《住院医师规范化培训临床医学英语》.doc

Chapter 1 Patient-Physician Interaction 第一章 医患沟通 The patient-physician interaction proceeds through many phases of clinical reasoning and decision making. 医患沟通在临床诊断和治疗决策的许多阶段中进行着。The interaction begins with an elucidation of complaints or concerns, followed by inquiries or evaluation to address these concerns in increasingly precise ways.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。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.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.医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。 The increasing availability of randomized trials to guide the approach to diagnosis and therapy should not be equated with “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。Evidence and the guidelines that are derived from it emphasize proven approaches for patients with specific characteristics.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。Substantial clinical judgment is required to determine whether the evidence and guidelines apply to individual patients and to recognize the occasional. 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。Even more judgment is required in the many situations in which evidence is absent or inconclusive.许多情况下，临床表现缺乏或不典型，需要考虑更多的判断。Evidence also must be tempered by patients’ preferences, although it is a physician’s responsibility to emphasize when presenting alternative options to the patient. 病人还会根据自己的倾向调节着临床症状，但医生有责任通过选择性问题搞清事实。The adherence of a patient to a specific regimen is likely to be enhanced if the patient also understands the ratio