如何用英语向病人告知坏消息？全国医学博士英语考试一则听力长对话带来的启示

小白老师说：语言可能是一剂良药，也可能是一把杀人的屠刀。如何告诉病人坏消息是一门艺术，体现着医生的职业道德和人文素养。今天就来跟大家聊一聊怎样用英语向病人告知坏消息，有案例，有音频，还给大家总结了实用的句子。

“有时去治愈，常常去帮助，总是去慰籍。”这是一名美国医生 Trudean 的座右铭，在医学界广为流传。治愈和帮助，医生做的比较多，其实慰籍同样十分重要。

全国医学博士英语统考2009年真题听力中的一段长对话，堪称是医生向患者告知坏消息（diliver bad news to patients）的典范。在这段医患对话中，医生向患者告知胰腺癌复发（a recurrence of cancer in pancreas）的坏消息，提出治疗方案并预后（prognosis）。态度真诚，措辞得体，实事求是，充分体现了医生的职业素养和谈话艺术。我们一起来听一下这段对话。

点击这里播放对话录音**▼**

Doctor : Mr. Scot, I’d like to record this consultation（咨询，谈话）, so you and Mrs. Scot can play back later for anything that may not be clear to you today. I’m afraid that the scan results（扫描结果） aren’t very good. It’s likely that you got a recurrence of cancer in your pancreas（胰腺癌复发）. That would explain why you’ve been feeling so tired, and your loss of appetite and weight（体重和胃口下降）.

分析：医生首先说要给这次谈话录音，万一患者和家属有什么不清楚的，可以播放谈话录音。然后开门见山地告诉患者扫描检测结果不容乐观，发现胰腺癌复发，并解释这就是患者出现疲劳、体重下降、胃口不佳的原因。

佳句总结：

• I’d like to record this consultation, so you can play back later for anything that may not be clear to you today.
• I’m afraid that the scan results aren’t very good.
• It’s likely that you got a recurrence of cancer in your …
• That would explain why you’v been feeling so …

Patient : Doctor Smith, do I need surgery?

分析：患者问是否需要动手术。

Doctor : Surgery isn’t an option at this stage（手术不是这个阶段的选择）. Although we cannot operate, there’s still a lot we can do to help you. You’ve got tablets（药片） for pain relief（缓解疼痛）, and we can give you something stronger if you need it. We can also start you on a course of chemotherapy（化疗） to help you with your symptoms（症状）. This won’t cure you, but will make you feel more comfortable. It’s unusual to have any unpleasant side effects（副作用） with kind of chemotherapy. I like you to see a dietician（营养师） for some advice on what you eat and to help you get your appetite back.

分析：医生先明确回答不考虑手术，紧接着提出了一些其他的治疗办法，包括给病人开药来减轻疼痛、给予化疗来帮助病人缓解症状。还宽慰病人说这种类型的化疗副作用不大，并建议病人咨询膳食营养师，想办法帮助病人恢复胃口。给人感觉设身处地方方面面都为患者着想。

佳句总结：

• Surgery isn’t an option at this stage.
• Although we cannot operate, there’s still a lot we can do to help you.
• This won’t cure you, but will make you feel more comfortable.

Patient : What’s my life expectancy（预期寿命）? How long have I got?

分析：病人提起预期寿命，问医生自己还有多长时间。这是一个非常敏感、棘手但又不得不正面回应的问题。我们接下来看这位 Dr. Smith 是如何作答的。

Doctor : One can never be certain about these issues. People with this condition vary a great deal. I would be wrong to give a definite time scale. But I’d say it’s a matter of months rather than years. I’m sorry to have to tell you all this, but my feeling is that it’s always good to be honest with people, then you know what’s what. If you are in agreement, I’d like to book you into Ward 2 to start your chemo. You’ll need to come in every week for the next month.

分析：医生表示这种问题并没有明确的答案，因人而异。如果自己给患者一个明确的时间范围，那是不对的。他告诉病人他的预期寿命应该是几个月，而不是几年。其实话说到这里，医生已经回答了病人的问题了，但她并没有打住，补充说道 “很遗憾我不得不告诉你这些，但是我感觉对病人诚实是件好事，病人可以了解情况，合理安排。” 最后，医生明确告诉病人后续复诊的时间和安排。

佳句总结：

• One can never be certain about these issues.
• People with this condition vary a great deal.
• I would be wrong to give a definite time scale.
• I’m sorry to have to tell you all this, but my feeling is that it’s always good to be honest with people, then you know what’s what.
• You’ll need to come in every week for the next month.

由于东西方文化背景、价值观和思维方式的差异及历史原因，中西方在对待“坏消息”方面的认识也存在很大差异。

我曾与美国医生交流，当我谈起中国人术前谈话签字的大都是患者家属时，他大为吃惊，这在他看来不可思议。美国联邦法律规定，病人有权了解自己的病情，医生不能以任何理由隐瞒病情，病人对自己疾病的知情权将使它可以充分安排自己剩余的时间，处理好财产遗嘱及有关事宜。

特鲁多医生曾说：“医学关注的是在病痛中挣扎、最需要精神关怀和治疗的人，医疗技术自身的功能是有限的，需要沟通中体现的人文关怀去弥补”。下面是一些实用的 TIPS, 可以使向病人告知坏消息这件小事充分散发医学人文关怀的光芒。附有实用例句。

Principles of giving bad news

1. Give warnig. 预警。

• I’m afraid your test results aren’t very good.
• I’m sorry to have to tell you that the new isn’t good.

2. Choose an appropriate stting and have a friend or relative of the patient present.

选择合适的谈话环境，让病人有朋友或家属陪同。

3. Take time. 不要着急，慢慢来。

4. Use appropriate language. 使用得体的语言。

5. Emphasize the positive. 强调积极面。

• There’s still a lot we can do to help you.
• Chemotherapy will make you more comfortable.

6. Discuss the prognosis. 与病人讨论预后。

• One can never be certain about these things but I’d say it’s a matter of months rather than years.

7. Supplement the verbal message.

补充其他信息。

• I’d like to record this consultation so you can listen again if anything isn’t clear.

8. Arrange a follow-up session. 安排复诊。

• I’d like to see you again next week.
• Can you come in again next week?

9. Confirm that the patient understands.

再次确认病人明确谈话内容。

• Could you tell me what we’re going to do for you?
• Is everything clear to you?

总之，善用这些 TIPS 和实用的英文表达，医生可以感性地、富有同情心地向说英语的患者传达消息，并通过建立医患之间密切的关系来发掘进一步的治疗潜力，这也是在患者面临疾病危机时医生能够给予支持的一种方法。