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临床医学英语Chapter?1????Patient-Physician?Interaction???Page?1第一章?医患沟通???第１页The?patient-physician?interaction?proceeds?through?many?phases?of?clinical?reasoning?and?decision?making.?proceed??进行、开展???reasoning?推论、推理???clinical?reasoning?诊断???clinical?decision?确定治疗方案???making?decision?做出决定医患沟通在临床诊断和治疗决策的许多时期进行着。The?interaction?begins?with?an?elucidation?of?complaints?or?concerns,?followed?by?inquiries?or?evaluation?to?address?these?concerns?in?increasingly?precise?ways.elucidation?说明、阐明????inquire?询问、调查????evaluation??评估、评价这种沟通开始于病人主诉或所关注问题的阐明，然后通过交流、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.integration?综合???consultation??磋商、会诊?这个过程通常需要细致的询问病史和体格检查，开具诊断性化验医嘱，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，然后与病人及家属反复磋商以完善治疗方案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?patientsrespecting??注意到、关系、说到???evidence-based?medicine?循证医学?尽管考虑到不同病人中个体差异是存在的，但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。The?increasing?availability?of?randomized?trials?to?guide?the?approach?to?diagnosis?and?therapy?should?not?be?equated?with?“cookbook”?medicineavailability　可利用性，?可得到????randomize?随机的cookbook?食谱，烹调书????approach?接近?但是，不断增加的可用于指导临床诊断与治疗的随机试验资料不应当作“烹调书”使用。Evidence?and?the?guidelines?that?are?derived?from?it?emphasize?proven?approaches?for?patients?with?specific?characteristics.Evidence??证据，迹象???guideline　指导方针??emphasize?强调?那些随机试验获得的临床表现和诊断思路是侧重于求证具有某些特征病人而来的。Substantial?clinical?judgment?is?required?to?determine?whether?the?evidence?and?guidelines?apply?to?individual?patients?and?to?recognize?the?occasional.?substantial?clinical?真实的，实在的???individual?个体