Good Practice Student's Book

Cambridge University Press
978-0-521-75590-0 - Good Practice Student’s Book: Communication Skills in English for the Medical Practitioner
Marie McCullagh and Ros Wright
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Good Practice
Communication Skills in English
for the Medical Practitioner
Student’s Book
Marie McCullagh
Ros Wright
© Cambridge University Press www.cambridge.org

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CAMBRIDGE UNIVERSITY PRESS

Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo, Delhi
The Edinburgh Building, Cambridge CB2 8RU, UK
www.cambridge.org
Information on this title: www.cambridge.org/9780521755900
© Cambridge University Press 2008
This publication is in copyright. Subject to statutory exception

and to the provisions of relevant collective licensing agreements,
no reproduction of any part may take place without the written
permission of Cambridge University Press.
First published 2008
Printed in Italy by Printer Trento Srl
A catalogue record for this publication is available from the British Library
ISBN 978-0-521-75590-0 Student’s Book

ISBN 978-0-521-75591-7 Teacher’s Book

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Contents
Introduction page 6
SECTION 1: INTRODUCTION TO COMMUNICATION

• Recognising the different elements that make up communication page 8
• Understanding how good communication benefits the patient interview
SECTION 2: DEVELOPING LANGUAGE AND COMMUNICATION SKILLS FOR THE PATIENT ENCOUNTER
Unit Communication skills Language focus Texts
1 Receiving the • Greeting patients and • Conveying warmth Reading
patient putting them at ease • Formulating the opening • Patient questionnaire
page 14 • Introducing yourself and question Listening
your role • Language for setting the • Presentation: the
• Asking the opening agenda importance of seating
question and setting the • Phrases to facilitate, repeat arrangements
agenda for the interview and clarify • Patients present their
perspective
• Receiving and greeting a
patient
• Asking the opening question
• Setting the agenda for the
interview
2 The presenting • Encouraging patients to • Using exploratory questions Reading
complaint express themselves in their • Adjectives to describe types • Patient-centred approach to
page 22 own words and intensity of pain history-taking
• Taking an accurate history • Patient speak: the suffix Listening
of the presenting complaint –ish • Using exploratory questions
• Asking about the intensity • Patient speak: phrasal verbs • Exploring the presenting
and degree of pain with up complaint
• Using techniques such as • Facilitating the encounter:
facilitation, repetition and voice management
clarification
DVD lesson 1: Patient-centred vs. doctor-centred approach
3 Past medical • Requesting the patient’s • Language to request the Reading
and family past medical history past medical history • Past medical history: the
history • Discussing the family • Patient speak: common components
page 32 medical history expressions to describe • Patient note
• Taking effective notes state of health • Pedigree diagram
during an interview • Expressions for signposting Listening
• Writing an effective patient and summarising • Conference presentation:
note • Standard medical the pitfalls of taking the
• Summarising and abbreviations PMH.
structuring the interview • Taking a past medical
history
• Taking a focused past
medical history
Contents 3

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4 The social • Enquiring about the • Asking about lifestyle and Reading
history and patient’s social history environmental health • Telephone consultations
telephone • Employing good telephone • Language for summarising Listening
consultations etiquette and checking information • University seminar
page 42 • Ensuring an effective • Patient speak: common discussion on taking a
telephone consultation suffixes in medical social history
• Summarising and checking terminology • Asking about occupational
information • Expressions for consulting health
by telephone • Discussing lifestyle and
environmental health
• Carrying out an effective
telephone consultation
5 Examining a • Preparing and reassuring • Indirect language for polite Reading
patient the patient during an instructions, • Techniques of the trade
page 52 examination • Patient speak: verbs and Listening
• Explaining examination prepositions for giving • Giving instructions during a
procedures instructions physical examination
• Giving effective instructions • Effective intonation for
in a patient-friendly manner instructions
• Softener: just
DVD lesson 2: Taking past medical history, family history and carrying out the physical examination
6 Giving results • Explaining results in a • Language for giving a Reading
page 60 way that patients can diagnosis • Jaundice
understand and remember • Phrases used to organise • Acute bronchitis
• Encouraging patients to information • Erythema nodosun
express their fears and • do for emphasis and Listening
concerns confirmation • Explaining test results
• Explaining medical • Word stress for emphasis • Organising information
terminology to a patient • Language for explaining
• Giving a prognosis medical terminology
• Patient speak: colloquial
questions for asking about
prognosis
• Language of probability
7 Planning • Explaining treatments to a • How to negotiate a plan of Reading
treatment and patient action • The New Quit Guide, So You
closing the • Discussing options • Language for making Want to Quit?
interview • Describing benefits and side suggestions Listening
page 69 effects • Phrases to explain • Outlining a treatment plan
• Advising on lifestyle advantages and • Describing possible
• Negotiating treatment disadvantages treatment plans for
• Closing the interview • Patient speak: expressing hypertension
likelihood • Negotiating treatment with
• Language for negotiating the patient
treatment • Advising on lifestyle
changes
8 Dealing with • Broaching sensitive issues • Language to broach Reading
sensitive without bias and remaining sensitive issues • Reading cues
issues non-judgemental • Identifying non-verbal • Letter of referral
page 77 • Reading and responding to patient cues • Questionnaire: Know your
patient cues • Techniques for drink
• Employing question contextualising, reassuring Listening
techniques: CAGE and asking permission • Broaching sensitive issues.
• Writing concise and • Patient speak: drug culture • Discussing sexual and
accurate notes • Ensuring specific and reproductive health
• Updating the patient note concise notes • Asking about alcohol
consumption
4 Contents

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9 Breaking bad • Delivering bad news in a • Patient speak: expressions Reading
news sensitive way showing level of • A time to listen
page 87 • Reassuring a patient or understanding Listening
relative • Softening the question • Breaking bad news
• Showing empathy • Language to deal with • Preparing the patient for
emotions receiving bad news
• Patient speak: talking • Dealing with emotions of
about current knowledge of an HIV patient
condition • Consulting with a relative
• Voice management when by telephone
communicating bad news • Breaking bad news to a
relative
DVD lesson 3: Breaking bad news
SECTION 3: INTERVIEWING DIFFERENT PATIENT CATEGORIES

10 Communicating • Encouraging a withdrawn • Reviewing question types Listening
with patient to speak • Using facilitative language • Receiving an
challenging • Calming an aggressive or • Language to respond to uncommunicative patient
patients angry patient body language • Interviewing an irritated
page 95 • Asserting your role as a • How to validate emotions patient
doctor • Patient speak: expressions • Dealing with a manipulative
to describe different patient
emotional states
DVD lesson 4: Dealing with challenging patients
11 Communicating • Carrying out an effective • Asking questions specific to Reading
with the interview with an elderly the elderly • Talking to the dying patient
elderly patient • Patient speak: collocations Listening
page 102 • Showing sensitivity and to describe conditions • Visualising life as an older
respect to an elderly common in the elderly patient
patient • Language to show • Interviewing an older
• Communicating with sensitivity patient
depressed elderly patients • Techniques for • Interviewing patients with
communicating with sensitivity and respect
patients with hearing • Consulting patients with
problems hearing problems
• Simple choice questions • Student presentation: tool
for assessing the ability to
live independently
• Dealing with a patient with
depression
• Assessing a patient with
mental issues
12 Communicating • Establishing and developing • Compliments for children Reading
with rapport with a child • Expressions to show • Now I feel tall: What a
children and • Reassuring a child empathy with must patient-led NHS feels like
adolescents • Gaining a child’s consent to • Language for reassuring a Listening
page 112 be examined child • Interviewing young children
• Explaining procedures to a • Child-friendly instructions and their parents
child • Patient speak: bodily • Reassuring a young child
• Responding to a child’s functions and body parts • Examining children and
verbal cues • Techniques for giving instructions
• Communicating effectively communicating with • Interviewing an adolescent
with an adolescent adolescents patient
DVD lesson 5: Interviewing young patients and their carers
Role-play and other additional material page 121
Audio scripts page 137
Answer key page 152
Contents 5

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Introduction
strategies to repair or avoid possible breakdown in

Who is Good Practice aimed at?
communication with your patient; encouraging use
Good Practice is intended for qualified doctors and of patient-friendly language when giving instructions
medical students with an upper-intermediate to or discussing treatment options; and familiarising
advanced level of English who are looking to work you with language commonly used by patients:
in an English-speaking environment. Mirroring the euphemisms, jargon, language used by children, etc.
increased emphasis on communication-skills training ● Non-verbal communication skills: developing
in medicine, this course aims to develop the language your awareness of body language to enable you to
and interpersonal skills essential to the establishment better read and interpret your patients' physical
and maintenance of rapport between doctors and their and emotional signs, as well as to better mirror
patients, thus enabling medical practitioners to carry out your own verbal communication with appropriate
their duties in English more effectively and with greater non-verbal signs.
confidence. Good Practice has been written in accordance ● Active listening skills: ensuring a successful
with the Calgary-Cambridge observation guide*. interview through techniques that facilitate
discussion, demonstrating that you are really
What aspect of medical English does listening to your patient and assimilating the
the course deal with? information given and its relevance to an eventual
diagnosis.
With reference to numerous medical communication ● Voice-management skills: improving use of
experts and through exposure to authentic clinical
intonation and word stress in order to build
scenarios, Good Practice demonstrates the impact of good
rapport with the patient, give encouragement and
communication on the patient–doctor relationship. The
show sensitivity.
course will train you how to sensitively handle a range ● Cultural awareness: widening understanding of
of situations, from taking a patient history, through the
cultural issues and the impact of your own cultural
physical examination and describing treatment options,
background on both your patient and the interview
to breaking bad news. It will also prepare you for dealing
itself.
with different patient types, including children and
the elderly, as well as patient situations requiring more
enhanced levels of sensitivity. How is Good Practice structured?
● Good Practice is divided into three distinct sections:
Medical vs. language content 1 The Introduction to communication provides you
with an overview of communication, highlighting
While Good Practice does make use of medical
its importance during the patient encounter.
communication models, and as a learner you will
2 Units 1 to 9 take you through the kind of
be encouraged to call on your medical expertise, it
language and communication skills required to
should be noted that the aim of this course is not to
ensure you are able to carry out each stage of the
teach medicine and medical practices. Similarly, the
patient encounter effectively.
trainer will act as facilitator and expert in the English
3 Units 10 to 12 offer the chance to consolidate
language and communication skills, rather than expert
and further hone these skills, putting them into
in medicine (although some may be experts in both).
practice within specific clinical situations and
with particular patient types.
What are the aims of the course? ● Each unit ends with an extended role-play and
Good Practice focuses explicitly on the five progress check.
components that make up communication: ● Audio transcripts, as well as a complete answer key
can be found on pages 137–176.
● Spoken communication skills: enhancing
your ability to use effective communication
6 Introduction

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What is the approach of Good Practice? How can Good Practice be used for self
Good Practice aims to develop the grammatical and study?
lexical features of English, employing an approach ● Depending on your goals, you can either follow
that encourages you to discover the language and its the course in a linear manner or you may wish to
properties for yourself. Language boxes interspersed use the Contents page to pinpoint areas you find
throughout each unit highlight useful expressions, particularly difficult – breaking bad news, dealing
while authentic texts – medical journal articles, with hearing problems, etc.
patient notes and doctor–patient dialogues – are ● Whatever your goals or time constraints, working
used to introduce language and present the essential through the Introduction to communication (pages
concepts of communication. Tasks draw on your 8–13) will be highly beneficial.
personal and professional experiences as both doctor ● Make use of the audio transcripts, some of which
and patient. The extended role-play is a chance for also include the non-verbal communication aspects
you to consolidate and put into practice the skills of communication.
covered in the unit, to observe and offer constructive ● Refer to the answer key, which includes suggested
criticism to your peers. A series of DVD-led lessons answers to many open-ended exercises.
allow examination and analysis of non-verbal ● Use the DVD and downloadable worksheets
communication and voice management, as well as which demonstrate the more visual aspects of
reinforcing those areas treated in the preceding units. communication that you might otherwise not have
In the DVD, roles are played by doctors and are non- access to, as well as acting as a reinforcement of the
scripted to ensure authenticity. language skills taught in the course book.
● Do the roleplays with a colleague or friend
What are the special features of the (all patients at some time) and ask them for
Student’s Book? constructive feedback. Access to a webcam means
you can record your role-plays and watch your
Think about … sections: Allow you to reflect
performance later, this time taking the role of
individually on your current knowledge of a given
observer. Complete the relevant feedback table
aspect of the patient encounter, or indeed the
(downloadable from the website), depending on
language used to carry it out, before tackling the
your particular goals.
target area; they also serve as a diagnostic for the ● Work through the downloadable worksheets,
trainer to evaluate your strengths and weaknesses.
complete with full answer keys (see www.cambridge.
Patient speak sections: Acquaint you with the
org/elt/goodpractice) to build on your existing
language spoken by your patients – colloquialisms,
knowledge base of verbal communication and
drug-culture jargon, childhood expressions, etc. This
cultural awareness.
important feature will aid you in deciding on the ● Devise a glossary of ‘Patient speak’; create a table
appropriate choice of language for a particular setting
which includes space for an example sentence and
or audience.
an indication of the context in which the example
Quotations from the experts: Ensure the link between
was spoken.
theory and practice by making reference to experts in
the field of medical communications skills.
*Calgary-Cambridge observation guide
Communication Skills boxes: Give you tips and hints
on appropriate communication strategies. The Calgary-Cambridge observation guide is a
Cultural Awareness boxes: Draw your attention to tool used for teaching medical communication,
specific aspects of culture that could possibly cause which reflects current theory and research for the
misunderstanding and offer a forum for discussion. doctor–patient interview. The guide lists the tasks
Out & About boxes: Encourage you to further that a doctor carries out during different stages of the
investigate the language by asking you to observe the consultation and the associated communication skills
way it is used in a particular context within your work required. It is derived from the work of S.M. Kurtz,
or study environment. J.D. Silverman and J. Draper:
● Silverman, J.D., Kurtz, S.M. and Draper, J. (2005)
Progress checks: Present you with the opportunity to
reflect on the progress you have made within the unit. Skills for Communicating with Patients. 2nd ed.
Radcliffe Medical Press (Oxford)
Introduction 7

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Introduction to communication
LEARNING OUTCOMES Lead in
At the end of this Communication is not only a basic part of our everyday lives, but an essential
introduction, you will: one, in the sense that we cannot not communicate.
● recognise the different
Thompson (2003)
elements that make up
communication a What do you think the author means by the phrase we cannot not
● understand how good communicate?
communication benefits
the patient interview b Look at these two models of communication.
Transmission model
Interactional model
In the transmission model, the communication process is complete when

a message has been transmitted from the sender to the receiver. In the
interactional model, the communication process is only complete when the
sender receives feedback that the message has been received as intended.
This may take a number of interactions.
Think of an example of communication which follows the

transmission model and one which follows the interactional model.
Discussion: Defining communication

1a Write down a definition of communication and share it with a partner.
b Read the quotation at the top of the next page. How do your definitions
compare with this?
8 Introduction to communication

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[Communication is] social interaction through messages.

Fiske (1990)
2 Fiske (1994) states that:

… communication is too often taken for granted when it should be taken
to pieces.
Breaking down communication allows us to examine the different
components we should consider when we are communicating. While there
are many ways of taking communication to pieces, this course uses five
elements as a means of analysis.
verbal
communication
This jigsaw represents five different components of communication. The

first piece of the jigsaw has been completed. What do you think the other
pieces might be?
Verbal communication
3 Write down at least three factors which make a difference to the way we
communicate with somebody (e.g. the person’s age).
4a Read this extract from a patient interview:

Doctor Do you have any history of cardiac arrest in your family?
Patient No, we’ve never had no trouble with the police.
West and Frankel (1991)
Clearly, the patient has misunderstood the question. Underline the
expression the doctor uses that caused the misunderstanding and
suggest an alternative expression.
b In the example above, what would you suggest that the doctor says next?
Communication Skills
At times, doctors may use phrases that the patient doesn’t understand. It is
important for a doctor to pick up on this quickly and to rephrase things so the
patient can understand. Communication strategies, such as clarifying, help to
maintain communication or prevent communication breakdown.
Introduction to communication 9

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Voice management
5 The way in which we use our voice can also influence the message that we
send, i.e. it’s not just what you say, it’s how you say it. What aspects of
voice can influence the verbal message that we send? Compare your ideas
with the rest of the group.
6 0.1 You are going to hear the same phrase spoken by three different Paralanguage [voice
doctors. Match how each doctor sounds (a–c) to the appropriate doctor management] is very
(1–3). important, as it can add
a bored b friendly c irritable extra meaning to what
is actually being said or
7 0.2 You are now going to hear a doctor ask a patient the same can even contradict or
question twice. Which one sounds more inviting? undermine it.
Thompson (2003)
Non-verbal communication
8 Write down as many ways as you can think of in which we communicate
non-verbally. Compare your examples with a partner.
9 Slight movement (e.g. nodding) is one way we communicate non-

verbally. For each of these pictures (1–8), indicate which of the ways of
communicating non-verbally (a–h) is being used.
3
1
2
4
5
7
6
a touch b eye contact c proximity d environment

e clothing and accessories f facial expression g orientation h posture

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10 Look again at the different forms of non-verbal communication in

Exercise 9. In the context of a medical interview, position them along the
line below in terms of how easy/difficult you think they are for the doctor
to control.
easy difficult
11 Why is it important to observe and respond to

non-verbal cues?
Just as the doctor is observing the patient, the patient will also be watching
the doctor. Posture, eye contact, gestures, as well as words, send messages.
Bickley (2003)
Active listening
12 With a partner, discuss these questions.
1 What is the difference between listening and hearing?
2 What can prevent you from hearing what people are saying?
3 What can prevent you from listening to people?
4 How can you show you are actively listening?
13a 0.3 Listen to a dialogue between a doctor and his patient. What is
wrong with the patient?
b How accurate is the doctor in obtaining information from the patient? How
effective do you think the consultation has been?
Cultural awareness
14a Write down:
1 three elements that make up culture (e.g. history)
2 three distinctive elements of your own culture.
b Compare your findings with a partner.

c Read this definition of culture:
Customs, world view, language, kinship system, social organisation or other
taken-for-granted day-to-day practices of a people which set that group apart as a
distinctive group
Scollon and Scollon (2001)
Think of two cultural factors that doctors, as a professional group, share.

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15a Read this text and decide what kind of cultural background and bias a
doctor, as an individual, might bring to his/her work (e.g. gender).
Cultural awareness means …

… recognising that your beliefs, habits and attitudes are inherently biased and can be puzzling
to others. It also means being tolerant of difference, being flexible and willing to embrace
change. However, cultural awareness does not mean having to leave your personal beliefs
behind. It means realising that language and culture are inextricably linked and, as such, cannot
be separated. Lack of cultural awareness can result in unintentionally offending others.
b Can you think of a situation where your lack of cultural awareness caused
a misunderstanding, in either your personal or professional life? Discuss
with a partner.
16a Read this case study. As you read, circle elements that surprise you or
are different from your way of thinking.
CASE STUDY
A child from the Hmong community (originating in South-East Asia) living in the USA was born with a
clubfoot. Doctors felt that this would not only cause social embarrassment, but also make ambulation
difficult for the child, and so recommended an operation to reshape the foot. However, the family
believed that by ‘fixing’ the foot, it would bring shame and punishment on both the family and the
Hmong community and so refused treatment. The family went to the Supreme Court to defend their
right to refuse treatment.
Adapted from Developing Cultural Self-Awareness in CASAnet Library: Cultural Competency
b Compare your findings with a partner and describe how you as a doctor
might have reacted to this case.
As individuals, we each have our own cultural background and biases.

These do not simply slip away as we become clinicians. It is important
to understand how culture shapes not just the patient’s beliefs and
behaviours, but also our own.
Bickley (2003)
17 Look at the completed jigsaw representing the five

voice
components of communication. Based on what you have management
read, why do you think the ‘cultural awareness’ component
appears in the middle?
verbal cultural non-verbal

communication awareness communication
active
listening

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Benefits of good communication
Communication is not just about being ‘nice’, but produces a more

effective consultation for both patients and doctors … (it) improves
accuracy, efficiency and supportiveness in the consultation.
Silverman, Kurtz and Draper (2005)
18 These outcomes result from good doctor–patient communication. For

each one, indicate whether it contributes to the effectiveness of the
consultation in terms of accuracy (A), efficiency (E) or supportiveness (S).
1 Identify emotional distress in patients and respond accordingly
2 Get the right information from a patient within time constraints
3 Allow patients to express their concerns
4 Get the correct information to make the right diagnosis
5 Have patients who agree with and follow the advice given
Piecing it all together

Verbal, non-verbal communication, listening, voice management and cultural
awareness all play an important part in helping to make communication more
accurate, effective and supportive.
As the course progresses, you will develop a greater awareness of how this
takes place and you will also be able to develop your own skills in these areas.
19 In small groups, discuss which of the five elements of communication you

consider to be:
1 your strength(s)
2 important for you to improve on during this course.

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Contents
Introduction page 6
SECTION 1: INTRODUCTION TO COMMUNICATION

• Recognising the different elements that make up communication page 8
• Understanding how good communication benefits the patient interview
SECTION 2: DEVELOPING LANGUAGE AND COMMUNICATION SKILLS FOR THE PATIENT ENCOUNTER
1 Receiving the • Greeting patients and • Conveying warmth Reading
patient putting them at ease • Formulating the opening • Patient questionnaire
page 14 • Introducing yourself and question Listening
your role • Language for setting the • Presentation: the
• Asking the opening agenda importance of seating
question and setting the • Phrases to facilitate, repeat arrangements
agenda for the interview and clarify • Patients present their
perspective
• Receiving and greeting a
patient
• Asking the opening question
• Setting the agenda for the
interview
2 The presenting • Encouraging patients to • Using exploratory questions Reading
complaint express themselves in their • Adjectives to describe types • Patient-centred approach to
page 22 own words and intensity of pain history-taking
• Taking an accurate history • Patient speak: the suffix Listening
of the presenting complaint –ish • Using exploratory questions
• Asking about the intensity • Patient speak: phrasal verbs • Exploring the presenting
and degree of pain with up complaint
• Using techniques such as • Facilitating the encounter:
facilitation, repetition and voice management
clarification
DVD lesson 1: Patient-centred vs. doctor-centred approach
3 Past medical • Requesting the patient’s • Language to request the Reading
and family past medical history past medical history • Past medical history: the
history • Discussing the family • Patient speak: common components
page 32 medical history expressions to describe • Patient note
• Taking effective notes state of health • Pedigree diagram
during an interview • Expressions for signposting Listening
• Writing an effective patient and summarising • Conference presentation:
note • Standard medical the pitfalls of taking the
• Summarising and abbreviations PMH.
structuring the interview • Taking a past medical
history
• Taking a focused past
medical history
Contents 3

Table of Contents
More information

4 The social • Enquiring about the • Asking about lifestyle and Reading
history and patient’s social history environmental health • Telephone consultations
telephone • Employing good telephone • Language for summarising Listening
consultations etiquette and checking information • University seminar
page 42 • Ensuring an effective • Patient speak: common discussion on taking a
telephone consultation suffixes in medical social history
• Summarising and checking terminology • Asking about occupational
information • Expressions for consulting health
by telephone • Discussing lifestyle and
environmental health
• Carrying out an effective
telephone consultation
5 Examining a • Preparing and reassuring • Indirect language for polite Reading
patient the patient during an instructions, • Techniques of the trade
page 52 examination • Patient speak: verbs and Listening
• Explaining examination prepositions for giving • Giving instructions during a
procedures instructions physical examination
• Giving effective instructions • Effective intonation for
in a patient-friendly manner instructions
• Softener: just
DVD lesson 2: Taking past medical history, family history and carrying out the physical examination
6 Giving results • Explaining results in a • Language for giving a Reading
page 60 way that patients can diagnosis • Jaundice
understand and remember • Phrases used to organise • Acute bronchitis
• Encouraging patients to information • Erythema nodosun
express their fears and • do for emphasis and Listening
concerns confirmation • Explaining test results
• Explaining medical • Word stress for emphasis • Organising information
terminology to a patient • Language for explaining
• Giving a prognosis medical terminology
• Patient speak: colloquial
questions for asking about
prognosis
• Language of probability
7 Planning • Explaining treatments to a • How to negotiate a plan of Reading
treatment and patient action • The New Quit Guide, So You
closing the • Discussing options • Language for making Want to Quit?
interview • Describing benefits and side suggestions Listening
page 69 effects • Phrases to explain • Outlining a treatment plan
• Advising on lifestyle advantages and • Describing possible
• Negotiating treatment disadvantages treatment plans for
• Closing the interview • Patient speak: expressing hypertension
likelihood • Negotiating treatment with
• Language for negotiating the patient
treatment • Advising on lifestyle
changes
8 Dealing with • Broaching sensitive issues • Language to broach Reading
sensitive without bias and remaining sensitive issues • Reading cues
issues non-judgemental • Identifying non-verbal • Letter of referral
page 77 • Reading and responding to patient cues • Questionnaire: Know your
patient cues • Techniques for drink
• Employing question contextualising, reassuring Listening
techniques: CAGE and asking permission • Broaching sensitive issues.
• Writing concise and • Patient speak: drug culture • Discussing sexual and
accurate notes • Ensuring specific and reproductive health
• Updating the patient note concise notes • Asking about alcohol
consumption
4 Contents

Table of Contents
More information

9 Breaking bad • Delivering bad news in a • Patient speak: expressions Reading
news sensitive way showing level of • A time to listen
page 87 • Reassuring a patient or understanding Listening
relative • Softening the question • Breaking bad news
• Showing empathy • Language to deal with • Preparing the patient for
emotions receiving bad news
• Patient speak: talking • Dealing with emotions of
about current knowledge of an HIV patient
condition • Consulting with a relative
• Voice management when by telephone
communicating bad news • Breaking bad news to a
relative
DVD lesson 3: Breaking bad news
SECTION 3: INTERVIEWING DIFFERENT PATIENT CATEGORIES

10 Communicating • Encouraging a withdrawn • Reviewing question types Listening
with patient to speak • Using facilitative language • Receiving an
challenging • Calming an aggressive or • Language to respond to uncommunicative patient
patients angry patient body language • Interviewing an irritated
page 95 • Asserting your role as a • How to validate emotions patient
doctor • Patient speak: expressions • Dealing with a manipulative
to describe different patient
emotional states
DVD lesson 4: Dealing with challenging patients
11 Communicating • Carrying out an effective • Asking questions specific to Reading
with the interview with an elderly the elderly • Talking to the dying patient
elderly patient • Patient speak: collocations Listening
page 102 • Showing sensitivity and to describe conditions • Visualising life as an older
respect to an elderly common in the elderly patient
patient • Language to show • Interviewing an older
• Communicating with sensitivity patient
depressed elderly patients • Techniques for • Interviewing patients with
communicating with sensitivity and respect
patients with hearing • Consulting patients with
problems hearing problems
• Simple choice questions • Student presentation: tool
for assessing the ability to
live independently
• Dealing with a patient with
depression
• Assessing a patient with
mental issues
12 Communicating • Establishing and developing • Compliments for children Reading
with rapport with a child • Expressions to show • Now I feel tall: What a
children and • Reassuring a child empathy with must patient-led NHS feels like
adolescents • Gaining a child’s consent to • Language for reassuring a Listening
page 112 be examined child • Interviewing young children
• Explaining procedures to a • Child-friendly instructions and their parents
child • Patient speak: bodily • Reassuring a young child
• Responding to a child’s functions and body parts • Examining children and
verbal cues • Techniques for giving instructions
• Communicating effectively communicating with • Interviewing an adolescent
with an adolescent adolescents patient
DVD lesson 5: Interviewing young patients and their carers
Role-play and other additional material page 121
Audio scripts page 137
Answer key page 152
Contents 5

Excerpt
More information
Unit 1 Receiving the patient

LEARNING OUTCOMES Lead in
At the end of this unit, As a group, share your thoughts on this quotation from a celebrated
you will be able to: 19th-century physician:
● greet patients and put
them at ease The kindly word, the cheerful greeting, the sympathetic look – these the patient
understands.
● introduce yourself and
William Osler (1849–1919)
your role
● ask the opening
question and set

the agenda for the Putting yourself in the patient’s shoes
interview
1 Prior to a consultation, some patients experience strong feelings of anxiety.
Discuss reasons for this in small groups. Why might patients be even more
anxious when visiting a hospital as opposed to a doctor’s surgery1?
2a Think back to the last time you were a patient and do this questionnaire.
Patient questionnaire
1 How do you feel when you enter a hospital as a patient?
(Circle the best answer.)
Relaxed Apprehensive
Unconcerned Anxious
Relieved Scared
Mildly concerned Other
2 What generally lessens any concerns you may have on entering
a hospital?
(Place in order of importance, 1 = most important)
Administrative staff Nursing staff
Doctor Surroundings
Other
3 Have you ever left a consultation more confused/frustrated than
when you arrived? YES / NO
4 If YES, why?
5 What qualities do you appreciate in a doctor?
The way you greet a

patient can determine
b In small groups, compare your responses and then answer these questions.
the rest of the 1 How might the factors in question 2 of the questionnaire increase or
consultation. decrease patient anxiety? Make a list.
Bickley (2003) 2 How might the age, gender or physical appearance of a new patient
affect a doctor’s relationship with that patient?
1
(US English) doctor’s office
14 Unit 1 Receiving the patient

Excerpt
More information
Think about
… how you would feel about establishing rapport with a patient in English.
3a Take a couple of minutes to think about this and then rate your ability to
do the following from 1 (lacking in confidence) to 5 (highly competent).
1 I can make the patient feel relaxed.
2 I can greet the patient appropriately.
3 I can set the agenda for the interview.
4 I can use an appropriate, welcoming tone of voice.
b Discuss your thoughts with the rest of the group and talk about the
language you would use to do these things.
Establishing initial contact

The setting for the patient encounter is very important.
4a 1.1 You’re going to hear a communications expert talk about the

importance of seating arrangements in a consulting room. Listen and
choose the best seating arrangement: 1, 2 or 3.
1 2 3
b 1.1 Listen again and answer these questions.
1 Why does the expert suggest this arrangement is the best option?
2 According to the expert, how far should you sit from your patient in
the UK?
a 3 feet (1 metre) b 9 feet (3 metres) c 5 feet (1.5 metres)
3 What reason does the expert give for this?
c Discuss these questions with a partner.

1 What do you think about the expert’s suggestion regarding the
distance between doctor and patient during an encounter?
2 Why might a doctor draw his/her chair closer to a patient?
3 What should a doctor consider when interviewing a patient in bed?
Unit 1 Receiving the patient 15

Excerpt
More information
5a 1.2 You are going to hear two patients talking to friends about a
recent encounter with their consultants1. Listen and tick the relevant
column (Competent, Fairly competent or Needs improvement) to show to
what extent the consultants are successful in establishing rapport with
their patients.
Consultant 1 (outpatients) Competent Fairly Needs Examples

competent improvement
1 He was able to make the patient
feel relaxed and comfortable.
2 He was able to greet the patient

appropriately.
3 He was able to use an appropriate,

welcoming tone of voice.
Consultant 2 (ward round)

1 He was able to make the patient
feel relaxed and comfortable.
2 He was able to greet the patient

appropriately.
3 He was able to use an appropriate,

welcoming tone of voice.
b 1.2 Listen again and note examples (positive or negative) in the

fourth column. The initial contact
with the patient sets
c In small groups, compare your findings and compile a list of points for the foundation for
the two consultants about how they could improve their technique. Share the relationship. Be
these with the group. prepared to give your
undivided attention.
Spend enough time
Greeting and putting your patient at ease and energy on your
greeting and the
6 1.3 You are going to hear three doctors welcoming their patients. patient’s response
Where does each take place: in a GP’s surgery, a hospital ward2 or a to achieve a level of
specialist’s office? How do you know? comfort on the part of
the patient.
1
(US English) doctors
Bickley (2003)
2
(US English) hospital department

Excerpt
More information
7a A doctor’s initial contact with a patient should include four main

objectives. Look at these phrases and give each set of objectives a
heading.
Objective 1 Objective 2
• Good morning, [Jenny], come in, take a seat … • I’m a student doctor1 working with Mr
• Good afternoon, Mr [Hanks], isn’t it? [Donaldson].
• Hello, can I just check it’s [Mr Wang]? We’ve not • My name is Dr [da Silva], I’m one of the
met before … registrars2 on the ward this evening.
• [William Denby]? Hello. What would you prefer me • I’m Dr Janowicz. My colleague, Dr [Taylor], has
to call you? asked me to come and see you about …
• Hello, Ms [Kavanagh] … Am I pronouncing it • Dr [Murad] has referred you to me for further

correctly? investigations. My name is Dr Lozano and I’m …
• Hello, I’m Dr [May], the locum with this practice3.
Objective 3 Objective 4
• I’ve come to have a little chat with you about … • If you don’t mind, I’d like to take some notes as
• I’d like to spend five minutes with you to ask we talk.
some questions if that’s OK? • Do you mind if [our student doctor] is present
• I wonder if we can chat for a few minutes during our chat?
about … • If it’s all right with you, I’d like to have a listen
to your heart.
b Compare your ideas with the rest of the group.
8 Look back at the first sentence in Objective 3.

1 What effect might the phrase have a little chat have on the situation?
2 In which situation(s) might you avoid using this verb when greeting
a patient?
9a 1.4 You are going to hear the beginning of a patient encounter. Listen
Communication
and number the objectives in Exercise 7a in the order you hear them. Skills
The following might be
b What else does the doctor do to make the patient comfortable? helpful:
‘I’m Dr [name]. You’ve
10 With a partner, practise greeting and introducing yourself to your
probably noticed I’m
patient.
[nationality], so I
apologise if I have to ask
you to repeat anything.
And please stop me if
1
(US English) medical student there’s anything you don’t
2
(US English) residents understand.’
3
(US English) Dr [May], covering for Dr [Franklin]

Excerpt
More information
Conveying warmth
11a 1.5 You are going to hear two versions of two different patient
encounters. Decide if the doctors sound welcoming or unwelcoming.
Encounter 1 Encounter 2
Version A Version B Version A Version B
welcoming
unwelcoming
b Compare your ideas with a partner. What helps you distinguish between a
welcoming and an unwelcoming voice in English / in your own language?
12a 1.6 Listen to and read these greetings. With a partner, decide what
Cultural awareness
the context is for each one. How do you know?
Eye contact and a smile
1 Good morning, Mr Barker, isn’t it? Your consultant asked me to are generally accepted
come and see you. forms of greeting in the
2 Anya Kaplinski? You’ve come for your six-month check-up, I see. English-speaking world.
3 [patient knocks] Hello? Come in? Sorry for the wait, Miss Staples, What form of non-
we’re running a little late this morning. verbal greeting, if any, is
considered appropriate
4 [doctor enters waiting room] Mrs Khan? in your country?
b Repeat each phrase until you are satisfied that your voice sounds
welcoming and has the right intonation. Your voice should rise on the
underlined words.
c Take turns to read the greetings. Listen and decide if your partner sounds
welcoming or unwelcoming.
13 Role-play these situations with a partner.

Student A: Turn to page 122.
Student B: Turn to page 128.
Think about
… how you would ask the opening question in a patient interview in English.
14a Look at this opening question. Think of two more ways of posing the
opening question. Compare your questions with a partner.
What brings you here today?
b Why is the opening question so important in the patient interview?

Discuss in small groups.
c Would you use these opening questions? Why (not)?

1 So, what’s the problem? 2 What’s up?

Excerpt
More information
Asking the opening question

15a Choose the most appropriate opening question(s) (1–10) for each
scenario (a–e). (There may be more than one answer in each case.)
1 Your GP has explained the situation, but I wonder if you could tell
Scenarios
me in your own words?
a First visit to surgery
2 What would you like to discuss today?
b Hospital round
3 Am I right in thinking you’ve come for baby [Killian’s] routine
check-up? c Follow-up visit
4 How are things with the [new tablets]? d Check-up for
newborn baby
5 What brings you here today?
e Following a referral
6 Has there been any improvement since I saw you last?
7 How are you feeling today?
8 I have your notes from your doctor, but could you tell me what’s
been happening?
9 So, what have you come to see me about today?
10 So, how is [little Rhana] doing?
b Discuss your choices with a partner. Why are some questions more
appropriate than others for each of the scenarios?
16a 1.7 You are going to hear more of the encounter with Mr Mahoney (see
Exercise 11). Listen to the interview and answer these questions.
1 Which opening question does Dr Patel use?
2 What is Mr Mahoney’s presenting complaint?
3 Was Dr Patel’s opening question the most appropriate for this
interview? Why (not)?
b As a group, rewrite Dr Patel’s opening question to ensure a more

appropriate line of questioning.
Am I right in thinking ?
It is easy to assume the
Note that Dr Patel could ask a follow-up question to ensure Mr Mahoney patient has come for
is able to express himself fully: their routine check-up …
Is there anything else you would like to discuss today / while you’re here today? when in fact the patient
Is anything else bothering you at the moment? has a more pressing or at
least a second agenda to
Do you have any other issues you’d like to address today? discuss.
Silverman et al. (2005)

Excerpt
More information
17 Other opening questions might also limit the patient’s contribution. Out & About
Look back at the opening questions in Exercise 15a and circle those which
If you are working in
require a follow-up question.
an English-speaking
environment, listen out
18 Some doctors use body language instead of an opening question.
for the use of opening
Demonstrate to your group how you might open a session using body
questions, as well as
language only. Would this technique be appropriate in your country?
the speaker’s tone of
Would you use this technique? Why (not)?
voice.
Compare your findings
Setting the agenda with the rest of the
The patient’s opening statement is possibly the most important part of the class next time you
interview. meet.
19 Dr Patel refers Mr Mahoney to a consultant, Mr Swift. Read the opening

statement that Mr Mahoney gives to the consultant, underline the
important points and explain your choices to a partner.
Mr Swift I wonder if you could tell me in your own words
what’s been happening.
Mr Mahoney Well, yes, I’m sure you’ve got all this information, but …
my arthritis has been playing me up1 a bit as usual – I’m
having difficulty sleeping and I’m in some pain first thing
in the morning. But it’s the headaches that are really
getting me down, they’re so painful. Sometimes I’ve been
sick2 with them … literally. I’m starting to have time off
work now because of them. My wife’s really worried. She’s
the one that insisted I go see Dr Patel.
20a With a partner, list the benefits of allowing the patient to make an
opening statement.
Examples: Enables doctor to hear patient’s story.
Signals the doctor’s interest in the patient.
b Compare your findings with the rest of the group.
21 1.8 Listen and complete the consultant’s next phrase to set the
agenda for the rest of the interview with Mr Mahoney.
Mr Swift the headaches that are really
bothering you, looking at those.
the arthritis later, if that’s
. Is there you
want to discuss today?
2
(US English) acting up, giving me trouble
2
(US English and UK English) I’ve thrown up, I’ve vomited

Excerpt
More information
Language for setting the agenda

Shall we / Let’s start with [the headaches]?
Shall we start by discussing / looking at [the headaches]?
We’ll come back to [the arthritis] later / after that.
We’ll talk about [the arthritis] later / after that.
If that’s all right / OK with you?
Does that sound all right / OK?
22 With a partner, choose a set of symptoms (a or b) and practise setting

the agenda with the patient.
a Recurrent headaches, ingrown toenail
b Eczema, diarrhoea1
Piecing it all together

23a Choose one of the situations from Exercise 13 and role-play the first part
of the encounter with your partner.
Student A: Turn to page 123.
Student B: Turn to page 129.
b Swap roles. Choose a different situation and role-play the first part of the
encounter as before.
Progress check
Complete the Progress check for this unit.
(1 = I need more work on this, 5 = I feel confident in this area)
Greeting the patient appropriately by:
– introducing myself and explaining my role 1 2 3 4 5
– obtaining the patient’s preferred form of address 1 2 3 4 5
Establishing rapport by:
– using a welcoming tone of voice 1 2 3 4 5
– making the patient feel relaxed 1 2 3 4 5
– using appropriate eye contact 1 2 3 4 5
Posing an opening question that is suitable for the
encounter 1 2 3 4 5
Setting the agenda for the interview 1 2 3 4 5
1
(US English) diarrhea

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Cambridge University Press

© Cambridge University Press www.cambridge.org

CAMBRIDGE UNIVERSITY PRESS

© Cambridge University Press 2008

This publication is in copyright. Subject to statutory exception

First published 2008

Printed in Italy by Printer Trento Srl

ISBN 978-0-521-75590-0 Student’s Book

© Cambridge University Press www.cambridge.org

SECTION 1: INTRODUCTION TO COMMUNICATION

© Cambridge University Press www.cambridge.org

Unit Communication skills Language focus Texts

© Cambridge University Press www.cambridge.org

Unit Communication skills Language focus Texts

SECTION 3: INTERVIEWING DIFFERENT PATIENT CATEGORIES

© Cambridge University Press www.cambridge.org

strategies to repair or avoid possible breakdown in

© Cambridge University Press www.cambridge.org

© Cambridge University Press www.cambridge.org

In the transmission model, the communication process is complete when

Think of an example of communication which follows the

Discussion: Deﬁning communication

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[Communication is] social interaction through messages.

2 Fiske (1994) states that:

This jigsaw represents ﬁve different components of communication. The

4a Read this extract from a patient interview:

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9 Slight movement (e.g. nodding) is one way we communicate non-

a touch b eye contact c proximity d environment

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10 Look again at the different forms of non-verbal communication in

11 Why is it important to observe and respond to

b Compare your ﬁndings with a partner.

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Cultural awareness means …

As individuals, we each have our own cultural background and biases.

17 Look at the completed jigsaw representing the ﬁve

verbal cultural non-verbal

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Beneﬁts of good communication

Communication is not just about being ‘nice’, but produces a more

18 These outcomes result from good doctor–patient communication. For

Piecing it all together

19 In small groups, discuss which of the ﬁve elements of communication you

© Cambridge University Press www.cambridge.org

SECTION 1: INTRODUCTION TO COMMUNICATION

© Cambridge University Press www.cambridge.org

Unit Communication skills Language focus Texts

© Cambridge University Press www.cambridge.org

Unit Communication skills Language focus Texts

SECTION 3: INTERVIEWING DIFFERENT PATIENT CATEGORIES

© Cambridge University Press www.cambridge.org

Unit 1 Receiving the patient

question and set

The way you greet a

14 Unit 1 Receiving the patient

© Cambridge University Press www.cambridge.org

Establishing initial contact

4a 1.1 You’re going to hear a communications expert talk about the

b 1.1 Listen again and answer these questions.

c Discuss these questions with a partner.

Unit 1 Receiving the patient 15

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Good Practice Student's Book

Good Practice Student's Book