2025年全国医学英语水平考试（METS四级）考前冲刺试题及答案一
2025/1/19
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2025年全国医学英语水平考试（METS四级）考前冲刺试题及答案一,更多相关资讯请继续查看易考吧全国医护英语水平考试
1). Innovation in Medical Education■Our nation′s lack of research in medical education contrasts starkly with the large and essential commitment to biomedical research.No one questions the need for sustained support for research in cancer， heart disease， or dementia， But despite medical education′s central role in creating a workforce capable of delivering the resulting biomedical advances， funding for medical education research is conspicuously absent.( )■The current duration， settings， and organization of graduate medical education(GME) are more the product of tradition than of evidence and have changed little in the face of substantial changes in the health needs of patients and the systems for delivering care.We face questions about the most appropriate structure and content for GME， along with questions that extend beyond GME： What should change in undergraduate medical education， and how should we ensure the continued competence of physicians 20 to 30years into practice? ( )whether and how to support the education of other clinicians (in addition to physicians)， and to what extent federal GME funding is an effective or appropriate tool for addressing imbalances in the geographic or specialty distribution of health care providers.■The research that could answer these questions requires funding and organization that don′t currently exist.The Centers for Medicare and Medicaid Services pay about $ 10billion a year toward GME but have neither a research and development budget to ensure that this investment is achieving their objectives nor even a clear definition of what those objectives are.Overall， the United States spends nearly $ 3 trillion a year on health care，nearly all of it delivered through clinicians， with no organized research investment directed at improving the way those clinicians are produced.( )The fund would be directed toward research and innovation in the substance of GME as well as its organization and financing， and the proposal echoes the recommendations of other consensus reports.The committee also proposed a governance mechanism to set research priorities and coordinate large scale efforts such as multi-institutional studies or nationwide pilot programs.We propose the following approach，■First， valid and feasible measures of training success need to be defined.The fundamental goal of medical training is the production of a workforce capable of delivering economically sustainable care that will improve the health of patients and populations in a changing environment.( )Medical education is currently assessed through process measures (whether residents get enough cases， enough lectures， enough sleep) or intermediate outcomes such as exam performance.Although competency assessment is receiving increased attention， the connections between resident competency and patient outcomes are assumed rather than demonstrated.In order to evaluate alternative processes of medical education， we need systems for routinely assessing meaningful outcomes； the quality，distribution， and cost of care.Outcomes driven approaches have the additional advantage of fostering innovation.■Second， we need to examine fundamental changes to the structure and content of medical education.Optimal approaches for medical training may differ dramatically from current practice.With meaningful outcomes measures in hand， we can examine more fundamental questions， such as whether graduation from medical school or residency training should be time based or competency-based.( )Indeed， the increasing availability of medical information at the point of care might allow us to reduce the time and cost of creating new physicians and redirect some resources toward keeping the practices of established physicians current.■Third， new models for financing medical education could be piloted.One reason that GME gets so much attention is that a lot of money flows through it.Currently， medicare(mostly) pays hospitals (mostly) for training residents (exclusively physicians)，using a historical formula that is largely untethered to current goals.( )Innovative funding experiments could include allowing some residents (perhaps defined by specialty or institution) to bill for their services instead of having their institutions receive federal GME funding.Other experiments might assess the effect of using larger payments to direct trainees toward undersupplied specialties or geographic areas.Pilot programs might also distribute support across undergraduate， graduate， and continuing medical education - or to nonphysicians- potentially enhancing the leverage of public investment.■The fact that we lack evidence today doesn′t mean that we can′t have evidence for the education we will deliver or the policy changes we will need to make in 10 or 20 years.( )With some funding and an organized approach to research investment， we can innovate toward the future workforce we need.Medical education research has not been attached great importance to currently.( )
A.True
B.False
C.Not mentioned
正确答案：A
2). Nurse Prescription■We started the week with a new proposal by the Grattan Institute to shake up the hospital workforce and allow nurses to take on more roles traditionally performed by doctors.But should registered nurses′ roles extend even further， to prescribing medication?■As the population ages and has a higher rate of chronic conditions such as diabetes，heart disease and arthritis， primary care needs will continue to grow.And as a previous Grattan report noted， more than one in four Australians already feel they have to wait too long for an appointment with a general practitioner.■But extending registered nurses′ roles to prescribing， as the Nursing and Midwifery Board of Australia has proposed， isn′t the answer.Australia already has a category of nurse specialists who can prescribe some medicines一nurse practitioners.■International prescription■In the United Kingdom， suitably trained nurses have been able to act as independent prescribers since 2006， and some nurses had limited prescribing rights before that date.The UK government implemented the change in a bid to improve patient choice，provide better access to care and enhance multidisciplinary team care.■Evidence from the UK suggests that overall， nurse prescribing is currently of a high quality： it′s safe， clinically appropriate and educational programs adequately prepare nurses for this role.Patients are also accepting of nurse prescribing.■Nevertheless， a re recent UK study found that patients generally preferred to see their own doctor for minor illnesses； however， those who had previously seen a nurse were happy to consult a nurse.■The cost of drugs prescribed and assessment and diagnostic skills are seen as areas where nurse prescribers need to improve.International evidence suggests that nurse practitioners in primary care tend to order more investigations than doctors.They also spend more time with patients and achieve better patient compliance to medication regimes.■Nurse practitioners■To become a nurse practitioner， Australian nurses must undergo extended education at masters level， then complete a long and rigorous process of endorsement to prove their clinical competency in a specified area such as emergency care， wound management，palliative care， and so on.■Most nurse practitioners in Australia work within hospitals， but some work in areas of need such as aged care， palliative care and primary care (in collaboration with a doctor，though in some isolated communities， doctors only visit periodically).■Once endorsed， nurse practitioners can diagnose and treat conditions within their scope of practice.And， since November 2010， nurse practitioners have had limited prescribing rights.■A nurse practitioner working in an aged care facility， for example， is able to diagnose conditions such as urinary tract infections and prescribe antibiotics in a timely manner.This means that the patient doesn′t have to wait for a doctor to visit and risk becoming more unwell or be transferred to hospital.■Studies show that nurse practitioners can address the needs of an ageing population with chronic and complex conditions.And they may be able to provide the most cost-effective care， if they can reduce the time they spend with patients and reduce their return consultation rate (which increase the cost of care).■There is obviously scope for nurse practitioners to provide more care in areas of geographic isolation， where it is hard to recruit doctors and in areas such as aged care，where patients have complex and high needs.■They are also able to provide effective care to patients with chronic and complex conditions.Such activities could include broadening the range of medications these nurses can prescribe and enabling them to review a patient′s medication.■Proposal for nurse prescribing■The Nursing and Midwifery Board of Australia， the body responsible for registering nurses and developing professional standards， released a draft proposal in October to allow registered nurses and midwives to “supply and administer” scheduled medicines.■This applies to registered nurses and registered midwives but not to nurse practitioners whose rights rest in legislation.■The proposal would see nurses administer a range of medicines：■·Schedule 2 and 3 medicines which are available from the pharmacy without prescription such as aspirin， paracetamol， ibuprofen， and cold and fu tablets■·Schedule 4 medicines that are available by prescription only， such as contraceptives and antibiotics■·Schedule 8 drugs， which doctors need a special permit to prescribe such as Fentanyl， morphine， oxycodone， which are highly addictive.■To be eligible for endorsement， the registered nurse or midwife would need to Have “completed a program of study in medicines management， clinical assessment and differential diagnosis.”■The draft standards state that the endorsement of registered nurses and midwives to supply and administer medication is “intended to provide safe and timely health care when a medical practitioner or nurse practitioner is not immediately available.” But it′s not clear from the draft standards how “immediately available” is defined.■Nurses working in rural and isolated areas currently have certain rights to supply and administer scheduled medicines.These are recognised areas of medical workforce shortages.■Unanswered questions■Nurse practitioners are a relatively new professional group in Australia and， in particular， in primary care.The public and even other health professionals often have little knowledge of their skills and scope of practice.Adding another level of prescriber may bring opposition from medical groups and confusion among the public.■While the proposals make it clear that nurses should be properly trained to administer medication， there is also a need for them to have skills in diagnostics， history taking and recognizing adverse drug reactions.As we learnt from the UK experience， this is required for best practice.■There is also a concern that broader nurse prescribing rights would lead to fragmentation of care and an increase in the number of people seeking out different health professionals for the supply of medication.Unlike the UK， Australians aren′t registered with a particular GP practice and can seek primary care anywhere.■There is also the question of insurance.Nurses endorsed to supply medication would likely face higher insurance premiums.Nurses working in health services would be covered by their employer.But those working for private business， such as a general .practice， would need to get their own insurance or the practice would need to agree to provide insurance cover under its policy.Although nurse prescribing has been extended in the UK， the Australian health system is different enough for us to think carefully before following this lead.What is the condition of nurse prescription in Australia?( )
A.Patients have well accepted the nurse practitioners in Australia
B.Nurse practitioners in Australia have taken less roles than those in the UK
C.Nurses working in rural areas of Australia have rights to administer scheduled medicine
D.Nurses working for private business in Australia will get less insurance
正确答案：C
3). Patient Access to Physician Notes Is Gaining Momentum■Family physician Richard Martin， MD， sees many patients with chronic conditions.Among them is a man in his 80s who arrives prepped by Martin′s notes from his last visit.Martin was one of the first physicians at Geisinger Health System， headquartered in Danville， Pennsylvania， to volunteer in 2010 for an OpenNotes pilot program making physician notes readily available through a secure online portal，( ).■Sharing medical notes with patients is a trend more health institutions are adopting they foster transparency in medical records.OpenNotes is an initiative to promote medical note sharing that was launched in 2010 by clinicians and researchers at Beth Israel Deaconess Medical Center in Boston.Funded by the Robert Wood Johnson Foundation and other charitable groups， OpenNotes has developed copyrighted materials that it shares for free with health systems to introduce simple patient access to medical notes.■“My patient contends that reading his medical notes motivated him to maintain his health，” said Martin.( ) According to a recent study， patients who frequently read their physician′s notes reported they better understood their health condition， took better care of their health， and had a better relationship with their physician.■For decades， patients could legally access their medical notes as part of the Health Insurance Portability and Accountability Act of 1996.( )What sets OpenNotes apart is the ease and speed with which patients can access notes.■The OpenNotes initiative was the brainchild of Tom Delbanco， MD， a professor of general medicine and primary care at Harvard Medical School， and Jan Walker， RN，an assistant professor of medicine， also at Harvard.Throughout his 40 years of practice，Delbanco freely shared his notes with patients.When patent portals were introduced，Delbanco realized that patients could email their physicians and schedule appointments，but physician notes were hidden.He and Walker decided to investigate the consequences of inviting patients to view physician notes via online patient portals by setting up a 1-year research and demonstration project， funded by the Robert Wood Johnson Foundation and 2 other organizations.■The project involved 105 primary care physicians and 13，564 patients at 3 sites：Beth Israel， Geisinger， and Harborview Medical Center in Seattle.Both participating patients and participating and nonparticipating physicians completed an online survey at the beginning of the study assessing their attitudes toward medical note sharing.( )At the study′s conclusion， after a year of access to physician notes，participating patients and physicians completed a follow-up online survey， which asked the same questions as the baseline survey， but with the verb tense changed to reflect that patient access to medical notes had been established.The results showed that 99% of responding patients supported continued access to medical notes online， and the majority of responding physicians at each of the 3 sites， ranging from 85% at Beth Israel to 91%at Geisinger， agreed that access was a good idea.■Some physicians were skeptical at first， expressing concerns that giving patients access to medical notes might add to their workload if patients called and emailed with questions based on what they read， Delbanco said.For the most part， those fears were unfounded， he noted.( )■Since the pilot study， other health systems have adopted the OpenNotes concept.Delbanco estimates that about 100 health care institutions are at some stage， from planning to implementation， of sharing medical notes with patients.Some have used the OpenNotes resources， and others have not， Delbanco said.■The medical notes that the patients read are the physician′s notes一the patient′s story - Delbanco emphasized， and not simply the after-visit laundry list of medications and instructions that patients customarily receive.■Despite OpenNotes′ benefits， some concerns remain.One is that patients might find the information they read upsetting.To cushion a potential blow， MD Anderson Cancer Center holds laboratory， radiology， and pathology results for 7 days and Mayo Clinic delays patient access to radiology and pathology results for 3 days so physicians can first speak with patients.■In addition， OpenNotes raises issues of access and fairness for patients who don′t have a computer or have a limited knowledge of English， noted Nancy Berlinger， PhD， a Hastings Center research scholar.■( ) The OpenNotes pilot study found that 28% of participating physicians at Beth Israel， 9% at Geisinger， and 11% at Harborview reported in the poststudy survey that they were less candid in their notes knowing patients could read them， suggesting the concern may be valid.■Steven Malkin， MD， an internist who practices in Arlington Heights， Illinois， is concerned that if his patients routinely read his notes， he would be less forthcoming.“My notes are for me，” Malkin said.“If I knew a patient was going to read them， I would write them differently.′”■Although Geisinger′s Martin said he has not changed the way he writes notes， he has learned that patients may， interpret a word differently than anticipated， citing a patient who took offense to being described as obese.( ).■Despite lingering apprehension， Milliner thinks sharing notes with patients is a good tool for improving communication between patients and physicians.“It is one more way they become part of decision making，” Milliner said.“I view that as a very positive thing.”( )
A.Nonetheless， that description motivated the patient to lose weight， he said
B.Less than 10% of participating physicians reported increased length of visits or time responding to patient queries
C.Sharing medical notes， he said， appears to engage his patients and refreshes their memory of office conversations
D.But fees or long wait times to receive the records sometimes hampered the process
E.Furthermore， physicians may be inclined to censor themselves because patients can electronically peer over their shoulder
F.The feedback from Martin′s elderly patient illustrates why health systems across the country are making physician notes easily available to patients
G.Although individual physicians can′t opt out of note sharing， certain types of notes， such as confidential psychiatric notes， may be withheld
H.Initially， most patients (92%～97%) at the 3 sites thought patient access to notes was a good idea， although fewer participating physicians thought so (69%～81 % at the 3 sites)
正确答案：F
......
1). Innovation in Medical Education■Our nation′s lack of research in medical education contrasts starkly with the large and essential commitment to biomedical research.No one questions the need for sustained support for research in cancer， heart disease， or dementia， But despite medical education′s central role in creating a workforce capable of delivering the resulting biomedical advances， funding for medical education research is conspicuously absent.( )■The current duration， settings， and organization of graduate medical education(GME) are more the product of tradition than of evidence and have changed little in the face of substantial changes in the health needs of patients and the systems for delivering care.We face questions about the most appropriate structure and content for GME， along with questions that extend beyond GME： What should change in undergraduate medical education， and how should we ensure the continued competence of physicians 20 to 30years into practice? ( )whether and how to support the education of other clinicians (in addition to physicians)， and to what extent federal GME funding is an effective or appropriate tool for addressing imbalances in the geographic or specialty distribution of health care providers.■The research that could answer these questions requires funding and organization that don′t currently exist.The Centers for Medicare and Medicaid Services pay about $ 10billion a year toward GME but have neither a research and development budget to ensure that this investment is achieving their objectives nor even a clear definition of what those objectives are.Overall， the United States spends nearly $ 3 trillion a year on health care，nearly all of it delivered through clinicians， with no organized research investment directed at improving the way those clinicians are produced.( )The fund would be directed toward research and innovation in the substance of GME as well as its organization and financing， and the proposal echoes the recommendations of other consensus reports.The committee also proposed a governance mechanism to set research priorities and coordinate large scale efforts such as multi-institutional studies or nationwide pilot programs.We propose the following approach，■First， valid and feasible measures of training success need to be defined.The fundamental goal of medical training is the production of a workforce capable of delivering economically sustainable care that will improve the health of patients and populations in a changing environment.( )Medical education is currently assessed through process measures (whether residents get enough cases， enough lectures， enough sleep) or intermediate outcomes such as exam performance.Although competency assessment is receiving increased attention， the connections between resident competency and patient outcomes are assumed rather than demonstrated.In order to evaluate alternative processes of medical education， we need systems for routinely assessing meaningful outcomes； the quality，distribution， and cost of care.Outcomes driven approaches have the additional advantage of fostering innovation.■Second， we need to examine fundamental changes to the structure and content of medical education.Optimal approaches for medical training may differ dramatically from current practice.With meaningful outcomes measures in hand， we can examine more fundamental questions， such as whether graduation from medical school or residency training should be time based or competency-based.( )Indeed， the increasing availability of medical information at the point of care might allow us to reduce the time and cost of creating new physicians and redirect some resources toward keeping the practices of established physicians current.■Third， new models for financing medical education could be piloted.One reason that GME gets so much attention is that a lot of money flows through it.Currently， medicare(mostly) pays hospitals (mostly) for training residents (exclusively physicians)，using a historical formula that is largely untethered to current goals.( )Innovative funding experiments could include allowing some residents (perhaps defined by specialty or institution) to bill for their services instead of having their institutions receive federal GME funding.Other experiments might assess the effect of using larger payments to direct trainees toward undersupplied specialties or geographic areas.Pilot programs might also distribute support across undergraduate， graduate， and continuing medical education - or to nonphysicians- potentially enhancing the leverage of public investment.■The fact that we lack evidence today doesn′t mean that we can′t have evidence for the education we will deliver or the policy changes we will need to make in 10 or 20 years.( )With some funding and an organized approach to research investment， we can innovate toward the future workforce we need.Medical education research has not been attached great importance to currently.( )
A.True
B.False
C.Not mentioned
正确答案：A
2). Nurse Prescription■We started the week with a new proposal by the Grattan Institute to shake up the hospital workforce and allow nurses to take on more roles traditionally performed by doctors.But should registered nurses′ roles extend even further， to prescribing medication?■As the population ages and has a higher rate of chronic conditions such as diabetes，heart disease and arthritis， primary care needs will continue to grow.And as a previous Grattan report noted， more than one in four Australians already feel they have to wait too long for an appointment with a general practitioner.■But extending registered nurses′ roles to prescribing， as the Nursing and Midwifery Board of Australia has proposed， isn′t the answer.Australia already has a category of nurse specialists who can prescribe some medicines一nurse practitioners.■International prescription■In the United Kingdom， suitably trained nurses have been able to act as independent prescribers since 2006， and some nurses had limited prescribing rights before that date.The UK government implemented the change in a bid to improve patient choice，provide better access to care and enhance multidisciplinary team care.■Evidence from the UK suggests that overall， nurse prescribing is currently of a high quality： it′s safe， clinically appropriate and educational programs adequately prepare nurses for this role.Patients are also accepting of nurse prescribing.■Nevertheless， a re recent UK study found that patients generally preferred to see their own doctor for minor illnesses； however， those who had previously seen a nurse were happy to consult a nurse.■The cost of drugs prescribed and assessment and diagnostic skills are seen as areas where nurse prescribers need to improve.International evidence suggests that nurse practitioners in primary care tend to order more investigations than doctors.They also spend more time with patients and achieve better patient compliance to medication regimes.■Nurse practitioners■To become a nurse practitioner， Australian nurses must undergo extended education at masters level， then complete a long and rigorous process of endorsement to prove their clinical competency in a specified area such as emergency care， wound management，palliative care， and so on.■Most nurse practitioners in Australia work within hospitals， but some work in areas of need such as aged care， palliative care and primary care (in collaboration with a doctor，though in some isolated communities， doctors only visit periodically).■Once endorsed， nurse practitioners can diagnose and treat conditions within their scope of practice.And， since November 2010， nurse practitioners have had limited prescribing rights.■A nurse practitioner working in an aged care facility， for example， is able to diagnose conditions such as urinary tract infections and prescribe antibiotics in a timely manner.This means that the patient doesn′t have to wait for a doctor to visit and risk becoming more unwell or be transferred to hospital.■Studies show that nurse practitioners can address the needs of an ageing population with chronic and complex conditions.And they may be able to provide the most cost-effective care， if they can reduce the time they spend with patients and reduce their return consultation rate (which increase the cost of care).■There is obviously scope for nurse practitioners to provide more care in areas of geographic isolation， where it is hard to recruit doctors and in areas such as aged care，where patients have complex and high needs.■They are also able to provide effective care to patients with chronic and complex conditions.Such activities could include broadening the range of medications these nurses can prescribe and enabling them to review a patient′s medication.■Proposal for nurse prescribing■The Nursing and Midwifery Board of Australia， the body responsible for registering nurses and developing professional standards， released a draft proposal in October to allow registered nurses and midwives to “supply and administer” scheduled medicines.■This applies to registered nurses and registered midwives but not to nurse practitioners whose rights rest in legislation.■The proposal would see nurses administer a range of medicines：■·Schedule 2 and 3 medicines which are available from the pharmacy without prescription such as aspirin， paracetamol， ibuprofen， and cold and fu tablets■·Schedule 4 medicines that are available by prescription only， such as contraceptives and antibiotics■·Schedule 8 drugs， which doctors need a special permit to prescribe such as Fentanyl， morphine， oxycodone， which are highly addictive.■To be eligible for endorsement， the registered nurse or midwife would need to Have “completed a program of study in medicines management， clinical assessment and differential diagnosis.”■The draft standards state that the endorsement of registered nurses and midwives to supply and administer medication is “intended to provide safe and timely health care when a medical practitioner or nurse practitioner is not immediately available.” But it′s not clear from the draft standards how “immediately available” is defined.■Nurses working in rural and isolated areas currently have certain rights to supply and administer scheduled medicines.These are recognised areas of medical workforce shortages.■Unanswered questions■Nurse practitioners are a relatively new professional group in Australia and， in particular， in primary care.The public and even other health professionals often have little knowledge of their skills and scope of practice.Adding another level of prescriber may bring opposition from medical groups and confusion among the public.■While the proposals make it clear that nurses should be properly trained to administer medication， there is also a need for them to have skills in diagnostics， history taking and recognizing adverse drug reactions.As we learnt from the UK experience， this is required for best practice.■There is also a concern that broader nurse prescribing rights would lead to fragmentation of care and an increase in the number of people seeking out different health professionals for the supply of medication.Unlike the UK， Australians aren′t registered with a particular GP practice and can seek primary care anywhere.■There is also the question of insurance.Nurses endorsed to supply medication would likely face higher insurance premiums.Nurses working in health services would be covered by their employer.But those working for private business， such as a general .practice， would need to get their own insurance or the practice would need to agree to provide insurance cover under its policy.Although nurse prescribing has been extended in the UK， the Australian health system is different enough for us to think carefully before following this lead.What is the condition of nurse prescription in Australia?( )
A.Patients have well accepted the nurse practitioners in Australia
B.Nurse practitioners in Australia have taken less roles than those in the UK
C.Nurses working in rural areas of Australia have rights to administer scheduled medicine
D.Nurses working for private business in Australia will get less insurance
正确答案：C
3). Patient Access to Physician Notes Is Gaining Momentum■Family physician Richard Martin， MD， sees many patients with chronic conditions.Among them is a man in his 80s who arrives prepped by Martin′s notes from his last visit.Martin was one of the first physicians at Geisinger Health System， headquartered in Danville， Pennsylvania， to volunteer in 2010 for an OpenNotes pilot program making physician notes readily available through a secure online portal，( ).■Sharing medical notes with patients is a trend more health institutions are adopting they foster transparency in medical records.OpenNotes is an initiative to promote medical note sharing that was launched in 2010 by clinicians and researchers at Beth Israel Deaconess Medical Center in Boston.Funded by the Robert Wood Johnson Foundation and other charitable groups， OpenNotes has developed copyrighted materials that it shares for free with health systems to introduce simple patient access to medical notes.■“My patient contends that reading his medical notes motivated him to maintain his health，” said Martin.( ) According to a recent study， patients who frequently read their physician′s notes reported they better understood their health condition， took better care of their health， and had a better relationship with their physician.■For decades， patients could legally access their medical notes as part of the Health Insurance Portability and Accountability Act of 1996.( )What sets OpenNotes apart is the ease and speed with which patients can access notes.■The OpenNotes initiative was the brainchild of Tom Delbanco， MD， a professor of general medicine and primary care at Harvard Medical School， and Jan Walker， RN，an assistant professor of medicine， also at Harvard.Throughout his 40 years of practice，Delbanco freely shared his notes with patients.When patent portals were introduced，Delbanco realized that patients could email their physicians and schedule appointments，but physician notes were hidden.He and Walker decided to investigate the consequences of inviting patients to view physician notes via online patient portals by setting up a 1-year research and demonstration project， funded by the Robert Wood Johnson Foundation and 2 other organizations.■The project involved 105 primary care physicians and 13，564 patients at 3 sites：Beth Israel， Geisinger， and Harborview Medical Center in Seattle.Both participating patients and participating and nonparticipating physicians completed an online survey at the beginning of the study assessing their attitudes toward medical note sharing.( )At the study′s conclusion， after a year of access to physician notes，participating patients and physicians completed a follow-up online survey， which asked the same questions as the baseline survey， but with the verb tense changed to reflect that patient access to medical notes had been established.The results showed that 99% of responding patients supported continued access to medical notes online， and the majority of responding physicians at each of the 3 sites， ranging from 85% at Beth Israel to 91%at Geisinger， agreed that access was a good idea.■Some physicians were skeptical at first， expressing concerns that giving patients access to medical notes might add to their workload if patients called and emailed with questions based on what they read， Delbanco said.For the most part， those fears were unfounded， he noted.( )■Since the pilot study， other health systems have adopted the OpenNotes concept.Delbanco estimates that about 100 health care institutions are at some stage， from planning to implementation， of sharing medical notes with patients.Some have used the OpenNotes resources， and others have not， Delbanco said.■The medical notes that the patients read are the physician′s notes一the patient′s story - Delbanco emphasized， and not simply the after-visit laundry list of medications and instructions that patients customarily receive.■Despite OpenNotes′ benefits， some concerns remain.One is that patients might find the information they read upsetting.To cushion a potential blow， MD Anderson Cancer Center holds laboratory， radiology， and pathology results for 7 days and Mayo Clinic delays patient access to radiology and pathology results for 3 days so physicians can first speak with patients.■In addition， OpenNotes raises issues of access and fairness for patients who don′t have a computer or have a limited knowledge of English， noted Nancy Berlinger， PhD， a Hastings Center research scholar.■( ) The OpenNotes pilot study found that 28% of participating physicians at Beth Israel， 9% at Geisinger， and 11% at Harborview reported in the poststudy survey that they were less candid in their notes knowing patients could read them， suggesting the concern may be valid.■Steven Malkin， MD， an internist who practices in Arlington Heights， Illinois， is concerned that if his patients routinely read his notes， he would be less forthcoming.“My notes are for me，” Malkin said.“If I knew a patient was going to read them， I would write them differently.′”■Although Geisinger′s Martin said he has not changed the way he writes notes， he has learned that patients may， interpret a word differently than anticipated， citing a patient who took offense to being described as obese.( ).■Despite lingering apprehension， Milliner thinks sharing notes with patients is a good tool for improving communication between patients and physicians.“It is one more way they become part of decision making，” Milliner said.“I view that as a very positive thing.”( )
A.Nonetheless， that description motivated the patient to lose weight， he said
B.Less than 10% of participating physicians reported increased length of visits or time responding to patient queries
C.Sharing medical notes， he said， appears to engage his patients and refreshes their memory of office conversations
D.But fees or long wait times to receive the records sometimes hampered the process
E.Furthermore， physicians may be inclined to censor themselves because patients can electronically peer over their shoulder
F.The feedback from Martin′s elderly patient illustrates why health systems across the country are making physician notes easily available to patients
G.Although individual physicians can′t opt out of note sharing， certain types of notes， such as confidential psychiatric notes， may be withheld
H.Initially， most patients (92%～97%) at the 3 sites thought patient access to notes was a good idea， although fewer participating physicians thought so (69%～81 % at the 3 sites)
正确答案：F
......
