1、Unit 7 Physician-Patient RelationshipPage 167Page 1671Issues to be coveredIssues to be coverednThe shift from paternalistic paradigm to patient-centered paradigm in medical decision makingnThe importance of good physician-patient relationship in both the medical practice and the patients recoverynTh
2、ings that counts in maintaining a amiable physician-patient relationshipnThe way to communicate properly and effectively with the patientsPage 167-188Page 167-1882Words talk with different overtones!ndoctornphysiciannmedical practitionernprovidernpatientnclientncustomerPage 167Page 1673Words talk wi
3、th different overtones!nPhysician:Physician:denoting a practitioner of the art of healing;nDoctor:Doctor:referring to a“teacher”to show,to teach;nMedical practitioner:Medical practitioner:a technique term without much connotation;nProvider:Provider:a generic term more or less related to business;Pag
4、e 167Page 1674Words talk with different overtones!nPatient:Patient:indicating a suffering or sick person under medical treatment;nClient:Client:referring to a person who is willing to pay for a good or a service;nCustomer:Customer:denoting one who pays a feePage 167Page 1675Situations where doctors
5、may be asked to make“tough decisions”for the patients Page 168Page 168nDecide whether life-support system should be continued or withdrawn;nDecide whether euthanasia should be considered;nDecide whether a new therapy should be tried;nDecide whether surgery should be the first choice or the last reso
6、rt;nDecide whether transfer or referral is needed.6Text AText AnLetting Doctors Make the Letting Doctors Make the Tough Decisions Tough Decisions qPauline W.ChenPage 168Page 1687What difficult situation is the young doctor facing?(Pre.1)nA dying patientnDecision whether to withdraw life-support mach
7、ines and medication and start comfort measuresnThe familys refusal to make any decision or withdraw any treatmentsPage169,P2Page169,P28英语短语 Clinical skills临床技能Large and powerfully built身材高大伟岸Loom over咄咄逼人Shrink down缩小身子9英语短语 Nursing station护士站Withdraw life-support machine撤下生命维持系统Comfort measures舒适护理
8、措施Inflict pain on给带来痛苦10What is paternalistic decision-making in medicine?(Pre.2)nDoctors as exclusive decision makernPatients as participants with little say in the final choicePage 169,P4Page 169,P411英语短语 Approach medical decisions应对医疗决策Exclusive purview of doctors医生独享权限Paternalistic decision-maki
9、ng process家长式决策程序Patient empowerment给患者授权12Language Focuses nas movements calling for patient as movements calling for patient empowerment grew and medical ethicists empowerment grew and medical ethicists began articulating principles regarding began articulating principles regarding the ethical car
10、e of patients.the ethical care of patients.n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。Page 169,P4Page 169,P413In what way can patient empowerment be good for the patient?(Pre.3)(Pre.3)nRespect for the patient,especially the patients autonomynPatient-centered carePage 169,P5-6Page 169,P5-614Two principl
11、es involved in the decision-making processnrespect for the personqa new clinical ideal:patient-centered care in wards,clinics and operating roomsnrespect for a persons autonomyqletting patients make their own decisionsPage 169,P5-6Page 169,P5-615Language FocusnOne tenet that gained particular One te
12、net that gained particular traction among clinicianstraction among cliniciansn临床医生们尤为拥护的一条宗旨nthis ethical principle led to a new this ethical principle led to a new clinical ideal:patient-centered careclinical ideal:patient-centered caren 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。Page 169,P5Page 169,P516Conseq
13、uence incurred by the two principles/tenetsnyoung doctors,myself included,young doctors,myself included,would be trained to restrain ourselves would be trained to restrain ourselves from making anything but emergency from making anything but emergency or mundane decisions for patientsor mundane deci
14、sions for patientsn 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。Page 169,P 6Page 169,P 617Consequence incurred by the two principles/tenetsnand that interpretation would work and that interpretation would work its way into the teaching programs of its way into the teaching programs of medical school
15、s and into state laws medical schools and into state laws that mandated discussion of that mandated discussion of treatment options with patients.treatment options with patients.n 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。Page 169,P6Page 169,P618英语短语 Ethical principles伦理准则Clinical ideal临
16、床理念Patient-centered care以患者为中心的护理Respect for autonomy尊重自主权19Why does the author say too much physician restraint may not be that good for the patient?(Pre.4)Pre.4)nThe patients are forced to make decisions they never want to.nPatients,at least a large majority,prefer their doctors to make final deci
17、sions.nShifting 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 uncertainPage 169-170 P 8-11Page 169-170 P 8-1120Language Focuses nWhile doctors might equate letting While doctors mig
18、ht equate letting patients make their own decisions with patients make their own decisions with respectrespectn虽然医生也许认为让病人自己作决定就是尊重病人Page 169 P8Page 169 P821Language Focuses:How many?nWhen it came to medical decisions,almost all the respondents wanted their doctors to offer choices and consider thei
19、r opinions.nBut a majority of patients two out of three also preferred that their doctors make the final decisions regarding their medical care.nmost patients dont want to make these decisions on their ownPage 170 P8-10Page 170 P8-1022The challengesnnot when the medical choices are obvious,but when
20、the best option for a patient is uncertainn不是医疗选择明显时，而是最佳选择不明确时ndoctors pass the burden of decision-making to a patient or familyn医生将决定重负转移给患者或其家人Page 170 P11Page 170 P1123What kind of considerations may have prevented doctors from making decisions for their patients?(Pre.5)Pre.5)nDoctors are very m
21、uch cautious about committing some kind of ethical transgression.qWho am I to presume to know what my patients need?Page 170 P12Page 170 P1224Language FocusesnSome will resort to veiling their own opinions in a halfhearted attempt to direct the decision.n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。Page 170 P1
22、2Page 170 P1225Language FocusesnWhile the doctors might be convinced that they are being objective and dispassionate,more often than not they are sending mixed messages.n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。Page 170 P12Page 170 P1226A Case in Point:Language Makes a Difference nTell relatives that it i
23、s their choice to withdraw life support from a dying patient.But that doctor may also use value-laden language to describe the options.nOne alternative may be described to the family as“reasonable”or“comforting,”while the other is depicted as“invasive,”“aggressive”or“painful.”Page 170,P 13Page 170,P
24、 1327The ProblemThe ProblemnPatients end up feeling manipulated and will resist making any decision at all.Page 170,P14Page 170,P1428The solutionThe solution nThe key to preserving patient autonomy and patient-centered care lies not in letting patients make the final decisions alone but in respectin
25、g their opinions and shouldering the responsibility together.Page 171,P16Page 171,P1629Do you agree that doctors should be prepared to make any decisions together with their patients?(Pre.6)Pre.6)nShouldering responsibility together with the patient may be better than having the patient make decisio
26、n on their own alone.nBalancing between paternalism and respect for patients autonomy constitutes a large part of medical practice.Page 167-171Page 167-17130Suppose a patient has got fatal disease.Would you tell him the truth?(Pre.7)Pre.7)Page 167-171Page 167-17131To Sum Up nWatch the Video and see
27、what are tips given by Dr.Thaddeus Bell to build a Amiable PP relationshipnDoctor-Patient RelationshipPage 170-171,P15-Page 170-171,P15-161632Task 1 OverviewTask 1 OverviewPage 172Page 172Background information:Change from the paternalistic care to the patient-centered care Two underlying ethical pr
28、inciples:respect for the person and respect for 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 DecisionsAne
29、cdote:a young doctors experience Main Supports:Study findings:most patients positionTwo arguments:Exacerbating the stressful situationCreating dishonesty in communicationPart I(P1-P8)Part II(P9-P14)Part III(P15-P16)33Task 1 Medical TerminologyTask 1 Medical TerminologyPage 174Page 174EnglishChinese1.medication药物，药物治疗2.Autonomy自主性3.clinician临床医生4.surgical外科的5.painful疼痛的6.clinical临床的7.ethicist伦理学家8.unethical不道德的9.physician医生，内科医生10.hospitalize住院34
