Unit-7-AEMP-physician-patient-relationship-(1)PPT课件.pptx

Unit7Physician PatientRelationship Page167 1 Issuestobecovered Theshiftfrompaternalisticparadigmtopatient centeredparadigminmedicaldecisionmakingTheimportanceofgoodphysician patientrelationshipinboththemedicalpracticeandthepatient srecoveryThingsthatcountsinmaintainingaamiablephysician patientrelationshipThewaytocommunicateproperlyandeffectivelywiththepatients Page167 188 2 Wordstalkwithdifferentovertones doctorphysicianmedicalpractitionerproviderpatientclientcustomer Page167 3 Wordstalkwithdifferentovertones Physician denotingapractitioneroftheartofhealing Doctor referringtoa teacher toshow toteach Medicalpractitioner atechniquetermwithoutmuchconnotation Provider agenerictermmoreorlessrelatedtobusiness Page167 4 Wordstalkwithdifferentovertones Patient indicatingasufferingorsickpersonundermedicaltreatment Client referringtoapersonwhoiswillingtopayforagoodoraservice Customer denotingonewhopaysafee Page167 5 Situationswheredoctorsmaybeaskedtomake toughdecisions forthepatients Page168 Decidewhetherlife supportsystemshouldbecontinuedorwithdrawn Decidewhethereuthanasiashouldbeconsidered Decidewhetheranewtherapyshouldbetried Decidewhethersurgeryshouldbethefirstchoiceorthelastresort Decidewhethertransferorreferralisneeded 6 TextA LettingDoctorsMaketheToughDecisionsPaulineW Chen Page168 7 Whatdifficultsituationistheyoungdoctorfacing Pre 1 AdyingpatientDecisionwhethertowithdrawlife supportmachinesandmedicationandstartcomfortmeasuresThefamily srefusaltomakeanydecisionorwithdrawanytreatments Page169 P2 8 英语短语 Clinicalskills临床技能Largeandpowerfullybuilt身材高大伟岸Loomover咄咄逼人Shrinkdown缩小身子 9 英语短语 Nursingstation护士站Withdrawlife supportmachine撤下生命维持系统Comfortmeasures舒适护理措施Inflictpainon给 带来痛苦 10 Whatispaternalisticdecision makinginmedicine Pre 2 DoctorsasexclusivedecisionmakerPatientsasparticipantswithlittlesayinthefinalchoice Page169 P4 11 英语短语 Approachmedicaldecisions应对医疗决策Exclusivepurviewofdoctors医生独享权限Paternalisticdecision makingprocess家长式决策程序Patientempowerment给患者授权 12 LanguageFocuses asmovementscallingforpatientempowermentgrewandmedicalethicistsbeganarticulatingprinciplesregardingtheethicalcareofpatients 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 Page169 P4 13 Inwhatwaycanpatientempowermentbegoodforthepatient Pre 3 Respectforthepatient especiallythepatient sautonomyPatient centeredcare Page169 P5 6 14 Twoprinciplesinvolvedinthedecision makingprocess respectforthepersonanewclinicalideal patient centeredcareinwards clinicsandoperatingroomsrespectforaperson sautonomylettingpatientsmaketheirowndecisions Page169 P5 6 15 LanguageFocus Onetenetthatgainedparticulartractionamongclinicians 临床医生们尤为拥护的一条宗旨 thisethicalprincipleledtoanewclinicalideal patient centeredcare 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 Page169 P5 16 Consequenceincurredbythetwoprinciples tenets youngdoctors myselfincluded wouldbetrainedtorestrainourselvesfrommakinganythingbutemergencyormundanedecisionsforpatients 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 Page169 P6 17 Consequenceincurredbythetwoprinciples tenets andthatinterpretationwouldworkitswayintotheteachingprogramsofmedicalschoolsandintostatelawsthatmandateddiscussionoftreatmentoptionswithpatients 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 Page169 P6 18 英语短语 Ethicalprinciples伦理准则Clinicalideal临床理念Patient centeredcare以患者为中心的护理Respectforautonomy尊重自主权 19 Whydoestheauthorsaytoomuchphysicianrestraintmaynotbethatgoodforthepatient Pre 4 Thepatientsareforcedtomakedecisionstheyneverwantto Patients atleastalargemajority prefertheirdoctorstomakefinaldecisions Shiftingresponsibilityofdecisionmakingtothepatientswillbringaboutmorestresstothepatientsandtheirfamilies especiallywhenthebestoptionforthepatientisuncertain Page169 170P8 11 20 LanguageFocuses Whiledoctorsmightequatelettingpatientsmaketheirowndecisionswithrespect 虽然医生也许认为让病人自己作决定就是尊重病人 Page169P8 21 LanguageFocuses Howmany Whenitcametomedicaldecisions almostalltherespondentswantedtheirdoctorstoofferchoicesandconsidertheiropinions Butamajorityofpatients twooutofthree alsopreferredthattheirdoctorsmakethefinaldecisionsregardingtheirmedicalcare mostpatientsdon twanttomakethesedecisionsontheirown Page170P8 10 22 Thechallenges notwhenthemedicalchoicesareobvious butwhenthebestoptionforapatientisuncertain不是医疗选择明显时 而是最佳选择不明确时 doctorspasstheburdenofdecision makingtoapatientorfamily医生将决定重负转移给患者或其家人 Page170P11 23 Whatkindofconsiderationsmayhavepreventeddoctorsfrommakingdecisionsfortheirpatients Pre 5 Doctorsareverymuchcautiousaboutcommittingsomekindofethicaltransgression WhoamItopresumetoknowwhatmypatientsneed Page170P12 24 LanguageFocuses Somewillresorttoveilingtheirownopinionsinahalfheartedattempttodirectthedecision 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 Page170P12 25 LanguageFocuses Whilethedoctorsmightbeconvincedthattheyarebeingobjectiveanddispassionate moreoftenthannottheyaresendingmixedmessages 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 Page170P12 26 ACaseinPoint LanguageMakesaDifference Tellrelativesthatitistheirchoicetowithdrawlifesupportfromadyingpatient Butthatdoctormayalsousevalue ladenlanguagetodescribetheoptions Onealternativemaybedescribedtothefamilyas reasonable or comforting whiletheotherisdepictedas invasive aggressive or painful Page170 P13 27 TheProblem Patientsendupfeelingmanipulatedandwillresistmakinganydecisionatall Page170 P14 28 Thesolution Thekeytopreservingpatientautonomy andpatient centeredcare liesnotinlettingpatientsmakethefinaldecisionsalonebutinrespectingtheiropinionsandshoulderingtheresponsibility