Exercise 48. Explain in English.

to perform a physical examination; without special treatment; primary care; specialized care; to keep up with all the important advances; nonsurgical treatment; to prescribe treatment; highly specialized laboratory tests; health-care career; under the guidance of physicians; to run smoothly around the clock; to maintain machinery; general anesthetic.

Exercise 49. Fill in the blanks with these words and phrases and translate the sentences.

physical and occupational therapists	examining patients	surgery
family practitioners and specialists	clinics and hospitals	relieve
provide medical care	health care	X-rays
medical technologists	ailments	diagnosis
perform laboratory tests	prevent	diagnose
doctors and nurses	dentists	treatment

1. When epidemics threaten, (1) ______ work to (2) ______ the spread of disease.

2. In the past, patients received (3) ______ at home for most kinds of illnesses and doctors cared for patients almost single-handedly. Today doctors head medical teams, made up of many skilled professionals. (4) ______ have become the chief centers for medical care in most countries.

3. In addition to medical care, (5) ______ includes the services provided by (6) ______, clinical psychologists, social workers, (7) ______, and other professionals in various fields of physical and mental health.

4. Serious (8) ______ require (9) ______ by an expert, who, in most cases, is a doctor.

5. For thousands of years, drugs and (10) ______ have provided the chief methods of treating disease. By now science has helped develop entirely new methods. Radiotherapy, for example, makes use of (11) ______ and radioactive rays to treat cancer. Besides, X-ray machines and other devices help doctors (12) ______ illnesses.

6. A lot of doctors in industrially developed countries serve as medical researchers, teachers of medicine, or administrators of medical institutions. Doctors who (13) ______ are called (14) ______.

7. Nurses with special training may (15) ______ doctors of various routine duties, such as (16) ______. Skilled (17) ______ operate complex equipment and (18) ______.

keep up with medical progress	physical examination	pharmacy
blood pressure and heart rate	emergency treatment	full-time staff
ambulatory surgical unit	round-the-clock-care	pharmacists
laboratory, medical, and pharmacy records	nurse practitioners	primary care
best quality of care	maternity unit	pediatrics
intensive care units	emergency room	specialized
accident victims	paramedics

8. Doctors have their own code of ethics. It includes charging reasonable fees, providing the (19) ______, respecting a patient's confidence, dignity, and privacy. Doctors (20) ______ by reading medical journals and books, attending conferences, and consulting with other specialists.

9. Hospitals offer services not available anywhere else. Patients receive (21) ______ from a (22) ______ of doctors, nurses, and other skilled workers. Modern hospitals have (23) ______, which use television and electronic devices to keep constant watch over seriously ill patients.

10. Clinics provide (24) ______ for outpatients. There are (25) ______ clinics that diagnose and treat alcohol and drug abuse, psychiatric disorders, or AIDS.

11. In the (26) ______ doctors provide immediate care for (27) ______ and people who have suddenly become ill.

12. The (28) ______ helps protect mothers and newborn babies from infection by keeping them apart from other patients. Many hospitals also have an (29) ______ which performs uncomplicated surgical procedures such as the repair of knees and elbows.

13. Electronic equipment helps keep a continuous record of a patient's (30) ______, respiration and temperature. Computers help hospitals keep (31) ______.

14. Today many ambulances are staffed by highly trained workers called (32) ______, who can provide lifesaving (33) ______.

15. (34) ______ are nurses who have had additional training in a certain area of specialized practice, for example, (35) ______. These nurses give (36) ______, diagnose and treat minor illnesses.

16. (37) ______ is the profession concerned with the preparation, distribution, and use of drugs. It also refers to a place where drugs are sold. At one time, (38) ______ compounded their own medicines. Today pharmaceutical manufactures supply most drugs.

Exercise 50. Translate the Ukrainian parts of the sentences.

1. Most парамедики handle routine medical duties, for example, невідкладна медична допомога жертвам нещасних випадків. Before treating а victim, they use а two-way radio to contact лікарі в найближчій лікарні. They report the extent of any injuries, the victim's pulse, blood pressure, and breathing condition. Such basic information helps the doctor визначити належне лікування.

2. In addition to caring for the sick медсестри допомагають багатьом людям залишатися здоровими. Вони навчають дітей та дорослих захищати себе від хвороб.

3. Досягнення в багатьох галузях науки й техніки have created а medical revolution in the 1900s. Відкриття рентгенівського проміння in 1895 enabled doctors to "see" inside the human body, щоб діагностувати хвороби й пошкодження. Some devices have helped хірургам розробити нові методики щодо порятунку життя, особливо у сфері кардіохірургії й пересадки органів.

4. Hospitals paid little attention to cleanliness before the mid-1800s. Операційні were often dirty, and surgeons проводили операції in street clothes. Up to half of all surgical patients вмирали від інфекцій.

5. Фізіотерапія корисна при лікуванні багатьох хвороб та недуг. Фізіотерапевти використовують різні види устаткування such as radiant heat lamps, hydrotherapy, and paraffin baths.

6. Працетерапія зазвичай призначається людям affected by an injury, illness, or emotional problem, or by aging. Фахівці з трудової терапії, перш ніж призначити курс лікування, ознайомлюються з історією хвороби, інтересами й біографією пацієнта.

7. Many nursing homes do not provide medical care on а regular basis. They accept patients, яким необхідний цілодобовий догляд, але не потрібна госпіталізація.

8. Зростання кількості медичних спеціальностей has led to а great improvement in the quality of medical care. But as more and more doctors have become фахівцями, fewer doctors may be available for первинної медичної допомоги. Зараз у США є попит не на педіатрів або дерматологів, а на лікарів загального профілю, так званих сімейних лікарів.

9. Active immunization is another term for вакцинація. А vaccine містить речовини, які стимулюють захисні сили організму (імунну систему) to produce antibodies against а particular infectious disease.

10. Крім штату лікарів та медсестер, а hospital employs дієтологів, медтехників, фармацевтів, фахівців з фізіо- й трудової терапії, сестер-господарок, кухарів, санітарок, прибиральників тощо.

Exercise 51. Reread Text D and decide whether these statements are true, false or not stated. Correct the false ones. If the statement is true, enrich it with details. If it is not stated, say whether you share the same view.

1. Treatment of disease or injury is the major element of medical care.

2. For making a final diagnosis, the doctor always asks the opinion of other specialists.

3. Disease prevention necessarily involves vaccination.

4. Family practitioners don't provide specialized care.

5. Registered nurses have graduated from a school of nursing.

6. People who wish to become paramedics must complete an extensive- training program given by a hospital or college.

7. Medical technologists supervise laboratory technicians, who perform routine laboratory tasks.

8. Teaching hospitals treat and educate children.

9. The nursing staff of a hospital consists of registered and practical nurses.

10. The rehabilitation department takes care of disabled people.

11. The emergency unit provides care for critically ill patients.

Exercise 52. Answer the questions:

1. What are the main elements of medical care?

2. How do doctors make a diagnosis?

3. What patients require special treatment?

4. How do doctors and local governments help prevent disease?

5. What do family practitioners do?

6. What is the difference between a general practitioner and a specialist?

7. What professionals help doctors?

8. What can nurse practitioners do?

9. How is technical support provided and who by?

10. What kinds of hospitals are there?

11. What departments of a hospital will you refer to the ones treating the sick?

12. What units are there in a typical general hospital?

Exercise 53.

A. Read and translate the text.

Why have health care costs risen so high? The answer to this question is multifaceted and includes such factors as physicians' fees, hospital costs, insurance costs, pharmaceutical costs, and health fraud. Of the total healthcare bill, physicians' fees account for approximately 19 percent. The fee-for-service that doctors charge has risen steadily in response to reimbursement through third-party payment plans such as Medicare* and private health insurance. Prior to this method of reimbursement, doctors charged less because it was coming directly out of their patients' pockets, and they knew that if they overcharged their patients, they would simply shop around for a better deal. It is ironic that the third-party payment plan that was introduced as a way to guarantee affordable health care for Americans has become the major factor fueling the rapid rise in the cost of health care. This form of reimbursement has not only reduced incentives to keep prices down, but has changed the very nature of medicine itself. Today private physicians have to spend increasing amounts of time and resources on administrative tasks just to cope with the mountain of paperwork brought on by third-party payments. Another factor contributing to rising health care costs is the number of overused and unnecessary medical procedures that are performed each year. Current evidence suggests that billions of dollars are wasted on unnecessary tests and surgeries that may also place the patient at risk. Their overuse often can be blamed on physicians' and hospitals' greed. However, the excessive use of medical procedures and technologies by physicians can also be attributed to overzealousness. In many instances, physicians choose to employ all the medical technology and procedures at their disposal, feeling that they should do everything medically possible to help a patient, regardless of the costs involved. Despite physicians' good intentions, they are nevertheless driving up the cost of health care. It would be interesting to ask these same physicians if they would order as many medical tests and procedures if they knew the patients would have to pay for them out of their own pockets. However, the focus has shifted from the emotional and medical needs of the patient to financial considerations of the doctor and the system. Hospitals have also contributed to the high cost of health care in the United States. Statistics indicate that they account for approximately 38 percent of all health care expenditures. Normally, in a free market economy, the concept of supply and demandusually dictates that as supply exceeds demand, the price drops. Unfortunately, the reverse is true in the case of hospitals. Studies have found that as the number of hospitals increases in a given region, the cost of hospitalization rises. This phenomenon may be explained by two principal factors: (1) with increased competition, hospitals try to attract doctors and patients to their facilities by equipping themselves with sophisticateddiagnostic and surgical facilities that increase the hospitals' costs, and (2) physicians tend to make their decisions regarding the admittanceof patients to hospitals based on the availability of beds. It has been estimated that 15 percent to 30 percent of hospitalizations are unwarranted and waste millions of health care dollars. Current estimates also indicate that approximately 20 percent of a hospital's budget is spent on billing and paperwork. The one area of health care costs that is often considered immutable is the cost of medical technology and pharmaceuticals. The plain truth is that Americans pay substantially higher prices for pharmaceuticals and diagnostic tests than in any other industrialized country. * Note. Medicare is a U.S. government health insurance program.

ошукування хворих (пацієнтів)   оплата, покриття     призначити завищену ціну   стимул   впоратися з     медичні процедури     надмірна старанність   в розпорядженні     витрати на охорону здоров'я попит та пропозиція   конкуренція складний     прийом   необґрунтований     незмінний

B. Make up 2-3 questions to each paragraph and ask your group-mates to answer them.

C. Is health care just another commodity? Or should it be treated differently from other consumer services?

D. Don't you think that before changing our health-care system we should learn from other nations' mistakes and critically study the strong and weak points of different types of medical insurance?

Exercise 54. Read the text and answer the questions below.

What do we mean by "health"? From one point of view, health can be defined simply as the absence of illness or disease. This view may be called the medical model of health, and it is the model that has come to prevail in Western nations. The medical model is the principal point of reference for the U.S. health-care system. This system includes practicing physicians and other medical professionals; the settings in which they practice (clinics, hospitals); the universities, research centers, and manufacturing corporations that create new drugs and medical technologies; and the organizations that regulate health care and help consumers purchase it (government agencies, insurance firms). Guided by the medical model, the health-care system focuses on responding to the problems of individuals who present themselves to it. The system is largely skewed toward curative, rather than preventive, activities. Critics have suggested that the medical model provides a very narrow, and in many ways inadequate, definition of health. A broader and more adequate conception would define health as the condition that exists when people are free to use their mental and physical capacities to the fullest extent possible. Anything hindering this freedom would be viewed as contributing to poor health. For example, a preventive health-care system might place high priority on making sure that everyone in a society had access to: 1. Adequate food, water, clothing, shelter, and hygiene. 2. Jobs with wages that permit a decent standardof living, and the education and training necessary to perform them well. 3. A guaranteed minimum income above the poverty line for those who cannot work. 4. Safe, flexible, low-stress workplace conditions. 5. Affordable, high-quality child care and elder care for households that need it. 6. Adequate vacation and leisure time to engage in individual and group recreation. 7. A natural environment cleansed of and protected against toxic and other harmful polluting substances. 8. A social environment unmarred by the threat or reality of warfare, criminal assault, and other forms of violence A preventive health-care system would be aimed at enhancing people's collective well-being, rather than primarily aimed at responding to individual cases, as is the medical model. Few societies have made far-reaching moves to organize their health-care systems around a preventive model. Sweden has perhaps gone the furthest in this direction. Because of the prevalence of the medical model, the most commonly used indexes of health status relate to illness and death, rather than to how well people are exercising their potential. Among these measures is life expectancy. This statistic can vary greatly from society to society. In 2002 life expectancy in Italy was 76 for men and 82 for women, but in Sierra Leone it was only 43 for men and 49 for women. Another commonly used measure of health status is the rate of infant mortality. This refers to infant death in the first year of life and is expressed in terms of the number of infant deaths per 1,000 live births. Again there is wide variation worldwide. In 2002 the infant mortality rate was 122 per 1,000 live births in Somalia but only 5 per 1,000 in Canada. Finally there is the rate of maternal mortality. This refers to the death of a mother as a consequence of pregnancy and birthing; the rate is expressed as the number of mothers who die per 100,000 infants born. The variation is once more quite extreme. In 1988 the rate was 123 maternal deaths per 100,000 infants born in Ecuador but less than 6 per 100,000 in Austria. In 1900 the leading causes of death in the United States were pneumonia, influenza, and tuberculosis. Today these acute infectious diseases rarely kill; instead, most people die of chronic diseases such as heart disorders or cancer. The primary reason for the change is that we now have antibiotics and other drugs that can cure infectious diseases. In addition, standards of living and public health have greatly improved. More people today eat a healthier diet, drink comparatively clean water and uncontaminatedmilk, and live in environments relatively free of insects, rats, and other carriers of disease. These factors tend to protect people from acute infections so that they may live long enough to develop the chronic diseases of "civilization" (those associated with modern life in highly developed countries). For example, lack of exercise and a diet high in fats and salt have been linked to the development of heart and vascular disorders. Similarly, modern dietary patterns and long exposure to low-level cancerogens have been associated with certain malignancies. Prosperity can thus have negative physical consequences. What would happen if these risks of modern life were greatly reduced or even eliminated? What if most people in the industrialized world quit smoking, ate a healthier diet, got regular exercise, and avoided cancerogens? Of course, everyone would still die eventually. But people would live longer, more active lives and would remain comparatively free of disease until their last few years. This process is called a compression of morbidity. With a compression of morbidity, suffering from disease would be confined to the very-end of life for most people. A widespread compression of morbidity will occur if we are able to reduce the factors that give rise to chronic diseases. Some reductions people can undertake by themselves, such as giving up smoking, drinking less alcohol, eating a diet low in fats and salt, and getting more exercise. Reduction of environmental pollution, in contrast, is more a matter of collective effort. The workplace, too, contains many health hazards, and certain occupations pose particular risk by exposing people to cancerogens. Controlling the environmental pollutants and toxins that cause work-related cancers requires that society adopt a "get-tough" policy with businesses that don't meet minimum safety standards. Another health hazard is violence. Violent acts may take many forms, but the most common are violent acts against women by men. Between June 1994 and October 1995 America was fascinated by one of the most violent crimes in the twentieth century – the O.J. Simpson murder case. While this case was about murder, it also raised the issue of spousal abuse. Aside from murder, sexual assault is one of the most violent acts. Date rape or acquaintance rape has recently emerged as a major security issue at numerous colleges and universities throughout the U.S. At this time it is difficult to determine whether this form of sexual violence is relatively new or has been quietly going on for years, like wife beating or sexual harassment. We do know that date rape is widespread, with the number of reported cases growing rapidly. In 1989 it was estimated that between 13 percent and 25 percent of all coeds attending American universities were victims of date rape. Statistics also indicated that in most cases the victims knew their assailants. Morbidity will probably be compressed for some groups much faster than others because of the social inequalities that exist in society. The incidence of many diseases differs significantly among Americans by sex, race and ethnic background, and socioeconomic status. Although some evidence exists that women experience more minor illness than men, women outlive men by an average of more than seven years. No one knows why this is so, but sociologists have proposed explanations that take into account differences in lifestyle, diet, activity level, and social circumstances between men and women. Some point to the fact that more men smoke cigarettes and engage in other risky behaviors (drinking too much, participating in dangerous sports, driving too fast), and until recently men experienced more stresses and strains of the workplace and of the breadwinner role. Others maintain that certain genetic factors make women physiologically hardier than men. Female hormones, for example, seem to play a role in protecting women from heart disease, and women seem less prone to high blood pressure than men are. There are also health differences based on race and age. For instance, African-Americans and Hispanic-Americans have higher mortality rates, or death rates than white Americans do. The cancer rate among black men is nearly one and a half times what it is among white men, and more than double what it is among white women. And black men have twice as many strokesas white men. These racial and ethnic differences point to the role of social factors, such as poverty, in illness and disease. Blacks and Hispanics are on average poorer than whites, and lack of material resources is linked to ill health throughout the world. Poverty means inadequate nourishment; unsanitary, poorly heated housing; and more exposure to stress and violence that can cause injury and disease. It also means lack of access to preventive health-care measures such as prenatal care and well-child checkups in addition to fewer trips to the doctor for treating minor illnesses before they become major. The frustrationof poverty may also foster self-destructive behavior such as alcoholism, smoking, drug abuse, and other forms of risk-taking that weaken the body's immune system and leave a person more vulnerable to disease and infection.

переважати     науково-дослідний центр     перекошувати     заважати, перешкоджати     гідний рівень     межа бідності     доступний   незатьмарений   підсилювати, підвищувати   передбачувана тривалість життя     дитяча смертність     варіювання, коливання   материнська смертність     хронічне захворювання   інфекційне захворювання   незабруднений   переносник хвороб   канцероген злоякісна пухлина   кинути палити     скорочення кількості хворих обмежувати   забруднювач навколишнього середовища   насильство     жорстоке поводження з дружиною /чоловіком зґвалтування, спроба зґвалтування     сексуальне домагання     студентка учбового закладу для представників обох статей нападник     соціальні обставини     годувальник сім'ї   схильний   рівень смертності   інсульт, параліч     харчування     медичне обслуговування вагітних розчарування сприяти

1. What does the medical model of health imply?

2. What does the U.S. health-care system consist of?

3. Why is the preventive health-care system considered a broader and more adequate conception?

4. On what does the preventive health-care system place priority?

5. What are the most commonly used indexes under the medical model?

6. What is the primary reason for the change in the leading causes of death?

7. Why can prosperity have negative physical consequences?

8. What process is called a compression of morbidity?

9. Mow can it be achieved?

10. What forms do violent acts take?

11. Why do women outlive men?

12. What racial and ethnic health differences in the incidence ofmany diseases are there inthe U.S.?

13. What does poverty mean?

Exercise 55. Compare and contrast:

1) fee-for-servicemedicine and free-of-charge medicine;

2) the U.S. health-care system and the one in this country;

3) internal and external health factors;

4) environmental, workplace, and violence health hazards;

5) chronic diseases of "civilization" and some infectious diseases (like anthrax – моровиця)

Exercise 56.

A. Prepare a talk beginning with the sentence:

A preventive health-care system is a multifaceted objective as...

B. Listen to your group-mates' talks, take notes of the new (not mentioned by you or in the texts) points, discuss the controversial ones and unite your effects in creating a final list of at least a dozen well-grounded advantages of this model as well as at least ten conditions that will make it possible.

Exercise 57. Have you ever thought that your convalescence may depend on the relationship with your doctor? Translate the following text and discuss whether the situation in the U.S. in the last decade of the 20th century is similar to ours. Argue if necessary the controversial issues or even delete them. Could you suggest any ideas of your own how to make the relationship between doctors and patients a lot better?

Ask just about anybody and you'll hear a doctor horror story, a tale that reflectsthe indignation with which Americans have come to view their healers. Although doctors were once the symbol of reassurance, the public seems to have relegated them, along with lawyers, politicians and journalists, to the pool of suspect professionals. The rise in malpractice suits – 300-fold in the past 30 years – would seem to bear out that disenchantment. Public opinion polls tell a somewhat different story. A poll commissioned by the American Medical Association, for instance, found that 93% of 1,519 people surveyed were satisfied with the care they had received in the preceding year. Wherein does the truth lie? As one might expect, it's somewhere in between. There will always be doctors who are able to shrug offthe dehumanizing pressures of modern medical practice to provide skilled and empathetic care. But the chorus of patients' complaints suggests that many doctors do not provide such care. The doctor-patient relationship, once considered the basis of therapy, has been subverted bytechnology, bythe medical education system and, more dramatically, by the intrusive demands of managed care. In the early part of the last century, most doctors lived and worked in the communities they served, making house calls and carrying the obligatory black bags stocked with the tools of their trade – thermometers, stethoscopes, cotton balls, syringes and a limited array of pharmacological treatments, including morphine and insulin. Most prescriptions were for vegetable extracts of dubious value, and most doctors were painfully aware of the limitations of their calling. Today's patients have access to technology and drugs that old-time doctors couldn't have dreamed of offering and people now go to hospitals to be cured rather than to die. Ironically, though, many-patients feel less "cared for" than ever. "In the 1950s and '60s the focus of care became not the person, but the disease," says Professor Anthony Balls. "It also became the approach in medical schools and medical centers. And we're still living with that." Medical school applicants are evaluated primarily on the basis of grades, standardized test scores and a formal interview. And though many medical educators say they continue to be impressed by the quality and motivation of students entering the field, most admit that the admission criteria place little value on those human qualities that make for a good caregiver. Until recently medical schools offered little training in humanistic skills, and what was offered was often given to students struggling under the burden of an increasingly complex course load. It has resulted in the undermining of primary care physicians, the generalists who field patients' most commoncomplaints. Primary care has low status. It's considered boring and easy. "Of course, there are people who are of such good and sturdycharacter that even this process of brutalization can’t crush their concern for patients," says Balls. "Fortunately for us all,there willalways be people like that." But statistics indicate that most malpractice suits result from poor communication between doctors and patients. More recent statistics indicate that of those patients who win malpractice suits, 80% say they sued because they felt shamed or humiliated by their doctor. On their part, doctors report practicing "defensive" medicine – ordering more tests or keeping their distance from patients, for example –inorder to protect themselves from malpractice suits. The latest approach is managed care, the umbrella term for the cluster of businesses that provide health care or health care insurance at low cost. The trade-off is that the organization, rather than the patient and his doctor, makes the final decision on when or if a medical visit or therapy is necessary. In theory, the system makes good sense. And in fact, many doctors, say these businesses don't have the best interests of the patient inmind, adding that they make their money by limiting care. Viewed by many as the solution to containing the rising cost of health care, managed-care organizations have delivered a blow to the doctor-patient relationship by restricting physicians' ability to prescribe therapies and make referrals, all in the name of containing costs. The doctor-patient conundrum has so far defied solution. There is no going back to the days of the black bag. And in truth, what patient would trade a long chat with his doctor for a cure? The trick now: how to find a balance between technology and empathy and control health care costs without compromising care. In the field of medical education, at least, there have been rumblings of change. The American Academy on Physician and Patient is devoted to investigating the relationship between doctors and patients and educating medical students and doctors about its findings. The number of research articles on the doctor-patient relationship has also grown dramatically in recent years. Medical schools across the country are also offering more classes designed to promote compassion. U.S. medical schools now have mandatory classes dealing with the doctor-patient relationship.

підбадьорювання відносити, класифікувати позов щодо проф. компетентності розчарування   відмахнутися     підривати, руйнувати нав'язливий     набір, комплект     сумнівний     оцінювати     тягар підривати, розхитувати приймати (на себе)   міцний   задум, компроміс   обмежувати направлення пацієнта (до фахівця тощо) головоломка   співпереживання, співчуття   гуркіт, гул     жалість обов'язковий

Exercise 58. Points for discussion:

1. Doctor horror stories that you know.

2. How can you try to repair matters if you are satisfied with your medical care but your relationship with your doctor is uncomfortable and strained?

3."Defensive" medicine.

4. What to do if you have doubts about your medical care?

5. Many underdeveloped countries spend much of their health budgets establishing medical schools and building hospital complexes. However, this approach addresses the health care of only 10-15percent of the population. Do such nations really need medicine for the elite?

6. The types of problems with the existing health-care system inthis country that you have personally encountered.

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