浙江省住院医师规范化培训《临床医学英语》讲义2012(精华版)

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1、临床医学英语讲义Chapter1Patient-PhysicianInteraction第一章医患沟通Thepatient-physicianinteractionproceedsthroughmanyphasesofclinicalreasoninganddecisionmaking.(proceed进行、开展reasoning推论、推理clinicalreasoning诊断clinicaldecision确定治疗方案makingdecision做出决定)医患沟通在临床诊断和治疗决策的许多时期进行着。Th

2、einteractionbeginswithanelucidationofcomplaintsorconcerns,followedbyinquiriesorevaluationtoaddresstheseconcernsinincreasinglypreciseways.(elucidation说明、阐明inquire询问、调查evaluation评估、评价)这种沟通开始于病人主诉或所关注问题的阐明，然后通过交流、评估不断精确地确定这些问题。Theprocesscommonlyrequiresacaref

3、ulhistoryorphysicalexamination,orderingofdiagnostictests,integrationofclinicalfindingswiththetestresults,understandingoftherisksandbenefitsofthepossiblecoursesofaction,andcarefulconsultationwiththepatientandfamilytodevelopfutureplans.(integration综合consulta

4、tion磋商、会诊)这个过程通常需要细致的询问病史和体格检查，开具诊断性化验医嘱，综合临床发现和化验结果，理解分析拟行治疗过程中的风险和疗效，然后与病人及家属反复磋商以完善治疗方案Physiciansincreasinglycancallonagrowingliteratureofevidence-basedmedicinetoguidetheprocesssothatbenefitismaximized,　whilerespectingindividualvariationsamongdifferentp

5、atients.(respecting注意到、关系、说到evidence-basedmedicine循证医学)尽管考虑到不同病人中个体差异是存在的，但医生们越来越容易查阅不断增长的循证医学文献来指导这个过程，使得疗效最大化。Theincreasingavailabilityofrandomizedtrialstoguidetheapproachtodiagnosisandtherapyshouldnotbeequatedwith“cookbook”medicine(availability可利用性，可得到r

6、andomize随机的,cookbook食谱，烹调书approach接近)但是，不断增加的可用于指导临床诊断与治疗的随机试验资料不应当作“烹调书”使用。Evidenceandtheguidelinesthatarederivedfromitemphasizeprovenapproachesforpatientswithspecificcharacteristics.(Evidence证据，迹象guideline　指导方针emphasize强调)那些随机试验获得的临床表现和诊断思路是侧重于求证具有某些特征病人

7、而来的。Substantialclinicaljudgmentisrequiredtodeterminewhethertheevidenceandguidelinesapplytoindividualpatientsandtorecognizetheoccasional.substantialclinical真实的，实在的individual个体occasional偶尔的，特殊的实际的临床判断需要确定这些临床表现和诊断依据标准是否能应用于普通病人的个体，并能找出例外。Evenmorejudgmentisre

8、quiredinthemanysituationsinwhichevidenceisabsentorinconclusive.(inconclusive不确定性，非决定性)在许多情况下，临床表现缺乏或不典型，甚至需要考虑得更多。Evidencealsomustbetemperedbypatients’preferences,althoughitisaphysician’sresponsibilitytoempha