以下の英文を読み、設問(1～5)に対する最も自然で適切なものを選択肢の中から一つだけ選び、それぞれ解答用紙の記号((a)、(b)、(c)、(d)または(e))を鉛筆で塗りつぶしなさい。

Vocabulary Preview

intimate: close, personal

cost contaminant: avoiding excessive costs

underscore: emphasize

utilitarian: practical

vulnerable: easily affected, sensitive

intrude: influence in a bad way

introspective: looking inside of yourself

constrained: limited

candor: fairness

Our purpose is to offer instruction in learning about the well and the sick as they seek care. History and physical examination are at the heart of this orderly but by no means rigid effort. It is not easy to get the sense of another person or to fully appreciate someone else's orientation in the world. You and the patient may seem to have a similar experience but may in all likelihood interpret it differently given, in particular, a base of information that may vary enormously. If you are to prevent misinterpretations and misperceptions, you must make every effort to sense the world of the individual patient as that patient senses it.

A primary objective is to discover the root of a patient's concern and to do something about lt. If you do not keep constant this need to identify underlying worries, believe them, and try to deal with them, you will probably not be of much help. You need to understand what is expected of you. Your judgment and flexibility will confirm that each interaction is unique. If you are successful, the intimate nature of the interview and physical examination will be reinforced, and there will be frequent sweet moments with patients when you recognize that your effort is going well and that trust and promise are there. We want to help you ensure those moments.

Much has been written about technology replacing the physical examination and history in some part, but the care of patients goes far beyond the merely technical. Health professionals are enabled by society to offer advice and the potential of healing to fellow human beings. Appropriate care satisfies a need that can be fully met only by a human touch, intimate conversation, and the “laying on of hands.” This physical realization of your relationships with patients, particularly when illness compounds vulnerability, cannot be replaced.

Because cost containment is also essential, the well-performed history and physical examination can, in an advantaged society, justify the appropriate and cost-effective use of technological resources. In a disadvantaged society, it can help compensate for their absence. This underscores the need for judgment and the use of resources in a balance appropriate for the individual patient and for the utilitarian needs of society (Jauhar, 2007).

At a first meeting, you are in a position of strength and your patients are vulnerable. You do not necessarily have similar perspectives but you need to grasp theirs if you are to establish a meaningful partnership. Your beliefs, attitudes, and values cannot be discarded, but you do have to discipline them. You have to be aware of your cultural beliefs, faith, and conscience so that they do not inappropriately intrude as you discuss with patients a variety of controversial issues, such as abortion. That means knowing yourself (Farr et al, 2007).

You react differently to different people. Why? How? Do you want to be liked too much? Does thinking about how you are doing get in the way of your effort? Why does a patient make you angry? Is there some frustration in your life? Which of your prejudices may influence your response to a patient? Talk about such questions with others you trust rather than make this a lonely, introspective effort. You will better control possible barriers to a successful outcome.

This first meeting with the patient sets the tone for a successful partnership as you inform the patient that you really want to know all that is needed and that you will be open, flexible and eager to deal with questions and explanations. Your negotiations are constrained only by the realities of the situation. You can also explain the rules of your practice and the degree of your availability in any situation. Tmst evolves from honesty and candor.

• 1 Which of the following is true about the text?
  • (a) Due to the advancement of medical technology, history taking and physical examination have become unnecessary.
  • (b) Even with today's advancements in the medical field, history taking and physical examination still play a significant role in patient care.
  • (c) History taking is not cost-effective in developed countries, but it could be beneficial in developing countries.
  • (d) The “laying on of hands” is an old tradition and has little impact on modem medical practice.
  • (e) Vulnerability compounded by illness cannot be replaced by physical contact with the patient.
• 2 Which of the following is true about the text?
  • (a) Doctors should be careful not to let their religious and personal beliefs affect the way they care for their patients.
  • (b) For the medical relationship to be successful, the patient should adjust to the doctor's cultural beliefs and faith to avoid any misunderstandings.
  • (c) If a patient requests an abortion, doctors should use their conscience and faith to change the patient's mind.
  • (d) In order to improve the relationship with patients, doctors must be willing to adopt their patients' cultural beliefs and faith.
  • (e) It is important for doctors to explain all the rules to patients during the first meeting, so that they understand what doctors are thinking.
• 3 Which of the following is NOT true about the text?
  • (a) Doctors should show flexibility and willingness to answer questions during the first interview.
  • (b) Prejudice may influence doctors’ responses to patients and become a barrier to a successful outcome.
  • (c) The first meeting with a patient will have an important impact on the type of relationship they develop in the future.
  • (d) When doctors are honest and fair, a sense of trust develops between them and their patients.
  • (e) When doctors feel anger or frustration with patients, they should not discuss their feelings with others.
• 4 Which of the following best summarizes the first two paragraphs of the text?
  • (a) A good understanding of patients' views is essential to discovering and solving their true concerns.
  • (b) Building good relationships between doctors and patients is a good way to encourage misinterpretations and misperceptions.
  • (c) Each patient is unique but doctors must always follow the same approach to ensure fairness for everybody.
  • (d) History taking and physical examination must be done in an orderly and rigid way to make sure doctors get all the necessary information.
  • (e) If you believe everything patients tell you, it is difficult to find and solve their real problems.
• 5 Which of the following best summarizes the final two paragraphs of the text?
  • (a) Doctors must strictly control all aspects of the interview in order to avoid any barriers to a successful outcome.
  • (b) During the first meeting, patients must be informed that they should be open and eager to answer all the doctor's questions.
  • (c) Excellent doctors understand the importance of adjusting to patient needs in building good relationships with patients.
  • (d) Good doctors should ignore their own beliefs in order to provide better patient care.
  • (e) The first interview must always be very comfortable for the patient, therefore, doctors should avoid asking too many questions that may make patients feel upset.