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  3. Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore t

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore t

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问题     Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’ t spend much on him.
    It’ s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’ s unusual about them is not how much treatment they get compared to most Americans, but how little. Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. Almost all medical professionals have seen what we call "futile care" being performed on people. That’ s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, "Promise me if you find me like this that you’ll kill me. "
    How has it come to this—that doctors administer so much care that they wouldn’ t want for themselves? The simple, or not-so-simple, answer is this: patients, doctors, and the system.
    To see how patients play a role, imagine a scenario in which someone has lost consciousness and been admitted to an emergency room, and shocked and scared family members find themselves caught up in a maze of choices. When doctors ask if they want "everything" done, they answer yes. Then the nightmare begins. Feeding into the problem are unrealistic expectations of what doctors can accomplish. For example, many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor.
    But of course it’ s not just patients making these things happen. Doctors play an enabling role, too. The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families. Imagine, once again, the emergency room with those grieving family members. They do not know the doctor. Establishing trust and confidence under such circumstances is a very delicate thing. People are prepared to think the doctor is acting out of base motives, trying to save time, or money, or effort, especially if the doctor is advising against further treatment.
    It’ s easy to find fault with both doctors and patients in such stories, but in many ways all the parties are simply victims of a larger system that encourages excessive treatment. In some unfortunate cases, doctors use the fee-for-service model to do everything they can, no matter how pointless, to make money. More commonly, though, doctors are fearful of litigation and do whatever they’ re asked to avoid getting in trouble.
The real problem the author is concerned about in this article is______.
选项 A、the overtreatment for dying patients
B、the different attitude of doctor and patients toward death
C、the disproportionately high medicare expenditure in America
D、the unequal and non-transparent doctor-patient relationship
答案A
解析 本文作者由“医生如何面临死亡”这一问题开篇，但是真正的目的并不仅停留在讨论医生和病人在面对死亡时的不同态度上，而是要讨论导致这种态度差异的原因。医生面临死亡往往能够泰然处之，不愿意接受过多的激进治疗，因为他们作为内行人，知道再多的治疗也可能无法挽救一个垂死病人的生命。而普通病患往往为了生存，愿意尝试一切可能的手段，不论成功几率多么微乎其微。这种不论结果，对垂死病人尝试所有治疗手段的做法使得美国医疗不堪重负，也是作者作为一个医生最为担忧和希望解决的问题。[B]“医生和病人在面对死亡时的不同态度”只涉及表面内容，而没有涉及作者的核心论点。[D]“不平等，不透明的医患关系”是作者谈到的一个细节问题，却不是中心内容。[A]和[C]有一定的关系，[A]中提到的对垂死病人的过度医疗是导致[C]美国昂贵的医疗花销的原因之一，但是就本文内容来看，始终围绕濒死病人的医疗问题展开，因此最佳答案应该选[A]。
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