新編臨床醫(yī)學(xué)英語

新編臨床醫(yī)學(xué)英語新編臨床醫(yī)學(xué)英語新編臨床醫(yī)學(xué)英語資料僅供參考文件編號：2022年4月新編臨床醫(yī)學(xué)英語版本號：A修改號：1頁次：1.0審核：批準:發(fā)布日期：新編臨床醫(yī)學(xué)英語第1期:病患的問題與訴求Unit

1

Text

A

Internal

Medicine

and

Today's

Internist第1單元文章A

內(nèi)科與內(nèi)科醫(yī)生Questions/Pleas

of

the

Patient病患的問題與訴求How

can

I

find

a

good

doctor"

我如何找到一位良醫(yī)？How

can

I

find

a

good

doctor

whom

I

can

afford"

如何能夠碰到一位價格親民的醫(yī)生？How

can

I

find

a

good

doctor

who

cares

about

me

as

a

person〃

又如何能夠遇見一位把我當(dāng)成“人”看待的醫(yī)生？How

can

I

find

a

good

doctor

who

will

take

the

time

to

listen

and

understand"

如何找到一位能夠花時間傾聽我的訴說，了解我的名醫(yī)？People

who

need

medical

care

ask

these

questions

throughout

the

world

every

day.每天，全球有許多病患都在詢問這些問題。They

ask

them

because

they

face

a

health

care

system

that

is

scientifically

complex,organizationally

overloaded,

and

generally

not

oriented

to

the

patient

as

a

person.他們之所以問這些問題，是因為他們所面對的醫(yī)療保健體系技術(shù)深奧、機構(gòu)臃腫，而且一般都沒有意識到病人首先是一個“人”。When

an

individual

first

becomes

ill,

regardless

of

the

symptoms,

he

or

she

needs

mostsomeone

who

seems

to

say,如果有人生了病，不管癥狀如何，他們最希望聽到的是："I

am

a

good

doctor；I

charge

a

reasonable

amount

for

my

services；I

care

about

you，thepatient

and

I

will

take

the

time

to

listen

and

understand."“我是醫(yī)生；我只收取親民價格，我關(guān)心病患，我將傾聽你的訴求，理解你?！盇

prominent

teacher/physician

in

a

major

medical

center

taught

his

students

to

listen

to

thepatient

and

he

will

tell

you

what

is

wrong,

and

he

will

tell

you

what

he

needs".主要醫(yī)療中心的知名學(xué)者/內(nèi)科醫(yī)生都會教授學(xué)生要學(xué)會傾聽，病人會告訴你哪里不舒服，也將會告訴你他們的需求。Having

found

a

physician

who

answers

so

profoundly

to

their

needs,

some

patients

areextremely

grateful

but

most

are

utterly

overwhelmed.有些內(nèi)科醫(yī)生完全滿足了病患的需求，有些患者表現(xiàn)出了極大的感激之情，但是絕大部分都激動不已。With

the

discovery

of

that

relationship,

the

difference

between

a

superb

technician

and

a

truephysician

really

becomes

evident

to

the

patient.有了這層關(guān)系之后，專業(yè)技師和內(nèi)科醫(yī)生的區(qū)別在病患面前展露無遺。That

physician/teacher

was

a

scholarly

gentleman

with

deep

scientific

insight

and

an

activeand

stimulating

clinical

and

research

practice.內(nèi)科醫(yī)生/教授都是學(xué)術(shù)人才，他們對學(xué)科有著科學(xué)的深刻見解，并活躍在臨床和研究領(lǐng)域中。Unfortunately

he

developed

crippling

rheumatoid

arthritis

in

the

midst

of

his

career.但是，他們在工作期間不幸患上了風(fēng)濕性關(guān)節(jié)炎。Beyond

question,

his

own

disease

sensitized

him

to

the

complex

mix

of

expectations,

needs,fears,毫無疑問，他自身的疾病使他對病人交織著期待、需要、恐懼和感激的復(fù)雜心情十分敏感，and

appreciation

that

patients

feel

when

facing

a

physical-mental

trial

while

at

the

same

timelooking

forthat

perfect

physician

to

help

them.這是患者們在經(jīng)歷身心煎熬、同時又盼望有那么一位德高望重的名醫(yī)能給他進行診治時所共有的感覺。Patients

flocked

to

this

doctor，not

just

for

his

accurate

diagnoses,

his

correct

therapies,

oreven

his

warmth,患者都去找這樣的醫(yī)生看病，并不是因為他們準確無誤的診斷，正確的治療方法，甚至是所給予的溫暖，but

for

the

intellect

he

expressed

and

the

sheer

joy

of

living

that

he

extended

in

everyencounter

with

another

human

being.而是他們所散發(fā)的智慧之光，以及他在面對每一個“人”時所展現(xiàn)的喜悅之情。He

had

a

Shakespearean

grasp

of

the

qualities

of

being

human

and

an

uncommon

ability

totransmit

love

and

respect

for

his

fellow

human

beings.他既能像莎翁那樣對人性特點有著深刻的了解，又身具異秉能把關(guān)愛和尊重傳遞給全人類。He

exhibited

the

ideal

all

physicians

should

emulate.他展現(xiàn)了所有內(nèi)科醫(yī)生應(yīng)該展現(xiàn)的最理想的一面。Many

readers

know

a

physician

with

these

characteristics

all

should

seek

to

know

one

and

todevelop

their

own

professional

persona

so

that

human

qualities

are

not

lost

to

technicalacumen.許多讀者都認為擁有這些特征的內(nèi)科醫(yī)生都應(yīng)該去了解，并培養(yǎng)自己的職業(yè)形象，只有這樣，人類的本質(zhì)才不會在技術(shù)面前甘拜下風(fēng)。1.be

oriented

to

面向,本句中的

them

是指上句的

these

questions.原文：They

ask

them

because

they

face

a

health

care

system

that

is

scientifically

complex,organizationally

overloaded,

and

generally

not

oriented

to

the

patient

as

a

person.

他們之所以問這些問題，是因為他們所面對的醫(yī)療保健體系技術(shù)深奧、機構(gòu)臃腫，而且一般都沒有意識到病人首先是一個“人”。2.in

the

midst

of：在…中，在…當(dāng)中原文：Unfortunately,

he

developed

crippling

rheumatoid

arthritis

in

the

midst

of

his

career.但是，他們在工作期間不幸患上了風(fēng)濕性關(guān)節(jié)炎。3.beyond

question

的意思是“毫無疑問地”；sensitize

sb

to

sth

意思是“使某人對某事敏感起來”。原文：Beyond

question,

his

own

disease

sensitized

him

to

the

complex

mix

of

expectations,needs,

fears,

and

appreciation

that

patients

feel

when

facing

a

physical-mental

trial

while

atthe

same

time

looking

forthat

perfect

physician

to

help

them.毫無疑問，他自身的疾病使他對病人交織著期待、需要、恐懼和感激的復(fù)雜心情十分敏感。這是患者們在經(jīng)歷身心煎熬、同時又盼望有那么一位德高望重的名醫(yī)能給他進行診治時所共有的感覺。4.rheumatoid

arthritis

風(fēng)濕性關(guān)節(jié)炎例句：The

study

was

also

too

short

to

show

whether

TwHF

can

slow

the

joint

damage

causedby

rheumatoid

arthritis.這項研究時間也太短，不能顯示雷公藤是否能減緩由風(fēng)濕性關(guān)節(jié)炎引起的關(guān)節(jié)損傷。第2期:好醫(yī)生的科學(xué)和技術(shù)專業(yè)背景THE

SCIENTIFIC

AND

TECHNOLOGIC

BACKGROUND

OF

A

"GOOD

DOCTOR"“好醫(yī)生”的科學(xué)和技術(shù)專業(yè)背景Since

Flexner

issued

his

famous

report

in

1910,

American

medical

education

has

striven

towardthe

development

of

a

strong

scientific

base.自從1910年弗萊克斯納的著名研究報告問世以來，美國的醫(yī)學(xué)教育致力于培養(yǎng)深厚的科學(xué)基礎(chǔ)。This

intellectual

prerequisite,therefore,has

become

an

integral

part

of

premedical,undergraduate,

graduate,

and,

indeed,

continuing

medical

education.所以，以學(xué)術(shù)知識為前提的教育就成為了醫(yī)學(xué)預(yù)科、本科生、研究生以及繼續(xù)醫(yī)學(xué)教育的主要組成部分。Biomedical

science

is

fundamental

to

understanding

disease,

making

diagnoses,

developingnew

therapies,

and

appreciating

the

complexities

and

contributions

of

new

technologies.生物醫(yī)學(xué)是掌握病情、作出診斷、研究新型治療方法的基礎(chǔ)，同時它還是研發(fā)新技術(shù)的基礎(chǔ)。Physicians

cannot

be

satisfied

with

simply

knowing

that

a

certain

form

of

therapy

works

80

to90

per

cent

of

the

time.內(nèi)科醫(yī)生不能夠只滿足于掌握某領(lǐng)域治療方法的80-90%。They

must

understand

the

basic

physiology

and

pharmacology

of

any

approach

they

use.他們必須對所應(yīng)用的生理學(xué)和藥物學(xué)的基本療法了如指掌。They

must

possess

the

intellectual

tools

to

follow

reports

of

current

research

in

medicaljournals他們必須能夠利用學(xué)術(shù)方法來掌握醫(yī)學(xué)雜志的最新研究成果，so

that

they

can

continue

to

grasp

the

newest

and

latest

approaches,

no

matter

howcomplicated

the

field

may

become.不管該領(lǐng)域變得多么復(fù)雜多變，他們都能夠掌握最新的治療方法。That

is

why,

in

a

textbook

of

medicine

like

this,

strong

emphasis

is

given

to

how

things

work,what

goes

amiss

when

pathologic

processes

ensue,這就是為什么像這樣的醫(yī)學(xué)教科書要著重強調(diào)事物的運作方法，以及在病理過程中所出現(xiàn)的差錯，and

what

effect

a

given

therapy

has

in

correcting

that

defect.以及特定治療方法對糾正差錯所帶來的影響。We

seek

to

create

within

the

minds

of

our

readers

a

yearning

for

a

greater

depth

ofunderstanding

and

a

continuing

commitment

to

stay

at

the

frontier

of

scientific

knowledge.我們希望我們的讀者能夠從內(nèi)心有著更加深入的了解，并繼續(xù)處在科學(xué)的最前沿。These

are,

in

fact,

among

the

hallmarks

of

a

professional

in

any

scientific

field.事實上，任意科學(xué)領(lǐng)域?qū)I(yè)都包含了這些特點。We

are

moving

into

an

era

when

pharmacotherapeutic

agents

are

no

longer

merely

wonders

oforganic

chemistry,

but

increasingly

often

are

biologic

products.當(dāng)今時代，藥劑已經(jīng)不僅僅是有機化學(xué)的奇跡，它也逐漸變成了生物制品。Some

of

these

are

isolated

from

nature

others

are

developed

by

recombinant

DNAtechnology.許多產(chǎn)品已經(jīng)脫離自然，有些是DNA技術(shù)重組的產(chǎn)物。On

the

horizon

is

the

availability

of

a

true

replacement

or

supplement

for

defective

ordeficient

biochemical

constituents

of

the

body.我們即將要面對的是真正能夠替代或是能夠補充生物化學(xué)成分中不足的產(chǎn)品。No

physician

can,

with

intellectual

honesty,

use

these

new

classes

of

agents

without

fullyunderstanding

their

action,

their

meaning,

and

their

potential

side

effects.任何一位有學(xué)術(shù)誠信的醫(yī)生都不會在沒有充分了解這些新型藥劑的功能、作用以及潛在副作用的情況下就使用它們。The

diagnostic

and

therapeutic

contributions

and

potential,

in

clinical

situations,ofbiocompatible

prosthetic

devices,

nuclear

magnetic

resonance

spectroscopy,通過一系列的發(fā)展（還沒有被確認），診療對未來臨床中的生物兼容性假肢器官、核磁共振譜、high-frequency

laser

beams,

and

so

on

through

developments

not

yet

conceivedappreciated

only

by

the

mind

that

is

disciplined

in

fundamental

science.高頻激光等所作出的貢獻只有在基礎(chǔ)科學(xué)中才能得以實現(xiàn)。1.per

capita

每人，按人口（計算）例句：The

United

States

spends

more

per

capita

on

health

care

than

any

other

nation

in

theworld.美國是全球個人醫(yī)療開銷最大的國家。2.Medicaid

plan

醫(yī)療補助制度例句：With

the

passage

of

the

Medicare

program

for

the

elderly

and

the

Medicaid

plan

for

thepoor

by

Congress

in

1965,

1965年，美國國會通過了補助老人的退休醫(yī)療福利，以及補助窮人的窮人醫(yī)療補助，3.dental

care

牙齒護理例句：Your

smile

depends

on

simple

dental

care

habits,

such

as

brushing

and

flossing.自信的笑容取決于簡單的牙齒護理習(xí)慣，如刷牙和使用牙線。4.cost-efficient

有成本效益的例句：It

also

helps

the

architect

manage

resources

in

a

very

cost-efficient

manner.

它還有助于架構(gòu)師采用一種非常具有成本效益的方式來管理各種資源。第3期:THE

ORGANIZATION

AND

FINANCING

OF

TODAY'S

MEDICINE當(dāng)代醫(yī)療制度與資金投入Patients,

as

well

as

their

representatives

in

government,

industry,

and

managed-careorganizations,

are

concerned

about

the

rising

cost

of

medical

care.政府、產(chǎn)業(yè)、管理型醫(yī)療保險代表以及病患都對不斷增加的看病價格給予了高度關(guān)注。The

total

bill

for

health

care

in

America

now

rises

at

a

rate

of

about

10

per

cent

per

year,

anincrease

that

seems

to

continue

unabated.在美國，醫(yī)療開銷以每年10%的價格增長，而這一趨勢還將繼續(xù)下去。Federal

legislation

instituting

diagnosis-related

groups

(DRC's)

has

clearly

moderated

the

riseof

hospital

costs,

but

physician

costs

continue

to

rise

at

an

ever-increasing

rate.聯(lián)邦立法已經(jīng)開設(shè)了診斷相關(guān)組，并已經(jīng)降低了醫(yī)院開銷，但是內(nèi)科醫(yī)生的開銷仍然在不斷增加。Every

student

of

medicine

should

ask

if

this

is

realistic.每一名醫(yī)學(xué)學(xué)生都在問這是不是真的。Is

it

sustainable

Is

it

defensible是可持續(xù)性的還是有可解決的辦法

What

will

be

the

limits

范圍到底在哪？Patients

already

ask,“Can

I

really

afford

the

best

doctors

in

the

most

prestigious

practices,

inthe

most

famous

medical

centers”

病患在問，“我能去最好的醫(yī)療中心，最好的科室，找最好的醫(yī)生看病嗎”“Can

I

afford

to

be

referred

to

a

subspecialist”

我有錢去看那些專業(yè)醫(yī)師嗎？“Can

I

afford

to

be

out

of

work

and

in

the

hospital”

我能支付得起不上班在醫(yī)院看病的開銷嗎？“Can

I

afford

to

pay

my

rising

insurance

premiums”

“我有錢支付不斷增長的保險嗎”“How

much

deductible

on

my

insurance

can

I

afford”

“保險中的扣除條款我能支付得起多少”Worse

yet,

an

increasing

number

of

patients

have

to

make

choices

between

seeking

medical

anddental

care

and

getting

food,

clothing,

shelter,

and

other

essentials

of

daily

living.更糟糕的是，有許許多多的病患不得不在看病，看牙和基本日常生活之間做出選擇。These

issues

have

become

major

concerns

in

American

households

and

clearly

represent

one

ofthe

most

disturbing

weaknesses

in

our

economy,這些問題已經(jīng)成為美國家庭關(guān)心的主要問題,并且是美國經(jīng)濟中最令人擔(dān)心的薄弱環(huán)節(jié)，of

which

now

nearly

12

per

cent

(

by

annual

gross

national

product)

is

devoted

to

health

care,up

from

8

per

cent

in

1975.醫(yī)療費用所占每年國民生產(chǎn)總值的比例已由1975年的8%增加到現(xiàn)在的12%。Over

the

last

two

to

three

decades

it

has

been

a

goal

of

the

United

States

to

promote

everincreasing

quality

and

cost-effectiveness

of

health

care

for

all.在過去的二三十年中，美國的目標就是要為全體民眾提供質(zhì)量高，成本高效益的醫(yī)療制度。Unfortunately,

we

have

failed

miserably.不幸的是，我們遭遇了慘敗。The

USA

spends

more

per

capita

on

health

care

than

any

other

nation

in

the

world.美國是全球個人醫(yī)療開銷最大的國家。Yet

in

the

major

indices

of

health

our

population

ranks

nineteenth！但是在主要醫(yī)療指數(shù)上，美國民眾排在了第19位！At

the

same

time

we

continue

to

see

a

wasteful

maldistribution

of

physicians

both

by

specialtyand

geographically

and

a

growing

number

of

medically

indigent

and

medically

uninsured

peoplein

our

nation.與此同時，無論在專業(yè)還是在地域上，內(nèi)科醫(yī)生的分配不合理，沒有保險，沒錢看病的人數(shù)還在不斷增加。Somehow,

the

costs

of

what

we

are

trying

to

achieve—even

though

the

goal

is

commendable—

are

not

being

placed

in

proper

perspective

by

the

medical

profession,

health-care

managers,and

representatives

of

the

people

in

order

to

provide

suitable

care

for

all.盡管我們要實現(xiàn)的目標值得贊揚，但是我們要實現(xiàn)的看病價格并沒有得到醫(yī)療人士、醫(yī)療衛(wèi)生監(jiān)管人士、以及代表的認真對待。Unfortunately，in

the

present

system

the

real

needs

of

the

populace

are

not

always

met

byaffordable

services.不幸的是，就目前的制度而言，大眾所能夠支付得起的醫(yī)療費用無法滿足人們的要求。At

the

same

time,

overutilization

of

medical

services

may

be

the

very

engine

that

drives

up

thetotal

cost

of

health

care

delivery.與此同時，醫(yī)療服務(wù)的過度使用或許也是增加醫(yī)療費用的引擎。With

the

passage

of

the

Medicare

program

for

the

elderly

and

the

Medicaid

plan

for

the

poor

byCongress

in

1965,1965年，美國國會通過了補助老人的退休醫(yī)療福利，以及補助窮人的窮人醫(yī)療補助，we

had

hoped

as

a

nation

that

we

were

moving

toward

a

more

just

and

efficient

system.我們希望美國的醫(yī)療系統(tǒng)能夠變得更加公正，更加有效。In

fact,

the

opposite

has

been

the

trend.但是事實上，我們卻背道而馳。This

societal

goal

must

now

be

readdressed

reformulated,

and

restructed

in

terms

of

modernneeds,就社會需求來講，我們應(yīng)該通過重組來實現(xiàn)社會目標，reflecting

fairly

and

fully

measured

cost-benefit

ratios

for

every

form

of

medical

service.全面反映醫(yī)療服務(wù)的成本與效益比例。1.per

capita

每人，按人口（計算）例句：The

United

States

spends

more

per

capita

on

health

care

than

any

other

nation

in

theworld.美國是全球個人醫(yī)療開銷最大的國家。2.Medicaid

plan

醫(yī)療補助制度例句：With

the

passage

of

the

Medicare

program

for

the

elderly

and

the

Medicaid

plan

for

thepoor

by

Congress

in

1965,

1965年，美國國會通過了補助老人的退休醫(yī)療福利，以及補助窮人的窮人醫(yī)療補助，3.dental

care

牙齒護理例句：Your

smile

depends

on

simple

dental

care

habits,

such

as

brushing

and

flossing.自信的笑容取決于簡單的牙齒護理習(xí)慣，如刷牙和使用牙線。4.cost-efficient

有成本效益的例句：It

also

helps

the

architect

manage

resources

in

a

very

cost-efficient

manner.

它還有助于架構(gòu)師采用一種非常具有成本效益的方式來管理各種資源。第4期:Medical

professionals

often

attribute

overutilization

to

patient

behavior.醫(yī)療專業(yè)人士經(jīng)常將過度使用歸罪于病患的行為。In

fact,

however,

physicians

control

70

per

cent

of

health

expenditures.但是，事實上，醫(yī)護人員卻掌控者70%的醫(yī)療支出。A

few

patients

with

hypochondriasis,

for

example,

may

visit

physicians

too

often,例如，少數(shù)患有疑病癥的病患會經(jīng)常就醫(yī)。and

many

older

patients

may

seek

medical

help

at

times

when

a

friendly,

reassuring

chat

istheir

real

desire,許多老年患者有時也會尋求醫(yī)療幫助，他們希望能夠得到友好，舒心的交談，but

in

the

final

analysis

utilization

of

the

health

care

system

is

in

the

hands

of

physicians.歸根結(jié)底，醫(yī)護系統(tǒng)的利用問題掌控在醫(yī)護人員手中。Ironically,

although

physician

competence

is

often

equated

to

mastery

of

expensivetechniques

and

technologies,具有諷刺意味的是，雖然醫(yī)術(shù)常常等同于掌握價格高昂的儀器設(shè)備和科技手段，physicians

are

actually

at

their

professional

best

when

listening

to

the

patient

and

respondingto

what

they

hear

and

see

with

medicine

most

comprehensive

armamentarium.但醫(yī)生達到爐火純青境地，往往是在能夠傾聽患者心聲并應(yīng)用最先進的醫(yī)療設(shè)備對他們聽到、看到的患者狀況采取相應(yīng)措施的時候。Overutilization,

when

it

occurs,

is

thus

most

likely

to

be

our

fault

as

physicians.當(dāng)出現(xiàn)過度使用問題時，醫(yī)護人員是最有可能出錯的。Our

responsibility

as

professionals

is

to

be

absolutely

certain

that

our

errors

in

this

directionare

driven

by

well-founded

concern

for

the

health

of

our

patients,作為專業(yè)人士，我們的責(zé)任就是要堅決確保這些錯誤是建立在對病患健康的關(guān)心之上，not

by

the

financial

interests

of

our

practices

or

the

hospitals

where

we

work.而不是建立在經(jīng)濟效益或是醫(yī)院之上。Individual

physicians,

then,

must

take

a

personal

and

professional

interest

in

the

control

ofhealth

care

costs

not

only

because

it

is

right

for

the

nation,

but

because

it

is

right

for

thepatient.對于個體醫(yī)護人員來說，他們必須從專業(yè)角度和個人角度來對醫(yī)療費用產(chǎn)生興趣，這不僅對國家有益，還將有益于病患。In

our

litigious

society,

a

legalistically

defensive

approach

to

medical

practice

has

become

tooprevalent.在我們這個喜歡訴訟的社會里，有關(guān)醫(yī)療的法律保護方法就變得非常普遍了。The

conditions

that

engender

this

tendency

must

be

altered.我們必須對這一趨勢進行糾正。Physicians

must

use

all

of

their

diagnostic

skills

to

focus

on

the

very

best

approach

to

medicaldiagnosis

and

therapy醫(yī)護人員必須使用其所有的診斷技能來關(guān)注醫(yī)療診斷和理療方法，and

to

steer

away

from

unnecessary

use

or

repetition

of

expensive

procedures

such

ascomputed

tomography,

magnetic

resonance

imaging,

and

cardiac

catheterization.并避免不必要的使用，或是重復(fù)價格昂貴的診治，例如計算機體層攝影、核磁共振成像或是心導(dǎo)管插入術(shù)。The

physician

must

use

intellect

scientific

knowledge

and

analytical

skillsto

best

serve

thepatient

without

inundating

the

system

with

unnecessary

costs醫(yī)生必須運用智慧（包括科學(xué)知識和分析能力）來為病人提供最佳服務(wù)，既不要給醫(yī)療保健體系增加不必要的費用，and

the

patient

with

a

financial

burden

he

simply

cannot

to

bear.也不要給病人造成不必要的、無法繼續(xù)承受的經(jīng)濟負擔(dān)。1.take（an）interestin對……發(fā)生興趣例句：We

takeinterestin

yourcannedgoodsandwishtohavethecatalogues.我們對你方的罐頭食品有興趣，希望能收到目錄。2.onthefinalanalysis歸根結(jié)底例句：Nowadays,thecompetitionoftechnologyandstrengthisthecompetitionofhumansandhumancapital

onthefinalanalysis.當(dāng)今世界科技和實力的競爭，歸根到底是人的競爭，是人力資本的競爭。3.steerawayfrom避開例句：Wewantedtomakeacleanbreakfromactressesand

steerawayfrom

blondesandcleansethepalette.我們不想再用女演員代言，也不想要金發(fā)女郎，我們重新做出選擇。4.financialburden財政負擔(dān)例句：Bearingthe

financialburden

ofcommercialandinvestmentarbitrationsisdifficultforanycountry,butmostespeciallysoforasmallcountrylikeUruguay.承擔(dān)商業(yè)和投資仲裁決定的財政負擔(dān)對任何國家都很艱難，對于烏拉圭這樣的小國來說更是如此。第5期:Costscanbecontrolledonlyifphysiciansareconvincedoftheneedandarewillingtoparticipateinprovidingthisvitalservice.只有醫(yī)護人員能夠真正明白這些需求，并愿意參與到提供重大服務(wù)上來，價格才能夠得到控制。Oneaspectofthiscontrolisattentiontovariouspossiblemeansofhealthcarefinance,控制價格的其中一個方面就是要重視各種衛(wèi)生保健,includingprepaidplans,preferredproviderorganizationshealthmaintenanceorganizations,andothermanagedcaresystems.包括重點服務(wù)計劃、優(yōu)先醫(yī)療服務(wù)提供者組織、健康維護組織以及其他管理式醫(yī)療系統(tǒng)。Allofthesemustbecarefullyexploredwithaviewtomakinghealthcareaccessiblewhereitismostneeded.為了讓最需要醫(yī)療保障的民眾接受到該服務(wù)，我們必須對這些系統(tǒng)進行細致地探究。Clearly,multipletoolsandprogramsmaybenecessary,buttheyshouldnotbethrustuponthepatientsimplytosatisfydoctrinesoffreeenterprise.顯然，這些措施和項目或許是不可或缺的，但是不能夠僅僅是為了滿足自由主義的信條而將其強加于病患身上。Toprovidethebesthealthcareinafiniteeconomyweneedsystemsthatprovidesuchcareinthemostefficientway,regardlessofthepaymentscheme.為了在有限的經(jīng)濟體中提供最好的醫(yī)療保障，不論支付計劃如何，我們需要利用最有效的措施來提供醫(yī)療服務(wù)Anotheraspectofourcost-controljobistosupportandparticipateinresearchonoutcomes,在這項成本控制工作中，另一個方面就是要參與到對支出的研究上來，aimingtowardsystematicevaluationofcost-effectivenessofthemedicalprocedureswechooseinthelightofalltheinterestsofourpatient.考慮到病患的利益，我們的目的就是要對醫(yī)療程序的成本效益進行系統(tǒng)的評估。Forexample,wedonotknowwhytreatmentofprostatichypertrophyismorecommonlymedicalinsomepartsofthenation,surgicalinothers.例如，我們不知道為什么有些地區(qū)對會利用內(nèi)科的方式來治療前列腺增生，有的地方會利用手術(shù)的治療方式。Whydoestheincidenceofcaesareansectionsvarysowidely?

為什么實施剖腹產(chǎn)的范圍會如此之廣？Thecostsandbenefitsofcoronaryangioplastyversusbypasssurgeryremainobscure.冠狀動脈成形術(shù)和心臟搭橋手術(shù)的成本和效益仍然不明確。Everyyearbillionsofdollarsarespentasaresultofclinicaldecisionsthatmayhingeontheseorsimilarissues.每年，政府都會在相似的臨床問題上花費數(shù)十億美金。Physiciansmustinvolvethemselvesintheprocessesofchangewithaneyefirsttotheindividualpatientandthentosociety.內(nèi)科醫(yī)生必須親身參與到變革的過程中來，這么做首先是為了病患，其次這也有利于社會。1.with

a

view

to

為了要例句：Time

after

time,

he

read

such

sentences

as:“Please

cause

an

investigation

be

made

witha

view

to

ascertaining

the

truth.馬弗里克一次又一次看到這樣的句子：“敬請以查明事實真相為宗旨，展開一番調(diào)查?！?.be

thrust

on

把…強加于例句：Specific

challenges

will

be

thrust

on

Mrs

Clinton

from

Day

1.希拉里從第一天開始就會面臨具體的挑戰(zhàn)。3.in

the

light

of

根據(jù)例句：They

will

adjust

their

bequests

in

the

light

of

yours.他們將根據(jù)你的贈予調(diào)整自己的遺產(chǎn)分配。4.hinge

on

靠...轉(zhuǎn)動例句：Somewhat

surprisingly,

the

answer

turns

out

to

hinge

on

what

you

mean

by

best

andwhat

you

mean

by

long-run.有些令人驚訝的是，答案取決于在你看來最好的和長期的是一個什么概念。第6期:THOSE

WHO

CARE那些關(guān)愛病患的醫(yī)生"How

can

I

find

a

good

doctor

who

cares

about

me

as

a

person"

如何找到一位拿病患當(dāng)“人”看的醫(yī)生？When

speaking

of

caring,

one

has

to

define

specifically

what

is

meant.說到關(guān)愛，人們不得不將其明確定義。A

physician

can

diagnose

and

prescribe

in

a

technically

correct

and

scientific

but

insensitiveway

and

the

patient

may

be

made

better

even

cured.醫(yī)生在確診病患時能夠保證在技術(shù)和科學(xué)上的準確性，但是卻不添加個人感情，患者能夠在這種情況下有所好轉(zhuǎn)，或是得到治愈。On

the

other

hand,

when

the

patient

asks

the

question,"Does

my

physician

really

care〃

另一方面，當(dāng)病人問道：我的醫(yī)生真的關(guān)心我嗎？the

patient

means,

Does

it

matter

to

the

physician

what

happens

to

me

病患的意思是：“我的情況對醫(yī)生來說重要嗎？Does

my

doctor

show

sensitivity

and

compassion

beyond

the

mere

technical

qualities

ofmedicine〃

醫(yī)生是否僅僅超越了技術(shù)層面而展現(xiàn)出同情和敏感。It

is

in

this

sense

that

we

address

ourselves

to

the

nature

of

those

who

care.我們正是要從這一層面去了解那些醫(yī)護人員的本質(zhì)。It

may

seem

odd

to

talk

about

caring

as

a

skill,

but

in

a

real

sense

it

is

just

that.把關(guān)愛當(dāng)做一種技能來討論似乎有一些奇怪，但是事實就是這樣。Those

involved

in

the

education

of

students

realize

that

at

least

some

forms

of

compassionhave

to

be

learned.那些接受了醫(yī)學(xué)教育的學(xué)生意識到他們至少要習(xí)得某些形式的同情。The

developing

physician

must

see

such

traits

in

action

in

order

to

acquire

and

apply

them

ininteraction

with

patients

and

their

families.為了在與病患和家屬的溝通中獲得并應(yīng)用這種同情，成長中的醫(yī)生必須將這些特點付諸行動。Sometimes

this

involves

learning

how

to

demonstrate

compassion.有時，這些要涉及到如何展現(xiàn)同情心。Kahlil

Gibran

has

taught

us,"You

give

but

little

when

you

give

of

your

possessionsit

is

whenyou

give

of

yourself

that

you

truly

give."紀伯倫教導(dǎo)過我們：“給予財產(chǎn)算不上給予，只有當(dāng)你獻出自己，那才算是真正的給予。”Giving

of

ourselveswith

ease,

with

grace,

and

with

meaning

is

for

most

of

us

an

acquired

skill.輕松，完美的獻出自己，這對于我們大多數(shù)人來說是一種習(xí)得的技能。Sometimes

it

involves

a

deep

sense

of

reawakening

within

to

bring

out

an

innate

sensitivityand

compassion

that

perhaps

has

not

expressed

itself

since

childhood.有時，這包括內(nèi)心深處的蘇醒，并迸發(fā)出自從童年時期就沒有表現(xiàn)過的同情和敏感。At

other

times,

learning

to

care

may

involve

a

complete

transformation

of

behavior

andattitudes

toward

people,

particularly

those

who

are

not

from

our

own

cultural

background.在其他時候，學(xué)習(xí)關(guān)愛或許要把對待他人的行為和態(tài)度進行全面的改變，特別是對那些擁有不同文化背景的人。Many

believe

that

the

greatest

responsibility

in

medical

education

today

is

to

fostercompassion

within

the

student

of

medicine.許多人相信當(dāng)今醫(yī)學(xué)教育中最重要的是將同情心滲透到醫(yī)科大學(xué)學(xué)生的心中。To

receive

medical

care,

patients

must

trust

their

bodies

and

their

very

lives

to

physicians,

andso

to

be

in

an

honest

position

to

give

medical

care，physicians

must

earn

such

radical

trust.為了獲得關(guān)愛，病患必須對自己的身體有著足夠的信心，并能夠?qū)⒆约旱纳坏结t(yī)生手中，那么醫(yī)生就完全能夠給予關(guān)愛，醫(yī)生必須獲得百分百的信任。Mere

technical

treatment

of

disease

does

not

suffice.僅僅是對于疾病的技術(shù)治療是不能夠滿足的。Patients

must

be

able

reasonably

to

believe

that

their

physicians

care

about

them

in

anextraordinarily

personal

way.病患必須合理地相信，他們的醫(yī)生從個人層面對他們非常關(guān)心。This

exchange

of

care

for

trust,

while

not

identical

to

friendship

or

love,

is

equally

binding.這種用關(guān)愛換取信任同樣相互關(guān)聯(lián)，這與友情和愛完全不同。From

it

develops

an

interdependence

that

is

far

from

unwholesome

rather,

it

potentiates

careand

promotes

healing.這種造成的相互依賴遠遠不會對身心造成傷害，反而這會增強關(guān)愛，提高治愈率。Our

late

twentieth

century

sophistication

and

technologic

orientation

have

too

often

cost

uswarmth,

humor,

and

humanity,

leaving

us

in

social

isolation.20世紀晚期以復(fù)雜和技術(shù)為目的的醫(yī)療經(jīng)常讓我們失去了溫暖、幽默以及仁慈，并讓我們被社會所孤立。We

do

far

better

as

professionals

to

err

on

the

side

of

being

human

with

our

patients

than

totry

to

play

deus

ex

machina,

the

god

from

the

machine.作為專業(yè)人員，我們對待病人要人性化，這么做即使犯些小錯也比扮演冷冰冰的解圍之神要好。1.identical

to/with：與…完全相同的例句：His

appearance

was

identical

to

his

mother,

Anyone

could

identify

that

he

was

herson.他的面容和母親是同樣的。任何人都可以識別他是她的兒子。2.in

a

position

to

do

能夠作某事例句：The

people

you're

in

a

position

to

do

something

nice

for,

even

if

they've

got

no

abilityto

reciprocate.你能做一些力所能及的事情的人，哪怕他們有沒有能力來報答。3.acquired

skill

習(xí)得的技能例句：Failing

to

recognize

that

speaking

is

an

acquired

skill.沒有認識到演講是一個可以后天習(xí)得的技巧。4.happen

to

發(fā)生于例句：Yes,

it

could

happen

to

any

of

us,

but

yesterday

it

happened

to

them.是的，這可能發(fā)生在我們?nèi)魏我粋€人身上，但是昨天卻發(fā)生在他們身上了。第7期HE

SOCIAL

RESPONSIBILITIES

AND

HUMANISTIC

QUALITIES

OF

"THE

GOODDOCTOR"“好醫(yī)生”的社會責(zé)任和人道主義素質(zhì)The

patient

says,"Take

charge,

make

me

well,

help

me

feel

comfortable,

show

me

compassionlisten

to

my

problems

and

I

will

give

you

trust."病患稱：“負責(zé)任，治好病，舒適感，同情心，傾聽我的訴求，我將信任你?！盌ag

Hammarskjold

reminds

us

of"the

humility

which

comes

from

others

having

faith

in

you".哈馬舍爾德提醒我們“要謙虛，謙虛來自于別人對你的信任”。The

natural

outcome

of

this

giving

and

receiving

of

trust

is

that

the

physician

must

acceptsome

degree

of

obligation

to

the

patient.信任別人和得到信任的自然結(jié)果是醫(yī)生必須要承擔(dān)一些對病患的義務(wù)。Of

course,

the

patient,

if

able,

keeps

some

responsibility

for

the

healing

process,

but

thephysician

must

be

willing

to

answer

the

patient's

needs,當(dāng)然，如果病患可以的話，他們也需要在治療過程中承擔(dān)一些責(zé)任，但是醫(yī)生必須愿意滿足病患的需求。however

demanding,

however

changing,

however

at

times

unreasonable

or

falsely

perceived.盡管這樣的要求過高，變動性較大，有時還會是不合理的，或是不正確的需求。Generalists

in

internal

medicine

undertake

a

long-term

commitment

to

a

patient's

care.內(nèi)科醫(yī)生對病患所承擔(dān)的責(zé)任需要持續(xù)很長一段時間。They

are

reminded

daily

that

this

commitment

continues

beyond

a

particularly

insightfuldiagnosis

or

the

completion

of

an

endoscopic

procedure；他們每天都會被提醒，這些責(zé)任超越了某一類高深的診斷，或是完成一次內(nèi)鏡檢查；that

the

patient

still

needs

care

when

the

numbers

are

back

from

the

most

recent

cardiaccatheterization就是當(dāng)病人完成最常見的心導(dǎo)管插手術(shù)，or

when

the

final

stitch

is

completed

in

a

complex

procedure

and

the

patient

is

rolled

from

theoperating

suite.或是完成了復(fù)雜手術(shù)的最后一針，就算病人從手術(shù)室中推出來，他們?nèi)孕枰亲o。The

internist

continues

to

care

for

and

nurture

the

patient

through

the

whole

process

ofhealing

in

a

way

that

requires

enormous

skill

in

close

personal

interaction.內(nèi)科醫(yī)生在全部治療過程中都會繼續(xù)對病患進行關(guān)愛和呵護，而這種關(guān)愛方式需要人際交流中的諸多技能。1.long-term

長期的例句：You

should

also

have

long-term

goals,

not

only

for

your

business

but

for

your

owncareer.同時，你也應(yīng)該為你的職業(yè)生涯設(shè)定一個長期的目標，而不僅僅是為了眼前的工作。2.care

for

關(guān)心例句：Lily

spent

years

caring

for

her

sick

uncle.莉莉照顧了她生病的叔叔好多年。3.endoscopic

procedure

內(nèi)鏡檢查例句：It

is

usually

done

in

the

hospital

or

an

endoscopic

procedure

room.通常結(jié)腸鏡檢查是在醫(yī)院或?qū)ｉT的內(nèi)鏡檢查室內(nèi)進行。4.internal

medicine

內(nèi)科例句：The

study

was

published

on

Monday

in

the

Archives

of

Internal

Medicine.這項研究在星期一發(fā)表在內(nèi)科醫(yī)學(xué)檔案上。第8期HELP

WITH

FAMILY

INTERACTIONS了解家庭關(guān)系The

woman

who

comes

into

her

physician's

office

with

a

history

of

fatigue,listlessness,inability

to

sleep,

and

irritability

may

be

describing

the

early

symptoms

of

amorbid

disease.進入醫(yī)生辦公室的這位女性患者擁有疲勞史，精神萎靡，并患有失眠癥和煩躁癥，這位病患或許還會描述她疾病的早期癥狀。She

may,

however,

be

showing

signs

of

depression

secondary

to

her

inability

to

cope

anylonger

with

an

alcoholic

husband,或許，由于她無力應(yīng)對酗酒的丈夫，with

a

teenage

son

addicted

to

cocaine,or

with

an

elderly

mother

for

whom

she

must

care.吸毒成癮的孩子，以及她必須要照顧的老母親而顯出抑郁狀態(tài)。The

wise

physician

considers

organic

pathology

but

also

realizes

that

presenting

symptomsmay

be

only

part

of

what

is

really

troubling

the

patient.睿智的醫(yī)生認為應(yīng)該運用器官病理學(xué)的方法來治療，但是醫(yī)生又意識到目前所展現(xiàn)的癥狀或許僅僅是煩惱病患的一部分。This

requires

an

unusual

sensitivity

and

an

ability

to

pursue

in

a

cautious,

understanding,andcareful

way

and

to

listen

to

the

concerns

and

needs

the

patient

describes--traits,

again,

thatcan

and

must

be

developed

and

practiced.這就需要醫(yī)生非常敏感并且能小心謹慎、善解人意、細致入微地去探尋并傾聽病人的憂慮和需求,醫(yī)生的這些能力能夠且必須加以完善和實踐。The

physician's

role

is

to

help

the

patient

understand

the

connections

between

unpleasantsituations,

emotional

disturbances,

and

organic

symptoms.醫(yī)生的角色就是要幫助病患了解不良狀況、情緒困擾以及身體癥狀之間的聯(lián)系。Sometimes

patients

are

helped

simply

by

understanding

those

relationships

and

being

awarethat

the

doctor

appreciates

them

and

reassures,

listens

with

a

sympathetic

ear,

and

seldomadvises

in

a

direct

way,

but

does

express

concern.有時候，幫助病人只需要讓他們知道這三者之間的關(guān)系并意識到：醫(yī)生了解他們，愿意安慰和傾聽他們，很少直言相勸、卻能表達關(guān)心之情。In

earlier

days,

when

most

medical

care

was

delivered

at

home,

the

physician

was

quickly

madeaware

of

living

situations

and

family

interactions,if

he

or

she

did

not

already

know

the

entirefamily

and

their

circumstances.早些時候，當(dāng)時絕大多數(shù)醫(yī)生都會在病人家中進行醫(yī)護治療，如果醫(yī)生并沒有完全了解病患的家庭和環(huán)境狀況，那么醫(yī)生也會很快察覺到病患的生活狀況以及家庭關(guān)系。Today

when

the

patient

comes

to

the

office,

generally

alone

and

certainly

out

of

socioeconomiccontext,

it

is

much

more

difficult

to

perceive

what

is

going

on.如今，病患來到醫(yī)生的辦公室，通常病患會獨自一人來，完全無法得知病患的社會經(jīng)濟背景，醫(yī)生就很難做出正確的判斷。The

physician

must

exercise

a

much

greater

degree

of

skill

and

understanding

in

exploringfamily

interrelationships

during

a

history

and

physical

examination

or

in

an

even

shorter

visit.通過既往史，體檢甚至是通過簡短拜訪的方式，醫(yī)生必須要提高他們了解家庭關(guān)系的技能。1.addicted

to

上癮例句：He

became

addicted

to

drugs.

他已吸毒成癮。2.medical

care

醫(yī)療護理例句：So

far,

however,

two

panels

of

government

experts

who

have

looked

at

the

issue

havenot

found

significant

impediments

to

research

or

medical

care

caused

by

gene

patents.

可是到目前為止，關(guān)注該案的兩個政府專家小組還沒有發(fā)現(xiàn)基因檢測專利制度對醫(yī)學(xué)研究和醫(yī)療護理方面明顯的障礙。3.physical

examination

體檢例句：A

careful

history

and

physical

examination

were

obtained,

but

there

was

no

obviousreason

for

the

patient's

problem.

也得到了一份詳細的病史和身體檢查，但是沒有任何明顯的證據(jù)表明病人患有該疾病。4.sympathetic

ear

同情心例句：Women

need

a

sympathetic

ear.

女士們需要一位具有同情心的聽眾。第9期HELP

WITH

OBTAINING

NECESSARY

ADDITIONAL

PROFESSIONAL

SERVICES幫助病患獲得必要的額外專業(yè)服務(wù)The

warm

and

intimate

relationship

that

any

patient

seeks

is

not

one

that

a

typical

patient

canhave

with

many

physicians

at

the

same

time.病患所需要的親密關(guān)系并不是哪位病患能夠在同一時間與多位醫(yī)生所擁有的。The

internist

must

demonstrate

a

variety

of

skills,

attitudes,

and

abilities

and

a

store

ofdiverse

information

that

allows

him

or

her

to

be

the

patient's

health

care

manager

as

well

as

hisconfidant,

keeping

in

mind

that

the

average

patient

does

not

understand

the

system

ofmedical

referrals

for

subspecialty

consultation.內(nèi)科醫(yī)生必須具有各種技能、觀點、能力和豐富的信息。這會讓他們既成為病人健康的管理者也成為患者的知心人。他們還要時刻牢記，普通病人對分科就診和轉(zhuǎn)診這套制度并不了解。An

oncologist/internist