Rebirth 1977 Great Era

Chapter 1309 Why Did I Pass? A New Doctor's Reading Comprehension of Director Fang (Two Chapters Combined)
The patient in the examination room also sensed something was wrong. His previously calm expression instantly tensed, and his voice became somewhat flustered:

"Doctor, so... so how should I treat this illness? I was fine when I took blood pressure medication, but I feel terrible all over when I catch a cold, and I always have heart palpitations..."

Fang Yan first turned to comfort the patient, softening her tone and trying to reassure her:
"Don't panic. It's just that the prescription approach wasn't fully considered. We can adjust it in time and it won't affect the treatment."

After speaking, he turned back to look at Pu Shijie, his tone still serious:

“In this situation, we need to stop the antihypertensive medication first. Her current blood pressure fluctuations are partly due to the outward escape of deficient yang. Using antihypertensive medication again will only aggravate the yang deficiency. Moreover, the Chinese medicine used should absolutely not be Ma Huang Tang. It should be replaced with Ma Huang Fu Zi Xi Xin Tang, but the ephedra must be reduced to 3 grams. Add 6 grams of aconite to warm yang and dispel cold, 3 grams of asarum to open the orifices and relieve the exterior, 15 grams of danshen to activate blood and remove blood stasis, and 12 grams of poria to promote diuresis and reduce swelling. This way, it can relieve the exterior and reduce fever, warm and tonify kidney yang, and also take care of her cardiac function without putting extra burden on her heart.”

As he spoke, Fang Yan took the new prescription sheet and began writing rapidly, each word showing meticulousness:

"Ephedra 3g, Aconite 6g, decoct for one hour first, Asarum 3g, Salvia miltiorrhiza 15g, Poria cocos 12g, Glycyrrhiza uralensis 6g."

Hearing Fang Yan still offering advice, Pu Shijie felt a glimmer of hope.

Fang Yan then spoke to the patient:
"You need to be admitted to the hospital for your current condition. After taking the medication, don't cover yourself with a thick blanket. Just sweat a little. If you experience worsening palpitations, dizziness, or weakness after taking the medication, you must stop taking it immediately without delay."

The patient nodded and then prepared to go through the admission process.

After writing down the prescription, Fang Yan handed it to the nurse next to her and asked her to get the medicine.

Then he turned to look at Pu Shijie, his tone softening slightly:
“Your foundation is not bad, and you are familiar with classical formulas, but you are too fixated on the form of combining Chinese and Western medicine, which has caused you to lose sight of the core of TCM diagnosis. Among the contraindications of Ephedra Decoction, hypertension and heart failure are key points. You only apply the symptoms without differentiating the underlying causes and do not consider the patient’s constitution and underlying diseases. This is irresponsible towards the patient’s safety.”

Pu Shijie lowered his head, a layer of cold sweat beading on his forehead, his voice filled with guilt and lingering fear:
“Director Fang, I… I was so focused on ‘rapidly reducing the fever’ that I completely forgot about the effects of ephedra on blood pressure, and I didn’t even connect the deep, thready pulse with the pathogenesis of Shaoyin disease… If you hadn’t come in in time, I really…”

Fang Yan waved his hand and said:
"Being a doctor is like walking on the edge of a cliff. Lack of clinical experience and inaccurate judgment of complex pathogenesis are like a toddler learning to walk; there will always be times when they fall. When you see them fall, help them up, explain it clearly, and they will practice slowly."

There was no sarcasm in his dialect; it was more like a statement of fact. He then shifted his tone, his voice becoming unusually heavy:

"But some mistakes are ones you can't afford to make even once. Especially fundamental errors in diagnosis, and especially ignoring life-threatening contraindications."

He pointed again to the medical record and the invalid prescription:
"Today, you saw the surface symptoms of chills and lack of sweating, but you overlooked the underlying deficiency of Shaoyin Yang and decline of Mingmen fire hidden beneath the deep, thready, and weak pulse. You only thought about quickly relieving the exterior and reducing fever, but you completely forgot the ironclad rule that ephedra is contraindicated for patients with hypertension and heart failure! This is not a lack of knowledge, but a mistake in basic judgment, and even more so, a sign of underestimating the risks to the patient!"

The voice, though soft and low in dialect, struck Pu Shijie's heart with every word:

"Treating illness is not a simple, quick formula, much less a matter of blindly applying Western medicine and adding a Chinese herbal prescription that looks like it! Its core is based first and foremost on accurate TCM diagnosis! If you don't even understand the basics of TCM itself, and can't even adhere to the fundamental principles of which patients cannot use which medicines, then it becomes a tree without roots, water without a source, or even a deep abyss where you fall into a hole!"

He looked at Pu Shijie's increasingly pale face, refrained from further accusations, but his final conclusion was resolute and unquestionable:
"It is fortunate that you were able to stop the operation in time today, which is both the patient's and yours. But it also clearly illustrates a fact: Peking Union Medical College Hospital's Department of Traditional Chinese Medicine needs doctors who can safeguard this bottom line of life and death."

The tone of the dialect eventually softened a bit:
"So, Dr. Pu, I'm sorry to say you didn't pass today's test."

Pu Shijie's shoulders slumped abruptly, his hands unconsciously clenching the hem of his white coat until his knuckles turned white. He lowered his head, his gaze falling on the grout lines in the clinic floor tiles. His Adam's apple bobbed, as if he wanted to say something, but he found his throat tight and could only manage a few dry, breathy sounds.

Although he had known for a long time that this might be the outcome, he still felt somewhat saddened upon hearing it now.

However, this was indeed his problem.

Fang Yan said to him:
"This is not to say that what you have learned is useless, nor is it to deny your future potential. It's just that right now, your risk management and fundamental understanding of dialectics do not yet meet the strict standards required by the Department of Traditional Chinese Medicine at Peking Union Medical College Hospital when facing complex situations."

Seeing his distraught state, Fang Yan didn't continue with her harsh words. Instead, she picked up the discarded prescription for Ephedra Decoction from the table, folded it twice, and stuffed it into Pu Shijie's white coat pocket.

"Take this and take a good look at it when you get home. It's not so you can remember this failure, but so you can remember that behind this prescription is a patient who could have been in danger because of your negligence."

Pu Shijie finally raised his head, his eyes a little red, his voice trembling with barely perceptible sobs: "Director Fang, I..."

"Alright, that's enough!" Fang Yan waved his hand. He had already done more than enough. If he didn't want to maintain his image, he could have cursed this kid's ancestors for eighteen generations.

Pu Shijie stood up and bowed deeply to Fang Yan:
"Director Fang, thank you. Although I didn't pass the assessment, what you said today is more useful than studying for half a year at school. I will go back and study the Treatise on Febrile Diseases more, and follow my teacher to do more clinical practice. If I have another chance next time, I will definitely not make this mistake again."

After Pu Shijie left, Fang Yan directed the other patients to Du Heng and Deng Nanxing's consultation rooms.

He continued to observe the other clinics.

At this point, no one knew about Pu Shijie's condition; everyone was focused on the last few patients.

Fang Yan checked their medical records and found that they had encountered patients who had not been cured by Western medicine and came to traditional Chinese medicine in the morning. However, the remaining five patients were all treated honestly according to the rules and did not ask them to use the combination of traditional Chinese and Western medicine.

Their thinking is quite simple. Since your previous Western medicine treatment didn't cure you, it means there's a problem. I don't know what the problem is, but you have to stop taking the medicine for me. I'll treat you according to my own method. If it doesn't cure you, that's my problem, but you have to stop taking the Western medicine!

Otherwise, I wouldn't be able to say for sure whether it's a problem with the Western medicine or my Chinese medicine.

The patients in the next few consultation rooms finished their treatment one after another, and everyone came out with their medical records and notes.

Fang Yan was already standing outside waiting for them.

"Director Fang!" Zou Guoqing was the first to come up with the medical records and handed them to Fang Yan.

Fang Yan looked at Zou Guoqing with a subtle expression. He had actually read all of everyone's medical records today, and this guy was just trying to show off by handing them over.

They certainly don't miss any opportunity to show off.

Zou Guoqing smiled at Fang Yan.

Fang Yan turned to one of the pages and pointed to the medical record, saying:
"Dr. Zou, the asthma patient referred from the Western medicine clinic, you immediately abandoned the old prescription for cough and asthma relief and switched to Ma Xing Shi Gan Tang with American ginseng for emergency treatment. Your priority in treating the patient is commendable, and your choice was also decisive and worthy of praise."

Zou Guoqing was delighted and brought up the most noteworthy thing that happened at noon today, speaking in his local dialect.

This is an affirmation of him!
But before he could answer, Fang Yan changed the subject and said:

“But what does the medical record say?” He tapped Zou Guoqing’s medical record with his fingers.

Pointing to the top in dialect, he said:

"Western diagnosis: acute phase of asthma; Traditional Chinese medicine treatment: combined with oxygen therapy to regulate qi and relieve asthma."

Zou Guoqing was immediately embarrassed. This was the original plan for the medical case, but it turned out to be unworkable, so he immediately switched to traditional Chinese medicine methods for treatment.

Fang Yan said to him:
"Medical records are a mirror reflecting your medical practice! Write down exactly what you did. What do you mean by 'cooperating with Western medicine' here? If I see any hesitation or inconsistencies in your medical records again, you'll have to go back and relearn how to write medical case records!"

Zou Guoqing nodded repeatedly:
"Yes, yes, Director Fang is right!"

Although he didn't smile, Zou Guoqing knew he had passed the review and was overjoyed. The process didn't matter; as long as the result was good, that was enough.

Then Fang Yan looked at the other people and commented on them:
"I observed all of your patient visits this morning. Your basic skills are very solid, and you are able to handle most illnesses, which is exactly what we want. Congratulations to you all for passing today's assessment. From now on, you can start practicing at Peking Union Medical College Hospital. However, I have something else to tell you..."

Fang Yan's gaze swept over the group in front of him, and the slight softening he had shown towards Zou Guoqing gradually disappeared. His tone became serious again: "Before we talk about what's next, I have to tell you something. Pu Shijie failed today's test."

Upon hearing this, the group from Capital Medical University were stunned, their faces full of surprise.

Looking around, I realized that I didn't see Pu Shijie.

Zou Guoqing's smile vanished, and he instinctively pressed for an answer:
"Director Fang, what did Pu Shijie... do wrong?"

“It’s not as simple as not doing a good job; it almost resulted in a major medical accident.” Fang Yan then gave a concise account of Pu Shijie’s case, from the patient’s underlying conditions of hypertension and heart failure, to the core of the diagnosis of “recurrent fever in Shaoyin disease,” and then to his mistake of mechanically applying Ma Huang Tang and continuing to use antihypertensive drugs. Every detail was covered.

He said in dialect:

"He was thinking about using a combination of traditional Chinese and Western medicine to quickly reduce fever, but he forgot that ephedra can raise blood pressure and increase the burden on the heart, and he forgot that the weak pulse indicates a deficiency of Yin and Yang. This is not a matter of experience, but a loss of the roots of traditional Chinese medicine and a failure to understand the taboos of Western medicine. In the end, he almost pushed the patient into danger."

Zhu Zhixin, who has always opposed the integration of traditional Chinese and Western medicine, couldn't help but nod in agreement upon hearing the dialect spoken:

“I’ve always felt that forcing them together is wrong. For example, when treating a cold, traditional Chinese medicine distinguishes between wind-cold and wind-heat, while Western medicine deals with viruses and bacteria. The approaches to medication are completely different. Forcing them together will either be too strong in relieving the symptoms and damage the body’s vital energy, or the antiviral drugs will affect the efficacy of traditional Chinese medicine. Now it seems that my view was a bit conservative. The situation is more serious than I thought…”

Fang Yan said to them:

“You all must remember the lessons of Pu Shijie. In the future, when you see patients, no matter what happens, first make sure you have a solid foundation in ‘differentiation of syndromes’, and then thoroughly understand the patient’s underlying disease and medication history. Don’t think about taking shortcuts or trying to combine traditional Chinese medicine. If you lose the roots of traditional Chinese medicine, no matter how much effort you put in, it will be in vain. And don’t gamble with the patients’ safety. As doctors, we hold human lives in our hands, and we can’t afford to make a single mistake.”

The remaining five people all became serious. Fang Yan, seeing their solemn expressions, softened his tone slightly:

"Alright, that's the lesson I've taught you. I hope you all keep it in mind. From now on, you can officially start practicing medicine at the Department of Traditional Chinese Medicine at Peking Union Medical College Hospital. But for the first month, you must submit your medical records for the day to me for review before you leave work each day. If you have any questions about a case, feel free to consult me ​​or other doctors on duty. Remember, caution is always more important than boldness."

"You're dealing with people's lives. You can't just cry a couple of times, say sorry, or express regret after something happens and that's it!"

"As doctors, before prescribing medication, you should all think about how to uphold that inviolable line between life and death!"

"Yes!" the group replied in unison.

"Alright, that's all for today. Let's go to the cafeteria for lunch! After lunch, we'll complete the formal onboarding process for the Traditional Chinese Medicine department, and you'll start seeing patients tomorrow!" Fang Yan said to the five of them.

The five of them then came to their senses; they were now doctors in the Department of Traditional Chinese Medicine at Peking Union Medical College Hospital!
I thought there would be a series of assessments, but it turns out there was only this one?
After Fang Yan left, everyone belatedly realized what had happened. Guo Xiaomei asked the group:

"It...it's approved?"

There was still a hint of disbelief in her eyes. Before coming, she had made countless mental preparations and even anticipated that she would have to go through a week of job rotation assessment. She never expected that after just one outpatient visit, she would get her "ticket" to Peking Union Medical College Hospital.

Deng Chunyan said:
"Director Fang just said it himself, and I can start work this afternoon!"

Zou Guoqing patted Lin Hongjun, who was standing next to him, and said:

"Haha, our pass rate is pretty high!"

He had long forgotten the embarrassment of being criticized by Fang Yan.

Lin Hongjun's expression remained somewhat serious as he said:

"You passed, but I... I feel like I haven't passed yet."

"What do you mean?" Zou Guoqing asked, looking puzzled.

Lin Hongjun waved his hand and said:

"It's nothing. I still have a patient I haven't cured! It was Director Fang who treated me."

"Huh?!" Zou Guoqing exclaimed in surprise.

As if they had discovered a big surprise, everyone quickly gathered around.

Lin Hongjun honestly told everyone about the first patient he encountered that morning.

As soon as Lin Hongjun said this, the group immediately crowded around him even closer, and Guo Xiaomei's eyes widened:
"Your first patient was a coma patient who had suffered a cerebral hemorrhage and overdosed on chlorpromazine? That's incredibly unlucky! If it were me, I would be so flustered that my hands would shake, let alone prescribe anything."

Deng Chunyan also frowned:
"How could someone like you, fresh out of college, handle such a complex case? But Director Fang didn't say anything to you and even let you pass. Why is that? Is it really like you said, there's some hidden assessment later?"

Zou Guoqing stroked his chin, pondering:

"That's not right. Director Fang just clearly said 'Congratulations to everyone for passing the assessment,' so there's no reason for him to hold back for you. Besides, even though you didn't address the root cause of the coma, didn't you prescribe the right formula for the fever and vomiting? Director Fang also said that your diagnosis of Sangju Decoction and Xiaochaihu Decoction was correct, didn't he?"

Lin Hongjun sighed, took out his medical records from his pocket, and turned to the page recording comatose patients:
"But I can't even get close to the aftereffects of a cerebral hemorrhage or the damage caused by chlorpromazine. Director Fang said to treat the symptoms first and then the root cause. He was the one who decided on the methods to promote awakening and treat paralysis. All I got was a prescription for treating a cold and vomiting. How can that be considered 'approved'?"

Zhu Zhixin, who had been silent until now, suddenly spoke up:
“You’re wrong, Lin Hongjun. What Director Fang is testing is never whether you can cure all diseases, but whether you can solve the problems you can solve within your own capabilities, without overreaching.”

He pointed to Lin Hongjun's medical records:

“You didn’t force yourself to prescribe a cerebral hemorrhage treatment for the comatose patient. To be honest, you were ‘not confident’, which shows you didn’t risk the patient’s life. At the same time, you correctly diagnosed the fever and vomiting, and you clearly marked the dosage and administration method of Sangju Yin and Xiaochaihu Yin. You even thought of washing away the alum taste from Banxia. This is ‘keeping the bottom line,’ which is exactly what Director Fang wanted.”

Deng Chunyan suddenly realized:
“That’s right! Pu Shijie almost had an accident because he insisted on combining traditional Chinese and Western medicine. Although you didn’t cure the root cause, you didn’t make any mistakes and you handled the emergency correctly. That’s better than anything else.”

Guo Xiaomei nodded in agreement:

“I just saw a patient with chronic enteritis who had been taking Western medicine for six months without getting better. I told her to stop taking the Western medicine and use a modified Shenling Baizhu Powder. When Director Fang passed by, he didn’t say anything, only that I ‘dared to insist on diagnosis and not be misled by Western medical thinking.’ Now that I think about it, as long as we don’t make any fundamental mistakes and do what we can do well, Director Fang will approve.”

Looking at his medical records, Lin Hongjun recalled Fang Yan's words and attitude, and gradually realized that the core of the assessment was not omnipotence, but steadfastness.

Not pretending to know what you don't, not taking risks, and doing things right within your own capabilities—that's the first step to being qualified.

At this moment, Zou Guoqing suddenly asked:

"Is it possible that it's related to the question we answered this morning?"

Everyone was stunned.

Zhu Zhixin asked Zou Guoqing:
"You mean, Director Fang actually supports Lin Hongjun's statement?"

"I'm just guessing. Think about it. Director Fang has always used pure traditional Chinese medicine treatment methods. Logically speaking, he should support pure traditional Chinese medicine rather than a combination of Chinese and Western medicine. Today, those who firmly support the combination of Chinese and Western medicine failed, but those who support traditional Chinese medicine or have an ambiguous attitude passed... Even when Lin Hongjun encountered problems, he received leniency from Director Fang."

Zou Guoqing's words were like a pebble thrown into calm water; the group instantly stopped their discussion and looked at each other.

They weren't as shrewd as Zou Guoqing; they only remembered the conversation from this morning when it was brought up now.

Guo Xiaomei continued thinking, saying, "So... this morning, when Director Fang asked us to share our views on the integration of traditional Chinese and Western medicine, it wasn't just a casual chat at all? I said that traditional Chinese medicine was compromising, and Director Fang didn't refute me. Now that I think about it, wasn't he already assessing our stance back then?"

Deng Chunyan frowned slightly. She had strongly supported the "integration led by traditional Chinese medicine" that morning, but now she was somewhat uncertain: "But I also support integration, so why was it approved?"

"It's different." Zhu Zhixin adjusted his glasses, his tone firm:

“You said ‘Western medicine diagnosis is the guide, and traditional Chinese medicine treatment is the root,’ but the core is still the syndrome differentiation of traditional Chinese medicine; Pu Shijie’s approach is ‘rapid fever reduction by combining traditional Chinese and Western medicine,’ directly using traditional Chinese medicine as an auxiliary to Western medicine, even forgetting the contraindications of ephedra. Director Fang’s criticism is that the combination ‘lost the root,’ not all combinations.”

Lin Hongjun recalled the "Yu Yunxiu's lingering influence" he had mentioned that morning. He said, "This morning I said that 'combining treatments is a way to subtly work on the roots of traditional Chinese medicine.' Director Fang didn't express his opinion at the time, but later when I encountered a comatose patient, he didn't blame me for not being able to cure the root cause. Instead, he taught me to treat the symptoms first... This attitude shows that he supports me on the surface!"

Zou Guoqing clapped his hands, further confirming his guess:

“Exactly! Look at Pu Shijie, he was obsessed with combining traditional Chinese medicine and almost caused a medical accident; the rest of us either stuck to the basics of traditional Chinese medicine or didn’t try to be reckless, and we all got away with it. Director Fang told us before that ‘the ultimate goal is to solve the patient’s problem,’ and I thought he meant ‘no matter what method we use,’ but now I understand that when he said ‘solving the problem,’ he meant solving the problem correctly within the framework of traditional Chinese medicine, not just forcibly combining Chinese and Western medicine!”

Guo Xiaomei also recalled the details of her consultation:

“I told patients with chronic enteritis to stop taking Western medicine and only use Shenling Baizhu Powder. When Director Fang passed by, he said, ‘You dare to insist on syndrome differentiation.’ At that time, I didn’t pay attention to it. Now that I think about it, he was praising me for not being misled by the Western medicine’s name of ‘chronic enteritis’ and for not thinking about ‘taking Chinese and Western medicine together’!”

Deng Chunyan nodded slowly, her tone less certain than before and more filled with sudden realization:

"So, Director Fang's attitude is... we can't lose sight of the core principles of TCM diagnosis, and we can't gamble with patients' safety for 'rapid results.' Pu Shijie was too eager for the 'combination' result, and that's why he forgot the most basic taboos."

Looking at the records of "Sangju Drink and Xiaochaihu Drink" on the medical record, Lin Hongjun recalled the tone of the dialect when they said "correct symptoms," and he finally understood:
"In other words, what Director Fang wants is a reliable TCM doctor who knows what he can and cannot treat. If he can treat something, he will use classical formulas to accurately diagnose it. If he cannot treat something, he will be honest about it and not force it or make up solutions randomly. No matter how different our positions are, at least we have not lost this sense of reliability, which is why it was approved."

Zhu Zhixin snorted, but a slight smile subtly appeared at the corner of his mouth:

"It should have been obvious long ago. Director Fang never uses Western medicine to treat patients. Even when adjusting treatment plans for comatose patients, he only mentions Angong Niuhuang Wan and Buyang Huanwu Tang. He never mentions combining Western medicine with treatment. He only believes in traditional Chinese medicine diagnosis. The reason he asked us to give our opinions this morning was to filter out those who use traditional Chinese medicine as an adjunct to Western medicine."

The group discussed amongst themselves, and the more they analyzed, the clearer the understanding became.

Unaware that Deng Nanxing and Du Heng were listening intently.

Is Brother Fang's attitude really that profound?

Just like those professors in Fang Yaozhong, he completely opposes the integration of traditional Chinese and Western medicine. Why does he have so many considerations?

These people really make reading comprehension quite profound.

PS: The basic chapter of 6000 words has been updated.

(End of this chapter)