国内很多的医生大多数的时间都用于写病历了。在国外那种求实的科学环境下是不是这样的呢？我有幸看到了这样一篇，给大家分享一下。  case: A 54-Year-Old Woman with Dizziness and Falls 病例：一位54岁女性伴头晕和跌倒 Presentation of Case Dr. Emily P. Zeitler (Medicine): A 54-year-old woman was admitted to this hospital because of episodes of dizziness resulting in falls.  病例介绍 Dr. Emily P. Zeitler (Medicine): 一位54岁的女性，因头晕发作而跌倒住入本院。 Approximately 2 months earlier, while walking to work, the patient had the sudden onset of dizziness and the sensation of falling to the left, associated with diaphoresis and palpitations. She sat down, and the symptoms improved, although she continued to feel as though she would fall to the left. She was taken by ambulance to another hospital and admitted. She had a history of borderline hypertension and intermittent atrial fibrillation but had been otherwise well. Medications included metoprolol (25 mg three times daily), furosemide, and propafenone. On examination, the vital signs reportedly showed orthostatic changes in the pulse and blood pressure, and the neurologic evaluation was normal. Fluids were administered intravenously. Furosemide and propafenone were discontinued, the dose of metoprolol was decreased (25 mg twice daily), and she was discharged.  大约2月以前，这位患者在步行上班时，突然头晕发作，有向左跌倒的感觉，伴有出汗和心悸。坐下后，症状缓解，尽管如此，她仍然觉得有向左跌倒的感觉。她被救护车送入另一家医院并收住入院。既往有临界高血压和阵发性房颤史，但其他方面都正常。用药史包括美托洛尔（25mg，一日三次），呋塞米和普罗帕酮。体格检查，报告的生命体征显示直立位时有脉搏和血压的变化，神经系统的检查正常。给予静脉输液。间断使用呋塞米和普罗帕酮，美托洛尔剂量减小（25mg，一日二次），患者出院。 During the next 6 weeks, additional episodes of dizziness occurred and increased in frequency; the patient fell several times. She consulted a neurologist and was admitted twice to the other hospital. Magnetic resonance imaging (MRI) of the brain and carotid ultrasonography were reportedly normal. Treatment with meclizine was begun, without improvement, and a 5-day course of levofloxacin was administered.  在随后的6周内，患者头晕发作的频率增加，摔倒好几次。经神经科专家会诊后第二次收住入该院。头颅MRI和颈动脉超声检查报告正常。开始给予美克洛嗪治疗未见改善，又给予一个5天疗程的左氧氟沙星治疗。 On the day of admission, an episode of dizziness occurred, with the sensation of almost passing out. The patient was brought to the emergency department of this hospital by a friend. On arrival, she reported continued dizziness as well as a generalized headache. She reported that the episodes of dizziness occurred only when standing, never when sitting or supine, and were associated with a sensation of falling, diaphoresis, weakness in the legs, and occasionally, palpitations. During the episodes, she could hear coworkers speak but did not feel fully alert, and she had to hold on to a support to avoid staggering or falling. She did not sense the room spinning, and she did not have visual changes, loss of consciousness, fever, chills, urinary retention, or a change in bowel habits.  在入院当天，患者又出现头晕发作，伴有几乎有知觉丧失，由一个朋友送到该院急诊科。到达急诊科，她诉说持续头晕以及整个头痛，还说头晕发作仅在站立时发生，在坐位和仰卧位时从未发生过，头晕时伴有跌倒感，出汗，左腿无力，偶尔有心悸。症状发作时，她能听见同事说话但不完全清醒，需抓住支撑物以避免摇晃和跌倒。发病时没有空间旋转感，没有视觉改变、意识丧失、发烧、寒战、尿储留或排便习惯改变。 Fifteen years earlier, the patient had had several episodes of vertigo, with a sensation that the room was spinning, which lasted up to 3 to 4 days, were not related to position or associated with tinnitus or hearing loss, and were different from her current symptoms. The symptoms resolved without treatment and did not recur. A diagnosis of atrial fibrillation had been made 2 years before admission, after an episode of palpitations. One year before admission, transthoracic echocardiography and a cardiac stress test had reportedly been normal. She had chronic ptosis of the left eyelid and mild peripheral edema. She had had three cesarean sections. She was widowed, worked as a waitress, and had been unable to work for 3 weeks because of her symptoms. She did not smoke, drink alcohol, or use illicit drugs. Her mother had had hypertension and cardiac arrhythmia and had died at 76 years of age, a sister had occasional supraventricular tachycardia, and a son had epilepsy; her other children and grandchildren were h ealthy. Her paternal family history was not known. Medications on admission included metoprolol, meclizine, and acetylsali