单选题 Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.
It's not a frequent topic of discussion, but doctors die, too. And they don't die like the rest of us. What's unusual about them is not how much treatment they get compared to most Americans, but how little. Of course, doctors don't want to die ; they want to live. But they know enough about modern medicine to know its limits. Almost all medical professionals have seen what we call "futile care" being performed on people. That's when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, "Promise me if you find me like this that you' ll kill me. "
How has it come to this—that doctors administer so much care that they wouldn't want for themselves? The simple, or not-so-simple, answer is this: patients, doctors, and the system.
To see how patients play a role, imagine a scenario in which someone has lost consciousness and been admitted to an emergency room, and shocked and scared family members find themselves caught up in a maze of choices. When doctors ask if they want "everything" done, they answer yes. Then the nightmare begins. Feeding into the problem are unrealistic expectations of what doctors can accomplish. For example, many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor.
But of course it's not just patients making these things happen. Doctors play an enabling role, too. The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families. Imagine, once again, the emergency room with those grieving family members. They do not know the doctor. Establishing trust and confidence under such circumstances is a very delicate thing. People are prepared to think the doctor is acting out of base motives, trying to save time, or money, or effort, especially if the doctor is advising against further treatment.
It's easy to find fault with both doctors and patients in such stories, but in many ways all the parties are simply victims of a larger system that encourages excessive treatment. In some unfortunate cases, doctors use the fee-for-service model to do everything they can, no matter how pointless, to make money. More commonly, though, doctors are fearful of litgation and do whatever they're asked to avoid getting in trouble.

单选题 The real problem the author is concerned about in this article is ______.
A. the over treatment for dying patients
B. the different attitude of doctor and patients toward death
C. the disproportionately high medicare expenditure in America
D. the unequal and non-transparent doctor-patient relationship
【正确答案】 A
【答案解析】中心主旨题
[解析] 本文作者由“医生如何面临死亡”这一问题开篇，但是真正的目的并不仅停留在讨论医生和病人在面对死亡时的不同态度上，而是要讨论导致这种态度差异的原因。医生面临死亡往往能够泰然处之，不愿意接受过多的激进治疗，因为他们作为内行人，知道再多的治疗也可能无法挽救一个垂死病人的生命。而普通病患往往为了生存，愿意尝试一切可能的手段，不论成功几率多么微乎其微。这种不论结果，对垂死病人尝试所有治疗手段的做法使得美国医疗不堪重负，也是作者作为一个医生最为担忧和希望解决的问题。[B]“医生和病人在面对死亡时的不同态度”只涉及表面内容，而没有涉及作者的核心论点。[D]“不平等，不透明的医患关系”是作者谈到的一个细节问题，却不是中心内容。[A]和[C]有一定的关系，[A]中提到的对垂死病人的过度医疗是导致[C]美国昂贵的医疗花销的原因之一，但是就本文内容来看，始终围绕濒死病人的医疗问题展开，因此最佳答案应该选[A]。
单选题 According to the text, doctors seem to accept death more readily than patients because ______.
A. they have seen so much deaths in their life that they take it for granted
B. they know quite well that there is a limit to what technology can do with one's life
C. they don't want to go through harsh and painful treatment
D. they are very conservative when it comes to applying new treatment on themselves
【正确答案】 B
【答案解析】细节事实题
[解析] 文章以作者导师平静面对死亡的例子引出了一个问题，那就是“为什么很多医生都能够泰然自若地面对死亡，而不去拼命接受治疗?”文章第二段对这个问题给出了回答。因为，they know enough about modem medicine to know its limits，“他们对现代医学心中有数，知道它的局限性。”[B]是对这句原话的同义改写，因此为正确答案。[A]说“他们因为看惯生死，而不惧怕死亡”，是文中没有提到的信息。[C]说“他们不愿经历痛苦的治疗”是对原文内容偷换概念，原文的意思是说他们知道很多激进的治疗手段毫无效果，因此才不愿意接受治疗，而不是他们本身害怕痛苦而不接受治疗。[D]利用原文中提到的radical treatment设置干扰，很多医生当然是反对激进治疗手段的，但这并不是因为他们为人保守，而是因为他们知道这么做根本毫无用处。
单选题 It can be known from the text that relatives of patients usually ______.
A. put excessive emphasis on medical treatment
B. have a good understanding of medical treatment
C. have a deep faith in doctors' professional advice
D. can not think rationally when it comes to saving their loved ones' lives
【正确答案】 D
【答案解析】细节事买题
[解析] 文中第四段提到病人的家属往往是过度医疗的始作俑者。当他们发现自己的亲人躺在急诊室时，他们往往由于对医学知识不了解，无法判断每种医疗手段的结果，而且对于医疗手段的治愈率过分信赖，而同意采取激进的治疗方法。另外，第五段中还提到，当家属面临抉择的时候，他们往往不愿意听到医生这样的建议，“这个病人不需要进行这项治疗，那项治疗”，他会认为这是医生在省钱省事，因此，他们在关键时刻对于医生并不完全信任。据此可判断，[A]、[B]、[C]错误，只有[D]的说法符合实际情况。
单选题 Which of the following does not account for doctors' inclination to provide patients with more treatment than necessary?
A. The paying mode in medical treatment lures them to make more money by treating more.
B. They can not effectively communicate with desperate family members about a reasonable treatment plan.
C. They fear that patients may sue them for not trying their best to save patients.
D. Doctors want to experiment new medical approaches on patients.
【正确答案】 D
【答案解析】判断题
[解析] 作者在分析导致过度医疗的原因的时候，除了分析病人及家属的原因之外，还着重分析了医生和医疗体系应该承担的责任。第五段中作者提到了医生和病人之间的沟通不畅导致的过度医疗问题。当面临悲痛欲绝的家属的时候，医生往往因为不知该如何跟病人家属沟通，让他们接受有节制的治疗方案，而采取任家属自行选择治疗方案的态度，这直接导致了过度医疗的结果。[B]“他们没有办法就一个合理的治疗计划和歇斯底里的病人家属进行有效沟通”描述的正是这层含义。另外，在文章的第六段作者谈论医疗体系纵容了过度医疗这个问题时还提到，doctors use the fee-for-service model to...make money，“医生利用按诊疗收费模式，在患者身上用尽一切治疗手段谋取暴利，无论这些方法是多么无济于事。”[A]谈到的正是医疗收费方式在过度医疗方面所起的作用。另外，第六段里还提到，doctors are fearful of litigation and do whatever they're asked to avoid getting in trouble，“医生害怕官司缠身，因此尽力满足患者的全部要求，以免惹上麻烦”，因此，医生过度医疗的倾向也来自于对诉讼的担心，这一点对应的是[C]。只有[D]的内容原文没有提到。
单选题 In the passages that follows the last paragraph in the excerpt, the author is most likely to ______.
A. discuss the way to overcome the problem of overtreating in medicare system
B. suggest the patients to adjust their expectation on medical treatment
C. appeal to doctors to adhere strictly to their moral grounds
D. urge relevant department to issues policies to reform American medicare system
【正确答案】 A
【答案解析】推理题
[解析] 作者在开篇引入话题之后，从第三段到第六段都在分析过度医疗产生的原因，那么自然而然地，在下文中就应该探讨针对上面论述的原因应该采取哪些有针对性的手段来遏止过度医疗。[A]为正确答案。[B]、[C]、[D]实际上涉及了遏制过度医疗的某个方面，但不是内涵最完整的答案。