The patient shook his head vigorously.
"Hold him down, he’s starting to exhibit hysteria, hurry and administer dication," Yang Ping ordered the surrounding graduate students to step in imdiately.
The patient’s tongue swiftly retracted halfway back: "Alright... alright... otherwise, observe... observe..."
Yang Ping sat down, speaking in his distinctively calm voice, but his words were not addressed to Li Gang, rather they seed to continue his teaching:
"In clinical diagnosis, apart from distinguishing the authenticity of diseases, sotis we also need to distinguish the authenticity of symptoms." His voice was not loud, yet very clear, "Organic muscle tension disorders stem from neurotransmitter imbalances, resulting from autonomic nervous system dysfunction which the patient cannot control. Its presentation has physiological foundations, like the tongue coloration I ntioned earlier, the uniform degree of muscle tension, accompanying slight tremors, etc."
He paused, his gaze still fixed on Li Gang.
"Psychogenic symptoms," he continued, his tone calm as if stating an objective fact, "often have a performative flair, deliberately mimicking severe manifestations from mory or imagination. For instance, they might exhibit extre, dramatic pain, but have difficulty perfectly replicating subtle, objective physiological signs. For example, in genuine acute tongue muscle spasms, the sublingual blood vessels will show specific color changes due to obstructed reflux, and the root of the tongue muscles will have a unique hard rubber-like texture..."
Yang Ping continued gently, "More importantly, the effect of dication does not deceive. Scopolamine, as an anticholinergic drug, has a sustained half-life in the body. Shortly after injection, when the blood concentration of the drug is at its peak, the likelihood of the sa etiology triggering symptoms of the exact sa intensity again is negligible. This does not conform to the basic principles of pharmacokinetics."
These words, like peeling away layers, gradually exposed the possibility of Li Gang’s feigned condition. It was not a harsh rebuke, but a calm analysis based on dical logic, yet more powerful than any accusation.
The agonized expression on Li Gang’s face began to falter.
Yang Ping finally directed his gaze formally at Li Gang, his tone still peaceful, "Mr. Li, your body has just recovered from the adverse reaction to the dication; what you need is rest and recuperation, not emotional upheaval and unnecessary physical exertion."
"Deliberately maintaining tension in certain muscles is straining in itself, and it isn’t beneficial for the recovery of your enteritis," he added, sounding like concern.
Then, turning to the ashen-faced Ms. Wang, he said, "I can understand the family’s feelings. But this is the outpatient room, and there are many other patients waiting. Family disputes, I believe, are better resolved calmly in a private space."
He did not directly say "your husband is pretending," but all his words, all his dical analysis, had already led to this conclusion.
With Yang Ping’s words, the remaining half of the patient’s tongue slowly and quietly retracted back, his face flushing: "Professor Yang, I’m alright, I’m fine."
"Dr. Li," Yang Ping signaled to Li Min, "The acute symptoms Mr. Li was experiencing have been resolved. The subsequent enteritis issue can be referred to the outpatient departnt of gastroenterology for routine treatnt. Help them contact the gastroenterology outpatient departnt."
"Yes, Professor." Li Min imdiately understood, stepped forward, and spoke to Li Gang still frozen on the examination bed and the furiously trembling Ms. Wang, "Mr. Li, please step down now; we need to clean the examination bed. If you experience any gastrointestinal discomfort later, you can book an appointnt with our hospital’s gastroenterology departnt."
Ms. Wang gave her husband a fierce glare that spoke of heartbreak. She grabbed her bag, forgetting to even say thank you to Yang Ping, and rushed out of the outpatient room.
Li Gang saw this, his face alternating between blue and white, clumsily climbed down from the examination bed, avoided eye contact with anyone, muttered a vague "Thank you, Professor" in Yang Ping’s direction, then almost fled, chasing after his wife’s departing figure.
The consultation room fell into a brief silence.
"Alright." Yang Ping’s voice broke the silence, he clapped his hands, drawing everyone’s attention back to work, "dicine is a science, but ultimately it’s a study of humans. We encounter all sorts of patients, all sorts of situations. Maintaining professional judgnt and providing appropriate treatnt is our duty."
The nurse swiftly began changing the disposable sheets on the examination bed, Li Min glanced towards the doorway, shook his head, and softly said to Yang Ping, "Professor, you’re truly amazing, not only curing his illness but also seeing through his feigned condition."
Yang Ping faintly smiled, calmly said, "Sotis, physical ailnts are easier to treat, but ntal ailnts are harder to heal; if we, as doctors, can cure the forr, we’ve already done our best."
"Professor Yang, I don’t quite understand why scopolamine was used to solve the patient’s problem just now instead of scopolamine?"
"Although both scopolamine and scopolamine belong to the tropane alkaloids, there are notable differences between these two drugs. Scopolamine has a strong central inhibitory effect. It’s often used for sedation and treating motion sickness; scopolamine has prominent peripheral anticholinergic activity, mainly used to relieve smooth muscle spasms and improve microcirculation. The problem with this patient earlier was central, hence scopolamine was used."
"In fact, side effects of these types of drugs leading to an inability to retract the tongue are not uncommon. For instance, chlorpromazine, haloperidol, olanzapine, risperidone, levodopa, phenytoin sodium, domperidone, etc., can all induce extrapyramidal reactions. Typically, neurologists and psychiatrists are more familiar with these drug side effects."
"Requesting a consultation from an oral surgeon in the ergency departnt was asking the wrong specialist; had they requested a consultation from the neurology or psychiatry departnt, this patient wouldn’t need to co to us."
As Yang Ping spoke, Li Min and the graduate students quickly took notes in their notebooks.
"So, Li Min, while you’re here undergoing advanced studies, make sure to learn thoroughly. What you’ll be doing in the future is the work of a primary care physician. Primary care physicians are extrely important; they’re the gatekeepers of health. Our general dicine isn’t well-developed; there aren’t many primary care physicians, so many patients often see the wrong specialist. So initially see the wrong specialist, so constantly see the wrong one, which leads to many illnesses that could have been handled well, but either miss the best timing or don’t get the correct treatnt."
Yang Ping’s outpatient recomndations are usually for complicated cases, so he’s not very busy and has ti to teach onsite.
"Common cases of seeing the wrong specialist: rheumatoid arthritis seeing orthopedics, you would say, there’s no mistake in seeing the wrong specialist theoretically, but in reality, it is wrong. Orthopedic doctors specialize in surgical operations; the vast majority of orthopedic doctors have no systematic, standardized concept for the dical treatnt of rheumatic arthritis, even surface-level treatnts are half-understood, completely incomparable to the rheumatology peers proficient in it. If it’s not to replace an artificial joint, rheumatoid arthritis should be treated in the departnt of rheumatology and immunology."
"Gout is the sa, it shouldn’t be treated in orthopedics; it’s a tabolic disease, so it should be treated in endocrinology."
Upon hearing this from Yang Ping, a spark of inspiration flashed in Li Min’s mind: "Professor Yang, when you say this, I have an idea. I’ll write a booklet in the future, telling people where to go for dical treatnt, so that when everyone has sothing wrong, they won’t take a detour, and can find the right doctor in the shortest possible ti and won’t feel uncertain about what kind of illness they have."
Yang Ping was very appreciative of this idea: "Your idea is excellent; so countries have such guidance booklets for dical treatnt, systematically providing dical popularization to the public. This kind of advocacy-type dical education can enhance mutual trust between doctors and patients, reduce unnecessary misunderstandings, and improve dical efficiency."
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