, allowing family doctors to make online appointments for large-scale examinations across hospitals, truly bringing scarce expert accounts to the community.
How should family doctors position themselves? Yu Zhuowei, the gatekeeper of basic medical care, the executor of public health, the head of health management, the trustworthy person of rehabilitation nursing, and the implementer of balancing Chinese and Western medicine, has made unequivocal demands. "I want to be a grounded doctor, and I also want to continue being a doctor behind family doctors."
