醫(yī)學(xué)英語(yǔ)查房(詳細(xì))

MakingWardRound醫(yī)學(xué)查房-床邊教學(xué)模式

楊明山第38章BEDSIDETEACHINGContents

一條路線二個(gè)功能三個(gè)等級(jí)四個(gè)入口五個(gè)程序六個(gè)人物七個(gè)思路八個(gè)業(yè)務(wù)1.Significance-bilingualism2.FunctionsTheoryOperation3.Tertiarysystemground一級(jí)查房：經(jīng)治醫(yī)師查房，分晨、午、晚三次。普查全組病人，為“醫(yī)患對(duì)話”。二級(jí)查房：主治醫(yī)師查房，外稱TeachingAttendingRounds，每天一次。輪流檢查所轄各組病人，除醫(yī)患對(duì)話，尚需“醫(yī)醫(yī)對(duì)話”。三級(jí)查房：主任查房，外稱professor’sground或chief’sround，每周二次;每次檢查主治醫(yī)師提供1至2病例;主要突出“醫(yī)醫(yī)對(duì)話”。大查房：greatrounds英美普及，除本科室外，其他相關(guān)科室均參加，國(guó)內(nèi)稱大型會(huì)診討論。01history:missing不全02exam:mistake不正03diagnosis:misdirect不明04treatment:misdeal不當(dāng)解決學(xué)生實(shí)際問(wèn)題4.Functions–糾錯(cuò)VisitingSurgeon:Haveyounoticedhislightcolorofhisstool?01Intern:Uh,I’msorryIhaven’t.02Missing病史不全Mistakes檢查不規(guī)Director:DrLi,isthereanyralesthatyouheardinthispatient?Intern:Iheardnoralesinthispatient.Director:Pleaselistentoitagain.Canyouhearfinemoistrale?Intern:Yes,Igotit.Director:Whydidn’tyouhearit?Intern:(Noresponse)Director:Youonlypaidattentiontothefrontchestandneglecttheauscultationonbaseoftheback.VisitingPhysician:Isitnecessaryforustodoaliverbiopsy?1Intern:Maybeit’sunnecessary.2VisitingSurgeon:Sorry.Youshouldanswermeit’snecessarybecausetheconfirmeddiagnosisofhepaticlesionoftendependsontheliverbiopsyinadditiontoultrasound.Howeveritwillbedecidedbythedirector.3Misdirect診斷不清Resident:Iassumethatyoublockedtheneurogenicphasewithatropine.Howdidyoublockthehormonalphase?Director:IputdownaLevintube,andthepatientonconstantgastricsuction.Resident:Thiswillkeepthegastriccontentsfromenteringtheduodenumandtheproductionofsecretin,which,inturn,wouldincreasetheliberationofpancreaticenzymes,thusaddingtotheinsult.Misdeal治療不當(dāng)01交班morningmeeting：住院總醫(yī)師；外稱SeniorResident’sMorningReport02引言introduction：主治醫(yī)師；提出重點(diǎn)查房病例，簡(jiǎn)述棘手問(wèn)題03病史報(bào)告casepresentation：實(shí)習(xí)醫(yī)生，可有無(wú)診斷，診治計(jì)劃須系統(tǒng)04教學(xué)查房對(duì)話teachingdialogue：在上下級(jí)醫(yī)生之間進(jìn)行；著重糾錯(cuò)05小結(jié)summary：主治醫(yī)師對(duì)主任查房作應(yīng)答，提出整改措施5.procedures6.figuresPatient病人Interns實(shí)習(xí)醫(yī)師Residents住院醫(yī)師Chiefresident住院總醫(yī)師Visitingphysician主治醫(yī)師Director主任EDCBAFRequirementsforplayBasedonNEJMca