ClinicalMedicalEnglishBiLiQi（畢黎琦）RheumatologyDept.ofChina-JapanUnionHospitalofJilinUniversityEmail:.cnLinBaiSong（林柏松）心外科LiuBo（劉波）CourseProblemsTeachingaimTextbookTeachersTeachinghoursExaminationCourseProblemsTeachingaimTextbookTeachersTeachinghoursExaminationProblems醫學專業英語的獨特性：詞匯量大、來源復雜、構詞講究。教學現狀：教材內容：科普文章、系統性及實用性差，缺少臨床實用內容。教學方法：簡單翻譯學與用：學生的英語學習與實際應用脫節。僅停留在應付考試上。研究生教學：沒有與其所學專業相匹配的專業英語教材。學生應用英語的能力亟待提高：英文簡歷，藥品英文說明書臨床英語查房（疾病的英文名稱、對患者病史做簡單介紹）指導留學生臨床實習，留學生全英文授課，醫療翻譯寫畢業論文英文摘要發表英文期刊論文（SCI收錄論文）深入學術交流和討論（國際會議發言、提問、交談、討論）外籍醫學專家學術報告口譯，同聲傳譯。Problems標準的醫學英語表達留學人員最困惑的是難以尋找到標準的醫學表達術語，意思表達清楚了，另類，不地道。舉例：患者有服用萬古霉素出現皮疹這樣的過敏史A：“Thepatienthadarashaftershetookycin.”B：“Thepatienthasdevelopedarashwithycininthepast.”患者狀況良好出院A：“Patientisfineandgohome.”B：“Patientisbeingdischargedhomeinstablecondition.”患者有手術治療的愿望A：“Thepatientwantsthesurgery.”B：“Thepatientdesiresthesurgery.”“經期正常，28～30天一次”A：menstruationisnormal,28to30dayspertime.B：Havenormalperiods(ofmenstruation)at28～30-dayintervals.Problems舉例：A學生：“Thispatientsufferfrommyoma.Wewanttodothesurgeryforher”.B學生：“Ms.Robisonisa23-year-oldfemalewithahistoryofmalignantgermcelltumoroftherightovaryinJanuaryof2015,metastasistoasinglelymphnodewithpositiveascites,statusatchemotherapywithBEP.”

腹部檢查的描述：

“abdomensoft,notendertopalpation,nomassespresent,tonenormalwithoutrigidityorguarding,normalbowelsounds.“醫學英語教學面臨的最大挑戰是：如何使臨床英語教學步入規范和實用性的軌道。CourseProblemsTeachingaimTextbookTeachersTeachinghoursExamination教育部《大學英語課程教學要求》

一般要求

較高要求

更高要求聽力理解能力

Listening

授課、日常談話、講座，語速慢的廣播。談話、講座、廣播電視，每分150~180詞。廣播電視、正常語速談話、專業課、講座。口語表達能力Speaking

交流、討論，簡短發言。流利會話，表達意見、觀點等。對話討論，概括文本或講話，國際會發言討論。閱讀理解能力Reading

一般題材文章，每分70詞，快速閱讀每分100詞。報刊雜志，每分70~90詞，快速每分120詞。專業綜述。有難度文章，國外報刊雜志，專業文獻資料。書面表達能力Writing

一般性寫作，常見應用文。專業論文摘要、小論文、描述圖表，半小時寫160詞短文。專業簡短報告和論文，半小時200詞說明文或議論文。翻譯能力Translating

熟悉的文章進行英漢互譯，英譯漢每小時300詞，漢譯英每小時250漢字。專業文獻，大眾報刊上熟悉文章，英漢每小時350詞，漢英每小時300漢字。專業文獻和報刊，國情或文化文章。英漢每小時400詞，漢英每小時350漢字推薦詞匯量words

掌握4795詞和700詞組，其中2000積極詞掌握6395詞和1200詞組，其中2200積極詞掌握7675詞和1870詞組，其中2360積極詞匯。Teachingaim臨床專業英語

Requirements閱讀：醫學專業論文(實驗研究、臨床研究、病例報告)

其他（臨床病歷、藥品說明書等）寫作：論文的英文摘要、英文病歷、英文簡歷口語表達：問病史常用規范語言

詞匯：醫學英語構詞法

語法：結合課文，醫學科技文體特點

技巧：閱讀和寫作技巧CourseProblemsTeachingaimTextbookTeachersMethodsTeachinghoursExaminationTextbook教材：《Physicaldiagnosis》6thedition

不同階段使用不同的教材，本科階段最佳選擇：《診斷學》英文原版教材學習正規的臨床術語和用法：美國醫學院校教材，由美國執業醫師完成的臨床病例資料（病史、體征、診斷、治療的全部信息）。以英語國家醫學院校的標準教材為藍本，根據教學需要選擇內容。如患者的病史、癥狀和體征的描述、查體方法，疾病名稱術語。使學生學到具有實用價值的、可以用于交流的英語。需要的是實用的專業英語，而不是考卷上的答案。CourseProblemsTeachingaimTextbookTeachersTeachinghoursExaminationTeachers

醫學專業英語教師缺乏。醫學專業教師一般難以勝任英語教學

而英語教師不懂醫學知識。學校聘用的外籍教學人員無醫學教育背景。有些教師沒有英語口語教學能力-“啞巴”英語。國際交流日益廣泛，學習模式落后于時代要求，影響學習質量和專業水平的國際化。CourseProblemsTeachingaimTextbookTeachersTeachinghoursExaminationTeachinghours40hours20lectures2016.3.18-2016.5.20ExaminationTakinghistoryPhysicalexaminationTranslationwordsTeachinghours

Examination“臨床場景”不僅僅是一個患者躺在病床上；而應是描繪這樣一幅畫面：病人身邊圍繞著家人、同事、親戚、朋友，他也被快樂、悲傷、希望和擔憂包圍著。ConductinganinterviewGettingStartedGreetthepatient“Goodmorning,Mr.Smith,I’mMaryJones,amedicalstudentattheNormanBethuneSchoolofMedicineinJilinUniversity.I’vebeenaskedtointerviewandexamineyouinthenexthour.”CorrecttitlesMr.,Mrs,Dr.,Ms.Pronunciation,askpatient“howtosayyournamecorrectly”SomesituationsHavingameal,“IfIcanreturnwhenyouhavefinishedeating?”Visitor,“Whetheryouwishthevisitortostay?”“Wouldyouturndownthevolumeofradioortelevision?”StandorSitSitinachair,notonthebed.Distance：3-4feet(1.0-1.2m)frompt.>5feet(1.5m):impersonal;<3feet:interferepatient’s‘privatespace’Eyes,atthesamelevel.bi’lingualism,trans’lation,inter’pretationConductinganinterviewBegintheinterview,askageneral,open-endedquestion.“whatmedicalproblemhasbroughtyoutothehospital?”Ifpatientsays:”Haven’tyoureadmyrecords?”“No,I’vebeenaskedtointerviewyouwithoutanypriorinformation.”or“Iwouldliketohearyourstoryinyourownwords.”VaguetermsOften經常,sometimes有時候,alittle有一點,fair還可以,reasonablywell基本可以,somewhat偶爾,rarely很少,average平均.“whatdoes‘sometimes’mean?”or“Howoftenis‘often?’”TheclosingArethereanyquestionsyoumightliketoask?Youhavebeenveryhelpful.Iwouldnowliketotakeafewnotes.Iamamedicalstudent.Ithinkitwouldbebesttoaskyourdoctorthatquestion.BasicInterviewingTechniquesQuestioning

Questionsthatstimulatethepatienttotalkfreelyarepreferred.Open-endedquestions（開放性問題）：

Whatkindofmedicalproblemareyouhaving?Howhasyourhealthbeen?Areyouhavingstomachpain?Tellmeaboutit.Tellmeaboutyourheadache.Howwasyourhealthbeforeyourheartattack?Canyoudescribeyourfeelingswhenyougetthepain?I’mcuriousabout……BasicInterviewingTechniquesDirectQuestions（封閉性問題）Wheredoseithurt?Whendoyougettheburningsensation?Howdoyoucomparethispainwithyourulcerpain?DirectQuestionsElementsofsymptoms：Bodilylocation,onset,quality,quantity,chronology,precipitatingfactors,associatedmanifestations.BodilyLocation‘‘Whereinyourbackdoyoufeelpain?’’‘‘Canyoutellmewhereyoufeelthepain?’’‘‘Doyoufeelitanywhereelse?’’Onset(Chronology)‘‘Whendidyoufirstnoticeit?’’‘‘Howlongdiditlast?’’‘‘Haveyouhadthepainsincethattime?’’‘‘Thenwhathappened?’’‘‘Haveyounoticedthatitisworseduringyourmenstrualperiod?’’DirectQuestionsPrecipitatingFactorsWhatmakesitworse?Whatseemstobringonthepain?Haveyounoticedthatitoccursatacertaintimeofday?Isthereanythingelsebesidesexercisethatmakesitworse?Doseexerciseincreasetheshortnessofbreath?Dosestressprecipitatethepain?DirectQuestionsPalliatingFactorsWhatdoyoudotogetmorecomfortable?Doselyingquietlyinbedhelpyou?Doseresthelp?Doseaspirinhelptheheadche?Doseeatingmakeitbetter?QualityWhatdoseitfeellike?Canyoudescribethepain?Whatdoyoumeanbya‘stickingpain’?Wasitsharp,dull,oraching?Whenyougetthepain,isitsteady,oritchange?DirectQuestionsRadiationWhenyougetthepaininyourchest,doyoufeelitinanyotherpartofyourbody?Whenyouexperienceyourabdominalpain,doyouhavepaininanyotherareaofyourbody?DirectQuestionsSeverity‘‘Whatdoyoumeanby‘alot’?’’‘‘Howmanysanitarynapkinsdoyouuse?’’‘‘Howmanytimesdidyouvomit?’’‘‘Whatkindofeffectdoesthepainhaveonyourwork?’’‘‘Howdoesthepaincomparewiththetimeyoubrokeyourleg?’’‘‘Canyoufallasleepwiththepain?’’‘‘Howhasthepainaffectedyourlifestyle?’’‘‘Onascalefrom1to10,with10theworstpainyoucanimagine,howwouldyouratethispain?’’DirectQuestionsTemporalDoseiteveroccuratrest?Doyouevergetthepainwhenyouareemotionallyupset?Wherewereyouwhenitoccurred?Dosethepainoccurwithyourmenstrualcycle?Doseitawakenyoufromsleep?Haveyounoticedanyrelationshipofthepaintoeating?DirectQuestionsAssociatedManifestationsDoyoueverhavenauseawiththepain?Haveyounoticedotherchangesthathappenwhenyoustarttosweat?Beforeyougettheheadache,doyoueverexperienceastrangetasteorsmell?O-P-Q-R-S-T，

onset(chronology),precipitating(orpalliative),quality,radiation,severity,andtemporal,isusefultohelpyouremembertheseimportantdimensionsofasymptom.QuestionTypestoAvoidSuggestivequestionDoyoufeelthepaininyourleftaimwhenyougetitinyourchest?(?)Whenyougetthepaininyourchest,doyounoticeitanywhereelse?(?)“Why”questionWhydidyoustoptakingthemedication?Whydidyouwaitsolongtocallme?QuestionTypestoAvoidMultipleorrapid-fireHaveyouhadnightsweats,fever,orchills?(?)Howmanybrothersandsistersdoyouhave,andhasanyoneofthemeverhasasthma,heartdisease,pneumonia,ortuberculosis?(?)medicaljargonYouseemtohaveahomonymoushemianopsia.(?)Haveyoueverhadamyocardialinfarction?(?)WeperformPapanicolaousmearstocheckforcarcinomainsitu.(?)IamgoingtoorderaCBCwithdifferential.(?)TheMUGAscanshowsthatyouhavecongestiveheartfailure.(?)QuestionTypestoAvoidleadingorbiasedYoudon’thavediabetes,doyou?(?)Doyouhavediabetes?(?)Youhaven’tbeenwheezing,haveyou?(?)Haveyoubeenwheezing?(?)saferHowdoyoufeelaboutit?Whatdoyouknowabout…?Howoftendoyoutakethismedication?Howdoyouremembertotakethismedication.Howdosethatmakeyoufeel?SilenceWhatareyouthinkingabout?Youweresaying…Thesethingsarehardtotalkabout.Youwereabouttosay…Questionstoavoid:Don’tcry(?)Pullyourselftogether(?)ConfrontationYoulookupset.Isthereanyreasonwhyyoualwayslookawaywhenyoutalktome?You’reangry.Yousoundfortableaboutit.Whatisthereasonyouarenotansweringmyquestions?Youlookasthoughyouaregoingtocry.InterpretationYouseemtobequitehappyaboutthat.Soundslikeyou’rescared.Areyouafraidyou’vedonesomethingwrong?Yourdizzinessappearstobeaggravatedbyyourargumentswithyourwife.

ReflectionPatient“IwassosickthatIhaven’tworkedsinceOctober2006”.Response“Haven’tworkedsince2006?”SupportSupportIunderstandReassurance“That’swonderful!I’mdelightedthatyoustartedintherehabilitationprogramatthehospital.”“You’reimprovingsteadily.”‘‘That’sgreatthatyouwereabletostopsmoking.’’Empathy‘‘Ihearwhatyou’resaying.’’I’msureyourdaughter’sproblemhasgivenyoumuchanxiety.Thedeathofsomeonesoclosetoyouishardtotake.Iguessthishasbeenkindofasilentfearallyourlife.Youmusthavebeenverysad.Iknowit’snoteasyforyou.I’mdelightedtoseethatyou’retryingtoeateverythingonyourtray.FormatoftheHistory

SourceandreliabilityChiefcomplaintHistoryofthepresentillnessanddebilitatingsymptomsPastmedicalhistoryHealthmaintenanceOccupationalandenvironmentalhistoryBiographicinformationFamilyhistoryPsychosocialandspiritualhistorySexual,reproductive,andgynecologichistoryReviewofsystemsChiefComplaint‘‘Whatisthemedicalproblemthatbroughtyoutothehospital?Chestpainforthepast5hours.Terriblenauseaandvomitingfor2days.Headacheforthelastweek,onandoff.Routineexaminationforschool.HistoryofPresentIllnessandDebilitatingSymptomsSymptomsincludepain,constipation,weakness,nausea,shortnessofbreath,depression,andanxiety.PainAreyouhavingpain?Haveyouhadpaininthepastweek?Tellmewhereyourpainorpainsarelocated.Howhasthepainaffectedyourlife?Areyousatisfiedwithyourpaincontrol?Tellmealittlemoreaboutyourpain.PastMedicalHistoryGeneralstateofhealthPastillnessesInjuriesHospitalizationsSurgeryAllergiesImmunizationsSubstanceabuseDietSleeppatternsCurrentmedicationsComplementaryandalternativetherapiesSleepandMedicationsSleep：Wheredoyougotobed?Doyouhavetroublefallingasleep?Doyoustayasleepthewholenight,ordoyouawakeninthemiddleofthenight,unabletogobacktosleep?Doyougotobedonlywhensleepy?Doyouadheretoaregularwakingtime?Allcurrentmedicationsshouldbenoted.Askyourpatient：Doyouuseanyprescriptionmedications?Doyouuseanyover-the-countermedications?Doyouuseanyherbalmedicationsorvitamins?Doyouuseanyrecreationaldrugs?OccupationalandEnvironmentalHistoryWhattypeofworkdoyoudo?Howlonghaveyoubeendoingthiswork?Describeyourwork.Areyouexposedtoanyhazardousmaterials?Doyoueveruseprotectiveequipment?Whatkindofworkdidyoudobeforeyouhadyourcurrentjob?Wheredoyoulive?Forhowlong?Haveyoueverlivednearanyfactories,shipyards,orotherpotentiallyhazardousfacilities?Hasanyoneinyourhouseholdeverworkedwithhazardousmaterialsthatcouldhavebeenbroughthome?Doyounowhave，orhaveyoupreviouslyhad，environmentaloroccupationalexposuretoasbestos,lead,fumes,chemicals,dusts,loudnoise,radiation,orothertoxicfactors?PsychosocialandSpiritualHistoryTellmealittleaboutyourself：yourbackground,education,work,family.Whoaretheimportantpeopleinyourlife?Whatdoyoudoforfun?Howdoyoufeelaboutthewayyourlifeisgoing?Doyouconsideryourselfspiritualorreligious?Howimportantarethesebeliefstoyou,anddotheyinfluencehowyoucareforyourself?臨床醫學英語教學查房常用詞Firstvisit初診?Toattendtheclinic復診?Out-call出診?Casehistory病歷?Sheet-for-casehistory病歷袋?Turnoverofbeds病床周轉率?Averageofhospitalstay平均住院日數?Wardround查房?Consultation會診?Medicalcertification診斷書?Certificationforleaveofabsence病假證明?Applicationforlaboratoryexamination化驗申請單?ApplicationforX-rayexaminationX光申請單?Requisitionfordrugs領藥單?caserecord病歷醫院工作人員directorofthehospital院長?headofthenursingdepartment護理部主任?attendingdoctor主治醫師?residentdoctor住院醫師interndoctor實習