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1、How Physicians Think,陈雪英 Sherry Chan No:11214494 E-mail: Stomatology The Sixth Affiliated Hospital,My Structure,Language Points,categorize vt. place into or assign to a category 分类，把分类(或分等级)；把归入一类(或同一等级)In information retrieval, a word used to categorize or index information.categorization n. One po
2、ssible categorization of actions is a shared historical context.in accord with 与一致；与相符合；与调和 Basic and applying disciplines which are in accord with times request and advance with time.,The most striking observation about how doctors think is the tendency to categorize and then to continue to operate
3、 in accord with the original categorization.(para.4 line1-3),Language Points,Although my chest pain was atypical for coronary occlusion(para.4 line 3),atypical adj. not representative of a group, class, or type非典型的；不合规则的The experiences of Nash and Yates are typical in some ways but atypical in other
4、s.coronary n. obstruction of blood flow in a coronary artery by a blood clot (thrombus) 1. 冠状动脉2. 【病理学】冠状动脉血栓形成 adj. surrounding like a crown (especially of the blood vessels surrounding the heart) coronary arteries 1. 冠的；冠状的2.【医学】冠状的；(心脏的)冠状动脉的occlusion n. closure or blockage (as of a blood vessel)
5、闭塞,Language Points,continued for seven or eight hours, and was not crushing or severe or made worse by exertion.(para.4 line 4-5),crushingadj. physically or spiritually devastating; often used in combination压倒的；使人受不了的；决定性的；支离破碎的You couldnt go anywhere without seeing people who nature had given, in m
6、any ways, a very bad deal along with crushing poverty.exertionn. use of physical or mental energy; hard work发挥；运用；努力,尽力，使劲；费力The problem today is that what can be done by a measure of exertion is considered by many to be impossible.,Language Points,Even when the laboratory reported that the cardiac
7、fraction of the serum creatine phosphokinase (CPK) level was normal(para.4 line 7-8),creatine phosphokinase肌酸磷酸激酶Routine laboratory tests showed a mild anemia, metabolic acidosis and elevation of plasma creatine phosphokinase. cpk 肌酸(creatine)和磷酸肌酸(creatinephosphate)在能量储存及利用中起重要作用。二者互变使体内ATP供应具有后备潜力
8、。肌酸在肝和肾中合成，广泛分布于骨骼肌、心肌、大脑等组织中。肌酸以甘氨酸为骨架，精氨酸提供脒基、SAM供给甲基、在脒基转移酶和甲基转移酶的催化下合成。在肌酸激酶(creatine phosphohinase,CPK)催化下将ATP中Pi转移到肌酸分子中形成磷酸肌酸,Language Points,the next diagnosis that was entertained was unstable angina (the laboratory did report that the total CPK level in the serum was elevated). (Page 41 li
9、ne 1-2),entertainvt. 1. take into consideration, have in view愿意考虑(想法、怀疑等)：2. maintain (a theory, thoughts, or feelings) 心存，怀着，怀抱，抱有(希望、信心、观点、意见等)：The golden rule as far as Im concerned is to not entertain any unsolicited contact. anginan. a heart condition marked by paroxysms of chest pain due to re
10、duced oxygen to the heart心绞痛Angina before operation is a serious problem. elevatev. raise from a lower to a higher position提升；举起；,Language Points,condemnv. express strong disapproval of 谴责，非难We condemn the racism in South Africa. generalizev. draw from specific cases for more general cases概括；推广;使.一般
11、化,reevaluatev. revise or renew ones assessment.再评估；重新估计Youd better reevaluate your priorities ; you are busy working and spend little time with your families.,I say this not so much to condemn as to remind us that we all, to some extent, think in categories and tend to generalize from a fixed positi
12、on. ( para.5 line 1-2),We have to be careful to always reevaluate a diagnosis and not think rigidly.( para.5 line 1-2),Language Points,incidentallyadv. introducing a different topic; by the way顺便；偶然地；附带地affiliate v. join in an affiliation 使附属；接纳；使紧密联系The sixth affiliated hospital of Sun-Yat-Sen Univ
13、ersityprominent adj. having a quality that thrusts itself into attention or importance 突出的，显著的；杰出的；卓越的prestigious adj. having an illustrious reputation; respected有名望的；享有声望的If you expect to enter this prestigious university, you should apply now.,Incidentally, I live in Boston, and the hospitals invo
14、lved were both university affiliated, one being a rather prominent hospital affiliated with a prestigious Boston medical school. (the last sentence),How Physicians Think Here,its wrong!,WHY?,How Physicians Think HereWhy did the physicians make a wrong diagnosis?,My Reaction,Thinking: how physicians
15、think correctly?,When it comes to me,My Reaction,1.How Physicians Think Correctly,Get the whole information and dont ignore any details. Consider the overall situation and dont only focus your majors.Broaden your horizons and dont develop a stereotyped mind.Reevaluate your diagnosis and dont think r
16、igidly.,My Reaction,2.How to get the right diagnosis?,Ask What else could it be? Combat satisfaction of search bias and consider a broader range of possibilities.,My Reaction,Ask Is there anything that doesnt fit? Combat confirmation bias and again think broadly,2.How to get the right diagnosis?,My
17、Reaction,Ask Is it possible I have more than one problem? Because multiple simultaneous disorders do exist and frequently cause confusing symptoms.,2.How to get the right diagnosis?,My Reaction,Tell what you are most worried about. Open discussion and lead either to reassurance (if the worry is unli
18、kely) or careful analysis (if the worry is plausible).,2.How to get the right diagnosis?,My Reaction,Retell the story from the beginning. Details that were omitted in the initial telling may be recalled, or different wording or the different context may make clues more salient. (This is most appropr
19、iate when the condition has not responded to treatment or there is other reason to believe that a misdiagnosis is possible.),2.How to get the right diagnosis?,My Reaction,3.What if I make a misdiagnosis?,Make up for it and do the right treatment.Communicate with the patient well.Reconsider the case
20、and find out what to be lost.Enrich my medical knowledge and think broadly.Dont think rigidly any more.Dont jump to a conclusion!,My Reaction,4.We are bound to be an excellent doctor if we understand how physicians think exactly!,By the way, recommend a TV serious- Dr. House! Its really an awesome one to teach you to think broadly and make the right diagnosis!,Thats all! Thank you!,
