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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.
Which of the following does not account for doctors’ inclination to provide patients with more treatment than necessary?
选项 A、The paying mode in medical treatment lures them to make more money by treating more.
B、They can not effectively communicate with desperate family members about a reasonable treatment plan.
C、They fear that patients may sue them for not trying their best to save patients.
D、Doctors want to experiment new medical approaches on patients.
答案D
解析 作者在分析导致过度医疗的原因的时候，除了分析病人及家属的原因之外，还着重分析了医生和医疗体系应该承担的责任。第五段中作者提到了医生和病人之间的沟通不畅导致的过度医疗问题。当面临悲痛欲绝的家属的时候，医生往往因为不知该如何跟病人家属沟通，让他们接受有节制的治疗方案，而采取任家属自行选择治疗方案的态度，这直接导致了过度医疗的结果。[B]“他们没有办法就一个合理的治疗计划和歇斯底里的病人家属进行有效沟通”描述的正是这层含义。另外，在文章的第六段作者谈论医疗体系纵容了过度医疗这个问题时还提到，doctors use the fee—for一service model to．．．make money，“医生利用按诊疗收费模式，在患者身上用尽一切治疗手段谋取暴利，无论这些方法是多么无济于事。”[A]谈到的正是医疗收费方式在过度医疗方面所起的作用。另外，第六段里还提到，doctors are fearful of litigation and dowhatever they’re asked to avoid getting in trouble，“医生害怕官司缠身，因此尽力满足患者的全部要求，以免惹上麻烦”，因此，医生过度医疗的倾向也来自于对诉讼的担心，这一点对应的是[C]。只有[D]的内容原文没有提到。
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