患者及医患沟通
1.The treatment of a disease may be entirely impersonal; the care of a patient must be completely personal.
—— Francis W.Peabody, 1881——1927
【译文】疾病的治疗或许完全不具人情味，但对患者的照护必须充分人性化。
【点评】“医学”是关于生物体的科学，允许具有更多“物”与“理”的属性；但“医疗”的对象是患者，必须赋予更多“人”的属性。
2.The physician is obligated to consider more than a diseased organ, more even than the whole man, he must view the man in his world.
—— Harvey Williams Cushing, 1869——1939
【译文】医生必须考虑的不仅仅是一个患病的器官，甚至也不局限于一个完整的个人，而必须在其所处的世界中去看这个人。
【点评】一般认为，“生物-心理-社会医学模式”是20世纪70年代美国罗切斯特大学的恩格尔（Engel G.L.）教授首先提出来的，没想到这种医学模式的理念早在上世纪40年代前就有人在倡导了，此人就是重要的神经外科先驱库欣病的发现者——美国的库欣（Cushing）教授。
3.A sick person needs someone to trust, and would hold onto a straw if he senses that he is drowning.
—— Vinzenz von Czerny, 1842——1916
【译文】患者需要找一个可以信任的人，当他觉得自己快要淹死时，有一根抓得住的稻草。
4.(reasserting the statement by Avicenna): often the confidence of the patient in his physician does more for the cure of his disease than the physician with all his remedies.
—— Henri de Mondeville, 1260——1320
【译文】（阿维森纳反复强调）：通常，患者对医生的信任比所有治疗方法都更能有效地治愈疾病。
【考注】Avicenna（980 BC——1037 BC）是著名波斯医生，预防医学的创始人，被誉为西方医学史上10位改变历史的医生。
5.The patient is always more anxious to talk than to listen.
—— Theodor Billroth, 1829——1894
【译文】患者总是焦虑不安地倾诉，而不是倾听。
【点评】耐心听患者的倾诉是对患者起码的尊重和安慰。
6.Never believe what a patient tells you his doctor has said.
—— William Jenner, 1815——1898
【译文】永远不要相信患者转述给你的有关医生所说的那些事。
【点评】其原因，我想一是患者不一定转述得准确全面，二是部分患者出于某种目的会刻意捏造一些说法以试探所面对医生的反应。
7.The patient longs for the doctor's daily visit; it is the event upon which all his thoughts and emotions turn.
—— Theodor Billroth, 1829——1894
【译文】患者渴望医生每天的例行查房，因为这是一件决定着他全部思想和情绪的大事。
【点评】请忙碌的医生们能认真对待你每天至少一次的查房。
8.Keep up your patient's spirits by music of viols and ten-stringed psaltery, or by forged letters describing the death of his enemies, or by telling him he has been elected to a bishopric, if a churchman.
—— Henri de Mondeville, 1260——1320
【译文】为患者鼓瑟吹笙，甚至不吝伪造信件说他的敌人已死，或告诉他已经被选为主教，如果他是一名教士的话，用这些办法来提振患者的精神。
【点评】虽有些滑稽可笑，但其良苦用心苍天可鉴。
9.Let the surgeon take care to regulate the whole regimen of the patient's life for joy and happiness by promising that he will soon be well, by allowing his relatives and special friends to cheer him and by having someone tell him jokes,and let him be solaced also by music on the viol or psaltery.The surgeon must forbid anger, hatred, and sadness in the patient, and remind him that the body grows fat from joy and thin from sadness.
—— Henri de Mondeville, 1260——1320
【译文】让外科医生通过承诺患者很快就会好起来，让他的亲朋好友为他加油，让别人给他讲笑话，演奏美妙的音乐来安慰他，以此来调节患者的整个生活方式以获得快乐与幸福。外科医生必须禁止患者嗔怒、怨恨和悲伤，并提醒他“心宽体胖、怒易伤身”。
10.In every case of serious illness someone, not necessarily the patient, should know the truth.
—— James Alexander Lindsay
【译文】 面对每一个重病患者，应该有人（并不一定是患者本人）知道真相。
11.The secret for caring for the patient is caring for the patient.
—— Francis W.Peabody, 1881——1927
【译文】照护患者的秘诀就是给患者以关爱。
12.No one in medicine can escape from the satisfaction which goes with grateful patients...herein ...lies the satisfaction of the practice of medicine and no person in academic life in any of the clinical branches of medicine can succeed who does not respond to such human instincts.
—— Elliot Carr Cutler, 1888——1947
【译文】在医学界，没有人能摆脱受患者之感激所带来的满足感……医学实践的满足就在于此，无论在医学的哪一个临床分支的学术生涯中，倘若对这种人性的本能无动于衷，将没人能获得成功。
【点评】一句话道出了“医生-患者-医学”三者之间良性互动的玄机——我们用先进的医疗技术为患者服务，患者感激医生、感激医学的进步，医生从患者的感激、医学科学的神奇力量中得到一份心灵满足，反过来更激励他们为医学而奉献，为患者而奉献。
13.It is more important to know the patient who has the disease, than to know the disease that has the patient.
—— William Osler, 1849——1919
【译文】了解患病的人比了解他所患的病更重要。
【点评】一语中的，切中要害！
14.The surgeon knows all the parts of the brain but he does not know his patient's dreams.
—— Richard Selzer
【译文】外科医生知道患者大脑的每一部分，但无法知道患者的梦想。
15.Medicines cure diseases, but only doctors can cure patients.
—— Carl Jung
【译文】药可治病，但只有医生才可以治好患者。
16.If doctors just spent more time with their patients so they felt more reassured, that might help.
—— Irving Kirsch
【译文】如果医生肯花多一点时间和患者在一起，让他们感到更安心，那将会有所助益。
17.One of the shortcomings of our medical system is that doctors have very little time with their patients.
—— Eula Biss
【译文】我们医疗体系的一个缺憾就是医生和患者待在一起的时间太少。
【点评】这是医患双方都认同的事实，但破解之道在哪儿呢？
18.Patients cannot tell their symptoms to the surgeon who will not talk to them.
—— Mark M.Ravitch, 1910——1989
【译文】患者无法向不愿与他们交谈的外科医生讲述他们的症状。
19.Patients who trust their doctors and have a psychological expectation of getting better could trigger a reaction in their body.
—— Irving Kirsch
【译文】信任医生，并且心理上有希望好转预期的患者，可能会激发其身体的反应。
【点评】良好的心态的确可转化为有助于疾病康复的生理反应。
20.First thing about being a patient——you have to learn patience.
—— Oliver Sacks
【译文】做患者的第一件事——你必须学会耐心。
21.There is nothing we appreciate more than appreciation.
—— Marie von Ebner-Eschenbach, 1830——1916
【译文】没有什么比感激更让我们感激的了。
22.For the patients the last doctor is always the smartest doctor.
—— Leo A.Gordon
【译文】对患者来说，他看的最后一个医生总是最聪明的医生。
【点评】会治病的医生治病尾。
23.With seriously ill patients, one third of the treatment is for the relatives.
—— Ivor Lewis, 1895——1982
【译文】面对重患患者，1/3的治疗是为其亲属做的。
【点评】即便如此，却不能省去，这就是人文关怀。
24.The intimacy between patient and surgeon is short-lived, but closer than between a son and his own father.
—— Alexander Solzhenitsyn
【译文】患者和外科医生之间的亲密关系虽然短暂，但却比父子更亲密。
【点评】难以承受之重，却也无可推卸。
25.When the patient enjoys the surgeon's visit, seeks his touch and his care,and rests secure in trust, a sort of stress-free basal state is established.
—— Francis D.Moore, 1913——2001
【译文】当患者乐享外科医生来查房，渴望他的触摸和关心，并在信任中获得安全感时，那么一种轻松的基本关系就建立起来了。(https://www.daowen.com)
26.The usual procedure for a doctor when he reached the patient's house was to greet the grandmother and aunts effusively and apt all the kids on the head before approaching the bedside.
—— Arthur E.Hertzler, 1870——1946
【译文】 医生进到患者家后的通常程序是：先热情地问候其祖母和阿姨们，走近病床前，再摸摸所有孩子们的头。
【点评】神父般仁慈的好医生！
27.The adult can safely be treated as a child, but the converse can lead to disasters.
—— Lancelot Barrington-Ward, 1884——1953
【译文】可以像对待小孩一样对待成人，但若反过来则会导致灾难。
28.Old men easily endure fasting; those who are middle-aged not so well;young men worse than these; and children worst of all, especially those who are of a more lively spirit.
—— James Alexander Lindsay
【译文】老年人容易忍受禁食，中年人次之，年轻人更差，最差的是小孩，尤其那些活蹦乱跳的小孩。
29.Every patient had become a "case".Not an individual, whereas in fact there was a good reason for regarding each patient as a separate problem for careful consideration according to individual circumstances.I have ever since that time tried to eliminate the word "case" from the writings.It had become a universal curse to medical thinking and still is.
—— Geoffrey Keynes, 1887——1982
【译文】每个患者都是“个案”，这并非个别现象，事实上有充分的理由根据每个人所特有的情况将每个患者视作一个单独的问题来仔细考虑。我一直试图从各种文章中删去“个案”这个词，它已经成为医学思维中一个普遍的咒符，现在依然如此。
【点评】习惯上我们只把那些特别与众不同的病例当作“个案”来报道，事实上每个案例彼此之间都存在很大差异，需区别对待。我们的传统中医就是这方面的典范，即使两个不同的人都诊断为“上感”，其处方未必相同。
30.Never refer to a patient as an organ or as an operation.
—— Leo A.Gordon
【译文】千万不要用器官或手术名称代指患者。
【点评】这种陋习，似乎已经见怪不怪了。
31.Doctors always think anybody doing something they aren't is a quack; also they think all patients are idiots.
—— Flannery O'Connor
【译文】医生们总认为那些与其做法不一样的人都是庸医，也认为所有患者都是白痴。
【点评】 生命奥妙无穷，新理论、新技术各显神通。临床医生应科学、客观、宽容地对待自己不熟悉的诊疗技术，并给予患者充分的选择权，没有必要唯我独尊。
32.There is among doctors, in acute hospitals at least, a presumption of stupidity in their patients.
—— Oliver Sacks
【译文】许多医生，至少在急诊室，想当然地认为他们的患者都是愚不可及的。
【点评】或许是一种“职业潜意识”，当警醒！
33.I truly feel the best doctors are ones who are criticized by nurses, patients and family.They do not make excuses and learn from their mistakes.
—— Bernie Siegel
【译文】我真觉得最好的医生是那些受到护士、患者及其家属批评的医生。他们不做辩解，然后从错误中汲取教训。
【点评】这样的好医生需要一生的修炼。
34.The art of medicine consists of amusing the patient while nature cures the disease.
—— Francois-Marie Arouet de Voltaire, 1694——1778
【译文】医学的艺术在于让患者开心的同时依靠其自然本能痊愈。
【点评】这也未必太理想化了！
35.Do not perform elective surgery on patients you dislike——refer them.
【译文】不要为你不喜欢的患者做择期手术——转给其他医生。
【点评】尽管我们不应该对任何患者有偏见，但实际工作中难免会有例外。为减少外科医生心理定式对手术的不良影响，应该考虑上述建议。
36.Encourage difficult patients or families to seek a second opinion.
【译文】鼓励难以对付的患者或其家属寻求第二意见。
37.The patient who has bad vibes before the operation is usually right.
【译文】手术前患者情绪不好是正常的。
38.When it comes to operation, you advise and the patient decides.
【译文】涉及手术时，无非就是你给建议，患者做决定。
39.It's not the surgeon who takes the chance; it's the patient.
—— Gail Waldby
【译文】承担风险的不是外科医生，而是患者。
【点评】因此，作为医生的我们，要充分理解患者的心理负担。
40.What the family will decide depends entirely on what and how you'll tell them.
—— Moshe Schein
【译文】患者家属的决定完全取决于你告诉他们什么，以及如何告诉他们。
【点评】完全认可这一说法。所以医生应尽可能客观全面地向患者及其家人介绍病情，既不夸大也不隐瞒，更不能诱导。
41.Make the patient earn the operation.
—— Moshe Schein
【译文】必须让患者从手术中获益。
42.Surgery is an irrevocably invasive remedy which links patient and surgeon more clearly than in other areas of medicine.
—— Charles L.Borsk
【译文】外科手术是一种不可逆转的侵入性治疗，它比医学其他专业更直接地将患者和外科医生联系在一起。
43.Compassionate doctors sometimes lie to patients about the severity of their condition, and it is not always wrong to do so.
—— Richard Dawkins
【译文】富有同情心的医生有时会对患者隐瞒其病情的严重性，这样做并不总是错误的。
【点评】对患者可适当隐瞒，但应明确告知其家属全部真相。
44.For us, an operation is an incident in the day's work, but for our patients it may be, and no doubt it often is, the sternest and most dreaded of all trials, for the mysteries of life and death surround it and it must be faced alone.
—— Berkeley Moynihan, 1865——1936
【译文】对我们而言，手术只不过是我们的一项日常工作 ；但对患者来说，手术可能是，而且毫无疑问常常是他们面临的最严峻、最令人畏惧的考验，因为身陷生死未卜之境，还必须独自面对。
45.Great intelligence, and high position in a patient, bear no relation to his understanding of medical problems.
—— Mark M.Ravitch, 1910——1989
【译文】患者的高智商、高地位，与其对医学问题的理解无关。
【点评】千真万确。经常遇到很多平日里六面玲珑、八面威风的患者，一见到医生就立刻变得思维混乱、莫衷一是了。
46.The patient's family will never forgive a guarantee of cure that failed and the patient will not let the physician forget a pronouncement of incurability if he is so fortunate as to survive.
—— George T.Pack, 1898——1969
【译文】患者家属永远不会原谅一个以失败而告终的治愈保证；同样，如果患者能幸运地活下来，他也不会让医生忘记当初那个无法治愈的宣判。
【点评】通常，无论是医生还是患者或其家人都更乐于接受后一种结果。
47.The stronger the family ties (helpful and unhelpful) the more intense will be the family's reaction (helpful and unhelpful).
—— Neal R.Reisman
【译文】与家庭关系越紧密（无论有益或无益），其家属（对患者结局）的反应就越强烈（无论正面或负面）。
48.Beware the patient with thin notes.
【译文】当心用小纸条的患者。
49.With seriously or terminally ill patients, be wary of kin from afar.They are often trouble.
—— Clifton K.Meador
【译文】对待重病或终末期疾病患者，要提防其远亲，他们经常惹麻烦。
【点评】没想到在美国也有这种情形!
50.Few things make me more unhappy than ingratitude——ingratitude of patients I have really served, ingratitude of assistants I have really helped.
—— J.Chalmers Da Costa, 1863——1933
【译文】几乎没有什么比忘恩负义更让我不高兴的——我真正服务过的那些忘恩负义的患者，我帮助过的那些忘恩负义的助手。
【点评】不高兴归不高兴，却没必要有“悔不该当初”的想法。医护人员慈悲为怀，“宁天下人负我，不可我负一人”。
51.Most patients are well-meaning and generally nice.But every now and then, you will get one who is a total pain to deal with … In fact, an article I read on CNN.com stated that doctors report having a "difficult" encounter with one out of every six patients.With some of the primary care docs seeing 24～30 patients a day, the number of difficult patients can add up every day and every week.It's no wonder why burnout rates are so high!
—— Ryan Gray
【译文】大多数患者都是善意的，一般来说都很好。但时不时地，你会遇到一个让你头疼的人。事实上，我在CNN.com上读到的一篇文章称，每六个患者中就能遇到一个“困难”的。一些初级保健医生每天要看24～30个患者，难缠患者的数量每天和每周都在增加。难怪（医生的）倦怠率如此之高!