Speaking notes

typical roleplay structure is as follows:

Brief introduction

Ask questions to make an initial diagnosis

Respond carefully to the patient’s responses.

Provide an explanation of the condition & respond to further questions and concerns of the patient.

Provide advice and reassurance as required.

Short simple concluding sentence.

Brief introduction

Good morning Sir. I’m Kate one of the doctors. Tell me why you've come here.

Good morning Patricia, you’ve brought your daughter along I see. What seems to be the problem?

In a hospital ward, Hello Maria, how are you feeling today?

Taken history (ask questions):

Example

When did you first have the problem?

Have you ever noticed any particular kind of other discomfort or pain, perhaps associated with the
heartburn?

Do any particular foods seem to bring on your heartburn?

Now, have you noticed that any particular foods that trigger the heartburn, for example fast food?

Explanation:

Based on my examination it will be necessary to…….

The x-ray indicates that your child has………

The blood test results indicate that child has………

The tests show that it is probably a condition known as……

Providing Information

Let me explain it to you in detail. Epilepsy is a condition....

We have some very effective strategies to cope with eczema. I would like to explain them to you one by
one. Is that OK?

Make sure your explanation is clear and well organized. For example:

The blood tests results indicate that you have Hepatitis A. Do you know anything about this condition?
No? Okay I will explain it to you.

It is a condition caused by….

The symptoms include…….

The best treatment is to…….

It is highly contagious so you need to….

Try not to talk continuously. Stop from time to time to check if the patient understands your
explanation.

Is that clear?

Do you understand so far?

Do you have any questions?

Reassuring the patient

It is a common condition and it is treatable and with the right treatment we can reduce the risk of any
serious complications and your son will make a complete recovery.

It is not as serious as you might think and I can tell you, the risk of developing any further complications
is quite low

Firstly, if you stay in hospital for further observations and treatment, then risk of further complications
will be minimized and you will be able to make a full recovery

It’s nothing to get alarmed about. It’s just a routine check.

There really is nothing to worry about. It’s a standard procedure.

Let me reassure you, if you follow my advice the risks of future problems will be greatly reduced.

Persuading the patient

Well, I realise that, but I do want you to understand that are significant risks and complications that can
be associated with this condition

I strongly recommend that you return to the clinic immediately for further treatment. Is that clear?
So with heavy weight and diet high in fat, it increases your risk factor for a variety of serious health
conditions. Therefore not only do I want you follow a health diet, but I also want you to start doing
regular exercise.

If you stop taking your medication, then you run the risk of having another heart attack.

The best advice is to get plenty of rest. If you go back to work too soon, then you may not make a full
recovery and your condition could get worse. You don't want that to happen, do you?

Let me reassure 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 and drink heavily, then the risk of heart attack is
much higher.

Expressing Concern and Understanding

I know how you must be feeling.

I understand your concern

I understand how you are feeling.

I understand how you feel.

I understand why you have this concern.

I understand why you are worried about fluoride in the water

I'm sorry to hear that.

Oh, I 'm very sorry to hear that, but there is a solution to every problem.

Encouraging Reluctant Patients

Tell me more about that please, John.

Could you tell me more about that, Mary?

Please tell me more.

Is there anything you'd like to tell me?

Justifying:

We noticed that your baby is very sleepy, not feeding well and becoming jaundiced. That’s the reason
why your baby needs to stay here for treatment.

Seeking Approval:

Is it okay if I ask you a few questions regarding your son's health?

Would you mind if I contacted Meals on Wheels on your behalf?

Now there is one more very important area I would like to address if I may

Moving Forward /Changing the Subject:

Now, I'd like to talk about your discharge.

Now, let's talk about your medications. Are taking them

regularly?

Now, lets talk about your current health. How are you feeling

today?

Offering Advice:

I advise that you continue taking this medication

My advice is that you continue taking this medication

What I would like you to do is reduce your alcohol consumption to no more than 2 standard drinks per
day.

Summarizing:

Let me go over again what we have talked about today. Your colonoscopy found that you have
diverticular disease. You need to improve your diet which includes taking high fibre foods, vegetables
and fruit. Also make sure your bowel movements are regular and do regular exercise. I will see you in
two weeks’ time. Take care.

To summarize, you came to see me because you have fever and persistent cough. I have ordered a chest
x-ray and a phlegm test. The results will be back in next week. I will see you in one week’s time. Good
bye.

Positive Language

That's a good question John, and I will explain it to you now.

I'm glad you asked and let me explain the treatment procedure.

The staff here are very experienced and will take good care of your daughter.

Tag Questions

It's your first visit to this clinic, isn't it?

You are here to get your blood test results, aren't you?
You haven't been taking your medication regularly, have you?

You didn't sleep well last night, did you?

Your daughter is only 8 years old, isn't she?

It is causing you quite a bit of discomfort, isn't it?

Concluding the Interview

Please make an appointment with reception to see me in a week. Goodbye.

In a hospital ward: I’ll come back and check on your condition later today.

Thanks for coming to see me today. Goodbye.

I would like to see your child again in two months time. Take care now.

Embedded Questions

You can soften your questioning technique and sound more polite by using embedded questions.

Why have you come here today? Could you tell me why you have come here today?

How did you injure your leg? Could you tell me how you injured your leg?

What time did the accident happen? Do you remember what time the accident happened?

When did the pain start? Can you tell me when the pain started?

How long have you had the pain? Could you tell me how long you’ve had the pain?

Is it a sharp or dull pain? Could you tell me if it is a sharp or dull pain?

Does the pain bother you at night? Can you tell me if the pain bothers you at night?

Why do you want a prescription for sleeping tablets? Can you explain why you want a prescription for
sleeping tablets?

Example 1:
Nurse: What brings you here today?

Patient: Well nurse, I haven’t been feeling well recently.

Nurse: I‘m sorry to hear that, please tell me more.

Patient: I have been getting tired a lot.

Nurse: I see, what about your appetite. Are you eating well?

Patient: Not really, I haven’t felt hungry.

Nurse: What about your sleeping habits. Are you getting enough sleep?

Patient: Well about 4 or 5 hours a night

Nurse: Oh, it’s really not enough, is it?

Patient: I guess not.

Nurse: How about your work. Are you under any stress at the moment?

Patient: Yes, a little as it’s the end of the financial year so I am busy.

Question examples:
1. Reason for presenting?

What brings you here today?

What brought you here today?

What seems to be the problem?

Tell me why you have come here today?

2. Employment

What do you do?

Are you a shift worker?

How long are your shifts?

Do you work on weekends?

Is your job stressful?

How long have worked at___________?

How long have you been unemployed?

3. Past History

Have you ever suffered from chest pain before?

Do you have any known allergies?

What operations have you had?

How many anaesthetics have you had?

Have you been vaccinated against tetanus and typhoid fever?

Are you up to date with your vaccinations?

How long have you had high blood pressure?

Did you have any complications with your last surgery?

Is there any auto immune disease in your family?

4. Social History

Are you married?

How many children do you have?

Do you live alone?

Do you have any siblings?

Do you have any inherited medical conditions?

Do you or any of your family suffer from high blood pressure, heart disease or diabetes?

5. Blood

What is your blood group?

Are you rhesus (Rh) positive or negative?

How much blood loss has he sustained?

How long have you had the bleeding?

Do you faint at the sight of blood?

Can you donate some blood to the blood bank?

What is your blood sugar level

6. Bowels

Have you opened your bowels today?

Have you ever had bowel cancer?

When was your last colonoscopy?

Do you suffer from Crohn’s disease?

Do you require an enema or some sort of laxative?

7. Rash

How long have you had the rash for?

Is the rash itchy or irritating or painful?

Is the rash a sign of an allergic reaction?

Does it look like a heat rash?

Does your baby get nappy rash often?

Do you know what may have caused the rash?

Is the rash linked to something you ate?

Have you ever had a rash like this before?

Where on your body is the rash?

8. Infection

Do you need some antibiotics for the infection?

How long have you had the infection for?

Is this disease contagious?

How does the virus spread?

What is the best treatment for this infection?

Do you have a temperature?

9. Injury (sprain/burn/fracture)

How did you sprain your ankle?

How much of your body was burned?

How did you injure yourself?

What caused the fracture?

Can you elevate your leg for two hours every day?

Would you like a cold pack for the swelling?

10. Breathing

Is it hard to breathe?

When do you have difficulty breathing?

Can you take some deep breaths for me please?

Can you hold your breath for a couple of minutes while we take the X ray?

Do you have trouble with snoring at night?

Do you need to take sleeping tablets?

11. Diet

What do you usually have for breakfast?

Do you have plenty of fibre in your diet?

Do you have healthy eating habits?

Do you need to go on a diet to lose weight?

What type of foods do you prefer to eat?

Do you have any food allergies?

12. Weight

Has your weight changed recently?

What is your usual weight in kilos?

Do you have trouble maintaining your weight?

Do you feel pressured to be thin?

What is your ideal weight?

13. Exercise

How often do you exercise?

What is your favourite form of exercise?

What is the most comfortable exercise for you?

Do you get regular exercise?

14. Alcohol

How many standard drinks do you consume per week?

Do you have any alcohol related problems in your family?

Do you drink alcohol?

Is there a history of alcoholism in your family?

Was alcohol the cause of this accident?

Have you had a liver function test before?

15. Smoking

At what age did you start smoking?

How long have you smoked for?

How many cigarettes do you smoke a day?

Have you tried to give up smoking?

Are you a heavy smoker?

Do you smoke socially?

16. Pain

How severe is the pain?

Where is the pain?

What type of pain is it?

Is it a sharp pain or is it a dull ache?

How would you rate your pain on a scale of 1 to 10?

Is your condition painful?

Do you have a strong pain threshold?

What pain relief have you been taking?

Has the pain relief been effective?

17. Medication

What medications are you on?

What medication works the best for you?

Are you on blood pressure tablets?

Do you take all your medications regularly?

18. Anxiety

What makes you anxious?

Have you tried a sedative to help calm you down?

Are you anxious often?

Does your anxiety cause you to become depressed?

Does your anxiety cause you to avoid social situations?

Did you have an anxiety attack?

Are you feeling anxious about the operation?

Do you have any chest pain?

19. Wounds

Have you had any discharge from the wound?

How long has the wound been inflamed for?

Do you have any redness or puffiness around the wound site?

Is the dressing still intact?

Does the skin around the incision site feel hot to touch?

How long do the sutures need to stay in for?

Have you had any oozing of pus from the wound?

What colour is the discharge from the wound?

Example 2:
Health Professional: All right, Mrs. Small. Let me have a look at John first. Fine, based on the
examination, it appears your son is suffering from a condition known as “Eczema”. Have you ever heard
of this?

Parent: No, I haven't. What is it?

Health Professional: Okay, I will explain it to you. Eczema is also called “atopic dermatitis”, and it is an
inflammatory skin condition in early childhood. Some experts say it might be related to allergy. But the
exact causes of this condition are still not known.

Parent: Is it serious? I am really worried about John. You see the rash has become cracked and weepy.

Health Professional: I totally understand your concern, Mrs. Small. Let me reassure you that eczema is a
self-limiting skin condition. Most children will get better after a short period of time even without any
treatment. But of course, with appropriate management, the rash will diminish more quickly.

Parent: So, doctor, please give me more advice on the treatment options. You know, not only rash, but
also itchiness, have made John feel so uncomfortable.
HP: All right, Mrs. Small. Don’t worry. If you can follow my suggestions, John will get much better soon.
We have some very effective strategies to cope with eczema. I would like to explain them to you one by
one. Is that okay?

Parent: Yes

Health Professional: Good, well first, as I said, the rash might be related to allergy and irritation, so
please avoid things that may irritate the skin, like soaps, woollen clothes, and so on. And also keep John
away from dust and pets, because they are the main sources of allergen. Secondly, please keep an eye
on the food John eats, to find the possible food that may trigger the condition or make it flare up.
Especially pay more attention to eggs, milk and wheat. Thirdly, stop John scratching the rash. It can
make it worse especially when the skin has become cracked and infection follows. Finally, I will prescribe
some skin emollient for you. You can apply it on the rash, 4 times a day, to keep the skin moist. That is a
good method to control the flare-up.

Parent: Thank you. What about the future. I mean, will he grow out of it?

Health Professional: As I said, eczema is a self-limiting skin condition. When the skin function becomes
more mature, this condition will heal and it will not be a problem anymore.

Parent: What about John’s brothers and sisters? Are they likely to suffer from the same condition?

Health Professional: Well, unfortunately yes. It is possible, because eczema is familial. If one child has
eczema in the family, his siblings may be more likely to have one than other children. But it is nothing to
get alarmed about, the risk is very low.

Example 3
Alcohol Consumption

Practice: Using the information below, practice giving advice. Add your own ideas as well.

Health Council Guidelines

Males » 4 standard drinks per day

Females » 2 standard drinks per day

One standard drinks contains 10g of alcohol which equals:

One pot of standard beer (285ml)

One small glass of wine (120ml)

One nip of spirits (30ml)

Try to have 3 alcohol free days per week

Change to low alcohol beer

Risks of heavy Drinking

Damage to body organs such as………

Memory blackouts

50% of fatal traffic accidents involve alcohol

Pregnancy risks when drinking more than 1 standard drink per day

Alcohol can interact with prescribed medications

Cause relationship breakdown

Poor work performance

Advice

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 Anonoymous or I can contact them on your behalf,
and arrange an

appointment. How does that sound?

Cut down on amount & frequency of drinking

Don't drink on an empty stomach

Avoid binge drinking

See your GP

Alcoholics Anonymous (AA)

Example 4
Diet Guidelines for Good Health

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 monounsaturated 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. See if
you can limit alcohol to 2 standard drinks a day.

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, sauces, chips and packaged foods. Definitely drink more water. It is
best to drink about 2 litres of water a day.

Practice: Using the underlined phrases above and information below, practice giving advice and
expanding on the notes below. Add your own ideas as well.

Eat a balanced diet Carbohydrates such as

Cereals, Fruit, Vegetables such as ……… Eat fish………………..Choose lean meats…………………..

Drink water

Avoid or reduce junk food

Reduce salt intake

Avoid fatty foods such as ………………

Replace sweet food with healthy options such as ……

EXAMPLE 5
Heart Disease

Before you leave hospital today I would like to give you some guidelines about protecting your heart.

How does that sound? As you know it is very important to quit smoking. I can give you some advice
about that as well at your next visit.

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?

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.

Also, be sure to exercise regularly. Even taking the stairs rather than the lift can help you get in that
extra exercise.
Please don’t forget to have your blood pressure checked regularly and take time out to relax!

How to Lose Weight

I’m 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. The second key is to exercise regularly to raise your
metabolism and burn extra calories. Do you think you can do that?

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.

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.

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.

EXAMPLE 6
How to 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. However, if
you can't do that, 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. As far as your diet goes, try to eat more fruit and vegetables. You can also have low- calorie
chewing gum.

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.
EXAMPLE 7:
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.

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!

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?

Importance of exercise

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. 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.

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

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.

EXAMPLE 8:
Referring to other Health Professionals

It is not necessary to be an expert in all areas. So often the best advice is to refer to another health professional.
Example

Now regarding your diet, I can refer you to a dietitian and they can provide really good guidelines and healthy food

options, based on your condition.

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?

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?

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?

There are many home services that can help you in your transition to 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.

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?

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?

To find out more about some of the common well known services available to patients, click on the links below:

Blue Care

Meals on Wheels

Quit now

Alcoholics Anonymous

ACAT Assessment

Grief Counseling

Other Health Professionals commonly referred to include:

Dieticians

Social Workers
Community Support Groups

EXAMPLE 9:
Responding to a Patient

Listening is a key component of the medical interview and it is important to listen attentively to what the patient
says, as this is of more importance than what is written in your role-play card. Careful listening will help you to
improve your communication skills by allowing you to respond appropriately, and show empathy and concern for
the patients condition or situation. If you are card focused you may not respond appropriately to the patient.

Here are some example responses:

Now, I understand how you feel…...you are worried about returning home and whether you can manage, but let
me reassure, we can provide good quality home care and there are a range of professional services available.
Would you like me to tell you more about that?

Well, you mentioned that you have had this condition for a few years, could you tell me about the mediation you
have been taking?

Now, as you said, the wound is causing you pain. That is why I recommend you visit our out-patient clinic as soon
as possible.

I am very sorry to hear that. Would you mind if I ask you a few further questions regarding this situation?

Do you have any other difficulties?

Is there anything else that is bothering you?

Apart from chest pain, what other symptoms have you experienced?

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?

I can see that you are worried, but try to not be too concerned as this condition can be managed with medication
and rest. I totally understand how you might feel, but let me reassure,this condition is not as serious as you might
think.

EXAMPLE 10:
Smoking Cessation

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.
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 support groups and programs available to help you to
quit smoking.

Practice: Using the underlined phrases above, practice giving advice and expanding on the notes below.
Add your own ideas as well.

Risks

20,000 Australians die every year from smoking related diseases

86% of lung cancers are caused by smoking

Chronic bronchitis » smokers cough

Hardening of the arteries » heart attacks/ strokes

Problems in pregnancy

Risks to other family members through passive smoking

Quitting

Cold Turkey

Nicotine patches

Nicotine gum

Quitline

Community groups

GP

Withdrawal Symptoms

Feeling restless

Irritable & tense

craving for cigarettes

Symptoms disappear after 10 days

EXAMPLE 11
Weight Loss & Benefits of Exercise

I’m 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. The second key is to exercise regularly to raise your metabolism and burn
extra calories. Do you think you can do that?

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.

Try to exercise regularly at least three times a week for about 30 minutes. Can I suggest even taking the stairs
instead of the lift? This will all make a difference in your goal to lose weight.

Practice: Using the underlined phrases above, practice giving advice and expanding on the notes below. Add your
own ideas as well.

Weight loss tips

Cut down of high calorie food such as…….

Eat natural foods

Avoid junk foods

Don’t eat between meals

Avoid second helpings

Exercise

Go for a 20~30 minute walk everyday

Swimming

Cycling

Join your local fitness club/ sports centre

Recovery

Start gradually and build up over time

Avoid strenuous activities such as……….

If you feel tired………

Build your self esteem

Reduce risks of heart disease by……………..

Put less pressure on your joints especially…………..

EXAMPLE 12:
Breaking Bad News

You may face a role-play task where you need to break bad news to a patient. This is a difficult circumstance, and
you need to be careful with the language you use.

Process Give information » Check the patient’s understanding » identify the patient’s main concerns »Give realistic
hope

Example 1

Health Professional: John, what I would like to tell you is that the cause of your symptoms could be more serious

than you think, and that there is a risk that it is some kind of brain disorder. Therefore, I believe that it is very

important that we do a few further investigations including an a CT scan and EEG.

Patient: What kind of brain disorder?

HP: Well we don't know at this stage, but we need to rule out the possibility of epilepsy or a brain tumour

Pt: Oh no, this is really serious HP: Well we do not know at this stage, but you are in very good hands, and the first
step is to complete our investigations.

Example 2

HP: We have the test results back and unfortunately the news is not good.

Pt: What do you mean? Have I got cancer?

HP: Yes I am afraid so. I realise that this comes as a shock to you. (pause)

Pt: Oh my gosh, what will happen now?

HP: Well, fortunately we caught it early and there are some treatment options such as chemotherapy.

Pt: Chemotherapy. But that can make your hair fall out

HP: Yes there are unpleasant side effects, but it is the most effective treatment option for your condition.

Pt: Will it cure me?

HP: Well, we hope you will improve after a course of treatment, but we can not say definitely that you'll be cured.

But we will keep a close on you and repeat the treatment if needed.

Pt: I see

HP: Now, it may be a good idea to talk to someone about this. Do you have any relatives or close friends who can

help you and provide support?

EXAMPLE 13:
Dealing with Complaints

Key points

Acknowledge the patient’s concerns and experiences, and take responsibility for what happened.

Try to resolve the complaint directly Be aware of differing views of what happened and what was said

People who make complaints are often worried that there will be some kind of negative consequences
for their ongoing care.

Inform the patient about how you will manage their complaint.

Complaint Dialogue:

Doctor: Hello, Sonia, I am Dr. Jones, the surgical registrar. How are you today?

Patient: Not so good doctor. I had a terrible night last night.

Doctor: Oh,I’m sorry to hear that. Can you tell me more?

Patient: Well,you know I had an operation last night?

Doctor: Yes,an appendectomy, wasn’t it?

Patient Yes,well during the night I wanted to talk to the nurses as I was very thirsty, and I rang the bell
twice and no one came to see me.

Doctor: So you rang the bell twice last night, but the nurses came very late, is that right?

Patient: Exactly, I had to wait about an hour!!

Doctor: I am sorry about the inconvenience. However, there are some reasons for the delay. First of all,
we do not have enough nurses at the moment. There is a flu epidemic. Lots of nurses are on sick-leave.
So at the moment, we have to have less

experienced on-call nursing staff fill in. It takes them a longer time to assist one patient compared with
experienced nurses.

Patient: Yes,but this is a private hospital. So I expected better care, especially after having an operation.

Doctor: You are quite right. And your care is important to all the staff here.However, we also had four
emergency operations last night. Those patients had life-threatening conditions. I understand that you
were on the priority list, but the condition of those patients was much more severe than yours, so most
of our staff was in the operating rooms.
I hope you can understand our situation and I appreciate your feedback. As you know, providing the
best service to our patients is our objective. I will certainly report it to the ward manager

Patient: I guess I understand. But I would like you to report it.

Doctor: Certainly.Now, let’s talk about your current health. (changing the subject)

How do you feel today?

Patient: I feel a bit better and to be honest I would like to go home.

Doctor: Well, I’m pleased that you feel much better today. But I am not sure if it is a good idea to go
home just yet. Do you have any discomfort today?

Patient: Yes, a bit on the wound site. But I can manage that. My husband can look after me at home.

Doctor: So you still have pain. Let me check your chart, your temperature is a bit high today. It can be a
normal reaction after the appendectomy, but we need to keep a close eye on you in case the symptoms
are caused by an infection.

Patient: Oh, I see

Doctor: In general, patients like you have to stay in hospital for 2-3 days. In addition, your surgeon hasn’t
seen you yet. You have to have a consultation with him before I discharge you. He will come to see you
around 11 am today. Therefore, you may be discharged tomorrow if you make good progress.

Patient: But doctor, I’m afraid I could have another situation like last night.

Doctor: I promise that will not happen again. We have a plan to put on extra staff tonight, and I know
the ward manager will make sure we have enough staff. Patient: Okay, thank you doctor.

EXAMPLE 14
Difficult Situations

Grief Counseling

Listen attentively to the bereaved person.

Allow for moments of silence and reflection.

Listen in a non-judgmental and accepting way.

Encourage the bereaved person to talk about their grief.

Explain that grief is a normal, natural and inevitable response to loss

Offer practical and emotional support e.g.pastoral support or a grief counselor

Understand that tears are normal and healthy part of the grieving process.

Remember that grief takes time to work through.

Priority Patients

Triage system: The process by which a health professional assesses a patient’s clinical urgency.

Key points

Urgency :Urgency is determined according to the patient’s clinical condition and is used to ‘determine the
speed of intervention that is necessary to achieve an optimal outcome’.

Urgency is independent of the severity or complexity of an illness or injury

Some patients may be triaged to a lower urgency rating because it is safe for them to wait for an
emergency assessment, even though they may still eventually require a hospital admission

Difficult Patients

Screen for depression or anxiety

Summarize the patient’s chief concern

Interrupt less

Offer ways to improve care, solutions to the problem or choices

Show empathy

Ask open questions to encourage the patient to talk

Indicate what part the patient must play in caring for his or her health

Useful Phrases

It’s difficult for me to listen to you when you use that kind of language.

You seem quite upset. Please tell me exactly what are angry about.

I cannot help you if you are not prepared to help yourself