临床医学英语2012

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1、临床医学英语Chapter1Patient-PhysicianInteractionPage1第一章医患沟通第１页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述说，然后通过交流、评估不断精确地确定这些问题。Theprocesscommonlyrequiresacarefulhist

3、oryorphysicalexamination,orderingofdiagnostictests,integrationofclinicalfindingswiththetestresults,understandingoftherisksandbenefitsofthepossiblecoursesofaction,andcarefulconsultationwiththepatientandfamilytodevelopfutureplans.integration综合consultation磋商、会诊这个

4、过程通常需要细致的病史询问和体格检查，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,　whilerespectingindividualvariationsamongdifferentpatientsrespectin

5、g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”medicineavailability　可利用性，可得到randomize随机的cookbook食谱，烹

6、调书approach接近但是，不断增多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强调因为随机试验获得的现象和思路是侧重于求证具有某些特征病人而来的。Substantialclinicaljudgmentisre

7、quiredtodeterminewhethertheevidenceandguidelinesapplytoindividualpatientsandtorecognizetheoccasional.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标准是否能应用于病人个体，并能找出例外。Evenmorejudgmentisrequiredinthemanysituationsinwhichevidenceisab

8、sentorinconclusive.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，需要考虑更多的判断。34Evidencealsomustbetemperedbypatients’preferences,althoughitisaphysician’sresponsibilitytoemphasizewhenpresenti