Exercise № 4

Practise the dialogue, getting a fellow student to play the part of the patient. He/she can select replies from the list (1) below

Doctor: What part of your back (chest, head, etc.) is affected

Patient: Just here.

Doctor: Can you describe the pain?

Patient: It’s…

(1)

a dull (тупой) sort of ache, throbbing (пульсирующая)

a feeling of pressure

very sore, like a knife

a burning pain

Note how the doctor asks if anything relieves the pain:

• Is there anything that makes it better?

Similarly (аналогично) he can ask:

• Does anything make it worse?

Doctors often ask if anything else affects the problem. For example:

• What effects (воздействие) does food have?

• Does lying down help the pain?

Exercise № 5

Work with a partner. In each of these four cases ask your partner where the pain is. Then ask two other appropriate questions to help you reach a diagnosis. Use all the ways of questioning we studied above. For example:

Doctor: Where does it hurt?

Patient: Right across here (indicating the central chest area)

Doctor: Can you describe the pain?

Patient: It’s like a heavy weight pressing on my chest.

Doctor: Does anything make it better?

Patient: If I stop for a bit, it goes away.

In this example, the patient’s symptoms suggest angina.

Now try each of these four cases in the same way.

1.

Doctor: _________________________________

Patient: Here, just under my ribs.

Doctor: _________________________________

Patient: It gets worse and worse. Then it goes away.

Doctor: _________________________________

Patient: Food makes it worse.

2.

Doctor: __________________________________

Patient: It’s right here (indicating the stomach area)

Doctor: __________________________________

Patient: It’s a gnawing (ноющая) kind of pain.

Doctor: __________________________________

Patient: Yes, if I eat, it gets better.

3.

Doctor: __________________________________

Patient: Down here (indicating down part of the chest).

Doctor: __________________________________

Patient: It’s a sharp (острая), stabbing (колющая) pain. It’s like

a knife.

Doctor: __________________________________

Patient: If I take a deep breath, or I cough, it’s really sore

4. Doctor: __________________________________

Patient: Just here (indicating upper part of the chest)

Doctor: __________________________________

Patient: My chest feels raw inside (боль внутри).

Doctor: When I cough, it hurts most.

Exercise № 6

Study this extract from a case history and try to select below questions the doctor might ask a patient to obtain the information in italics

The patient was a 55-year-old man, head of a small motor transport firm (1), who complained of central chest pain (2) which occurred on exertion (3) and was sometimes accompanied by sweating (4). He smoked 40 cigarettes a day (5). The pain had first appeared three months previously (6) and was becoming increasingly frequent (7). He had noticed some weight gain recently (8) and also complained that his hair had become very dull (вялый, не упругий) and lifeless. He felt the cold much more than he used to. He denied (отрицает) any palpitations (9) or ankle oedema (10).

And now question (have been given not in the order for each piece of information in italics):

1. What’s your job?

2. What’s brought you along today?

3. Have you had any problem with swelling of the ankles?

4. Have you noticed any change in the frequency of the pain?

5. How has your weight been?

6. Does the pain come on at any particular time?

7. When did you first notice the pain?

8. Apart from the pain, do you feel anything else wrong?

9. Do you ever become aware (знали ли вы) of your heart beating too quickly?

10. Do you smoke? How much do you smoke?

11. Which part of your chest is affected?