浙江省住院医师规范化培训英语翻译

临床医学英语Chapter 1 Patient-Physician Interaction Page 1第一章医患沟通第１页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阶段中进行着。

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诉说或所关注问题，然后通过询问、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病史询问和体格检查，进行诊断性化验，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，并与病人及家属反复磋商以形成治疗方案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 patientsrespecting 注意到、关系、说到evidence-based medicine 循证医学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，但要考虑到不同病人中个体差异是存在的。

The increasing availability of randomized trials to guide the approach to diagnosis and therapy should not be equated with “cookbook” medicineavailability可利用性，可得到randomize 随机的cookbook 食谱，烹调书approach 接近越来越多的可用于指导临床诊断与治疗的随机试验资料不应变成“烹调书”医学。

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 强调因为随机试验获得的现象和思路是着重于特征性病人的求证过程。

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现象和思路能否应用于某个病人个体，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，非决定性许多情况下，临床表现缺乏或不典型，需要考虑更多的判断。

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emphasize 强调，详述，阐明presenting 提出alternative 可选择的，二选一病人还会根据自己的倾向调节着临床症状，但医生有责任通过选择性问题搞清事实。

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 基本原理假如病人也懂得医生问题的基本原理和表现，有特殊生活方式病人的固执容易被强化。

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(为了个体化的照料病人)，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.fundamental 基本的，根本的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折磨。

If the physician does not appreciate and address these issues, the science of medicine cannot be applied appropriately, and even the most knowledgeable physician fails to achieve appropriate outcomes.appreciate 欣赏、感谢、评价appropriate 适当的、恰当的假如医生没有正确理解和定位这个问题，医学就不可能恰当地应用于临床，甚至一个知识最渊博的医生也不能取得理想的治疗结果。

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.aware of 意识到，知道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资源得到他们的信息，当然，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、开处方替代疗法和辅助疗法的应用不断增加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 approachessubstitute 代替、代用rely on 依赖、信任医生对未证实的疗法应该保持开放的思想，但是，如果这些疗法可能带来任何程度的潜在风险，医生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 considercrucial 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能考虑的治疗选择，是极及关键的。