住院医师规范化培训临床医学英语

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1、Chapter1Patient-PhysicianInteraction第一章医患沟通Thepatient-physicianinteractionproceedsthroughmanyphasesofclinicalreasoninganddecisionmaking.医患沟通在临床诊断和治疗决策的许多阶段中进行着。Theinteractionbeginswithanelucidationofcomplaintsorconcerns,followedbyinquiriesorevaluationtoaddresstheseconcernsin

2、increasinglypreciseways•这种沟通开始于病人诉说或所关注问题，然后通过询问、评估不断精确地确定这些问题。Theprocesscommonlyrequiresacarefulhistoryorphysicalexamination,orderingofdiagnostictests,integrationofclinicalfindingswiththetestresults,understandingoftherisksandbenefitsofthepossiblecoursesofaction,andcarefulco

3、nsultationwiththepatientandfamilytodevelopfutureplans.这个过程通常需要细致的病史询问和体格检查，进行诊断性化验，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，并与病人及家属反复磋商以形成治疗方案Physiciansincreasinglycancallonagrowingliteratureofevidence-basedmedicinetoguidetheprocesssothatbenefitismaximized^whilerespectingindividualvari

4、ationsamongdifferentpatients底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，但要考虑到不同病人中个体差异是存在的。Theincreasingavailabilityofrandomizedtrialstoguidetheapproachtodiagnosisandtherapyshouldnotbeequatedwith"cookbook"medicine越来越多的可用于指导临床诊断与治疗的随机试验资料不应变成"烹调书''医学。Evidenceandtheguidelinesthatared

5、erivedfromitemphasizeprovenapproachesforpatientswithspecificcharacteristics.因为随机试验获得的现象和思路是着重于特征性病人的求证过程。Substantialclinicaljudgmentisrequiredtodeterminewhethertheevidenceandguidelinesapplytoindividualpatientsandtorecognizetheoccasional.实际的临床判断需要确定这些现象和思路能否应用于某个病人个体,并能找出例外。E

6、venmorejudgmentisrequiredinthemanysituationsinwhichevidenceisabsentorinconclusive.许多情况下，临床表现缺乏或不典型，需要考虑更多的判断。Evidencealsomustbetemperedbypatients'preferences^althoughitisaphysician'sresponsibilitytoemphasizewhenpresentingalternativeoptionstothepatient.病人还会根据自己的倾向调节着临床症状，但医生有

7、责任通过选择性问题搞清事实。Theadherenceofapatienttoaspecificregimenislikelytobeenhancedifthepatientalsounderstandstherationaleandevidencebehindtherecommendedoption.假如病人也懂得医生问题的基本原理和表现，有特殊生活方式病人的固执容易被强化。Tocareforapatientasanindividual^thephysicianmustunderstandthepatientasaperson.为了把病人作为一

8、个个体进行治疗，医生必须理解病人是一个人（不是一群人）。Thisfundamentalpreceptofdoctoringincludesanunde