d****y
发帖数: 2180 | 1 请大家把记录的笔记，感想放到这个帖子下面，以便于收精华区。
同时也保证你成为以后会议的VIP.谢谢！ | t********n
发帖数: 90 | 2 The art of language -- communicate effectively in clinical settings
重点讲在医院里的communication，怎样适应美国的文化，怎么在医院中混的如鱼得水
、风生水起～
关于英文：
细节参见麦地前阵子的那两个有关英文的帖子，补充一点非常重要的：不仅要多说、多
念，更重要的是写作能力，脑子里有多少东西嘴巴才能讲出来多少东西。对CMG来说口
音并不是致命问题，更严重的是语言组织能力差，有条件的最好take一门写作的课程。
语言是一门艺术，讲话的方式、body language很重要，语言本身只占2%而已。
做人要nice，但是讲话要让人觉得你 assertive but not aggressive.
eg: 想请护士帮忙查昨夜的vital signs，“This is Dr. Emma, how are u? (各种问
候) I know you’re very busy now, but I really need to see xxx. Would you
please help me to check xxx？ I really appreciate your help”
一定不要讲：CAN you do xxx for me? 而是要用would、could之类的。也不要说
Please check xxx, 即使是用了please了，依然是不礼貌的讲法。
永远要eye ontact、微笑、说thank you very much、握手等，不管多么忙、病人情况
多么危险，都不能慌乱，尽量要自信、淡定地跟别人交流。 如果讲话声音特别大、语
速快，会被人认为你很angry。
医院的基本结构：
护士、护工、各种pharmacists，case manager，social worker，各种therapists
护士：
有很好的，也有会犯错的，要看清那些是dependable的。一定要跟护士搞好关系，关键
时刻会救你一命。
早上查房前先问下护士，昨夜有没有什么事情发生，有特别需要的我注意或者做的。
那些会提醒你某些病人需要特别治疗的护士是好护士。当护士提出对的治疗建议时，一
定要当面感谢、夸赞之，并向nurse manager表扬一下那位护士。
护士不follow你的order或者做错了什么，不要直接向上级医生抱怨，首先要confront
犯错的护士(找个没人的地方)，但是要冷静、不带emotion。Eg：护士多给了aspirin，
confront时，护士肯定不愿承认错误，你要跟护士讲自己什么时间下了这个医嘱，不要
问do u remember，要陈述事实，然后跟她讲，这个不会有致命危险，但是这是个错误
，我们要fix it而且以后要避免。然后要跟主管护士反应这件事情（打电话时一定要问
is xxx available?而不是直接我说要找xxx谈），一样不要带emotion，只讲事情本身
、不要说你们的护士都太差了之类的。最后找attending，跟他讲：this is not
ergent, but I think you need to know. 然后讲事实，告诉他你已经处理这事了，以
防有人告黑状。查房时见到犯事儿的护士，要跟她说：I know你现在心情很难过，但是
这件事过去就过去了，以后我们还是朋友。
如果护士犯了个非常大的错，你没控制住情绪对她发了飙，事后一定要找那个护士道歉
，说今天这件事情错不在我，但是我对你发脾气是不对的。
Case Manager (social worker)
每个医院的CM的工作不完全一样，要搞清楚自己医院CM具体负责什么，会帮到很大的忙
，例如跟家属的交流等。
合理用各种consulting，比如diabetic consultant，可以帮你省去很多对病人做
health education的时间，且可能会提出很多正确的建议。有呼吸系统问题的病人就可
以请 respiratory therapist来，他们可以帮你做很多事情，比如评估病人情况、随访
之类的。情绪不好的病人，可以请chapman consulting帮他们平复心情。对药物不太熟
悉(比如说有肝病的病人需要用有肝损害的药时)，可以咨询pharmacist.
跟medical student的关系
intern、resident都要带学校，med student都觉得自己很牛，另外他们掌握的知识非
常细，但是不系统，他们可能会因为你是外国人就歧视你。一定要看他们的notes，会
发现他们记得东西过于细、不临床，教会他们临床思维。
跟整个team的关系：
要让领导看到你的闪光点，但是功劳都是领导的，苦劳都是自己的，即使一个诊断是你
独立做出的，也要表现出是在领导的指导下做出的正确诊断。切莫抢功劳！要让别人说
你聪明，而不是自己说自己聪明。
team之间出现矛盾，唯一的原因－miscommunication。
跟同事有了毛病，一定不要哭着去跟上级告状，上级会觉得你很幼稚。要自己设法跟当
事人解决问题，设法让对方先讲他觉得什么问题，对方可能指责你之类的，不要反击，
听着。等对方讲完说；谢谢你坦陈的跟我讲这些，现在我来讲讲我对这件事的想法，然
后开始冷静的一条条反驳，讲你为什么这么做的原因，尽量把事儿说开了，一定不要跟
第三个人八卦这事。
遇到“好为人师”的人，跟你平级却整天跟你说“Dr.xxx，I think you should learn
this or that”，还整天拿paper给你看，有些人可能是好意，但是有些人是在挑衅你
，对这种人说句thank u，结果paper就走，找个没人的地方把扔掉就好，不要跟这种人
一般见识。在工作场合，不管怎样都不能发火，一旦发火骂人，你就输了，要强大到不
怒反笑，表现出professional。还有，不能当别人面哭！
建议读一本书： Crucial Conversations: Tools for Talking When Stakes Are High
http://www.amazon.com/Crucial-Conversations-Talking-Stakes-Second/dp/0071771328/ref=sr_1_3?s=books&ie=UTF8&qid=1345687368&sr=1-3&keywords=Crucial+Conversations%3A+Tools+for+Talking+When+Stakes+Are+High
如果遇到病人不愿搭理你，比如说他说“Dr. xxx已经来看过我了，我已经回答过类似
的问题了” 你就按CS上教的方式处理。
如果病人发飙乱吼，就直接问“are u yelling? I notice you’re raising your
voice”但是不要喊会去，也不要怯生生的。大部分人会冷静下来，如果病人还发飙，
就说我知道你现在很upset，我晚点再来看你，然后离开。
发email找医生求做OB的机会，如果对方没有回复email，不要问Did u receive my
email? 这是一种很rude的讲话方式，对美国人来说，这是一种质问。应该说：Dr. XXX
, how are u? I see u’r very busy today. Do you have a minute? 如果没时间就
跟他约时间谈，不要直接问你收到我email没？如果能见面，就不要发email。 | c*****t
发帖数: 625 | 3 Thank you very much Emma for sharing your personal experience and valuable
communication skills.
Effective Clinical Communication
Key point-Adjust yourself to American culture, avoid friction and minimize
trouble during residency life.
1. hospital organization:
from her own experience. English, esp. oral English is not that good when
came to states. Then went to nursing school, struggling for English
communication, with lots of effort, eventually graduate as the top student.
Writing ability is important. Writing capability affect the way your are
speaking. Accent is not that important in effective communication. Accent
reduction is needed, but not the most important. So improve English writing
is a systematic work-from the logic, organize words etc. If your writing
ability improved, your communication will be improved accordingly. Go back
to the two posts before, including lots of good points and tips…
The art of language: the tone, voice, speed, body language (95%) deliver the
most important thing. So the way of communication is very important in
achieving your goal. Be assertive, but not aggressive, rely mostly on your
body language, not the content of the message you delivered. Eg, I need the
nurse to check the vital signs of the patient. “I know you are very busy
right now, would you please go check the vital sign for me? I really
appreciate that.” In stead, if you say quickly” I need you to check the
vital sign, I really really want to check it, can you do this for me?” even
if you are nice, this is very rude. You probably already people without.
Pay attention to the speed and body language when you speak, even in
urgent moment, don’t panic. No matter how you are anxious and panic
, being a group leader, you have to calm down yourself, do not show your
panicky and anxiety.
The organization of the hospital: nurse, resident and attending, pharmacist,
student, occupation therapist, social worker etc. chaplin consulate:
spiritual.
Nurse-know who is dependentable. Know what the nurse is doing. If the work
it beyond her range of work. Like if the nurse say: I think the patient need
a PICC line. She is actually reminding you and you should thank her remind
you, compliment her and make her feel proud of herself. Talk to her nurse
manager (I thank her remind me something that I forgot, I think she’s a
really qualified nurse. Her supervisor will know this for sure) and tell him
/her how good you think she is. She will cover your back from now on. On the
opposite, if you meet an unqualified nurse, she didn’t do what you ordered
the next day. How would you do? You can’t complain that’s the nurse’s
fault. If this is fatal, confront the nurse, without any emotion. Cool down
yourself until you can say anything calmly. Stick to the fact, without any
emotion. “Remind her this is an error, and we need to fix it so that it won
’t happen in the future.” Then talk to the nurse manager, ”is she
available? “thank you very much call me back, I’ll keep it short. Then
state the fact…” then it’s over. Then talk to the attending, it’s not
urgent but I would like to let you know. Then tell him you’ve talked to the
nurse and the manger story. You do this to back you up in case someone is
back stab you…
If someone is back stab you. Talk to the nurse, hug her: I know you are
frustrated…
If you really pissed off and lost your cool. because the nurse
’s fault. You have to talk to the patient but cant admit it’s your fault.
If you did this, please apologize to the nurse cordially. It’s a mutual
process, if you treat the nurse well, then will back you up when you are in
trouble. Appreciate their effort. Don’t say anything harsh.
Talk to the nurse before you round. They will remind you or push you order
stuff.
Low appetite, constipation are very common in hospitalized patients. Order
stool softener. Notice C. difficile when use abx long term.
2. case management (CM)-social worker(SW): know what they do. Know who is
the case manager and social worker today. Anticipate what the patient need,
then talk to the CM and SW. eg if PT need OT/PT. they will talk to the
patient’s family, negotiating with the family and they will get involved,
you don’t have
to put more effort on this. Anticipate the date of discharge (write this in
the order), they will know this from this. Any weak patients with
dizziness/OA/
RA/hypotention etc. Order notes OT/PT consult. HTN/DM, use diabetic counsult
, they will talk to the pt, saved lots of your time. Delegate your job! The
counsalt will suggest you how many times you should check blood glucose or
adjust insulin level, which is very helpful to you.
3. Respiratory therapist (RT)- if you hear wheezing, just call RT. They will
follow up, and show patients how to cough etc. adjustment disorder-chaplin
consulate.
4. pharmacist-hospital has its own protocol. They will take care of dose. If
you have question about the meds, refer to pharmacist and then report in
the rounds.
Talk to your 2nd yr resident, but not attending. FYI him/her, “I ordered
this and that, is there anything else I should do?” more communication
means less troubles from attending.
5. medical student-they are arrogant but not as experienced as you. They pay
more attention to the details. But don’t look down on you. Point out the
problem if they have, don’t care their attitude. Check their notes, because
they are under your wings. double check their notes and correct them.
Relationships
1. about your team- shine yourself but not show off. Attribute all the honor
to your team, not you. Don’t try to show off. If you have friction in the
team, then it’s because of miscommunication. A have conflict with B, but A
talked to C, C gossiped with D, then D talked to E. or A have conflict with
B, A then talked to attending. The right way is: A should talk to B in
person. “I would like to talk to you in private, I want to hear what you
are thinking about this.” Listen to B first “thank you very much letting
me know this. Here’s what I think ... patients care is our first priority,
why I did this, all is for the benefit of the patient. Both of us were
actually did for the good of the patient, do not let this be the conflict
betwn A and B.” confrontational conversation books are very helpful. Solve
conflict.
2. What if someone isolate/distant you? You don’t have to like each other,
but you can work with them. If you don’t like A, it wouldn’t affect the
fact working with A.
If someone distant you, don’t loose your cool. “不以物喜，不以己悲。 If he
pointed out that your poor care, “I understand, but I will relate this to
my attending…” “drxx, you should learn this about high BP, just read this
” if you really don’t know, then thank him. But if he challenge your
boundry, thank him, then toss it in the trash can. Don’t get hurt by their
malicious challenge. Protect yourself from their insult. Don’t loose your
cool, no matter what. If you did this, then you loose in the first place.
They can be unprofessional, but you should be professional. Esp. don’t
loose your cool in public, don’t cry-indication of weakness and immature.
Q1-How introvert people communicate with people?
Nobody is finger pointing to you. Be nice but not a wallflower! American is
very nosy, they are gossiping all the time (so true!!!).
If you distant them, they will be distant you in the same way. So you need
to break the ice. Be proactive and talk to people first. Initiate
conversation. If you are really shy, don’t want to talk to people, then do
something show your nice.
Q2-how did you improve your English in one year?
First, talk more, talk more than 12hours. Murmur to yourself. Watch talkshow
and respond like you were there; Second, improve your writing ability.
Public speech-make a
draft and outline. Or presentation-don’t just read it, but make a vivid
presentation. Third-accent reduction-native language is different in tones
and tunes than English. Use different muscle group when speak English.
Q3-If the patient yelled at you. Then ask him: are you yelling? If he said
yes. “ok, I see you are upset. I’ll come back to see you later.”, then
leave. If he said no:” then say, then we can say politely, continue the
conversation. Know the culture difference.
If the patient is not comply to your treatment. Let him know whatever you
did is for his own benefit. Stay away from the insult.
Q4-dr. did you get my email? (it’s like finger-pointing him) but what you
really want to say is “I was wondering if you would like to let me remind
you again? ” harsh tone.
Address his situation (I see you very busy). Do you think you have one
minute today?
Crucial conversation-when stake is high:
http://www.amazon.com/Crucial-Conversations-Tools-Talking-Stake
Q5-opportunity for public speech?
International office recruit volunteer. Academic presentation-make it as an
public speech. Practice for your smile, for your speech, for your eye
contact and body language. When you running out words-you tend to lookup and
search in your mind. But try your best not do it. Be confident. Admit your
weak point, then improve it.
Q6-English writing class-ENG111, ENG112. Community university offer this
class.
Thinking guild how you speak.
Q7-don’t be afraid making mistake, so don’t care too much. | T****t
发帖数: 616 | 4 最近睡得晚，实在是太困了，没精神记细的笔记了，就说说主要感想吧。不一定是Emma
原话，是我听后心得。
1）说好英文，不只是发音好，要言之有物，会组织语言，把自己表达出来。
2) Be nice to your staff (nurse), show sincere respect to their work，be
generous with "thank you" and praise. They will support your back in return.
3) Keep calm, keep the speed of your speak even in emergency situation.
4）Handle conflict, 一个原则，be professional,别人的冷嘲热讽就当没听见，改干
嘛干嘛。
5）Keep good communication with your colleges, know them personally,their
family et al.
6）多说，一定要有写作能力，胸中有话才能说的出来。练public speech, 要有草稿。 | b********p
发帖数: 20 | 5 我从９点２０时开始听得，之前session is full.
基于TheCat的帖子，补充我听到的一些细节：
6）多说，一定要有写作能力，胸中有话才能说的出来。练public speech, 要有草稿。
a. 上英文写作课，比如大学一年级二年级的课，练习topic writing.逻辑清晰，穿插
名人名言引用，等等，以让文章更生动，更吸引人。
b. 练习演讲，不光是讲清楚技术性知识点，最好能加入笑话等等，调动观众。
推荐阅读：
Crucial Conversations: Tools for Talking When Stakes Are High | d****y
发帖数: 2180 | | m****r
发帖数: 234 | 7 非常感谢Emma，讲的有理有据还幽默。
下面是一些小笔记：
Be assertive, but not aggressive.
与人为善，乐于助人
对待喜欢当老师或者挑衅的人
--保持prefessional，不要往心里去（保护自己）
千万不能发火，维持公共场合的形象（女生不要在公众场合哭鼻子—软弱的表现）
练习Public speech （网友推荐toastmasters）
不要害怕出错，逆流而上
上大一大二的英语（写作）课，e.g. ENG111(书面文), ENG112（应用文）
--练习写作有助于提高说话的水平
--社区大学就可以选，每个州的情况可能不同
推荐的书
"Crucial Conversations: Tools for Talking When Stakes are High"
http://www.amazon.com/s/ref=nb_sb_noss/191-4686404-3911866?url=
对待Difficult pt
--不要把自己置于一个危险的环境
--Be assertive
避免用Did you? Can you? (rude)
--先address对方的情况，表示体谅
--避免质问的口气 | m*********8
发帖数: 292 | 8 语言:
1. 参阅http://www.mitbbs.com/article_t/MedicalCareer/31490657.html
http://www.mitbbs.com/article_t/MedicalCareer/31490715.html
2. 除听说读外, 写作也要特别注意练习.
交流:
说话时注意语气,语调, 方式, 方法, 肢体语言, eye contact.
和nurse, pharmacist, social worker等搞好关系. 比如护士提醒自己工作疏漏的地方
, 要当面感谢她, 并向她的上级提及. 护士工作有严重错误自己发火后, 要为自己的
态度道歉.
出现人际关系矛盾要注意沟通.
有人孤立你怎么办? 告诫自己1) You don’t have to like each other. Talk to
each other. 2)不以物喜, 不以己悲.
不要流露自己的情绪 (掉眼泪, 发火等), 时刻保持微笑和professional.
推荐书: crucial conversation when stake is high
Q: 性格内向不爱说话怎么办? A: 不要等别人跨出第一步来和自己说, 美国人也喜欢
八卦.
Q: 如何快速提高英语? A: 注意写作, 上写作课, 社区大学一般都有开设 (ENG111,
112). 听talk show, 做public speech, 每天说, 不要怕出错. 出错了要能够自嘲.
开发出说美语的肌肉.
Q: 时态总出错怎么办? A: 多说, 熟练到不加思索就能说出正确的时态. | j*******l
发帖数: 7 | 9 Thanks Emma alot for taking her time to give this webinar. I felt it really
helpful.
Just typed some notes during the webinar.
1. Most of us doing research without English training that leads to poor
English, especially writing skills. Accent is not the biggest problem for
CMG. The ability of organizing English and writing is more important-- Had
better taking some writing skill courses.
2. Communication—the art of Language
Body language 95-98% Oral language only 2-5%
Deliver message-nice but assertive
For example: if you need nurse to do something for you: “I know you are
busy right now but I need…Could you do such and such…?”
“I would like/love you to …. Thank you very much”+always smiling, shake
hands etc.
No matter what emergency happens, always keep calm, keep the same speaking
speed. Act like a leader.
3. Hospital organization-need to know how to use most resources:
(1) Nurses: How to keep good relationship with nurses
(A). If a very experience nurse remind you something- you need to show your
appreciation by words. Also find the nurse manager tell them how good the
nurse is. Later on that nurse will cover your back.
(B)If a bad nurse not following your prescriptions then don’t report to
nurse manager first otherwise they will think you can’t handle it. You need
to manage it yourself---you need to confront the nurse yourself. You can
call the nurse “Do you have sometime I need to talk to you in a private
setting”.+ You need to state the fact. + “I don’t think that will put the
patient in danger however I want you know this is an error and we need to
fix it. I hope it won’t happen in the future.”
Call nurse manager: “ I would like to talk to …Is she available today? “
You can leave your pager number.
After nurse manager call you back. “Thank you for calling me back. State
the fact then I don’t think it is going to put patient in danger but hope
it won’t happen again. I already talk to….She is OK with it.”
Talk to attending: “Can I talk to you ...this is not an emergency”.
Next day the first thing is going to wards, hug the nurse show your
understanding.
If in any case you lost your temper you need to apologize to the nurse later
on.
(2) Case manager and social worker
ICU patients you need to touch base with case manager and social worker. Let
me know there is possibility the patient will need PT/OT. Get them on
board.
If need to discharge a patient, you need to put it in doctor’s order.
Diabetes patient if nurse suggest dose adjustment, you can use their
suggestions.
As long as you caught patient has Wheezing you can call respiratory consult.
Ask for help from Chaplain for difficult families.
Talk to nurse before round the wards.
To your attending: let them know everything
Medical students: looks confident but more detail oriented- always check
their notes.
Relationship with your team: let your light shine before but everything
great belong to the boss.
What if there are some conflicts happened in the team? All coming from
miscommunication. Never bypass someone.
“This is what I think..I understand….All we do is to do the best for
patients…”
If someone just want be your enemy, you need to tell yourself I don’t need
to like/being liked by everyone we just work together.
If someone really doing everything against you, that person thought you are
doing poor care. “Our decision is made by attending, but just by me. If
that person still insist, you say that person might be right+ "I will make
sure the attending acknowledge it.”
If challenge You should say thank you but don't let it bother you.
Never lose your temper in public. Be professional! Smile instead of getting
angry. Never cry in public.
Keep Eye contact is important during public speech.
Reference:
Crucial Conversations: Tools for Talking When Stakes Are High
Kerry Patterson (Author), Joseph Grenny (Author), Ron McMillan (Author), Al
Switzler (Author), Stephen R. Covey (Foreword) | u****g
发帖数: 90 | 10 1. need to strengthen writing in order to excel, be a leader;
2. read Emma's two post about English;
3. body language is extremely important for communication, accounting for
more than 95%;
4. be assertive, not aggressive;
5. never be harsh, don't speak too fast;
6. always smile, shake hands, eye contact, be confident, calm. | | | s****7
发帖数: 194 | 11 Emma同学讲的真好！感谢emma百忙之中给我们讲课！最喜欢听emma讲课了，很有感染力
，如行云流水一般流畅，也充满激情。听完讲座，我觉得今晚就应该把书买了，把辅导
班报
了，不然就对不起emma了。
关于语言学习语音语调需要练习，但是如果只练这些，那将只是一些表面功夫。还需要
练习什么？写作，通过写作练习思路及表达，是口头语言提高的基石，这也正是被我们
所忽视的。写作是个痛苦的过程，通过参加eng writing 101class（iTune上我找到有
些课程）等可以有效的提高。但是需要push自己，争取拿到优秀。
----这是我及其认同的，我也认为是及其重要的。
其他还有很多重要的东西，等我慢慢梳理，回头来补充。 | c*******9
发帖数: 122 | 12 Thank you so much, Emma.
You are so generous to share your experience. I learned a lot from you today
. Thanks!!
good nurse:
say thanks to nurse face to face, even can admit you didn't think about it (
excellent, exceeding average nurse). mention the name to the nurse manager
that we have great nursing team here
bad nurse:
confront the nurse. need some time to talk to your privately. state the fact
. is there any reason that u didn't do this? well, i asked you to d/c
aspirin yesterday and it happen at 2:30pm. i asked the pt condition, you
said xxx, I took time to explain the importance and you said yes, and that
happened at 2;30pm. i don't think it is dangerous to have 2 more aspirin
this time. i don't wanna it happens bt you and me. recognize, fix and make
sure it doesn't happen again. but i have to report to your nurse mange.
i need to talk nurse in charge today, is she available now. ok, i can leave
you my pager. thank you very much for calling so quickly. you are busy and i
will keep it short. report and thank you very much.
talk to attending. dr. smith. i don't think it is urgent and i don't think
we need to do anything about it. xxx happened and the nurse admitted the
mistake. but i do wanna let you now. (don't make it a great deal. )
nurse in charge---i am dr. on call. any thing happened over night and any
order do you want
case manager or social worker-----figure out the role of case manager and
social worker. touch base with them (save time for you when pt get
discharged if you involve them early on in pt management). write order "
anticipate discharge in 2 days" to speed up the discharge process.
pt/ot consult (walk difficulty, dizziness, htn, hypotension), speech therapy
evaluation.
dm---diabetic education consult, they might help you suggest insulin dose
adjustment (use their experience).
dietitian consult---at the time of discharge, you don't have to spend time
to educate them.
respiratory therapist---lung problem, help pt recover
depression/very sick pt/stressful pt family: adjust disorder---prescribe
ssri + chapel consult, no matter if they are christian or not.
pharmacist---vancomycin iv per pharmacy----ask and know what prescription
can be managed by pharmacist
pt on antibx ( increase c. diff risk) --- order c. diff toxin(high
specificity, order multiple stool tests)/PCR (99% sensitivity, one stool
test is ok)---don't order meds slow bm. if + then, give metronidazole
resident at 2nd /3rd year----FYI and ask for advice, always update them.
they need to know pt's current situation as well.
medical students----they like to stick to details…HAVE to check their notes
.
when comes to conflict--- i would like to hear your opinion on what happened
today. --- thank you for letting me know what you think, i appreciate it.--
--pt safety is the first priority, i think…
when you are isolated---you can work with people you don't like. you don't
have to be friends with everyone, don't have to like everyone. --we made the
decision with attending. ---- i understand your concern. i will relay your
concern to the attending.
if someone challenges you in public---thank you, bye bye, talk to you later- | m****r
发帖数: 234 | 13 非常感谢Emma，讲的有理有据还幽默。
下面是一些小笔记：
Be assertive, but not aggressive.
与人为善，乐于助人
对待喜欢当老师或者挑衅的人
--保持prefessional，不要往心里去（保护自己）
千万不能发火，维持公共场合的形象（女生不要在公众场合哭鼻子—软弱的表现）
练习Public speech （网友推荐toastmasters）
不要害怕出错，逆流而上
上大一大二的英语（写作）课，e.g. ENG111(书面文), ENG112（应用文）
--练习写作有助于提高说话的水平
--社区大学就可以选，每个州的情况可能不同
推荐的书
"Crucial Conversations: Tools for Talking When Stakes are High"
http://www.amazon.com/s/ref=nb_sb_noss/191-4686404-3911866?url=
对待Difficult pt
--不要把自己置于一个危险的环境
--Be assertive
避免用Did you? Can you? (rude)
--先address对方的情况，表示体谅
--避免质问的口气 | w*********2
发帖数: 26 | 14 Thanks so much, Emma and Daisy!!
Add Social worker and case manger: always touch base with social worker so
they can arrange nursing home etc for you ahead of time. You could also
write "anticipate discarging patient in two days" in order.
For overweight and long stay pts, consult dietitian
For diabetes, consult diabetic consultant
For wheezing, pneumonia, consult respiratory therapist
For ICU and severe pts, consult chaplain
For speaking problem and stroke, consult speech therapist
All save your time and no problem with attending
Check hospital protocol for Pharmacisit and Case manger
responsibility --save your time and work independently
Long-time antibotics, diarrhea do tcdB PCR and contact precaution | m*********s
发帖数: 2268 | 15 感谢emma在百忙中为我们准备的精彩讲座。我是今天8点多开放注册后才进去听的，前
面的错过了，好可惜。就总结一下我听到的。
1。说话的时候注意礼貌，要注重用词用法。请人做事要用could you? would you?不要
用什么can you, will you。不礼貌，容易得罪人。
2。医护关系：对于好的护士，一定好好当面感谢和表扬，他们可以cover your back.
对于不小心饭错误的护士，要及时跟他本人address issue，要及时委婉的报告上级和
nurse manager，不要包子，也不要夸张。
3. consultant：高血压、糖尿病、呼吸病都有consultant可以叫，他们专业性强，有
经验，可以有效减少你在病人身上花的时间。他们提的建议很多也很好，可以参考
4。用药可以找药剂师资讯。
5. 对于在校医学生，觉得建议有用可以用。他们的东西比较细节，不一定都好。
6. 团队关系：
a.让领导看到自己的闪光点。功劳都是领导的，苦劳都是自己的。
b.不要鞠躬，不要自夸，要等别人夸。
c.矛盾都是因为沟通不良：这时要打着patient safety is priority.的旗帜
进行专业、有效的沟通。
7。永远和同事心平气和的说话：工作时一定不能发火，不能吵架，也不能哭。一定要
Be professional，一定要有理有据有节。
8。提高说话能力: 可以练习speech，加强写作，可以去修社区的大学的免费课（如果
有的话），推荐一本好书：Crucial Conversations （amazon link见下
http://www.amazon.com/Crucial-Conversations-Tools-Talking-Stake | f**********d
发帖数: 231 | 16 谢谢emma，讲得很好，学到不少经验。
前面的同学都记得很详细了。我就讲一些感想吧。
1，纠正英语口音重要，但不是最重要。Emma 指出，有时候用英文讲出的话，很冲，自
己都意识不到。确实如此，还是要多注意，时常提醒自己，要委婉的表达。相信不少人
有同样的经历，话讲出来，怎么对方就变了脸色。
2. 和别人相处，不要只是被动，把自己当客，等着别人来和你聊天。我也深有体会。
记得组里来了新人，位子离我较远，我上班抽空看usmle的书，还忙实验，所以和新人
聊得比较少，直接被人打入敌人行列。
3. public speaking, 这个要加强啊 | b******y
发帖数: 31 | 17 Thank Emma, very helpful.
Writing skill help us organize our thoughts. Deliver our thoughts calmly and
clearly in good manner, with appropriate body language. Don't lose your
cool and let your emotion control you. No matter what happens, be
professional and keep eye contact at all time.
Keep updates with any personnel involved in your patient's care. Know their
responsibility, case mange, social worker, pharmacist, dietician, dibetic
education, and chaplin ..., order consultation when needed. Let your upper
level know what you've done, and ask advice.
Praise good nurse, thank her, and mention her to her charge nurse.
Talk to bad nurse in private setting, Be professional, inform the fact , be
assertive. Notify the charge nurse about the issue and then inform the
upper level. 先下手为强，防止恶人先告状。Later on, be nice to this nurse, 对
事不对人。 | l*****y
发帖数: 86 | 18 特别感谢Emma百忙之中给我们做这么精彩的讲座，大爱Emma，讲的生动、幽默、有感染
力，有大将风范。把我的感触分享给大家
关于英语部分：
强调写作的作用，早有成竹在胸，方能出口成章，有机会可以上writing的课：ENG111
、112。
如果没有机会上课，要把握public speech的机会，多锻炼。
语言没有捷径，多练习很重要
不要怕犯错，有自嘲精神
关于沟通，态度特别重要：
遇到困难、刁难：“不以物喜、不以己悲”；不卑不亢；不失去理智，万事淡定
日常工作：与人为善；受到帮助，不吝惜当面赞扬；不当众发飙，私下沟通错误，给犯
错的人机会
遇到矛盾：正面直视、积极解决，不背后议论
要自信、冷静，但时时微笑对人
在医院工作中要积极与各个方面合作，可以节省自己很多时间和麻烦
向人体要求的时候要委婉客气而有礼貌，用would，could，不用can、did
推荐一本关于沟通的书“crucial conversation when stake is high” | j******1
发帖数: 138 | 19 感谢Emmma牺牲自己的休息时间给我们讲了生动的一课。个人觉得这节课的意义远超出
学英语，做医生的范围，很多体会感想对于我们待人处事方面也是很有指导意义的。听
了Emma 的故事，觉得Emma自己蜕变成今天这样心态成熟，运筹帷幄的医生和她近10年
来的风雨历练是分不开的。总之，很感动，感激。最重要的，她能百忙之中抽出时间毫
不保留的告诉我们这些事，让我们少走弯路，这一点就很值得我们学习。
以下是边听边记的东西，有时候不连贯，但是看到精髓就好。
如何在工作中让别人满意
a.问题：大多数来美国的CMG缺乏英文训练，写作能力差，直接影响语言能力。所以只
注重口音不够。应该加强写作能力，下笔如有神。
b.说话方式很重要，否则会让人觉得你很rude, naïve，很难合作的。说话之前应
该考虑 措辞方式以达到效果。应该assertive，而不是aggressive。
Can you do this for me? Rude
I would like you to drop the blood for me. Better
永远微笑，永远eye contact。即使病人情况很危急，你心情万马奔腾，也许要保
持一 直以来的语速，不能语速慌乱，要平静，永远保持平静，有条不紊的指挥。
c. 好护士提醒你没想到的病人出院后的治疗，一定要谢谢他的提醒, 告诉nurse
manager， 当面赞扬，会越来越融洽。
反之碰到不合作的护士，不能向上级抱怨。自己要处理，否则给人没断奶的感觉
。如果是大错，让自己先冷静，找护士谈话，先陈述护士的错误，否认时可说出具体时
间，使其不能否认，并说病人没被置于危险境地，但是希望以后不要再犯这样的错，我
也会告诉manager, 护士会说ok.然后打电话给manager,不带情绪的陈述事实。最后告诉
attending,陈述事实，说前先告诉说不是重要紧急的，但是需要让他知道。这样杜绝别
人在后面嚼舌头。也不会让attending觉得很突然。最后，再见到这个护士，拥抱。
要是很大很大的错误，发过火候记得道歉，做popula人 doctor.
d. 和case manager，soicial worker consult打交道：把你的potential plan 先告
诉他们，让他们心里有数，对你的病人提前安排，这样才能一切顺利运转。
Call diabetic consult, respiratory consult,这些人很专业，甚至给你很专业
的意见。 Call chaperon遇到很难缠的病人的时候，他们很专业，会找病人谈，病人因
此会对你满意。
e. call PT/OT,nutrientist需要的时候，帮你省很多时间。
f. 问pharmacist about 剂量，等等问题，如不知道的话。时时和高年级的resindent
沟通，求建议，告诉他你怎末做的，再求他的意见。让他也了解病人，不至于在
attending面前丢脸。
g. 和team的关系: 功劳都领导的，还要让领导看到你的闪光点。不要抢功劳。Team之
间出现矛盾，一定是沟通不良。双方当面解决，不要跟第三者讲，态度要好，让情绪方
先谈，发完火，再谈你的看法。不要结死结，要及时解决，不要哭鼻子告上级。学会处
理conflict, 有相关很多书籍，也有相关课程。Emma自己觉得上课培训之后，整个人的
说话方式，处理问题的方式都变了。
h. 如果被人孤立，记住不需要喜欢，只有合作。被人给难堪，记住不以物喜，不以己
悲。
i. 记住工作场合一定不能发火，骂人，一定要任何时候都professional，不论多麽被
人冤枉，一定不能掉眼泪，在美国会被认为loser, 在工作场合不要流露情绪，否则都
是不成熟的表现。
对于英语提高方面的建议：
1.寻找 Public speech的机会，可通过international student office到老人院等地方
做volunteer,还有toastermaster,报名费用也不贵。
2.大一大二的英语写作课，让人扒层皮，但是收益很深，课名叫ENG111(
议论文),ENG112(说明文）。（具体什莫文也许不对，大家可自己查找）
3.处理conflict,提高speech书名：crucial conversation when stake is high.
Amazon 有。
最后，个人也觉得提高说话能力和英语水平会让我们路走得更平坦，而不是被人误解
，曲解。说话之前都要作充分铺垫，而不是劈头盖脸，开门见山。Emma讲到在医院和各
种工作者打交道的时候有点吓到了，可能平时生活过于简单，人际也过于简单，这才发
现step1,2,3真的只是行医道路上小小一部分，以后需要修行的地方还很多，从来也没
想到过要怎样措辞，总觉得有好的心意就好。这样原来是很不够的。
总之，大家在学习知识理论的时候，其他方面也要给与时间加强和锻炼。 | d******d
发帖数: 192 | 20 高手讲座，绝不是简单告诉你HOW TO DO IT， 而是会拔高到WHY WE NEED TO
DO IT，虽说主题是提高英语， 但咱们学好英语为了啥， 不就是想让别人理解自个
儿， 喜欢自个儿嘛。 而这个目的不是简单的说出没有口音的英语就能达到的，你得
肚里有货才能讲出水平（先练写作去），你得有足够的情商才能做到不跟领导抢功劳哪
怕确实是你的功劳（看看余泽成咋办的），在同事间脱颖而出而出而又能与之打成一片
，对待下级恩威并重，无论那个级别，在你有麻烦时，都愿意帮着你...
高人啊，对照自己，先把爱哭的毛病改了，拿那时间赶紧练去了。
【在 d****y 的大作中提到】
: 请大家把记录的笔记，感想放到这个帖子下面，以便于收精华区。
: 同时也保证你成为以后会议的VIP.谢谢！
| m******r
发帖数: 1904 | 21 麦地速记员们辛苦了，谢谢大家。
爱马今年还是很红! LOL |
|
