Speaking
Introduction
Good morning, Mr/Mrs. X! I am Dr Hutahaean.
- What brings you along here today?
- What’s brought you along today?
- What can I do for you today?
- How can I help you today?
- What seems to be the problem?
- What seems to be the trouble?
- What seems to be bothering you?
- It’s alright, I am here to help you.
Duration
- When did it start?
- Can you tell me exactly when it started?
- When did it first start?
- When did it happen?
- How long have you had it?
- How long have you been suffering from this problem?
- How long have you been feeling like this?
- How long has it been bothering you?
- How long has she/he been like this?
- When did she/he start complaining about these symptoms?
- When did she/he start showing these symptoms?
- When were you first diagnosed with hypertension?
- When do you get it?
- How long have you had the cough?
- How long have you had the pain?
- How long have you been suffering from Diabetes?
Details on what happened
- Can you describe it to me?
- Can you describe how she fell?
- How did it happen?
- Tell me what happened?
- Can you describe what happened?
Location
- Where does it hurt?
- Can you tell me where the pain is?
- Can you tell me where it hurts?
- Where do you feel sore?
- Where does it feel sore?
- Tell me where the pain is?
- Show me where the pain is!
- Which part of your body is affected?
- Can you show me where the pain occurs?
- Is it painful for you?
The quality
- Is the pain dull or sharp?
- What is the pain like?
- What kind of pain is it?
- Can you describe the pain to me?
- How severe is the pain?
- Is it continuous or does it come and go?
- Does it occur all the time or just now and again?
- Does it feel numb at night?
- Does it wake you at night?
- Does it affect your work?
- Did it come on suddenly or gradually?
- Does anything special bring it on?
- What seems to bring it on?
- Does anything make it better / worse?
- Is there anything that makes it better/worse?
- Does anything relieve it?
- Does it come on at any particular time?
- Does it spread to anywhere else in your body?
- Apart from what you’ve told me, do you have any other symptoms?
Other Symptoms
- Do you have any other symptoms?
- Apart from your ( headaches ), are there any other symptoms?
- How about ( a cough, a runny nose, vomiting, swelling, pain ,etc)?
- Do you have ( a cough, a fever , etc )?
- Do you also suffer from (a runny nose, etc )?
- Has he developed ( a cough, a fever , etc )?
- Are there any signs of ( a fever, etc)?
Medication
- Have you done anything about this?
- Have you taken anything for it?
- What have you done about this problem?
- Did you take any painkillers?
- Did you put (a cold pack) on it?
- Did you give him Panadol for his fever?
- How often do you give him Paracetamol?
- How often have you been giving him Paracetamol?
- Did it help?
- How often do you take the tablets?
Habit/Lifestyle
- Do you smoke?
- Do you smoke much ( a lot )?
- When did you start smoking?
- How many cigarettes do you smoke everyday?
- Have you ever considered stopping smoking?
- Have you ever considered giving up cigarettes?
- Have you ever thought about quitting?
- Have you ever tried to quit?
- Do you drink alcohol?
- How often do you drink alcohol?
- Do you exercise regularly?
- How often do you exercise?
- Do you get much exercise?
- How much exercise do you do?
- What kind of exercise do you do?
- Do you live alone?
- Are you under any stress at work?
- Are you stressed at work?
- What is your height? And your weight?
Medical History
- Can you tell me about your medical history?
( including : surgery, allergies, medication, other particular diseases)
- How have you been keeping up to now?
- Are you on any medication?
- What tablets do you take for your ( blood pressure, Diabetes, etc)?
- How often do you take the medication ( the tablets )?
- Is his/her immunization up to date?
- Are her immunizations up to date?
- Is she up to date with her immunizations?
- Do you have any other particular problems that I should know about?
- Do you have any other problems that I should know about?
- Have you had an operation before?
- Have you had an accident recently?
- Have you ever been admitted to hospital?
- Has there been any change in your health since your last visit?
- Have you ever experienced ( had ) anything like this
( headaches, sore throat, etc ) before?
- Have you ever checked up on your general health?
Family’s Medical History
Can we talk for a minute about your family?
- Has anyone in your family suffered from any particular diseases?
- Does anyone in your family suffer from the same problem?
- Are your parents alive and healthy?
- How old are they?
- How about your siblings?
- What did he/she die of?
Examinations
- I”ll need ( I’m just going )to examine you, will you come over the bed ( the couch ) , please?
- I”ll need to examine him/her, will you put him/her on the bed ( the couch ), please?
- I’m just going to ( test your reflexes ).
- I’d just like to examine ( your mouth, his eyes, etc).
- Now, I’m going to ( tap your arm ).
- I’ll just check your ( blood pressure, pulse rate, etc ).
- Would you strip to the waist, please?
- Can you put your hands on your hips?
- Could you ( bend down and touch your toes )?
- Now, I just want to see you ( walking, etc ).
- Lift it up as far as you can go, will you?
- Let me see you (standing)!
- Will you hop up on the bed, please?
- Can you look at the ceiling, please? I need to examine at your conjunctiva!
- I’ll have a look at you, will you hop up on the bed, please?
- Take your top off and slip your trousers down, please!
Other Examinations
- I need to order some blood tests to confirm my diagnosis and exclude other possible diagnoses. How does it sound to you?
- I need to order blood tests to check on your general health.
- I need to send you to the radiology department to have an x-ray done. Is that alright with you?
Explanation of the findings
- Your temperature (your pulse rate) is within the normal range.
- Your blood pressure is ….. over ……
- Your lungs (your heart sounds) sound normal.
- From the physical examination findings and from your description, I’d say you have (a cold, conjunctivitis, bilateral cataracts, etc).
- After examining him and from your description, I’d say he has (diarrhea, croup, greenstick fracture, etc).
- You have diarrhea and you are a little bit dehydrated.
- I think you are anemic.
- I found a wheezing sound in your lungs.
Explain the disease/the condition
- ( Diarrhea, Influenza, etc ) is a common disease in ( children, people, men, etc ).
- It is a common condition in newborn.
- It is an infection caused by ( a virus, a bacteria, a parasite, etc ).
- …. It causes your symptoms
- Most children suffer from this mild reaction.
- That’s why you can not (see clearly, breath well, etc).
- The good news is it is a self limiting disease so it does not need any special treatment.
- I have to put him/her on a course of antibiotics.
- I will prescribe medication but first of all I want to talk to you about some lifestyle changes that you should make.
- I will prescribe antibiotics to clear up the infection.
- I will write ( give ) you a prescription for antibiotics and symptomatic drugs
- You do not need to worry, it will resolve itself in (two, three, etc) days.
- Don’t worry, It won’t develop into ( epilepsy, cancer, glaucoma, etc ).
- You won’t become blind.
- You won’t become addicted to it.
- Unfortunately, there is chance that your weight will balloon again.
- You just won’t be able to breathe easily.
- You are more susceptible to other diseases.
- You are prone to other disease.
- I am afraid that ( the operation has not been successful ).
- I am sorry to have to tell you that ( your son has bone cancer, your father has little chance of recovery ).
- I won’t give you any medication for that because it will resolve ( clear up ) itself.
- If the temperature rises quickly, ….
- This condition is irreversible but we can stop the progression by smoking cessation.
- Look on the bright side.
- You have to go cold turkey.
Giving advice
- I recommend that you (take your tablets regularly, eat more nutritious food, quit smoking, etc).
- It will be better for you if you go back to doing some exercise.
- I strongly suggest that you start exercising regularly.
- I strongly suggest you start a diet.
- Let me make a suggestion. Why don’t you try to (stop smoking, cut down your fatty foods, etc).
- You really need to try to change your eating habits.
- Avoid ( smoking situations, substituting alcohol for cigarettes, etc ).
- I think it will be helpful if you ( stay at his bed side, etc ).
- It would be best if he rests.
- I advise you continue breastfeeding him.
- Try to (give him/her sips of fluid, etc).
- Try to keep your leg elevated.
- Give him/her (soft food after 24 hours, etc).
- It’s better to (give him/her plenty of fluid, etc).
- Make sure you (you give him/her the full course of antibiotics, etc).
- You should/must (give him/her Gastrolyte whenever he passes a stool, etc ).
- We will do it ( take )one step at a time.
- If you bandage/ dress it properly, there shouldn’t be any problem.
- You won’t become addicted.
- It will not affect your vision.
- I don’t recommend you do that.
- You will have to cut down on fatty foods.
- Well, I see your point but…..
- Yes, but you must start to….
- I ‘m trying to suggest what is best for you.
- I’m sure that you do not need to worry about that.
- If you don’t follow this advice, you’ll end up far worse and you’ll have to be admitted to hospital.
- I have to refer you to the…..specialist.
- I will write a referral letter to the…..specialist.
- If he does not settle in 3 days, please come and see me again.
- If you are not improving in 5 days, please come and see me.
- If it doesn’t clear up, please come and see me again.
- If he has difficulty in breathing, seek help.
- If there is no improvement in 3 days, you can come and see me again.
- Do you have any questions to ask me?
- Do you have anything to ask me?
- Any question at all?
- We can consider getting rid of ( removing ) the tonsils if……
- It will depend on what the findings of the orthopedic surgeon are.
- This is your prescription, your referral, your pathology slip and your radiology slip. Please make an appointment to see me in 2 days so I can review your condition and your results.
- I will give you a certificate to stay home for 3 days.
- It was nice meeting you. Bye.
- If you have private medical insurance you will probably have the operation within 12 months or you can go to a public hospital and be put on the waiting list.
- If you take out private medical insurance, you will be able to have the operation in 12 months time, but if you get put on the public hospital waiting list , it could be 2 years or more , before you finally have the operation.
- Elevate your leg on another chair.
- Don’t put any weight on your leg.
- You have to refrain from sporting activities 3 weeks after you recover.
- I’ll get the ball rolling.
- It’s probably better if you take ( have ) a holiday so you can contemplate what you might like to do in your future.
- You will need to have strong motivation to do that.
- I could refer you to weight watchers where you can support and encourage one another to lose weight.
Reassuring
- Mm, I can understand how you feel …………
- Yes, you must be very worried ………..
- I can understand your concern ……….
- Yes, that’s understandable …..
- It’s quite natural to be worried about that ………..
- Yes, people often get anxious about that ……….
BUT
- I’m sure we can sort this problem out.
- Please try not to worry about that.
- He’s in good hands.
- He needs your support.
- Let’s try to work together to solve this problem.
- I’m sure we’ll soon see an improvement.
Dealing with patients who are upset/ angry
- I understand that you are upset but please try to remain calm.
- This must be a very difficult time for you.
- I can see that you are upset. Why don’t you tell me what’s troubling you?
- Please tell me what’s wrong and I ‘ll see what I can do to help.
- I’m sorry you feel that way, but there is really nothing more I can do.
- It’s perfectly natural for you to feel angry about this, but….
- Rephrase the patient’s statement e.q. :
Patient : “ I insist you let me see my child immediately.”
Health professional : “ So, you would like to see your daughter as soon as possible.”
Cardio + HT
- Do you ever have palpitations?
- Do you ever have any chest pain?
- Are you aware of your heart beating fast?
- When do you get your chest pain?
- Does the chest pain occur more commonly when you are sitting in a chair or when you are walking?
- Have you noticed that it is accompanied by anything else?
- What do you do when you get your chest pain?
- Does position make any difference to your chest pain?
- Do you ever get chest pain at night?
- If you take a tablet how quickly does this help relieve the chest pain?
- Does it spread anywhere else in your body?
- Do you ever become dizzy?
- Have you ever fainted?
- Before you actually faint, are you aware that you are about to faint?
- Do you actually fall to the ground?
- When you feel faint, are you able to steady yourself against the wall or an object?
- Do you sometimes feel faint when you get up from a chair or out of a hot bath?
- If you have palpitations, how would you first become aware of them?
- Does it come on gradually or in some either way?
- Are there any other symptoms that you notice when you have palpitations?
- When your heart is beating fast, can you tell me whether it is beating regularly or irregularly?
- How long have your ankles been swollen?
- Are they swollen first thing in the morning?
- How far can you walk?
- Can you walk as far as you could five years ago?
- How many flights of stairs can you climb?
- If you have a fainting episode, can you describe the sequences of the events leading up to it?
- How long have you been suffering from hypertension?
- When were you first diagnosed with hypertension?
- What do you take for your hypertension?
- How often do you take the tablets?
- What was your latest blood pressure?
- What was your highest blood pressure?
- Do you have headaches in the morning?
- Do you suffer from shortness of breath?
- When do you usually get it?
- Didn’t you know that you have hypertension?
Cough
- Do you have a cough?
- Do you suffer from a cough?
- Have you a cough?
- How long have you had a cough?
- What kind of cough is it?
- Can you describe the cough to me?
- Do you bring anything up?
- Do you bring up any phlegm?
- Can you describe the phlegm to me?
- Is it frothy, watery or….?
- What color is the phlegm?
- Have you noticed any blood in your phlegm?
- Is there a lot of blood or just streaky with blood?
- Is it like a dog barking or like a whooping cough?
- How much do you bring up?
- Does anything special bring it on?
- When do you usually get it?
- Does any position make it worse?
- Do you get a pain in your chest when you cough?
- Are you wheezing?
- Have you been wheezing?
Skin
- Do you have any problems with your skin?
- Have you ever had a skin rash?
- Any itching of the skin?
- Are you using anything on your skin?
- Do you feel itchy?
- What medication are you using?
- Do you use sunscreen, sunglasses, long sleeves, hat,, if you go out in the sun?
- Can you describe the lump to me?
- Have you noticed any change in the color, the shape, the size, the surface of the lump or the mole?
- Does it itch or bleed?
Fever
- Do you have a fever?
- Have you a fever?
- Have you developed a fever?
- Did you measure the temperature?
- How did you do that?
- What was your last temp?
- What was his temp?
- Did you sponge him/her?
- Did you give him/her Paracetamol?
- Did you sponge him?
- Does he sweat, chill or convulse?
- When did the fit start?
- How many times did he have the fit?
- Can you describe the convulsion to me?
- Has he ever had convulsions before?
- Has he ever convulsed before?
- What did you do when he convulsed?
How long did he convulse?
- Can you describe how he/she convulsed?
- Do you lose consciousness when you convulse?
- Have you noticed any urine loss when he is convulsing?
Diarrhea
- Do you suffer from diarrhea?
- How long have you had it?
- How long have you been suffering from diarrhea?
- Can you describe the stools to me?
- How many times have you been to the toilet?
- How often do you have bowel motions in a day?
- How many times a day do you have a bowel motion?
- How often do you change his/her nappy in a day?
- Have you noticed any mucus or any blood in the stools?
- Is it mushy and greasy?
- Do you have a problem with flatulence?
- What did you have to eat before you have diarrhea?
- What seems to bring it on?
- Can you think of anything special brings it on?
- Are you always thirsty?
- Do you pass urine frequently?
Vomit
- Do you vomit?
- Do you throw up?
- How often do you vomit in a day?
- How many times have you vomited?
- Can he/she eat or swallow anything?
- Can you keep the food down?
- How about nausea, flatulence or bloating?
- Have you been vomiting?
Vision
- Do you suffer from blurred vision?
- How long have you been suffering from blurred vision?
- Do you have any problems with reading, watching TV, driving at night?
- Do bright lights bother you?
- Have you noticed any discharge from your eyes?
- Is it a pus or bloody discharge?
- Is the discharge pus or blood?
- Do your eyes feel gritty?
- Do your eyes feel itchy at all?
- Have you ever injured your eyes?
- Have you had an operation on your eyes before?
- Have you had an eye operation before?
- Have you noticed any floaters?
Passing Water
- Do you have problems in passing water?
- Have you any trouble with passing water?
- Do you feel pain when you pass water?
- Is there a burning sensation?
- Is it burning in the beginning, middle or the end of urination?
- Is the difficulty when you start passing water, throughout or afterwards?
- Do you feel relief after you pass water?
- Is it a normal flow when you pass water?
- Have you a weak stream?
- Have you noticed any blood or stones in your urine?
- Do you wake up at night and feel the urgent need to urinate but then only pass a small amount of urine?
Pregnancy
- Is this your first pregnancy?
- How many children do you have?
- How old are you?
- How long did your pregnancy last?
- Have you delivered your baby early ( at full term )?
- How far into the pregnancy were you?
- What weeks are you in?
- How far along are you?
- Have you tested with pregnancy kit?
- Did you have any trouble during your pregnancy such as raised blood pressure?
- Was labor induced or did it start by itself?
- How long were you in labor?
- Did you have a normal delivery /forceps or caesarian operation?
- Have you had any miscarriages?
- Have you had any abortions?
- At what stage of pregnancy were they?
- Did the obstretician tell you the reason why you have miscarriages?
- Have you had your blood checked for TORCH ( Toxoplasmosis, Rubella, Cytomegalovirus and Herpes ) ?
Hearing
- Does he have an earache?
- Do you suffer from earache?
- Does he/she have a pain in his/her ears?
- Have you noticed any loss of hearing?
- Does she/he respond to sound?
- Does she/he pull at her/his ear?
- Have you had an infection/ an injury/ an operation in your ears before?
- Have you noticed any fluid ( blood, pus ) drain from his/her ears?
Diet
- Typically, what sort of meals do you eat?
- Describe your eating pattern!
- What would you usually eat during a day?
- Tell me what you had to eat yesterday!
- Do you feel that you have an excessive appetite?
- Have you noticed anything special brings it on?
- Have you noticed any loss of appetite?
- How often do you usually eat?
- Do you eat regularly?
- How about snacks, soft drinks, cakes?
- Tell me about your diet!
- What have you done to try to lose weight?
- How many kilograms have you gained recently?
- Do you know what your weight now?
- How about your height?
- How are things in your relationship with your spouse?
- Do you feel your weight causes difficulty in your sexual life?
Depression
- Are you feeling lethargic?
- Have you been feeling dizzy, tired or depressed?
- How long have you been feeling like this?
- What do you think the matter is?
- Can you think of any reason why you feel depressed?
- Can you tell me about your social life?
- Where would you rate yourself on a scale between 1 to 10?
- What are your energy levels like?
- What is your appetite like?
- Can you sleep easily?
- Do you feel guilty about anything?
- Do you feel that life is worthwhile?
- Do you feel that you are coping well?
- Do you take recreational drugs?
- Do you drink alcohol? Tell me about it!
- Has anything changed in your life?
- Have you ever felt / been depressed before?
- Has anyone in your family suffered from depression?
- Have you ever thought of ending your life?
- Have you ever tried to end your life?
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