Unit-7-AEMP-physician-patient-relationship-(1)PPT课件

Unit7Physician-PatientRelationshipPage167IssuestobecoveredTheshiftfrompaternalisticparadigmtopatient-centeredparadigminmedicaldecisionmakingTheimportanceofgoodphysician-patientrelationshipinboththemedicalpracticeandthepatient’srecoveryThingsthatcountsinmaintainingaamiablephysician-patientrelationshipThewaytocommunicateproperlyandeffectivelywiththepatientsPage167-188Wordstalkwithdifferentovertones!doctorphysicianmedicalpractitionerproviderpatientclientcustomerPage167Wordstalkwithdifferentovertones!Physician:denotingapractitioneroftheartofhealing;Doctor:referringtoa“teacher”toshow,toteach;Medicalpractitioner:atechniquetermwithoutmuchconnotation;Provider:agenerictermmoreorlessrelatedtobusiness;Page167Wordstalkwithdifferentovertones!Patient:indicatingasufferingorsickpersonundermedicaltreatment;Client:referringtoapersonwhoiswillingtopayforagoodoraservice;Customer:denotingonewhopaysafeePage167Situationswheredoctorsmaybeaskedtomake“toughdecisions”forthepatientsPage168Decidewhetherlife-supportsystemshouldbecontinuedorwithdrawn;Decidewhethereuthanasiashouldbeconsidered;Decidewhetheranewtherapyshouldbetried;Decidewhethersurgeryshouldbethefirstchoiceorthelastresort;Decidewhethertransferorreferralisneeded.TextALettingDoctorsMaketheToughDecisionsPaulineW.ChenPage168Whatdifficultsituationistheyoungdoctorfacing?(Pre.1)AdyingpatientDecisionwhethertowithdrawlife-supportmachinesandmedicationandstartcomfortmeasuresThefamily’srefusaltomakeanydecisionorwithdrawanytreatmentsPage169,P2英语短语Clinicalskills临床技能Largeandpowerfullybuilt身材高大伟岸Loomover咄咄逼人Shrinkdown缩小身子英语短语Nursingstation护士站Withdrawlife-supportmachine撤下生命维持系统Comfortmeasures舒适 护理 卵巢癌的护理查房优质护理服务内容doc优质护理服务内容肺癌的护理常规消毒供应室优质护理 措施 《全国民用建筑工程设计技术措施》规划•建筑•景观全国民用建筑工程设计技术措施》规划•建筑•景观软件质量保证措施下载工地伤害及预防措施下载关于贯彻落实的具体措施 Inflictpainon给…带来痛苦Whatispaternalisticdecision-makinginmedicine?(Pre.2)DoctorsasexclusivedecisionmakerPatientsasparticipantswithlittlesayinthefinalchoicePage169,P4英语短语Approachmedicaldecisions应对医疗决策Exclusivepurviewofdoctors医生独享权限Paternalisticdecision-makingprocess家长式决策程序Patientempowerment给患者授权LanguageFocuses…asmovementscallingforpatientempowermentgrewandmedicalethicistsbeganarticulatingprinciplesregardingtheethicalcareofpatients.…要求病人授权的呼声越来越高，而且医学伦理学家也开始阐述病人伦理关怀的相关原则。Page169,P4Inwhatwaycanpatientempowermentbegoodforthepatient?(Pre.3)Respectforthepatient,especiallythepatient’sautonomyPatient-centeredcarePage169,P5-6Twoprinciplesinvolvedinthedecision-makingprocessrespectforthepersonanewclinicalideal:patient-centeredcareinwards,clinicsandoperatingroomsrespectforaperson’sautonomylettingpatientsmaketheirowndecisionsPage169,P5-6LanguageFocusOnetenetthatgainedparticulartractionamongclinicians…临床医生们尤为拥护的一条宗旨…thisethicalprincipleledtoanewclinicalideal:patient-centeredcare…这条伦理原则导致了一种新的临床理念的出现：以病人为中心的医护。Page169,P5Consequenceincurredbythetwoprinciples/tenets…youngdoctors,myselfincluded,wouldbetrainedtorestrainourselvesfrommakinganythingbutemergencyormundanedecisionsforpatients…包括我在内，年轻医生将接受培训，学会除了一些紧急状况或日常琐事，不为病人作其他任何决定。Page169,P6Consequenceincurredbythetwoprinciples/tenets…andthatinterpretationwouldworkitswayintotheteachingprogramsofmedicalschoolsandintostatelawsthatmandateddiscussionoftreatmentoptionswithpatients.…而且，对病人自主性的解释逐渐进入了医学院校的课程，也被写进各州的法律，规定医生必须与病人讨论治疗 方案 气瓶 现场处置方案 .pdf气瓶 现场处置方案 .doc见习基地管理方案.doc关于群访事件的化解方案建筑工地扬尘治理专项方案下载 的选择。Page169,P6英语短语Ethicalprinciples伦理准则Clinicalideal临床理念Patient-centeredcare以患者为中心的护理Respectforautonomy尊重自主权Whydoestheauthorsaytoomuchphysicianrestraintmaynotbethatgoodforthepatient?(Pre.4)Thepatientsareforcedtomakedecisionstheyneverwantto.Patients,atleastalargemajority,prefertheirdoctorstomakefinaldecisions.Shiftingresponsibilityofdecisionmakingtothepatientswillbringaboutmorestresstothepatientsandtheirfamilies,especiallywhenthebestoptionforthepatientisuncertainPage169-170P8-11LanguageFocusesWhiledoctorsmightequatelettingpatientsmaketheirowndecisionswithrespect…虽然医生也许认为让病人自己作决定就是尊重病人…Page169P8LanguageFocuses:Howmany?Whenitcametomedicaldecisions,almostalltherespondentswantedtheirdoctorstoofferchoicesandconsidertheiropinions.Butamajorityofpatients—twooutofthree—alsopreferredthattheirdoctorsmakethefinaldecisionsregardingtheirmedicalcare.…mostpatientsdon’twanttomakethesedecisionsontheirownPage170P8-10Thechallenges…notwhenthemedicalchoicesareobvious,butwhenthebestoptionforapatientisuncertain不是医疗选择明显时，而是最佳选择不明确时…doctorspasstheburdenofdecision-makingtoapatientorfamily医生将决定重负转移给患者或其家人Page170P11Whatkindofconsiderationsmayhavepreventeddoctorsfrommakingdecisionsfortheirpatients?(Pre.5)Doctorsareverymuchcautiousaboutcommittingsomekindofethicaltransgression.‘WhoamItopresumetoknowwhatmypatientsneed?’Page170P12LanguageFocusesSomewillresorttoveilingtheirownopinionsinahalfheartedattempttodirectthedecision.有些医生采取的做法是隐藏自己的观点，用隐隐约约的方式引导病人作决定。Page170P12LanguageFocusesWhilethedoctorsmightbeconvincedthattheyarebeingobjectiveanddispassionate,moreoftenthannottheyaresendingmixedmessages.虽然医生坚信自己的态度客观冷静，但往往他们在向病人发出莫衷一是的信息。Page170P12ACaseinPoint:LanguageMakesaDifferenceTellrelativesthatitistheirchoicetowithdrawlifesupportfromadyingpatient.Butthatdoctormayalsousevalue-ladenlanguagetodescribetheoptions.Onealternativemaybedescribedtothefamilyas“reasonable”or“comforting,”whiletheotherisdepictedas“invasive,”“aggressive”or“painful.”Page170,P13TheProblemPatientsendupfeelingmanipulatedandwillresistmakinganydecisionatall.Page170,P14ThesolutionThekeytopreservingpatientautonomy–andpatient-centeredcare–liesnotinlettingpatientsmakethefinaldecisionsalonebutinrespectingtheiropinionsandshoulderingtheresponsibilitytogether.Page171,P16Doyouagreethatdoctorsshouldbepreparedtomakeanydecisionstogetherwiththeirpatients?(Pre.6)Shoulderingresponsibilitytogetherwiththepatientmaybebetterthanhavingthepatientmakedecisionontheirownalone.Balancingbetweenpaternalismandrespectforpatient’sautonomyconstitutesalargepartofmedicalpractice.Page167-171Supposeapatienthasgotfataldisease.Wouldyoutellhimthetruth?(Pre.7)Page167-171ToSumUpWatchtheVideoandseewhataretipsgivenbyDr.ThaddeusBelltobuildaAmiablePPrelationshipDoctor-PatientRelationshipPage170-171,P15-16Task1OverviewPage172Backgroundinformation:Changefromthepaternalisticcaretothepatient-centeredcareTwounderlyingethicalprinciples:respectforthepersonandrespectfortheperson’sautonomyConclusion:Thekeyforpreservingpatientautonomyliesinrespectingtheiropinionsandshoulderingtheresponsibilitytogether.Theme:Toomuchphysicianrestraintisharmfulorunethical.LettingDoctorsMaketheToughDecisionsAnecdote:ayoungdoctor’sexperienceMainSupports:Studyfindings:mostpatients’positionTwoarguments:ExacerbatingthestressfulsituationCreatingdishonestyincommunicationPartI(P1-P8)PartII(P9-P14)PartIII(P15-P16)Task1MedicalTerminologyPage174EnglishChinese1.medication药物，药物治疗2.Autonomy自主性3.clinician临床医生4.surgical外科的5.painful疼痛的6.clinical临床的7.ethicist伦理学家8.unethical不道德的9.physician医生，内科医生10.hospitalize住院