Chapter 15: The Diagnostic Dilemma

The diagnosis represents the theoretical conclusion provided by the attending doctor, and the subsequent treatment plan will revolve around this diagnosis. A misdiagnosis could easily lead to a medical accident.

Out of responsibility for the patient, if there are doubts, one cannot simply fill in the diagnostic opinion.

He felt it necessary to check whether the patient had any previous medical history.

“Search Medical History.”

After entering four characters, the patient’s medical history details appeared.

“The patient has no prior history of heart disease, nor does any close family member within three generations.”

This indicates that there is no familial predisposition.

The patient’s heart must have been quite healthy in the past.

“Onset Details.”

He input another four characters.

Normally, this information should have appeared under the physical examination section, but it did not.

Only targeted queries would display such details.

Zhou Can gradually realized that the examiner had likely intentionally withheld some information or considered it unimportant and omitted it.

“Before the onset, the patient lost his job and divorced his wife. Alone and isolated, he suddenly experienced chest pain and difficulty breathing.”

When Zhou Can saw the patient’s details, his eyes lit up slightly.

Something just didn’t add up.

In hindsight, it seems the patient’s medical history and onset details weren’t shown.

Losing a job is bad enough, and it would undoubtedly drag down one’s mood.

Without any comfort at that time, his wife’s decision to divorce him only made matters worse.

The greatest grief is the death of the heart.

When a person is overwhelmed with sorrow and pain, it is easy for symptoms such as chest pain and difficulty breathing to emerge.

Zhou Can’s gaze grew more determined, his mind sharpening.

“Emergency: Chest pain, difficulty breathing, elevated troponin levels, and an ECG indicative of myocardial infarction. From the start, the candidates had prematurely jumped to the conclusion of acute myocardial infarction.”

Watching the candidates, smug and satisfied after filling in their diagnostic results, Zhou Can couldn’t help but shake his head.

These candidates were bound to lose points.

To confirm whether the patient had suffered a myocardial infarction, the most authoritative test is not the ECG or X-ray but a coronary angiography.

An X-ray cannot detect a thrombus.

Only a coronary angiography is the definitive and effective diagnostic method.

This procedure is usually performed by an experienced cardiothoracic doctor. A needle is inserted into the femoral artery at the top of the thigh, followed by the insertion of a guidewire.

The guidewire is advanced deep into the blood vessel until it reaches the abdominal aorta, then further pushed to the thoracic aorta, through the aortic arch, and finally into the coronary arteries.

Once the guidewire is successfully in place, a catheter can be threaded over it.

And then?

Contrast dye is injected through the catheter, which flows smoothly into the coronary arteries.

An X-ray is then taken, revealing the arteries.

It clearly shows if the coronary arteries are blocked or even where there is any narrowing.

Zhou Can decisively exited the diagnostic entry page and returned to the medical examination request page.

“Request a coronary angiography.”

He promptly submitted the new test request.

“Congratulations, you have earned additional points for supplemental testing.”

The examiner was truly despicable.

He had layered one confusing haze after another, requiring the candidates to possess immense self-control, high-level diagnostic skills, meticulous observation, and a responsible, rigorous attitude to dispel the confusion and uncover the truth.

No matter how much he complained, it couldn’t be denied that the examiner’s questions were top-notch.

They were designed to identify real elites from over 1,500 outstanding candidates.

This would allow Tuyu Hospital to recruit the most promising talents.

“Alright, I’m sure many candidates have filled in their diagnostic results. Now, please provide your treatment plans.”

A subtle, almost imperceptible sly smile appeared at the examiner’s lips.

It was clear that his scheme had succeeded, watching the candidates fall into the trap he had set with an expression of smug satisfaction.

Zhou Can ignored the examiner’s urgency and carefully examined the coronary angiography results.

The angiography revealed that the patient’s coronary arteries were normal.

There was no myocardial infarction.

A knowing smile spread across Zhou Can’s face.

“Just as I suspected.”

Next, the task was simple. In the diagnostic result page he wrote, “Patient’s heart is normal. The symptoms resembling a heart attack were due to severe emotional distress.”

After submitting the diagnostic results, the treatment plan page popped up.

He silently cursed the cunning examiner.

Once the previous test items were submitted, the system immediately released a score, confirming that those test items were correct.

But upon submitting the diagnostic results, no prompt appeared; it directly moved on to the treatment plan page.

Many candidates were likely kept in the dark.

It was the epitome of being set up by the examiner.

Candidates and examiners are natural adversaries, at least that was Zhou Can’s conclusion.

In the treatment plan section, he entered, “Suggest psychological counseling.”

Then he submitted his response.

Next was the long wait for the examiner to announce the results.

“Luckily, I upgraded the pathology diagnosis to level three; otherwise, I might have failed the first round of the interview.”

His gaze swept over the other candidates, some of whom were still diligently filling out their answers.

It went without saying—nine out of ten of those absorbed in their work had fallen into the trap.

The treatment plan for acute myocardial infarction was so lengthy that it would take at least fifteen to twenty minutes to complete.

From a medical standpoint, if the diagnosis is wrong, no matter how precise the treatment plan is, it’s all incorrect.

It was similar to the rule of multiplication.

If one factor is zero, however large the other factor, the result remains zero.

Bored out of his mind, he looked over at the nursing candidates’ recruitment area.

A group of youthful, attractive girls caught his eye.

Their presence lifted his spirits and even stirred thoughts of romance.

Over there, the candidates had also reached the interview stage, honing basic skills like injection techniques.

It’s particularly trying when a nurse with abysmal injection skills treats you.

Drawing blood, she could miss a vein for so many attempts. Even a simple intramuscular injection might feel like being jabbed into your bone, promising an excruciating agony.

Just as you’re about to complain, you see that the nurse is a young, pretty girl, and you find yourself holding back your words out of sympathy.

“Candidates who haven’t submitted their diagnostic results and treatment plans, please hurry—the final 60 seconds remain.”

The examiner’s voice brought Zhou Can’s attention back.

After announcing the final time limit, the candidates quickened their pace.

“Time’s up! Now you can view the scores for the pathology diagnosis.”

The candidates eagerly checked their scores.

“Ah… why did I only get 2 points?”

“Examiner, was there a glitch in the scoring system? I got every test item right, and my diagnostic results and treatment plan were flawless. How did I only get 5 points?”

“I also got 5 points. There must be an error in the scoring.”

……

The candidates began protesting, and chaos erupted in the examination hall.

Candidates for nursing and medical technology training turned to look over.

They wondered what on earth was going on.

“What’s all this noise about? Quiet down, everyone!”

The examiner bellowed in anger, and no one dared challenge his authority as the protesting candidates fell silent.

Yet the anger on their faces betrayed their deep dissatisfaction.

Without a reasonable explanation from the examination committee, they were bound to continue their uproar.

“Do you know why your scores are so low? The total score for the pathology diagnosis is 30 points, and candidates scoring below 10 likely only answered part of the test items correctly.”

The room fell silent in shock at his words.

Candidates scoring below 10 began re-examining the questions, desperately searching for any possible error.

“This can’t be wrong! The patient showed low blood pressure, elevated troponin levels, and an ECG indicative of myocardial infarction. Isn’t that clearly acute myocardial infarction?”

The candidates who answered incorrectly were left bewildered.

The examiner smiled slightly, “Pathology diagnosis cannot be based solely on appearances. What we see and hear can sometimes deceive us. We must discern truth from falsehood with our hearts to avoid misdiagnosis. By the way, did any candidate score full marks on this question?”