By Sarah Poggi

①The narrator（叙述者，解说员）asked: “Are you going to be a victim or a survivor-protector（幸存者的保护者）”? ②I am an obstetrician（产科医生）, and I was taking my annual online course on “workplace violence（工作场所暴力）.” ③Myfavorite part is the instructions（指导）on how to “fight” a gunman（持枪歹徒）if one shows up at my office: I am advised to throw a cupof coffee at them. ④But in our “infectioncontrol（感染控制）” course, I learned I couldn’t have anyfood or drink in the hospital. ⑤As a backup（作为后备）, it was suggested that I could hurl（用力投掷） a stapler（订书机）. ⑥I use apaperless records system, but I keep my stapler locked and loaded（准备好了，填弹完毕，锁定目标）just in case.

①   开头用一句话引起读者兴趣，一个问题吸引读者继续读下去。Take course修课。

②   第二句给出了第一句话的出处，并指出了作者的职业和本文的焦点work violence.

③   My favoritepart is the instructions on howto “fight” a gunman（宾语从句） if one shows up at myoffice（条件状语从句）:（冒号表示解释说明，还有强调的作用） I am advised to throw a cup of coffee at them.

④   But（表示转折）in our “infection control” course, I learned I couldn’t have any food ordrink in the hospital. 本句暗示上文所说的防御措施没有什么用，本文表达很幽默，要注意体会。

⑤   As a backup（引出作者下文要提到的独特的防身方法）, it was suggested that I could hurl a stapler.

⑥   I use apaperless records system, but I keep my stapler locked and loaded（非常形象生动，将订书机比喻成枪一样上膛锁定目标） just in case.

①Four years ago, when I was first required to view thismaterial, I was cynical（讽刺的）about it. ②Then in2012 the tragedy at Sandy Hook unfolded（展现，出现）, and other shootings（枪击事件）have followed. ③LastJanuary, my medical school classmate Michael Davidson was shot to death at Boston’s Brigham and Women’s Hospital bya family member of a former（之前的）patient.

①   指出一开始对应对工作场所暴力这件事不以为然。View this material指的是上网课。

②   Then（暗示自己的态度发生了转变）in 2012 the tragedy at Sandy Hook unfolded, and other shootings havefollowed.

③   举例说明身边的朋友受到了暴力伤害并去世，这些事例都让作者开始重视work violence这件事。

Davidson was murdered in pro-gun-control（支持枪械管制）Massachusetts（马萨诸塞州）. I practice（行医）in Virginia, with more relaxed（宽松的）gun laws.

通过两个州对枪械管制的不同程度来说明，对于枪支的管制并不一定能制止暴力。

①Over the past year I paid more attention to my training,which focused on identifying “behaviors ofconcern.（担忧的行为）” I learned that people don’t “just snap（咬，厉声说）.” Even “normal” patients and family members can be frustrated（使懊恼）by a lack of control over health problems. ②These feelings can escalate（逐步增强）to the use of profanity（脏话，侮辱）, yelling（叫喊）and threats. ③The coursesuggested that I should call security（保安）if patients display these “behaviors of concern.”

①  Over the past year I paid more attention to my training, which focused on identifying“behaviors of concern.” Which引导的非限定性定语从句修饰前面的training.同时这句话引出了本段的话题。

②  进一步解释behaviors of concern是什么行为。

③  The course suggested that I should call security if patients display these“behaviors of concern.”条件状语从句，指出遇到了behaviors of concern该怎么做。

While the vast majorityof（绝大部分，大部分）our patients arelovely, we still see these kinds behaviors with some frequency（带有一些频率）. It is difficult to discern（识别，辨别）which incidents merit（值得）action.

过渡段，引出下面患者的行为。

①Our receptionist（接待员，前台）smiles easily and has a bell-like（清脆的）laugh, but lately she has been a bit more solemn（严肃的）inour staff meetings. ②“Dr. Poggi, it’s getting crazy out there,”she told me. “[Mrs. X] swore at（咒骂）me in front of the waiting room because we were 20minutes late. I was running through（浏览）the routine（日常的）Ebola（埃博拉病毒）travel questionnaire（调查表）,and a man whose wife had a head scarf（头巾）yelled at me that I was profiling（简介）them because they were Muslim（穆斯林）.”

①  Our receptionist smiles easily and has a bell-like（形象生动）laugh, but（表示转折，对比了前台接待员前后状态的不同）lately she has been a bit more solemn in our staffmeetings.

②  “Dr. Poggi, it’s getting crazy out there,” she told me.“[Mrs. X] swore at me infront of the waiting room（后置定语） because we were 20minutes late（原因状语从句）. I was running through the routine Ebola travel questionnaire, and a man whose wife had a head scarf（定语从句）yelled at me that I was profiling them because they were Muslim（原因状语从句）.” 用了直接引语的方式叙述接待员的话，更直接。指出了接待员遇到了behaviorsof concern的患者。

①Sometimes the invective（恶言谩骂）that she hears is aimed at me. (Note: If you think whatyou are telling the front office（前台）will not be repeated, you are misguided（误导）.) ②An obese（肥胖的） patient was angry because, as per（按照，根据）national standards, I suggested that she minimize（使减到最少）her weight gain（增重）during her pregnancy（怀孕）, which was not well received. Upon her exit（离开）fromthe office, she threatened: “I am going to get Dr. Poggi’s ass（叫……滚蛋）!”

①  Sometimes the invective that she hears（定语从句，修饰invective） is aimed at me. (Note: If you think what youare telling the front office will not be repeated, you are misguided.)括号中的内容对前面的句子做进一步的解释说明。

②  An obese patient was angry because, as per national standards（插入语）, I suggested that she minimize her weight gain during her pregnancy, which was not well received（非限定性定语从句，修饰前面作者对患者建议的内容）.举了具体的例子还说明有些患者的恶言相向。

①More recently a patient requested that the results of heramniocentesis（羊膜穿刺术）— a test of amnioticfluid（羊水）— be givento her by phone. ②I had relayed（转述）the information that, based on preliminary testing（初步实验）, there was a 95 percent chance they would bepositive for Down syndrome（唐氏症）. ③When, asrequested, I called her with this result, she was furious（狂怒的，大发雷霆）that I had not broughther in to the office. ④I had beeninformed that she had previously been observed to storm around（大发雷霆）thewaiting room cursing（诅咒）and bullying（欺负）the staff. ⑤I got off easy（没有遇到多少麻烦）.

①  More recently a patient requested that the results of heramniocentesis —（解释说明）a test of amniotic fluid —（表示接下来的动作）be given to her by phone.又举了一个具体的例子说明自己怎么避免behaviors of concern.

②  I had relayed the information that, based on preliminary testing（插入语）, there was a 95 percent chance they would be positive for Down syndrome（宾语从句）.

③  When, asrequested（插入语）, I called her with this result, she wasfurious that I had not brought her in to the office. 患者抱怨作者为什么没让她去办公室说。

④  I had been informed that she had previously been observedto storm around the waiting room cursing and bullying the staff（动名词做宾语补足语）.这句话说明了作者为什么没让患者去他办公室，而是给患者打电话，是因为作者事先被告知患者脾气很不好，对医护人员很不礼貌。

⑤  这句话表明了作者因为事先知情，很容易的躲过了一次behaviors of concern.

①Did I report any of these “behaviors of concern”? ②No. I justified（为……做出解释）every case, empathizing with the patient: The patientfrustrated by lateness had children to pick up. The Muslim couple was at risk（处于危险中）for pretermdelivery（早产）. The obese（肥胖的）woman felt bad about her weight. Thepatient whose fetus（胎儿）had Down syndrome was blaming the messenger（报信者）.

①   用问句引起读者兴趣，并引出下面的话题。

②   No（作者用一个否定的回答，强调了自己并未报告behaviors of concern，这会让读者很想知道他为什么没有报告）. I justified every case, empathizing with the patient（站在患者的角度来思考）:（具体解释说明患者行为出现的原因）The patient frustrated by lateness had children to pickup. The Muslim couple was at risk for preterm delivery. The obese woman feltbad about her weight. The patient whose fetus had Down syndrome（定语从句）was blaming the messenger.这一段主要用了具体的事例，将前面讲到的behaviors of concern的患者为什么会出现不理智的行为，作者站在患者的角度上考虑了问题，很全面。

Notifying（通知）security in such instances seems likely only to aggravate（加重，激怒） an already angry patient. In all of theabove cases, I apologized to the patient for her negative experience.

这一段进一步解释了自己为什么不去报告那些behaviors of concern，并指出了自己是如何应对这些行为的。这一段有承上启下的作用。

①But there is also a self-serving（自私的）motive（动机）for letting intemperance（过度）go unchecked. An angry patient is far more likely tograde me poorly than a satisfied one is to grade me highly on one of the manydoctor-rating Internet sites.

① But（引出另一个原因）there is also a self-serving motive for lettingintemperance go unchecked.

② 这段指出了自己不去报告患者过分行为的另一个原因，就是被激怒的患者很可能会在网上给医生差评，这种几率要远远高于一个满意的患者给医生好评。

①I am also subjected to（受到）patient satisfaction surveys as dictated（强行规定）by the Affordable Care Act（平价医疗法案）. Here’s a reasonable-sounding sample question: “Howoften did doctors treat you with courtesy（礼貌）and respect? The possible answers are “never,”“sometimes,” “usually” and “always.” ②My hospitalhas made it clear that some of thefederal funding（联邦基金）we receive is tied to（捆绑于） the proportion of（…的比例）“always” answers; we get no credit（赞扬）for“usually,” which might as well be “never.” ③Nor is there a mechanism（方法）to identify what a patient might consider disrespectful.

①  I am also（指出自己忍受患者过分行为的第三个原因）subjected to patient satisfaction surveys as dictated bythe Affordable Care Act.

②  My hospital has made it clear that some of the federalfunding we receive（定语从句，修饰federal funding） istied to the proportion of “always” answers;（分号表示并列） we get no credit for “usually,” which might as well be “never.”（非限定性定语从句，表明得到usually于得到never几乎是一样的）。

③  Nor（引导倒装句） is there a mechanism to identify what a patient might considerdisrespectful.

①We are receiving mixed messages about our patients. ②On one hand, we are told to watch for angry behavior andto report it. On the other, we are incentivized（以物质刺激鼓励）to excuse the same behavior and even accommodate（适应）it. ③In myoffice we treat patients civilly（谦恭地）, using honorifics（尊称，敬语）when we address them and speaking politely as we involvethem in clinical decision-making（临床决策）. ④We do thisnot only because it’s the right way to treat people but also because we areaware of their ability to publicly shame（羞辱）us or to deny us compensation（补偿，赔偿金） for issues that have nothing to do with the care weprovide. ⑤In this setting（背景）, how are we to treat the rude, even threatening patient?

①   统领全段，并呼应了题目中的dilemma.

②   On one hand, we are told to watch for angry behavior and to report it. On the other, we areincentivized to excuse the same behavior and even accommodate it. 用这两个短语具体的指出了矛盾所在。

③   In my officewe treat patients civilly, using honorifics when we address them（when引导的时间状语从句） and（表示并列） speaking politely aswe involve them in clinical decision-making（as引导的时间状语从句）.

④   We do this not only because it’s theright way to treat people butalso because（用两个because指出我们小心翼翼对待患者的原因） we are aware of their ability to publicly shame us or to deny us compensation for issues（不定式做后置定语） that have nothing to do with the care we provide（定语从句修饰care）.

⑤   In thissetting, how are we to treat the rude, even threatening patient? 用一个反问句来表达作为医生，对言行过分的患者非常无奈，进退两难的态度。

①We are tired of the concept that “the customer is alwaysright” when a patient displays a “behavior of concern.” And to be honest, we are also a little afraid.

①  We are tired of the concept that “the customer is alwaysright” when a patientdisplays a “behavior of concern.”（when引导的条件状语从句）

②  结尾一段总结医生对于behaviors of concern的态度，很疲于应对甚至有点害怕。