学术英语(医学)_Unit_7.ppt

1、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 i

2、mportant 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,Get reading for Unit 8,Lead-in,Issues to be cove

3、red 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

4、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with the patients,Unit 7 Life and Medicine,Lead-in,Decide whether life-support system should be continued or withdrawn; Decide whether euthanasia should be considered; Decide whether a new therapy should be tried;

5、 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 an

6、d 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

7、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 li

8、fe-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,

9、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 li

10、ttle 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

11、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

12、 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

13、 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

14、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 uncerta

15、in,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

16、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 exacerbat

17、e 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 so

18、me 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

19、 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

20、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

21、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?,T

22、ext 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

23、7 Life and Medicine,Text A,Useful expressions,the key to preserving patient autonomy and patient-centered carelies 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 whe

24、ther 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-Pat

25、ient 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 cal

26、ling 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 clin

27、icians,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 anythin

28、g 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

29、 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

30、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 docto

31、rs 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) _ decisi

32、on-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,patie

33、nt _ (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

34、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 thinki

35、ng,Unit 7 Life and Medicine,Text A,Suggested answers,Task 1 Overview,Critical reading and thinking,Unit 7 Life and Medicine,Text A,Task 1/ Medical terminology Match each definition with its corresponding English term and Chinese equivalent.,medication,药物，药物治疗,自主性,autonomy,临床医生,clinician,surgical,外科的

36、,painful,疼痛的,Suggested answers,Language building-up,2,Unit 7 Life and Medicine,Text A,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

37、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,Unit 7 Life and M

38、edicine,Text A,Task 3 / Formal English,The following sentences are taken from Text A. Replace the underlined formal words with less formal ones.,For generations, these decisions were the exclusive purview of doctors(para.4) One tenet that gained particular traction among clinicians was respect for t

39、he person.(para.5) 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

40、 A,Task 3 / Formal English,The following sentences are taken from Text A. Replace the underlined formal words with less formal ones.,When it came to medical decisions, almost all the respondents wanted their doctors to offer choices and consider their options. (para.9) But a majority of patientstwo

41、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,consc

42、ious / 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 aspec

43、ts: 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

44、 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,Criti

45、cal 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 palliat

46、ive 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 th

47、e 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

48、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

49、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

50、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

51、 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 ques

52、tions 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

53、 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 information on the following topics. Then compare your answers with your partner.,

54、Unit 7 Life and Medicine,Text B,Critical Reading and Thinking,6. the lesson the writer learned from Pat (P181),Accepting unexpected Forgiving Celebrating Hoping Living and dying with courage and dignity,Write down the information on the following topics. Then compare your answers with your partner.,

55、Unit 7 Life and Medicine,Text B,Useful expressions,Critical reading and thinking,The primary lesion was detected years ago, but there was no follow-up. Someone dropped the ball. reports from a hospital stay more than 3 years ago Pat presented infrequently for care and usually only if something was w

56、rong. sort out my thoughts mildly labored breathing distraught about conflicts with many family members who were not on speaking terms not fulfilled my responsibility to made a difference in the outcome A tremendous load was lifted from my shoulders.,Unit 7 Life and Medicine,widespread _ (广泛转移) _tre

57、atment (积极治疗) _ lesion (原发病灶) to recommend _ (建议随访) electronic_ (电子病历) pulmonary _ (肺栓塞) computerized _ (CT, 计算机断层扫描) bilateral _ (双侧浸润) a(n)_ X-ray (X线胸片) left _ pneumonia (左下叶肺炎) _ breathing (呼吸困难) the hospice_ (临终关怀团队),Text B Language Building-up,Vocabulary Test,metastases,aggressive,primary,foll

58、ow-up,record,emboli,tomography,infiltrates,chest,Unit 7 Life and Medicine,lower-lobe,labored,team,Text B,Suggested answers,Critical reading and thinking,Task 1 Reflection,1. B 2. B 3. C 4. D 5. C 6. A,Unit 7 Life and Medicine,Text C,Language building-up Suggested answers,Unit 7 Life and Medicine,_ illness (慢性病) _ aspects (社会心理学领域) evidence-based _ (询证临床指南) to _a plan of care(实施治疗方案),Text C Language Building-up,Vocabulary Test,chronic,psychosocial,guidelines,implement,Unit 7 Life and Medicine,Text C,Task: Complete the following brief s