Unit-7-AEMP-physician-pa教學(xué)講解課件

Unit7

Physician-PatientRelationshipPage1671Unit7

Physician-PatientRelaIssuestobecoveredTheshiftfrompaternalisticparadigmtopatient-centeredparadigminmedicaldecisionmakingTheimportanceofgoodphysician-patientrelationshipinboththemedicalpracticeandthepatient’srecoveryThingsthatcountsinmaintainingaamiablephysician-patientrelationshipThewaytocommunicateproperlyandeffectivelywiththepatients1882IssuestobecoveredTheshiftWordstalkwithdifferentovertones!doctorphysicianmedicalpractitionerproviderpatientclientcustomerPage1673WordstalkwithdifferentoverWordstalkwithdifferentovertones!Physician:

denotingapractitioneroftheartofhealing;Doctor:referringtoa“teacher”toshow,toteach;Medicalpractitioner:atechniquetermwithoutmuchconnotation;Provider:

agenerictermmoreorlessrelatedtobusiness;Page1674WordstalkwithdifferentoverWordstalkwithdifferentovertones!Patient:

indicatingasufferingorsickpersonundermedicaltreatment;Client:referringtoapersonwhoiswillingtopayforagoodoraservice;Customer:

denotingonewhopaysafeePage1675WordstalkwithdifferentoverSituationswheredoctorsmaybeaskedtomake“toughdecisions”forthepatients

Page168Decidewhetherlife-supportsystemshouldbecontinuedorwithdrawn;Decidewhethereuthanasiashouldbeconsidered;Decidewhetheranewtherapyshouldbetried;Decidewhethersurgeryshouldbethefirstchoiceorthelastresort;Decidewhethertransferorreferralisneeded.6SituationswheredoctorsmaybTextALettingDoctorsMaketheToughDecisionsPaulineW.ChenPage1687TextALettingDoctorsMaketheWhatdifficultsituationistheyoungdoctorfacing?(Pre.1)AdyingpatientDecisionwhethertowithdrawlife-supportmachinesandmedicationandstartcomfortmeasuresThefamily’srefusaltomakeanydecisionorwithdrawanytreatmentsPage169,P28Whatdifficultsituationisth英語(yǔ)短語(yǔ)

Clinicalskills臨床技能Largeandpowerfullybuilt身材高大偉岸Loomover咄咄逼人Shrinkdown縮小身子9英語(yǔ)短語(yǔ)Clinicalskills9英語(yǔ)短語(yǔ)

Nursingstation護(hù)士站W(wǎng)ithdrawlife-supportmachine撤下生命維持系統(tǒng)Comfortmeasures舒適護(hù)理措施Inflictpainon給…帶來(lái)痛苦10英語(yǔ)短語(yǔ)Nursingstation10Whatispaternalisticdecision-makinginmedicine?(Pre.2)DoctorsasexclusivedecisionmakerPatientsasparticipantswithlittlesayinthefinalchoicePage169,P411Whatispaternalisticdecision英語(yǔ)短語(yǔ)

Approachmedicaldecisions應(yīng)對(duì)醫(yī)療決策Exclusivepurviewofdoctors醫(yī)生獨(dú)享權(quán)限Paternalisticdecision-makingprocess家長(zhǎng)式?jīng)Q策程序Patientempowerment給患者授權(quán)12英語(yǔ)短語(yǔ)ApproachmedicaldecisionLanguageFocuses…asmovementscallingforpatientempowermentgrewandmedicalethicistsbeganarticulatingprinciplesregardingtheethicalcareofpatients.…要求病人授權(quán)的呼聲越來(lái)越高，而且醫(yī)學(xué)倫理學(xué)家也開(kāi)始闡述病人倫理關(guān)懷的相關(guān)原則。Page169,P413LanguageFocuses…asmovementsInwhatwaycanpatientempowermentbegoodforthepatient?(Pre.3)Respectforthepatient,especiallythepatient’sautonomyPatient-centeredcarePage169,P5-614InwhatwaycanpatientempoweTwoprinciplesinvolvedinthedecision-makingprocessrespectforthepersonanewclinicalideal:patient-centeredcareinwards,clinicsandoperatingroomsrespectforaperson’sautonomylettingpatientsmaketheirowndecisionsPage169,P5-615TwoprinciplesinvolvedintheLanguageFocusOnetenetthatgainedparticulartractionamongclinicians…臨床醫(yī)生們尤為擁護(hù)的一條宗旨…thisethicalprincipleledtoanewclinicalideal:patient-centeredcare

…這條倫理原則導(dǎo)致了一種新的臨床理念的出現(xiàn)：以病人為中心的醫(yī)護(hù)。Page169,P516LanguageFocusOnetenetthatgConsequenceincurredbythetwoprinciples/tenets…youngdoctors,myselfincluded,wouldbetrainedtorestrainourselvesfrommakinganythingbutemergencyormundanedecisionsforpatients…包括我在內(nèi)，年輕醫(yī)生將接受培訓(xùn)，學(xué)會(huì)除了一些緊急狀況或日?，嵤?，不為病人作其他任何決定。Page169,P617ConsequenceincurredbythetwConsequenceincurredbythetwoprinciples/tenets…andthatinterpretationwouldworkitswayintotheteachingprogramsofmedicalschoolsandintostatelawsthatmandateddiscussionoftreatmentoptionswithpatients.…而且，對(duì)病人自主性的解釋逐漸進(jìn)入了醫(yī)學(xué)院校的課程，也被寫(xiě)進(jìn)各州的法律，規(guī)定醫(yī)生必須與病人討論治療方案的選擇。Page169,P618Consequenceincurredbythetw英語(yǔ)短語(yǔ)

Ethicalprinciples倫理準(zhǔn)則Clinicalideal臨床理念Patient-centeredcare以患者為中心的護(hù)理Respectforautonomy尊重自主權(quán)19英語(yǔ)短語(yǔ)Ethicalprinciples19Whydoestheauthorsaytoomuchphysicianrestraintmaynotbethatgoodforthepatient?(Pre.4)Thepatientsareforcedtomakedecisionstheyneverwantto.Patients,atleastalargemajority,prefertheirdoctorstomakefinaldecisions.Shiftingresponsibilityofdecisionmakingtothepatientswillbringaboutmorestresstothepatientsandtheirfamilies,especiallywhenthebestoptionforthepatientisuncertain170P8-1120WhydoestheauthorsaytoomuLanguageFocusesWhiledoctorsmightequatelettingpatientsmaketheirowndecisionswithrespect…雖然醫(yī)生也許認(rèn)為讓病人自己作決定就是尊重病人…Page169P821LanguageFocusesWhiledoctorsLanguageFocuses:Howmany?Whenitcametomedicaldecisions,almostalltherespondentswantedtheirdoctorstoofferchoicesandconsidertheiropinions.Butamajorityofpatients—twooutofthree—alsopreferredthattheirdoctorsmakethefinaldecisionsregardingtheirmedicalcare.…mostpatientsdon’twanttomakethesedecisionsontheirownPage170P8-1022LanguageFocuses:Howmany?WhThechallenges…notwhenthemedicalchoicesareobvious,butwhenthebestoptionforapatientisuncertain不是醫(yī)療選擇明顯時(shí)，而是最佳選擇不明確時(shí)…doctorspasstheburdenofdecision-makingtoapatientorfamily醫(yī)生將決定重負(fù)轉(zhuǎn)移給患者或其家人Page170P1123Thechallenges…notwhenthemeWhatkindofconsiderationsmayhavepreventeddoctorsfrommakingdecisionsfortheirpatients?

(Pre.5)Doctorsareverymuchcautiousaboutcommittingsomekindofethicaltransgression.‘WhoamItopresumetoknowwhatmypatientsneed?’Page170P1224WhatkindofconsiderationsmaLanguageFocusesSomewillresorttoveilingtheirownopinionsinahalfheartedattempttodirectthedecision.有些醫(yī)生采取的做法是隱藏自己的觀點(diǎn)，用隱隱約約的方式引導(dǎo)病人作決定。Page170P1225LanguageFocusesSomewillresoLanguageFocusesWhilethedoctorsmightbeconvincedthattheyarebeingobjectiveanddispassionate,moreoftenthannottheyaresendingmixedmessages.雖然醫(yī)生堅(jiān)信自己的態(tài)度客觀冷靜，但往往他們?cè)谙虿∪税l(fā)出莫衷一是的信息。Page170P1226LanguageFocusesWhilethedoctACaseinPoint:

LanguageMakesaDifferenceTellrelativesthatitistheirchoicetowithdrawlifesupportfromadyingpatient.Butthatdoctormayalsousevalue-ladenlanguage

todescribetheoptions.Onealternativemaybedescribedtothefamilyas“reasonable”or“comforting,”whiletheotherisdepictedas“invasive,”“aggressive”or“painful.”P(pán)age170,P1327ACaseinPoint:

LanguageMakTheProblemPatientsendupfeelingmanipulatedandwillresistmakinganydecisionatall.Page170,P1428TheProblemPatientsendupfeeThesolution

Thekeytopreservingpatientautonomy–andpatient-centeredcare–liesnotinlettingpatientsmakethefinaldecisionsalonebutinrespectingtheiropinionsandshoulderingtheresponsibilitytogether.Page171,P1629ThesolutionThekeytopreserDoyouagreethatdoctorsshouldbepreparedtomakeanydecisionstogetherwiththeirpatients?

(Pre.6)Shoulderingresponsibilitytogetherwiththepatientmaybebetterthanhavingthepatientmakedecisionontheirownalone.Balancingbetweenpaternalismandrespectforpatient’sautonomyconstitutesalargepartofmedicalpractice.17130DoyouagreethatdoctorsshouSupposeapatienthasgotfataldisease.Wouldyoutellhimthetruth?(Pre.7)17131SupposeapatienthasgotfataToSumUp

WatchtheVideoandseewhataretipsgivenbyDr.ThaddeusBelltobuildaAmiablePPrelationshipDoctor-PatientRelationship171,P15-1632ToSumUpWatchtheVideoandTask1OverviewPage172Backgroundinformation:Changefromthepaternalisticcaretothepatient-centeredcareTwounderlyingethicalprinciples:respectforthepersonandrespectfortheperson’sautonomy

Conclusion:Thekeyforpreservingpatientautonomyliesinrespectingtheiropinionsandshoulderingtheresponsibilitytogether.Theme:Toomuchphysicianrestraintisharmfulorunethical.

LettingDoctorsMaketheToughDecisionsAnecdote:ayoungdoctor’sexperienceMainSupports:Studyfindings:mostpatients’positionTwoarguments:ExacerbatingthestressfulsituationCreatingdishonestyincommunicationPartI(P1-P8)PartII(P9-P14)PartIII(P15-P16)33Task1OverviewPage172BackgroTask1MedicalTerminologyPage174EnglishChinese1.medication藥物，藥物治療2.Autonomy自主性3.

clinician臨床醫(yī)生4.surgical外科的5.painful疼痛的6.clinical臨床的7.ethicist倫理學(xué)家8.

unethical不道德的9.physician醫(yī)生，內(nèi)科醫(yī)生10.hospitalize住院34Task1MedicalTerminologyPageUnit7

Physician-PatientRelationshipPage16735Unit7

Physician-PatientRelaIssuestobecoveredTheshiftfrompaternalisticparadigmtopatient-centeredparadigminmedicaldecisionmakingTheimportanceofgoodphysician-patientrelationshipinboththemedicalpracticeandthepatient’srecoveryThingsthatcountsinmaintainingaamiablephysician-patientrelationshipThewaytocommunicateproperlyandeffectivelywiththepatients18836IssuestobecoveredTheshiftWordstalkwithdifferentovertones!doctorphysicianmedicalpractitionerproviderpatientclientcustomerPage16737WordstalkwithdifferentoverWordstalkwithdifferentovertones!Physician:

denotingapractitioneroftheartofhealing;Doctor:referringtoa“teacher”toshow,toteach;Medicalpractitioner:atechniquetermwithoutmuchconnotation;Provider:

agenerictermmoreorlessrelatedtobusiness;Page16738WordstalkwithdifferentoverWordstalkwithdifferentovertones!Patient:

indicatingasufferingorsickpersonundermedicaltreatment;Client:referringtoapersonwhoiswillingtopayforagoodoraservice;Customer:

denotingonewhopaysafeePage16739WordstalkwithdifferentoverSituationswheredoctorsmaybeaskedtomake“toughdecisions”forthepatients

Page168Decidewhetherlife-supportsystemshouldbecontinuedorwithdrawn;Decidewhethereuthanasiashouldbeconsidered;Decidewhetheranewtherapyshouldbetried;Decidewhethersurgeryshouldbethefirstchoiceorthelastresort;Decidewhethertransferorreferralisneeded.40SituationswheredoctorsmaybTextALettingDoctorsMaketheToughDecisionsPaulineW.ChenPage16841TextALettingDoctorsMaketheWhatdifficultsituationistheyoungdoctorfacing?(Pre.1)AdyingpatientDecisionwhethertowithdrawlife-supportmachinesandmedicationandstartcomfortmeasuresThefamily’srefusaltomakeanydecisionorwithdrawanytreatmentsPage169,P242Whatdifficultsituationisth英語(yǔ)短語(yǔ)

Clinicalskills臨床技能Largeandpowerfullybuilt身材高大偉岸Loomover咄咄逼人Shrinkdown縮小身子43英語(yǔ)短語(yǔ)Clinicalskills9英語(yǔ)短語(yǔ)

Nursingstation護(hù)士站W(wǎng)ithdrawlife-supportmachine撤下生命維持系統(tǒng)Comfortmeasures舒適護(hù)理措施Inflictpainon給…帶來(lái)痛苦44英語(yǔ)短語(yǔ)Nursingstation10Whatispaternalisticdecision-makinginmedicine?(Pre.2)DoctorsasexclusivedecisionmakerPatientsasparticipantswithlittlesayinthefinalchoicePage169,P445Whatispaternalisticdecision英語(yǔ)短語(yǔ)

Approachmedicaldecisions應(yīng)對(duì)醫(yī)療決策Exclusivepurviewofdoctors醫(yī)生獨(dú)享權(quán)限Paternalisticdecision-makingprocess家長(zhǎng)式?jīng)Q策程序Patientempowerment給患者授權(quán)46英語(yǔ)短語(yǔ)ApproachmedicaldecisionLanguageFocuses…asmovementscallingforpatientempowermentgrewandmedicalethicistsbeganarticulatingprinciplesregardingtheethicalcareofpatients.…要求病人授權(quán)的呼聲越來(lái)越高，而且醫(yī)學(xué)倫理學(xué)家也開(kāi)始闡述病人倫理關(guān)懷的相關(guān)原則。Page169,P447LanguageFocuses…asmovementsInwhatwaycanpatientempowermentbegoodforthepatient?(Pre.3)Respectforthepatient,especiallythepatient’sautonomyPatient-centeredcarePage169,P5-648InwhatwaycanpatientempoweTwoprinciplesinvolvedinthedecision-makingprocessrespectforthepersonanewclinicalideal:patient-centeredcareinwards,clinicsandoperatingroomsrespectforaperson’sautonomylettingpatientsmaketheirowndecisionsPage169,P5-649TwoprinciplesinvolvedintheLanguageFocusOnetenetthatgainedparticulartractionamongclinicians…臨床醫(yī)生們尤為擁護(hù)的一條宗旨…thisethicalprincipleledtoanewclinicalideal:patient-centeredcare

…這條倫理原則導(dǎo)致了一種新的臨床理念的出現(xiàn)：以病人為中心的醫(yī)護(hù)。Page169,P550LanguageFocusOnetenetthatgConsequenceincurredbythetwoprinciples/tenets…youngdoctors,myselfincluded,wouldbetrainedtorestrainourselvesfrommakinganythingbutemergencyormundanedecisionsforpatients…包括我在內(nèi)，年輕醫(yī)生將接受培訓(xùn)，學(xué)會(huì)除了一些緊急狀況或日常瑣事，不為病人作其他任何決定。Page169,P651ConsequenceincurredbythetwConsequenceincurredbythetwoprinciples/tenets…andthatinterpretationwouldworkitswayintotheteachingprogramsofmedicalschoolsandintostatelawsthatmandateddiscussionoftreatmentoptionswithpatients.…而且，對(duì)病人自主性的解釋逐漸進(jìn)入了醫(yī)學(xué)院校的課程，也被寫(xiě)進(jìn)各州的法律，規(guī)定醫(yī)生必須與病人討論治療方案的選擇。Page169,P652Consequenceincurredbythetw英語(yǔ)短語(yǔ)

Ethicalprinciples倫理準(zhǔn)則Clinicalideal臨床理念Patient-centeredcare以患者為中心的護(hù)理Respectforautonomy尊重自主權(quán)53英語(yǔ)短語(yǔ)Ethicalprinciples19Whydoestheauthorsaytoomuchphysicianrestraintmaynotbethatgoodforthepatient?(Pre.4)Thepatientsareforcedtomakedecisionstheyneverwantto.Patients,atleastalargemajority,prefertheirdoctorstomakefinaldecisions.Shiftingresponsibilityofdecisionmakingtothepatientswillbringaboutmorestresstothepatientsandtheirfamilies,especiallywhenthebestoptionforthepatientisuncertain170P8-1154WhydoestheauthorsaytoomuLanguageFocusesWhiledoctorsmightequatelettingpatientsmaketheirowndecisionswithrespect…雖然醫(yī)生也許認(rèn)為讓病人自己作決定就是尊重病人…Page169P855LanguageFocusesWhiledoctorsLanguageFocuses:Howmany?Whenitcametomedicaldecisions,almostalltherespondentswantedtheirdoctorstoofferchoicesandconsidertheiropinions.Butamajorityofpatients—twooutofthree—alsopreferredthattheirdoctorsmakethefinaldecisionsregardingtheirmedicalcare.…mostpatientsdon’twanttomakethesedecisionsontheirownPage170P8-1056LanguageFocuses:Howmany?WhThechallenges…notwhenthemedicalchoicesareobvious,butwhenthebestoptionforapatientisuncertain不是醫(yī)療選擇明顯時(shí)，而是最佳選擇不明確時(shí)…doctorspasstheburdenofdecision-makingtoapatientorfamily醫(yī)生將決定重負(fù)轉(zhuǎn)移給患者或其家人Page170P1157Thechallenges…notwhenthemeWhatkindofconsiderationsmayhavepreventeddoctorsfrommakingdecisionsfortheirpatients?

(Pre.5)Doctorsareverymuchcautiousaboutcommittingsomekindofethicaltransgression.‘WhoamItopresumetoknowwhatmypatientsneed?’Page170P1258WhatkindofconsiderationsmaLanguageFocusesSomewillresorttoveilingtheirownopinionsinahalfheartedattempttodirectthedecision.有些醫(yī)生采取的做法是隱藏自己的觀點(diǎn)，用隱隱約約的方式引導(dǎo)病人作決定。Page170P1259LanguageFocusesSomewillresoLanguageFocusesWhilethedoctorsmightbeconvincedthattheyarebeingobjectiveanddispassionate,moreoftenthannottheyaresendingmixedmessages.雖然醫(yī)生堅(jiān)信自己的態(tài)度客觀冷靜，但往往他們?cè)谙虿∪税l(fā)出莫衷一是的信息。Page170P1260LanguageFocusesWhilethedoctACaseinPoint:

LanguageMakesaDifferenceTellrelativesthatitistheirchoicetowithdrawlifesupportfromadyingpatient.Butthatdoctormayalsousevalue-ladenlanguage

todescribetheoptions.Onealternativemaybedescribedtothefamilyas“reasonable”or“comforting,”whiletheotherisdepictedas“invasive,”“aggressive”or“painful.”P(pán)age170,P1361ACaseinPoint:

LanguageMakTheProblemPatientsendupfeelingmanipulatedandwillresistmakinganydecisionatall.Page170,P1462TheProblemPatientsendupfeeThesolution

Thekeytopreservingpatientautonomy–andpatient-centeredcare–liesnotinlettingpatientsmakethefinaldecisionsalonebutinrespectingtheiropinionsa