(规培)英语重点.doc

Chapter 1 patient-physician interaction（第二四段） The increasing availability of evidence from randomized trials to guide the approach to diagnosis and therapy should not be equated with “cookbook” medicine. Evidence and the guidelines that are derived from it emphasize proven approaches for patients with specific characteristics. Substantial clinical judgment is required to determine whether the evidence and guidelines apply to individual patients and to recognize the occasional exceptions. Even more judgment is required in the many situations in which evidence is absent or inconclusive. Evidence also must be tempered by patients preferences, evidence when presenting alternative potions to the patient. The adherence of a patient to a specific regimen is likely to be enhanced if the patient also understands the rationale and evidence behind the recommended option. 但是，不断增多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。因为随机试验获得的现象和思路是侧重于求证具有某些特征病人而来的。实际的临床判断需要确定这些临床表现和诊断标准是否能应用于病人个体，并能找出例外。在许多情况下，临床表现缺乏或不典型，需要考虑更多的判断。虽然医生有责任要提出选择性问题让病人回答，但病人肯定会根据自己的倾向调节临床症状。假如病人懂得基本原理和表现，对医生提出的问题，有特殊生活方式病人的固执容易被强化。 Even as physicians become increasingly aware of new discoveries, patients can obtain their own information from a variety of sources, some of which are of questionable reliability. The increasing use of alternative and complementary therapies is an example of patients?frequent dissatisfaction with prescribed medical therapy. Physicians should keep an open mind regarding unproven options but must advise their patients carefully if such options may carry any degree of potential risks, including the risk that they may relied on to substitute for proven approaches. It is crucial for the physician to have an open dialogue with the patient and family regarding the full range of options that either may consider. 甚至，当医生越来越容易知道新发现的同时，病人也能够通过各种资源得到他们的信息，当然，某些信息是不可靠的。替代疗法和辅助疗法的应用不断增加就是病人对常规疗法经常不满意的一个例子。医生对未证实的疗法应该保持开放的思想，但是，如果这些疗法具有任何程度的潜在风险，都必须细致地告知病人，包括可能需要用已证实的常规疗法去替代的风险。对医生来说，对病人及家属开诚布公地介绍所有可考虑的治疗