词汇大师--When There Is Bad News

　　AA: I'm Avi Arditti with Rosanne Skirble, and this week on Wordmaster: giving doctors better skills to communicate bad news.
RS: Anthony Back [pronounced like Bach] is a medical oncologist at the University of Washington and the Fred Hutchinson Cancer Research Center in Seattle. He and four colleagues are in the fifth year leading a program funded with one and one-half million dollars from the National Cancer Institute.
AA: Doctor Back says specially¹ trained actors play cancer patients to help oncologists learn how to avoid sounding insensitive when the prognosis is grim.

　　ANTHONY BACK: "Probably the biggest misconception I face is that you're either born with this or you're not. In fact, what the research shows is that people learn to do this over time. And the way they learn to do it is they see good role models, they practice, they get specific feedback on what they're doing, they try out new things, they innovate² and develop new conversational³ practices for themselves."
AA: "Can you give us some examples of those conversational practices -- what are some ways to impart bad news?
ANTHONY BACK: "Here's an example: The patient has had cancer in the past, has been doing well and is coming in for some routine follow-up tests. The routine follow-up tests unexpectedly show the cancer has started to come back.
"The doctor will typically go in and say to the patient, 'Guess what, your cancer's back.' And the patient will be just blown away, right? There are a couple of practices there that doctors can do that can help. One is to start with -- especially if you don't know the patient -- asking what the patient expected, what did they understand about their cancer, what were they expecting with this test.
"Because if the patient says to you 'You know, they didn't tell me anything. I'm just here because I got this appointment in the mail,' that's one whole kind of comprehension level. Whereas if the patient says 'I had a t-one-n-one-m-zero lung cancer and they told me I had a fifty-five percent chance of disease recurrence⁴ in the next two years,' that's a whole different story, right?
"The second thing is that after you give this difficult news, then I think it's really important to address both the cognitive⁵ reaction and also the kind of the emotional side of it."
RS: "What are some of the phrases or the ways in which you can couch this news?"
ANTHONY BACK: "You know, the way to make it easier is to make sure that you are going from the context the patient drew for you. So you go from what the patient understands and you try to use their words as much as possible. And then, when you get to the really bad part of the news, I think it's actually important to be direct and concrete and not to couch the news.
"It's better to say 'The cancer has come back' than to say 'There are hypo-densities in your liver on the CT' [or] 'You have a malignancy.' All those euphemisms⁶ force patients to struggle to understand what's happening to them, and it adds to their confusion and distress⁷."
RS: "Well, should they say things like 'I wish things were different' or 'I hope for the best,' or should a doctor kind of maintain a distance?"
ANTHONY BACK: "You know, my thought about that actually is that the more skilled the physician, the less they have to distance themselves. There are some phrases that we use, and the most important ones are really the ones that are about empathy for the patient. You know, 'I see this is a difficult situation, I see this is not what you expected, I'm hoping for the best.' And I think it's fine for doctors to talk about hope, and I think it's important actually."
AA: "Let me ask you, have you seen any cultural differences come up in the training programs as you've had doctors go through?"
ANTHONY BACK: "You know, we have actually a very multicultural⁸ group of physicians who come, and they all bring in all their own different values about how frank should people be. Because the American standard, of course, is that patients themselves get all the information, they make the decision themselves, and there's this very strong emphasis on autonomy. And in a lot of other cultures that's really not the case."
RS: "And what got you started in the first place?"
ANTHONY BACK: "What got me started was, when I was an oncology trainee⁹, and this was after a personal experience -- my mother had died of a pre-leukemia kind of thing -- I remember walking around in the bone-marrow transplant wards¹⁰ with this experienced -- it was this other, older senior physician -- going around having these life-and-death conversations with patients and thinking, 'God, there has got to be a better way to do this."
AA: The result, says Doctor Tony Back in Seattle, is a program that has now trained about one hundred-eighty oncologists at retreats held twice a year. The program Web site is oncotalk.info -- that's o-n-c-o-t-a-l-k dot i-n-f-o.

1 specially   

adv.特定地；特殊地；明确地

参考例句：

• They are specially packaged so that they stack easily.它们经过特别包装以便于堆放。
• The machine was designed specially for demolishing old buildings.这种机器是专为拆毁旧楼房而设计的。

2 innovate   

v.革新，变革，创始

参考例句：

• We must innovate in order to make progress.我们必须改革以便取得进步。
• It is necessary to innovate and develop military theories.创新和发展军事理论是必要的。

3 conversational   

adj.对话的，会话的

参考例句：

• The article is written in a conversational style.该文是以对话的形式写成的。
• She values herself on her conversational powers.她常夸耀自己的能言善辩。

4 recurrence   

n.复发，反复，重现

参考例句：

• More care in the future will prevent recurrence of the mistake.将来的小心可防止错误的重现。
• He was aware of the possibility of a recurrence of his illness.他知道他的病有可能复发。

5 cognitive   

adj.认知的，认识的，有感知的

参考例句：

• As children grow older,their cognitive processes become sharper.孩子们越长越大，他们的认知过程变得更为敏锐。
• The cognitive psychologist is like the tinker who wants to know how a clock works.认知心理学者倒很像一个需要通晓钟表如何运转的钟表修理匠。

6 euphemisms   

n.委婉语，委婉说法( euphemism的名词复数 )

参考例句：

• No point is in mincing words or hiding behind euphemisms. 没有必要闪烁其词或者羞羞答答。 来自辞典例句
• No point in mincing words or hiding behind euphemisms. 没必要闪烁其词或者羞羞答答。 来自辞典例句

7 distress   

n.苦恼，痛苦，不舒适；不幸；vt.使悲痛

参考例句：

• Nothing could alleviate his distress.什么都不能减轻他的痛苦。
• Please don't distress yourself.请你不要忧愁了。

8 multicultural   

adj.融合多种文化的，多种文化的

参考例句：

• Children growing up in a multicultural society.在多元文化社会中长大的孩子们。
• The school has been attempting to bring a multicultural perspective to its curriculum.这所学校已经在尝试将一种多元文化视角引入其课程。

9 trainee   

n.受训练者

参考例句：

• The trainee checked out all right on his first flight.受训者第一次飞行完全合格。
• Few of the trainee footballers make it to the top.足球受训人员中没有几个能达到顶级水平。

10 wards   

区( ward的名词复数 )； 病房； 受监护的未成年者； 被人照顾或控制的状态

参考例句：

• This hospital has 20 medical [surgical] wards. 这所医院有 20 个内科[外科]病房。
• It was a big constituency divided into three wards. 这是一个大选区，下设三个分区。