TRAVELLING THROUGH ENGLISH FOR MEDICINE

Stages for Doctor- patient medical interview.

I- Greeting the patient.

II- History taking.

III- Clinical examination.

IV- Discussing patient’s problem with him/her.

V- Management.

VI- Conclusion.

Functions and examples for the stages.

I- Greeting the patient (good morning, good afternoon, )

II- Interviewing the patient. (history taking)

To inquire about:

 Chief complaint
 Site of pain
 Radiation
 Character of pain
 Severity of pain
 Time of onset
 Type of onset
 Duration
 Accompanying symptoms

Flashing lights.

Interrogative words are of key importance when taking the patient’s history
looking for information.

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What (generally used for things but can also be used for persons).

 Doctor: What is your chief complaint?

 Patient: I have a terrible headache.

 Doctor: What is your name?

 Patient: My name is Richard.

What is also used to ask about the description of someone or something.

 Resident: What is the patient like?

 Intern: The patient seems to be reliable.

 Doctor: What is the pain like?

 Patient: It is like a heavy pressure.

 Doctor: What kind of pain is it?

 Patient: It is like a heavy pressure.

Where (to ask about place/ location/ site)

 Doctor: Where exactly is your headache?

 Patient: It is in my forehead.

When (to ask about time/ onset/ beginning)

 Doctor: When did the pain begin?

 Patient: The pain began 2 hours ago.

How (to ask about the way)

 Doctor: How did the pain appear?

 Patient: It appeared gradually.
 Doctor: How bad is it?
 Patient: It is terrible.

Why (to ask for reasons)

 Doctor: Why did you come to the clinic?

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  Patient:I came to the clinic because I have a terrible headache.

Who (to ask for persons)

 Who did you see in the clinic?

 I saw the doctor.

Asking for much specific information.

History Taking

Doctors when taking a history very often begin inquiring about:

-Chief complaint:

 What seems to be the trouble?

 What’s been bothering you most?
 What brings you to the doctor today?
 What’s your number one complaint?
 What’s your main problem you wanted to see me about?

If the patient does not provide all the information the doctor needs.
More specific questions should be asked.

 Site Where is it? Show me where the pain is:

 Radiation Does it move? Does it go anywhere else?
 Character What is it like? What kind of pain is it?
 Severity How bad is it? What do you do when it comes on?
 Time of onset When did you first notice it?
 Type of onset did it come on suddenly or gradually?
 Duration How long does it last?
 Frequency How often do you get it?
 Progress Has it changed in any way? Is it getting better, worse?
 Times of When do you get it? Do you get it at any special time?
occurrence
 Precipitating Have you noticed anything that brings it on?
factors
 Aggravating Have you noticed anything that makes it worse?
factors
 Relieving Have you noticed anything that makes it better?
factors

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  Accompanying Do you get any other symptom with it?
Symptoms
 Past medical history Have you had any other medical problem before?
 Toxic habits Do you smoke? Do you drink alcohol/ coffee?
 Family history Has anyone in your family had /suffered from ?

Sometimes much more specific questions may be needed. They require the use of
auxiliaries in different tenses.

-(Yes/ No questions).

 Interrogative statements with BE in present.

He
Is She ... ?
it

Is Peter sick?/ Yes, he is./ No, he isn’t.

Is Mary a doctor? /Yes, she is/ No, she isn’t.
Is it painful? / Yes, it is/ No, it isn’t.
Is my problem serious?/ Yes, it is./ No, it isn’t.

You
Are They ... ?
we

Are you a surgeon? / Yes, I am/ No, I am not.

Are you married?/ Yes, I am/ No, I am not.
Are you surgeons? / Yes, we are/ No, we aren’t.
Are they medical students? / Yes, they are/ No, they aren’t.

Am I ...?

Am I sick doctor? / Yes, you are/ No, you aren’t.

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  Interrogative statements with BE in past.

I
Was He ... ?
She
it

Was I unconscious? /Yes, you were/ No, you weren’t.

Was she at the hospital yesterday / Yes, she was/ No, she wasn’t.
Was it painful? / Yes, it was/ no, it wasn’t.

We
Were You ... ?
they
Were you on duty yesterday? / Yes, I was/ No, I wasn’t.
Were you at the hospital yesterday? / Yes, we were/ No, we weren’t.
Were your periods regular? / Yes, they were/ no, they weren’t.

 Interrogative statements with Do and Does. (Simple present tense).

I
Do We ... ?
You
they

Do you study medicine? / Yes, I do/ No, I don’t.

Do you smoke or drink alcohol?/ Yes, I do/ No, I don’t.
Do they work in the hospital? / Yes, they do/ No, they don’t.

She
Does He ...?
it

Does she have pain? / Yes, she does/ No, she doesn’t.
Does he smoke? / Yes, he does/ No, he doesn’t.
Does it hurt? / Yes, it does/ No, it doesn’t.

 Interrogative statements with Did. ( past tense).

Did → I, you, he, she, it, we, they.

Did she have any other symptoms? / Yes, she did/ No, she didn’t.

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More specific questions related to:
 Character Is it sharp or dull?
 Severity Do you have to stop what you are doing?
 Times of Does it come on before or after meals?
occurrence
 Precipitating Can you eat fatty food, fish and chips, for example?
factors
 Aggravating Do you have any trouble climbing stairs?
factors
 Relieving Does milk relieve it?
factors
 Accompanying Do you vomit?
Symptoms

(Other possibilities should be included depending on the disease the patient may be
suffering from at the moment).

III- Examining the patient. (Does it hurt when I press here? And down here?
Have you had any pain in this area? Have you had any discharge of the nipple?

Giving instructions. (breathe in, breathe out, say 99, open your mouth).

IV- Reassuring the patient, giving opinions, giving advice.(calm down, take it
easy, everything’s going to be fine/ I think you should give up smoking/ You
shouldn’t drink alcohol or coffee).

V- Prescribing medications, ordering investigations. (take an aspirin every 8

hours if fever/ I am going to order some investigations to determine the real
cause of your problem).

VI- Making appointments, giving instructions, reassuring the patient.

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 Doctor- Doctor Discussion.

Questions used during doctor- doctor discussion.

-You say you have a new case?
-Do you have a new case?
-Do you have any cases you would like to present/ discuss?
-Is there any cases you would like to discuss?
-What is your case about?
-Tell me what you know about the case.
-Has she/he had other symptoms?
-What other symptoms has she/he had?
-Was there any precipitating factor?
-What did you find on the physical/ physical exam/ examination?
-What did the physical exam reveal/ show?
-Were there any significant physical findings?
-What about the laboratory report?
-What kind of investigations did you order?
-What laboratory studies or diagnostic procedures would you perform on this patient?
-What did the investigations reveal/ show?
-What were the results of the investigations you performed?
-What is your presumptive diagnosis?
-What is your diagnostic impression?
-What do you think she/he has had?
-What is the most likely diagnosis for this case?
-What is your treatment/plan for this patient?
-What kind of medication did you use?
-What is the management for this case?
-How did you manage this patient?
-What conditions would you think of in ruling out a/an ?
-What conditions would you consider in a differential diagnosis?
-How did you make the differential diagnosis?
-How is/was the differential diagnosis made?
-What kind of complications may the patient have?
-What are the most common complications in this case?
-What complications will you be looking for during the recovery period?
-What is your prognosis for this case?

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 CLINICAL HEALTH HISTORY/ CASE HISTORY FORM.

Surname: First Name:

Age: Sex: Marital Status:

Occupation:

Present Complaint:
O/E:
General condition:
ENT:
RS:
CVS:
GIS:
GUS:
CNS:
Musculoskeletal System:

Endocrine System:

Ciculatory System :

Imediate Past History:

Points of notes:

Investigations:

Management:

_______________________________________________________________________
____________

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Symbols and Abbreviations.
Time 1/7 days (one day of the week) There are seven days in a week.
1/52 weeks (one week of the year) there are 52 weeks in a year.
1/12 months (one month of the year) there are 12 months in a year.
↑ Raised
Elevated
Enlarged
Increased

↓ Decreased
Down
Worse
Low
C/O- Complaining of
C- With, (in association with/ associated with)
+ - and, plus.
+++- severely, greatly
O/E- On examination
PMH- Past medical history
SH- Social history
FH- Family history
Ix- Investigations.
∆/ Dx- Diagnosis.
DDx- Differential diagnosis.
Rx- Treatment
Px- Prognosis.
CXR- chest x-ray
ECG/ EKG- electrocardiogram
HBP- high blood pressure
Hb/ Hgb- hemoglobin
HS- heart sounds
Abd- abdomen
?- possibly
<- less than
>- more/ greater than
=- equal
- minus
x- multiplied by/ ÷ divided by
GP- General practitioner
Doctor home office
General Comprehensive Medicine
F- female/ M- male
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 Steps used for reporting cases

1. Introduction.
2. History of present illness.
3. Past medical history
4. Habits.
5. Family History.
6. Findings on the physical examination.
7. Investigations.
8. Differential Diagnosis.
9. Diagnosis.
10. Management.
11. Complications.
12. Prognosis.

 When reporting cases we have to center the attention to important grammatical and
linguistic elements such as: present, past and perfect tenses, the use of the passive
voice, regular and irregular verbs, linking words used to give coherence and
cohesion, elements of puntuation mark (language discourse markers), etc.

I-Introduction ( patient`s general data).

Present tense.
Eg: -John Green is a 59- year- old carpenter...
- This case is about a 59- year- old carpenter...
II- History of present illness( chief complaint and accompanying
symptoms)
b) Simple present tense when describing pains.
c) Past simple.
d) Passive voice.
e) Perfect tenses.
Eg: - who came to the hospital complaining of a terrible pain in the center of the chest
that radiates to his neck and left arm. The pain is like a heavy pressure. It started 30 minutes ago
while he was walking up stairs and lasted 15 minutes. It was accompanied by cold sweat. ( He
has also had cold sweat) .The patient got a relief with rest.

III- Past medical history ( patient’s previous history/ disease/ medical problem).
- Present tense.
Eg: There is a past medical history of pneumonia

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 -Past tense.
Eg : He had pneumonia two months ago.
-Past perfect tense.
Eg :- The patient had had pneumonia.
- He had suffered from pneumonia.

IV-Social history( toxic habits / psychological factors).

Toxic habits: generally in present tense.
Eg: He is a heavy smoker.

Psychological factors( past and perfect tenses).

Eg: - He had a terrible argument with his boss.
- He has had problems at work.

V- Family history.
- Simple present.
Eg: -There is a positive family history of heart diseases.
-Simple past.
Eg : His mother died of a heart attack..

VI- Findings on examination.

-Past tense.
Eg: There was nothing remarkable on examination except obesity.

VII-Investigations.
-Past simple / Passive voice.
There was nothing remarkable on examination except ,obesity.The chest x- ray and the
EKG were normal.

VII-Differential diagnosis.
-Passive voice.
Eg: The differential diagnosis was made with disecting aneurysm, myocardial infarction,
pulmonary embolus and acute pericarditis.

IX- Diagnosis.
- Present / Past tenses/ Pasive voice.
Eg: -The most likely diagnosis is angina pectoris.
-The most likely diagnosis was angina pectoris.
- A diagnosis of angina was confirmed.

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 X- Management / Treatment.
- Passive voice / Present / Past tenses.
Eg: The patient should be treated with nitroglycerine and morphine to relieve the pain,
oxygen by face mask and was ordered rest in bed / The treatment includes nitroglycerine
and morphine to relieve the pain, oxygen by face mask and bed rest.

XI- Complications( generally in present tense).

Congestive heart failure; pulmonary embolus, secondary to phlebitis of the leg;
arrhythmias; cerebrovascular accident; rupture of the heart and ; shock
are some of the most common complications that may appear in this case.

The most frequent complications in this case are ...

XII- Prognosis.
- Present tense.
Eg: The prognosis is favourable if the patient follows the treatment plan.

Useful expressions for reporting cases.

 Different data about the patient(general information)
- name -age - sex - occupation
 Chief complaint (presenting symptoms)
 Site( be): It’s in the center of the chest.
 Radiation: The pain migrates/ moves/ goes to...
 Character: It’s a sharp/ dull pain / like a heavy pressure/ like something heavy
pressing ...
 Severity: It’s a very bad/ terrible pain.
 Time of onset: It started/ began/ first appeared...
 Type of onset: It appears/comeson gradually.
-It suddenly appears.
 Duration: It last/ lasted an hour.
 Frequency: It appears every two hours.
 Progress: The pain has been more frequent lately.
Increasing its frequency lately.
Being more frequent lately.
 Precipitating factors:The pain often appears after drinking
coffee/after eating fatty/greasymeals.
 Times of Occurence: It occurs at any time of the day.
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 Aggravating factors: The pain gets worse/increases/ exacerbates on exertion.
 The patient feels worse/ aggravates after making any kind of physical effort.
 Relieving factors: The pain gets better when leaning forward.
- The patient feels a relief when he rests.
- The pain relieves/ alleviates with rest.
- Aspirin allays/eases the pain.
 Accompanying symptoms: This pain is associated with / accompanied by...
 Past history: There is a positive past history of....
- There is a previous history of...
- The patient was in good health prior to this.
 Family hitory: There is a positive family history of...
- The patient’s father/ mother suffered from.../ is alive/dead / died of...
 Social history(habits): The patient smokes/ drinks/ doesn’t drink/ ( used to
smoke/ gave up smoking).
 Physical Exam(O /E): There was nothing relevant/ remarkable except...
 History of Present Ilness: He has been suffering from...
 Lab Test/ Investigations: Different investigations / lab tests were ordered. The
ECG revealed / showed...
-The x- ray disclosed ...
- The ECG and x- ray were normal.
 Diagnosis: The most likely diagnosis is...
- The diagnosis was ...
- A diagnosis of ... was made/ established / confirmed.
 Management: Different medications were ordered / prescribed.
- The patient was put on antibiotics.
- The management included pharmacological and non-
pharmacological treatment.
- The treatment consists of ...
- The patient was treated with ...
- The patient was prescribed ...
 Prognosis: Good guarded poor
Favourable doubtful grim
uncertain bad
bleak
gloomy

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Common verbs and compound verbal forms used in the different steps when
reporting together with prepositions if they are needed.

Present Past past participle preposition Step for

used reporting cases.
BE (is,are,am) BE (was,were) Been patient’s general
data/ FH/ PMH/
∆/ DDx.
Complain complained complained Complain of Chief complaint.
radiate radiated radiated radiate to Radiation of the
pain.
go went gone go to Radiation of the
pain.
move moved moved move to Radiation of the
pain.
accompany accompanied accompanied Accompanied by Accompanying
symptoms/ other
symptoms.
last lasted lasted duration
associate associated associated Associated with Accompanying
symptoms/ other
symptoms
start started started Onset
begin began begun Onset
appear appeared appeared Onset
have had had PMH
suffer suffered suffered Suffered from PMH/ HPI
Get better Got better Gotten better Relieving factor/
alleviating factor.
Get worse Got worse Got worse Aggravating
factor.
treat treated treated Treated with Rx
make made made Made with DDx/ Dx
die died died Died of FH
reveal revealed revealed Physical exam/
Ix
show showed showed Physical exam/
Ix
confirm confirmed confirmed Dx
disclose disclosed disclosed Physical findings.
relieve relieved relieved Relieved with Relieving factor.

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alleviate alleviated alleviated Alleviated with Relieving factor
order ordered ordered Ix
prescribe prescribed prescribed Rx
come came came Chief complaint
include included included Rx
consist consisted consisted Consisted of Rx
find found found Physical exam.
notice noticed noticed HPI
avoid avoided avoided Rx

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