Chapter 69: Surgery Fees

Translator: EndlessFantasy Translation Editor: EndlessFantasy Translation

The third surgery Ling Ran carried out using the M-Tang technique was very successful.

Huo Congjun and Lu Wenbin were not the only ones who thought so. Ling Ran himself felt very good about it, too.

Similar to how students solved problems during examinations, when performing surgeries, doctors would often have the feeling that things were going well. Every time this feeling came, the result of the surgery would be better than expected. Oftentimes, a lot better.

If you were to investigate the reason for it, it would probably be because the patient's condition was predicted.

Students often guessed and predicted the questions that would come out when preparing for examinations. Actually, doctors often did the same thing before performing surgeries—they try to predict all the possible complications that might arise during surgery.

Medical imaging information, obtained from MRI scans, X-rays, CT scans, ultrasonography, Doppler ultrasonography, or the more expensive PET scans; all sorts of laboratory tests, and even biopsies and endoscopies, were used to increase the information available for doctors to make diagnoses. The information would also be used by doctors making preoperative diagnoses to predict the complications that could arise during surgery. If a doctor managed to predict all the complications, the surgery may be carried out smoothly and pleasantly. If the doctor did not manage to predict the complications, then his performance would be dependant on the knowledge he accumulated and the preparations he took on usual days.

Even though modern medicine seemed advanced, if you were to look at it in relation to the complicated human body, it was still extremely infantile. There was once an ace doctor in China whose wife suffered from cancer. He led his favorite students to perform a thorough examination before the surgery, and was said to be very well-prepared. But the moment he cut open his wife's abdominal cavity, he found that the cancer cell infiltration totally exceeded his expectations. He had to bear the burden of self-blame and suffering as he painstakingly tried his best to remove the cancer cells bit by bit and complete the surgery. If there were other reasonable choices, even a minor one, no doctors would be willing to put themselves in such a situation.

You could say that things that occur outside of expectations are a doctor's greatest enemies. And if things went as expected, it would be the prelude to success.

As modern medicine developed, more and more illustrative cases were established and expanded. The most important diagnoses doctors had had to make were to determine the illustrative cases certain diseases belonged to, whether those diseases could be treated, and how they were to be treated.

Ling Ran's diagnostic skills were still very weak. But compared to the complicated diseases doctors of internal medicine faced, it was relatively simple for surgeons to make diagnoses. The M-Tang technique could be used on a patient with a ruptured flexor tendon. As for how the surgery was to be executed, the judgements made during the course of the surgery, and the continuation of the surgery, those depended on Ling Ran's prediction of the difficulties that might arise during the surgery, and his ability to improvise on the spot.

Maybe it was because Ling Ran was motivated by the fact that the patient's flexor digitorum profundus and flexor digitorum superficialis were ruptured at the same time. Maybe it was because Ling Ran knew the surgical method better now after performing surgery using the M-Tang technique twice. In short, the surgery which was planned to be completed in four hours, and would have taken three and a half hours in practice, was completed in only two and a half hours.

During that period of time, Ling Ran neither deliberately increased his speed nor tried any methods to accelerate the course of the surgery.

When Ling Ran put down the pair of surgical scissors and announced that the surgery was completed, Lu Wenbin dumbly started packing up. On the other hand, Huo Congjun who sat on the round chair raised his head to look at the clock. He was deep in thought.

Su Jiafu the anesthetist's buttocks trembled slightly. He felt as though he had lost more than three pounds.

Using his memory which had scored him more than six hundred points on his college entrance examination, he vowed to bring his own round chair the next time he participated in Huo Congjun's surgery.

"Can I go back now?" Ling Ran carried out another round of inspections and made sure that no medical instruments were missing. He then relaxed.

He had done most of the things he could do as a surgeon. The rehabilitation and recovery that came after depended mainly on the patient himself.

Huo Congjun hummed as he came to his senses. He kicked the round chair away and said, "Go home and get a good rest. That was a pretty long surgery."

Even though the media often reported on surgeries that lasted for six or eight hours, when it came to life in the hospital, a two-and-a-half hour surgery was pure torture.

Ling Ran took off his gloves and subsequently looked at the monitor. He then followed Huo Congjun out of the operating theater.

Most doctors who performed surgeries in most operating theaters actually rarely looked at the monitors because the monitoring instruments nowadays were too highly automated. In general, the fact that the monitors did not beep meant that the patients were alright. Sometimes, no one paid any attention to the monitors even when they beeped.

But Ling Ran did not like them; he was even more doubtful of automated instruments than he was of artificial intelligence.

"Lu Wenbin, remember to pay attention to the patient's recovery from the anesthesia," Huo Congjun ordered before he left.

"Okay," Lu Wenbin answered obediently. As a junior resident doctor, he had to do all the remaining chores. Every now and then, when it was busy in the operating theater, the circulating nurses would even urge him to act faster.

Fortunately, habits became second nature.

Ling Ran exited the operating theater and greeted Huo Congjun. He then entered the shower room.

The operating theaters of the Emergency Department followed the standard layout. Even though there were only four operating theaters right now, the shower room had eight cubicles. Ling Ran let the warm water from the shower head hit his body and carefully recollected the earlier surgery.

This surgery felt the greatest among all the surgeries he had performed. Even though there were also times before this when he felt wonderful when debriding and suturing wounds, those surgeries were too minor and brief, and ended before Ling Ran could properly savor the amazing feeling.

Today's surgery went on for two and a half hours, and Ling Ran was busy for two of those hours. At that time, he was nervous, excited, and 'in the zone'. He felt great during the process, and also felt great about the outcome. He even felt great when he thought about it.

After drying himself, Ling Ran wondered where he should go when he saw Doctor Zhou waiting for him in a corner of the shower room. He looked as if he was about to fall asleep.

"You only needed to take a quick shower. I waited so long for you that I'm tired now." Doctor Zhou yawned.

Ling Ran looked at Doctor Zhou, who waited for him to finish showering, and asked in surprise, "Don't you have work?"

"Why would I not have work?" Doctor Zhou got up by supporting himself against the wall and said, "I got someone to cover for me."

Ling Ran nodded in understanding.

Even though he had left the treatment room and was no longer interested in the debridement and suturing of wounds, there were still a lot of resident doctors, housemen, postgraduate students, and medical interns from various departments waiting for opportunities to perform treatment in the Emergency Department's waiting room.

Doctor Zhou snorted a few times and said, "I'm here today to tell you about the division of fees."

"Surgery fees?" Ling Ran asked.

Doctor Zhou froze for a moment and said with a smile, "Even though other people say that you are slow-witted, I think that you are pretty bright. Department Director Huo asked me to come over and explain to you that the surgery fees that will be paid to you were supposed to be for him, that it's his business whether he wants to give them to you, and that you don't have to think too much about it."

If surgery fees were to be shared, Doctor Zhou would not have let other people perform the surgeries that he was supposed to perform.

Surgery fees were paid to the chief surgeon. It was impossible for them to be paid to medical interns, and Huo Congjun was worried that misunderstandings would arise from the fact that the money was transferred to his card. It would not be nice if that happened. That was why he specifically asked Doctor Zhou to explain things to Ling Ran.

Because the conversation involved money, Doctor Zhou found an empty meeting room and shut the door. He said, "At the moment, our hospital follows the charging standards of tertiary hospitals. The surgery fees were decided by the Price Supervision and Anti-monopoly Bureau and cannot be changed. According to new hospital rules, the medical staff get fifty percent of the surgery fees. This is many times more than what the medical staff in other hospitals get. As for the division of the fifty percent received, it would be decided by our department."

Doctor Zhou glanced at Ling Ran and continued, "Our department fixed the second division at a 2:1 ratio, which means that the chief surgeon gets two-thirds of the surgery fee, while the remaining one-third is divided between the assistants, nurses, and the anesthetist.

"Most surgery departments in our hospital do it this way. To be specific, let's take the surgery all of you performed today as an example..."

Doctor Zhou took out the list he printed and said, "All of you performed a flexor tendon reconstructive surgery under the code 331521014. You can see from this form that the surgery fee would be 1,210 RMB in secondary hospitals, and 1,344 RMB in tertiary hospitals. Our hospital is a tertiary one, so we would be receiving 1,344 RMB. Besides, 210 RMB would be added to the fee with every extra finger that requires surgery. So, the total surgery fee for today would be 1,554 RMB, and the Emergency Department would be getting 777 RMB out of it. Because the chief surgeons get two-thirds of the surgery fees, you would in the end be getting 518 RMB. Do you understand?"

"I understand." Since Ling Ran was not very sensitive to money, he did not react much.

Doctor Zhou chuckled and said, "You are now considered a high-earning doctor in our hospital, and are receiving as much money as a senior-ranked chief physician."

Ling Ran asked, "Is it different for doctors of different ranks?"

"There's a very huge difference," Doctor Zhou said. "If you adhere strictly to the rules, junior-ranked resident doctors can only be the chief surgeons of Level 1 surgeries, senior-ranked resident doctors can only be the chief surgeons of Level 2 surgeries, and you have to at least be a junior-ranked attending physician to participate in a Level 3 surgery. Up to this point, all of them require the guidance of superior doctors. You currently perform Level 3 surgeries which require the chief surgeon to be a senior-ranked attending physician."

Like other institutions, hospitals practised double standards. The ostensibly strict regulations could actually be bent according to needs. The consultation system, the prohibition on doctors from performing for an external salary without approval from the hospital, and the ban on doctors from being treated to free meals (receiving bribes) were also part of the strict regulations.

Ling Ran nodded slowly.

"The fees for Level 1 surgeries performed by ordinary resident doctors are only around 100 RMB. The cheaper ones such as the debridement and suturing of wounds would only be 70 or 80 RMB. Even if you perform three or four such surgeries a day, you would only get 100 RMB or so." Doctor Zhou paused for a while and said, "Assistants don't get much either. For example, Lu Wenbin would get a big chunk out of the... 259 RMB remaining, probably around 150 RMB. The remaining 100 RMB would be divided among the two nurses and the anesthetist.... What I'm saying is, doctors earn very little."

Ling Ran looked suspiciously at Doctor Zhou and said, "If Lu Wenbin participates in three surgeries a day, he would get 500 RMB a day. This way, he can get 15,000 RMB per month?"

"Are you crazy? Twenty surgeries a month is already too much for a doctor to handle. A doctor could die from fatigue if he were to perform thirty surgeries a month. Who in the world can do ninety surgeries each month...?" Doctor Zhou's voice became softer and softer as he spoke, because he saw that there was something obviously wrong with Ling Ran's gaze.

Ling Ran was reading notifications from the system in his mind.

[Mission: Practice the M-Tang technique]

[Mission Details: Every time you perform ten surgeries using the M-Tang technique in the same month, it would be seen as the completion of one mission.]

[Reward: Basic Treasure Chest]

[Progress: (1/10)]