1、學術(shù)英語 醫(yī)學Academic English for Medicine學術(shù)英語 醫(yī)學Academic English for MeUnit 7Physician-Patient RelationshipLife can be hard. Relationships are often difficult. In an era of fast advancing medical technology, rapidly changing medical ethics, and in increasingly litigious society, good physician-patient re

2、lationship is critically important for effective health care delivery. This unit sheds some light on how to build such a relationship to help us through the unpredictability in life.Unit 7Physician-Patient RelatiUnit 7 Life and MedicineUnit ContentsLead-inText AText BText CListeningSpeakingWritingGe

3、t reading for Unit 8Unit 7 Unit ContentsLead-inTexLead-inIssues to be coveredTaskUnit 7 Life and MedicineLead-inIssues to be coveredUniLead-inIssues to be covered The shift from paternalistic paradigm to patient-center paradigm in medical decision makingThe importance of good physician-patient relat

4、ionship in both the medical practice and the patients recoveryThings that counts in maintaining a amiable physician-patient relationshipThe way to communicate properly and effectively with the patientsUnit 7 Life and MedicineLead-inIssues to be covered ThLead-inDecide whether life-support system sho

5、uld be continued or withdrawn;Decide whether euthanasia should be considered;Decide whether a new therapy should be tried;Decide whether surgery should be the first choice or the last resort;Decide whether transfer or referral is needed.Task: Read the title of Text A and imagine three different situ

6、ations in which doctors may be asked to make “tough decisions” for their patients. Then write them down.Unit 7 Life and MedicineLead-inDecide whether life-supText A Critical reading and thinking Topics for presentation Useful expressions Difficult sentencesLanguage building-up Signpost language Voca

7、bulary testSuggested answersUnit 7 Life and MedicineText A Critical reading and thText A Critical reading and thinkingTopics for presentation1 What difficult situation is the young doctor facing? A dying patientDecision whether to withdraw life-support machines and medication and start comfort measu

8、resThe familys refusal to make any decision or withdraw any treatmentsUnit 7 Life and MedicineText A Critical reading and tText A Useful expressions護士站 nursing station停止使用呼吸機并停藥/停止治療 withdraw life-support machines and medications / treatmentwho was impressive not only for his clinical skills but als

9、o for his devotion to patientswho was impressive not only for his clinical skills but also for his devotion to patientsI told them suffering or comfort it was their decision.But in the end, they made no decision and just walked right out of the room Critical reading and thinkingUnit 7 Life and Medic

10、ineText A Useful expressions護士站 2 What is paternalistic decision-making in medicine? Topics for presentationText A Critical reading and thinkingDoctors as exclusive decision makerPatients as participants without little say in the final choiceUnit 7 Life and Medicine2 What is paternalistic decisiText

11、 A Useful expressionsThe way doctors and patients approach medical decisions has changed sharply over the last 50 years.and patients, if they participated, often had little say in the final choice. Critical reading and thinkingUnit 7 Life and MedicineText A Useful expressionsThe Text A Topics for pr

12、esentation3 In what way can patient empowerment be good for the patient? Critical reading and thinkingRespect for the patient, especially the patients autonomyPatient-center careThe Patients as decision maker based on the information provided by the doctorUnit 7 Life and MedicineText A Topics for pr

13、esentatioText A Topics for presentation3 In what way can patient empowerment be good for the patient? Critical reading and thinkingTwo principles /tenets / notions involved in the decision-making processrespect for the person a new clinical ideal: patient-centered care in wards, clinics and operatin

14、g roomsrespect for a persons autonomy letting patients make their own decisionsUnit 7 Life and MedicineText A Topics for presentatioText A Topics for presentation4 Why does the author say too much physician restraint may not be that good for the patient? Critical reading and thinkingThe patients are

15、 forced to make decisions they never want to.Patients, at least a large majority, prefer their doctors to make final decisions.Shifting responsibility of decision making to the patients will bring about more stress to the patients and their families, especially when the best option for the patient i

16、s uncertainUnit 7 Life and MedicineText A Topics for presentatioText A Useful expressionsa majority of patients are being left to make decisions that they never wanted to in the first place.When it came to medical decisions, almost all the respondents wanted their doctors to offer choices and consid

17、er their opinions. But a majority of patients two out of three also preferred that their doctors make the final decisions regarding their medical care. not when the medical choices are obvious, but when the best option for a patient is uncertainwhen doctors pass the burden of decision-making to a pa

18、tient or family, it can exacerbate an already stressful situation.Critical reading and thinkingUnit 7 Life and MedicineText A Useful expressionsa mText A Topics for presentation5. What kind of considerations may have prevented doctors from making decisions for their patients? Critical reading and th

19、inkingDoctors are very much cautious about committing some kind of ethical transgression. Who am I to presume to know what my patients need?Unit 7 Life and MedicineText A Topics for presentatioText A A Case in Point: Language Makes a Difference Tell relatives that it is their choice to withdraw life

20、 support from a dying patient. But that doctor may also use value-laden language to describe the options. One alternative may be described to the family as “reasonable” or “comforting,” while the other is depicted as “invasive,” “aggressive” or “painful” .Critical reading and thinkingUnit 7 Life and

21、 MedicineText A A Case in Point: LanguText A A Case in Point: Language Makes a Difference Dr. Curlins Wisdom IBizarre dishonest of communicationPatients end up feeling manipulated and will resist making any decision at all.Critical reading and thinkingUnit 7 Life and MedicineText A A Case in Point:

22、LanguText A A Case in Point: Language Makes a Difference Dr. Curlins Wisdom II “We have to stop drawing a circle around patients and their families,” “We have to stop subjecting them to the loneliness and burden of autonomy and instead begin standing in that circle with them.”Critical reading and th

23、inkingUnit 7 Life and MedicineText A A Case in Point: Langu6 Do you agree that doctors should be prepared to make any decisions together with their patients? Text A Topics for presentationCritical reading and thinkingShouldering responsibility together with the patient may be better than having the

24、patient make decision on their own alone.Balancing between paternalism and respect for patients autonomy constitutes a large part of medical practice.Unit 7 Life and Medicine6 Do you agree that doctors shText A Useful expressionsthe key to preserving patient autonomy and patient-centered carelies no

25、t in letting patients make the final decisions alone but in respecting their opinions and shouldering the responsibility together.I admit, myself, will need to be more mindful of whether patients want them to share information, be directive or hand over the responsibility of the decision.Critical re

26、ading and thinkingUnit 7 Life and MedicineText A Useful expressionsthe Text A Additional ActivityWatch the Video and see what are tips givenby Dr. Thaddeus Bell to build a Amiable PPRelationshipDoctor-Patient RelationshipCritical reading and thinkingUnit 7 Life and MedicineText A Additional Activity

27、WatText A Difficult sentencesHe was large and powerfully built but never seemed to loom over his patientsCritical reading and thinking他身材高大偉岸，但是從來不讓病人有咄咄逼人的感覺Unit 7 Life and MedicineText A Difficult sentencesHe Text A Difficult sentencesas movements calling for patient empowerment grew and medical e

28、thicists began articulating principles regarding the ethical care of patients. Critical reading and thinking要求病人授權(quán)的呼聲越來越高，而且醫(yī)學倫理學家也開始闡述病人倫理關(guān)懷的相關(guān)原則。Unit 7 Life and MedicineText A Difficult sentencesasText A Difficult sentencesOne tenet that gained particular traction among cliniciansCritical reading

29、and thinking臨床醫(yī)生們尤為擁護的一條宗旨this ethical principle led to a new clinical ideal: patient-centered care這條倫理原則導致了一種新的臨床理念的出現(xiàn)：以病人為中心的醫(yī)護。Unit 7 Life and MedicineText A Difficult sentencesOneText A Difficult sentencesyoung doctors, myself included, would be trained to restrain ourselves from making anything

30、 but emergency or mundane decisions for patients.Critical reading and thinking包括我在內(nèi)，年輕醫(yī)生將接受培訓，學會除了一些緊急狀況或日?，嵤?，不為病人作其他任何決定。Unit 7 Life and MedicineText A Difficult sentencesyoText A Difficult sentencesand that interpretation would work its way into the teachingprograms of medical schools and into sta

31、te laws that mandated discussion of treatment options with patients.Critical reading and thinking而且，對病人自主性的解釋逐漸進入了醫(yī)學院校的課程，也被寫進各州的法律，規(guī)定醫(yī)生必須與病人討論治療方案的選擇。Unit 7 Life and MedicineText A Difficult sentencesanText A Difficult sentencesWhile doctors might equate letting patients make their own decisions wi

32、th respectCritical reading and thinking雖然醫(yī)生也許認為讓病人自己作決定就是尊重病人Unit 7 Life and MedicineText A Difficult sentencesWhiText A Difficult sentencesSome will resort to veiling their own opinions in ahalfhearted attempt to direct the decision.Critical reading and thinking有些醫(yī)生采取的做法是隱藏自己的觀點，用隱隱約約的方式引導病人作決定。Uni

33、t 7 Life and MedicineText A Difficult sentencesSomText A Difficult sentencesWhile the doctors might be convinced that they are being objective and dispassionate, more often than not they are sending mixed messages.Critical reading and thinking雖然醫(yī)生堅信自己的態(tài)度客觀冷靜，但往往他們在向病人發(fā)出莫衷一是的信息。Unit 7 Life and Medici

34、neText A Difficult sentencesWhia nursing _ (護士站)_machines (生命維持系統(tǒng))comfort _(舒適護理措施)to _ treatment (停止治療)_ decision-making process(家長式?jīng)Q策程序)patient _ (給病人授權(quán))medical _ (醫(yī)學倫理學家)ethical_ (倫理準則)clinical _ (臨床理念) _ care (以病人為中心的護理) Text A Language Building-up Vocabulary Teststation life-support measureswit

35、hdrawpaternalisticempowermentethicistsprinciplesidealUnit 7 Life and Medicinepatient-centereda nursing _ (護士站)Text Apatient _ (病人自主權(quán))treatment _ (治療選擇)_purview(專屬領(lǐng)域)_ decisions (緊急情況下做的決定)physician_ (對醫(yī)生的限制)_ and confusion (焦慮與困惑)ethical _ (違背倫理)family _ (家庭醫(yī)療) Text A Language Building-up Vocabulary

36、 Testautonomy options exclusiveemergencyrestraintanxietytransgressionpracticeUnit 7 Life and MedicineText A Language Building-up VText A Suggested answersTask 1 OverviewThis text can be briefly divided into three parts: introduction of the topic and the theme, argumentation for the theme, and conclu

37、sion. Read the text carefully and fill in the missing information for each part in the following diagram.Critical reading and thinkingUnit 7 Life and MedicineText A Suggested answersTask 1Text A Suggested answersTask 1 OverviewCritical reading and thinkingBackground information:Change from the pater

38、nalistic care to the patient-centered care Two underlying ethical principles: respect for the person and respect for the persons autonomy Conclusion: The key for preserving patient autonomy lies in respecting their opinions and shouldering the responsibility together.Theme: Too much physician restra

39、int is harmful or unethical. Letting Doctors Make the Tough DecisionsAnecdote: a young doctors experience Main Supports: Study findings: most patients positionTwo arguments: Exacerbating the stressful situationCreating dishonesty in communicationPart I(P1-P8)Part II(P9-P14)Part III(P15-P16)Unit 7 Li

40、fe and MedicineText A Suggested answersTask 1Text A Task 1/ Medical terminology Match each definition with its corresponding English term and Chinese equivalent.EnglishChinese Definition1medicine or drugs given to people who are ill2the condition or quality of being autonomous; independence3an exper

41、t clinical physician4of, pertaining to, or correctable by surgery5causing pain, full of painmedication藥物，藥物治療自主性 autonomy臨床醫(yī)生cliniciansurgical外科的painful 疼痛的Suggested answersLanguage building-up2Unit 7 Life and MedicineText A Task 1/ Medical terminoText A EnglishChinese Definition6of, relating to, or

42、 connected with a clinic7a specialist in ethics8not ethical9a person licensed to practice medicine; a medical doctor10admit or send (a person) into a hospital for treatmentphysician醫(yī)生，內(nèi)科醫(yī)生clinical臨床的ethicist倫理學家unethical不道德的hospitalize住院Task1 / Medical terminologyMatch each definition with its corre

43、sponding English term and Chinese equivalent.Suggested answers2Language building-upUnit 7 Life and MedicineText A EnglishChinese DefinitiText A Task 2 / Signpost language Underline the first sentences of paragraphs 4,5,6,8,11 and 12, analyze how the author manages to bring a new topic and maintain c

44、oherence, and complete the following table.Language building-upSuggested answersKey words repeated to achieve smooth transitionKey words used to introduce a new topic1st sentence of Para.4decisionschanged 1st sentence of . 5tenetrespect for the person1st sentence of . 6ethical principlerespect for a

45、 persons autonomy1st sentence of . 8physician restraintnot be all that good, unethical1st sentence of . 11medical choices, optionchallenge, uncertain1st sentence of . 12patients and their families(doctors) own set of worriesUnit 7 Life and MedicineText A Task 2 / Signpost languText A Task 3 / Formal

46、 EnglishThe following sentences are taken from Text A. Replace the underlined formal words with less formal ones.For generations, these decisions were the exclusive purview of doctors(para.4)One tenet that gained particular traction among clinicians was respect for the person.(para.5)and that interp

47、retation would work its way into the teaching programs of medical schools and into state laws that mandated discussion of treatment options with patients.(para.6)Language building-upSuggested answersbelief / ideaarea / fieldorderedUnit 7 Life and MedicineText A Task 3 / Formal EnglishText A Task 3 /

48、 Formal EnglishThe following sentences are taken from Text A. Replace the underlined formal words with less formal ones.When it came to medical decisions, almost all the respondents wanted their doctors to offer choices and consider their options. (para.9)But a majority of patientstwo out of threeal

49、so preferred that their doctors make the final decisions regarding their medical care.(para.9)6 doctors, like my young colleagues and, I admit, myself, will need to be more mindful of whether patients want them to share information(para.15) Language building-upSuggested answersconscious / awarerelat

50、ing to/ aboutanswerersUnit 7 Life and MedicineText A Task 3 / Formal English Text A Additional activity Group presentationHospice movement has been a popular concept in recent decades in the field of health care. Work in a small group and explore relevant information about this subject in the follow

51、ing aspects: 1. definition2. history 3. advantages 4. development in ChinaUnit 7 Life and MedicineText A Additional activity Text BCritical reading and thinkingLanguage building-upSuggested answersUnit 7 Life and MedicineText BUnit 7 Text B Critical Reading and Thinking1. Pats Personal Status (P181)

52、 A 78-year-old woman suffering from lung cancer with widespread metastases and receiving palliative care from hospiceA dairy farmerMother of sixInterior designerOne of the best pie bakers in the countyWrite down the information on the following topics. Then compare your answers with your partner.Uni

53、t 7 Life and MedicineText B Critical Reading and TText B Critical Reading and ThinkingKnowledge of Subject Matter Write down the information on the following topics. Then compare your answers with your partner.lung cancerReports from the hospital and oncologist confirmed widespread metastases.Pat ha

54、d declined aggressive treatment.She was receiving palliative care from hospice under the supervision of an oncologist.1. Pats Personal Status (P181) Unit 7 Life and MedicineText B Critical Reading and TText B Critical Reading and Thinking2. Pats electronic record (P181) The computerized tomography (

55、CT) : extensive bilateral infiltrates and a possible small nodule in the base of the left lung with follow-up recommended but not obtainedA chest X-ray more than a year ago: a left lower-lobe pneumonia with follow-up suggested but not obtained Write down the information on the following topics. Then

56、 compare your answers with your partner.Unit 7 Life and MedicineText B Critical Reading and TText B Critical Reading and Thinking2. the reasons for her having problems with doctors (P154) Knowledge of Subject Matter Write down the information on the following topics. Then compare your answers with y

57、our partner.pulmonary embolicomputerized tomography (CT)extensive bilateral infiltratesa possible small nodule in the base of the left lungA chest X-ray report from a visit more than a year ago with one of my partners revealed a left lower-lobe pneumonia and suggested follow-up to ensure resolutionU

58、nit 7 Life and MedicineText B Critical Reading and TText B Critical Reading and Thinking3. the medical mistake(P 181)Write down the information on the following topics. Then compare your answers with your partner.The abnormality not noted.Frequent visits to doctors but not informed of the findingsUn

59、it 7 Life and MedicineText B Critical Reading and TText B Critical Reading and Thinking4. the authors self-reflection (P 181)Write down the information on the following topics. Then compare your answers with your partner.Who to blame? None of the hospital team, my partners, or the radiologists to ta

60、ke the blame.As Pats family physician, the authors responsibility to follow up abnormal tests; the author made the serious mistake.All sorts of questions running through the authors mind: pats response, possibilities of other mistakes, problems with health care system, causes of medical mistakes or