经济学人精读|面临改变的英国医疗体系，别再说中国看病难啦

本文节选自《经济学人》2019.06.29期Britain版块的一篇文章，讲述了英国的医疗体系正面临改变

本文共节选5段，建议大家先自主阅读原文，再学习精读笔记。

文末会总结此次学习写作可以使用的词句，读者也可自己总结。会定期将内容进行总结，做成word分享，希望大家也能坚持学习

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The national health service is free, so it is also rationed. Family doctors, known as general practitioners (GPS), act as the ﬁrst port of call for patients; friendly gatekeepers to the rest of the service who refer people to specialists only if needed. “You can’t book an appointment to see me here,” explains Stewart Smith, a 39-year-old GP, one of a team in charge of an innovative new medical centre. “You go on a list and then we triage you.”

national health service：国家医疗服务体系

ration：配给、限量供应。Something is rationed，指的是某物被限量供给，这里指的是国外的医疗服务虽然是免费的，但是确实有一定量限制的，及医疗资源不足【词汇积累】

known as：以……而闻名，这里的意思是为人所知

general practitioner：全科医生a doctor who is trained in general medicine. general medicine是全科医学，special medicine则是专科医学。全科医生指的是who treats patients in a local community rather than at a hospital（在社区而不是在医院里和治疗病人）【词汇积累】

act as：充当，担当【词组积累】

the ﬁrst port of call for patients：port意为避风港，这里指的是病人寻求帮助时的首个避风港【词汇积累】

refer people to specialists：refer A to B指的是让A到B寻求帮助，这里指的是让病人到专家处求助【词组积累】

only if：表示只有当，而if only表示只要【词组积累】

book an appointment：book在这里是预定，预约的意思

triage：分诊，患者鉴别分类【词汇积累】

国家医疗服务体系是免费的，因此也是限量供给的。家庭医生，以全科医生为人所知，担当病人求医时的首个避风港。至于剩下的医疗资源，只有当有需要的时候，“友好的看门人”才会让病人去专家处求诊。“你不能预约和我见面，你要先在等待列表上，然后我们会对你进行分诊”。创新医学中心的成员，一个39岁的全科医生Stewart Smith解释道。

Simon Stevens, chief executive of NHS England, has said that being a GP is arguably the most important job in the country. There is, however, a severe shortage of them. According to theNuﬃeld Trust, a think-tank, there are 58 GPS per 100,000 people, down from 66 in 2009— the ﬁrst sustained fall since the 1960s. Only half of patients say they almost always see theirpreferred doctor, down from 65% six years ago. The average consultation lasts just nine minutes, among the quickest in the rich world.

NHS：National Health Service (NHS) 英国公立医疗体系

arguably：按理来说【词汇积累】

There is a severe shortage of them：缺乏某事物，可以用severe表示缺乏的程度【句式】

Nuﬃeld Trust：trust表示信托基金。Nuffield Trist is a charitable trust with the mission of improving health care in the UK through evidence and analysis.

think-tank：智库，智囊团a group of experts who provide advice and ideas on political, social or economic issues

a sustained fall：一个持续的下降。sustained表示持续的，如a sustained fall in prices价格的持续下降【词汇积累】

preferred：prefer表示更喜欢，这里加ed是形容词性，但表示的意思为“首选的”，one’s preferred doctor即首选的医生【词汇积累】

数字……, down from 数字+时间：与某个时间段的某个数字相比，有所下降。【句式】

among sth：included in sth，文中among the quickest in the rich world表示英国全科医生接诊时间是发达国家中最快的国家之一

consultation：（向专家请教的）咨询会；（尤指）就诊a meeting with an expert, especially a doctor, to get advice or treatment，consultation虽然是咨询，商讨的意思，但这里表达的是其就诊的意思【熟词僻义】

英国公立医疗体系首席执行官Simon Stevens说过全科医生按理说来一个国家最重要的工作。然而全科医生资源却严重匮乏。根据Nuffield Trust，每100000人中仅分配有58个全科医生，与2009年的66个相比有所下降，是自上世纪60年代以来的第一个持续下降。只有一半的病人说他们几乎总是能看到自己喜欢的医生，与6年前的65%相比也有所下降。其平均接诊时间仅持续9分钟，是发达国家中最快的国家之一

The GPS kept a diary, noting precisely what they got up to during the day. It turned out thatlots could be done by others: administrators could take care of some communication with hospitals, physios could see people with bad backs and psychiatric nurses those with anxiety. So now they do. Only patients with the most complicated or urgent problems make it to a doctor. As a result, each GP is responsible for 3,800 locals, compared with an average of 2,000 in the rest of Cornwall.

precisely：precise是精确的，准确的，这里并不是你这个意思，precisely这里强调真是或明显，解释为“正是，确实”。这里以nothing precisely what they …… 来强调医生们整天忙于的并不是治病。下文以it turned out that（事实证明，原来） ……与之承上启下，引出很多事情可以由其他人做，而不是医生【熟词僻义】

what they got up to：get up to指的是忙于，从事，如he is getting up to his tasks他忙于自己的任务。【词组积累】

physio：physiotherapist理疗师

bad backs：背痛

make it to：make it表示成功，做成，make it to a doctor表示条件足以达到看医生。【词组积累】

全科医生有着写日记的习惯，但却不是记录他们一天所从事的事情。事实证明很多事可以由其他人来完成：管理人员可以处理与医院的交流任务，理疗师可以处理背痛的病人，精神师看护那些焦虑的病人。所以他们现在这么做了，只有那些有最复杂的以及最紧急的问题的病人可以看到医生。结果，每个全科医生对3800名当地人负责，康沃尔剩余地区则平均为2000人。

The NHS estimates that 30% of GPS’ time is spent on musculoskeletal problems, for instance, which could often be handled by a physiotherapist. Another estimate suggests 11% of their dayis taken up by paperwork. Doctors complain that they are overworked, and growing numbers retire early. They are also expensive: the starting salary for a GP is £57,655, whereas a physio costs around half as much.

musculoskeletal problems：肌肉骨骼疾病

be handled by：由……处理【词组积累】is taken up by：被……占据【词组积累】

the starting salary：起薪【词汇积累】

NHS估计全科医生30%的时间用在了肌肉骨骼疾病上，这些通常可以由理疗师处理。另一个估算表明他们一天的11%的时间被书面工作占据。医生埋怨他们劳累过度，提前退休的人数也在增长。但他们也很贵，每个全科医生起薪为57655英镑（1英镑=9.4844人民币元），然而一个理疗师大约只有一半。

The shortage of GPS leaves the NHS with little choice but to try something new. “A lot of the world has either copied or is trying to copy English primary care,” in particular its openness to all and the continuity of care that it provides, says Dr Chana. Keeping these strengths, while changing how primary care works, is the task NHS oﬃcials are now facing up to. Even if they succeed, it will take time for the public to adjust.

leaves the NHS with little choice but to do：使某人没有选择只能【词组积累】

primary care：基础医疗

either do or…...：要么……，要么……

the continuity of care：医疗服务的持续性【词组积累】

face up to：面对的

it will take time for……：需要一段时间

全科医生的短缺使NHS没有选择只能尝试一些新的措施。Chana医生说，世界上很多国家要么已经复制了，要么正试图复制英国的基础医疗，尤其是其开放度和服务的连续性。保持这些优势的时候，要改变基础医疗的运行模式，是NHS人员现在正面临的问题。即使成功了，人们也要花费一段时间来适应。

总结