Clinical Dialogues

Part 1. Woman complained of tightness in abdomen associated with belching() wind which did not relieve feeling. Symptoms usually began between 5 and 6 p.m. lasting several hours. Relieved by white mixture.(D=Doctor, P=Patient)

D: Does the pain come on in the night?[come on: to startIf a cold, headache, or some other medical condition is coming on, it is just starting.e.g. I felt a cold coming on. ]P: Not often.

D: When it comes on, do you get up?P: Yes, I get up and walk around and it relieves.

Pain

I have a headache. I have a splitting headache. I have a stomach-ache.I feel a dull pain in the stomach.I seem to have pain all over. Im aching all over.

Its a dull sort of pain, and I dont know whats causing it.Its not a sharp pain; just sort of a dull ache.It all began yesterday.It started two days ago.It came on last night.It hurts terrible.

Its been hanging about for nearly a week. It keeps hanging on. It sort of hung on. Or: Just off and on. Ive got a pain in my back.

My eyes have been sore. My left foot hurts. My tooth is aching up again. I feel shivery and Ive got a sore throat. The pains been keeping me awake.

D: Does anything but the white mixture help it?P: Ive been on a strict diet for six months. I never touch milk.

on a diet: If you are on a diet, you are eating special kinds of food because you want to lose weight. touch: If you do not touch a particular kind of food or drink, you never eat it or drink it. e.g. Drink?No, she never touches the stuff.

D: Does any position help you?P: No, It comes on after tea, about five. I have my main meal midday.D: Have you been sick? (=Any vomiting?)P: Only at the beginning I was very sick then.

A sick person has an illness or some other problem with their health.To be sick means to bring up food through your mouth from your stomach.e.g. I think Im going to be sick.

Note that George is being sick means George is bringing up food from his stomach; George is sick means George is ill. However, George was sick can mean either George brought up food from his stomach or George was ill.

Vomit has the same meaning as be sick. Vomit is a fairly formal word.e.g. She was stricken with(...) pain and began to vomit.Throw up: In conversation, some people say throw up instead of be sick.e.g. I think Im going to throw up.Ive been throwing up.

D: Do you feel sick?(= Have you got any feeling of nausea?)(=Are you feeling nausea?)

P: Yes, I feel sick but I cant be sick. Feel sick: To feel sick means to feel that you want to be sick.e.g. Flying always makes me feel sick.

Note:ILL and sick are both used to say that that someone has a disease or some other problem with their health.e.g. Davis is ill.Your uncle is very sick.A sick child

Most British speakers do not use ill in front of a noun unless they are also using an adverb(). For example, they do not talk about an ill woman, but they might talk about a seriously ill woman. a terminally ill patient.

American and Scottish speakers sometimes use ill in front of a noun without using an adverb.We had to get medical help for our ill sisters.

D: Does the pain go through to the back?P: No, but it goes under my armpits. D: Whats your weight been doing? (=Have you lost weight recently?)P: Ive lost one and half stone but Ive been on a fat-free diet for six months.(or: My weight fell from 65kg. to 50 kg.)

Stone: a unit of weight in Great Britain, 14 pounds (6.4 kilograms) [14(6.4]

D: Whats your appetite like?(=How about your appetite?)(=Do you have any appetite?)

Whats (your)/(the) ? / What seems to be the ?Whats your appetite like?

Whats your complaint? ()=Whats your trouble?=Whats the trouble?=Whats bothering you?=What seems to be bothering you?

=What do you complain of?=Whats the matter with you?=What seems to be the matter?=Whats wrong with you?=What hurts you?=What seems to be the problem?=What seems to be the trouble?

P: Poor as ever.(=Ive got a bad appetite.)D: What about your bowels? (=Are your bowels acting properly?)(=Are your bowels regular?)P: I go twice a day, in the morning.

D: Is this a life-long habit?P: Yes.D: What do the motions look like? Well-formed, firm? P: Yes.D: What about the color? Has it changed?P: No.

D: Are they dark?P: Yes.D: Any sign of blood?P: No.D: Do they float on the water when you flush the lavatory? P: No.

D: Have you noticed an unpleasant smell?P: No.D: Have you noticed any difference in your water?P: No.D: Do you have to get up in the night?P: Once.

D: Your water hasnt been darker?P: No. D: Do you smoke?P: 10 a day.D: Do you drink?P: Not much.

D: Have you any other trouble?P: No, my anginas been very good. Ive not had much trouble with that for two years. -- Or:I feel absolutely rotten. [If you feel or look rotten, you feel or look ill]

I feel a bit off color. [Here, color means reddish-pink color in ones face that shows that ones health is good. ]I feel so ill.I feel rather unwell.I feel very bad.

I really feel terrible.I think Im dying. Im feeling rather out of sorts these days. [If you feel out of sorts, you feel slightly unwell, discontented, or annoyed. ]

Im under the weather. [If you say that you are under the weather, you mean that you feel slightly ill.]My whole body feels weak.I just feel all pooped out. [be pooped out: to be very tired; used mainly in informal American English.]

D: Youve also had trouble with your leg?P: Yes, they thought it was thrombosis ().D: When did you first start with your tummy trouble?Tummy: the human stomach or belly P: About 14 years ago.

D: The same, but more bothersome now? ?P: Yes, its tighter. Warning: 1) You do not say that someone becomes iller or more ill. You say that they become worse.2) You do not use ill or sick to say that someone has received an injury. You say that they are injured or hurt.

D: Have you ever been jaundiced? P: No.D: Is your tummy swollen when you feel like this? P: It feels as though Im going to burst.

D: Well, Id like to have a look at you. Will you get undressed and lie on the couch please? Or:Lie down on the couch there. Let me just see.Lie down on the couch there. Let me examine your belly.

Would you mind taking off all your clothes except your pants (for men)/except your pants and bra (for women)? Lie on the couch and cover yourself with the blanket.Well, lets see.Now slip off your coat and shirt, please.Strip to your waist, please.

Roll your sleeve up.Slip your shoes off and hop up on the bed.Slip off your shoes and socks.Let me check your lungs and heart.Let me listen to your lungs and heart.

Let me examine your stomach.Let me sound your lungs. ()Unbutton your shirt and let me listen to your lungs.Open your mouth and say Ah.Open your mouth please, and show me your tongue.

Put this thermometer() under your tongue.Ill have your temperature taken.Well, Id better take your blood pressure.May I take your blood pressure?Let me take your blood pressure.

Clinical Examination

During the examination the doctor asked the following questions:

D: Do you suffer from heartburn?P: No.D: Have you had any children?P: No.D: Are your hands always cold and red?P: Yes. A lovely color in the winter!

D: Just hold your breath for a moment. Breathe through your mouth. Show me where you get this pain. Your age?P: 72.D: Your periods finished when? P: When I was about 52 or 3.

D: Any tenderness here?P: Its a bit sore but not a lot. D: Does it catch you at all when you breathe?P: No.

D: Have you any pains in your legs?(=Do you have any pains in your legs?)P: I get cramp a bit when Im in bed.D: More in one leg than the other?P: I get it in my right leg; thats my varicose leg.

D: Apart from this, youve had no other serious illness in the last 14 years?P: No.D: Im going to take a drop of your blood and Id like you to have a stomach X-ray. Youll have to come specially, dont eat anything before and drink a white paste which outlines your stomach and well take some pictures.

Or:I think wed better give you a few tests.A blood test is necessary.Take your blood count first, please.Youre to have a blood test.

Im going to take a throat culture so well know for sure.You must have an electrocardiograph examination.Well, lets take an X-ray of your chest.Go and have your chest X-rayed.

BOWELS Medical words: faeces, stools, to defaecateColloquial words: motion, to have the bowels opened

Useful questions How often do you have your bowels opened? Is this a life-long habit? What do the motions look like? Are they quite well formed? What about the color? Has it changed?

Are they darker in color Have you ever seen any blood in your motions? Have you noticed an unpleasant smell? Do you ever have diarrhea() or constipation ()? Do you have to go in a hurry? Can you hold your motions?

Do you have to strain() to pass your motions? (tenesmus) , Do you take laxatives()? Do the motions float on the water after flushing the lavatory? Do you ever have any pain on passing your motions?

Do you get pain before, during or after passing your motions? Do you suffer from wind? Have you noticed any special food upsets your bowels? Have you lost any weight?

Descriptive wordsColor: black, brown, clay-like, colorless-like rice-water (cholera), dark brown, green, grey, pale, pea-soup-like, putty-like(), porridge-like)()(steatorrhoea), jelly-like, tarry(), white, yellow, etc.

Form and consistency(): bloody, bulky, dry, fatty, floating, friable, frequent, frothy(), greasy(), hard, hard dry balls, loose, purulent(), slimy(), soft, watery, well-formed, worms, etc.

Amount: copious, scantyOdor: offensive (very bad)

Useful ExpressionsGreeting Good morning, Mrs. Rayner, come and sit down.Asking patients to describe their symptoms Well now, how can I help you? Well, Mrs. Rayner, whats the trouble? Your doctor says youve been having trouble with your back. Tell me about it.

Collecting casesMentioned above.Directing patients how to undress Would you mind taking off all your clothes except your pants (for men)/except your pants and bra (for women)? Lie on the couch and cover yourself with the blanket. Slip off your shoes and socks. Roll your sleeve up.

Directing patients how to assume appropriate positions Please lie on your tummy. Please turn over and lie on your back. Roll over onto your left side. Bend your knees.

Sit up. Lean forward. Get off the couch and stand up. Walk across the room.

painful: 1) You say that something is painful when it makes you feel pain.e.g. a long and painful illness2) If a part of your body is painful, it hurts.e.g. My back is so painful that I can not stand upright.

3) When someone feels pain, you do not say that they are painful. You say that they are in pain. e.g. He was in pain and could not move into a comfortable position.

Part 2.

D: I see you have had several attacks of influenza(). Anything else?P: Ive had dizziness() and Ive been sick. If you feel dizzy, you feel that you are losing your balance and are about to fall.To be sick means to bring up food through your mouth from your stomach.

D: When did this start?P: Two months ago.D: How often are the attacks?P: Nearly every day.

D: How long do they last?P: Some last all day, some a couple of hours.A couple of things or quantities means approximately two things or quantities. You use this informal expression when you are not sure of the exact number of things or quantities you are referring to and the number is not important.

D: Does anything bring on these attacks?bring on: to cause to occur You can use the structure Something brings on an illness, pain, or attack.P: No.

D: Will you describe one of these attacks?P: It starts with a headache a throbbing() headache. My eyes start running. I cant touch them, they are so sore(). And then the whole house goes round. Then it goes dark.

D: Do you see flashing lights()?P: No.D: When you say you go dizzy, what do you mean?P: I feel Ill fall over and the room spins() round. If I go to bed, the bed goes round.

fall over: If you fall over from an upright or standing position, you become unbalanced and fall to the ground, lying lengthways() or in a heap.

D: When you move, do you stagger?stagger: to move or stand unsteadily, as if you about to fall P: Im too scared to move. If you are scared, you are very frightened of someone or something, and therefore unable to behave calmly.

D: Have you noticed anything else?P: I cough a lot.D: Do you bring anything up? vomit/sputumWhen you bring up food, you vomit; an informal use.P: No.

D: Is your hearing affected? Do you have buzzing() or ringing noises?P: Yes.D: In both ears?P: Yes.

D: When you go to bed, do you sleep?P: I just lie and it goes off within a few hours.If you go off, you fall asleep; an informal use. e.g. He went off as soon as his head touched the pillow.

D: Have you ever woken up like this?wake up: When you wake up or something wakes you up, you become conscious again after being asleep.

You can use like this or like that when you are drawing attention to something that you are doing or that someone else is doing. e.g. Sorry to break in on you like this(), Dr. Mark.

P: No. It is always in the day.D: Does movement of the head cause it?P: No.D: If you suddenly get up out of a chair does it start?P: No.

D: How long have you been diabetic()?P: Four years.D: Any other serious illness?P: I had my gall bladder() removed.

have sth. done patternGo and have your chest X-rayed.You must have your tooth extracted.You must have your appendix () removed.Youll have to have your decayed tooth pulled out.

D: Anything else?P: I had VD[ (venereal disease)] nine years ago. I was in hospital for three weeks and had a course of injections().

Clinical Examination

D: Take a deep breath in and hold your breath. Close your eyes gently. Not too tight. Look up to the ceiling(). Hold your arms out. Are your bowels () all right?P: Yes.

D: No trouble with your water()?P: No.D: Your periods() finished some years ago?P: Yes. Four years ago.

D: Well, there doesnt seem anything seriously wrong with you. Id like you to have some X-rays through and a blood test.

Diagnosing and treating

By the look of it, it should be a rash. By the sound of it, its bronchitis().It looks like measles. It looks as if its SLE.

It sounds like bronchitis. It sounds as if youve caught cold. I should say youve caught cold. I should think youve got the flu.

You probably have contracted the flu. You seem to have picked up some kind of infection. It could be a case of TB. Its inflammation of the skin.

Youre suffering a heart disease, Im afraid.Youre running a temperature.Youve got a drop of fever. I dont think its anything serious. Its not so serious as it seems.

Theres nothing to be alarmed about. Nothing serious. Your case is not very serious.Youve got the flu, but not very serious.

Its nothing serious, but youd better stay in bed.Its nothing but a little infection in the finger tip. Youll be all right soon. =Youll get over it soon.

I think you need a shot to deaden the pain first. If your recovery goes on like this, you can leave in three days.Ill give you an injection first.

Ill have to give you a shot, Im afraid. Im afraid an urgent operation is necessary. Im afraid youll have to be operated on for appendicitis.

Giving prescription and advice

Heres prescription for you. Please take the medicine according to the instruction. Heres a prescription. Have someone to get it filled.

Heres a prescription. Id like you to take one of these pills three times a day. Drink this mixture four times a day, one measure each time.

One tablet each time, three times a day after meal. Take a dose three times a day. Take one capsule every four hours.

Take ten c.c. each time, three times a day. 10c.c. Put a plaster on the sore once a day. If your fever lingers(), come to me again. Come back and see me in two weeks if youre not feeling better.

THANKS!