The Returning Doctor Wanted to Live Quietly - Chapter 346



Only Noblemtl

Episode 346. Specialist 2nd Exam (1)

okay.

They weren’t enemies.

He was just someone passing by.

Why isn’t everyone there?

Just an ordinary person you meet in your social life.

So there was no need to get angry. But it was still pathetic.

Lawyers, tax accountants, accountants.

Everyone was trying to survive.

But only the doctor.

Only the doctor was acting rudely.

It seems like there are only 500 people.

so.

‘If you were so worried about the health insurance finances, why did you accept so many rapid antigen tests?’

It was natural to have such thoughts.

The amount of money I received from one nose piercing during the Corona era was 55,920 won.

I clearly remember the days when I was at Seosin University, when morale was further dampened by talk of 300 million or 500 million won in certification per month due to the influx of patients.

When the thought of what to do about the coronavirus that may occur in the future permeates the mind.

The dispatcher shouted.

“Okay, let’s start the test! I’ll get in right away!”

* * *

A temporary examination room.

Various surgical instruments and models for demonstrating surgical techniques.

Table for interviewers.

And there was a beam projector.

It’s scary to sit on a chair.

One of the interviewers stepped forward.

“Okay, I see some familiar faces. Let’s introduce ourselves first.”

“Hello, this is Lee Ji-hoon from Samseon Hospital.”

“Hello, this is Lee Jin-hyeok from Asin Hospital.”

.

.

.

The greetings continued for a long time.

The voice was thunderous.

The situation changed from a 1:N interview to an N:N interview.

I had to look good to the interviewer.

hereto.

“Wow. That’s a big voice. They’ll all be great writers. Don’t you think so?”

“Haha. That’s right. I’m so grateful and thankful that you all applied to the surgery department.”

“Well, I paid 1 million won in application fees. There’s no way I could help it if the interview went like this. This year, I’m doing it at the same time as my 3rd and 4th year, so it turned out like this. So please understand. Hmm.”

Interviewers each saying a few words.

Among them, the professor who had been speaking vaguely looked straight at Jinhyeok.

“By the way, Mr. Lee Jin-hyeok? We met before, right?”

“Yes, Professor. I greeted you in Gyeongju.”

“Yeah, we should get together for a meal sometime. Call me.”

“Yes, Professor.”

“Hey. Professor Seo, I want to talk to you too. Me? Do you remember? Why, back at the spring conference?”

“Yes, your daughter said she knew about it… … .”

“Haha. I remember. I’m currently training.”

The talks continued.

All attention was focused on Jinhyuk.

This is a complete change from when I was interviewing for an internship.

It was a completely different treatment from the old days when I was treated like air among my fellow students.

“Haha. Everyone doesn’t look so happy. Come on, don’t be so upset. Okay?”

“Hehehe, I’m not saying that because I’m afraid of being compared to Mr. Lee Jin-hyeok. I’ll do it fairly, fairly. But anyway… … .”

“… … .”

“The passing rate is 95% to 98%. But everyone is anxious. Do you know why?”

“I did that because I was afraid I might fall!”

“Yeah, that’s right. That’s what a specialist exam is like.”

“… … .”

“It’s only a 2% drop. No, it’s only a 5% drop. There’s nothing more embarrassing than that. If you drop, there’s no shame like this. There’s no law that says I won’t be the target.”

“It seems like everyone is getting more nervous.”

“Oh, really. I didn’t mean to tell you to be nervous. Anyway, don’t be too nervous. Just do your best. The hospital’s reputation is at stake.”

As the professors finished speaking and all turned their gazes, the operator began to operate the computer.

* * *

Unlike the first written exam, the second practical exam is administered by the academic society.

Since the surgical professors were all drafted at the same time, it was not surprising that the examination method changed strangely.

The first test that started like that was the slide test.

It was the same as before, except that anyone could answer on a first-come, first-served basis.

“Okay, okay. What kind of surgery is it?”

Photo of a patient whose flank had been opened.

Jinhyuk had to guess the name of the surgery and answer the questions, but he raised his hand.

“I think I had an inguinal hernia repair.”

“This is a rectal/anal deformity surgery.”

“It looks like you have intestinal obstruction.”

“I think I had Ladd due to intestinal rotation abnormality.”

Jinhyuk Lee quickly solves the problem without giving anyone else a chance to speak.

Just by looking at the opened wound, he was able to guess it accurately, and everyone in the room was amazed.

Rather than being jealous of the excellence of his juniors, he is simply happy, like a child, that a new writer has been born.

In response to that.

‘If the atmosphere is this friendly, there’s no need to step forward anymore, right?’

Jinhyuk immediately became silent.

Looking at it broadly, the other applicants are also colleagues who will continue on to the surgical field.

There seemed to be no need to go any further.

* * *

In the form of a refund or suture.

The question of showing and asking about the surgical site continued.

After all 100 questions were presented in an instant, one of the interviewers asked,

“Mr. Lee Jin-hyeok. No, Mr. Lee.”

“Yes, professor.”

“Why didn’t you answer? You were always right the first time.”

“Huh, why are you asking such a thing? I’ll give in. You have a great personality. Haha.”

Professors who promote themselves.

Jinhyuk’s face turned red.

It seems like it was only recently that it was called Maligue.

Before I knew it, I had grown up.

Was loved.

Of course, he was a murderer because he kicked the honey pot.

* * *

The next test is a review of the surgical records.

Since each person submitted thirty questions, it was conducted in an individual Q&A format.

When it was Lee Ji-hoon’s turn, he answered.

“It was a primary tumor surgery. We performed a frozen section examination beforehand (a method of making a frozen section using liquid nitrogen during surgery and then examining it under a microscope).”

“Why did you do FSB (frozen section biopsy)?”

“It was to check for metastasis to the sentinel lymph nodes (lymph nodes that show more than 10% of the radiation dose).”

“But FSB. The false negative rate is quite high. Why, Professor Park Chang-hyun presented it at the last conference.”

“Yes, I know it’s 30%.”

“To be exact, it’s 19% to 30%. Now, with such a high false negative rate, what do you think? Do you think you can trust the results and have surgery?”

Sharp question.

During surgery, samples had to be collected and sent to the pathology lab.

The pathology lab doctors had to check for metastasis and report the results in a very short period of time.

The problem is that there are many cases where it is difficult to make an accurate judgment.

“If it is a true false negative, it would be a disaster for the patient. It would mean that they are abstaining for no reason.”

“Yeah, that’s what I’m saying.”

“Still, I think it should be done.”

“Can it be cured with radiation therapy alone, without additional surgery? Do you know about false negative cases?”

“There are cases where the sampled section is negative, but metastases are found in the permanent tissue section… … .”

“Yes. The opposite is also true.”

“Yes, there are cases where misjudgment occurs because the membrane is missing or part of the tissue is folded.”

Lee Ji-hoon gives an answer that Jin-hyeok thinks is reasonable.

so.

“I heard the answer well. What does our teacher Lee Jin-hyeok think?”

If I were asked this question, I could answer the same way.

It was Jinhyuk who said just one more thing.

“This seems to be a question of value judgment. We cannot simply disregard the false-negative rate and resect the axillary lymph nodes.”

“Why?”

“Because there are so many complications that appear after resection.”

“Yes. So the doctor’s judgment is important.”

“Yes, I think we need to comprehensively observe the patient’s condition and consider the benefits of proceeding, as well as the damages the patient might lose.”

“Is this a problem without a correct answer?”

“It is a correct theory, but I think that is what makes it difficult to follow the correct theory.”

This means that you have to judge it comprehensively.

Easier said than done.

Because it is something that requires a lot of surgical cases to accumulate.

Jinhyuk said, looking over the professors.

“In fact, the same goes for the issue of reinforcement. The quality of education may decline. There may also be a shortage of cadavers. Health insurance finances may be rapidly depleted. Overtreatment may be recommended.”

“hmm?”

“However, there are also benefits to increasing the number of troops, so in the end, what I am saying is that we need to comprehensively evaluate the results that will appear when we implement it.”

A roundabout way of talking about surgery.

Although it did not escalate to an extreme strike.

The interviewers laughed bitterly, knowing that there were still many doctors who were opposed to it.

The reality is that even professors have to stand on duty due to a shortage of residents and fellows.

They also had the same thoughts as Jinhyeok.

* * *

‘How dare this kid turn his back on me?’

The interviewers probably reacted that way because they didn’t know what happened at the Samyuk University athletic field.

Jinhyuk’s answer made Lee Jihoon angry, but he tried to keep his composure.

If I leave now, I won’t have any food or drink.

He spoke with his mind hidden.

“I think so too. The false negative rate is high, but in the end, we have to make a comprehensive judgment.”

“Yeah, okay. But you know.”

“yes.”

“The surgical records submitted by Dr. Lee Ji-hoon. It’s good that he underwent sentinel lymph node dissection due to cancer metastasis. But was that the only method?”

“yes?”

“Was it best to remove it all? It could have been removed partially with axillary lymph node dissection.”

“that…….”

“It’s not in the surgical records. There’s no reason for that. I mean, not all tissues were biopsied.”

I’m asking because the exact reason wasn’t stated.

Lee Ji-hoon’s answer was slow.

“Proceeding with Gwak Cheong-sul means treating locally… … .”

“We can also determine the status of lymph node metastasis more accurately.”

“Yes, but then I have to do it twice… … .”

“Aren’t there cases where they are done simultaneously?”

“Yes, that’s right.”

Lee Ji-hoon answered, biting his lips slightly.

Thirty surgical records were submitted.

I was too busy to write properly.

Because I was completely focused on whether or not my thesis would pass or not.

‘Ha, that was definitely something that was discussed at the conference… … .’

Lee Ji-hoon, who was at a loss for an answer, brought up another reason.

“Sentinel lymph node dissection is a recent trend. I believe it has been active in the United States since the 1990s.”

“Is this the latest surgical technique?”

“Yes, so I think it would be better to consider it as a sentinel lymph node dissection.”

“Hmm.”

Interviewers who show an unpleasant attitude.

They turned their heads and asked Jinhyeok.

“Professor Lee Jin-hyeok, what do you think?”

* * *

It wasn’t a question intended to start a fight.

I just wonder if he himself knows.

It was the attitude of a surgeon with many eccentricities, or rather, a surgeon with a hasty personality who doesn’t care about anything.

So, Jinhyuk had to answer the question right away, but he remained silent.

Of course, it wasn’t because I didn’t want to be at odds with Lee Ji-hoon.

I could have just stepped on it, but it was something the professors might not like.

I had to wait a little longer.

“Haha, doesn’t this teacher know either?”

“Well, you might not know. Didn’t you say that you only worked in pediatric surgery from the middle of your third year?”

“That’s right. I should have taken more classes in other departments… … .”

“I think differently. Isn’t it because of love for your colleagues? I think he’s saying this because he’s worried that if he gives a different answer, Mr. Lee Ji-hoon will be in trouble… … .”

Everyone smiled faintly at the words of one of the interviewers, Professor Seo Chang-hoon.

okay.

It could have been.

Even though the hospital was different, I thought of my colleagues.

There were people who misunderstood that Jinhyeok’s spending was generous.

As the situation ripened, Jinhyuk stepped forward.

“Axillary lymph node dissection is a method that has been used for a long time. On the other hand, sentinel lymph node dissection is a new technique that was introduced recently, as Dr. Lee Ji-hoon said.”

First, let me explain the timing of introduction.

“Sentinel lymph node dissection. It’s good. It only removes the sentinel lymph nodes that are suspected of having metastasized. It also reduces complications. It also allows you to accurately determine the stage (stage 1, stage 2, etc.).”

It also tells us the advantages.

And then.

“But as with all surgeries, it requires skill. Depending on who does it, the prognosis can vary significantly.”

“Oh, of course I wasn’t criticizing the attending physician who performed the surgery.”

I expressed my concerns.

After giving it a cushion like that.

“According to a paper published in the United States, the number of patients needed to become proficient is 60. I heard that you need to have experience performing up to 80 surgeries to maintain an accuracy of over 90%.”

I came to a conclusion.

Just because it’s a new surgical technique doesn’t mean it’s necessarily good.

That can’t be the reason.

immediately.

“Yes. That’s right. That’s right. A patient who was operated on before the doctor became skilled. He’s a kind of teaching material.”

“That’s right. The prognosis is not good. And the probability of failure is high. It’s due to poor handling during the surgery. It can happen anytime, anywhere.”

“Okay, do you understand, Dr. Lee Ji-hoon? The patient’s prognosis, the surgeon’s skill level, the surgical environment. You have to take everything into consideration.”

The professors all supported Jinhyeok’s answer.

In fact, it was perhaps a natural reaction.

They are all professors who are called first generation.

Although times were changing rapidly, conservatism remained.

But then, Lee Ji-hoon stepped forward.

“Excuse me, but then I would like to ask Mr. Lee Jin-hyeok in reverse.”

“hmm?”

“Then, does that mean that there can be no such thing as a skilled doctor in the first place? It’s a problem that you can’t practice with cadavers.”

“In the end, do you have to take the risk? All the tangible and intangible damage that the patient will suffer until you gain proficiency?”

“Yes, I think it is a necessary process for the advancement of medicine.”

It’s not something that can be said to be completely unreasonable.

Since everyone had different thoughts, it couldn’t be said that they were wrong.

Those who do not know the difference between the two are causing chaos in the world.

soon.

“So, what do you think, Mr. Lee Jin-hyeok?”

The interviewers all started looking at Jinhyuk.