Chapter 1 Patient-Physician Interaction
第一章 医患沟通
The patient-physician interaction proceeds through many phases of clinical reasoning and decision making. (proceed 进行、开展 reasoning 推论、推理 clinical reasoning 诊断
clinical decision 确定治疗方案 making decision 做出决定)
医患沟通在临床诊断和治疗决策的许多时期进行着。
The interaction begins with an elucidation of complaints or concerns, followed by inquiries or evaluation to address these concerns in increasingly precise ways.
(elucidation 说明、阐明 inquire 询问、调查 evaluation 评估、评价)
这种沟通开始于病人主诉或所关注问题的阐明，然后通过交流、评估不断精确地确定这些问题。
The process commonly requires a careful history or physical examination, ordering of diagnostic tests, integration of clinical findings with the test results, understanding of the risks and benefits of the possible courses of action, and careful consultation with the patient and family to develop future plans. (integration 综合 consultation 磋商、会诊)
这个过程通常需要细致的询问病史和体格检查，开具诊断性化验医嘱，综合临床发现和化验结果，理解分析拟行治疗过程中的风险和疗效，然后与病人及家属反复磋商以完善治疗方案
Physicians increasingly can call on a growing literature of evidence-based medicine to guide the process so that benefit is maximized, while respecting individual variations among different patients. (respecting 注意到、关系、说到 evidence-based medicine 循证医学)
尽管考虑到不同病人中个体差异是存在的，但医生们越来越容易查阅不断增长的循证医学文献来指导这个过程，使得疗效最大化。
The increasing availability of randomized trials to guide the approach to diagnosis and therapy should not be equated with “cookbook” medicine (availability可利用性， 可得到 randomize 随机的, cookbook 食谱，烹调书 approach 接近)
但是，不断增加的可用于指导临床诊断与治疗的随机试验资料不应当作“烹调书”使用。
Evidence and the guidelines that are derived from it emphasize proven approaches for patients with specific characteristics.(Evidence 证据，迹象 guideline 指导方针 emphasize 强调)
那些随机试验获得的临床表现和诊断思路是侧重于求证具有某些特征病人而来的。
Substantial clinical judgment is required to determine whether the evidence and guidelines apply to individual patients and to recognize the occasional.
substantial clinical 真实的，实在的 individual 个体 occasional 偶尔的，特殊的
实际的临床判断需要确定这些临床表现和诊断依据标准是否能应用于普通病人的个体，并能找出例外。
Even more judgment is required in the many situations in which evidence is absent or inconclusive. (inconclusive 不确定性，非决定性)
在许多情况下，临床表现缺乏或不典型，甚至需要考虑得更多。
Evidence also must be tempered by patients’ preferences, although it is a physician’s responsibility to emphasize when presenting alternative options to the patient.
temper 脾气，调音 preference 偏爱 presenting 提出 alternative 可选择的，二选一
虽然医生喜欢提出选择性问题让病人回答，但病人肯定会根据自己的倾向调节临床症状。
The adherence of a patient to a specific regimen is likely to be enhanced if the patient also understands the rationale and evidence behind the recommended option.
(adherence 坚持、固执 regimen 养生法、食物疗法enhance 提高、加强 rationale 基本原理)假如还懂得所提供问题的基本原理和表现，有特殊生活方法病人的固执容易强化这种倾向
To care for a patient as an individual, the physician must understand the patient as a person.
(care for 喜欢、照料) 为了把病人作为一个个体进行治疗，医生必须理解病人是一个人（不是一群人)。
This fundamental precept of doctoring includes an understanding of the patient’s social situation, family issues, financial concerns, and preferences for different types of care and outcomes, ranging from maximum prolongation of life to the relief of pain and suffering.
(precept 训戒 doctoring 行医 prolongation 延长)
这个最基本的行医原则包括了解病人的社会地位，家庭问题，资金状况以及正确理解病人对不同治疗方法、不同治疗结果的选择，从最大限度地延长生命到临时缓解疼痛和症状。
Even as physicians become increasingly aware of new discoveries, patients can obtain their own information from a variety of sources, some of which are of questionable reliability.
questionable 可疑的、成问题的、不可靠的 reliability 可靠、可信赖的
甚至，当医生越来越容易知道新发现的同时，病人也能够通过各种途径得到他们的信息，某些信息是不可靠的。
The increasing use of alternative and complementary therapies is an example of patients’ frequent dissatisfaction with prescribed medical therapy.
alternative 选择，替代 complementary 补充的、相配的 prescribe 规定、指定、开处方
不断增加的替代疗法和辅助疗法的应用就是病人对常规疗法经常不满意的一个例子。
Physicians should keep an open mind regarding unproven options but must advise their patients carefully if such options may carry any degree of potential risks, including the risk that they may relied on to substitute for proven approaches (substitute 代替、代用 rely on 依赖、信任)
医生对新疗法应该保持开放的思想，但是，如果这些疗法具有任何程度的潜在风险，都必须细致地告知病人，包括可能需要用已证实的常规疗法去替代的风险。
It is crucial for the physician to have an open dialogue with the patient and family regarding the full range of options that either may consider. (crucial 严酷的、决定性的 either 两者任一)对医生来说，对病人及家属开诚布公地介绍所有可考虑的治疗选择，是非常重要的。
The physician does not exist in a vacuum but rather as part of a complicated and extensive system of medical care and pubic health. (vacuum 真空 extensive 广阔的、大量的)
医生不是生存在真空中，而是作为一个复杂而庞大的医疗和公共健康体系中的一部分。
