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1、学术英语 医学,Academic English for Medicine,Unit 7,Physician-Patient RelationshipLife can be hard.Relationships are often difficult.In an era of fast advancing medical technology,rapidly changing medical ethics,and in increasingly litigious society,good physician-patient relationship is critically importa
2、nt for effective health care delivery.This unit sheds some light on how to build such a relationship to help us through the unpredictability in life.,Unit 7 Life and Medicine,Unit Contents,Lead-in,Text A,Text B,Text C,Listening,Speaking,Writing,Get reading for Unit 8,Lead-in,Issues to be coveredTask
3、,Unit 7 Life and Medicine,Lead-in,Issues to be covered,The shift from paternalistic paradigm to patient-center paradigm in medical decision makingThe importance of good physician-patient relationship in both the medical practice and the patients recoveryThings that counts in maintaining a amiable ph
4、ysician-patient relationshipThe way to communicate properly and effectively with the patients,Unit 7 Life and Medicine,Lead-in,Decide whether life-support system should be continued or withdrawn;Decide whether euthanasia should be considered;Decide whether a new therapy should be tried;Decide whethe
5、r surgery should be the first choice or the last resort;Decide whether transfer or referral is needed.,Task:Read the title of Text A and imagine three different situations in which doctors may be asked to make“tough decisions”for their patients.Then write them down.,Unit 7 Life and Medicine,Text A,C
6、ritical reading and thinking Topics for presentation Useful expressions Difficult sentencesLanguage building-up Signpost language Vocabulary testSuggested answers,Unit 7 Life and Medicine,Text A Critical reading and thinking,Topics for presentation,1 What difficult situation is the young doctor faci
7、ng?,A dying patientDecision whether to withdraw life-support machines and medication and start comfort measuresThe familys refusal to make any decision or withdraw any treatments,Unit 7 Life and Medicine,Text A,Useful expressions,护士站 nursing station停止使用呼吸机并停药/停止治疗 withdraw life-support machines and
8、medications/treatmentwho was impressive not only for his clinical skills but also for his devotion to patientswho was impressive not only for his clinical skills but also for his devotion to patientsI told them suffering or comfort it was their decision.But in the end,they made no decision and just
9、walked right out of the room,Critical reading and thinking,Unit 7 Life and Medicine,2 What is paternalistic decision-making in medicine?,Topics for presentation,Text A Critical reading and thinking,Doctors as exclusive decision makerPatients as participants without little say in the final choice,Uni
10、t 7 Life and Medicine,Text A,Useful expressions,The way doctors and patients approach medical decisions has changed sharply over the last 50 years.and patients,if they participated,often had little say in the final choice.,Critical reading and thinking,Unit 7 Life and Medicine,Text A,Topics for pres
11、entation,3 In what way can patient empowerment be good for the patient?,Critical reading and thinking,Respect for the patient,especially the patients autonomyPatient-center careThe Patients as decision maker based on the information provided by the doctor,Unit 7 Life and Medicine,Text A,Topics for p
12、resentation,3 In what way can patient empowerment be good for the patient?,Critical reading and thinking,Two principles/tenets/notions involved in the decision-making processrespect for the person a new clinical ideal:patient-centered care in wards,clinics and operating roomsrespect for a persons au
13、tonomy letting patients make their own decisions,Unit 7 Life and Medicine,Text A,Topics for presentation,4 Why does the author say too much physician restraint may not be that good for the patient?,Critical reading and thinking,The patients are forced to make decisions they never want to.Patients,at
14、 least a large majority,prefer their doctors to make final decisions.Shifting responsibility of decision making to the patients will bring about more stress to the patients and their families,especially when the best option for the patient is uncertain,Unit 7 Life and Medicine,Text A,Useful expressi
15、ons,a majority of patients are being left to make decisions that they never wanted to in the first place.When it came to medical decisions,almost all the respondents wanted their doctors to offer choices and consider their opinions.But a majority of patients two out of three also preferred that thei
16、r doctors make the final decisions regarding their medical care.not when the medical choices are obvious,but when the best option for a patient is uncertainwhen doctors pass the burden of decision-making to a patient or family,it can exacerbate an already stressful situation.,Critical reading and th
17、inking,Unit 7 Life and Medicine,Text A,Topics for presentation,5.What kind of considerations may have prevented doctors from making decisions for their patients?,Critical reading and thinking,Doctors are very much cautious about committing some kind of ethical transgression.Who am I to presume to kn
18、ow what my patients need?,Unit 7 Life and Medicine,Text A,A Case in Point:Language Makes a Difference,Tell relatives that it is their choice to withdraw life support from a dying patient.But that doctor may also use value-laden language to describe the options.One alternative may be described to the
19、 family as“reasonable”or“comforting,”while the other is depicted as“invasive,”“aggressive”or“painful”.,Critical reading and thinking,Unit 7 Life and Medicine,Text A,A Case in Point:Language Makes a Difference,Dr.Curlins Wisdom IBizarre dishonest of communicationPatients end up feeling manipulated an
20、d will resist making any decision at all.,Critical reading and thinking,Unit 7 Life and Medicine,Text A,A Case in Point:Language Makes a Difference,Dr.Curlins Wisdom II“We have to stop drawing a circle around patients and their families,”“We have to stop subjecting them to the loneliness and burden
21、of autonomy and instead begin standing in that circle with them.”,Critical reading and thinking,Unit 7 Life and Medicine,6 Do you agree that doctors should be prepared to make any decisions together with their patients?,Text A,Topics for presentation,Critical reading and thinking,Shouldering respons
22、ibility together with the patient may be better than having the patient make decision on their own alone.Balancing between paternalism and respect for patients autonomy constitutes a large part of medical practice.,Unit 7 Life and Medicine,Text A,Useful expressions,the key to preserving patient auto
23、nomy and patient-centered carelies not in letting patients make the final decisions alone but in respecting their opinions and shouldering the responsibility together.I admit,myself,will need to be more mindful of whether patients want them to share information,be directive or hand over the responsi
24、bility of the decision.,Critical reading and thinking,Unit 7 Life and Medicine,Text A,Additional Activity,Watch the Video and see what are tips givenby Dr.Thaddeus Bell to build a Amiable PPRelationshipDoctor-Patient Relationship,Critical reading and thinking,Unit 7 Life and Medicine,Text A,Difficul
25、t sentences,He was large and powerfully built but never seemed to loom over his patients,Critical reading and thinking,他身材高大伟岸，但是从来不让病人有咄咄逼人的感觉,Unit 7 Life and Medicine,Text A,Difficult sentences,as movements calling for patient empowerment grew and medical ethicists began articulating principles re
26、garding the ethical care of patients.,Critical reading and thinking,要求病人授权的呼声越来越高，而且医学伦理学家也开始阐述病人伦理关怀的相关原则。,Unit 7 Life and Medicine,Text A,Difficult sentences,One tenet that gained particular traction among clinicians,Critical reading and thinking,临床医生们尤为拥护的一条宗旨,this ethical principle led to a new
27、clinical ideal:patient-centered care,这条伦理原则导致了一种新的临床理念的出现：以病人为中心的医护。,Unit 7 Life and Medicine,Text A,Difficult sentences,young doctors,myself included,would be trained to restrain ourselves from making anything but emergency or mundane decisions for patients.,Critical reading and thinking,包括我在内，年轻医生
28、将接受培训，学会除了一些紧急状况或日常琐事，不为病人作其他任何决定。,Unit 7 Life and Medicine,Text A,Difficult sentences,and that interpretation would work its way into the teachingprograms of medical schools and into state laws that mandated discussion of treatment options with patients.,Critical reading and thinking,而且，对病人自主性的解释逐渐
29、进入了医学院校的课程，也被写进各州的法律，规定医生必须与病人讨论治疗方案的选择。,Unit 7 Life and Medicine,Text A,Difficult sentences,While doctors might equate letting patients make their own decisions with respect,Critical reading and thinking,虽然医生也许认为让病人自己作决定就是尊重病人,Unit 7 Life and Medicine,Text A,Difficult sentences,Some will resort to
30、veiling their own opinions in ahalfhearted attempt to direct the decision.,Critical reading and thinking,有些医生采取的做法是隐藏自己的观点，用隐隐约约的方式引导病人作决定。,Unit 7 Life and Medicine,Text A,Difficult sentences,While the doctors might be convinced that they are being objective and dispassionate,more often than not the
31、y are sending mixed messages.,Critical reading and thinking,虽然医生坚信自己的态度客观冷静，但往往他们在向病人发出莫衷一是的信息。,Unit 7 Life and Medicine,a nursing _(护士站)_machines(生命维持系统)comfort _(舒适护理措施)to _ treatment(停止治疗)_ decision-making process(家长式决策程序)patient _(给病人授权)medical _(医学伦理学家)ethical_(伦理准则)clinical _(临床理念)_ care(以病人为中
32、心的护理),Text A Language Building-up,Vocabulary Test,station,life-support,measures,withdraw,paternalistic,empowerment,ethicists,principles,ideal,Unit 7 Life and Medicine,patient-centered,patient _(病人自主权)treatment _(治疗选择)_purview(专属领域)_ decisions(紧急情况下做的决定)physician_(对医生的限制)_ and confusion(焦虑与困惑)ethical
33、 _(违背伦理)family _(家庭医疗),Text A Language Building-up,Vocabulary Test,autonomy,options,exclusive,emergency,restraint,anxiety,transgression,practice,Unit 7 Life and Medicine,Text A,Suggested answers,Task 1 OverviewThis text can be briefly divided into three parts:introduction of the topic and the theme,
34、argumentation for the theme,and conclusion.Read the text carefully and fill in the missing information for each part in the following diagram.,Critical reading and thinking,Unit 7 Life and Medicine,Text A,Suggested answers,Task 1 Overview,Critical reading and thinking,Unit 7 Life and Medicine,Text A
35、,Task 1/Medical terminology Match each definition with its corresponding English term and Chinese equivalent.,medication,药物，药物治疗,自主性,autonomy,临床医生,clinician,surgical,外科的,painful,疼痛的,Suggested answers,Language building-up,2,Unit 7 Life and Medicine,Text A,physician,医生，内科医生,clinical,临床的,ethicist,伦理学家,
36、unethical,不道德的,hospitalize,住院,Task1/Medical terminologyMatch each definition with its corresponding English term and Chinese equivalent.,Suggested answers,2,Language building-up,Unit 7 Life and Medicine,Text A,Task 2/Signpost language,Underline the first sentences of paragraphs 4,5,6,8,11 and 12,ana
37、lyze how the author manages to bring a new topic and maintain coherence,and complete the following table.,Language building-up,Suggested answers,Unit 7 Life and Medicine,Text A,Task 3/Formal English,The following sentences are taken from Text A.Replace the underlined formal words with less formal on
38、es.,For generations,these decisions were the exclusive purview of doctors(para.4)One tenet that gained particular traction among clinicians was respect for the person.(para.5)and that interpretation would work its way into the teaching programs of medical schools and into state laws that mandated di
39、scussion of treatment options with patients.(para.6),Language building-up,Suggested answers,belief/idea,area/field,ordered,Unit 7 Life and Medicine,Text A,Task 3/Formal English,The following sentences are taken from Text A.Replace the underlined formal words with less formal ones.,When it came to me
40、dical decisions,almost all the respondents wanted their doctors to offer choices and consider their options.(para.9)But a majority of patientstwo out of threealso preferred that their doctors make the final decisions regarding their medical care.(para.9)6 doctors,like my young colleagues and,I admit
41、,myself,will need to be more mindful of whether patients want them to share information(para.15),Language building-up,Suggested answers,conscious/aware,relating to/about,answerers,Unit 7 Life and Medicine,Text A,Additional activity,Group presentationHospice movement has been a popular concept in rec
42、ent decades in the field of health care.Work in a small group and explore relevant information about this subject in the following aspects:1.definition2.history 3.advantages 4.development in China,Unit 7 Life and Medicine,Text B,Critical reading and thinkingLanguage building-upSuggested answers,Unit
43、 7 Life and Medicine,Text B,Critical Reading and Thinking,1.Pats Personal Status(P181),A 78-year-old woman suffering from lung cancer with widespread metastases and receiving palliative care from hospiceA dairy farmerMother of sixInterior designerOne of the best pie bakers in the county,Write down t
44、he information on the following topics.Then compare your answers with your partner.,Unit 7 Life and Medicine,Text B,Critical Reading and Thinking,Knowledge of Subject Matter,Write down the information on the following topics.Then compare your answers with your partner.,lung cancerReports from the ho
45、spital and oncologist confirmed widespread metastases.Pat had declined aggressive treatment.She was receiving palliative care from hospice under the supervision of an oncologist.,1.Pats Personal Status(P181),Unit 7 Life and Medicine,Text B,Critical Reading and Thinking,2.Pats electronic record(P181)
46、,The computerized tomography(CT):extensive bilateral infiltrates and a possible small nodule in the base of the left lung with follow-up recommended but not obtainedA chest X-ray more than a year ago:a left lower-lobe pneumonia with follow-up suggested but not obtained,Write down the information on
47、the following topics.Then compare your answers with your partner.,Unit 7 Life and Medicine,Text B,Critical Reading and Thinking,2.the reasons for her having problems with doctors(P154),Knowledge of Subject Matter,Write down the information on the following topics.Then compare your answers with your
48、partner.,pulmonary embolicomputerized tomography(CT)extensive bilateral infiltratesa possible small nodule in the base of the left lungA chest X-ray report from a visit more than a year ago with one of my partners revealed a left lower-lobe pneumonia and suggested follow-up to ensure resolution,Unit
49、 7 Life and Medicine,Text B,Critical Reading and Thinking,3.the medical mistake(P 181),Write down the information on the following topics.Then compare your answers with your partner.,The abnormality not noted.Frequent visits to doctors but not informed of the findings,Unit 7 Life and Medicine,Text B
50、,Critical Reading and Thinking,4.the authors self-reflection(P 181),Write down the information on the following topics.Then compare your answers with your partner.,Who to blame?None of the hospital team,my partners,or the radiologists to take the blame.As Pats family physician,the authors responsibi
