1, the core problem of treatment is the target problem.

Last class, we talked about the logic of diagnosis and learned how diseases are diagnosed. After the diagnosis, it is treatment. Let's talk about the treatment in this class.

If you want to treat, you must first make clear the treatment goal, which is the core problem of treatment.

To understand this, let's look at a case first.

1992, Michael Jackson appeared in a concert in Bucharest.

When he put on his hat and diamond gloves and made a classic gesture, the whole world was quiet.

He just stood quietly for three minutes, then the music suddenly started, and he walked out of his smart and elegant spacewalk on the stage.

The fans in the audience kept screaming, almost hysterical. Countless people burst into tears, and from time to time, some people fainted, and then they were put out by the audience from the top of their heads.

That kind of passion makes people feel that the universe is going to explode.

Michael Jackson, 1992 Bucharest concert.

Such a music superstar is also a controversial person.

Some people say that Michael Jackson is rich and has the best medical resources in the world. In order to change his black identity, he bleached his skin and transplanted it. Finally, my health is getting worse and worse.

Others say that he wears lipstick, heavy makeup, gloves and umbrellas on sunny days, all of which are quirks.

However, all this is a misunderstanding. These seemingly strange behaviors are all for treatment.

According to the information provided by Wikipedia and Jackson's dermatologist on the Internet, Jackson was diagnosed with vitiligo.

You must have seen patients with vitiligo, whose skin turns white one by one. The cause of this disease is unknown, which is characterized by the loss of melanocyte function, and the whitening place is because there is no pigment.

It can occur in every part of the body, especially around the lips, the back of the hand, face, neck and genitals.

So far, there is no definite and effective treatment for this disease.

When there were few white spots at the beginning of the disease, he applied ointment on the white spots to delay whitening. He wears heavy makeup, lipstick and gloves to cover the white spots on his skin.

With the aggravation of the disease, more and more white skin, more than black skin. He can only apply hydroquinone, a drug that can reduce pigment, to black skin in order to make it look even.

Finally, the skin turned white, as if from black to white, but it was a disease. There is no skin bleaching technology in medicine, and it is impossible to change a person's skin color by transplanting skin.

Whether it's white to black or black to white, it's all about getting him on stage.

With this goal and treatment, every performance of his has been a great success. It can be said that within 100 years, no one can surpass him in the history of pop music.

His final cause of death has nothing to do with the target. He died of an overdose of sedatives.

This case tells us that the core problem of treatment is the goal problem.

Goals should be set before treatment, and treatment should be goal-oriented. This is the first level of treatment.

2. The patient's needs determine the treatment goal.

So how to determine the treatment goal?

Different patients have different needs.

20 12 London Olympic Games, 1 10 meter hurdles,1300 million China people are nervously waiting for the appearance of "Asian trapeze" Liu Xiang.

When Liu Xiang appeared in a red sports vest and shorts with the number 1356, the audience applauded warmly.

But there is one detail you may not know.

Before playing ball, the doctor gave him an injection on his right heel. Before the start, Liu Xiang smiled. After the shot, he got off to a good start, but when he crossed the first hurdle, he tripped over the hurdle and the audience hissed with regret.

Finally, Liu Xiang jumped to the finish line and limped out of the race.

Liu Xiang, 20 12 London Olympic Games.

Liu Xiang's disease is called Achilles tendon terminal disease, that is, chronic repeated traction strain of the tendon of the heel, causing local inflammation and severe pain.

There are surgical and non-surgical treatments for this disease.

Surgery is to remove the diseased tissue, repair the defect and recover after exercise. But the disadvantage of the operation is that he can't participate in key competitions until he recovers.

Non-surgical treatment can take pain point blocking, that is, injecting drugs at the most painful point to temporarily relieve pain for 1-2 hours. The risk is that you may not be able to stop the pain, but there is hope for the game after all.

Liu Xiang's demand is clear, even if he is injured, he should fight.

Therefore, the doctor and he chose non-surgical treatment. Although this method failed in the end, he tried.

Assuming that Liu Xiang's demand is to give up the game and be cured completely, then surgery is the choice.

This is the second level of treatment, which sets goals according to the needs of patients, and the needs of patients determine the treatment goals.

3. Match patients' needs with medical goals.

However, patients' needs are only subjective requirements, which are not objective and accurate, and are different from medical goals.

For example, for parents of congenital deaf-mute children, their demand is that their children can listen and speak.

But how can you hear it?

You can only hear the voice of "Yi Yi". Do you hear me? Do you hear all frequencies or a certain range of sounds?

For another example, a patient with bad teeth needs beauty and a companion.

How can it be beautiful? Or can you find someone by biting your teeth together?

Let's start with the deaf.

In order to meet the needs of patients who can hear sound, doctors will decide whether to implant cochlear implants according to the specific situation.

This small machine can convert sounds into electrical signals, which can directly stimulate children's auditory nerves and produce hearing. The children heard exactly what we heard. In this way, we can understand the language he has learned.

Cochlear implants convert sound signals into electrical signals.

In this case, the medical goal is to ensure the normal conversion and conduction of sound.

After the operation, the parameters should be adjusted to accurate values. Such as electrical stimulation mode, channel selection, etc.

Let the children hear that these are objective data and indicators.

Besides, the patient with bad teeth wants to be beautiful.

Doctors can make the patient's dentition neat, the teeth are comfortable, and the edges are accurate, smooth and seamless, neither wide nor narrow.

According to most people's aesthetic point of view, teeth alignment can be beautiful.

Moreover, orthodontics can also prevent periodontal disease and reduce the incidence of cancer, diabetes, stroke and coronary heart disease. These are objective medical goals.

Moreover, today's medicine can also meet people's needs that are not aimed at treating diseases, such as:

Cosmetic surgery, breast augmentation and wrinkle removal are for beauty;

Vaginal contraction and male cavernous prosthesis implantation are to make life more colorful;

IVF and artificial insemination are to have a child;

Sex change surgery is to meet psychological needs.

Therefore, patient needs and medical goals are two concepts.

This is tertiary treatment.

However, in many cases, it is difficult to meet the needs of patients and will be subject to various restrictions.

For example, the level that medicine can reach, the patient's physical condition, economic factors, social factors, legal and ethical constraints.

Patients' needs and medical goals will also conflict.

There is such a case.

A 22-year-old girl with congenital absence of uterus came to see a doctor. Her need was to have a child of her own.

This case was put in the past, and the patient's needs and medical goals were in conflict.

How can you have a baby without a uterus? Not only is the patient's physical condition not allowed, but the medical level is not up to standard.

But this conflict will not last forever.

20 15 The obstetrics and gynecology department of Xijing Hospital transplanted the girl's mother's uterus. With the help of this transplanted uterus, she successfully gave birth to a healthy baby boy.

This is the 14 child born with a transplanted uterus in the world and the first case in China.

Therefore, with the development of medicine, doctors will try their best to approach the needs of patients with scientific medical goals, because the essence of treatment is the matching of medical goals and patients' needs.

Get it now:

1, after diagnosis, it is treatment. If you want to treat, you must first make clear the treatment goal, which is the core problem of treatment.

On sunny days, Jackson wears lipstick, heavy makeup, gloves and an umbrella. The goal of these is not to cure or change the black identity, but to make the appearance as close as possible to normal people. All his treatments revolve around this goal. Whether it is white to black or black to white, his treatment goal is actually very simple, not to cure vitiligo, but to "perform", all in order to get him on stage.

3, the first level of treatment, treatment must first set goals, treatment is goal-oriented.

4. How to determine the treatment goal? It is to design different treatment goals according to the needs of patients. There is no absolutely correct best solution in medicine. Patients' needs and goals are different, so the treatment schemes are different.

5. In the second level of treatment, goals are set according to patients' needs, and patients' needs determine the treatment goals.

6. The patient's demand is only subjective, not objective or accurate. Different from medical goals. Doctors must match patients' subjective needs with objective data and indicators.

7. In the third level of treatment, patients' needs and medical goals are two concepts. Treatment is to approach the needs of patients with quantifiable, objective and standardized medical goals.

8. The core problem of any treatment is to set the goal first, and then treat it around the goal. ? Treatment goals must be based on the needs of patients. The essence of treatment is to match patients' needs with objective and quantifiable medical goals. The process of treatment is the process of interaction between medical goals and patients' needs.