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
40
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.
Which of the following can best serve as the title for the passage?
选项
A、Standardized Testing and Medical Tests
B、The Doctor as a Slave to Tests
C、Psychic and Physical Damage Inflicted by Medical Tests
D、Quality Care: Not Ordering and Not Prescribing Medical Tests
答案
B
解析
转载请注明原文地址:https://kaotiyun.com/show/6qSO777K
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
Theenvironmentalproblemdemonstratesa________ofourmodernlife,whichisconfrontedtoeverygovernmenttosolve.
女士们、先生们:我非常高兴能利用英中贸协年会的机会向英国工商界朋友们致以诚挚的问候。多年来,英中贸协一直关心和支持中英关系发展,是堪称两国友好交流的桥梁和互利合作的纽带。在此,我谨对英中贸协及诸位长期为促进中英经贸合作所做的不懈努力和杰出贡献表示
下面你将听到外商有关中国零售业发展情况的一段讲话。China’seconomy,oncereliantonstatespendinginheavyindustry,hasincreasinglylookedtothe
儿童的生存、保护和发展是提高人口素质的基础,直接关系到一个国家和民族的前途与命运。中华民族素有“携幼”、“爱幼”的传统美德,中国古语“幼吾幼以及人之幼”流传至今。中国政府一向以认真和负责的态度,高度关心和重视儿童的生存、保护和发展,把“提高全民族
DeepeningthefinancialreforminChinawilloffernewopportunitiestofacilitatecooperationbetweenforeignbanksandtheChi
A、tomeettheirbasicneedsinlifeB、toenjoyspendingmoneyC、foradifferentreasonfromtheonetheyclaimD、tosatisfythei
Theearthisourhome.Wemusttakecareofit,forourselvesandforthenextgeneration.Thismeanspreservingthe.qualityof
Oneday,droughtmaybeathingofthepast,atleastinanycountrynottoofarfromthesea.Vastareasofdesertthroughoutt
A、Movingfromplacetoplace.B、Enjoyinglifeinthecountry.C、Makingalittleprogresseachday.D、Workingandlearning.D
Thereisevidencetobelievethatgamblinginmanyformshasbeenengagedinforalmostaslongascivilization.Eveninprimiti
随机试题
A.风邪外袭之头痛B.痰浊上逆之头痛C.血不上奉之头痛D.肝阳上亢之头痛E.瘀血阻络之头痛川芎茶调散主治()
A.胆汁性呕吐B.粪性呕吐C.血性呕吐D.呕吐物为宿食低位肠梗阻常表现为
表示均数抽样误差大小的统计指标是
下列对法官的规定中。哪些表述是正确的?()
下列各项经济业务中,资产发生变化的是()。
甲公司在2006年制定了未来五年的发展战略,其中一个重点就是要以出口的形式扩大海外市场。但意想不到的是2007年发生了世界范围内的经济危机,造成出口订单锐减,公司不得不修改原来制定的出口战略,转向国内市场。从战略失效的角度看,这属于()。
功能固着也可以看作是一种定势,即从物体的正常功能的角度来考虑问题的定势。有时候功能固着能够对问题解决起积极作用,有时候起消极作用。()
姥姥的端午①十余年前的五月,姥姥忙碌完生命里最后一个端午,便匆匆离去。②此后每自清明夜始,随着金银花的细碎步声,临近粽香五月,便有姥姥的絮语叮咛,踱着疲惫的小脚,轻轻推门,轻轻走近,拾起床边垂落的被角,为我一掩再掩。③物质极度贫瘠的岁月,端午,在童年
A、 B、 C、 D、 C图形中小图形的种类数依次是1、2、3、4、(5)。
根据以下资料回答101-105题2007年,全国研究与试验发展(R&D)经费总支出为3710.2亿元,增长23.5%,研究与试验发展(R& D)经费投入强度(与国内生产总值之比)为1.49%。按研究与试验发展人员(全时工作量)计算的人均经费支出为21.4
最新回复
(
0
)