7. Describe the hospital team. What are the responsibilities of different specialists?

In a busy general hospital there may be several thousand staff on the payroll. Although they are a tea.il that works closely together. Team members don't have equal status but function within a complicated system of ranks and grades. The medical hierarchy is well known for its strict divisions and class structure.

The basic hospital chain of command in British hospitals remains unchanged and is represented by № pi к

consultant, registrar, senior house officer and the house officer.

A senior house officer (SHO) is a junior doctor undergoing training within a certain speciality. SHOs are supervised by consultants and registrars, who oversee their training and are their designated clinical su­pervisors. A doctor typically works as an SHO for 2-3 years, or occasionally longer, before becoming a reg­istrar. A registrar is a doctor who is receiving advanced training in a specialist field of medicine in order to become a consultant. A consultant typically leads a "firm" (team of doctors) which comprises specialty regis­trars, and foundation house officers, all training to work in the consultant's specialty, as well as other "career grade" doctors such as clinical assistants, clinical fellows and staff grade doctors.

In the UK primary care - the first contact with hospital team - is often provided by general practitio­ners and nurses called health visitors. General practitioner treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating peo­ple with multiple health issues and comorbidities.

When it comes to recoveiy care and corrective treatment, other members of the team with special expertise come into the picture. These are professionals such as surgeons, physiotherapists, anesthetists, car­diologists, paediatricians, radiologists and others. Such professionals work in hospital specialist departments. Big general hospitals may have up to 50 specialist departments, for example, Coronary, Dermatology, Gas- troenterology, Genitourinary, Haematology, Obstetrics, Rheumatology, Gynaecology and Ophthalmology. Because barriers are breaking down between ancient and modern views of illness, many hospitals now en­courage interaction with complementary medicine, so it is now common for acupuncturists and masseurs to have a part to play too.

The whole structure of hospital team is kept going by the ancillary staff - the lab technicians, mid- \ ives, paramedics, porters, cleaners and scrub nurses. A paramedic is a medical professional, usually a member of the emergency medical services, who primarily provides pre-hospital advanced medical and trauma care. Midwifery is a health care profession in v/hich providers offer care to childbearing women dur­ing their pregnancy, labour and birth, and during the postpartum period, a practitioner of midwifery is known as a midwife. Porter is a person who carries some things; he also helps the invalids to move around the hos­pital on the carriage. Cleaners and scrub nurses provide medical hygiene practice.

The ancillary staff is an important force of individuals whose contribution to the effectiveness of hospital work is often underestimated.

As you see, hospital team represents the whole system, in which every specialist carries out his own function and has his own responsibilities

.10. Describe history taking

The medical history or anamnesis of a patient is information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information (in this case, it is sometimes called heteroan- amnesis), with the aim of obtaining information useful in formulating a diagnosis and providing medical care to the patient.

History-taking may be comprehensive - a fixed and extensive set of questions, as practised only by medical students, or iterative hypothesis testing, where questions are limited and adapted to rule in or out likely diagnoses based on information already obtained, as practised by busy clinicians. Medical students are taught to follow a structured guide when learning how to take a medical history on the wards. Computer­ised history-taking could be an integral part of clinical decision support systems.

As soon as the patient seeks medical attention a doctor fills in the patient's case his­tory. A full case history covers: personal details, presenting complaint, chief complaint, review of systems, past medical history, drug history, family history, patient's expecta­tions and others.

Normally, patient's personal details have been entered in their records by a nurse or administrative staff before the doctor sees them. However, on later consultations a doctor may wish to check details such as address, date of birth or occupation. Personal details may also include social history describing living arrangements, marital status, number of children, recent foreign travel, and exposure to environmental pathogens through recreational activities or pets.

The doctor also must know if any of the family has ever been ill with tuberculosis or has had any mental or emotional impairments. These findings are devoted to the family history.

The patient's medical history must also include the information about the diseases with the patient had both being a child and an adult, about the operations which were performed, about the traumas he had. These findings compose the past medical history.

The attending doctor must know what the patient's complaints and symptoms are. He must know how long and how often the patient has had these complaints. This part of taking a history is called presenting complaints.

The other integral part of case history is drug history. It is essential for the doctor to obtain full details of all drugs and medications taken by the patient. It is necessary to determine the precise identity of the drug, the dose used, the frequency of administra­tion and the patient's compliance and lack of it. The case history must always be written very accurately and consist of exact and complete information.

The information obtained in this way, together with clinical examination, enables the physician to form a diagnosis and treatment plan. If a diagnosis cannot be made, a provisional diagnosis may be formulated, and other possibilities (the differential diagnoses) may be added, listed in order of likelihood by convention. The treatment plan may also include further investigations to clarify the diagnosis.

MEDICAL SERVICE IN RUSSIA 6 Al the Chemist's

Text A

AT THE CHEMIST'S Chemists' shops are specialized shops where medicines are sold. Chemists' shops are usually situated on the ground floor. They have a hall for visitors, two departments for selling drugs, and proper working rooms.

The department for reception of prescriptions and delivery of drugs is called a prescription department. The other one is called a chemist department. At the prescription department medicines are sold or made up according to prescriptions. At the chemist department one may buy medicines without prescriptions. In this department one may buy also different things for medical care and medicinal plants^{A J}

The working rooms of a chemist's include rooms for washing, drying and sterilization of glassware, an analytical laboratory, a room for storing medicines, a room for dispensing them and some others.

At the chemist's all medicines are kept in drug cabinets, on the open shelves and in the refrigerator. Poisonous drug are kept in the drug cabinet with the letter A. Strong effective drugs are kept in the drug cabinets having the letter B.

The drugs prepared at the chemist's for immediate use should be kept in the refrigerator. Powders, galenical preparations and medicines produced at the pharmaceutical plants are usually kept on the shelves protected from light at a constant temperature, not higher than a room temperature.

Every small bottle or box has a label with the name of the medicine. There are labels of four colours for the drugs prepared at the chemist's: labels of a green colour indicate medicines for internal use; blue labels indicate drugs used for injections. Drugs for external application have labels of a yellow colour. Drugs used for treatment of eye diseases have labels of a pink colour.j

The single dose and the total dosage are indicated on the label or the signature. The directions for the administration of a drug are very important for sick people as well as for those who take care of them.

At the chemist department medicines are kept according to the therapeutic effect: drugs for cough, cardiac medicines, drugs for headache. Disinfectants, herbs and things for medical care such as hot-water bottles, medicine droppers, cups, thermometers are kept separately.

At the prescription department one can see drugs of all kinds: boxes and parcels of different powders, ampoules of glucose and camphor used for intramuscular and intravenous injections; tubes of ointments for rubbing; different pills and tablets for internal use; tonics and sedatives administered orally.

The personnel of an average chemist's consists of a manager of the chemist's, a dispensing pharmacist who takes prescriptions and delivers drugs, a chemist controlling the prescriptions, that is, physical, physico-chemical and pharmacological compatibility of the ingredients of the compound prescribed by the physician. The personnel includes also a chemist-analyst who controls effectiveness of the drug prepared at the' chemist's as well as that of manufactured drugs. There is also a pharmacist who is in charge of the supply of necessary medicines.

chemist department - отдел ручной продажи poisonous drags - ядовитые лекарства prescription department -рщептурный отдел strong effective drugs - еыльнодейств. лек-ва cabinetf - шкаф для лекарств galenical preparations -галеновые препараты

to store - хранить to keep on the shelves - хранить на полках

refrigerator - холодильник to be in charge of - отвечать з

а13. Discuss the problem of clinical drug trials. What is your opinion on using animals for research? Should prisoners or sick people agree to participate in such trials?

Clinical trials are conducted to allow safety and efficacy data to be collected for health interven­tions, for example, drugs, devices and therapy protocols.

Depending on the type of product and the stage of its development investigators enroll healthy volunteers or patients into small pilot studies initially, followed by larger scale studies in patients that often compare the new product with the currently prescribed treatment. As positive safety and efficacy data are gathered, the number of patients is typically increased. Clinical trials can vary in size from a single center in one country to multicenter trials in multiple countries.

During the clinical drug trial the investigators recruit patients with the predetermined characteris­tics, administer the treatment, and collect data on the patients' health for a defined time period. These data include measurements like vital signs, concentration of the study drug in the blood, and whether the patient's health improves or not. The researchers send the data to the trial spon­sor who then analyzes the pooled data using statistical tests.

While performing a drug trial the investigators should compose a clinical trial protocol, which is a document used to gain confirmation of the trial design by a panel of experts and adherence by all study investigators, even if conducted in various countries.

The biggest barrier to completing studies is the shortage of people who take part. All drug and many device trials target a subset of the population, meaning not everyone can participate. Some drug trials require patients to have unusual combinations of disease characteristics. It is a chal­lenge to find the appropriate patients and obtain their consent, especially when they may receive no direct benefit. In the case of cancer patients, fewer than 5% of adults with cancer will partici­pate in drug trials.

The other problem concerning clinical drug trials is high frequency of accidents during it. In March 2006 the drug TGN14 caused catastrophic systemic organ failure in the individuals re­ceiving the drug during its first human clinical trials in Great Britain.

Potential drugs first have to be discovered, purified, characterized and tested in labs with the help of specific animal studies before undergoing clinical trials. The problem of involving animals in the process of drug trial has always been discussed in scientific circles. There may be a lot of ar­guments for and against it. However, in some severe cases it becomes necessary to test the drug on animals in order to secure the patient's life.

The World Medical Association's Declaration of Helsinki requires researchers to take special care with consent involving vulnerable subject populations which have barriers to informed con­sent. These groups include minors, prisoners, and the mentally ill.

To approve the trial for such groups of people it must meet all of the following conditions:

• The trial must involve no more than a minor increase over minimal risk.

• The treatments must be appropriate to the condition or to medical care that the patient would otherwise receive.

The treatment must either yield "generalizable knowledge" about the specific condition that is vital for understanding or treatment

.9. Discuss what people should/shouldn't do to lead healthy lifestyle

Duration and effectiveness of our life fully depends on our lifestyle. From this point it is only our decision, how long and how joyful our life can be.

One the one hand, if we watch out for our diet, take care of health, including mental one, go in for sports or fitness, our chances of enjoying prolonged life are increases. On the other hand, people who smoke and drink have a lot of lung, heart and vascular problems. They could also suffer from obesity. Those who live under stress are also unlikely to live long. But in this case there is a way out to extend efficiency of life.

Any doctor will advise you to:

• lose your weight by cutting down sweets, reducing calories

• eat as much low-fat food as possible (chicken, fish and yogurt)

• eat at least five portions of fruit and vegetables a day to ensure vitamins and minerals

• give up smoking

• avoid snacks

• avoid stress

• lead an active lifestyle and stay in shape with exercise that give of benefit

• not to go to bed late

• not to be a fitness or diet fanatic

This advice is not difficult at all, but unfortunately very few people follow it. So it is important for a patient how doctor can prove them the importance of these simple rules. Attempts to change patients' behavior is a matter of negotiation. Right strategy is that which involves the patients themselves. This is achieved not through forcing opinion or ordering to do something, but by coaxing and encouraging patients. Patients should know the benefits of following the rules of healthy lifestyle and harmful effects of bad habbits.

Also a health adviser should provide the patient wide options from which the patient can make a choice. Options need to be patient-centered, taking into account the patient's way of life. For example, no need to say to a patient who doesn't use buses, to exercise by getting off one stop early when going to work.

you with

you a lot

Effective negotiation requires sympathy and empathy. Doctor must be kind, patient and responsive. Otherwise, patient might begin to lose faith in the doctor's attempts to help him.