国外医学生教材选读(一)

鬼才

为了让大家了解医学教学的情况，我们在这选读一些国外医学生教材，这些选编的内容均来自目前国外最新医学教材，为方便大家学习，我用英中文两种语言提供给大家，如有不明确的地方，欢迎 大家提出来，我将为大家解答。

Good medical practice

最佳医学实践

Since the time ofHippocrates, the role of the doctor has extended beyond the narrow remit ofcuring patients of their ailments. Good medical practice, or the art ofmedicine, hinges on recognising and respecting the breadth of physical, cultural,experiential and psychosocial characteristics of each patient, and understandingtheir impact on the patient’s beliefs, attitudes and expectations. Doctors mustdeliver appropriate care which considers the technical complexities of moderntreatment, and at the same time deals with the communication and interpersonalneeds of the patient, at a time when he or she may feel most vulnerable. Inaddition to the diagnosis and treatment of illness, the scope of medicine hasexpanded to preventing disease through measures such as screening, vaccinationand health promotion. Doctors are centrally involved in tacklinglifestyle-related issues of the modern world, such as obesity, alcohol excess, cigarettesmoking and sexual health.

从希波克拉底时代起，医生的角色已经远远超出了通过医治病人的疾病及解除病人痛苦的范围。良好的医学实践或医疗技术，一方面取决于医生对每个病人的体质、文化、经历和心理特征的广泛认同和尊重，还要了解影响病人的信仰、心态和期望方面的有关情况。考虑到现代治疗技术的复杂性，医生必须适时关心病人，同时要用一定的时间与病人沟通和交流，而此时也是病人（他或她）感觉最脆弱的时候。另一方面，对于疾病的诊断和治疗，医学的范畴已经延伸到诸如通过疾病筛查、预防接种和健康促进等措施来预防疾病。医生应（已）更多关注解决当前与生活方式相关的问题，如肥胖、酗酒、吸烟和性健康问题。

Medical professionalismhas been described in the UK by a Royal College of Physicians working party (2005) as ‘a set ofvalues, behaviours and relationships that underpin the trust the public has in doctors’.They stated that doctors should be committed to integrity, compassion,altruism, continuous improvement, excellence, and working in partnership with membersof the wider health-care team. They perceived that medical professionalism wasrelevant to leadership, education, career pathways, appraisal and research.

医师执业精神被英国皇家医师学院工作组(2005)描述为“医师群体有着一整套得到公众信赖的相互支持的价值观和行为规范”，医师应该为人正直、具有同理心、为他人着想，并致力于持续改进、追求卓越和有合作精神的医疗保健团队。他们认为，医师执业精神与领导力、教育、职业生涯、评估和研究相关。

The chapter outlines how doctorsmust provide patients and their families with relevant but complex information,discuss management options, and reach appropriate clinical decisions, commensuratewith the available resources. It also describes processes to develop, maintainand assure medical professionalism.

本章概述了医生怎样必须为病人和他们的家属提供相关的、详尽的信息，讨论管理选项，并做出相应的临床决策，此决策应与可提供的资源相符合。同时还描述了开发、维护和保证医疗业务开展的进程。

春语

    谢谢老师分享 ，学习了。

阿丹丹

谢谢老师分享 ，学习了。

鬼才

MEDICAL PRACTICE

医疗实践

The doctor-patient relationship

医患关系

The contents of this book are not all basedon indisputable contemporary evidence; many reflect, wisdom and understandingdistilled over hundreds of years and passed from generation of doctors. This perceivedwisdom lies at the heart of the way that doctors and patients interact; itdemands respect, and if the doctor also displays compassion, sets the scene forthe development of trust.

这本书的内容并非都是取决于当代无可争议的证据；许多观念、智慧和认识来自于一代代医生数百年经历的结晶。这当中的智慧核心是医患互动的方式；它需要相互尊重，医生表现出来的同情心，为相互之间的信任奠定了基础。

Due to the complexitiesof many chronic diseases and treatments, and the multifaceted impact of illnesson a patient there is an increasing role for health care to be delivered by a multidisciplinaryteam (Box 1.1).This model of care recognizes the different skill of each allied health professionaland focuses patient care beyond surgical procedures or pharmacological manipulation.The doctor usually takes the lead in determining the overall direction of carebut must also:

由于许多慢性疾病及治疗、疾病对患者多方面影响的复杂，医疗工作的一个新角色由多学科成员提供(Box 1.1)。这个医疗模式彰显出了各个医疗团队成员不同的技巧，对患者护理的关注程度超越了外科手术和药物处方。医生通常在确定医疗整体方案中起决定性的作用，但也必须做到：

●        guide the patient through theunfamiliar landscape, language and customs of clinical care

●        指导病人在临床治疗中适应陌生的环境、语言和习惯

●        interpret, synthesise andconvey complex information

●        说明、综合和传递复杂的信息

●        help patients and families toparticipate fully in the decision-making process.

●        帮助病人和家属在决策过程中充分地参与

In many clinical disciplines, doctor fromseveral specialties form a multidisciplinary term in order to formulate atreatment plan. In oncology, for example, this ensures that various modalitiesof treatment (surgical, oncological and palliative) are considered.

在许多临床学科中，为制定医疗计划，几个不同专业的医生组建成一多学科治疗团队。例如，在肿瘤科，应确保治疗的各种方式(手术治疗、肿瘤治疗、姑息治疗)。

  Thedoctor-patient relationship is in itself therapeutic; a successful consultationwith a trusted and respected practitioner will have beneficial effects irrespectiveof any other therapy given. The doctor-patient relationship is multilayered, dynamicand bilateral (Fig. 1.1).

医患关系本身就是治疗；与一个值得胜任和受尊重的医生的成功交流胜于其他任何治疗。医患关系是多层次、充满活力和双方互动的。

鬼才

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