Chapter 1 Patient-Physician Interaction
第一章 醫(yī)患溝通
The patient-physician interaction proceeds through many phases of clinical reasoning and decision making. (proceed 進(jìn)行、開(kāi)展 reasoning 推論、推理 clinical reasoning 診斷
clinical decision 確定治療方案 making decision 做出決定)
醫(yī)患溝通在臨床診斷和治療決策的許多時(shí)期進(jìn)行著。
The interaction begins with an elucidation of complaints or concerns, followed by inquiries or evaluation to address these concerns in increasingly precise ways.
(elucidation 說(shuō)明、闡明 inquire 詢(xún)問(wèn)、調(diào)查 evaluation 評(píng)估、評(píng)價(jià))
這種溝通開(kāi)始于病人主訴或所關(guān)注問(wèn)題的闡明，然后通過(guò)交流、評(píng)估不斷精確地確定這些問(wèn)題。
The process commonly requires a careful history or physical examination, ordering of diagnostic tests, integration of clinical findings with the test results, understanding of the risks and benefits of the possible courses of action, and careful consultation with the patient and family to develop future plans. (integration 綜合 consultation 磋商、會(huì)診)
這個(gè)過(guò)程通常需要細(xì)致的詢(xún)問(wèn)病史和體格檢查，開(kāi)具診斷性化驗(yàn)醫(yī)囑，綜合臨床發(fā)現(xiàn)和化驗(yàn)結(jié)果，理解分析擬行治療過(guò)程中的風(fēng)險(xiǎn)和療效，然后與病人及家屬反復(fù)磋商以完善治療方案
Physicians increasingly can call on a growing literature of evidence-based medicine to guide the process so that benefit is maximized, while respecting individual variations among different patients. (respecting 注意到、關(guān)系、說(shuō)到 evidence-based medicine 循證醫(yī)學(xué))
盡管考慮到不同病人中個(gè)體差異是存在的，但醫(yī)生們?cè)絹?lái)越容易查閱不斷增長(zhǎng)的循證醫(yī)學(xué)文獻(xiàn)來(lái)指導(dǎo)這個(gè)過(guò)程，使得療效最大化。
The increasing availability of randomized trials to guide the approach to diagnosis and therapy should not be equated with “cookbook” medicine (availability可利用性， 可得到 randomize 隨機(jī)的, cookbook 食譜，烹調(diào)書(shū) approach 接近)
但是，不斷增加的可用于指導(dǎo)臨床診斷與治療的隨機(jī)試驗(yàn)資料不應(yīng)當(dāng)作“烹調(diào)書(shū)”使用。
Evidence and the guidelines that are derived from it emphasize proven approaches for patients with specific characteristics.(Evidence 證據(jù)，跡象 guideline 指導(dǎo)方針 emphasize 強(qiáng)調(diào))
那些隨機(jī)試驗(yàn)獲得的臨床表現(xiàn)和診斷思路是側(cè)重于求證具有某些特征病人而來(lái)的。
Substantial clinical judgment is required to determine whether the evidence and guidelines apply to individual patients and to recognize the occasional.
substantial clinical 真實(shí)的，實(shí)在的 individual 個(gè)體 occasional 偶爾的，特殊的
實(shí)際的臨床判斷需要確定這些臨床表現(xiàn)和診斷依據(jù)標(biāo)準(zhǔn)是否能應(yīng)用于普通病人的個(gè)體，并能找出例外。
Even more judgment is required in the many situations in which evidence is absent or inconclusive. (inconclusive 不確定性，非決定性)
在許多情況下，臨床表現(xiàn)缺乏或不典型，甚至需要考慮得更多。
Evidence also must be tempered by patients’ preferences, although it is a physician’s responsibility to emphasize when presenting alternative options to the patient.
temper 脾氣，調(diào)音 preference 偏愛(ài) presenting 提出 alternative 可選擇的，二選一
雖然醫(yī)生喜歡提出選擇性問(wèn)題讓病人回答，但病人肯定會(huì)根據(jù)自己的傾向調(diào)節(jié)臨床癥狀。
The adherence of a patient to a specific regimen is likely to be enhanced if the patient also understands the rationale and evidence behind the recommended option.
(adherence 堅(jiān)持、固執(zhí) regimen 養(yǎng)生法、食物療法enhance 提高、加強(qiáng) rationale 基本原理)假如還懂得所提供問(wèn)題的基本原理和表現(xiàn)，有特殊生活方法病人的固執(zhí)容易強(qiáng)化這種傾向
To care for a patient as an individual, the physician must understand the patient as a person.
(care for 喜歡、照料) 為了把病人作為一個(gè)個(gè)體進(jìn)行治療，醫(yī)生必須理解病人是一個(gè)人（不是一群人)。
This fundamental precept of doctoring includes an understanding of the patient’s social situation, family issues, financial concerns, and preferences for different types of care and outcomes, ranging from maximum prolongation of life to the relief of pain and suffering.
(precept 訓(xùn)戒 doctoring 行醫(yī) prolongation 延長(zhǎng))
這個(gè)最基本的行醫(yī)原則包括了解病人的社會(huì)地位，家庭問(wèn)題，資金狀況以及正確理解病人對(duì)不同治療方法、不同治療結(jié)果的選擇，從最大限度地延長(zhǎng)生命到臨時(shí)緩解疼痛和癥狀。
Even as physicians become increasingly aware of new discoveries, patients can obtain their own information from a variety of sources, some of which are of questionable reliability.
questionable 可疑的、成問(wèn)題的、不可靠的 reliability 可靠、可信賴(lài)的
甚至，當(dāng)醫(yī)生越來(lái)越容易知道新發(fā)現(xiàn)的同時(shí)，病人也能夠通過(guò)各種途徑得到他們的信息，某些信息是不可靠的。
The increasing use of alternative and complementary therapies is an example of patients’ frequent dissatisfaction with prescribed medical therapy.
alternative 選擇，替代 complementary 補(bǔ)充的、相配的 prescribe 規(guī)定、指定、開(kāi)處方
不斷增加的替代療法和輔助療法的應(yīng)用就是病人對(duì)常規(guī)療法經(jīng)常不滿(mǎn)意的一個(gè)例子。
Physicians should keep an open mind regarding unproven options but must advise their patients carefully if such options may carry any degree of potential risks, including the risk that they may relied on to substitute for proven approaches (substitute 代替、代用 rely on 依賴(lài)、信任)
醫(yī)生對(duì)新療法應(yīng)該保持開(kāi)放的思想，但是，如果這些療法具有任何程度的潛在風(fēng)險(xiǎn)，都必須細(xì)致地告知病人，包括可能需要用已證實(shí)的常規(guī)療法去替代的風(fēng)險(xiǎn)。
It is crucial for the physician to have an open dialogue with the patient and family regarding the full range of options that either may consider. (crucial 嚴(yán)酷的、決定性的 either 兩者任一)對(duì)醫(yī)生來(lái)說(shuō)，對(duì)病人及家屬開(kāi)誠(chéng)布公地介紹所有可考慮的治療選擇，是非常重要的。
The physician does not exist in a vacuum but rather as part of a complicated and extensive system of medical care and pubic health. (vacuum 真空 extensive 廣闊的、大量的)
醫(yī)生不是生存在真空中，而是作為一個(gè)復(fù)雜而龐大的醫(yī)療和公共健康體系中的一部分。
