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　　Uncooperative Patients Need Psychological Therapy

By refusing to take essential medication after a kidney transplant, a 49-year-old woman drives her doctors and nurses to distraction—to no avail, because the organ has in the end to be removed____(1)_____ Patients refusing to cooperate with medical professionals cause damage not only to themselves but also impose substantial costs on the community. The pharmaceutical company Glaxo Welcome estimates the costs to the German taxpayers of this kind of negative behaviour at around five billion dollars a year.

A recent conference of medical professionals, health insurers, the pharmaceutical industry and patient representatives revealed a wide range of factors behind non-compliance. Not all defiant behaviour in a patient can be characterized as non-compliance. Greater stress should be placed on psychology during medical training, delegates said.____(2)_____ Psychologist Sibylle Storkebaum told of an eight-year-old boy who ran amok in a hospital before undergoing a heart transplant, threatening to rip out his drip tubes.____(3)_____“Doctors and nurses failed to see that they had downgraded a boy already conscious of his own responsibilities into a small child,” Storkebaum said, explaining that the boy merely wanted to be taken seriously and to be involved in his own treatment. “Once this was acknowledged, the anger attacks subsided.____(4)_____” Jan-Torsten Tews of Glaxo Welcome highlighted the problem of excessive medication, with patients having to take a wide range of medicines at short intervals. Educating patients and self-management were the key to treating patients with chronic conditions, he said.

Health insurers also expressed interests in better cooperation between doctor and patient. “The fact that non-compliance exists is a result of patient dissatisfaction with their treatment,” Walter Bockemuehl, a senior executive in the statutory medical insurance scheme. said. According to one study, half of all patients did not want medication, but had drugs prescribed nevertheless.____(5)_____

　　詞彙：

medication 藥物治療，藥劑 kidney 腎 transplant 移植

distraciton 心煩意亂 avail 用處 non-compliance 不順從，固執

professional 專業人員 impose把……強加給……

pharmaceutical 製藥的，藥學的 characterize表示……的性格特徵

insurer 承保人，保險公司 defiant 反抗的，無禮的

therapy 治療，療法 insecure 缺乏安全感的

amok 狂怒的，狂暴的 fit 發作 rage 盛怒，狂怒

assert 主張，堅持，維護 downgrade 貶低，小看

noticeably 明顯地 highlight 使顯著，強調，把注意力集中於……

dissatisfaction 不滿意 statutory 法定的額

　　註釋：

no avail：徒勞無功

characterized：被描繪成……

amok：變得勃然大怒。run在這裏是系動詞，有“變”的意思。

rip out his drop tubes：把他的點滴管扯下 rip out 扯掉，扯出

　　drip：水滴，點滴

　　練習：

A. However, there are still some medical professionals who don't believe in psychological therapy.

B. He became noticeably quieter and turned into a good patient.

C. “In these cases we should not be surprised if the advice is ignored,” he said.

D. This case of medical non-compliance is not an isolated example.

E. There was evidence that psychological therapy for insecure patients could improve cooperation between doctors and patients, they added.

F. His fits of rage were subsequently seen as an attempt to assert his rights as a patient.

　　答案與題解：

1.D 空白處的前一句舉了一位46歲婦女在腎移植手術以後拒服必要的藥物的例子。空白處的後一句説拒絕與醫務人員合作的病人會給自己、給社會帶來什麼害處。我們必須注意到後一句的病人是泛指的，當然應該包括這位49歲的'婦女在內，因此將D(像這樣不合作的事情並非僅此一例)填入空白處可以將上下文更完美地連接起來。

2.E 空白處的前一句説道應該更多地強調心理學在藥物治療中的作用。E説有證據表明，對缺乏安全感的病人進行心理治療可增加醫患之間的合作。前後兩句話是連貫的，而且they added 還在一定程度上起到了提示作用，故E為最佳選項。

3.F 空白處的前一句講了一個小男孩在做心臟移植手術前脾氣非常暴躁的故事。空白處的後偶棉幾句敍述瞭如何解決這個小男孩的心理障礙問題，F説“後來這種憤怒被人物是他要正確作為一個病人的權利”，正好起着承上啟下的作用。由於醫務人員有這種認識才有後面的好結果。

4.B 空白處的前一句説“一旦他的想法被認可，他的怒氣就消退了”，所以B項所説的“他明顯地安靜多了，並且變成了一個服從治療的好病人”是自然而然的結果。

5.C 空白處的前一句説“根據一項調查，有一半的病人並不想吃藥，但仍然開了很多藥”，C説“在這種情況下醫囑被置之腦後也就不足為怪了”，這種連接是順理成章的。