A 40-year-old male patient with chronic hepatitis B came from a foreign province to see me at Long March Hospital. This patient appeared very confident in front of me, and he particularly insisted on the idea that “people can live peacefully with the virus” and tried to convince me that he was already a “good doctor”. The patient was vertically transmitted from mother to child with chronic hepatitis B. At the age of 28, he was found to have a “major triplet” during a marriage test, with a viral gene level of seven times ten, but his transaminases were always normal, and there were no cirrhosis or liver cancer patients in the last two generations of his family. He has also been sharing his experience with patients on various hepatitis B communication websites or microblogs, and has a clear understanding of the diagnosis, treatment and prognosis of hepatitis B, as well as liver protection, enzyme reduction and antiviral treatment programs. Therefore, it also stubbornly formed the idea that “active conditioning, proper exercise, balanced nutrition and ‘enhanced immunity’ can ensure that the hepatitis B virus and humans can coexist peacefully; antiviral treatment is not necessary; interferon treatment is very ineffective, inconvenient to inject, too many side effects and too expensive; long-term If you take nucleoside analogs, not only will drug resistance occur, it will be more difficult to deal with the emergence of mutated strains of the virus, but also cause kidney damage, muscle damage, osteoporosis, and even cancer, which is not worth the cost”, listened to him eloquently, just like an expert in science. I introduced to him in detail the results of 13 years of research by Taiwanese scholars, telling him that “a chronic hepatitis B virus infection, even if the aminotransferase is normal, if the initial amount of virus exceeds six times ten, then from the age of 30, in the next ten years or so, the probability of transformation into cirrhosis is about 35%, and the probability of liver cancer is about 15 “. Unexpectedly, he laughed, “I know about that study, but then isn’t there still 65% of people who don’t develop cirrhosis? Isn’t there still 85% of people who don’t have liver cancer?” I repeatedly explained what “probability” was all about and told him a childish truth: “Your mother was born to your grandfather and grandmother, and you were born to your father and mother, and just because you don’t have severe liver disease in your family doesn’t mean you’re safe. In the end, I was unable to convince him in 30 minutes with my three-inch tongue. Three years later, he came to my clinic for the second time, accompanied by his family, carrying a pocket of CT films and a dark complexion. His eyes were moist with remorse upon seeing me. This patient, who also used various prescriptions for a long time, had normal “liver function” because the drugs and prescriptions he took contained liver-protecting and enzyme-lowering plants, but he never tested his viral load, did not do ultrasound, and of course firmly refused antiviral treatment. However, he never tested his viral load, did not take ultrasound examinations, and of course, firmly refused to take anti-viral treatment. Later, under my guidance and persuasion, he underwent surgical treatment and started antiviral treatment, and also used medically proven immune-boosting and anti-cancer drugs, and is now recovering well. When he left the clinic, he said to me emotionally, “Professor Miao, a long illness does not make a good doctor!” I humbly told him, “A long-time doctor is not necessarily a good doctor!” Through this true story, readers must have understood my intention, and such lessons are by no means isolated. In today’s extremely advanced network, medical information is very easy to obtain, and “Baidu” can do almost anything. But we must also be soberly aware that medicine is a complex and esoteric science, only the organic combination of self-care and medical consultation, and the development of good compliance with medical treatment, to ensure maximum benefit, to avoid tragedies. Ancient people proposed the “long illness into a good doctor”, actually refers to a person suffering from a chronic disease, in the long-term medical treatment and conditioning process, gradually have a more comprehensive and profound understanding of the diagnosis and treatment process of the disease and even the pathogenesis, its cognitive level is far more than the non-patient, seems to have reached a ” The level of knowledge is much higher than that of non-patients, and seems to have reached the realm of a “doctor”, which has more or less inspirational significance. The author does not deny that the knowledge of the corresponding disease may be higher in the patient, but this knowledge must be limited, one-sided and superficial, in today’s explosion of medical knowledge, not to mention the patient, even doctors, because of the different professional “barrier”, and the knowledge of the same disease will be very different, the so-called The so-called “different professions are like different mountains”! Even for doctors of the same specialty, differences in cognition can occur due to differences in overall knowledge structure, clinical experience, and the speed and depth of updated knowledge for the same disease (e.g., liver disease). It is not polite to say that old doctors (long-time doctors) may not be good doctors (good doctors). What I have said before actually tells the reader how to properly treat the relationship between managing one’s own liver disease and seeking help from a doctor, and then how to look at liver disease. Chronic liver disease is a “chronic disease”, but there is a wide range of chronic liver disease. There are five most common clinical categories of chronic liver disease: chronic viral liver disease (mainly chronic hepatitis B and C), alcoholic liver disease, autoimmune liver disease, drug-related liver disease, and steatohepatitis. All of these liver diseases share the common feature of inflammation of the liver with progressive exacerbation, but the severity of their conditions, the prognosis of the disease, and the means of treatment vary widely. For example, viral liver disease, without effective antiviral treatment, can easily develop into cirrhosis, liver cancer and liver failure, but some patients can be cured, especially chronic hepatitis C is curable, and a few chronic hepatitis B can also be cured; autoimmune liver disease, the current treatment is mostly aimed at delaying disease progression, but cannot be cured; alcoholic liver disease that has not developed into cirrhosis or liver cancer actually does not require The treatment of overweight-related non-alcoholic fatty liver disease lies in weight loss, and the main measures for weight loss are diet and exercise, and drugs, basically, are not the first choice for treating this type of fatty liver disease; drug liver disease, less chronic, but once chronic, must deal with the treatment of the primary disease (such as long-term use of antihypertensive drugs, hypoglycemic drugs, lipid-lowering drugs, anti-tuberculosis drugs and anti-cancer drugs, etc.) and liver protection The relationship between treatment and liver protection. It is also important to remember that regular monitoring of liver disease is no less important than drug therapy itself. In the case of chronic hepatitis B, for example, clinicians always instruct patients to go to the hospital regularly to check liver function, virus quantification, two-to-one half, alpha-fetoprotein and liver imaging, with the aim of early detection of possible viral resistance and exacerbation of liver disease, and this regular monitoring must be done in the hospital, where patients cannot self-monitor and cannot be their own “good doctor “. In conclusion, liver disease is very complex and requires good cooperation between the patient and the doctor. The patient should not be overconfident to the point of disrespecting medical advice and distrusting the doctor, but should also have proper general knowledge about liver disease in order to identify abnormal conditions that may occur at various stages of chronic liver disease so as not to lose the best opportunity for diagnosis and treatment, and should also regularly follow the progress in the field of liver disease in order to obtain the best treatment in a timely manner. Therefore, there is no need to be too controversial about whether chronic liver disease can become a good doctor, but science and proper treatment are what is important.
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