SPEAKING

Stage 1: Brief introductions and Opening Questions

1) Introduction:
At a medical clinic, health center or general practice.
1-­ Greeting:
*Hello Good afternoon sir\madam , my name is doctor… I’m the
Treating doctor for today , how can I address you?
*Hello Good morning sir\madam, my name is doctor… I’m one of the
doctors here in this clinic, how may I address you?
*Hello Good morning sir\madam, I am the doctor who'll take care of
your daughter during her hospitalization.

*f \ up visit: Good Afternoon, nice to meet you again. How are you So far?
Good Afternoon, let me remind you that I am ……, how….?
Hello Good morning sir\madam, thank you for visiting the
Clinic once again.
Hello again, Mr Waites. We met last week, didn’t we?
I’ve been telling my colleague here about you.
I’ve seen the results of the tests but there are just one or two
points I’d like you to clarify for me ?.

2-­ opening questions: Questions about the reason for presentation:

How may I help you today?
What can I do for you today?
What’s brought you along/in today?
What seems to be the problem?
Can you tell me what brings you here today?
Do you mind if we start off by getting some background to your condition?
Erm, just in your own words could you talk me through the reason you’re here
and how it all started?

In a hospital ward
* Hello Maria, how are you feeling today?
* Hello John, you are looking better today. How do you feel?
In a ER
* Hello Maria, Can you tell me what's brought you here today?

Let me check sir that I touch you well so far, you came here today
because …………. Is that right?

Stage 2: Taking the patient history (Ask questions to make an initial diagnosis)

Stage 3: The Main Body

Stage 4: Concluding the Roleplay (Short simple concluding sentence)

2. Sympathy:
* Oh, I am really sorry to hear that/
* it must have been very painful/
* it must be stressful for you//
* I appreciate your (fears, worries, concern, condition,... )

3. History:

* can I ask you some questions first if you don’t mind?

* All right Mr. … would you mind if I ask you a few further questions
regarding this situation?

Questioning about duration of complaint

How long have you been suffering from this problem?
How long have you been feeling like this?
How long have you had this pain/it/them?
How long has it/have they been bothering you?
How long has this been troubling you?
How often do you have the pain/feel the symptom?
How long does it last when you have it?
Questioning about onset of complaint /precipitating factors:
When did it start?
Can you remember anything that brought it on?
Can you pinpoint when it started?
Does anything particular bring it on?
What seems to bring it on?
Questioning about location of complaint:
Can you tell me\ Can you show me exactly +
Where does it hurt?
Where is it sore?
Where’s the pain/discomfort?
Where exactly is the pain?
where the pain is?
Which part of your (back) is affected the most?
Does it come on at any particular time?

Questions about the nature of the pain:

Can I get you to describe the character of the pain - or in other words, tell us
what does it like exactly?
Can you describe the pain?
What’s the pain like?
What sort/kind of pain is it?
Is it sharp or dull?
When you have this discomfort, what does it feel like?
Have you ever had anything like this before?
Does it affect your sleep/work/appetite?
Does it come and go or is it there all the time?
Does it occur all the time or just no and again?

Questions about the radiation of pain:

Does the pain stay in one place or does it move around?
Does it go anywhere else?
Is it just there or does it move around?
Besides your (back), have you had any other pain, say in your (legs)?
Questioning about relieving or aggravating factors:
Is there anything that seems to relieve it?
Is there anything that makes it better/worse?
Does anything special make it better/worse?
Does anything seem to bring it on or aggravate it?

Questioning about associated symptoms:

Have you had any other symptoms?
Have you had any nausea?
Have you felt dizzy at any time?
Have you experienced any difficulty in breathing?
Any diarrhea?
Any problems with your waterworks?
What about your bowels?
What about appetite? Are you eaten well?
What about your breathing when you get the pain?
Apart from your (dizziness), are there any other problems/symptoms?
I just mean if we were to walk what do you think would happen? Do you think
you could keep up with me if I walked fast?
Questioning about medication:
Have you tried/taken any medication for it?
Have you taken anything for it?
Did (the tablets) work?
Are you on any medication?
Questioning about previous health/past history:
Have you had any….like this before?
Have you noticed this before?
Have you ever been admitted to hospital?
Has there been any change in your health since your last visit?
Questioning about family history:
Does anyone else in your family suffer from this problem?
Are your parents alive and well?
What did he/she die of?
How old was he/she?
Talking about what you’re going to do
I’d just like to (examine your mouth).
Now I’m going to (feel your glands).
I’ll just check your (blood pressure).
Let’s have a listen to your chest.
Let me take your blood pressure.
3-­Telling the patient what to do:
Would you please (read the chart over there?)
Can you move your finger?
Can you touch your toes?
Now I just want to see you bending.
Look this way.
Open your mouth and say “Aah”
4. Diagnosis:
* Well, based on your symptoms and after examination, I believe that you
have what is called …. , and let me explain ….
* you are suffering from a condition known as … have you ever hear of
that
* the X ray indicates that you have …..
* the tests show that it is probably a condition known as ….. and let me
explain….
* It is a condition caused by …. The symptoms include ….. the best
treatment is ….

* I think you’ve got a condition called pseudomembranous colitis. It’s a long

way of saying you’ve got an inflamed colon.

5. Management:
* I see that must be a very difficult situation for you but the good news is
that there several options available which will help you. Would you like to
hear more about that?

* There are some very effective strategies to cope with ……,

// I would like to explain them for you
// let me explain them to you in details. Is that okay?

* First of all …… it is also important to // necessary to ….. do you think

you can do it?

* It is a good time to start …. , in terms of ……. , it will be necessary for

you to ……
6. I think we would start with …
I will give you a prescription for ...
I’ll write a referral letter to …
We will run some tests to see …

6. Reassurance:
1. Let me reassure you that eczema is self-limited // Rest reassure, this is a
quiet common It is nothing to get alarmed about,…
2. It’s very important for you at this time not to worry.

3. Do not worry it will go away by itself in a few days with some rest.
I know it sounds difficult at first but with practice, I am sure you will be
able to ….

4. Don’t worry, if you can follow my advice you will get much better soon.
5. Don’t worry, everything will settle down in a few days. These symptoms
are very normal for this virus.

6. Try not to worry. I’m sure he will feel better once we get his/her
temperature down.

7. Try not to worry too much,Your BP is normal and as long as you stay on
the medication, you’ll be fine.

8. Honestly, I am sure you don’t have any more trouble

Honestly, I’m sure you’ll feel better in a few days.

9. There’s really no need to worry.

10. There’s really nothing to worry about.
11.There’s really no reason to be worried.
12.There’s really no cause for concern.
13. The more rest and relaxation you have, the better you will feel.

14.The staff here are very experienced and will take good care of you.

15. Well, at the moment, Mrs James, we’re operating on a ‘one in, one out
basis’ . . . but I do think that a side room will free up in the next few
hours. The outlook is very good in most cases, we’re going to give you
antibiotics and fluids but there is a small risk of the infection returning
in the future.

16. And again, I just want to emphasize the point that you don’t need to be
worried;;

7. Reluctant Patient:
1. I’m really appreciate your concern // I can understand your worries // I
know how you feel but let me …
2. I completely understand your busy time, but your health is my priority,
what is more important your health or your job? So I think you must find
some time to … visit a specialist // who is more important the risk of …..
Or your business.
3. Let me assure you, if you follow my advice the risk of heart attack will
be greatly reduced; however, if you do not follow my advice and continue
to smoke then the risk of heart attack is much higher.// you don’t want that
to happen, do you?

4. Let me explain to you why the insulin therapy is necessary for you.
5. Of course you will need to continue …. ; However, I don’t think …. Will
be helpful in your situation. I would prefer alternatives. //
I understand … but let me explain to you why it is not a good choice for
you to …

6. Finally after agreement: I’m pleased to hear that. Now …

8. Checking understanding:
1. Is that clear // am I clear so far? // How does that sound// Am I clear till
now?
2. Do you think you can do that // Do you feel comfortable about my
advice?
3. Do you have any question so far // would you like me to tell you more
about that?

9. Signposting:

1. First of all … as I said before // as I told you earlier …

2. I’m concerned about your smoking habit. It is important to // necessary
to stop smoking
4. I have to highlight/ emphasize the importance of … // it is very beneficial
for you …
5. I recommend that // I strongly advice that you should lose weight.
6. that is a good question and let me explain to you that …// It is a good
idea to …
9- it’s a good idea that
10- another thing I ould like you to do is to be careful about…..

11. Breaking bad news:

1. June, we have the test results back and I’m sorry to tell you that the
cause of your symptoms could be more serious than you think and that
is a risk that ….
2. I realize that this come as a shock to you (pause)
3. It is a very important that we do a few further investigations including
4. Fortunately, we caught it early and there are some treatment options
such as chemotherapy.
5. We will keep a close on you and be sure you are in very good hands.
6. It may be a good idea to talk to someone about this. Do you have any
relative or close friend who can help you and provide support?

7. Hello sir/ma`am, thank you for visiting the clinic once again. I know
that you have been waiting for the results of the (test). However, before
telling you what the (test) had revealed, I would like to tell you that life
sometimes puts us in serious situations, but we have to be strong enough
to face such difficulties. Sir/Ma`am, the unfortunate truth that we have is
that you are suffering from ………

8. Sometimes life is difficult, full of ups and downs, but we have to be

strong enough in order to face such difficulties. Sir, the results of your
tests revealed that, unfortunately, you have a …..

9. The word cancer might sound scary to you and to many people. But,
we are lucky enough as we discovered it in an early stage.
Consequently, through a simple operation the tumor will be completely
removed.

10. Chemo and radiotherapy will not be determined neither by me nor

now, this is the role of the oncologist. According to the tumor extension,
he will determine whether we will use chemo therapy or not.
11. I would like to stress on that we are all here in the clinic to help and
support you and to give you a hand at any time.

12. (Not convinced with the results): Sir/Ma`am, we are here at this
clinic to provide our patients with precise and correct information, this is
because all of our team members are highly trained and professionals. If
we are not confident with these results, we would not reveal them to
you.

Persuasion:
1. The early intervention will enable us to have a better outcome.
2. Your health is my priority, I am here to support you and help you, so
you should listen to my advice.

Paving the way to your children will allow them to accept such truth
peacefully and not to be shocked with the diagnosis later on.
ture complications if you do not listen to my
advice.

/ tell your children.

stance
helps control your symptoms. Without it, we will not be able to manage
your condition and further complications might happen.

that…..
nalgesia that you requested,
but actually I can`t. your condition is really serious and it demands a
referral to / urgent admission to the hospital / urgent operation.

- Mr. X, as a matter of fact, nobody can appoint

himself to be your MPOA. This is because it depends upon your own
choice. If you do not trust your son, simply enough you can refuse
appointing him. And even if he became your MPOA, he would not be
able to arrange euthanasia or deprive you from your palliative care. We
can contact the court of law if you want to be more secured and want to
be in a safe position.

- Giving you a false certificate is against the law, and it is a misleading

conduct. Sir/Ma`am, we live in Australia, a country that respects its
citizens, and at the same time, citizens should respect the Australian law.
To clarify more, no one can break the law without consequences; he/she
might put himself in a critical situation under the court of law.
- To be honest with you, if you visit another clinic for another point of
view, you will just waste your time. This is because we are living in a
systemized country that has a strict law that should be followed. So if
I were you, I would not go to another place and I would follow the given
instructions by my doctor.

9-­Suggesting:
How about trying cutting down on the number of cigarettes you’re
smoking?
Why don’t you get a little more rest each day?
Why don’t you try some exercise each day?
What about visiting you each day and check up on your progress?
Maybe you ought to ..
Perhaps you should slow down a bit.
It might be a good idea to…
How about joining a social club?

Ending:

condition.

able after receiving

the news of your condition, so I can offer you a drive home, if you
would like.

see that you are a little bit anxious / irritated.

y card with my personal number, if you
would like to ask about anything later, please do not hesitate to contact
me at any time.

1. Do you have any more question? … Hope you feel better soon // Wish
you a speedy recovery.
2. I would like to see you in a week, don’t hesitate to call me if you have
any concerns.

Is there anything else I can help you with today? Do you have any other
concerns? Is there anything you’d like to clarify?

Life style modifiation

a) diet :
1. Now regarding your diet, I can refer you to a dietician and they can
provide really good guidelines and healthy food options.

2. Now let's talk about your diet .

* try to eat a wide range of foods.
* You can also control your weight by cutting back on foods such as
sugar, fats and alcohol.
* It is a good idea to use non saturated oils for cooking such as olive oil.
* Also try to cut back on full cream products, bakery goods and snack
foods and eat plenty of fresh fruit and vegetables instead.
* It is very important to eat less sugar and increase your intake of
complex carbohydrates.
* Fibre is very important in your diet. You can increase fibre by
choosing wholegrain foods such as cereals, bread and rice.
* Using less salt is one of the ways you can protect against high blood
pressure. Beware of foods that have a high salt content such as crackers,
sources, chips and packaged foods.
* Definitely drink more water. It is best to drink about 2 litres of water a
day.
3. Regarding your diet. Try to keep to your ideal weight and waist size
and avoid saturated fats as much as you can. The heart foundation
recommends that you eat low salt foods and eat fish at least twice a
week. Do you think that you can do that?

4. Another thing I would like you to do is to be careful of consuming too

much caffeine, alcohol and sugar. I know this sounds a little strict but it
will make such a difference to your health. How does that sound?

5. I am glad you asked about how to lose weight. It will certainly help
your health and self esteem.
Well, there are basically two simple keys to losing weight. The first one
is to eat less fattening foods. You should also be careful of your alcohol
intake.

6. It is also very important to reduce high calorie foods- foods such as

peanut butter, nuts, soft drinks cakes and biscuits. Instead of these foods,
aim to increase your intake of complex carbohydrates like grains and
vegetables.

It's a good idea to plan your diet and only have healthy foods in the
house. Let me encourage you to be realistic about your weight loss
goals. Crash diets rarely work.

As far as your diet goes, try to eat more fruit and vegetables. You can
also have low- calorie chewing gum.

a) Exercises :
1. refer to physiotherapy:
One way to speed up the recovery process and to increase mobility is to
visit a physiotherapist. They will be able to design a rehabilitation
program based on your needs and it can make a big difference. Would
you like to try that?

2. You need to start an exercise program, and I recommend joining a

local gym or sports Centre. They will be able to create a fitness program
that can help you lose weight and feel healthier. Do you think you can
do that?

Also, be sure to exercise regularly. Even taking the stairs rather than the
lift can help you get in that extra exercise.

The second key is to exercise regularly to raise your metabolism and

burn extra calories. Do you think you can do that?

Try to exercise regularly at least three times a week for about 30

minutes. I'm sure that you have some favourite activities like tennis, golf
or swimming. Am I right? Can I suggest even taking the stairs instead of
the lift? This will all make a difference in your goal to lose weight.

Let's talk about exercise. It’s not as hard as you think to exercise
regularly. It helps if you can do some activity that you really enjoy.
There are all sorts of activities you can choose from, such as bike riding,
swimming, tennis and yoga.
I recommend that you exercise for at least 30 minutes a day three times
a week.

4. Quit smoking:

I'm glad you've made the decision to quit smoking. The good news is
that it is possible to give up smoking.
I’d like to reassure you that many of the complications caused by
smoking can be reversed.
If you quit smoking you will have more energy, better health and
improved sense of taste and smell.
Now to the challenging part: how to quit. The best way to stop smoking
is to go cold turkey. I suggest you reduce the number of cigarettes
gradually, say by three day and aim to stop smoking completely within
two weeks. Does that sound realistic to you?
Don't worry if you feel irritable or tired or sweaty at first. After about 10
days these unpleasant feelings will disappear and you will feel great.
Let me give you some good tips for quitting smoking. It is best to have a
definite date in mind to stop smoking

Now in order to quit smoking, I recommend that you attend our

hospital’s quit smoking program. They run regular classes and I can tell
you that it has helped many patients succeed in giving up smoking.
Would you like to do that?

It's a good idea to avoid smoking situations and do activities that can
distract you from smoking. I'm sure you will enjoy saving money. Don't
forget to reward yourself!
Another thing I should mention is that there many supportive groups and
programs available to help you to quit smoking. Success is achieved one
day at a time.

5. Alcohol addiction:
Is quite a serious condition, and you really need some outside support to
help you overcome this. Therefore, I recommend that you contact
alcoholics anonymous, or I can contact them on your behalf, and arrange
an appointment. How does that sound?5

.
6. Starting insulin:
I understand that self-injecting insulin can be challenging at first, but at
our clinic we run weekly training programs which are run by our nurses.
They can take you through the process step by step and help you gain
confidence. Would you like me to make an appointment for you?

you will have to roll the bottle of insulin well between your hands 2--3
times.
You must mix well and you shouldn’t shake the bottle, as this will form air
bubbles which
will affect the amount of insulin withdrawn. Draw exactly the same amount
of insulin as
required into the syringe;; always measure from the top of the plunger and
check the syringe
for air bubbles. Well, air bubbles in the syringe will not harm you, but still
this may reduce
the amount of insulin drawn into the syringe...

Here, the insulin injection is being prescribed just as a precautionary

measure...just to bring the blood sugar level to the normal position.

Heart Disease
Before you leave hospital today I would like to give you some
guidelines about protecting your heart. How does that sound?

If you stick to your exercise plan you can protect yourself against heart
disease, high cholesterol and all sorts of obesity related disorders. You
will also look and feel much better.

As you know it is very important to quit smoking. I can give you some
advice about that?

.
4. Care of Wounds
Now let's talk about the care of your wound. Firstly always keep the
wound clean and dry.
If you notice any swelling, redness or discharge please gets on medical
advice.
You may need some antibiotic treatment.
Don't forget to drink plenty of fluids.
It is important that you get adequate rest and eat a healthy diet high in
protein.
As you know, it is vital that you wash your hands regularly and pay
attention to personal hygiene.
If you can, try to get some sun to your wound.
If the wound develops a scab, don't pull it off as it may cause scarring.
Speaking of scarring, you could use of vitamin E oil or cream which
should help the wound to heal nicely.

5. Overcoming burnout
I'm glad that you have come to talk about burnout. Just talking about the
problem can help sometimes.
Let me reassure you that burnout is not a terminal condition, but it is a
sign that you need to make some changes in your life.
A good piece of advice is to look at what situations cause you to feel
stressed and anxious. Now , write down at least one way you can think
of to modify the situation. Also, it's a good idea not to take on any new
commitments for a while. Learning how to delegate can help you with
this. Can I suggest that you take breaks when you finish a project?
Praise yourself for effort, not just outcome. Be aware of devices such as
mobile phones and computers which can take up lots of your time and
energy. Turn them off when you can. How does this sound so far?
A lot of our patients have found joining a support group really helps
them. Take care to rediscover your passion and enjoy life!

6. High Blood Pressure

Now let's talk about keeping your blood pressure under control.
It’s vital to have regular blood tests to check your cholesterol levels.
Your doctor will record your blood pressure each time you visit. He will
probably aim to keep your blood pressure around 120/80.
The most important thing you need to remember is to take all your
medications as prescribed.
It’s also helpful to eat a healthy diet and to exercise for general good
health. Do you think you can manage that?

7. Importance of exercise
I hope this chat has encouraged you to look after your health by
exercising regularly. The rewards really pay off!

8. Problems with memory

Thank you for coming here today to discuss your memory problems.
Firstly I'd like to reassure you that memory problems are common.
Secondly, memory can be affected by a range of things such as common
illnesses, nutrition and ageing.
It may be helpful if I give you some tips for preventing memory loss. Is
that okay with you?
I have a brochure here which I will leave with you. It gives tips such as
exercising regularly, which helps blood flow to the brain and also helps
with anxiety.
Staying social is important. Being with other people helps you to stay
alert and engaged with life.
Try to eat plenty of fruits and vegetables in Omega three fats.
See if you can manage your stress. This lowers cortisol levels which can
lead to problems with memory.
Of course getting plenty of sleep is also great to help with memory and
concentration.
This advice should help you a great deal with your memory. If you are
experiencing any signs of serious memory problems, then of course,
don't hesitate to come back and see me and we will run some tests.

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

home life. For example, Meals on Wheels can provide nutritious meals
everyday, so you will not need to cook all your meals. The Blue Nurses
will come and provide all your nursing care needs including help with
medications, dressing your wound and with showering. We can also
arrange a social worker to help with any other difficulties you may
encounter.

At the end :
‫نقول ملخص للمحادثة‬
Let me go through what we have discussed before you came to me
worried about

So what happened then?

Yes, of course
Right
Well
That’s sound great
Ok, doesn’t matter
Oh dear!