搜索
1临床医学英语翻译Chapter1Patient-PhysicianInteractionPage1第一章医患沟通第１页Thepatient-physicianinteractionproceedsthroughmanyphasesofclinicalreasoninganddecisionmaking.proceed进行、开展reasoning推论、推理clinicalreasoning诊断clinicaldecision确定治疗方案makingdecision做出决定医患沟通在临床诊断和治疗决策的许多阶段中进行着。Theinteractionbeginswithanelucidationofcomplaintsorconcerns,followedbyinquiriesorevaluationtoaddresstheseconcernsinincreasinglypreciseways.elucidation说明、阐明inquire询问、调查evaluation评估、评价这种沟通开始于病人诉说或所关注问题，然后通过询问、评估不断精确地确定这些问题。Theprocesscommonlyrequiresacarefulhistoryorphysicalexamination,orderingofdiagnostictests,integrationofclinicalfindingswiththetestresults,understandingoftherisksandbenefitsofthepossiblecoursesofaction,andcarefulconsultationwiththepatientandfamilytodevelopfutureplans.integration综合consultation磋商、会诊这个过程通常需要细致的病史询问和体格检查，进行诊断性化验，综合临床发现和化验结果，理解分析拟行治疗过程中的风险和疗效，并与病人及家属反复磋商以形成治疗方案Physiciansincreasinglycancallonagrowingliteratureofevidence-basedmedicinetoguidetheprocesssothatbenefitismaximized,whilerespectingindividualvariationsamongdifferentpatientsrespecting注意到、关系、说到evidence-basedmedicine循证医学医生们越来越容易查阅不断增长的循证医学文献来指导这个过程，使得疗效最大化，但要考虑到不同病人中个体差异是存在的。Theincreasingavailabilityofrandomizedtrialstoguidetheapproachtodiagnosisandtherapyshouldnotbeequatedwith“cookbook”medicineavailability可利用性，可得到randomize随机的cookbook食谱，烹调书approach接近越来越多的可用于指导临床诊断与治疗的随机试验资料不应变成“烹调书”医学。Evidenceandtheguidelinesthatarederivedfromitemphasizeprovenapproachesforpatientswithspecificcharacteristics.Evidence证据，迹象guideline指导方针emphasize强调因为随机试验获得的现象和思路是着重于特征性病人的求证过程。Substantialclinicaljudgmentisrequiredtodeterminewhethertheevidenceandguidelinesapplytoindividualpatientsandtorecognizetheoccasional.2substantialclinical真实的，实在的individual个体occasional偶尔的，特殊的实际的临床判断需要确定这些现象和思路能否应用于某个病人个体，并能找出例外。Evenmorejudgmentisrequiredinthemanysituationsinwhichevidenceisabsentorinconclusive.inconclusive不确定性，非决定性许多情况下，临床表现缺乏或不典型，需要考虑更多的判断。Evidencealsomustbetemperedbypatients’preferences,althoughitisaphysician’sresponsibilitytoemphasizewhenpresentingalternativeoptionstothepatient.temper脾气，调音preference偏爱emphasize强调，详述，阐明presenting提出alternative可选择的，二选一病人还会根据自己的倾向调节着临床症状，但医生有责任通过选择性问题搞清事实。Theadherenceofapatienttoaspecificregimenislikelytobeenhancedifthepatientalsounderstandstherationaleandevidencebehindtherecommendedoption.adherence坚持、固执regimen养生法、食物疗法enhance提高、加强rationale基本原理假如病人也懂得医生问题的基本原理和表现，有特殊生活方式病人的固执容易被强化。Tocareforapatientasanindividual,thephysicianmustunderstandthepatientasaperson.carefor喜欢、照料为了把病人作为一个个体进行治疗(为了个体化的照料病人)，医生必须理解病人是一个人（不是一群人）。Thisfundamentalpreceptofdoctoringincludesanunderstandingofthepatient’ssocialsituation,familyissues,financialconcerns,andpreferencesfordifferenttypesofcareandoutcomes,rangingfrommaximumprolongationoflifetothereliefofpainandsuffering.fundamental基本的，根本的precept训戒doctoring行医prolongation延长这个最基本的行医原则包括了解病人的社会地位，家庭问题，资金状况以及对不同治疗方法、不同治疗结果的选择，从最大限度地延长生命到临时缓解疼痛和折磨。Ifthephysiciandoesnotappreciateandaddresstheseissues,thescienceofmedicinecannotbeappliedappropriately,andeventhemostknowledgeablephysicianfailstoachieveappropriateoutcomes.appreciate欣赏、感谢、评价appropriate适当的、恰当的假如医生没有正确理解和定位这个问题，医学就不可能恰当地应用于临床，甚至一个知识最渊博的医生也不能取得理想的治疗结果。Evenasphysiciansbecomeincreasinglyawareofnewdiscoveries,patientscanobtaintheirowninformationfromavarietyofsources,someofwhichareofquestionablereliability.awareof意识到，知道questionable可疑的、成问题的、不可靠的reliability可靠、可信赖的甚至，当医生越来越容易知道新发现的同时，病人也能够通过各种资源得到他们的信息，3当然，某些信息是不可靠的。Theincreasinguseofalternativeandcomplementarytherapiesisanexampleofpatients’frequentdissatisfactionwithprescribedmedicaltherapy.alternative选择，替代complementary补充的、相配的prescribe规定、指定、开处方替代疗法和辅助疗法的应用不断增加就是病人对常规疗法经常不满意的一个例子。Physiciansshouldkeepanopenmindregardingunprovenoptionsbutmustadvisetheirpatientscarefullyifsuchoptionsmaycarryanydegreeofpotentialrisks,includingtheriskthattheymayreliedontosubstituteforprovenapproachessubstitute代替、代用relyon依赖、信任医生对未证实的疗法应该保持开放的思想，但是，如果这些疗法可能带来任何程度的潜在风险，医生都必须细致地告知病人，包括可能需要用已证实的常规疗法去替代的风险。Itiscrucialforthephysiciantohaveanopendialoguewiththepatientandfamilyregardingthefullrangeofoptionsthateithermayconsidercrucial严酷的、决定性的either两者任一对医生来说，对病人及家属开诚布公地介绍所有能考虑的治疗选择，是极及关键的。Thephysiciandoesnotexistinavacuumbutratheraspartofacomplicatedandextensivesystemofmedicalcareandpubichealth.vacuum真空extensive广阔的、大量的医生不是生存在真空中的，而是复杂而庞大的医疗和公共健康体系中的一部分。Inpremoderntimesandeventodayinsomedevelopingcountries,basichygiene,cleanwater,andadequatenutritionhavebeenthemostimportantwaystopromotehealthandreducedisease.adequate足够的、恰当的在未发达时代，甚至当今在一些发展中国家，基本卫生、清洁饮用水和最低营养保障是促进健康减少疾病的最重要措施。Indevelopedcountries,theadoptionofhealthylifestyles,includingbetterdietandappropriateexercise,arecornorstonestoreducingtheepidemicsofobesity,coronarydisease,anddiabetes.adoption采纳、采用epidemic流行、传染而在发达国家中，健康的生活方式包括合理饮食和适当锻炼，是减少肥胖、冠心病和糖尿病盛行的基础。Publichealthinterventionstoprovideimmunizationsandtoreduceinjuriesandtheuseoftobacco,illicitdrugs,andexcessalcoholcollectivelycanproducemorehealthbenefitthannearlyanyotherimaginablehealthintervention.illicit非法的、违禁的collectively全体地、共同地produce生产、创造公共健康干预如进行疫苗接种、减少损伤、减少吸烟、减少吸毒、减少酗酒等措施共同产生