1、学术英语 医学,Academic English for Medicine,Unit 7,Physician-Patient Relationship Life 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 i
2、mportant 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 cove
3、red Task,Unit 7 Life and Medicine,Lead-in,Issues to be covered,The shift from paternalistic paradigm to patient-center paradigm in medical decision making The importance of good physician-patient relationship in both the medical practice and the patients recovery Things that counts in maintaining a
4、amiable physician-patient relationship The 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with the patients,Unit 7 Life and Medicine,Lead-in,Decide whether life-support system should be continued or withdrawn; Decide whether euthanasia should be considered; Decide whether a new therapy should be tried;
5、 Decide whether 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 an
6、d Medicine,Text A,Critical 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 th
7、e young doctor facing?,A dying patient Decision whether to withdraw life-support machines and medication and start comfort measures The 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-
8、support machines and medications / treatment who was impressive not only for his clinical skills but also for his devotion to patients who was impressive not only for his clinical skills but also for his devotion to patients I told them suffering or comfort it was their decision. But in the end, the
9、y made no decision and just 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 maker Patients as participants without littl
10、e say in the final choice,Unit 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
11、 Medicine,Text A,Topics for presentation,3 In what way can patient empowerment be good for the patient?,Critical reading and thinking,Respect for the patient, especially the patients autonomy Patient-center care The Patients as decision maker based on the information provided by the doctor,Unit 7 Li
12、fe and Medicine,Text A,Topics for presentation,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 process respect for the persona new clinical ideal: patient-centered care in wards, clinics and
13、 operating rooms respect for a persons autonomyletting 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
14、decisions they never want to. Patients, at 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,Un
15、it 7 Life and Medicine,Text A,Useful expressions,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 pa
16、tients two out of three also preferred that their 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 uncertain when doctors pass the burden of decision-making to a patient or family, it can exacerbate an a
17、lready stressful situation.,Critical reading and thinking,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 kin
18、d of ethical transgression.Who am I to presume to know 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 descri
19、be the options. One alternative may be described to the 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 I Bizar
20、re dishonest of communication Patients end up feeling manipulated and 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 f
21、amilies,” “We have to stop subjecting them to the loneliness and burden 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,T
22、opics for presentation,Critical reading and thinking,Shouldering responsibility 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
23、and Medicine,Text A,Useful expressions,the key to preserving patient autonomy 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 pa
24、tients want them to share information, be directive or hand over the responsibility of the decision.,Critical reading and thinking,Unit 7 Life and Medicine,Text A,Additional Activity,Watch the Video and see what are tips given by Dr. Thaddeus Bell to build a Amiable PP RelationshipDoctor-Patient Rel
25、ationship,Critical reading and thinking,Unit 7 Life and Medicine,Text A,Difficult 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
26、 patient empowerment grew and medical ethicists began articulating principles regarding 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,C
27、ritical reading and thinking,临床医生们尤为拥护的一条宗旨,this ethical principle led to a new 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 em
28、ergency or mundane decisions for patients.,Critical reading and thinking,包括我在内，年轻医生将接受培训，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 teaching programs of medical schools and into state laws that mandated discuss
29、ion of treatment options with patients.,Critical reading and thinking,而且，对病人自主性的解释逐渐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
30、自己作决定就是尊重病人,Unit 7 Life and Medicine,Text A,Difficult sentences,Some will resort to veiling their own opinions in a halfhearted 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
31、 be convinced that they are being objective and dispassionate, more often than not they 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-makin
32、g 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
33、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 _ (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,Suggest
34、ed answers,Task 1 Overview This text can be briefly divided into three parts: introduction of the topic and the theme, 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
35、 Life and Medicine,Text A,Suggested answers,Task 1 Overview,Critical reading and thinking,Unit 7 Life and Medicine,Text A,Task 1/ Medical terminologyMatch 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
36、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,unethical,不道德的,hospitalize,住院,Task1 / Medical terminology Match each definition with its corresponding English term and Chinese equivalent.,Suggested answers,2,Language building-u
37、p,Unit 7 Life and Medicine,Text A,Task 2 / Signpost language,Underline the first sentences of paragraphs 4,5,6,8,11 and 12, analyze 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,Te
38、xt A,Task 3 / Formal English,The following sentences are taken from Text A. Replace the underlined formal words with less formal ones.,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.(
39、para.5)and that interpretation would work its way into the teaching programs of medical schools and into state laws that mandated discussion 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 /
40、Formal English,The following sentences are taken from Text A. Replace the underlined formal words with less formal ones.,When it came to medical decisions, almost all the respondents wanted their doctors to offer choices and consider their options. (para.9)But a majority of patientstwo out of threea
41、lso preferred that their doctors make the final decisions regarding their medical care.(para.9)6 doctors, like my young colleagues and, I admit, myself, will need to be more mindful of whether patients want them to share information(para.15),Language building-up,Suggested answers,conscious / aware,r
42、elating to/ about,answerers,Unit 7 Life and Medicine,Text A,Additional activity,Group presentationHospice movement has been a popular concept in recent decades in the field of health care. Work in a small group and explore relevant information about this subject in the following aspects: 1. definiti
43、on 2. history 3. advantages 4. development in China,Unit 7 Life and Medicine,Text B,Critical reading and thinking Language building-up Suggested answers,Unit 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 wi
44、despread metastases and receiving palliative care from hospice A dairy farmer Mother of six Interior designer One of the best pie bakers in the county,Write down the information on the following topics. Then compare your answers with your partner.,Unit 7 Life and Medicine,Text B,Critical Reading and
45、 Thinking,Knowledge of Subject Matter,Write down the information on the following topics. Then compare your answers with your partner.,lung cancer Reports from the hospital and oncologist confirmed widespread metastases. Pat had declined aggressive treatment. She was receiving palliative care from h
46、ospice 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),The computerized tomography (CT) : extensive bilateral infiltrates and a possible small nodule in the base of the left lung wit
47、h follow-up recommended but not obtained A 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 the following topics. Then compare your answers with your partner.,Unit 7 Life and Medicine,Text B,Critical Reading and Thi
48、nking,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 partner.,pulmonary emboli computerized tomography (CT) extensive bilateral infiltrates a possible small nodule in the b
49、ase of the left lung A 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 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.,
