首页
外语
计算机
考研
公务员
职业资格
财经
工程
司法
医学
专升本
自考
实用职业技能
登录
外语
I spent the usual long afternoon at work doing little but ordering tests, far more than I thought any patient needed, but that’s
I spent the usual long afternoon at work doing little but ordering tests, far more than I thought any patient needed, but that’s
admin
2017-12-31
31
问题
I spent the usual long afternoon at work doing little but ordering tests, far more than I thought any patient needed, but that’s what we do these days. Guidelines mandate tests, and patients expect them: abnormal tests mean medication, and medication means more tests. My tally for the day: 14 reasonably healthy patients, 299 separate tests of blood composition, three scans and a handful of referrals to specialists for yet more tests.
Teachers complain that primary education threatens to become a process of teaching to the test. They wince as the content of standardized tests increasingly drives their lesson plans, and the results of these tests define their accomplishments. We share their pain: Doctoring to the tests is every bit as dispiriting. Some medical tests are cheap and simple. Some are pricier and more complicated. As in education, our test-ordering behavior and our patients’ results increasingly define our achievements, and in the near future our remuneration is likely to follow. Still, like all test-based quality control systems, ours can be gamed. Our tests can also inflict psychic damage, and physical damage as well. Most distressing: dealing with the endless cycle of repeat testing absorbs much all our time.
It is all in the name of good and equitable health care, a laudable goal. But if you reach age 50 and I cannot persuade you to undergo the colonoscopy or mammogram you really don’t want, am I a bad doctor? If you reach age 85 and I persuade you to take enough medication to normalize your blood pressure, am I a good one? I am not the only one who wonders. A cadre of test skeptics at Dartmouth Medical School specialize in critically examining our test-based approach to well adult care. These folks deserve much of the blame: They have repeatedly demonstrated that these tests and many others do not necessarily make healthy people any healthier.
Dr. H. Gilbert Welch, a Vermont physician who is part of the Dartmouth group, has a new book that might serve as the test skeptic’s manifesto and bible. Its title, "Less Medicine, More Health," sums up his trenchant, point-by-point critique of test-based health care and quality control. In medicine, "true quality is extremely hard to measure," Dr. Welch writes. "What is easy to measure is whether doctors do things. " Only doing things like ordering tests generates data. Deciding not to do things and let well enough alone generates nothing tangible. Dr. Welch points out that doctors get to become doctors because they are good with tests, and know instinctively how to behave in a test-focused universe. Rate them by how many tests they order, and they will order in profusion, often more than the guidelines suggest. They will do fine on assessments of their quality, but patients may not do so well. Even perfectly safe tests that are incapable of doing their own damage may, given enough weight, trigger catastrophe.
Yes, little blood pressure cuff over there in the corner, that means you. The link between very high blood pressure and disease is incontrovertible, and the drugs used to control blood pressure are among the cheapest and safest around. Even so, as Dr. Welch pointed out in a recent conversation, systems that rate doctors by how well their patients’ blood pressure is managed are likely to invite trouble. Doctors rewarded for treating aggressively are likely to keep doing so even when the benefits begin to morph into harm.
That appears to happen in older adults, at least in those who avoid the common complications of high blood pressure and continue on medication. One study found that nursing home residents taking two or more effective blood pressure drugs did remarkably badly, with death rates more than twice that of their peers. In another, dementia patients taking blood pressure medication with optimal results nonetheless deteriorated mentally considerably faster. Yet no quality control system that I know of gives a doctor an approving pat on the head for taking a fragile older patient off meds. Not yet. at least. Someday, perhaps, not ordering and not prescribing will mark quality care as surely as ordering and prescribing do today. For the average healthy, happy adult, let’s be honest: We really haven’t completely figured out why you are in the waiting room. And so we offer a luxuriant profusion of tests.
What does the sentence "It is all in the name of good and equitable health care, a laudable goal. "(para. 3)most probably imply?
选项
A、Medical tests are practised with imagined, unsubstantiated reasons.
B、Endless cycle of repeat testing helps confirm and treat diseases of patients.
C、Medical tests are practised to promote fair health care of patients.
D、Test-ordering behavior should be conducted with the consent of patients.
答案
A
解析
转载请注明原文地址:https://jikaoti.com/ti/k4CYFFFM
本试题收录于:
NAETI高级口译笔试题库外语翻译证书(NAETI)分类
0
NAETI高级口译笔试
外语翻译证书(NAETI)
相关试题推荐
Europethusneedstotakeapathtoavoidingtheextremesofnaivetyandhostility.
当前,国际金融危机已从局部发展到全球,从发达国家传导到新兴市场国家,从金融领域扩散到实体经济领域,给世界各国经济发展和人民生活带来严重影响。值此关键时刻,我们在这里共同探讨维护国际金融稳定、促进世界经济增长的举措,具有十分重要的意义。//我们正在
下面你将听到的是一段有关中国经济社会发展的讲话。中国的改革开放已经走过了26个年头。26年来,中国发生了翻天覆地的变化。中国经济持续快速增长,国内生产总值从不到1500亿美元增长到1.65万亿美元。进出口总额从206亿美元增长到1.15
InterpretthefollowingpassagesfromEnglishintoChinese.Startinterpretingatthesignalandstopatthesignal.Youmaytak
ThemovieactorArnoldSchwargenegger,whoisrunningforgovernorofCalifornia,belongstotheconservativeDemocraticParty.
Accordingtothepassage,whathasmadeAmerica’ssystemofhighereducationagreatsuccess?
A、ThekillingofaJapaneseFishermanB、ShootingofJapaneseFishermanTriggeringDisputewithRussiaC、JapanandRussiaFightin
1.Ascompaniesincreasinglytestnewdrugsinothercountries,theyarestrugglingtodecidewhattheyowethepatientswhoser
A、Byrecyclingallthewater.B、Byusingverylittle.C、BytransportingplentyfromEarth.D、Bycontrollingthehumidityonboar
A、Topromotesalesofbicycles.B、Toencouragecycling.C、Toreducecaraccidents.D、Toimproveroadconditions.B
随机试题
审慎监管就是监管当局要()评估银行机构的风险。
诊断恶性肿瘤的主要根据是
症见身目发黄,黄色较淡而不鲜明,食欲不振,肢体倦怠乏力,食少腹胀便溏,心悸气短,舌淡苔薄,脉濡细,治法应为:
患儿8个月,3天高热,咳嗽频繁。查体:138℃,精神萎靡,呼吸困难,肺部闻及细湿哕音,心率快,胸片示两肺有多发性小脓肿,血象WBC30.0×109/L,N0.90。最可能的诊断为
关于滴丸有关叙述错误的是
刑罚的主刑包括()。
商鞅,姓公孙,是()的没落贵族。
Thetextismainlyabout______.Whatisthemainpointthewriteristryingtomakeinthelastparagraph?
Well,therewasamanhereoncebythenameofJimSmiley,inthewinterof1849—ormaybeitwasthespringof1850.Anyway,he
A、Tooslowforadifficultbookthoughjustrightforanon-seriousone.B、Tooslowforanon-seriousbookbuttoofastforadi
最新回复
(
0
)