学术英语（医学）unit7 ppt课件

学术英语 医学 Academic English for Medicine Unit 7 Physician-Patient Relationship Life 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 important 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 Medicine Unit Contents Lead-in Text A Text B Text C Listening Speaking Writing Lead-in Issues to be covered Task Unit 7 Life and Medicine Lead-in Issues 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- patient relationship The way to communicate properly and effectively with the patients Unit 7 Life and Medicine Lead-in Decide whether life-support system should be continued or withdrawn; Decide whether euthanasia should be considered; Decide whether a new therapy should be tried; Decide whether surgery should be the first choice or the last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 Medicine Text A Critical reading and thinking Topics for presentation Useful expressions Difficult sentences Language building-up Signpost language Vocabulary test Suggested answers Unit 7 Life and Medicine Text A Critical reading and thinking Topics for presentation 1 What difficult situation is the young doctor facing? A dying patient Decision whether to withdraw life-support machines and medication and start comfort measures The familys refusal to make any decision or withdraw any treatments Unit 7 Life and Medicine Text 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 / treatment 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 out of the room Critical reading and thinking Unit 7 Life and Medicine 2 What is paternalistic decision-making in medicine? Topics for presentation Text A Critical reading and thinking Doctors as exclusive decision maker Patients as participants without little say in the final choice Unit 7 Life and Medicine Text 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 thinking Unit 7 Life and Medicine Text A Topics for presentation 3 In what way can 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 doctor Unit 7 Life and Medicine Text A Topics for presentation 3 In what way can patient empowerment be good for the patient? Critical reading and thinking Two 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 make their own decisions Unit 7 Life and Medicine Text A Topics for presentation 4 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 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 uncertain Unit 7 Life and Medicine Text A Useful expressions a majority of patients are being 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 decisions regarding their medical care. not when the medical choices are obvious, but when the best option for a patient is uncertain when doctors pass the burden of decision-making to a patient or family, it can exacerbate an already stressful situation. Critical reading and thinking Unit 7 Life and Medicine Text A Topics for presentation 5. 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 and Medicine Text 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,” while the other is depicted as “invasive,” “aggressive” or “painful” . Critical reading and thinking Unit 7 Life and Medicine Text 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. Critical reading and thinking Unit 7 Life and Medicine Text 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 that circle with them.” Critical reading and thinking Unit 7 Life and Medicine 6 Do you agree that doctors should be prepared to make any decisions together with their patients? Text A Topics for presentation Critical reading and thinking Shouldering responsibility together with the patient may be better 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 Medicine Text A Useful expressions the key to preserving patient autonomy and patient- centered care lies not in letting 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 thinking Unit 7 Life and Medicine Text A Additional Activity Watch the Video and see what are tips given by Dr. Thaddeus Bell to build a Amiable PP Relationship Doctor-Patient Relationship Critical reading and thinking Unit 7 Life and Medicine Text A Difficult sentences He was large and powerfully built but never seemed to loom over his patients Critical 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 Medicine Text A Difficult sentences as movements calling for patient empowerment grew and medical ethicists began articulating principles regarding the ethical care of patients. Critical reading and thinking 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 Medicine Text A Difficult sentences One tenet that gained particular traction among clinicians Critical 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 7 Life and Medicine Text A Difficult sentences young 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 Medicine Text A Difficult sentences and 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. 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 Medicine Text A Difficult sentences While doctors might equate letting patients make their own decisions with respect Critical 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 Medicine Text A Difficult sentences Some will resort to veiling their own opinions in a halfhearted attempt to direct the decision. Critical reading 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 Medicine Text A Difficult sentences While 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。 Unit 7 Life and Medicine a 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 Test station life-support measures withdraw paternalistic empowerment ethicists principles ideal Unit 7 Life and Medicine patient-centered patient _ (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 Test autonomy options exclusive emergency restraint anxiety transgression practice Unit 7 Life and Medicine Text A Suggested answers Task 1 Overview This 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 the following diagram. Critical reading and thinking Unit 7 Life and Medicine Text A Suggested answers Task 1 Overview Critical reading and thinking Background information: Change from the paternalistic care to the patient- centered care Two underlying ethical principles: 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 Decisions Anecdote: a young doctors experience Main Supports: Study findings: most patients position Two arguments: Exacerbating the stressful situation Creating dishonesty in communication Part I (P1-P8) Part II (P9-P14) Part III (P15-P16) Unit 7 Life and Medicine Text A Task 1/ Medical terminology Match each definition with its corresponding English term and Chinese equivalent. English Chinese Definition 1 medicine or drugs given to people who are ill 2 the condition or quality of being autonomous; independence 3 an expert clinical physician 4 of, pertaining to, or correctable by surgery 5 causing pain, full of pain medication 药物，药物治疗 自主性 autonomy 临床医生clinician surgical 外科的 painful 疼痛的 Suggested answers Language building-up 2 Unit 7 Life and Medicine Text A English Chinese Definition 6 of, relating to, or connected with a clinic 7 a specialist in ethics 8 not ethical 9 a person licensed to practice medicine; a medical doctor 10 admit or send (a person) into a hospital for treatment physician 医生，内科医生 clinical 临床的 ethicist 伦理学家 unethical 不道德的 hospitalize 住院 Task1 / Medical terminology Match each definition with its corresponding English term and Chinese equivalent. Suggested answers 2 Language building-up Unit 7 Life and Medicine Text A Task 2 / Signpost language Underline the first sentences of paragraphs 4,5,6,8,11 and 12, analyze how the author manages to bring a new topic and maintain coherence, and complete the following table. Language building-up Suggested answers Key words repeated to achieve smooth transition Key words used to introduce a new topic 1st sentence of Para.4 decisions changed 1st sentence of . 5 tenet respect for the person 1st sentence of . 6 ethical principle respect for a persons autonomy 1st sentence of . 8 physician restraint not be all that good, unethical 1st sentence of . 11 medical choices, option challenge, uncertain 1st sentence of . 12 patients and their families (doctors) own set of worries Unit 7 Life and Medicine Text A Task 3 / Formal English The following sentences are taken from Text A. Replace the underlined formal words with less formal ones. 1 For generations, these decisions were the exclusive purview of doctors(para.4) 2 One tenet that gained particular traction among clinicians was respect for the person.(para.5) 3 and 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-up Suggested answers belief / idea area / field ordered Unit 7 Life and Medicine Text A Task 3 / Formal English The 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 preferred 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-up Suggested answers conscious / aware relating to/ about answerers Unit 7 Life and Medicine Text A Additional activity Group presentation Hospice 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. definition 2. history 3. advantages 4. development in China Unit 7 Life and Medicine Text B Critical reading and thinking Language building-up Suggested answers Unit 7 Life and Medicine Text B Critical Reading and Thinking 1. Pats Personal Status (P181) A 78-year-old woman suffering from lung cancer with widespread metastases and receiving palliative care from hospice A dairy farmer Mother of six Interior designer One of the best pie bakers in the county Write down the information on the following topics. Then compare your answers with your partner. Unit 7 Life and Medicine Text B Critical Reading and Thinking Knowledge of Subject Matter Write down the information on the following topics. Then compare your answers with your partner. lung cancer Reports 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. Pats Personal Status (P181) Unit 7 Life and Medicine Text B Critical Reading and Thinking 2. 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 than a year ago: a left lower- lobe pneumonia with follow-up suggested but not obtained Write down the information on the following topics. Then compare your answers with your partner. Unit 7 Life and Medicine Text B Critical Reading and Thinking 2. the reasons for her having problems with doctors (P154) Knowledge of Subject Matter Write down the information on the following topics. Then compare your answers with your partner. pulmonary emboli computerized tomography (CT) extensive bilateral infiltrates a possible small nodule in the base of the left lung A chest X-ray report from a visit more than a year ago with one of my partners revealed a left lower-lobe pneumonia and suggested follow-up to ensure resolution Unit 7 Life and Medicine Text B Critical Reading and Thinking 3. the medical mistake(P 181) Write down the information on the following topics. Then compare your answers with your partner. The abnormality not noted. Frequent visits to doctors but not informed of the findings Unit 7 Life and Medicine Text B Critical Reading and Thinking 4. the authors self-reflection (P 181) Write down the information on the following topics. Then compare your answers with your partner. Who to blame? None of the hospital team, my partners, or the radiologists to take the blame. As Pats family physician, the authors responsibility to follow up abnormal tests; the author made the serious mistake. All sorts of questions running through the authors mind: pats response, possibilities of other mistakes, problems with health care system, causes of medical mistakes or errors, what-ifs, and next actions Unit 7 Life and Medicine Text B Critical Reading and Thinking 5. the authors the visit to Pat (P181) Pat lying in bed in a darkened room with mildly labored breathing The author kneeling at the bedside listening to Pats stories The author apologizing for the serious mistake Pats forgiveness for the authors mistake Write down the info