1、医患关系U1（医生繁忙的工作性 质导 致了医生与病人之 间 的相互 误 解 ,对 病人来 说 ，需要理解医生的工作）Mean idea:Its really common to read or hear about the complaints of doctors be impatient and careless.Although there are probably a few doctors who truly are tone-deaf, most are reasonably empathic human beings, and I wonder why even these do
2、ctors seem prey to this criticism为 什么会有 这 种 误 解：1. Neuron overload on the doctor side that leads to the problem. Sometime, one stray request（一个冷不丁的问题） from a patient- even one that is quite relevant- might interrupt doctors thinking（might catch one of the doctors neurons in mid-fire)2. Patients high
3、 expectation 3. Mistrust and misunderstanding between the patients and physicianU7/主要是 讨论 病人自主，但可以在医患关系里提及生了 /（医学 伦 理学在解决医患关系 时 需要注意的， 对 医生来 说 ，需要 顾 及到病人的情况）Respect for the patient, especially the patients autonomy(自主 权 )Mean idea:In an era of fast advancing medical technology, rapidly changing medi
4、cal ethics, and in increasingly litigious society, good physician-patient relationship is critically important for effective health care delivery.医生和患者需要做出哪些 艰难 的决定：1. Decide whether life-support system should be continued or withdrawn2. Decide whether a new therapy should be tried3. Decide whether
5、surgery should be the first choice or the last resort4. Decide whether transfer or referral（转 介） is needed5. Decide whether euthanasia（安 乐 死） should be considered什么是 paternalistic decision-making（家 长 式决策）A doctor play the role of an exclusive decision maker while his patient is considered as the par
6、ticipant without little say in the final choice.什么是 patient-center care(病人中心式照 顾 )The Patients are the decision maker based on the information provided by the doctor.为 什么不可以全以医生 为 主或全以病人 为 主Doctors are very much cautious about committing some kind of ethical transgression（医生都非常 谨 慎以免犯下某种侵犯道德的罪名）When
7、 it came to medical decisions, almost all the respondents wanted their doctors to offer choices and consider their opinions.我 们应该 怎么做Shouldering responsibility together with the patient may be better than having the patient make decision on their own alone.Balancing between paternalism and respect f
8、or patients autonomy constitutes a large part of medical practice.病人自主（见 U7）抗生素U2/如果只需 谈论 抗生素 问题 ，只要提及抗 药 与病毒的 变 异 /(抗生素作 为 人 类对 抗疾病的一大 创举 ，现 在面 临 着耐 药 性且缺少 创 新的大 问题 )Mean idea:Although great progress has been made in the treatment and prevention of diseases in the last century, there is no reason f
9、or complacency. Human health is constantly threatened not only by emerging diseases but also by re-emerging ones once thought to have been controlled or eradicated.我 们 取得在 对 抗疾病上的巨大突破及抗生素的 诞 生1. “The book on infectious disease” has been written2. A string of impressive victories incurred by antibiot
10、ics(抗生素 ) and vaccines（疫苗）所面 临 的挑 战 （如果只 谈 抗生素 1/2/4 即可）1. A change in virulence2. Mutation(突 变 ) in the exterior of the bacterium3. Emerging diseases such as AIDS and Ebola are intractable for us to solve. 4. The effectiveness of the antibiotics has, however, led to their misuse. And the old enemie
11、s get drug resistance我 们应该 做什么1. Need for surveillance2. Updated science capable of dealing with discoveries in the field3. Appropriate prevention and control4. Strong public health infrastructure治未病Literally means preventive treatment of disease. U3(疾病的 预 防和治 疗 之 间 的关系 )Mean idea:Despite the progre
12、ss in medicine, many diseases are still untreatable and incurable. It has been generally agreed that prevention is more cost-effective than the treatment of diseases.预 防和治 疗 之 间 的区 别Before someone was diagnosed with, prevention can be taken to avoid getting sick.In contrast, if you fall ill unfortun
13、ately, a treatment should be taken to make health again.患病的因素Take MS(multiple sclerosis) as an example, genetics account only 10% to 30% of the risk of MS; the rest is due to some combination of unknown environmental factors.人 际 交往与健康的关系Research on the link between relationships and physical health
14、has established that people with rich personal networks- who are married, has close family and friends, are active in social and religious group- recover more quickly from disease and live longer.如何治未病/中医的角度来治未病 /As a concept in Traditional Chinese Medicine(TCM), there are some effective methods to
15、take this preventive treatment of disease.Acupuncture(针 灸 ), herbs(中 药 ), massage and taichi all the effective methods to prevent diseases.其他U4(传统 医学与可 选择 医学的碰撞 )Mean idea:When you are ill but failed by conventional treatments or suffering chronic conditions, you may try some traditional or alternat
16、ive therapies as the last resort.中国 传统 医学的特点1. Simple and inexpensive facilities2. Substances used as medicine are all from nature3. Effectiveness has been proven and ensured with a long history4. Most procedures and operations are noninvasive(无 创 的 )5. New theories and practices shed with ongoing r
17、esearch around the world on acupuncture, herbs, massage and taici.如今在美国中医的 现 状1. More intense research2. Higher adoption of acupuncture3. Greater interest by stakeholder4. Stronger push for coverage5. An interesting number of physician acupuncturists现 代医学和中国 传统 医学的区 别Modern medicine is analytical, q
18、uantitative and mechanistic(体制化的 )TCM is systemic, holistic and individualisticU6(临终 关 怀 的方式 )Mean idea:Medical advances and value changes have increased and acceptability of palliative care and hospice care, which can be provided to critically ill patients at home, hospitals or nursing homes.Things
19、 to consider when choosing the right place to die:1. The most sensible type of care2. Availability of such care 3. Availability of support system4. Management of the costWhat advantages does a hospital have over a nursing home for end-of-life careAvailability of medical resources, including doctors,
20、 nurses and facility around the clockWhats the role of family and friends when the patient is cared at home?1. Taking on a job which is big job physically, emotionally, and financially;2. Hiring a home nurse for additional help;3. Arranging for services (such as visiting nurses) and special equipmen
21、t (like a hospital bed or bedside commode)What needs to be considered to make comfort care available at home?1. Health insurance2. Planning by a professional, such as a hospital discharge planner or a social worker3. Help from local governmental agencies4. Doctor supervision at homeU8/U9(医生 应 当遵守的原
22、则 与医学生的学 习 )What is the primary purpose of medical education?For students to learn, in depth, what it means to be a physician:1) Upon graduation, they can have an understanding of what it means to be a physician when are bestowed with the title, and 2) they can have the personal qualities for a phys
23、ician to be capable of meeting the publics expectations of a doctor.Why must a physician be inquisitive（好 问 的）1. A great deal about medicine that is not known.2. A great deal that individual physicians do not know about what is known.SUM1. a physician not caring, inquisitive, and civic minded may be
24、 a highly skilled technician involved in the practice of medicine, such an individual will not truly reflect the essence of what it means to be a physician2. medical schools continue to modify their educational programs to reflect a commitment to ensuring that their graduates be caring, inquisitive, and civic-minded physicians
