Practical Clinical Surgery Non-Surgical Methods

Author: Zhang Xueqi
Publisher:
Publish Date: 1997-10-01
Features: The book provides a comprehensive and detailed exposition of the principles, indications, contraindications, clinical applications, and precautions of various non-surgical treatment methods commonly used in surgical practice. It also includes necessary introductions to some new non-surgical techniques. This book is highly valuable for correctly mastering and rationally applying various non-surgical treatment methods, broadening their scope of treatment, and improving the cure rate of surgical diseases. The book consists of 35 chapters, accompanied by essential illustrations. It is well-structured, highly practical, and possesses modernity, theoretical depth, and scientific rigor, making it an excellent reference for surgical teaching and clinical practice. It will benefit not only medical students and young surgical healthcare professionals but also clinicians from other medical disciplines. Excerpt: Chapter Introduction to the Treatment of Surgical Diseases
Therapeutics is an important branch of clinical medical science, a clinical discipline that studies the origin and development of treatment, therapeutic methods and techniques, their classification, mechanisms of action, indications, and contraindications. With the advancement of clinical medical diagnosis and treatment technologies and the growing understanding of disease mechanisms by basic medical sciences, doctors rely on clinical reasoning to scientifically analyze collected patient histories and various examination findings, thereby arriving at correct diagnoses and formulating effective treatment plans. Through continuous learning, accumulation, and exploration in long-term clinical practice, doctors gradually enrich their clinical thinking and working abilities, enhancing their understanding of diseases and the precision of their treatments, while also accumulating increasingly rich clinical experience. Surgical diseases, in particular, have their own unique characteristics, requiring not only profound theoretical knowledge from surgical healthcare professionals but also skilled treatment techniques. It is well-known that, in addition to surgical operation skills, there are many non-surgical treatment skills that need further development and exploration.
Section Clinical Thinking and Disease Treatment
Clinical thinking is a scientific method of thinking and refers to the mental activities of clinicians during the diagnosis and treatment of diseases. The level of clinical thinking ability is a key factor determining a doctor's medical proficiency. Generally, clinical thinking can be divided into two stages: diagnosis and treatment. Due to space limitations, this book focuses on the thinking process during clinical treatment, primarily covering five aspects:
1. Testing, Revising, and Developing Clinical Diagnoses
Strictly speaking, treatment is a continuation of the doctor's understanding of the disease and a different stage of clinical thinking. Due to subjective and objective limitations, clinical diagnoses of diseases (especially surgical ones) are often made with insufficient information, sometimes involving speculation, inference, or even assumptions. Even with specific tests confirming the diagnosis, it is difficult to ascertain all internal changes the patient experienced when suffering from the disease. Although the initial understanding may be correct, it must be continuously refined and deepened as the condition progresses. Some complex cases may require long observation periods, sometimes even post-mortem pathology to fully understand. Therefore, the treatment measures taken based on clinical diagnoses often carry a testing and exploratory nature. Some diseases require repeated review, evaluation, supplementation, and revision of diagnoses based on treatment responses, sometimes even overturning initial diagnoses. Experienced doctors are adept at learning from their own and others' mistakes to achieve correct diagnoses and treatment plans, accumulating clinical experience through continuous learning.
2. Developing Rational Treatment Plans
The expected outcomes of treatment measures adopted by doctors generally include: eliminating the cause (etiological therapy), alleviating symptoms (symptomatic therapy), and improving general condition (supportive therapy). When formulating treatment plans, doctors must consider factors such as the cause of the disease, pathological changes, complications, the patient's physical condition (gender, age, constitution), social and psychological status (family, marital status, financial situation, cultural background, occupation, personality, social status, religious beliefs, lifestyle, and thinking patterns), medical conditions, and the experience and technical proficiency of healthcare professionals. Etiological therapy may achieve the goal of curing the disease, which is, in a sense, the ideal approach. However, clinical practice does not always yield such results. Under certain conditions, adopting symptomatic or supportive therapy may be more beneficial to the patient. The duty of doctors is to formulate scientific and feasible optimal treatment plans for each patient, considering not only short-term treatment but also long-term prognostic impacts, including disease recurrence and spread. Therefore, formulating rational treatment plans is a highly complex issue, requiring not only medical knowledge but also knowledge from humanities such as psychology, sociology, and ethics. It is essential to tailor treatment plans to individual patients, diseases, locations, and times, adopting a dialectical approach to understand and treat each case.
3. Correctly Understanding Treatment Side Effects
Generally, most treatment measures, apart from their therapeutic effects, cause varying degrees of interference with the internal environment of the human body. The therapeutic effects are often inseparable from side effects, some of which may even be severe and easily overlooked. Therefore, achieving optimal therapeutic effects while minimizing or eliminating side effects and sequelae is one of the key aspects of clinical thinking during treatment. Extensive clinical data indicate that iatrogenic diseases caused by the overuse of certain treatment measures have become a serious issue that must be addressed seriously (e.g., neurosensory hearing loss caused by ototoxic drugs, harm caused by the overuse of antibiotics and corticosteroids). Therefore, in clinical practice, it is crucial to understand the scope of applicability of treatment measures while being well-versed in their side effects and preventive measures, avoiding the tendency to overuse treatments to ensure patient safety.
4. Mobilizing the Patient's Subjective Initiative
Throughout the implementation of treatment plans, healthcare professionals must strive to mobilize the patient's subjective initiative, making the treatment plan a shared goal between doctors and patients. Only by fully caring for and understanding the patient, adapting appropriate methods to their actual circumstances (economic conditions, education level, psychological state), and helping them understand and accept the treatment plan can a strong doctor-patient partnership be established, which is beneficial for disease recovery. Some doctors with limited clinical experience often neglect patient cooperation, mistakenly believing that the prognosis depends entirely on their diagnosis and treatment. Some even display indifference to patients' doubts and requests, failing to provide necessary explanations or comfort, leaving patients in a passive and blind state, which can severely hinder disease treatment and prognosis. This must be taken seriously.
5. Continuously Improving Treatment Methods
During the implementation of treatment measures, doctors should closely monitor treatment responses and outcomes, promptly identify issues, analyze strengths and weaknesses, refine and improve existing therapies, and explore new effective methods. Avoiding rigid adherence to conventions and being satisfied with achieved results, while paying attention to patient responses, conducting serious summaries and studies, and daring to innovate, can drive clinical treatment forward. Although modern medicine has created and expanded many effective treatment methods, there remains a significant gap between the current level of human understanding of diseases and the actual needs for health protection. Additionally, the correct application of various treatment methods in clinical practice requires proper thinking methods. The treatment of diseases should be guided by materialist dialectics, with in-depth research and exploration in clinical practice to overcome the misconception of treating diseases merely as technical operations, as well as the tendency to overemphasize diagnosis over treatment or vice versa.