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
71
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 will NOT be accepted by Dr. H. Gilbert Welch?
选项
A、It is very difficult to determine the real quality of medicine.
B、Medical tests do not necessarily make a healthy person healthier.
C、Test-based systems are used mainly to evaluate doctors’ practice.
D、Perfectly safe tests can be guaranteed not to do any damage to patients.
答案
D
解析
转载请注明原文地址:https://kaotiyun.com/show/bqSO777K
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.
当前,亚欧两地区都处于蓬勃发展的阶段。亚洲是世界上最具经济活力的地区,资源丰富,市场广阔,区域合作方兴未艾。欧盟是世界上最大的发达经济体,资本充裕,科技先进,一体化程度高。两地区政治上共识很多,经济上优势互补,文化上各具特色,为开展更广泛和具有实质性的对话
世界著名的《格萨尔王传》是藏族人民在漫长历史长河中创造出来的一部珍贵的长篇英雄史诗,是中国乃至世界文学宝库中少有的珍品,但一直是通过民间说唱艺人口头流传为了保护藏民族的这一文化瑰宝,西藏自治区于1979年成立了抢救、整理《格萨尔王传》的专门机构,进行全面搜
Accordingtothepassage,whathasmadeAmerica’ssystemofhighereducationagreatsuccess?
Accordingtothepassage,whathasmadeAmerica’ssystemofhighereducationagreatsuccess?
A、Asanexampleofendangeredlanguage.B、ToshowthediversityoflanguagesinJapan.C、Totestifytheeffectivenessofmultili
A、Mostcollegestudentslackascertainedlevelofproficientskills.B、Universitiesshoulddomoretobetterpreparethosecolle
Itlooksunlikelythatmedicalsciencewillabolishtheprocessofageing.Butitnolongerlooksimpossible."Inthelongr
OnSaturdaymorningsIworkedinthefamilyshop.IstartedcyclingdowntotheshopwithDadonSaturdayassoonasIwasbige
Weneedvacations.Theyrechargeus,allowingustobemoreefficientalltheothertimes.Thetroubleis,toomanyofthevacat
随机试题
A.清肺解毒,化瘀消痈B.化瘀排脓C.清肺消痈,软坚散结D.排脓解毒(2011年第107,108;1997年第56,57题)肺痈溃脓期的治法是()
目前最常用的推算预产期的依据是
流行性出血热的流行特征是
A、生地黄、木通B、生地黄、知母C、地骨皮、桑白皮D、生地黄、黄连E、熟地黄、知母属于清胃散的药物组成的是
A.Ⅰ期临床试验B.Ⅱ期临床试验C.Ⅲ期临床试验D.Ⅳ期临床试验E.临产前实验上市后药品临床再评价阶段是
中国银行业协会的日常办事机构为()
某企业购入一台需要安装的设备,取得的增值税专用发票上注明的设备买价为200000元,增值税额为34000元,支付的运输费为15000元,设备安装时领用生产用原材料45000元,该批材料相应的增值税额为7650元,设备安装时支付有关人员工资薪酬9000元。该
设平面区域D={(x,y)|(x-1)2+(y-1)2≤2},I1=(x+y)dσ,I2=ln(1+x+y)dσ.则正确的是()
Ittakes(much)______timetogotherebytrainthanbyplane.
Athirdoftheplanet’slandisseverelydegradedandfertilesoilisbeinglostattherateof24bntonnesayear,accordingto
最新回复
(
0
)