Huge health care bills, long emergency-room waits and the inability to find a primary care physician just scratch the surface of the problems that patients face daily.
Primary care should be the backbone of any health care system. Countries with appropriate primary care resources score highly when it comes to health outcomes and cost. The U.S. takes the opposite approach by emphasizing the specialist rather than the primary care physician.
A recent study analyzed the providers who treat Medicare beneficiaries (老年医保受惠人). The startling finding was that the average Medicare patient saw a total of seven doctors—two primary care physicians and five specialists—in a given year. Contrary to popular belief, the more physicians taking care of you don’t guarantee better care. Actually, increasing fragmentation of care results in a corresponding rise in cost and medical errors.
How did we let primary care slip so far? The key is how doctors are paid. Most physicians are paid whenever they perform a medical service. The more a physician does, regardless of quality or outcome, the better he’s reimbursed (返还费用). Moreover, the amount a physician receives leans heavily toward medical or surgical procedures. A specialist who performs a procedure in a 30-minute visit can be paid three times more than a primary care physician using that same 30 minutes to discuss a patient’s disease. Combining this fact with annual government threats to indiscriminately (任意地) cut reimbursements, physicians are faced with no choice but to increase quantity to boost income.
Primary care physicians who refuse to compromise quality are either driven out of business or to cash-only practices, further contributing to the decline of primary care.
Medical students are not blind to this scenario. They see how heavily the reimbursement deck is stacked against primary care. The recent numbers show that since 1997, newly graduated U. S. medical students who choose primary care as a career have declined by 50%. This trend results I emergency rooms being overwhelmed with patients without regular doctors.
How do we fix this problem?It starts with reforming the physician reimbursement system. Remove the pressure for primary care physicians to squeeze in more patients per hour, and reward them for optimally (最佳的) managing their diseases and practicing evidence-based medicine. Make primary care more attractive to medical students by forgiving students loans for those who choose primary care as a career and reconciling the marked difference between specialist and primary care physician salaries.
We’re at a point where primary care is needed more than ever. Within a few years, the first wave of the 76 million Baby Boomers will become eligible for Medicare. Patients older than 85, who need chronic care most, will rise by 50% this decade.
Who will be there to treat them?
1. We learn from the passage that people tend to believe that ________.A.the more costly the medicine, the more effective the cure |
B.seeing more doctors may result in more diagnostic errors |
C.visiting the same doctor on a regular basis ensures good health |
D.the more doctors a patient sees, the better |
A.increase their income by working overtime |
B.improve their expertise and service |
C.see more patients at the expense of quality |
D.make various deals with specialists |
A.Bridge the salary gap between specialist and primary care physicians. |
B.Extend primary care to patients with chronic diseases. |
C.Recruit more medical students by offering them loans. |
D.Reduce the tuition of students who choose primary care as their major. |
A.The Health Care in Trouble | B.The Imbalance System |
C.The Declining Number of Doctors | D.The Ever-rising Health Care Costs |
相似题推荐
【推荐1】Scientists from Tufts University have developed tiny groups of human cells that can move on their own-and in a lab experiment, these so-called “anthrobots” inspired sheets of human neurons to repair themselves when damaged. The researchers hope the collections of cells could one day be used to treat diseases or aid with healing in humans.
The study comes on the heels of earlier work from one of its authors, who produced tiny robots by stitching together frog embryo cells. These robots, known as “xenobots”, could assemble themselves, move across surfaces and travel through liquid.
Since they're not made from human cells, xenobots can't be used to treat humans, writes Matthew Hutson, a freelance science writer. But the anthrobots in the new study could theoretically. Each anthrobot started with a single cell from an adult human lung. It then grew into a multicellular biobot after being cultured (培养) for two weeks.
These lung cells are covered in cilia. But at this point in the research, the cilia were growing inside the clumps of cells. So, for the next week, the researchers grew the cells in a solution (溶液) that caused the cilia to face outward instead, enabling these structures to move the anthrobots, which could move in tight loops, travel in straight lines or wiggle in place. Their speed varied as well.
The researchers also tested how these robots might heal wounds. They mimicked (模拟) a wound by scratching a layer of neurons in a dish. Then, they introduced anthrobots to the site of the scratch, and within days, the neurons regrew, bridging the gap created by the wound. The findings show new structures that might have uses in biomedical settings can be developed without gene editing and without having to design the structures manually, the study authors write.
“Unlike xenobots, anthrobots don't require tools to give them shape, and we can use adult cells-even cells from elderly patients-instead of embryonic cells,” says Gizem Gumuskaya, the paper's lead author. "We can produce these robots in large amounts in parallel, which is a good start for developing a therapeutic tool.”
1. How are the advantages of the anthrobot highlighted in the text?A.By showing comments from users. | B.By explaining some terms. |
C.By making comparisons. | D.By listing the data of questionnaires. |
A.The weaknesses of the anthrobot. | B.The culture of the anthrobot. |
C.The structure of the anthrobot. | D.The application of the anthrobot. |
A.It can travel both on land and in water. | B.It requires no genetic modification. |
C.It can be applied in a controlled way. | D.It can develop from any cells of humans. |
A.Regenerative medicine. | B.New materials. |
C.Environmental protection. | D.Individualized education. |
【推荐2】Jennifer Udler was in the middle of a 50-minute session with a patient when it started to rain. Walking and talking about anxiety and stress, she and her teenage patient got wet. But when they made it back indoors, Jennifer said, “Hey, look at us! We’re wet, but we got through it! Now you can use that next time you have anxiety before and during an event.” This kind of insight is key to her practice.
Jennifer, a social worker whose practice focuses on adolescents, has been a therapist(治疗师)for 20 years. For most of that time, she practiced in a traditional office, but she noticed how easy it was for her running partners to open up about their problems. After doing some research, in 2013, Jennifer founded Positive Strides Therapy, where she conducts sessions while walking outdoors. She conducts all of her sessions outdoors and in all kinds of weather.
“When somebody asks me if I specialize in walking therapy, I say, ‘No, that’s how I practice,’” Udler said. “I specialize in family systems theory. Walking in the park is just where I practice.”
Despite the lack of formal research, Jennifer believes strongly in the benefits, saying that it can be helpful. “We’ll be talking about ‘moving forward’ as we are actually moving forward on the path, building muscle memory of how they can move forward and leave the anxiety behind.”
And outdoor walking therapy doesn’t just benefit teens. Jennifer says the adults in her practice welcome the humanizing effect of taking therapy outdoors.
1. What lesson did Jennifer teach her teenage patient through the rain?A.Rain and suffering are a part of life. | B.She is ready to help the young man. |
C.We can beat our difficulty after all. | D.Rain can help us deal with our trouble. |
A.Jennifer always talks with his patients in the rain. |
B.Jennifer found it easy to talk with her patients in traditional office. |
C.Jennifer conducts all of her sessions outdoors in Positive Strides Therapy. |
D.Jennifer specializes in walking therapy. |
A.Doubtful. | B.Confident. | C.Unconcerned. | D.Disappointed. |
A.The lack of formal research about the therapy. |
B.Building physical memory of past experience. |
C.Treating her teen patients in a traditional office. |
D.Conducting walk-and-talk therapy for teens. |
A.Walking outdoors is similar to managing worries. |
B.Moving in the rain is a bit too difficult to tolerate. |
C.The rain can make one excited and face the trouble. |
D.Running in the rain or storm will make one healthy. |
【推荐3】Patients in the early stages of Alzheimer’s disease often struggle to remember recently learned information, meaning they forget things like important appointments or where they left their keys. But it seems that these memories are not lost. They are still filed away in the brain somewhere; they just can’t be easily accessed.
Now, researchers at MIT have developed a means of getting back memories in mice suffering from Alzheimer’s. The method relies on a technique that uses light to control genetically modified neurons (转基因神经元). Currently it is too early to be used in human trials as it involves inserting light emitting (发光) equipment into the subjects’ brains, but the same principles still apply, the researchers said.
“The important point is that this is evidence of concept. That is, even if a memory seems to be gone, it is still there. It’s a matter of how to get it back,” said senior researcher Susumu Tonegawa.
The team took two groups of mice, one genetically engineered to develop Alzheimer’s and one healthy. They then placed them into a room and gave them a mild electric shock. All of the mice showed fear when put back in an hour later. When placed in the room a third time several days later, the Alzheimer’s mice acted normally. They had forgotten the shock.
The researchers were then able to bring back the memory of the shock by activating (激活) the cells in which the memories were stored. Even when the mice were put into an unfamiliar room, they showed fear when the cells associated with the shock were activated.
“Short-term memory seems to be normal, on the order of hours. But for long-term memory, these early-Alzheimer’s mice seem to be damaged,” said lead researcher Dheeraj Roy. “Directly activating the cells that we believe are holding the memory helps them get it back. This suggests that it is indeed an access problem to the information, not that they’re unable to learn or store this memory.”
1. What can we learn about the researchers at MIT?A.They are the pioneers of brain research. |
B.They have used the method in human trials. |
C.They can cure Alzheimer’s using the new method. |
D.They can get back memories in mice with Alzheimer’s. |
A.They failed to remember the electric shock. |
B.They were accustomed to the situation. |
C.They managed to overcome the fear. |
D.They activated the association. |
A.can activate their blood cells |
B.can’t learn new tricks well |
C.can easily get back their memory |
D.can’t access the information stored |
A.introduce a method of a research |
B.report the latest discovery about a disease |
C.give advice on how to improve memory |
D.explain how our brain stores information |
【推荐1】A recent experiment conducted at the University of British Columbia(UBC)in Canada has an “Aha!” moment for anyone who wants to form habits that increase everyday happiness and well-being.
Researchers walked around campus handing out $5 or $20 bills, asking participants to spend the money by the end of the day. The participants weren’t told what the purpose of the research was, only that they were part of a study. Half the participants were told to spend the money on themselves, the other half were tasked with spending it to benefit someone else. At the end of the day, those who had spent the money on others reported a greater sense of happiness and well-being than those who had spent it on themselves.
Aha! Kindness is connected to happiness. This likely won’t surprise many readers who live by the Golden Rule and generally attempt to anchor our happiness in ways we can contribute to the lives of others. But the UBC study is part of a broader idea that can help us deepen our commitment to these values during the busy holiday season and beyond.
Two students at the university have started a Random Acts of Kindness Club to strengthen that kindness is a daily habit. So far, the group has created public displays of inspirational and practical messages encouraging the community to care for their emotional health. Simple acts of kindness, members say, are benefiting themselves as well as making a difference in the broader community.
Elizabeth Dunn, the professor of psychology who led the research study, added that regularly practicing kindness to others can help us with another kindness habit, one that is often more challenging—kindness to ourselves. She said, “The form of compassion that is perhaps most beneficial for ourselves is really all about self-kindness…that same sort of gentle compassion that we would extend to a treasured friend or maybe a younger person in our life that we care about.”
1. The text is especially helpful for those who care about_________.A.making more friends in life. |
B.sharing joy with loved ones. |
C.concerning about emotional health. |
D.forming habits to increase daily happiness. |
A.It focuses on college students’ living habits. |
B.Its conclusion has caused heated discussion. |
C.It offers participants advice on mental health. |
D.Its purpose remains secret to the participants. |
A.By displaying some messages. | B.By observing the Golden Rule. |
C.By donating money to others. | D.By giving inspirational lectures. |
A.Skeptical. | B.Supportive. |
C.Conservative. | D.Tolerant. |
【推荐2】According to the most recent census (人口普查) figures, nearly half of women between the ages of 15 and 44 don’t have children. Half of women is a lot of women, and yet, advertisers continue to behave as though they don’t exist. “The majority of marketing talks to adult women like they are all moms or want to be mothers,” Adrianna Bevilaqua, chief creative officer at M Booth, a public relations company, told The New York Times.
Industry experts explained to The Times that the absence of childless women in marketing materials is likely the result of inertia (惯性). Advertisers have long targeted moms because they buy their goods. In 2015, American moms were in charge of $3.4 trillion worth of spending decisions, which makes them the largest consumer group in the United States.
While they might not have the collective spending power of moms — many of whom, I suspect, would be very happy to give up some power of choosing laundry detergent (洗衣粉) in exchange for power of choosing something else with equal pay — childless women also have the potential to improve a business’ bottom line. One report has found that they spend twice as much on beauty products as women with children, and spend 60 percent more time abroad. The Times also notes that they spend 35 percent more on groceries than moms.
Of course, advertising has had a long time to adapt to the ongoing change in gender (性别) roles, and still, brands has made sexist ads that many find degrading (降低品格的). And even when brands do try to get with the times, as is the case with Dove and Pantene, many women still think them unpleasant. These critics are angry about the way such campaigns overstate female empowerment when, in reality, such empowerment is far from being fully realized.
Earlier this year, ad agency Saatchi & Saatchi researched moms’ understanding of their representation in advertising and found that they weren’t happy either. They surveyed nearly 8,000 women from around the world, the majority of whom responded with feelings of frustration (挫败) at the outdated mom images, including the busy mom and the saintly (神圣的) and perfectionist mom we so often see. Above all, they resented the view of motherhood as a job. “Motherhood is about being, not doing,” said Mary Mills, worldwide director of strategic intelligence from Saatchi & Saatchi, when describing the findings.
So as it turns out, both childless women and moms are motivated by the same desire. They want advertisers to let go of motherhood as an all-consuming identity for women and instead present them as the varied and unique beings they’ve long known themselves to be.
1. What can we learn from the passage?A.Few American women do not want to have children. |
B.Moms are happy because they are targeted by advertisers. |
C.Moms were the largest consumer group in America in 2015. |
D.Half of American women have no children according to the recent census figures. |
A.Childless women spend mainly on beauty products and travel. |
B.A report about women’s spending power has been produced. |
C.Moms spend less on groceries than childless women. |
D.Childless women’s spending power is not lower than that of moms. |
A.Respected. | B.Hated. |
C.Misunderstood. | D.Formed. |
A.Moms’ representation in advertising has been researched by ad agencies. |
B.Most American women want to be seen as unique beings. |
C.Advertisers should pay attention to childless women. |
D.Advertisers misunderstand moms’ images. |
【推荐3】Young Africans are logging in and clocking on
His home is Bungoma, a small town in western Kenya, but his workplace is the world. Kevin, who asks that his real name be masked to protect his credibility, has written about offices in China without ever going there. He has reviewed home-security systems he has never seen.
Some are attracted to the work by the flexibility and pay; others because they cannot find a traditional job. There are advocates for freelancing.
Freelances, like the wider outsourcing (外包) industry, “are fighting against a reputation of Africa as somewhere where you would not expect digital work to take place,” says Mohammad Amir Anwar of the University of Edinburgh, who co-wrote a book about Africa’s digital workforce. Some African freelances use virtual private networks and fake names to pretend they are somewhere else.
The available data suggest that it will take time for Africa to become a continent of digital freelances. In 2019, Mr. Anwar and colleagues estimated that there were 120,000 African workers on Upwork, the continent’s most popular platform—fewer than in the Philippines. Most did not seem to be making any money.
Outsourcing practices have also sparked moral questions. Al Astra (a live-streaming company) content-moderation center in Kenya run by Sama (an outsourcing firm), workers told journalists that they were mistreated and misled about the nature of their work.
Technological change bounces in unpredictable directions. Could Al tools, previously trained by Kenyan workers, one day make these freelances such as Kevin unnecessary?
A.Africa’s digital workers are re-mapping the old geographies of labor. |
B.The internet creates new kinds of work, without any patterns of inequality. |
C.A former employee has taken both companies to court, accusing them of forced labor. |
D.Typical tasks include data entry, online marketing, or even writing essays for lazy students. |
E.Baraka Mafole, a student in Tanzania, organizes training events for navigating online platforms. |
F.Power cuts and competition for part-time jobs from cheaper workers in Asia and beyond create other challenges. |
【推荐1】For generations, depression has been seen as an illness, disorder or even weakness. Such an idea makes sense because depression causes suffering and even death. But what if we’ve got it all wrong?
The common wisdom is that depression starts in the mind with abnormal thinking. That leads to symptoms like headaches, stomachaches, or tiredness. Now, models like the Polyvagal Theory suggest that we’ve got it backward. It’s the body that detects danger and initiates a defense strategy meant to help us survive. That biological strategy is called immobilization, and it demonstrates in the mind and the body with a set of symptoms we call depression.
When we think of depression as unnecessary suffering, we are telling people with depression that they are not part of the group, they are not right and they don’ t belong. That robs them of hope. But when we begin to understand that depression, at least initially, happens for a good reason we lift the shame. Instead, people with depression are courageous survivors, not damaged sick people.
The autonomic nervous system (ANS) is constantly scanning our internal and external environment for signs of danger. If our ANS detects a threat or even a simple lack of safety, its next strategy is the fight or flight response, which we often feel as anxiety. Sometimes the threat is so bad or goes on for so long, that the nervous system decides there is no way to fight or to flee. At that point, there is only one option left: immobilization.
The immobilization response is the original biological defense in higher animals. It dulls pain and makes us feel disconnected. Think of some reptiles (爬行动物), which shut down their bodies to avoid cold temperatures and the lack of food and water. In humans, people often describe feeling “out of their bodies" during extremely unpleasant events, which has a defensive effect of reducing the emotional shock. This is important because some things are so terrible, we don’t want people to be fully present when they happen. What incredible capacity of our biology to find a way in hard times!
1. Why does the author mention the Polyvagal Theory?A.To offer a standard for identifying depression. |
B.To raise people’s awareness of mental problems. |
C.To make sense of how depression affects people. |
D.To correct a commonly held idea about depression. |
A.Depression can bring people in crisis hope. |
B.People may feel it wrong to have depression. |
C.Depression is an unnecessary human emotion. |
D.People often feel proud of fighting depression. |
A.Building up anxiety. | B.Fighting for a crisis. |
C.Shutting down action. | D.Thinking abnormal. |
①seek to work out solutions
②become aware of a threat
③suffer emotional shock
④start defensive disconnection
A.②③④① | B.④②①③ | C.②①③④ | D.④①②③ |
【推荐2】Birds rely on their keen sense of hearing to detect prey (猎物) and identify other birds on the basis of their songs. In fact, birds have better hearing than humans, so they hear with much more detail. So how do birds hear?
Birds and humans both have an inner ear and a middle ear. However, birds differ from humans in that they lack an external ear structure. Where humans have an outer ear organ, birds have a funnel-shaped opening that functions as their outer ear, located on each side of their head. These openings are usually positioned behind and slightly below a bird’s eyes and are protected by soft feathers.
The position of a bird’s head also plays a role in its hearing abilities. Scientists have determined that noises register at different frequencies on each side of the bird’s head. Depending on the angle from which the noise originates, it registers with a certain frequency in the left eardrum but with a different frequency in the right eardrum. This allows the bird to locate a sound’s origin.
For example, owls are known for their extremely accurate hearing, which helps them locate prey at night. This hearing ability is due in part to the unbalanced arrangement of the ear openings, with one opening being lower than the other. Sounds register in these openings at slightly different times. Owls can use this time difference, which is only 30 millionths of a second, to determine whether the sounds are coming from their left or their right. Other birds of prey have flaps in front of their ears that help them determine whether sounds are coming from above them or below them. Some owls do appear to have ears on the top of their head, but those are actually feathers controlled by small muscles under the skin that do not affect their hearing at all.
1. What is the difference between birds and humans according to paragraph 2?A.Ears’ structure. | B.Ears’ function. |
C.Ears’ position. | D.Ears’ sensitivity. |
A.The angle of noise sources. |
B.The bird’s unique ear structure. |
C.The intensity of the sound around the bird. |
D.The difference in frequencies between the eardrums. |
A.The flaps of birds of prey have little impact on their hearing. |
B.Owls determine the direction of sound based on their feathers. |
C.Different birds have varying abilities to judge the direction of sound. |
D.Many birds have unbalanced positions of the ear openings besides owls. |
A.The Secret of Owls’ Hearing | B.Special Ear Structure of Birds |
C.Different Hearing Systems of Birds | D.Remarkable Hearing Abilities of Birds |
【推荐3】Every year on April 22,Earth Day marks the anniversary of the birth of the modern environmental movement in 1970.It gave a voice to an emerging public consciousness about the state of our planet.The founder was Gaylord Nelson.
What moved Gaylord Nelson to action was the1969massive oil spill(溢出)in California,the largest oil spill in the United States at that time.The spill proved to be an environmental nightmare as it had a strong impact on marine life,killing an estimated3,500sea birds,as well as marine animals such as dolphins,elephant seals and sea lions.Inspired by the student antiwar movement at that period of time,Nelson found it was a right time to channel the energy of the students towards a fight for environmental protection.He decided that it was time to educate the Americans on the need to protect the environment.Thus,Earth Day was born in1970,and public environmental consciousness took centre stage.
On 22nd April 1970,millions of Americans took to the streets to demonstrate for a healthy,sustainable environment and thousands of students marched in protest of the terrible situation of the environment.Businesses were forced to follow environmental standards if they wanted to continue their operations.The year1990 saw Earth Day reach out to many more countries around the world.It helped pave the way for the 1992 United Nations Earth Summit in Rio de Janeiro,bringing together many nations,for a joint effort towards protecting the environment.In 2009,the United Nations decided to officially set April 22 as Earth Day.
For his role as founder of Earth Day,Gaylord Nelson was awarded the Presidential Medal of Freedom(1995),the highest honour given to civilians in the United States.We honor the man,as the fight for a cleaner environment continues.
1. What can we learn about Earth Day?A.It was founded at the end of 1970s. |
B.It was first celebrated in Rio de Janeiro. |
C.People will march on the street on this day. |
D.It arouses public environmental awareness. |
A.He reduced the loss of the oil spill. |
B.He participated in an antiwar movement. |
C.He set environmental standards for business. |
D.He involved more people in environmental issues. |
A.The focus of Earth Day. |
B.The development of Earth Day. |
C.The world 's concern on the environment. |
D.The joint efforts of different countries. |
A.Intelligent. | B.Responsible. | C.Considerate. | D.Knowledgeable. |