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
73
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 is TRUE about the discussion of blood pressure medication?
选项
A、For older patients the medication should never be stopped.
B、For nursing home residents taking blood pressure drugs, the death rates are lower than that of their peers.
C、Dementia patients taking blood pressure drugs gained good results, however mental deterioration goes down more quickly.
D、When blood pressure is managed, the drug benefits will not morph into harm.
答案
C
解析
转载请注明原文地址:https://kaotiyun.com/show/EqSO777K
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
Letmeillustratethat.AsChinagrowsworldclasscompaniesandthesegooutintointernationalmarkets,manyareattractedto
ThemovieactorArnoldSchwargenegger,whoisrunningforgovernorofCalifornia,belongstotheconservativeDemocraticParty.
A、soonaftertheylearntotalkB、bylookingattheclockC、whentheybegintobemathematicallymatureD、aftertheyreachsecon
WhichofthefollowingcanbedesignatedthecorrespondingpostaccordingtotheBrettonWoodscommonpractice?
A、Thatofacreator.B、Thatofare-creator.C、Thatofareceiver.D、Thatofaperformer.C
作弊极具诱惑,这一点并不奇怪。今日的因特网诱惑重重——有学期论文供出售,还有免费文章共摘抄,你只要鼠标轻轻一点即可。一项调查表明,30%的学生承认常在测试中作弊,另有65%的学生承认,即使教授要求他们独立完成作业,他们也会向朋友求助。我们难以相信这些年轻人
Theearthisourhome.Wemusttakecareofit,forourselvesandforthenextgeneration.Thismeanspreservingthe.qualityof
A、Shoppers.B、Trafficpolice.C、Youngpeople.D、Thehandicapped.D
总体上来说,女性工作时间更长,收入更低,工作中的乐趣更少,研究表明,同等工作,男性能挣到一美元,而女性只能挣到74美分。这句话也是一个比较句,做笔记时要把比较的内容记下来。longerhours,lesspay,enjoyment,另外一个是要把第二个
A、Near2million.B、3.2millionand3.7million.C、About18,000.D、20,000and24,000.B从“...Thestoryboardisvaluedatbetween
随机试题
面向对象方法中,继承是指()。
能使心率加快:治疗室上性心律失常:
试述洋地黄中毒的诊断和治疗措施。
药物中所含杂质的最大允许量叫做
地下贮库的建设应遵循的技术要求包括()。
室内消火栓的布置应满足同一平面有2支消防水枪的2股充实水柱同时达到任何部位的要求。但在某些情况下,可采用1支消防水枪。则下列场所中可只采用1支消防水枪的是()。
(2019年)下列各项中,有关以银行存款偿还所欠货款业务对会计要素影响的表述正确的是()。
受理申请或接到推荐报告后,相应评定权限的旅游饭店星级评定机构应在()内以明查和暗访的方式安排评定检查。
以下关于儿童眼睛特点的描述正确的是()。
A、Tuesday.B、Wednesday.C、Thursday.D、Friday.C[听力原文]M:HasthelatestShanghaiDailyarrivedyet?TodayisalreadyTuesday.W:
最新回复
(
0
)