3- SPEAKING ALL NEEDED NOTES.pdf.pdf

A Chart for OET Interview
 Greeting
 Introduce
 Asking about age and job
 Asking about chief compliant
 Present history (how, when, how long, how often…)
 Accompanying symptoms
 Asking about any treatment for the problem in the past
 Other diseases (DM, HTN …)
 Asking about smoking and drinking
 Familial history about same problem
 Invite to examination
 Examination (Ask to get ready, explaining what’s going on, finishing)[If
you have few tasks]
 Now that I’ve examined you… Diagnosis
 Asking about patient’s knowledge
 Explain diagnosis and specific interventions (Endoscopy, Laparoscopy …)
 Prescribe, arrange tests, give advice or referral
 Any questions?
 Arrange revisit and ‘ If you had any problem don’t hesitate …’
 … ‘Your welcome’

Dos and Don'ts
There are many ways to successfully approach the speaking task. Below
are a list of simple points to remember to help you succeed on the day.
Dos Don'ts
Do read the roleplay card carefully
and ask the interviewer if you are
unsure of any of the words or
expressions in the task.
Don't plan what you are going to say
in advance. React to the scenario on
your roleplay card and plan your role
accordingly.
Do react to what the interviewer (as
patient) asks or says and respond
accordingly. This is much more
important than simply following the
tasks on the card.
Don't plan what you are going to say
in advance. React to the scenario on
your roleplay card and plan your role
accordingly.
Do focus on the patient and respond
to their questions and concerns.
Don't be card focussed at the
expense of the patient. It is much
more important to respond to the
patient in a natural and caring
manner (where required).
Do take charge of the roleplay. You
are a medical professional and
should act accordingly by leading the
roleplay. This means you must start
and conclude the roleplay, and if the
patient is quite or silent, then it is
your responsibility to keep the
conversation moving.
Don't wait for the interviewer to lead
the roleplay. They may not!!
This is your job.
Do utilise the allowed 2~3 minutes
to identify the key points on your
card including:
• the setting
• whether you know the patient,
or if it's the first time to meet
• the main topic of conversation
& relevant background
information
• task requirements
Don't rush through your card in 30
seconds and say you are ready to
start! You may miss some important
details.
Do refer to your card occasionally
during the exam, especially if you
are unsure of what to say.
Don't try to memorise the whole
card. You can refer to it as required
during the roleplay.
Do be prepared to discuss matters
which are not on your card. The
patient's card usually contains
information which is not on your
card.
Don't feel you must complete every
aspect of your task. Remember it is
a guide only and you will not be
penalised if you do not complete
every detail of your card.
Do look at the patient during the Don't look at you card only and read

roleplay. Although only your speech
is recorded, your communication will
be more effective if you have eye
contact with the interviewer.
it while the patient is talking as you
must listen carefully to what they
the patient says so that you can
respond appropriately.
Do stay focussed on the task at
hand. You only have 5-6 minutes to
complete the task!
Don't spend too much time on
unrelated matters such as a detailed
medical history as you do not have
time for this.
Do practise as many tasks as
possible with a partner to ensure
you are familiar with the speaking
test. Remember it is very different
to IELTS and requires different
language skills, such as the ability to
persuade, convince and reassure.
Don't ignore the task requirements
and say what you think based on
your medical knowledge. Remember
it is a test of English language ability
and not a place to demonstrate your
medical knowledge.
Do act confidently and speak with a
positive voice. If you are unsure of
the details of the condition, it is okay
to make it up! Remember it is a test
of English not your medical
knowledge.
Don't show how nervous you are as
this can negatively affect your
result. Lots of practice is the best
way to overcome nerves.
Do slow down your speech when
using unfamiliar words such as
names of medications or treatment
procedures. Always be prepared to
explain the meaning of any medical
terminology you use.
Don't use a lot of medical jargon and
technical words. You need to use
layman’s language to describe the
condition.
Do regularly check that the patient
understands your explanations. Ask
questions such as:
• Is that clear?
• Can you do that?
Don't speak in a continuously in a
monologue.You are taking part in a
2 way conversation.
Do stop speaking if the patient
wants to interrupt you. You must
respond to the patient.
Definitely do not talk over the
patient. You will be penalised for
this!
Correct a grammatical or vocabulary
mistake immediately if you are
aware that you have made one.
(Native speakers certainly do this!)
Don't rush your sentences as you
are more likely to make an error.
Try to remain clam and in control.
Do be aware of the gender of your
patient and if you say he instead of
she, try to correct it.
Don't be too stressed if you make a
gender error, 1 or 2 slips is
acceptable but more than this may
be penalised.

ABOUT the medical interview
The medical or diagnostic interview consists of a number of structural
elements or stages. The doctor does a number of things at each stage.
stages of the interview what the doctor does
the opening greets the patient
settles the patient down
may have a chat with the patient
enquires about the reason for the visit (i.e. elicits
the presenting problem)
the history of the present
illness
asks questions to elicit symptoms
in the case of pain these questions will cover
location, radiation, frequency, onset, duration,
character and intensity of pain, trigger factors,
factors that make it better or worse, past experience
with pain of this type
past medical history gathers or reviews information about medications
and past or continuing medical problems
eg allergies, previous operations
family and social history asks the patient about medical problems in the
family and lifestyle issues such as family situation
and support systems, occupation, smoking, alcohol,
drug use
review of systems gathers information about problems involving the
various body systems
the physical exam conducts a number of physical tests
the diagnosis shares information about diagnosis with the patient
tells patient about any other diagnostic procedures
that may be necessary
prognosis and treatment
options
may discuss prognosis with the patient (depends on
the nature of the presenting complaint)
talks to the patient about treatment options
may prescribe medication or refer the patient to a
specialist
the closing may set a date for follow up
closes the consultation
¤ NSW AMES 2005 page 1 of 1

Opening a consultation
Greeting the patient
Hello Susan. Would you like to come in?
Good morning, Mr Hamilton. Please come in.
Settling the patient in
Come in and sit down.
Come in and have a seat.
Just have a seat.
Just take a seat.
Please take a seat.
Asking about the reason for the visit
How are you today?
How can I help you today?
What can I do for you?
What seems to be the problem?
What’s brought you here today?
Asking for more information
Just tell me a little bit more about it.
Tell me a bit more about it.
Tell me what’s been going on.
Tell me what’s been happening.
¤ NSW AMES page 1 of 1

Observe, listen and note: opening the consultation
Observe
level of formality
1. Watch the interaction again. What is the nature of the relationship
between the doctor and the patient? Is it formal or informal? Give
reasons.
_
_
body language (eg facial expressions, gestures)
2. What does Dr Cooper do to establish rapport and maintain an
empathic relationship with Andrew?
rapport = a connection; you might establish a rapport through body
language, facial expression, sharing a joke and so on
empathy = an understanding of what it means to be in someone else’s
situation—sometimes referred to as ‘walking in their shoes’
_
Listen
language
3. Highlight the word the doctor uses to show that she is ready to begin
the history-taking.
So how can I help you today?
4. Dr Cooper wants Andrew to tell her as much as possible about his
complaint. Highlight the words she uses to encourage him to do this.
Just tell me a little more about it.
pronunciation
5. Listen closely to Dr Cooper’s opening question.
So how can I help you today?
a. Dr Cooper’s question has two parts divided by a short pause. Mark
the pause with a slash (/).
b. Now focus on Dr Cooper’s intonation. Does her voice move in an
upward or downward direction at the end of each part of the
question?
c. Mark the key words, that is, the words you hear most clearly.
d. What do you think Dr Cooper is communicating with her pausing,
stress and intonation?
©NSW AMES page 1 of 3

_
6. Listen to Dr Cooper’s invitation.
OK. Just tell me a little bit more about it.
a. Focus on Dr Cooper’s intonation. Does her voice move in an upward
or downward direction on OK? And at the end of the invitation?
b. Highlight the key words.
c. What do you think these key words and intonation communicate?
_
Compare your observations
level of formality
1. The interaction is friendly and rather informal. The doctor uses an informal
mode of address (i.e. calls Andrew by his first name). This is quite usual in
an Australian consulting context especially where the doctor knows the
patient. First names are always used when the patient is a younger person.
Sometimes a doctor uses a title (Mr, Mrs, Ms) and surname with a first-time
or older patient. Never use a title and first name (eg Mr Andrew) or call a
patient Mr, Mrs, Sir or Madam.
In Australia some patients call their doctor by their given name, others use
the title Doctor or Doctor plus surname.
2. When she greets Andrew, she smiles and makes good eye contact. She
shows him to her room and uses an inviting gesture on come in. She closes
the door behind her to maintain privacy. When she sits down at the desk
and asks Andrew the reason for his visit, she leans forward. When she asks
Andrew for more information about his complaint, she looks up expectantly
and maintains good eye contact.
language
3. So, how can I help you today?
It is the doctor’s role to open the consultation and this is usually done with
a formulaic phrase such as How can I help you today? Dr Cooper starts with
the word So. A lot of meaning is conveyed in this one word. It indicates
something like: Well, here we are, I’m ready, let’s get down to business.
4. Just tell me a little more about it.
Using just is one way in which native speakers soften requests. The doctor
uses it here to encourage the patient to tell his story. She uses a little more
for the same reason. It understates or minimises what he has to do.
pronunciation
5. Ì Ì
a. SO / HOW can I HELP you toDAY? /

b. Dr Cooper pauses after SO and her voice moves in a downward direction
(falling tone) on SO and toDAY.
c. The key words are: SO HOW HELP toDAY and they communicate Dr
Cooper’s essential meaning.
d. Falling tones generally communicate certainty. The pause, two falling
tones and key word stress communicate a serious and business-like
approach.
However, notice that Dr Cooper’s voice has a warm quality and this helps to
create an empathic relationship with Andrew. A warm voice quality could be
described as soft or soothing.
Ê Ì
6. OK / Just TELL me a little bit MORE aBOUT it /
a. Dr Cooper’s voice moves in an upward direction (rising tone) at the end of
OK and downward (falling tone) on aBOUT it.
b. The key words are: OK / TELL MORE aBOUT.
c. The rising tone on OK communicates feedback to Andrew that Dr Cooper is
‘open’ and ready to hear what he has to say. The falling tone at the end of
the invitation marks the beginning of the history-taking. Although Dr
Cooper uses softeners like just and a little bit more, her use of falling tone
maintains the serious and business-like approach of her opening question.
You will find useful resources on the way we move our voice in tones and tones in
questions on the Pronunciation focus: questions screen.

Taking it further: opening a consultation
Ideas for further practice
Role play
Role play the opening of a consultation. Work with a partner and take it in
turns to play the doctor and patient.
As doctor: vary the ways you greet the patient and start the interview.
As patient: vary the presenting problem.
Possible scenarios
1. Your patient is a thirty year old female. You know her well as she has
been coming to your practice for some years. You have had a busy
morning and you are running about 30 minutes late.
2. Your patient is an seventy year old man. You haven’t seen him before.
On-screen language resources
Click on opening a consultation for some language you could use.

Observe, listen and note: taking a history—the complaint
Listen
language
1. How does the doctor get the information she needs? What do you
notice about her questioning style?
_
_
pronunciation
2. Listen to Dr Coopers’ question:
And have you ever had anything like this before?
a. Highlight the key words, that is, the three words you hear most
clearly.
b. Now focus on Dr Cooper’s intonation. Does her voice move up
(rising tone) or down (falling tone) at the end of the question?
c. Listen to the slight hesitation around ANything. Doctor Cooper’s
voice is fairly flat or level. What do you think this communicates?
3. Now listen to another question:
And whereabouts was the pain?
a. Highlight the two key words.
b. How does Dr Cooper’s voice move at the end of the question? Does
it move up (rising tone) or down (falling tone)?
Observe
4. Dr Cooper sometimes moves her head in synchrony with the words she
emphasises. What head movement does she make when she asks this
question?
And have you ever had anything like this before?

Can you suggest a reason why Dr Cooper does this when she asks this
question?
_
5. Can you describe Dr Cooper’s head movement on the next question?
Can you suggest an explanation?
So just on ONE SIDE of the HEAD?
_
language
1. The doctor starts with an open invitation. OK. Just tell me a little bit more
about it, then goes on to ask a mix of ‘open’ and ‘closed’ questions.
open question: How can I help you today?
closed question: And have you ever had anything like this before?
She asks ‘open’ questions to encourage Andrew to talk. She doesn’t want to
influence his answers in any way. She asks ‘closed’ questions when she
needs to rule out alternatives or test hypotheses. When you look at the next
segment, you will find she asks more closed questions. The questioning
pattern in medical interviews is usually cone-shaped: open at the top and
focused at the base.
For more information on open and closed questions, click on types of
questions.
pronunciation
2. Æ Ê
/ And have you EVer had ANything like this beFORE? /
a. The key words are: EVer ANything beFORE and they express the essential
information Dr Cooper is asking Andrew to tell her.
b. Dr Cooper’s voice moves up (rising tone) on beFORE at the end of the
question because she wants Andrew to tell her whether or not he has
experienced this type of headache before. This is the standard tone for a
yes/no question.

c. Dr Cooper hesitates and her voice is level on ANything because she is
searching for the best way to complete her question.
Ì
3. / And WHEREabouts was the PAIN? /
a. There are only two key words here: WHEREabouts and PAIN.
b. Dr Cooper’s voice moves down (falling tone) on PAIN because she is
asking for specific information about Andrew’s pain. This is the standard
tone for a wh-question.
You will find explanations of stress and voice movement in sentence stress,
tones, tones and questions on the Pronunciation focus: questions screen.
4. Dr Cooper moves her head from side to side as she asks this question. This
head movement could indicate sympathy with the negative nature of what
Andrew is describing (Oh no, it must have been awful). She may also be
predicting that Andrew probably has not had this sort of pain before.
5. Dr Cooper nods her head at the same time she emphasises three words in
her question: ONE SIDE and HEAD. When she asks this question, she is
confirming her understanding of Andrew’s non-verbal ‘description’ of where
he felt the pain. Speakers often use body movement and gesture in
synchrony with the words they emphasise to highlight important aspects of
their meaning. Nodding also has a generally affirmative meaning.
©NSW AMES 2005 page 3 of 3

Observe, listen and note: taking a history—associated
symptoms
Listen
language
1. Dr Cooper uses another ‘reference back’ in this segment. This time it’s
a reference back to a time frame. She wants to check for symptoms
Andrew may have felt when the headache was really severe. How does
she start the question about possible speech disturbances?
OK. ___________________________ , did you notice anything
strange about your speech at all?
Do some practice. Exclude or confirm some other symptoms.
• nausea
• photophobia (intolerance or sensitivity to light)
• phonophobia (intolerance or sensitivity to sound)
• diarrhoea
• lacrimation (tearing or watering of the eyes)
And when you had this headache, …
_____ _____
_____
_____
_____
_____
pronunciation
2. Listen to Dr Cooper ask this complex question again. It’s been
arranged in chunks below so you can focus on each part:
And when you had this headache
did you notice
anything strange about your speech …?
a. Highlight the key words in each chunk.
b. What tones can you hear in each chunk? Can you suggest why Dr
Cooper uses these tones?
_____ _____
_____
_____

language
1. OK. And when you had this headache, did you notice anything strange about
your speech at all?
And when you had this headache, were you nauseous?
And when you had this headache, were you sensitive to light?
And when you had this headache, were you sensitive to noise?
And when you had this headache, did you have any diarrhoea?
And when you had this headache, did your eyes water at all?
pronunciation
2. Ì Ê
/ And when you HAD this HEADache /
Æ
/ did you NOtice /
Ì
/ ANything strange about your SPEECH..?/
a. The key words Dr Cooper stresses communicate her essential meaning.
One interesting key word stress is on ANything rather than strange. This
is probably because Dr Cooper wants Andrew to try to remember every
possible detail about his symptoms.
b. Dr Cooper uses the following tones:
• falling-rising tone in the first chunk because she is referring back to
Andrew’s headache. Her voice falls on HAD and then rises on HEADache.
The rising tone at the end of the chunk also communicates the
introductory nature of this clause.
• level tone in the second chunk because it leads to the information she
is asking for in the next chunk.
• falling tone in the last chunk, perhaps because she expects that
Andrew may answer in the affirmative. The falling tone also
communicates completion or the end of this complex question.
You will find voice movement explained in tones, tones and questions on the
Pronunciation focus: questions screen.

Asking about symptoms
Symptoms associated with headaches
general questions
And apart from the pain, have you had any other symptoms?
Has there been anything else apart from the pain?
Did any other symptoms begin after the headaches began?
specific questions
nausea and vomiting
And did you feel sick at all? Nauseous?
Do you have any other symptoms, like nausea or vomiting?
You’ve mentioned nausea. What about vomiting?
other associated symptoms
Have you had a fever?
Did you notice anything strange about your speech?
And you had no weakness on any side of your body?
Was your vision affected in any way before the headache began?
Did you see any spots or flashing lights?
What about the eye on that side? Did it water?
Any nasal discharge or stuffiness on that side?
Any diarrhoea?

ABOUT types of questions
The doctor uses a number of question types during the consultation:
x open questions
x wh-questions (questions requesting specific information)
x yes/no questions
x either/or questions
x tag questions
x statements used as questions
Also, the doctor uses ellipsis in some questions. That is, she shortens the
questions.
She also asks sensitive questions in a special way.
Open questions
The doctor starts the interview with an open question in order to elicit
information from the patient:
How can I help you today?
She then says:
This could also be expressed as an open question:
Could you just tell me a little bit more about it?
Open questions generally encourage the patient to talk. The patient’s
responses will give the doctor insight into his ideas, feelings and concerns
and a comprehensive picture will emerge.
Wh-questions and yes/no questions
After the doctor establishes the general problem she asks a number of
questions which are more specific in focus. These include yes/no
questions:
Have you ever had anything like this before?
Did you eat anything out of the ordinary?
Did you feel sick at all?
Did you have a fever?
and wh-questions:
Whereabouts was the pain?
What were you drinking?

These questions gather precise information and enable the doctor to
explore a hypothesis. These types of questions are sometimes referred to
as closed questions because they require a limited answer.
Some questions appear to be simple yes/no questions:
Have you any idea about what might have brought this on?
However, the answer to this is not a simple yes or no. This question is an
invitation for the patient to hypothesise on possible causes of the
headache. It is an open question “in disguise”.
Either/or questions
The doctor also asks an either/or question:
Was it like a tight band or was it more a throbbing pain?
This kind of question also allows the doctor to pursue a hypothesis, but in
this case the doctor narrows the options for response.
Tag questions
The doctor also asks a tag question:
You’re not on any medication, are you?
Tag questions consist of a statement followed by a tag such as have you?
haven’t you? are you? do you? etc. These questions are usually asked to
verify and confirm what the doctor already knows or suspects.
Tag questions can be confusing for many second language patients.
Statements used as questions
Sometimes the doctor asks questions using a declarative sentence. These
questions usually have a rising tone at the end of the sentence:
You’ve still got the headache now?
There was no weakness on any side of your body?
This type of question is often asked to confirm or check understanding.
Ellipsis in questions
The doctor uses ellipsis in a number of questions. That is, she shortens
some questions by omitting a number of words. These words are
understood.
(Was it) just on one side of your head?
(There is) no history of trauma or an accident or an injury at all?
Ellipsis is very common in spoken English.

Sensitive questions
The doctor asks Andrew about his home life and work life. She raises the
potentially sensitive subject of Andrew’s psychological well-being. To
soften this sensitive question she asks if she may ask the question:
Can I ask you Andrew, is everything OK? At home, at work?

ABOUT tense in questions
In the consultation the doctor asks questions using a range of tenses.
Remember that the patient says that he had the headache yesterday.
I had a really bad headache yesterday.
Past simple tense
So, the doctor asks a number of questions using the past simple tense.
We use the past simple tense to talk about actions completed in the past.
When we use this tense, we mention or imply a definite point or period of
time in the past, in this case, yesterday:
Was it like a tight band...?
Did you notice anything before this came on?
What did you find helped?
Did you feel sick at all?
Did you notice anything strange about your speech at all?
Present perfect tense
The doctor also asks a number of questions using the present perfect
tense. She uses this tense to ask about an action that took place at an
unspecified time in the past:
Have you ever had anything like this before?
She also uses this tense to ask about an action in the recent past that has
consequences for the present:
You haven’t lost any weight or anything?
The present continuous tense
The doctor also asks a question in the present continuous tense. She uses
this tense to ask about an action that is happening (or not happening)
now:
Is there anything else happening at the moment?
We can also use this tense to ask about present actions that are
continuing over a period of time:
Are you taking any kind of medication?
and something that will or will not happen in the near future:
When are you seeing the specialist?

The present simple tense
The doctor uses the simple present tense. She uses this tense to ask
about permanent situations or situations that last for some time:
You’re not on any medication, are you? (Are you on any
medication?)
She also uses this tense to ask about a present state:
Your appetite’s OK? (Is your appetite OK?)

Taking it further: review of systems
Ideas for further research
Collect questions
The questions asked in the systems review depend very much on the
system being reviewed.
Draw up sets of questions for the systems listed below. Search this site
and other resources. Share questions with other users and/or colleagues.
Examples
Respiratory system
Are you ever short of breath?
Have you coughed up any blood?
Have you ever had pneumonia or TB?
Genito-urinary system
Do you have any problems passing urine?
Have you ever had a urinary tract infection?
Do you have excessive pain or bleeding with your periods?
Cardiovascular system
Do you get short of breath when you exercise?
Have you had any pain in your chest, neck or arm?
Have you ever had rheumatic fever or a heart attack?
Gastrointestinal system
Do you suffer from indigestion?
Have you had diarrhoea or are you constipated at all?
Have you ever had hepatitis, peptic ulcers or bowel cancer?

Physical examination
telling the patient what’s going to happen
I’ll just check you out.
I’ll just have a look at you.
Let’s have a quick look at you.
I just want to listen to your heart.
I’ll just take your pulse.
I’ll take your temperature now.
I’m just going to take your blood pressure.
I’m going to check your heart and lungs.
I’d just like to examine your eyes.
I’m going to tap your elbow.
I’m just going to test your reflexes.
I’m just going to tap behind your heel with this hammer.
reassuring the patient
It won’t hurt.
You shouldn’t find it painful.
You shouldn’t feel it at all.
You’ll just feel a little prick/jab. OK?
It might be a bit cold. I’ll warm it up first.
You might find this a bit uncomfortable, but it won’t take long.
You’re doing well. Won’t be long now.
asking for feedback
Can you feel that?
How does that feel?
Where does it hurt?
Does that hurt at all?
And what happens if I …?
Does it hurt when I do this?
Let me know if any of this is uncomfortable for you.
asking the patient to remove clothing
note use of politeness markers or softeners (in italics)
Just slip your shoes off.
Could you roll your sleeve up, please?
I’d like you to take your shirt off, please.
Could you just strip down to your underwear, please?

If you could just pop your top off, then I can check …
If you’d like to roll up your trousers, I’ll just check your reflexes.
Would you take everything off above your waist and slip this gown
on, please?
telling the patient what to do
note use of politeness markers or softeners (in italics)
Just breathe normally.
I’d just like to see you walk a bit.
I’ll just get you to hop up onto the couch.
Just bend your chin forward a bit for me.
If you could just cover each nostril in turn …
Can you stand on one foot for me?
Can you lie on your back, please?
Could you bend forwards, please?
Would you like to sit up for me now?
instructions without politeness markers and softeners
Open wide for me and say Ah.
Open your mouth. Poke your tongue out and say Ah.
Bend over.
Straighten up.
Lean backwards.
Turn your shoulders to the right.
Go back to the centre again.
Now go to the opposite side.
Relax your arm.
Let your arm go floppy.
Breathe in and out through your mouth. Take deep breaths.
Clasp your hands like this and try to pull your fingers apart.
Now I want you to lean forwards. Can you do that? How far can you
go?
some useful verbs
slip off your shirt/top/sandals
take off your top/shoes and socks
roll up your sleeve/trousers
roll down your sleeve/trousers
slip down your trousers/skirt
strip down to the waist
pop on your shirt/your top
pop off your top/trousers
hop on the couch

hop off the couch
poke out your tongue
stick out your tongue
indicating the end of each stage of the examination
usually said with a falling intonation
Fine.
OK.
Excellent.
That’s all fine.
That’s all your reflexes finished now.
indicating the end of the examination
That’s all finished now.
That’s it. You can put your shoes back on again now.
Come and sit down so we can talk.

Explaining the condition
finding out what the patient knows
What do you know about …?
How much do you know about …?
Do you know anything about this condition?
Have you heard anything about this condition?
providing an orientation
This is a
This is an
common
very rare
long-term
unusual
condition.
It’s fairly
quite
common.
unusual.
rare.
There’s often a pattern in families.
It tends to run in families.
affect young people.
affect women after menopause.
explaining the condition and its causes
It is basically …
It’s due to …
It’s called … and we think it’s due to…
It’s caused by …
The cause of your problem is …
explaining the process
What it does is …
What happens is …
What has happened is …
This condition affects …
There are well-recognised triggers …

relating diagnosis to patient’s symptoms
And that’s why you are getting …
you are experiencing …
you are feeling …
supplying reading matter
Here is a pamphlet about … that explains it very clearly.
I’ll give you something to read which will help you …
shifting to discussion of management plan
So, what we need to do now is …
We have various options.
There is a lot we can do to help.
There are various steps we can take to manage the condition.

Primary headaches
This table lists the vocabulary used to describe three types of primary
headache: tension headaches, migraine headaches and cluster headaches.
tension migraine cluster
location both sides usually on one
side
one side only,
usually around or
behind one eye
nature of pain band-like pressure throbbing,
pulsating
sharp
severity mild to moderate moderate to
severe
severe,
excruciating
onset gradual gradual rapid
visual
disturbances
none in 20% of cases
flickering or
flashing lights
none
associated
symptoms
sensitivity to light
and sound
not aggravated by
physical activity
nausea
vomiting
diarrhoea
sensitivity to light
and sound
aggravated by
physical activity
nasal blockage
and discharge on
affected side
watering of
affected eye
triggers physical or
emotional stress
environmental
factors such as
loud noise
alcohol
allergies
drugs
fatigue
food additives
lack of sleep
light
menstruation
some foods
stress
alcohol
stress
smoking
Note: This table is intended for language training only and should not be used for
diagnostic purposes.

ABOUT talking a patient through the physical examination
Patients are often anxious about visits to the doctor and, in particular,
about the physical examination. It’s important to talk patients through the
examination. Good communication will keep them informed and involved,
will reassure them and make them feel comfortable.
Good communication practice
1. Always tell your patient when you are going to begin the physical
examination. Let’s have a look at you is just one way of doing this.
2. Then for each test or set of tests:
x let your patient know what you’re going to do (preparation)
I’m going to check the strength of some of your muscles in your
legs.
x tell your patient what you want them to do (instruction)
Keep your leg straight and lift. Don’t let me stop you.
x give positive feedback (feedback)
That’s fine.
Your feedback signals that you have completed that component of the
examination.
3. Be explicit about the end of the whole examination, saying something
like: That’s it. We’re finished now. Come and sit down now and we can
have a chat.
4. If a patient raises a question during the examination, you can respond
immediately or plan discussion with your patient when the examination
is complete.

Talking about pain
about the location of pain
And where do you feel the pain?
Can you show me exactly where it is?
Can you show me where you get the pain?
Where exactly is the pain?
Whereabouts is the pain?
Which part of your body is affected?
Does it go anywhere else?
Does it spread to any other parts of your body?
about the nature of pain
Can you describe the pain?
What does it feel like?
What kind of pain is it?
Is it a sharp/stabbing/dull/throbbing pain?
What does the pain feel like? Does it ache? Throb? Burn? Tingle?
The patient may say:
It’s a burning pain.
cramping pain.
dull ache.
dull sort of pain.
mild pain.
nagging pain.
pressing pain.
severe pain.
sharp pain.
shooting pain.
stabbing pain.
throbbing pain.
It’s like a heavy weight pressing on my chest.
tight band around my head.
knife going through me.
¤ NSW AMES page 1 of 2

about the severity of pain
Did it make you double up?
How bad is/was the pain?
How severe is/was the pain?
Would you say it was the worst pain you have ever had?
How would you rate your pain on a scale of 0 to 10, if 0 is no pain at
all and 10 is the worst pain you can imagine?
about the onset of pain
When did it start?
When did you first feel the pain?
When do you usually get the pain?
about the duration of the pain
How long does/did it last?
Have you still got the pain now?
Is it steady or does it come and go?
about triggers
Any idea about what brought this on?
Did you have anything out of the ordinary to eat?
Do you know what set it off?
Do you get pain when you …?
What started it off, do you think?
about relief from pain
What relieves the pain?
Does anything make it better or worse?
What makes it better or worse?
Have you taken anything for it? And did it help?

Presenting a coherent explanation
How will you present your information coherently?
Look again at how Dr Cooper presented her information.
orientation
Well, basically a classic migraine is a throbbing, usually on one
side of the head.
causes and process
It's caused by the blood vessels dilating. The nausea and the
flashing lights are part of this process.
relating diagnosis to information given by patient
There's often a pattern in families and there are well-recognised
triggers, and you know red wine is certainly a trigger and the late
night might have also contributed.
So what did she do?
She:
x presented her information in 3 steps (with some overlap between steps
2 and 3).
x presented her information in sentences of different lengths.
x didn’t use complex medical terminology.
x used the present simple tense appropriately throughout the
explanation.
x made the explanation as ‘conversational’ as she could (ie it doesn’t
read like a written technical explanation)
x said you know to acknowledge things Andrew had told her.
You will need to incorporate these strategies as you work on your
explanation of multiple sclerosis. Start working on your explanation now.
As an alternative, you can work through the exercises on the next few
pages.

Exercises
Work through the series of exercises below.
Note:
You can do the exercises on paper but editing would be simpler in a Word
document. You would need to copy the facts on multiple sclerosis into a Word
document, save it and then edit the text as you work through the exercises.
Multiple sclerosis
x involves the nervous system
x comes and goes
x affects people differently
x some patients never have another episode
x other patients have further episodes - can lead to serious
disability
x our nerves carry messages from the brain to various parts
of the body
x the covering around the nerves wears away in places
x the affected nerves cannot carry messages normally
1. Read through the facts about multiple sclerosis again.
Which facts would you put into:
x orientation
x causes and processes?
2. Read the two paragraphs. The facts have been put into full sentences.
orientation
Multiple sclerosis is a condition involving the nervous system.
Multiple sclerosis is a condition that comes and goes. Multiple
sclerosis affects people differently. Some patients never have
another episode. Other patients have further episodes.
Further episodes can lead to serious disability.
causes and process
Our nerves carry messages from the brain to various parts of
the body. The covering around the nerves wears away in
places. The affected nerves cannot carry messages normally.
There’s still a problem here, isn’t there? The explanation doesn’t sound
natural and fluent. It still reads like a list of facts. See what you can do
to improve it.

a. Edit the orientation.
x Some words are repeated, aren’t they? (eg multiple sclerosis) Can
you replace these words (ie use words like it and they)?
x The sentences are all roughly the same length. Can you join some
of the ideas? (ie use words like and and however)
b. Edit the process.
Find places in the second paragraph where you might add:
x This means that
x What happens with multiple sclerosis is
x You probably know that
c. How would you include an illustration in the explanation.
Look at the whole text again. Where could you add this sentence: You
can see that in this illustration.
d. The patient has reported difficulties walking and bladder problems.
Where could you explain the connection between the diagnosis and the
these problems and how would you say this? Write an explanation into
the text.
e. Read through the text again. Does it sound more conversational now?
Compare it with the model on the next page.

Model
You might have ended up with a text that looks something like this:
orientation
Multiple sclerosis is a condition involving the nervous system.
It's a condition that comes and goes and it affects people
differently. In some cases the patient never has another
episode. In other cases further episodes can lead to quite
serious disability.
process
You probably know that our nerves carry messages from the
brain to various parts of the body. What happens with multiple
sclerosis is that the covering around the nerves wears away in
places. You can see that in this illustration. This means that the
affected nerves cannot carry messages normally.
effect of disease on patient
Now that’s why you are experiencing difficulty walking and
problems with your bladder.
Why does this model work?
Analysis
Note:
x the verbs in present simple tense (in bold)
x the words that mark what’s coming next (underlined)
x how the doctor uses the underlined words to put different pieces of
information together and create a fluent text
x how the doctor refers to multiple sclerosis in different ways (eg uses
the pronoun it and the word condition instead of repeating the word)
These linguistic devices all help to create a coherent explanation for the
patient.
orientation
Multiple sclerosis is a condition involving the nervous system. It's a
condition that comes and goes and it affects people differently.
In some cases the patient never has another episode. In other
cases further episodes can lead to quite serious disability.
process
You probably know that our nerves carry messages from the brain
to various parts of the body. What happens with multiple sclerosis
is that the covering around the nerves wears away in places. You
can see that in this illustration. This means that the affected
nerves cannot carry messages normally.
effect of disease
Now that’s why you are experiencing difficulty walking and
problems with your bladder.

Taking it further: physical examination
Role play
Role play a physical examination.
Examine Ms Julia Smith. Read her case notes below.
Remember to:
• tell the patient what you are going to do
• ask the patient to tell you if she is experiencing pain
• forewarn the patient if you are likely to cause pain
• maintain constant eye contact with the patient to assess any pain
• acknowledge any pain caused and apologise
• let the patient know when you have completed the examination
Case notes
Patient’s name: Julia Smith
Age: 48
Family situation: married, 4 children
Reason for presentation:
Severe abdominal pain of sudden onset. Pain came on during the night following a
meal of fish and chips. The patient has vomited this morning.
Physical examination notes:
General appearance: anxious, tired looking woman, appears to be in considerable
pain
Vital signs
Temperature: 38.5
Blood pressure: 140/90
Pulse: 88 and regular in character
Respiration: 20
BMI: 28
Hands and nails: NAD
No jaundice
Tongue coated

Abdominal examination
Observation
No scars, no distension
Palpation
Marked tenderness in right upper quadrant
Murphy’s sign: positive
page 1 of 2
Deep palpation
No abdominal masses
No organomegaly
Percussion: NAD
Auscultation: Bowel sounds present. No bruits.
Click on physical examination for some language you could use.

Taking it further: diagnosis, explanation and management
Role play
Continue the role play.
On the basis of the history, physical examination and office tests your
provisional diagnosis is acute cholecystitis.
1. Explain the likely diagnosis to your patient in every day language that
she will understand.
2. Then outline your management plan to Mrs Smith.
Remember to:
x reassure the patient
x explain immediate management
x provide analgesia
x explain long-term management that may include
cholecystectomy
x foreshadow the need to address diet
x invite the patient to raise any concerns
Case notes
Patient’s name: Julia Smith
Age: 48
Family situation: married, 4 children
Reason for presentation:
Severe abdominal pain of sudden onset. Pain came on during the night following
a meal of fish and chips. The patient has vomited this morning.
Physical examination notes:
General appearance: anxious, tired looking woman, appears to be in
considerable pain
Vital signs
Temperature: 38.5
Blood pressure: 140/90
Pulse: 88 and regular in character
Respiration: 20
BMI: 28
Hands and nails: NAD

No jaundice
Tongue coated
Abdominal examination
Observation
No scars, no distension
Palpation
Marked tenderness in right upper quadrant
Murphy’s sign: positive
Deep palpation
No abdominal masses
No organomegaly
Percussion: NAD
Auscultation: Bowel sounds present. No bruits
Click on explaining the condition and developing a plan for
some language you could use.

Alcohol Consumption
Practice: Using the information below, practice giving advice. Add your own ideas
as well.
Health Council Guidelines
 Males » 4 standard drinks per day
 Females » 2 standard drinks per day
 One standard drinks contains 10g of alcohol which equals:
o One pot of standard beer (285ml)
o One small glass of wine (120ml)
o One nip of spirits (30ml)
 Try to have 3 alcohol free days per week
 Change to low alcohol beer
Risks of heavy Drinking
 Damage to body organs such as………
 Memory blackouts
 50% of fatal traffic accidents involve alcohol
 Pregnancy risks when drinking more than 1 standard drink per day
 Alcohol can interact with prescribed medications
 Cause relationship breakdown
 Poor work performance
Advice
 Alcohol addiction is quite a serious condition, and you really need some outside
support to help you overcome this. Therefore, I recommend that you contact
Alcoholics Anonoymous or I can contact them on your behalf, and arrange an
appointment. How does that sound?
 Cut down on amount frequency of drinking
 Don't drink on an empty stomach
 Avoid binge drinking
 See your GP
 Alcoholics Anonymous (AA)

Diet Guidelines for Good Health
Now let's talk about your diet . ry to eat a wide range of foods. You can also control
your weight by cutting back on foods such as sugar, fats and alcohol. It is a good
idea to use monounsaturated oils for cooking such as olive oil. Also try to cut back on
full cream products bakery goods and snack foods and eat plenty of fresh fruit and
vegetables instead. See if you can limit alcohol to 2 standard drinks a day.
It is very important to eat less sugar and increase your intake of complex
carbohydrates. Fibre is very important in your diet. You can increase fibre by choosing
wholegrain foods such as cereals, bread and rice.
Using less salt is one of the ways you can protect against high blood pressure. Beware
of foods that have a high salt content such as crackers, sources, chips and packaged
foods. Definitely drink more water. It is best to drink about 2 litres of water a day.
Practice: Using the underlined phrases above and information below, practice
giving advice and expanding on the notes below. Add your own ideas as well.
 Eat a balanced diet
 Carbohydrates such as cereals………
 Fruit
 Vegetables such as ………
 Eat fish………………..
 Choose lean meats…………………..
 Drink water
 Avoid or reduce junk food
 Reduce salt intake
 Avoid fatty foods such as ………………
 Replace sweet food with healthy options such as ……

General Health Explanations and Guidelines
1. Heart Disease
Before you leave hospital today I would like to give you some guidelines about
protecting your heart.
How does that sound? As you know it is very important to quit smoking. I can give you
some advice about that as well at your next visit.
Regarding your diet. Try to keep to your ideal weight and waist size and avoid saturated
fats as much as you can. The heart foundation recommends that you eat low salt foods
and eat fish at least twice a week. Do you think that you can do that?
Another thing I would like you to do is to be careful of consuming too much caffeine,
alcohol and sugar. I know this sounds a little strict but it will make such a difference to
your health.
Also, be sure to exercise regularly. Even taking the stairs rather than the lift can help
you get in that extra exercise.
Please don’t forget to have your blood pressure checked regularly and take time out to
relax!
2. How to Lose Weight
I’m glad you asked about how to lose weight. It will certainly help your health and self
esteem.
Well, there are basically two simple keys to losing weight. The first one is to eat less
fattening foods. You should also be careful of your alcohol intake. The secondkey is to
exercise regularly to raise your metabolism and burn extra calories. Do you think you
can do that?
It is also very important to reduce high calorie foods- foods such as peanut butter,
nuts, soft drinks cakes and biscuits. Instead of these foods, aim to increase your intake
of complex carbohydrates like grains and vegetables.
Try to exercise regularly at least three times a week for about 30 minutes. I'm sure
that you have some favourite activities like tennis, golf or swimming. Am I right? Can I
suggest even taking the stairs instead of the lift? This will all make a difference in your
goal to lose weight.
It's a good idea to plan your diet and only have healthy foods in the house. Let me
encourage you to be realistic about your weight loss goals. Crash diets rarely work.

3. How to quit smoking
I'm glad you've made the decision to quit smoking. The good news is that it is possible
to give up smoking. I’d like to reassure you that many of the complications caused by
smoking can be reversed. If you quit smoking you will have more energy, better health
and improved sense of taste and smell.
Now to the challenging part: how to quit. The best way to stop smoking is to go cold
turkey. I suggest you reduce the number of cigarettes gradually, say by three day and
aim to stop smoking completely within two weeks. Does that sound realistic to you?
Don't worry if you feel irritable or tired or sweaty at first. After about 10 days these
unpleasant feelings will disappear and you will feel great.
Let me give you some good tips for quitting smoking. It is best to have a definite date
in mind to stop smoking. As far as your diet goes, try to eat more fruit and
vegetables. You can also have low- calorie chewing gum.
It's a good idea to avoid smoking situations and do activities that can distract you from
smoking. I'm sure you will enjoy saving money. Don't forget to reward yourself!
Another thing I should mention is that there many supportive groups and programs
available to help you to quit smoking. Success is achieved one day at a time.
4. Care of Wounds
Now let's talk about the care of your wound. Firstly always keep the wound clean and
dry. If you notice any swelling, redness or discharge please gets on medical advice. You
may need some antibiotic treatment.
Don't forget to drink plenty of fluids. It is important that you get adequate rest and eat
a healthy diet high in protein. As you know, it is vital that you wash your hands
regularly and pay attention to personal hygiene. If you can, try to get some sun to your
wound. If the wound develops a scab, don't pull it off as it may cause
scarring. Speaking of scarring, you could use of vitamin E oil or cream which should
help the wound to heal nicely.
5. Overcoming burnout
I'm glad that you have come to talk about burnout. Just talking about the problem can
help sometimes.
Let me reassure you that burnout is not a terminal condition, but it is a sign that you
need to make some changes in your life.
A good piece of advice is to look at what situations cause you to feel stressed and
anxious. Now , write down at least one way you can think of to modify the
situation. Also, it's a good idea not to take on any new commitments for a
while. Learning how to delegate can help you with this. Can I suggest that you take
breaks when you finish a project? Praise yourself for effort, not just outcome. Be aware
of devices such as mobile phones and computers which can take up lots of your time
and energy. Turn them off when you can. How does this sound so far?

A lot of our patients have found joining a support group really helps them. Take care
to rediscover your passion and enjoy life!
6. High Blood Pressure
Now let's talk about keeping your blood pressure under control. It’s vital to have regular
blood tests to check your cholesterol levels. Your doctor will record your blood pressure
each time you visit. He will probably aim to keep your blood pressure around 120/80.
The most important thing you need to remember is to take all your medications as
prescribed. It’s also helpful to eat a healthy diet and to exercise for general good
health. Do you think you can manage that?
7. Importance of exercise
Let's talk about exercise. It’s not as hard as you think to exercise regularly. It helps
if you can do some activity that you really enjoy. There are all sorts of activities you can
choose from, such as bike riding, swimming, tennis and yoga.
I recommend that you exercise for at least 30 minutes a day three times a week. If you
stick to your exercise plan you can protect yourself against heart disease, high
cholesterol and all sorts of obesity related disorders. You will also look and feel much
better.
I hope this chat has encouraged you to look after your health by exercising regularly.
The rewards really pay off!
8. Problems with memory
Thank you for coming here today to discuss your memory problems. Firstly I'd like to
reassure you that memory problems are common. Secondly, memory can be affected
by a range of things such as common illnesses, nutrition and ageing.
It may be helpful if I give you some tips for preventing memory loss. Is that okay with
you? I have a brochure here which I will leave with you. It gives tips such as exercising
regularly, which helps blood flow to the brain and also helps with anxiety. Staying social
is important. Being with other people helps you to stay alert and engaged with life. Try
to eat plenty of fruits and vegetables in Omega three fats. See if you can manage your
stress. This lowers cortisol levels which can lead to problems with memory. Of
course getting plenty of sleep is also great to help with memory and concentration.
This advice should help you a great deal with your memory. If you are experiencing any
signs of serious memory problems, then of course, don't hesitate to come back and see
me and we will run some tests.

9. Sore joints
I'm sorry to hear that you have sore joints. It is a common problem but I’m glad to
say that there are ways you can reduce your joint pain and discomfort. Can I
suggest some ways that might help with your joint pain?
Firstly, you can use a hot or cold pack alternatively on the affected area of your body.
This can be very effective in helping to reduce the pain. You can also dolight stretching
exercises which works well in treating sore joints. These exercises help the muscles
around the joints to relax and to retain their strength.
You can also buy some over-the-counter creams such as Voltaren which can help
reduce the pain. You might need to take some painkillers, such as Nurofen which also
acts as an anti-inflammatory. Do think you will be able to try these therapies I have
talked about? I think they will help you quite a lot.

Referring to other Health Professionals
It is not necessary to be an expert in all areas. So often the best advice is to refer to
another health professional. Example
 Now regarding your diet, I can refer you to a dietitian and they can provide really
good guidelines and healthy food options, based on your condition.
 Now in order to quit smoking, I recommend that you attend our hospital's quit
smoking program. They run regular classes and I can tell you that it has helped
many patients succeed in giving up smoking. Would you like to do that?
 I understand that self injecting insulin can be challenging at first, but at our clinic
we run weekly training programs which are run by our nurses. They can take you
through the process step by step and help you gain confidence. Would you like
me to make an appointment for you?
 Alcohol addiction is quite a serious condition, and you really need some outside
support to help you overcome this. Therefore I recommend that you contact
alcoholics anonymous, or I can contact them on your behalf, and arrange an
appointment. How does that sound?
 There are many home services that can help you in your transition to home life.
For example, Meals on Wheels can provide nutritious meals everyday, so you will
not need to cook all your meals. The Blue Nurses will come and provide all your
nursing care needs including help with medications, dressing your wound and with
showering. We can also arrange a social worker to help with any other difficulties
you may encounter.
 One way to speed up the recovery process and to increase mobility is to visit a
physiotherapist. They will be able to design a rehabilitation program based on
your needs and it can make a big difference. Would you like to try that?
 You need to start an exercise program, and I recommend joining a local gym or
sports centre. They will be able to create a fitness program that can help you lose
weight and feel healthier. Do you think you can do that?
To find out more about some of the common well known services available
to patients, click on the links below:
 Blue Care
 Meals on Wheels
 Quitnow
 Alcoholics Anonymous
 ACAT Assessment
 Grief Counseling
Other Health Professionals commonly referred to include:
 Dieticians
 Social Workers
 Community Support Groups

Responding to a Patient
Listening is a key component of the medical interview and it is important to
listen attentively to what the patient says, as this is of more importance
than what is written in your role-play card. Careful listening will help you to
improve your communication skills by allowing you to respond
appropriately, and show empathy and concern for the patients condition or
situation. If you are card focused you may not respond appropriately to the
patient.
Here are some example responses:
 Now, I understand how you feel…...you are worried about returning
home and whether you can manage, but let me reassure, we can
provide good quality home care and there are a range of professional
services available. Would you like me to tell you more about that?
 Well, you mentioned that you have had this condition for a few years,
could you tell me about the mediation you have been taking?
 Now, as you said, the wound is causing you pain. That is why I
recommend you visit our out-patient clinic as soon as possible.
 I am very sorry to hear that. Would you mind if I ask you a few
further questions regarding this situation?
 Do you have any other difficulties?
 Is there anything else that is bothering you?
 Apart from chest pain, what other symptoms have you experienced?
 I see,that must be a very difficult situation for you. But the good news
is, that there several options available which will help you. Would you
like to hear more about that?
 I can see that you are worried, but try to not be too concerned as this
condition can be managed with medication and rest.
 I totally understand how you might feel, but let me reassure,this
condition is not as serious as you might think.

Smoking Cessation
I'm glad you've made the decision to quit smoking. The good news is that it is possible
to give up smoking. I’d like to reassure you that many of the complications caused by
smoking can be reversed. If you quit smoking, you will have more energy, better health
and improved sense of taste and smell.
It's a good idea to avoid smoking situations and do activities that can distract you from
smoking. I'm sure you will enjoy saving money. Don't forget to reward yourself!
Another thing I should mention is that there many support groups and programs
available to help you to quit smoking.
Practice: Using the underlined phrases above, practice giving advice
and expanding on the notes below. Add your own ideas as well.
Risks
 20,000 Australians die every year from smoking related diseases
 86% of lung cancers are caused by smoking
 Chronic bronchitis » smokers cough
 Hardening of the arteries » heart attacks/ strokes
 Problems in pregnancy
 Risks to other family members through passive smoking
Quitting
 Cold Turkey
 Nicotine patches
 Nicotine gum
 Quitline
 Community groups
 GP
Withdrawal Symptoms
 Feeling restless
 Irritable tense
 craving for cigarettes
 Symptoms disappear after 10 days

Weight Loss Benefits of Exercise
I’m glad you asked about how to lose weight. It will certainly help your health and self
esteem.
Well, there are basically two simple keys to losing weight. The first one is to eat less
fattening foods. You should also be careful of your alcohol intake. The secondkey is to
exercise regularly to raise your metabolism and burn extra calories. Do you think you
can do that?
It is also very important to reduce high calorie foods- foods such as peanut butter,
nuts, soft drinks cakes and biscuits. Instead of these foods, aim to increase your intake
of complex carbohydrates like grains and vegetables.
Try to exercise regularly at least three times a week for about 30 minutes. Can I
suggest even taking the stairs instead of the lift? This will all make a difference in your
goal to lose weight.
Practice: Using the underlined phrases above, practice giving advice and expanding
on the notes below. Add your own ideas as well.
Weight loss tips
 Cut down of high calorie food such as…….
 Eat natural foods
 Avoid junk foods
 Don’t eat between meals
 Avoid second helpings
Exercise
 Go for a 20~30 minute walk everyday
 Swimming
 Cycling
 Join your local fitness club/ sports centre
Recovery
 Start gradually and build up over time
 Avoid strenuous activities such as……….
 If you feel tired………
 Build your self esteem
 Reduce risks of heart disease by……………..
 Put less pressure on your joints especially…………..

ABOUT polite instructions and imperatives
During the physical examination the doctor gives Andrew a number of
directions or instructions, for example:
Now open your mouth, stick out your tongue, say Ah.
Traditionally we give commands using the imperative mood. That is we
put a verb at the beginning of the clause and leave out the subject you –
the person who must follow the instruction. The subject you is understood
by both the speaker and hearer.
(You) open your mouth.
However, it is impolite in English to give all your instructions with the
imperative. It makes the relationship more like a relationship in the
military between an officer and a soldier! So, we modify or soften the
instructions in a number of ways.
In the video we see that we can start an instruction with a conjunction
before the imperative:
… so put your hands up. And squeeze my hands.
This softens the effect of the command slightly.
An instruction can also have other elements in front of the imperative
which soften it and make it more polite. We can see an example of this in
the video:
So just come and sit down.
and in the video from unit 1:
Here the adverb just softens the force of the instruction.
Note that imperatives can have other adverbs in front of them, such as
first, then etc:
First extend your fingers as far as possible, then flex them from the
middle knuckle, hold that for five seconds, then extend them again.
Here the adverbs simply place the instructions in a sequence.
Instructions are also given in the video without using the imperative. The
subject you is actually used with a modal verb can.

You can roll them down again.
Note that we can use the modal verbs can or could. The modal verbs
should or must or have to are too strong for this situation.
The doctor uses even more polite ways of giving instructions with if in a
conditional clause together with modal verbs:
If you’d like to hop up onto the couch …
If you could just roll your pants up.
All of these strategies soften the instructions and vary the way the doctor
delivers them. They make the relationship between the doctor and the
patient more relaxed. Instructions with no softeners or variation would
sound like an army exercise!

Giving the diagnosis
giving the diagnosis
certain:
What we’re looking at is …
What you’ve got is …
Well, what you’ve got is a condition called …
I feel certain you have …
We can rule out/exclude …
It definitely isn’t …
fairly certain: positive
(I think, It seems, probably, likely)
You probably have …
I think we’re looking at …
It seems we’re looking at …
It seems you might have …
It’s likely that you have …
It seems likely that you have …
I believe you have …
fairly certain: negative
(I don’t think, unlikely)
I don’t think …
It’s unlikely to be …
It’s unlikely that you have …
less certain:
(might, could, may, possibly, possibility)
You might have …
It’s possible that you have …
… is a possibility.
reassuring the patient
It’s not serious. It will pass.
This is something we can cure.
We can certainly cure this condition.
It’s not a serious condition and it’s easy to treat.
This is quite a common condition and we can treat it effectively.
It’s a long-term condition but we can manage it well.

Although we cannot cure this condition, there are many things we
can do to manage it.
This is a serious condition and we will need to admit you to hospital,
but you will be in very good hands.
explaining the need for further tests
I’m not quite sure at the moment so we need to do some more tests
to find out exactly what’s going on.
exploring feelings and attitudes
This must come as a relief to you.
This must be a shock for you.
How do you feel about all this?
What’s worrying you most about all this?
Is there anything bothering/troubling you about this?

Developing a management plan
opening the discussion
What I’d like to do now is discuss how we will manage/treat your
condition.
What we need to do is …
There are a number of things we can do.
There are a number of options open to us.
There are a number of ways we can go. First of all …
We’ll try to solve the problem first of all with …
giving advice
You must
You’ll have to
modify your diet.
rest.
cut down on alcohol.
stop smoking.
exploring contraindications
Are you allergic to anything?
Have you ever had a bad reaction to …?
prescribing medication
I’ll give you a prescription for …
This will take the pain away and …
Take one tablet in the morning/evening.
Always take it with food to avoid stomach problems.
You will need to take one tablet twice a day.
warning about risks
Don’t drink alcohol
drive
use machines
while you are on the medication.
exploring preventive measures
eliciting patient’s ideas
How do you think you could reduce your alcohol consumption?
It’s important to think of ways to reduce the amount of stress in your
life. What do you think you could do?

supplementing ideas with further suggestions
These are excellent ideas. You might also like to think about …
Many people think that … helps. Is that something you would like
to try?
Is that something that might work
for you?
referring patient to specialists and community resources
I’d like to refer you to someone who is a specialist in the field.
There are a number of people who can work with us to help us manage
your condition. I’d like you to see …
And there is a support group I’d like you to contact.
letting patient know what to expect
You will/may need to take a week off work.
You may experience some nausea.
It will be some time before you can get back to work.
We may find we have to operate … but we’ll see how things go.
informing patient of danger signs
There are a number of things we need to look out for.
If you notice any …,
If you experience any …,
then I’d like you to call me immediately.
go to the hospital.
call an ambulance straight
away.
encouraging questions
Do you have any questions?
Do you have any other questions?
Is there anything else you’d like to ask?

ABOUT managing transitions
Managing transitions throughout the different parts of the interview is an
important clinical interviewing skill. Although doctors and patients are
‘partners in care’ and both play active roles in the medical consultation,
doctors generally control the direction of the consultation and manage the
shifts or movements from one phase to another.
The major shifts occur between:
x the opening and the history taking
x the history taking and the physical examination
x the physical examination and the management phase
x the management phase and the closing
As the physical examination in particular can be unfamiliar and
threatening, it’s important to warn a patient about the shift to the
examination and then to support the patient with relevant information.
Doctors communicate this shift to patients by using a mix of verbal and
non-verbal behaviours.
For example, they may use:
x words like Alright or OK to close off the history taking
x words like Now and Well (‘shift’ markers) to signal the beginning of a
new phase. These can be followed by a request to examine the patient
or an explanation that the examination is about to take place
x shifts of posture (eg from sitting to standing) or other movements (eg
putting down pen, setting file aside).
Alright. Well, let me examine you and then we’ll have a chat.
Rightio. I’ll have a look at you and then we’ll go over what you can
take.
In the transition from physical examination to the diagnosis and
discussion of treatment options they might say:
Well that’s it. We’re finished now. Come and sit down.
Well Mr Stelios, I think it’s possible you may have …

Patient notes
Harris Street Medical Practice
Patient details
Family name: MARKS
First name: ANDREW
Age: 35
DOB: 20/6/XX
Sex: M
Occupation: Accountant
Marital status: Married
Address: 11 Bush Road
Fountain Lakes 2095
Tel No: (H) 02 9817 4415
(W)
(M)
Presenting complaint
Systems review
Past history
Family history
Medication
Investigations
Diagnosis
Date
Management

Taking it further: questioning and giving feedback
Work with a partner. Read through the text below. This is what a
consultation might sound like if questions are not varied and there is no
feedback for the patient. The doctor’s style is abrupt and interrogating,
the interaction is very stilted and there is no obvious rapport between
doctor and patient.
What can you do to improve the doctor’s communication style? Work on
the questioning style and feedback for the patient. A good strategy would
be to role play the consultation in your own words, record your role play
and compare your version of the consultation with the one here. Consider
how you might improve doctor-patient communication with effective use
of body language and meaningful use of stress and intonation.
Doctor: Come in. What’s the problem?
Patient: I’ve got stomach pain.
Doctor: Where does it hurt?
Patient: Here.
Doctor: Just in the upper abdomen?
Patient: Yes.
Doctor: Does it go anywhere else?
Patient: Yes, sometimes it goes around here to my back.
Doctor: How long have you had it?
Patient: For a few months now.
Doctor: What brought it on?
Patient: I’ve no idea.
Doctor: What makes it worse?
Patient: It gets really bad when I’m hungry.
Doctor: Does anything help?
Patient: Yoghurt helps sometimes. And Quick-Eze.
Doctor: Have you had stomach pain before?
Patient: No, not like this.
Doctor: What about your bowel habits? Have they changed at all?
Patient: No, no problems there.
Doctor: Have you ever been in hospital?
Patient: No.
Doctor: Is there any family history of stomach trouble?
Patient: No, my father has a bit of heart trouble, but my mother’s healthy
and active.
Doctor: Do you smoke?
Patient: Yes, I do. About 20 cigarettes a day.
Doctor: Do you drink?
Patient: Yes, about 2 to 3 beers a night, and more at weekends.
Doctor: Are you under any stress?
Patient: Yes, work’s very stressful. I work long hours and I worry about it a
lot.
Doctor: All right. Let’s have a look at you.

Closing the consultation
making follow-up arrangements
Now I’d like to see you after you’ve been for your tests.
I want to see you in two week’s time.
And in the meantime, just ring me if anything is worrying you at all.
If you run into any problems, I want you to call and come to see me.
repeating arrangements
So I’ll see you in a few days.
in 6 week’s time.
after you’ve had the tests.
after you’ve seen the specialist.
So make an appointment and I’ll see you then.
saying goodbye
Bye bye.
Goodbye for now.

ABOUT giving feedback
Giving feedback is an important part of communication. When you use
feedback, you show a patient that you are listening carefully and following
what they are saying.
Feedback can be verbal or non-verbal. Non-verbal feedback is given
through facial expressions, physical gestures or other body language.
Nodding and smiling are two examples.
Verbal feedback takes several forms. You can:
• give minimal verbal feedback by using expressions such as OK, I see,
Mm, Right, Oh, Uh huh, Really.
• repeat what the patient says, for example:
Doctor: When did the headache start?
Patient: Monday morning, late Monday morning.
Doctor: Late Monday morning. And how long did it last?
• paraphrase what the patient says, ie restate the information in your
own words.
Doctor: So when did the pain start?
Patient: Well, I first had some pain back in January.
Doctor: So about three months ago?
Patient: Yes, that’s right.
Paraphrasing and repeating allow you to check information and give
your patient a chance to correct any misunderstandings.
• summarise what the patient has told you. This may be done at the
start of the physical examination, for example:
Doctor: So, the headache started on Monday morning. It was
preceded by flickering lights, and it was on the left side of
your head. You had it almost all day and you’ve still got a
little bit of it now.
Patient: Yes, that’s right.
Doctor: OK. I’d just like to examine you now. Could you just roll up
your sleeve and we’ll start with blood pressure.
Notice that the patient in turn confirms the doctor’s summary with
feedback: Yes, that’s right.
Questions can also be a form of feedback. When you follow up what a
patient has said with a question for clarification or additional information,
you are effectively saying ‘Yes, I’ve heard what you said and I’d like you
to tell me more or explain a little more’.

ABOUT tones and questions
We use both falling and rising tones in questions. There are no strict rules
but there are some recognisable patterns. These are summarised below.
1. Questions beginning with a question word (wh-questions
beginning with words such as who, where, why, what, how, how long)
are normally asked with a falling tone.
example
Ì
HOW would you deSCRIBE the pain?
Why use falling tone?
In wh-questions the speaker needs specific details or information
(who, where, why, what, how, how long etc) about some topic. These
details close or complete the information required. In general,
completing or finishing information is expressed with a falling tone.
2. Questions without a question word (questions that can be
answered with a ‘yes’ or a ‘no’) are usually asked with a rising tone.
example
Ê
And you’ve STILL got the HEADache NOW?
Why use rising tone?
In yes/no questions the speaker is unsure or doesn’t know if
something is the case or not. In general, uncertainty and lack of
completion are expressed with rising tone. Rising tone can also have
an important interactive meaning and can signal that the speaker is
‘open’ to the listener.
3. In tag questions, where the speaker wants to check or verify the
statement part of the question, both parts of the question have a
falling tone.
example
Doctor is pretty sure about information and just confirms that it is correct:
Ì Ì
And you HAVEn’t lost any WEIGHT, HAVE you?
4. If the speaker is not sure of the statement and questions it in the tag,
the statement is spoken with a falling tone and the tag with a rising
one.
© NSW AMES 2005 page 1 of 2

example
Doctor’s receptionist thinks she recognises patient, but is not really sure:
Ì Ê
You’ve BEEN here beFORE, HAVen’t you?
5. Questions which give alternatives (questions with ‘either’/ ‘or’) are
usually asked with rising tone on the first alternative and falling tone
on the second alternative. These questions ask the listener to choose
between two possibilities which are presented as contrasts. Only one
alternative is required in the answer.
example Ê Ì
Was it like a TIGHT BAND / or was it a THROBbing pain?
Why use rising and falling tone?
In the case of either/or alternatives, the rising tone expresses the first,
incomplete part of the question and the falling tone occurs on the
second, completed part of the question.
6. Variations
The above are generalisations mostly based on the grammatical forms
of questions. In real life, however, there is always variation and
flexibility. Within the framework of a conversation, for example,
speakers may choose:
• Rising tone in wh-questions:
We may ask a wh-question with a rising tone if we want to sound
less demanding or we are asking the speaker to repeat something.
• Falling tone in yes/no questions:
We might ask a yes/no question with a falling tone if we want the
listener to consider the answer very carefully or if we are repeating
the question. Other cases for using falling tone include situations
where the yes/no question is an open question ‘in disguise’, that is,
where the question requires more than a yes or no answer and is
an invitation for the listener to provide that information.
The position of the question in a sequence of questions might also
have an impact on tone choice eg a final question, even if it’s a
yes/no one, can be asked with a falling intonation, just to signal
that it’s the last in a long chain of questions.
Speakers also sometimes use a different tone just for variety,
especially if they have already asked a lot of questions of the same
type.

ABOUT tones
What is tone?
Tone is the change of vocal pitch or movement up or down of the voice.
Basic tones of English
Many of the world’s languages, for example, Mandarin, Vietnamese and
some African languages, are tone languages. Speakers of these languages
use changes in pitch to show different meanings of words. English is not a
tone language and its speakers do not use tones in this way. However
English does have tones. The table shows the basic tones of English.
Falling tone the voice moves in a downward direction
Rising tone the voice moves in an upward direction
Level tone the voice stays at the same level, moving neither
up nor down
Falling-rising tone the voice moves down and then up
Rising-falling tone the voice moves up and then down
When we use them
There are no hard and fast rules about when to use a particular tone but
there are some recognisable tendencies. It’s usual, for example, to use a
falling tone to indicate certainty, definiteness or completion and to use a
rising tone to suggest the opposite: uncertainty or tentativeness or lack of
completion.
Why we use them
We use tones for many different purposes. For example, to:
• express a range of emotions
• contrast old and new information
• indicate that we have or haven’t finished speaking
Tones also work as a sort of verbal punctuation. For example, they mark
the beginning and ending of clauses and sentences. Tones can also have a
grammatical function. For example, we can use them to contrast question
forms with statements. However there is considerable variation in the way
individual speakers use tones. The choices we make depend very much on
the context and purpose of the interaction and on the status of the people
taking part.

Notation
Tones occur on the main key word stress in a chunk or piece of speech
and arrows show the direction the voice moves. The arrows can be placed
in different positions. Sometimes we place them above the word to show
the place where the tone starts (see observations).
speech chunk
Ì
There’s OFten a PAttern in FAmilies
the blue arrow shows the direction
the voice moves
the stressed syllable in the main key word
(the tonic) is underlined
stressed syllables in key word are in CAPS
Tone arrows can also be placed at the beginning or end of the speech
chunk in longer stretches of speech.
There’s OFten a PAttern in FAmilies Ì
and there are WELL-REcognised TRIggers Ì
Linking words and fillers spoken as separate speech chunks, are written in
lower case.
There’s OFten a PAttern in FAmilies Ì
and er Æ
there are WELL-REcognised TRIggers Ì
linking word and filler

ABOUT softening language
When Dr Cooper prepares Andrew for the blood pressure and eye tests,
she says:
I’ll just take your blood pressure now.
Now, I'll just check your eyes.
In fact, she uses the word just frequently in the consultation. She
sometimes uses it to soften a request and make it polite as in:
So just come and sit down.
At other times she uses it to minimise the impact of what she has to do,
as in Now, I’ll just check your eyes. She downplays what she’s going to
do.
Softeners are often used by medical professionals when they prepare
patients for procedures. It’s one of many strategies they use to reduce
patient anxiety.
Of course you can introduce procedures in other ways too. For example,
you could say: I’d like to check your eyes now.
You would use other softening strategies with this preparatory statement,
for example, voice quality, intonation or a reassuring smile.
Examples of other minimisers are: a bit, only, slight, a little, some, kind
of.
Here are some examples of their use:
It might hurt a bit.
It will only take a moment.
You will feel a slight discomfort.
There are often some side effects.

ABOUT sentence stress
Sentences are made up of groups of words and some sentences are longer
than others.
If a sentence is short, we usually speak it smoothly and fluently in a single
chunk.
example
So just on one side of your head?
If the sentence is very long, we break it up into shorter word groups or
chunks. The length of each chunk varies; it is usually a small block of
meaningful language (often a conventional grammatical unit), but it may
also be a single discourse marker (eg So … Well ...).
example
Well / basically / a classic migraine / is a throbbing / usually on one side of
the head /
Stressed and unstressed words
When we speak, we give some words in each group more prominence
than others. We do this by saying them louder and longer than other
words. This contrasts them with the words we leave unstressed.
On the whole, we tend to stress content words or words that give most
information (eg verbs, nouns, adjectives and adverbs).
example (with stressed syllables in the content words in bold)
Well / basically / a classic migraine / is a throbbing / usually on one side
of the head /
We tend not to stress grammatical words (eg pronouns, prepositions and
articles) although we can stress them if we want to emphasise them for
some reason.
Key words
If you look at the example again, you’ll see that we don’t stress all
content words equally.
example (with the stressed syllables in the key words in capitals)
WELL / BASically / a CLAssic MIgraine / is a THROBbing / USually on ONE
side of the head /
We tend to stress some content words in the chunk more strongly than
others. These are the key words and our choice of key words depends on
the specific meaning we want to get across. We mark key words in several
ways. For example, we:
• say them longer and louder than the other content words

• sometimes accompany the key word with a particular gesture or facial
expression.
Hierachy of stress
In summary, English has a hierarchy of stress. The table below represents
the different levels of stress in English.

ABOUT syllables and word stress
If you want to communicate effectively in English, you need to
understand syllables and the ways stress works in English. If you stress
the wrong syllable in a word, you may make the word difficult to
understand and this may cause misunderstandings with patients and
medical colleagues.
What is a syllable?
A syllable can be either a whole word or part of a word.
A syllable in English always contains a vowel sound.
examples
one syllable
bad
pain
two syllables
pa/tient
head/ache
three syllables
di/la/ting
ap/point/ment
four syllables
con/sul/ta/tion
me/di/ca/tion
five syllables
pa/ra/ce/ta/mol
Syllables and word stress
When we say polysyllabic words (words with many syllables), we do not
stress all the syllables equally. In two and three-syllable words we
stress one syllable more strongly than others. This syllable can occur at
the beginning, middle or end of a word.
DOCtor
preSCRIBE
diSEASE
preSCRIPtion
In longer words, we stress one or more syllables. They have a primary
and secondary stress. The primary stress is the strongest stress.
consulTAtion
Ê É
secondary primary
Getting the primary stress correct should be your priority. If you’re
unsure about where to place the primary or strongest stress in a word,
you can always check the word in your dictionary. Dictionaries using the
International Phonetic Alphabet (IPA) use the diacritic (l
) to indicate
primary stress and the diacritic (l) to indicate secondary stress. Always
stress the syllable following the primary stress diacritic (l
).

Characteristics of stressed syllables
Stressed syllables have three main characteristics. They sound louder
and longer. Stress is also marked by a change in pitch (movement of
the voice up and down). These characteristics are most marked in the
syllable that carries the primary stress.
Is syllable stress predictable?
Some medical terms do follow predictable patterns.
examples
In words ending in tion: we stress the syllable before tion.
mediCAtion
consulTAtion
opeRAtion
In words ending in itis: we stress the syllable before the final tis.
arTHRItis
bronCHItis
hepaTItis
However word stress is not always predictable. For example, related
words sometimes keep the same stress pattern.
preSCRIBE
preSCRIPtion
… but other related words have a different stress pattern when they
have a different grammatical function.
conSULT consulTAtion
eXAmine examiNAtion
SYMPtom symptoMAtic
...so although word stress is sometimes predictable, it’s best to learn
the primary stress when you learn a new word.

ABOUT body language
Why is body language important?
Body language is a major part of non-verbal communication and
contributes in a major way to overall communication.
How do we use it?
We use it to:
x colour what we say
x emphasise what we say
x express something that is difficult to put into words
x make connections with people
We use body language to reinforce what we say but it can also contradict
what we say. This happens when we are not being open about something.
For example, we may tell a doctor we’re OK but our body language may
indicate quite the opposite.
Body language and cultural contexts
Body language plays an important part in doctor-patient relationships.
Of course, it is used differently in different cultural contexts, and in clinical
practice you may be treating people from many different backgrounds.
You need to be sensitive to differences. In instances where patients use
very different body language, take the lead from them.
In a western English speaking context …
Eyes and hands are important to us all, although we may use them in
different ways.
eyes
Eyes are very expressive and we use them in diverse ways: to show
emotions, to convey subtle meanings, to make (or avoid) contact with
people.
We start interactions with good eye contact and maintain this contact,
relaxing it from time to time with short breaks. The right amount of eye
contact is important. If you stare fixedly at someone, you make them feel
uncomfortable. If you don’t look at them at all, you seem unfriendly or
even untrustworthy.
hands
Hands give important messages too. A person who uses open hands with
palms turned up will appear open and approachable. Hands held across
the chest give the opposite impression: the person seems closed and
defensive.
We also use our hands to emphasise points; we describe and explain
things with our hands.

And we could go on and on … but what does this all mean for clinical
practice? Which elements of body language really make a difference?
Effective use of body language in consultations
Smile!
It’s important to smile, especially when greeting a patient. Smiles show
warmth and help build rapport.
Keep an open posture
Don’t begin consultations until you are both seated. Keep an open posture
when you sit down. An open posture will show that you are approachable.
You can also lean forward slightly to show that you are interested, but not
too far into your patient’s personal space.
Maintain eye contact
This is very important. Keep your eye levels in line. Rest your gaze briefly
from time to time. You will need to consult notes or maybe a computer
screen but don’t turn away for too long. If you do that, you will lose all-
important contact with your patient and may even miss vital non-verbal
messages: hidden emotions, lack of understanding and so on.
Use your head
Yes, nod, and give minimal feedback to show that you are listening and
understanding what your patient is telling you.
There are many ways to build mutual understanding and using body
language effectively is one of them. If you establish good rapport right
from the start, you and your patient can build an effective and mutually
rewarding health care partnership.

ABOUT modality
We use modality to express the level of probability of a statement. For
example, the doctor in the video says:
… the late night might have contributed.
You may have no migraine for ten years.
You might start having them every week.
By using the modal auxiliary verbs might and may she is saying that all of
these things are possibly true.
We can also express probability using adverbs:
Red wine is certainly a trigger.
Maybe the late night contributed.
And we can use adjectives to express probability.
If the attacks become frequent, it’s possible that you will need
medication to prevent migraines coming on.
And we can use nouns, too:
There is a possibility that the medication won’t work if you don’t
take it immediately.
The expression I think is another way the doctor expresses her level of
certainty:
I think you’ll find that it’ll settle down.
The table below shows how different levels of probability are expressed
using different grammar.
modal
auxiliaries
adverbs adjectives nouns
high must
have to
certainly
definitely
certain certainty
medium can
could
likely
probably
probable probability
low may
might
possibly
maybe
perhaps
possible possibility

ABOUT phrasal verbs
In conversations, even between a doctor and patient, we often use
common, everyday vocabulary, including many phrasal verbs.
A phrasal verb is a normal verb such as get put together with one or more
prepositions such as off, over or around to make a new meaning. Get by
itself means obtain or receive but get over means to recover from an
illness or disappointment.
In our video the doctor tells Andrew:
I’ll check you out. If you’d like to hop up onto the couch, I’ll
examine you.
In this example check you out means to examine you and hop up onto the
couch means to go to the couch and sit on it.
Most phrasal verbs have a more formal equivalent verb:
Phrasal verbs Equivalent formal verbs
get over recover
check somebody out examine somebody
come along improve
Phrasal verbs are very common in English, especially spoken English, and
you can find whole dictionaries of them! Have a look for an online
dictionary of phrasal verbs.

ABOUT linking
When we speak fluently and naturally we do not speak all words separately.
We link words together. We do this by joining the last sound of one word
with the first sound of the next word.
Some types of linking
1. link consonant + vowel: when words ending in a consonant are
followed by words beginning with a vowel
come in
take off
roll up
stick out
hop up onto
straight away
2. link consonant + consonant: when the last sound in the word is a
consonant and the first sound in the next word is the same consonant
or a similar one
Please sit down.
And I want to see you …
3. link vowel + vowel: when words ending in a vowel are followed by
words beginning with a vowel
x Insert a /w/ sound if the lips are rounded at the end of the first
word.
And have you/w/ever had anything like this before?
Nothing out of the ordinary to/w/eat
x Insert a /j/ sound if the lips are spread at the end of the first word
in the/j/eye on that side.
x When words like where, are, there are pronounced in isolation or
followed by a word beginning with a consonant, the final /r/ sound
is not pronounced and the words end in a vowel.
Where was the pain?
However when these words are followed by words beginning with a
vowel, then the /r/ is pronounced.
There are well-recognised triggers.
Is there anything else …

ABOUT shortening questions
The doctor often shortens questions during the consultation.
Shortening questions or other sentences (using ellipsis) is very common in
spoken English. Leaving out words allows us to say or ask what we want
to more quickly. It is a more economical and efficient way to use language
to “get the job done.” It usually signals informality.
How we shorten questions.
We usually shorten questions by removing the verb, auxiliary verb and the
subject from the beginning of yes/no questions.
Have you had any nausea?
Any nausea?
Did you have and flickering lights before your eyes?
Any flickering lights before your eyes?
Are your parents still alive?
Parents still alive?
Note that the doctor starts asking shortened questions after she has
initially asked some full questions.
Another way of shortening questions
Although it didn’t occur in this consultation people often shorten sentences
by removing words from the end of the sentence and just leaving the
question word(s), for example:
Doctor: Are you still smoking?
Patient: Yes, I’m having a lot of trouble giving up.
Doctor: How many?
Note that the shortened question How many refers back to the previous
question Are you still smoking? To use the verb smoke again would be
unnecessarily repetitive.

A to Z of Common Phrasal Verbs in a Medical Context
A Example Sentence
 Adds up to: equal  The cost of the medication adds up to $86.95
 Apply for: make a request  You will need to apply for some time off work to
recover.
 Abide by: adhere to  You need to abide by the doctor’s orders
 Account for: explain  I can’t account for the spots on my leg.
 Ask for: make a request  Please ask for anything you need while you are
on bed rest
B Example Sentence
 Break down: fail or collapse  After losing his job, Mark suffered a mental
break down
 There was a communication break down
between the doctor and the medical staff.
 Break out in: develop a rash or skin condition  My daughter broke out in a rash after catching
chicken pox.
 The patient broke out in to welts all over his
body.
 Break through: force through a barrier  Despite the medication, he was suffering from
break through pain.
 We are waiting for a medical break- through.
 Bring about: cause something to happen  Sarah’s obesity was brought about by a diet
high in saturated fats and sugar and a lack of
exercise.
 Bring something on: cause something
unpleasant, to occur or develop
 Too much sweet food can bring on tooth decay.
 Bring someone to: restore consciousness  The nurse brought him to with smelling salts.
 Bring someone up: raise  After Mary died, John brought up the 3 children
on his own.
 Bring something up: start talking about a
subject
 The patient brought up all his lunch.
 Bring it on: cause to happen or encourage  What brings on your headaches?
 Build up: strengthen  These vitamins should help build up your
immunity.

c Example Sentence
 Call around: phone many people or place  The nurse will call around and get you an
appointment.
 Call someone back: return a phone call  I will call you back in an hour.
 Call something off: cancel  All surgeries have been called off tomorrow
because of the strike.
 Call on someone: ask for an answer or opinion  All the specialists call on each other when they
need to.
 Call on someone: visit someone  The physiotherapist will call on you this
afternoon.
 Calm down: relax after being tense  The medication calmed her down.
 Care for: look after  Is there someone to care for you at home?
 Carry out: perform  We need to carry out an examination before
you can be admitted.
 Check in: to register  Please check in at the front desk for admission.
 Check out: leave a hospital  Don’t forget to check out before you leave the
hospital.
 Check something out: look at carefully, examine  The doctor needs to check you out before you
are discharged.
 Check up: medical examination  You need a complete medical checkup.
 Cheer up: become happier  Your visitors will cheer you up.
 Cheer someone up: make happier  I bought you some chocolates to cheer you up.
 Clean something up: tidy, clean  The cubicle needs to be cleaned up before the
next patient.
 Clear up: get rid off  This ointment will help clear up your son’s acne.
 Come across: find unexpectedly  We came across your old X rays the other day.
 Come apart: separate  The stitches have come apart.
 Come down with something: become sick  I have come down with a cold.
 Come forward: volunteer for a task  Any potential donors were asked to come
forward.

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