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
70
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://www.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
Intheircountry,drunkdrivingisafelony,butdrivinganautomobileinexcessofthespeedlimitisa________.
LadiesandGentlemen,RecentpollsshowthatthemajorityofAmericansactuallydobelievethatSino-Americanrelationship,
我国金融改革的不断深化将为外资银行与中资银行的合作带来新的机遇。银监会鼓励外资银行通过参股中资银行,在业务、客户和市场方面获得突破;同时,在公司治理、内控、风险管理和经营理念方面带来先进的经验和做法,使中、外资银行在合作中共同获得发展。作为深化金
我想从科学技术的角度讲一讲我自己对全球化的观察和认识,请各位指正。我看到的是,全世界大多数科技工作者,包括很多中国科学家、工程师们在内,都张开双手,欢迎甚至期待着全球化的到来。这一现象很值得重视。//科学技术是人类现代文明的中心,是任何国家、民族
本次会议是信息社会世界峰会的首次政府间筹备会议,既要处理程序性问题,又要处理实质性问题。开好筹备会,是峰会取得成功的重要保证。中国代表团愿就峰会筹备工作谈以下几点看法://一、要高度重视知识和人才问题。在未来信息社会中,知识和技能是促进经济发展的
A、Solarenergy.B、Fossilfuels.C、Newnuclearplants.D、Nonuclearplants.C根据原文第二段,核问题涉及能源安全和气候变化的问题。前者反对关闭核电站,并且支持开新型核电站,因为废除核
A、Nuclearenergyisenvironmentallyfriendly.B、Nuclearenergyisindispensabletomankind.C、Fossilfuelscausepollutiontoth
Accordingtothepassage,whathasmadeAmerica’ssystemofhighereducationagreatsuccess?
A、Asanexampleofendangeredlanguage.B、ToshowthediversityoflanguagesinJapan.C、Totestifytheeffectivenessofmultili
Likemanyteenagegirls,LeeAnnThillwasobsessedwithherappearance.Adiabetic,shealreadywassufferingfrombulimia—forc
随机试题
运用紫外线灯照射消毒时照射时间应
最有助于迅速确定诊断的表现若心音消失,应立即采用的抢救措施
()就是指证券交易内幕信息的知情人和非法获取内幕信息的人利用内幕信息从事证券交易活动。
网络营销中产品和服务的定价要考虑的因素包括()。
导游人员在导游活动中讲解质量差或是不讲解的,可被旅游行政管理部门扣除()分。
医学专家声称:被蛇咬伤而前来就医的大多是。型血的女性。他们还发现,咬伤这些患者的蛇大多是花斑环蛇。因此医学专家得出结论:蛇最倾向于咬O型血的女性。如果以下陈述为真,最严重地削弱了上述结论的一项是()。
现代有学者根据金字塔所包含的各种建造数据与天体运行规则的对应性、预见性,_______这是古人对后人的一种智能_______。填入划横线部分最恰当的一项是()。
下面与嵌入式处理器复位相关的叙述中,错误的是()。
TestClass类定义如下:classTestClass{private:intid;chargender;char木phone;public:TestClass():id(
Whatisspecialaboutopen-accessjournals?
最新回复
(
0
)