1、学术英语学术英语 医学医学Academic English for MedicineUnit 7Physician-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 impo
2、rtant 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 MedicineUnit ContentsLead-inText AText BText CListeningSpeakingWritingGet reading for Unit 8Lead-inIssues to be coveredTaskUnit 7 Li
3、fe and MedicineLead-inIssues 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 amiable physician-pa
4、tient relationship The way to communicate properly and effectively with the patientsUnit 7 Life and MedicineLead-in Decide whether life-support system should be continued or withdrawn;Decide whether euthanasia should be considered;Decide whether a new therapy should be tried;Decide whether surgery s
5、hould 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 MedicineText A Critical readin
6、g and thinking Topics for presentation Useful expressions Difficult sentencesLanguage building-up Signpost language Vocabulary testSuggested answersUnit 7 Life and MedicineText A Critical reading and thinkingTopics for presentation1 What difficult situation is the young doctor facing?A dying patient
7、 Decision whether to withdraw life-support machines and medication and start comfort measures The familys refusal to make any decision or withdraw any treatmentsUnit 7 Life and MedicineText 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 medications/treatm
8、ent 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,they made no decision and just walked right ou
9、t of the room Critical reading and thinkingUnit 7 Life and Medicine2 What is paternalistic decision-making in medicine?Topics for presentationText A Critical reading and thinking Doctors as exclusive decision maker Patients as participants without little say in the final choiceUnit 7 Life and Medici
10、neText 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 thinkingUnit 7 Life and MedicineText A Topics for presentation3 In what way c
11、an 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 doctorUnit 7 Life and MedicineText A Topics for presentation3 In what way
12、can patient empowerment be good for the patient?Critical reading and thinkingTwo principles/tenets/notions involved in the decision-making process respect for the person a new clinical ideal:patient-centered care in wards,clinics and operating rooms respect for a persons autonomy letting patients ma
13、ke their own decisionsUnit 7 Life and MedicineText A Topics for presentation4 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 least a large majority,prefer
14、 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 uncertainUnit 7 Life and MedicineText A Useful expressionsa majority of patients are be
15、ing 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 their doctors make the final decision
16、s 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 thinkingUnit 7 Life and MedicineText
17、 A Topics for presentation5.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 know what my patients need?Unit 7 Life a
18、nd MedicineText 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 family as“reasonable”or“comforting,”whi
19、le the other is depicted as“invasive,”“aggressive”or“painful”.Critical reading and thinkingUnit 7 Life and MedicineText A A Case in Point:Language Makes a Difference Dr.Curlins Wisdom I Bizarre dishonest of communication Patients end up feeling manipulated and will resist making any decision at all.
20、Critical reading and thinkingUnit 7 Life and MedicineText 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 of autonomy and instead begin standing in t
21、hat circle with them.”Critical reading and thinkingUnit 7 Life and Medicine6 Do you agree that doctors should be prepared to make any decisions together with their patients?Text A Topics for presentationCritical reading and thinking Shouldering responsibility together with the patient may be better
22、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 MedicineText A Useful expressions the key to preserving patient autonomy and patient-centered carelies not in letting
23、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 responsibility of the decision.Critical reading and thinki
24、ngUnit 7 Life and MedicineText A Additional ActivityWatch the Video and see what are tips givenby Dr.Thaddeus Bell to build a Amiable PPRelationshipDoctor-Patient RelationshipCritical reading and thinkingUnit 7 Life and MedicineText A Difficult sentencesHe was large and powerfully built but never se
25、emed to loom over his patientsCritical 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 MedicineText A Difficult sentencesas movements calling for patient empowerment grew and medical ethicists began articulating principles regarding the ethical care of patients.Critical reading and think
26、ing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 MedicineText A Difficult sentencesOne tenet that gained particular traction among cliniciansCritical 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
27、 7 Life and MedicineText A Difficult sentencesyoung 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 MedicineText A Difficult se
28、ntencesand 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 MedicineText A Difficult s
29、entencesWhile doctors might equate letting patients make their own decisions with respectCritical 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 MedicineText A Difficult sentencesSome will resort to veiling their own opinions in ahalfhearted attempt to direct the decision.Critical reading
30、 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 MedicineText A Difficult sentencesWhile the doctors might 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。Un
31、it 7 Life and Medicinea 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(以病人为中心的护理)Text A Language Building-up Vocabulary Teststation life-support measureswithdrawpaternalistice
32、mpowermentethicistsprinciplesidealUnit 7 Life and Medicinepatient-centeredpatient _(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 _(违背伦理)family _(家庭医疗)Text A Language Building-up Vocabulary Testautonomy options exclusiveemergencyrestrainta
33、nxietytransgressionpracticeUnit 7 Life and MedicineText A Suggested answersTask 1 OverviewThis 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
34、the following diagram.Critical reading and thinkingUnit 7 Life and MedicineText A Suggested answersTask 1 OverviewCritical reading and thinkingBackground information:Change from the paternalistic care to the patient-centered care Two underlying ethical principles:respect for the person and respect f
35、or the persons autonomy Conclusion:The key for preserving patient autonomy lies in respecting their opinions and shouldering the responsibility together.Theme:Too much physician restraint is harmful or unethical.Letting Doctors Make the Tough DecisionsAnecdote:a young doctors experience Main Support
36、s:Study findings:most patients positionTwo arguments:Exacerbating the stressful situationCreating dishonesty in communicationPart I(P1-P8)Part II(P9-P14)Part III(P15-P16)Unit 7 Life and MedicineText A Task 1/Medical terminology Match each definition with its corresponding English term and Chinese eq
37、uivalent.EnglishChinese Definition1medicine or drugs given to people who are ill2the condition or quality of being autonomous;independence3an expert clinical physician4of,pertaining to,or correctable by surgery5causing pain,full of painmedication药物，药物治疗自主性 autonomy临床医生cliniciansurgical外科的painful 疼痛的
38、Suggested answersLanguage building-up2Unit 7 Life and MedicineText A EnglishChinese Definition6of,relating to,or connected with a clinic7a specialist in ethics8not ethical9a person licensed to practice medicine;a medical doctor10admit or send(a person)into a hospital for treatmentphysician医生，内科医生cli
39、nical临床的ethicist伦理学家unethical不道德的hospitalize住院Task1/Medical terminologyMatch each definition with its corresponding English term and Chinese equivalent.Suggested answers2Language building-upUnit 7 Life and MedicineText A Task 2/Signpost language Underline the first sentences of paragraphs 4,5,6,8,11
40、 and 12,analyze how the author manages to bring a new topic and maintain coherence,and complete the following table.Language building-upSuggested answersKey words repeated to achieve smooth transitionKey words used to introduce a new topic1st sentence of Para.4 decisionschanged 1st sentence of.5tene
41、trespect for the person1st sentence of.6ethical principlerespect for a persons autonomy1st sentence of.8physician restraintnot be all that good,unethical1st sentence of.11medical choices,optionchallenge,uncertain1st sentence of.12patients and their families(doctors)own set of worriesUnit 7 Life and
42、MedicineText A Task 3/Formal EnglishThe following sentences are taken from Text A.Replace the underlined formal words with less formal ones.1For generations,these decisions were the exclusive purview of doctors(para.4)2One tenet that gained particular traction among clinicians was respect for the pe
43、rson.(para.5)3and 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-upSuggested answersbelief/ideaarea/fieldorderedUnit 7 Life and MedicineText A Task 3/Formal
44、 EnglishThe following sentences are taken from Text A.Replace the underlined formal words with less formal ones.4.When it came to medical decisions,almost all the respondents wanted their doctors to offer choices and consider their options.(para.9)5.But a majority of patientstwo out of threealso pre
45、ferred 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-upSuggested answersconscious/awarerelating to/abouta
46、nswerersUnit 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.definition2.history 3.advantage
47、s 4.development in ChinaUnit 7 Life and MedicineText BCritical reading and thinkingLanguage building-upSuggested answersUnit 7 Life and MedicineText B Critical Reading and Thinking1.Pats Personal Status(P181)A 78-year-old woman suffering from lung cancer with widespread metastases and receiving pall
48、iative care from hospice A dairy farmer Mother of six Interior designer One of the best pie bakers in the countyWrite down the information on the following topics.Then compare your answers with your partner.Unit 7 Life and MedicineText B Critical Reading and ThinkingKnowledge of Subject Matter Write
49、 down the information on the following topics.Then compare your answers with your partner.lung cancerReports from the hospital and oncologist confirmed widespread metastases.Pat had declined aggressive treatment.She was receiving palliative care from hospice under the supervision of an oncologist.1.
50、Pats Personal Status(P181)Unit 7 Life and MedicineText B Critical Reading and Thinking2.Pats electronic record(P181)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 obtained A chest X-ray more
