I. Raising awareness
Attach great importance to basic public health services, and ask rural doctors to change the idea of "emphasizing treatment over prevention" and treat the provision of basic public health services and disease treatment as equally important tasks. By providing high-quality basic public health services, we can reduce the prevalence rate of residents in the area, improve the quality of life of patients with hypertension, diabetes and mental illness, and be a good gatekeeper of the life and health of residents in the area.
Second, strengthen study.
Strengthening the basic knowledge and skills of rural doctors and improving service quality are the core of basic public health service projects and the focus of this training. By strengthening professional skills, mastering the diagnosis and treatment of common diseases, frequently-occurring diseases and infectious diseases, timely and effectively diagnosing and treating the diseases of residents in the jurisdiction, scientifically guiding the daily activities, diet and treatment of key people (the old, the weak, the sick and the disabled in the jurisdiction), controlling the symptoms of patients with hypertension, diabetes and mental illness at an ideal level, and improving the quality of life of key people. By improving their own professional knowledge, learning to communicate effectively with residents in the jurisdiction, guiding residents' healthy lifestyle and common sense, improving residents' compliance with health education for medical workers, thus continuously improving people's healthy living habits and reducing the number of people.
The occurrence of many common diseases and chronic diseases will further solve the phenomenon of poverty caused by illness and returning to poverty due to illness in rural areas. This training, from the physical examination of healthy people to the diagnosis and treatment of diseases, and then to the follow-up health guidance, has done detailed training and guidance, providing a strong professional guarantee for the service quality of basic public health services.
Third, change your mind.
Do a good job in serving residents in the jurisdiction. After the medical reform, the state will increase investment in primary medical institutions, and primary health workers will change from "I want to do" to "I want to do". We should take the initiative to provide enthusiastic services, provide high-quality health services for residents in the jurisdiction, and meet the growing health needs of the people. Create a good mass atmosphere for the smooth development of basic public health service projects.
Fourth, the existing problems
1. Some rural doctors don't know enough about training and their learning attitude is not serious.
2. The professional level of rural doctors is low, and it is difficult for rural doctors to understand some policy contents in a short time under the circumstances of tight training time and heavy tasks.
In this training work, with the strong support of leaders at all levels of Donggang District Health Bureau, Donggang District Health School and Donggang District Hospital and the close cooperation of all participants, the training work was successfully completed and achieved remarkable results, so that the participants:
1. Appreciate the overall policy of medical reform;
2. Re-standardized the diagnosis and treatment of common diseases and frequently-occurring diseases;
3. Have a new understanding of common sense of medical laws and regulations;
4. The level of medical professional knowledge has been significantly improved;
5, understand and master the public health, maternal and child health care, child health care and other related knowledge and requirements;
In order to ensure the high quality and high standard of this training, the district hospital has set up a training leading group, which attaches great importance to it, carefully organizes it, improves the attendance system, strictly enforces the training discipline, and strives to make the number of rural doctors participating in the training reach 1 0,000%. Secondly, to ensure the quality of learning, the assessment results are recorded in personal files at the end of each lecture. At this stage, the guiding ideology and training purpose of rural medical training are clear, the training content is practical, the assessment procedure is standardized, and the training process is arranged orderly. This training was strongly supported and actively cooperated by township hospitals and township doctors, and this doctor training was successfully concluded.
Summary of doctor's work 2. Internship life is coming to an end. Looking back on the dribs and drabs of this period, although I can't say that I am passionate, I have paid a lot of effort and I am inevitably excited. It's really sad to leave the teachers who led us into the ranks of doctors, but all things must come to an end. This time, the difference is that we can get together better next time. Our first experience as a doctor will never be forgotten. Internship means that I am no longer a baby in the cradle of school, but a toddler who is about to enter the society.
When I first entered the ward, I always felt at a loss I am in a relatively unfamiliar state with my clinical work, and I still don't have a formed concept of what I can do in such a new environment. Fortunately, some teachers introduced us to various departments, introduced some rules and regulations, the responsibilities of doctors at all levels and so on. , and on behalf of the rich experience of teachers, let us quickly adapt to clinical work. According to the requirements of schools and hospitals, I actively completed medical record writing, teaching rounds and case discussions, and cultivated my writing, organization and expression skills. During this short internship, we have gained a lot, which will lay a good foundation for our future work and study.
In the first week of training, I got a preliminary understanding of the hospital and learned a lot of new knowledge. First of all, the assistant of the medical department told us about the development history and scale of the hospital, which made me understand that our hospital has a long history, brilliant background and great development potential. At the same time, the substitute teachers in various departments have also formulated strict management regulations for us in teaching management, so that we can establish a rigorous style and serious work attitude from the beginning, form our fixed way of thinking, and lay a good foundation for future work. Medical ethics education really makes me feel the sacredness and pragmatism of being a doctor. We must establish our own image and adhere to principles, so as to better safeguard the sacred authority of angels in white and gain the respect of patients and colleagues. Secondly, specific clinical work, such as writing medical documents, lectures on medical knowledge and clinical operations, makes us realize how difficult it is to do clinical work well, and it is impossible to master theoretical knowledge only. At the same time, I have a perceptual understanding of correctly handling the relationship between doctors and patients.
For the first time, I was fully exposed to how to write patient medical records.
Medical record writing should reflect the following parts:
1 General information of the patient. Name, age, occupation, native place, residence, etc.
Chief complaint: the information about the patient provided by the patient's family.
Current medical history of the patient: information provided by the patient about his current condition.
Patient's past medical history: information about the patient's past diseases provided by the patient or his family. Special attention should be paid to
To determine whether the patient has organic brain trauma, especially whether the patient has alcohol dependence.
Patient's personal medical history: including natural childbirth, parents' personality, living environment, work situation, study situation, alcohol and tobacco history, marriage history, family history, etc.
Psychiatric examination: consciousness disorder, sensory perception disorder, thinking disorder, attention disorder, memory disorder, intellectual activity disorder, self-control, emotional activity disorder, will and behavior activity disorder, etc.
7. Scale evaluation, super inspection report, X-ray inspection report, etc.
All the reports should be finished within 72 hours. If one of them is not finished, you should call back and do it, and the patient cannot be diagnosed.
This part of the medical record transcription needs to be introduced, accounting for only a small part of the whole practice teaching content, which only takes less than 30 minutes, but I feel it is particularly important for us. It is the main idea of diagnosis, in other words, the question of which step your thinking is carried out in order to characterize the case. Whether the medical records are rigorous or not can reflect the level of a hospital and the medical skills of doctors. It is also seriously related to the accuracy of diagnosis and directly related to patients.
In the previous textbooks, it was simply said that it was necessary to understand the general situation, physical symptoms, psychological symptoms, family support system structure and assist the scale evaluation. But the introduction in the book is not as comprehensive as what the teacher said. The substitute teacher clearly emphasized the following points in class.
1 To highlight the past medical history, pay special attention to excluding the influence of organic encephalopathy on neurosis, such as pulmonary encephalopathy, hepatic encephalopathy, mumps, etc., and don't forget to consider alcohol and drug dependence.
In the part of personal history (first of all, the teacher's level is very detailed, which is more thoughtful than that in the book, and the teacher particularly emphasizes), the part of study and life from primary school to university should be asked in detail, and almost as long as the patient has setbacks, he should ask why. In family history, he should ask his parents about the marriage of close relatives within three generations of two families.
In the part of mental examination, we should pay full attention to checking the patient's self-control.
There is also a physical examination report, which contains a B-ultrasound test report and an X-ray test report.
The above points are not included in the textbook, nor are they emphasized. Those parts are very important in clinic. According to the idea of copying medical records introduced by the teacher, people feel serious, earnest, scientific and rigorous. It embodies the scientific spirit of humanism and a responsible attitude worthy of patients' trust.
After several months of internship, I have a certain understanding of the overall operation of hospitals and departments. Now I am learning basic clinical operations, such as chest puncture, dressing change and stitches removal. At the same time, learn the treatment of diseases and the use of commonly used drugs from substitute teachers. Diagnostics and internal medicine used to be the basis, but they are still somewhat out of touch with clinic. For example, the use of antibiotics, books and practice are really different, and different teachers have different habits and experiences. Before there is definite evidence of etiology, medication is based on experience. The most basic pharmacological mechanism of drugs was learned in the pharmacology class of junior year, but I spent a lot of time memorizing things before, because I never used drugs, and almost all of them were returned to the teacher. However, I think if you use it often, it should be very
Very easy to remember. Anyway, I'm never ashamed of my nagging questions. The teacher with the tour group is very busy, so it is not so easy to ask questions at any time. Help me work overtime and write more medical records. It doesn't matter if you go back later. I'm young anyway. At that time, I will run more errands to exercise. In addition to guiding my clinical skills, they also taught me a lot of their own experience in the internship, which saved me a lot of detours.
Our boss gave a small lecture to the interns in the whole internal medicine department. Mainly to teach us to watch CT films. I've studied imaging before. It doesn't sound that hard. Usually, there are often difficult medical records to discuss in the department, and there are also some small topics in our group. There are many opportunities to watch films, but most of the films of real patients are not typical in lectures. For an intern with little clinical experience, it is really impossible to watch a good film overnight.
With my understanding of medical knowledge gradually deepened. My internship is coming to an end. During my internship, I deeply felt that it is not easy to be a doctor, and it is even more difficult to be a good doctor. Practice makes true knowledge, practice makes talents! In the first clinical practice, I realized the importance of combining theory with practice and the importance of good doctor-patient relationship. Without the test of practice, no matter how many theories are on paper.
I have established a good relationship with my teacher in just one year, which makes me reluctant to leave. Walking into the offices of various subjects, I feel less strange and more cordial; Less loneliness, more comfort; Less worry, more sincerity! Here, I not only really learned knowledge, but also understood some truths: be practical and work hard!
Finally, I would like to thank Haikou Fucheng Hospital for giving me the internship opportunity, and also thank all the substitute teachers for leading the interns when they are busy with their work and pointing us in the right direction. I am also very happy to learn from each other and become good friends with other interns in the intense internship life. Although the internship time is very short, it has given me great gains. Besides studying in practical work, the expansion of interpersonal relationship, the diversity of workplace culture and the participation in some activities have benefited me a lot. I think such a full life will be an unforgettable time in my life.
In short, I will cultivate my dribs and drabs in Haikou Fucheng Hospital, and I will take up my post with a more proactive working attitude, more solid operational skills and deeper theoretical knowledge, improve my clinical work ability and do my part for the health cause!
Summary of doctor's work 3 Pediatrics, including children from fetus to adolescence, the fetus is more described in obstetrics and gynecology, newborns, infants, preschool children, school-age children, and all belong to pediatrics until the end of adolescence.
Let's start with the nutrition of newborns and the six benefits of breastfeeding. Of course, the most important thing is the nutrients in breast milk. Protein content is low, which reduces the formation of protein clot in the baby's stomach. High in fat, providing more energy. Lactose is also an indispensable ingredient. The most important protein is whey protein and casein, which is higher than milk. Protein content in milk is high, and the baby's digestive system is underdeveloped and difficult to digest. Active substances in breast milk.
After talking about nutrition, we will enter the topic of pediatric diseases. The first thing to say is rickets, which is caused by vitamin D deficiency. It is divided into three stages, the most obvious in the active stage, such as ping-pong skull, square skull, hand and foot bracelet, beaded chest, rib groove, chicken breast and so on. There are many abnormal manifestations, and there are often sequelae in the later stage. CT showed that there was bone deposition at the epiphyseal end, and the edge was obviously brush-like. Vitamin D can regulate the absorption, metabolism and transformation of calcium. Calcium can be used in the acute phase, and the rest can be treated with vitamin D.
Pneumonia and asthma are common respiratory diseases in children. Asthma has a large part of genetic factors, showing airway hyperresponsiveness. Chronic airway inflammation is the essence, and anti-inflammatory therapy combined with hormone and theophylline can be diagnosed by airway relaxation test, and wheezing is also a common symptom. Pneumonia is caused by Streptococcus pneumoniae and treated with antibiotics.
The diagnosis of tuberculosis in children is mainly tuberculin test, and the treatment principle is the same as that of adults, such as early, adequate, regular, whole course and combined chemotherapy.
The cause of children's diarrhea needs to be clarified, whether it is infectious or non-infectious. Infectious requires the use of antibacterial, antiviral or parasite-killing drugs. Non-infectious diseases may be caused by improper feeding, lactase deficiency and allergic constitution, so differential diagnosis is needed. Diarrhea is classified into light and severe types and diagnosed according to the color of stool. No matter whether there is blood in the stool or not, severe diarrhea often has electrolyte disorder and acid-base imbalance, so water and electrolyte need to be supplemented. It is necessary to find out that it is hypotonic before filling.
Children's cerebral palsy is mainly characterized by non-progressive central system injury from death to one month after birth, which is characterized by central motor disorder and abnormal posture. According to the severity of the disease, it can be divided into total paralysis, quadriplegia, hemiplegia and paraplegia.
The most serious cardiovascular diseases in children are tetralogy of Fallot, right ventricular outflow tract obstruction, right ventricular hypertrophy, aortic straddle and ventricular septal defect. Treatment also belongs to surgical severe congenital heart disease. According to the flow direction of heart blood, heart disease is divided into left-to-right shunt type, because arterial blood flows into right ventricular venous blood, so there is no cyanosis. Right-to-left shunt type, that is, right cyanosis, is a manifestation of circulatory hypoxia, and the lightest is no shunt type.
The most important thing to say here is the diagnosis of pneumonia complicated with heart failure. Breathing is suddenly greater than 60 beats per minute, and heartbeat is suddenly greater than 180 beats per minute, which is serious.
Unconsciously, I have written a lot. Pediatric diseases have their particularity, which should be considered in terms of dosage and medication. Children are in the period of growth and development, and their physiological functions have not yet reached the level of adults. It is necessary to observe their physiological and psychological changes to help them grow up healthily.
Slowly, I found myself growing up and began to study children. Hehe, I hope all the children in the world will grow sturdily and become the pillars of the motherland!
Summary of Doctor's Work 4 It has been more than five months since I joined the work in June. With the care of hospital and department leaders and the help of my colleagues, I successfully completed various tasks, quickly became familiar with the new working environment, and made great progress in my work attitude and professional and technical level, mainly in the following aspects:
First, correct working attitude and serve patients enthusiastically. As a doctor, serving patients is both a responsibility and an obligation. Our hospital is still a new thing for mainland residents. In order to be stronger and bigger in the shortest time, I think we should first improve the service quality and satisfy every patient, so as to expand the popularity of our hospital. After joining the work, strive to improve their ideological quality and professional ethics, correct the attitude of the master, worry about the patient's urgency, think about the patient's thoughts, and do their best to serve the patient; Treat every patient patiently, no matter how tired, take pains to explain and communicate, and strive to implement the work of "two good things and one satisfaction".
Two, seriously and responsibly do a good job in medical work, improve the professional and technical level. 1, insist on business study. After taking part in the work, I still insist on studying every day and mastering a disease every day; At the same time, do not forget to learn the new achievements of this major, constantly absorb new nutrition and exercise scientific research thinking; 2. Adhere to the principle of "Excellence and meticulousness" and carry out work in strict accordance with routine medical operations to avoid medical accidents and errors; I will constantly enrich my clinical experience in my work, always be modest and prudent, and be brave enough to ask the superior doctors for advice when I encounter problems I don't understand.
Strive to improve their comprehensive analysis and problem-solving ability; Closely observe the condition, timely and accurately record the condition, and properly handle patients; As a new doctor, I should guard against arrogance and rashness, be full of energy and keep learning.
Third, be strict with yourself and actively contribute to the development of the hospital. As a member of the hospital, it is my unshirkable responsibility to make suggestions and contribute to the greater development of the hospital. On the basis of doing a good job, we will actively make suggestions for the development of the department and hope that the workload will reach a new high next year.
To sum up, with the help of hospital leaders and colleagues, my work has been successfully completed, but I can't relax at all, because my future work will face greater challenges and opportunities. At the same time, there is still a gap compared with other advanced colleagues. In my future work, I will continue to work hard to overcome my own shortcomings and create more excellent work results.
Summary of doctors' work 5. Advanced surgical technical cooperation
During the seven-month study in the PLA General Hospital, with the care and help of doctors and nurses in the General Hospital, the rotation of each group was successfully completed. Through the study, I have been able to independently complete the surgical cooperation of orthopedic internal fixation of limbs, anterior and posterior cervical internal fixation, thoracolumbar internal fixation and percutaneous low-temperature plasma ablation of nucleus pulposus vaporization; Portal vein shunt, radical resection of rectal cancer, total gastrectomy and retroperitoneal tumor in general surgery; Esophageal and pulmonary surgery in thoracic surgery and three esophageal incisions; Cooperation in neurosurgery, such as anterior and posterior cervical internal fixation, oral and nasal pituitary adenoma, meningioma, carotid aneurysm clipping, acoustic neuroma resection, etc. Popular reading: Scientific Outlook on Development's personal analysis materials
Second, advanced instruments and equipment.
I went to the PLA General Hospital for further study, and saw and personally operated many advanced instruments. Such as ultrasonic scalpel, blanket heater, ring electrode, orthopedic and neurosurgical navigation system, neurosurgical craniotomy electric drill and pneumatic drill, nerve electrical stimulator, rapid disinfection pot, low-temperature disinfection pot, instrument ultrasonic cleaning pot and ethylene oxide disinfection pot.
Two chemical sterilization methods, glutaraldehyde soaking and formaldehyde re-steaming, have been eliminated in the operating room of general hospitals. They usually choose high-pressure sterilization, ethylene oxide sterilization and low-temperature sterilization, so the types of disinfection pots are relatively complete, and the operation is convenient and safe, which not only ensures the sterilization requirements of instruments, but also greatly saves the time for the next operation. In the nerve group, the advanced navigation system is used to cooperate with the operation. Through navigation, the position, size and completeness of the resection of the space-occupying lesion during the operation can be accurately judged, which greatly improves the quality of the operation. The navigation system used in orthopedic surgery of spinal internal fixation can help doctors to judge whether the nail is in the cone or not and whether there is nerve damage, which increases the safety factor of the operation.
Third, the operating room management experience
The PLA General Hospital has many advantages in logistics management, human resource management, equipment management and high-value goods storage, which is worth learning. Each department prints a detailed list of charging items, and the toll collectors check and keep accounts after each operation, and the fees are settled on the same day to prevent arrears and missed charges. The instrument is responsible for all operations the next day. Conventional instruments and special instruments should be used, and the supply of emergency surgical instruments should be guaranteed. After the operation, the instruments should be cleaned, maintained, packaged and sent for disinfection. The teaching of new nurses and advanced students in general hospitals is very strict and standardized, and the training is managed by a teaching team leader. In order to prevent students from blindly coming to the stage, they were first organized to learn the rules and regulations and workflow of the hospital operating room, which laid a solid foundation for students to cooperate with the operation smoothly in the later period. Every operation has been trained in a unified way, and personal habits in the operation process have been eliminated. Adopt the "One Belt, One Belt" teaching method. In this process, teachers set an example, so that all students can understand the cooperation process of each operation, get used to the habits of operators and the matters needing attention in the operation process, and benefit all students.
Fourth, learning summary
Through the comparison during the research period, it is found that there are both gaps and advantages between us and the PLA General Hospital. For example, in the operation notice, the foreign hospital will indicate the operation site, special supplies, whether it needs autologous blood recovery instrument and whether the patient has special infection, so that the head nurse can arrange the operation; Our hospital has done a very detailed job in cleaning, maintaining and disinfecting instruments, and has also done a very good job in maintaining instruments, basically putting an end to the strike phenomenon of instruments during surgery.
After seven months of advanced study, with the help of doctors and nurses in the operating room of PLA General Hospital and personal active study, my theoretical knowledge and professional skills have been greatly improved, and I have achieved the established internship goal, successfully completed the advanced study task and won unanimous praise from the teaching teachers. Strive to further improve my work in the future with the income from further study, and at the same time implement and carry forward the advanced management concepts and practices of other hospitals in our hospital.
Summary of Doctor's Work 6 In the past few years, under the leadership of the unit leaders and with the strong support of my colleagues, I have been able to successfully complete all the tasks I have undertaken, and have made some progress in political and ideological awareness and professional work ability. Now I will summarize my 20xx years of study and work as follows:
First, strengthen self-construction and constantly improve ideological and political quality.
I have always stressed strengthening theoretical study, especially after work in the unit, paying more attention to theoretical study, enriching knowledge and raising awareness. I can actively participate in various political theory studies organized by the unit, deeply understand the spirit of the party, constantly improve my thoughts through various forms such as learning and writing my experience, and at the same time strengthen my business knowledge study and strive to improve my professional quality. Actively carry out medical quality management activities to benefit the people, adhere to the patient-centered and quality-centered nursing service concept, adapt to the new situation of health reform and social development, actively participate in various political activities, take serving the people and contributing to society as the purpose, take patient satisfaction as the standard, and serve the people wholeheartedly.
Second, work hard and do a good job.
At work, I always insist on being strict with myself, work hard and do my job well in ordinary and ordinary jobs.
Third, learn from each other's strengths and strive to improve the level of work.
Ask for advice modestly at work, actively improve working methods, enhance working ability, and make yourself better qualified for the job.
Four. Future goals
I am determined to further invigorate my spirit, strengthen the transformation of my personal world outlook, and strive to overcome my own problems, so as to:
1, do a good job in theoretical study and maintain political firmness.
2. Under the care and guidance of hospital leaders, department directors and head nurses, we successfully completed medical and nursing tasks, earnestly performed our duties and loved our jobs.
3, take the department as the home, work actively, treat patients with enthusiasm and patience, and meet the needs of patients.