所有医护人员都应该将此贴看一遍！美国USMLE考试的医患关系20条(转载)
国内医学伦理学教育彻底失败，整天讲什么医学模式转变，对具体实践毫无用处！！！现将美国USMLE考试的医患关系20条贴出，（所有医生都应该将此贴看一遍！！！
Physician-PatieRnetlationships
医患关系
Rule #1:
Patient is number one; alwaysplace the interests of the patient first.
a. Choose the patient's comfort and safety over anyone else's.
b. The goal is to serve the patient, not to worry about legal protection for the
physician.
规则1：
患者是第一位的，永远把患者利益放在首位。
a.选择患者的舒适和安全要高于选择任何人之上。
b.以服务患者为目的，不要操心法律保护医生的条规。
Rule #2:
Alwaysrespond to the patient.
a. Answer any question that is asked.
b. Respond to the emotional as well as the factual content of questions.
规则2：
永远回应患者。
a.回答任何提问的问题。
b.对事实内容的问题要有回应，对情感也一样。
Rule #3;
Tellthe patient everything. even if he or she does not ask.
a. Do not force a patient to hear bad news if he does not want it at that
moment, but do try to discuss it with him or her as soon as possible.
b. Information should flow through the patient to the family,not the reverse.
c. If you have only partial information, saythat it is partial, and tell what you
know.
规则3：
告诉患者一切，即使他或她没有问。
a.不要强迫患者听坏消息，如果他不想要在那时候听的话，但是一定要尽快尝试和他或她讨论该消息。
b.信息流向应该是从患者到家人，而不是反之。
c.如果你只拥有部分信息，就说它还只是一部分，并说出据你所知。
Rule #4:
Work on long-term relationships with patients, not just short-term problems.
a. Make eye contact.
b. Defined touch: tell him or her what you are doing.
c. Talk to patient, not colleagues: patient is alwaysthe focus.
d. Arrange seating for comfortable, close communication.
e. Shy away from large desks and tables.
f. Both patient and physician should both be sitting if at all possible.
规则4：
致力于与患者保持长期关系，而不仅仅是短期问题。
a.眼神接触。
b.对触摸要详细解释说明：告诉他或她你在做什么。
c.与患者谈话，而非同事们：患者永远是焦点。
d.安排就坐要可以舒适，亲密的交流。
e.离开大办公桌和工作台。
f.患者和医生二者如果可能都要就坐。
Rule #5;
Listening is better than talking.
a. Getting the patient to talk is generally better than having the physician
talk.
b. Take time to listen to the patient before you, even if other patients or colleagues
are waiting.
规则5：
听比说好。
a.让患者说要比医学谈话好。
b.在听你之前要从容地倾听患者，即使其他患者或者同事在等着。
Rule#6~
Negotiate rather than order.
a. Treatment choices are the result of agreement, not commands by the
physician.
b. Remember, the patient makes medical decisions from the choices provided
by the physician.
规则6：
协商优于命令。
a.治疗选择是达成一致的结果，而不是医生的指令。
b.记住，患者从医生提供的选项中决定医学选择。
Rule #7:
Trust must be built. not assumed.
a. Don't assume that the patient likes or trusts you.
b. Treat difficult or suspicious patients in a friendly, open manner.
- -- n
规则7：
信赖必须被建立，不是假定的。
a.不要设想患者喜欢或信任你。
b.治疗难相处的或多疑的病人，要以一种友好的，开放的方式。
Rule #8:
Admit to the patient when you make a mistake.
a. Take responsibility. Don't blame it on the nursing staff or on a medical
student.
b. Admit the mistake even if it was corrected and the patient is fine.
规则8：
如果犯错，就向患者承认。
a.担起责任。不要归咎于护士或医学生。
b.承认错误，即使错误已经被修正而且患者安然无恙。
Rule #9:
Never "pass off" your patient to someone else.
a. Refer to psychiatrist or other specialist when beyond your expertise (but
usually not the case).
b. Refer only for ophthalmology or related subspecialties.
c. Provide instruction in aspects of care, e.g., nutrition, use of medications.
规则9：
决不把患者“过继”给别的人。
a.求助于精神病学家或别的专家，当超出你专业范围时（但通常不是案例）
b.只查眼科学或相关附属专业。
c.提供护理方面的指导，例如，营养，药物使用。
Rule~ #10:
Express empathy, then give control: "I'm sorry, what woilld you like to do?"
a. Important when faced with a patient who is grieving or is angry.
b. Important when faced with angry or upset family members.
规则10：
表达同情之心，然后控制：“很遗憾，你想怎么做呢？”
a.很重要，当面对悲痛中或愤怒的病人。
b.很重要，当面对愤怒的或沮丧的家庭成员。
Rule #11:
Agree on problem before moving to solution.
a. Tell the patient your perceptions and conclusions about the condition
before moving to treatment recommendations.
b. Informed consent requires the patient to fully understand what is wrong.
c. Offering a correct treatment before the patient understands his or her
condition is wrong.
规则11：
对问题达成一致，在准备解决之前。
a.告诉患者你对情况的理解和结论，在进行治疗推荐之前。
b.得到信息后的同意，需要患者充分理解哪里出错。
c.提供正确的治疗在患者明白他或她的情况出问题之前。
Rule #12:
Be sure you understand what the patient is talking about before intervening.
a. Seekinformation before acting.
b. When presented with a problem, get some details before offering a solution.
c. Begin with open-ended questions, then move to closed-ended questions.
规则12:
在你打断插入前要确定理解患者所谈。
a.寻求信息，在行动之前。
b.当一个问题被呈现时，获得一些细节在提供解决方案前
c.以开放式提问开始，然后过渡至闭锁式提问。
Rule #13:
Patients do not get to select inappropriate treatments.
a. Patients select treatments, but only from presented, appropriate choices.
b. If a patient asks for an inappropriate medication that he heard advertised,
explain why it is not indicated and suggest an alternative.
规则13：
患者不要选择不恰当的治疗。
a.患者选择治疗，但仅是从提供的，合适的选择。
b.如果患者要求他听广告上的不恰当的药物治疗，解释为什么不需要并建议另一选择。
Rule #14:
Be sure who your patient is.
a. Is it the injured child, or the mother who brings him in? (the child)
b. Is it your long-term patient who is now in a coma, or her husband? (the
patient)
规则14：
确定你的患者是谁。
a.是受伤的孩子，或带他来的母亲？（孩子）
b.是你的长期的病人现处于昏迷中，还是她的丈夫？（患者）
Rule # 15:
Never lie.
a. Not to patients, their families, or insurance companies.
b. Do not deceive to protect a colleague.
规则15：
永远不要撒谎。
a.不要向患者，及其家人，或保险公司。
b.不要因保护同事而欺骗。
Rule #16:
Accept the health beliefs of patients.
a. Be accepting of benign folk medicine practices. Expect them. Diagnoses
need to be explained in the way patients can understand, even if not technically
precise.
c. Be careful about having young family members translate for elderly
patients.
规则16：
接受患者的健康信条。
a.接受良性的民间医药实行。期待它们。诊断需要以一种患者可以的理解的方式解释，尽管学术上不能达到精确。
c.要当心年轻的家庭成员如何向年长的患者传达。
Rule #17:
Accept patients' religious beliefs and participate if possible.
a. Your goal is to make the patient comfortable. Religion is a source of comfort
to many.
b. Agrowing body of research suggeststhat patients who pray and are prayed
for have better outcomes.
c. Ask about a patient's religions beliefs if you are not sure (but not as a prelude
to passing off to the chaplain!).
d. Of course, you are not expected to do anything against your own religious
or moral beliefs.
规则17：
接受患者的宗教信仰并尽量参与。
a.你的目标是使患者舒适。宗教是许多人的舒适的来源。
b.在一个成长的身体上研究表明，祈祷和被祈祷的患者有更好的结果。
c.询问患者的宗教信仰如果你不确定的话（但不是作为放弃这个病人让他去找牧师的引子）
d.当然，你不被期望做任何与你自己宗教信仰或道德信条违背的事情。
Rule #18:
Anything that increases communication is good.
a. Takethe time to talk with patients, even if others are waiting.
b. Ask"why?"
c. Seekinformation about the patient beyond the disease.
规则18：
任何增进交流的方式都是好的。
a.抽时间与患者交谈，即使其他人在等着。
b.问“为什么”.
c.寻求患者除了疾病之外其他的信息。
Rule #19:
Be an advocate for the patient.
a. Work to get the patient what he or she needs.
b. Never refuse to treat a patient because he or she cannot pay.
规则19：
成为患者的支持者。
a.努力得到患者需要的东西。
b.永远不要拒绝治疗患者，因为他或她不能支付。
Rule #20:
The key is not so much what you do. but how you do it.
a. The right choices are those that are humane and sensitive, and put the
interests of the patient first.
b. Treat family members with courtesy and tact, but the wishes and interests
of the patient come first.
规则20：
关键不是你做的有多少，而是你怎么做。
a.正确的选择是人性的敏感的，并且把患者的利益放在首位。
b.谦恭老练地对待家庭成员，但是对患者的期望和患者利益是第一位的。
翻译者:安静得意台 edited on 2008-08-15 21http://www.dxy.cn/bbs/post/view?bid=116&id=11779312&sty=1&tpg=3&age=0(丁香园)
回复 #1 zhangfh 的帖子
谢谢版主，真是好东西，赶快摘下来给我们院长看，建议他用此来教育全院的医务人员回复 #1 zhangfh 的帖子
谢谢张版，所有医护人员应该好好学习运用到实际工作后中去，院长看后一定非常高兴。:lol 患者是第一位的，永远把患者利益放在首位。是否比医学伦理道德教育还正宗呢?!:lol
[ 本帖最后由 zhangfh 于 2008-8-19 14:17 编辑 ]
回复 #1 zhangfh 的帖子
病人在我心中！:) 碰到患者开好青光眼手术 ，我去会诊时，患者生活自理，所有指令都准确迅速，连药片都找得到，却当手术医生的面，全家人都说视力给开刀开坏了，什么都看不到，得赔偿如何如何！你还能说什么？是什么把医疗给搞变味？当然， 个案不能改变我们的良心！张版给我们提供的仍然是以往作的，还须作得更好！
回复 #1 zhangfh 的帖子
认真学习体会，星火斑竹带来的异域的东东，非常好呢！ 也许理想和现实差距还很大，需要共同努力。 体制不一样，服务宗旨应该一样，可是我们的差距还是在扩大。 “永远不要拒绝治疗患者，因为他或她不能支付”1、救护车送来身无分文，又说不清自己身份或不愿意说出自己身份的患者，急救后稍好转，是否到治愈为止？
2、一些吸毒的人，没钱了，患病了，到医院连挂号费都没有，是否免费给予治疗？
等等---------
如果这样医院岂不变成慈善医院了吗？ 西方的理念如何与国内医疗行为有机结合是广大医务人员应该深思的:shit 谢谢分享！真好。:victory: 看来我们的差距太远了，认真总结不足，细细品味。 他山之石，可以攻玉！！
借鉴！！学习！！
回复 #1 zhangfh 的帖子
今天遇到故交咨询:她在某医院做宫腔镜检查，结果同去的5人当中有4人需要住院手术。她本人是子宫内膜下（4mm*4.5mm)肌瘤，宫颈息肉。大夫告知要赶快住院手术还要化验
故交一夜无眠…… 说得真好,值得学习!
可就象前面有的战友说的,面对身无分文、重病在身的患者，面对医院制定的经济指标,你能做得到吗？
很多时候,医生护士把患者从死亡的边缘救回来了，可因为交不起欠下的费用偷偷从医院跑了，这些费用不也得由科室自己来承担。
难！难！难！ 很有必要，应该好好学习。患者是第一位的，永远把患者利益放在首位。这是最重要的。
页:
[1]