SPEAKING Stage 1: Brief introductions and Opening Questions 1) Introductic Ata medical lnc, health center or general practice. = Greeting! "Hello Good afternoon si\mmadam , my name is doctor... I'm the ‘Treating doctor for today , how can I address you? “Hello Good morning sirimadam, my name is doctor... im one of the doctors here inthis elinic, how may I address you? ‘Hello Goo! moming stjmadam, Iam the doctor who'll tke care of| your daughter during her hospitalization, tomect you again, How are you So far? Good Afternoon, let me remind you that Lam... HOW... Hello Good morning sifmadam, thank you for visiting the Clinic once again Hello again, Me Waites. We met lst week, didn't we? rye been telling my colleague here about you, Irvescen the results ofthe tests but there are just one oF two points I'd like you to clarify for me ? ‘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 tobe the problem? Can you tell me what brings you here today? Do you mind if we start of by getting some background to your condition? nn, jst in your own words could you tlk me tough the reason you're hete and how iall tated? Inahospital ward Hello Maria how are you feling today? * Hello John, you ate looking better today. How do you fel?* Hello Maria, Can you tell me what's brought you here today’? Let me check sir that [touch you well so far, you eame here today because .oorsvon Is that right? Stage 2: Toing the patient histor (Ask questions to make an nia agnosis), Stage 3: The Main Body forming the patient © Describing the condition De Reassurng he patent Persuading the patent ‘Stage 4 Conc the Roleplay (Short simple concluding sentence) ‘Sympathy: Oh, Lam really sorry to hear that! * it must have been very painful’ * it ust be stressful for you// " Tappreciate your (fears, worries, concer, condition History: * can Task you some questions first if you don’t mind?” * All ight Mr... would you mind if | ask you a few further questions regarding this situation? ‘Questioning about duration of complaint ‘ow long have you been sffering fom this problem? ow long have you been fein ike his? ow log have you had this painter? ow ong has have they been bothering you? How long has this been troubling you? ow often do you have the painfel the symptom?How long does it ast when you havi? (Questioning about onset of complaint preipltating factors: ‘When didit sar? (Can you remember anything that brought ton? (Can you pinpoint when it stated? oes anything particular ring ton? ‘What seems io bring it on? Questioning bout eatin of compan (Can you tell me\ Can you show me exactly + ‘Where does it hu? Wher sit sore? Where's the puinidiscomton®? ‘Where exactly isthe pain? where the pain? Which par of your (back) is affected the most? oes it come om at any paicular time? ‘Questions about the nature ofthe pal ‘Can got you wo describe the character ofthe pain - or in ether wows, ell us ‘what does it ike exactly (Can you deseribe he pain? What's the psi ike? ‘What sorkind of pain sit? Ist sharp or du? ‘When you have this discomfort, ha does it feo ike? Have you ever had anything like this before’? Does it affect your slepwork/appetite? Dox iteome and goo sit there all the time’? oes it accra the ine or just no nd agin? (Questions about the radiation of pain: Does the pain stay in one place or does it move around? Does it go anywhere ese? {situs there or does it move around? Besides your (hack) have you had any other pai, say in your legs)? Qvestoning about living oF aggravating facto Tsthere anything tha acest relieve if? Is there anything that makes i beter worse? ‘Does anything special make it beter worse? Does anything sem wo bing iton or aggravate i? Qvestioning about awocinted symptoms: Have you had any oer symptoms?Have you had any massa? “Have you fl dizzy at any time? Have you experienced any difficulty in breathing? ‘Any dirt? ‘Any problems with your waterworks? ‘What about your bowels? ‘What about appetite? Are you eaten well? ‘What about arbi when You et the pain? Apart rom your (iznes), ae there any other poblem/symptoms? {just mean if we were to walk what do you thnk would happen? Do you think {you could keep up with me if walked fast? ‘Questioning about medication: ‘ave you tiedtaken any medication frit? Have you taken anything fori? id the abet) work? Are you on any medication? ‘Questioning about previous bealth/past history: Have you had any...like this before? Have you noticed this before? Have you ever boon admited to hospital? Has there been any’ change a your health ‘Questioning about family history: ‘Does anyone else in you family suffer frm this problem’? ‘Are your parent alive and well? ‘What di else die of? How old was he'she? “Talking about what you're going todo Trust ike to (examine your mouth). [Now I'm going to (el your gland), Filjustehock your (blood pressure. Ler'shave alten to your chest. Let me take your blood pressure, |3-Taling the patient what to de: ‘Would you pease ead the chan over there?) Can you move your finger? Can you touch your tes? [Now {just want to se you bending. ‘Look this way. (Open your mouth and say “Aah” 8 Your Las wisi?Diagnosis: * Well based on your symptoms and after examination, {believe that you have what is called... and let me explain * you ae suffering from a condition known as... have you ever hea of that * the X ray indicates that you have * the tests show that iis probably a condition known as... and let me explain * Ibis a condition caused by .... The symptoms include .. treatment is the best * Ithink you've got a condition called psadanembrencus colts, T's a Hong, way of saying you've got an inflamed colon. ‘5. Management: *T see that must be avery 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 // would like to explain them for you 1/tet me explain them to you in details. Is that okay? ° First of all... it is also important to / necessary to... do you think you ean d * This a good time to start... im terms of will be nevessary for you to 6. 1think we would start with will give you a prescription for. TM write a referral leer to We will run some tests o see Reassurance: 1 Let me reassure you that eczema is self-limited // Rest reassure, this is a ‘quiet common Itis nothing to get alarmed abot2. It's very important for you a this time not to worry. 3. Do not worry it will go away by itself in afew days with some rest. [know it sounds difficult t first but with practice, Tam sure you able 0 Whe 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 hisher 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, Lam sure you don’t have any more trouble Honestly, I'm sure you'll fel better ina few days. 9, There’ really no need to worry. 10, There’s really nothing to worry about 1-There’s realy no reason to be worried. 12-There’s really no eause for concer. 13. The more est and relaxation you have, the bel you will fel 14-The stalT here are very experienced and will take good care of you. 15. Well atthe moment, Mrs James, we're operating on a Yone in, one out basis"... but I do think that ssn wl ep ine ext fe twas: The outlook is very good in most cases, we're going to give you amibiotcs and fluids but there isa 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 woried; clu1. Pm really appreciate your concern / 1 ean understand your wortes /1 know how you feel but let me 2. Tecompletely 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 .. visita specialist // who is mote important the Fisk of | Or your business 3. Let me assure you, if you follow my advice the risk of heart atack will be greatly reduced; however, if you do not follow my advice and continue to smoke then the risk of heart atack is much higher./ you don't want that to appen, 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 bo helpful in your situation, I would prefer alternatives. // ‘understand... but let me explain to you why itis not a good choice for youto 6. Finally after agreement: I'm pleased to hear that, Now ech |. Ts that clear am Telear so far? // How does that sound/ Atm I clear til 2. Do you think you ean do that / Do you feel comfortable about my advice? 3..Do you have any question so far// would you like me to tell you mone about that? 9. Signposting: 1. First ofall... a Isai before / as told you earlier 2. 1'm concetned about your smoking habit. I is important to // necessary to stop smoking 4. Thave to highligh emphasize the importance of... //itis very beneficial for you 5.1 recommend that // strongly advice that you should lose weight. 6. that isa good question and et me explain to you that ..//Itis a good ieato p9- ts a good idea that 10- another thing | ould like you todo is to be earefil about. LL. Breaking bad news: 1 June, we have the test results back and I'm sorry to tell you thatthe cause of your symptoms could be more serious than you think and that is arisk that 2. realize that this come asa shock vo you (pause) 3. Iisa very important that we doa few further investigations including 4, Fortunately, we eaught it early and there are some treatment options seh as chemotherapy. 5. We will keep a close on you and be sure you are in very good hand 6. 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 suppor” 7. Hello siima°am, thank you for visiting the einie once again. Tknow tht you have been waiting forthe results ofthe (test). However, before telling you what the (les) had revealed, I would ike 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 lite is dificult, full of ups and downs, but we have to be ‘rong 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 seary to you and to many people. But, ‘we are lucky enough as we discovered i in an early stage. Consequently though simple operation the tumor will be completely removed. 10, Chemo and radiotherapy will nt be determined neither by me nor ‘now. tis isthe role ofthe oncologist. According tothe tumor extension, the will determine whether we will use chemo therapy oF not.11.1 would like to stress on that we are all here inthe clini to help and support you and to give you a hand at any time, 12, (Not convinced with the results): Sit/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 ae highly trained and professionals. IF ‘we are not confident with these resus, 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, Tam 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 withthe diagnosis later on. ‘You might have future complications if you do not listen to my advice If were you, | would not be worried /not stop taking the medication /tell your children, This isa stage we do not want to reach to This medication contains a substance called... This substance helps control your symptoms, Without it, we will not be able to manage ‘your condition and further complications might happen. ‘understand that you have some fear from... but let me assure you that. | wish I could prescribe the pain killer/aalgesia that you requested, bt actually I ean't, your condition is really serious and it demands referral to / urgent admission to the hospital / urgent operation, (MPOA situation) 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 be ina safe position. {you want to be more secured and want 10 (Medical certificate situation): ~ Giving you a false certificate is against the law, and i isa misleading conduct. SirMa’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 aertical situation under the court of law. ‘To be honest with you, if you visit another cline for another point of view, you wil just waste your time. This is because we are living in a systerized country that has strict law that should be Followed. So if Twere you, [would not goto another place and T would follow the given instructions by my doctor. SSingestig: Ho ab traction the rbot cores ste ‘Whi dont you get aitle more rest each day? ‘Why dont you try some exercise each day? ‘wnat about visting you each day and check up on your progress? Maybe you ought to Perhaps you should sow down abit TEemight be a goed iea to. How about joing a social db? Ending ‘Areletralt... might be nde he is a special conltion ‘Would you like met arrange a drive for yout your home? Would you like tole one of my assistants drive you home? SirfMatam, I el that you became ait bit iriable afer receiving the news of your condition, oF ean offer you a dive home, you would ike Ifyou ike, can tel my asitant to give you adrve home, a can see that you area ite it anious itd. n your| would like to give you my card with my personal number, if you ‘would like to ask about anything later, please do not hesitate to contact sme at any time. ‘Wish you a speedy recovery and a good luck, 1.Do you have any more question? ... Hope you fel better soon // Wish {you a speedy recovery. 2. 1 would like to sve you in a week, don’t hesitate to call me if you have ‘any concerns. Is there anything else I ean help you with today? Do you have any other concerns? Is there anything you'd like to clarify? Life style modifiation 1. Now regarding your diet, I can refer you toa dietician and they ean provide really good guidelines and healthy food options. 2. Now ler talk about your diet * try to eat a wide range of foods. + You can also contol your weight by cutting back on foods such as sugar, fats and alcoho * Tris 8 good idea to use non saturated oil for cooking such as olive il * Also try to cut back of ful eream products, bakery goods and snack foods and eat plenty of fresh fruit and vegetables instead. © Its very important to eat less sugar and increase your ina ‘complex carbohydrates. * ibe is very important in your diet, You ean increase fibre by choosing wholegrain foods such as cereals, bread and ric. * Using less sat is one ofthe ways you eam protect against high blood pressure, Beware of foods that have high salt content such as crackers, sources, chips and packaged Foods. * Definitely drink more water Is best to drink about 2 litres of water a say. ke of3. 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. [know this sounds alte strict but it will make such a difference to your health. How does that sound? 5. Tam glad you asked about how to lose weight. I wil certainly help ‘your health and self esteem. Well, there are basicaly two simple keys to losing weight. The first one to eat less fattening foods. You should also be careful of your alcohol ake. 6. Ibis also very important to reduce high calorie foods- foods such as peanut butter, nuts sft drinks cakes and biscuits. Instead of these foods, aim to increase your intake of complex carbohydrates like grains and vegetables. wa good idea to plan your diet and only have healthy foods in the house. Let me encourage you tobe 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 mobi Visita physiotherapist. They will be able to design a rehabilitation program based on your needs and it ean make a big difference. Would ‘you lke to try that? 2. You need to start an exercise program, and I recommend joining a Jocal gym or sports Centre. They will be able to create a fitness programthat can help you lose weight and feel healthier. Do you think you can dothat? Also, be sure to exercise regularly. Even taking the stats rather than the {if can help you get in that extra exercise, “The second key isto exercise regularly to raise your metabolism and ‘burn extra calories. Do you think you ean do that? ‘Try to exercise regularly atleast thre times a week for about 30 T'm sure that you have some favourite activities like tennis, olf ing. Am I right? Can I suggest even taking the stairs instead of the lft? This will all make a difference in your goal to lose weight Lot's talk about exercise, I'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. | recommend that you exercise for atleast 30 minutes a day three times a week, 4. Quit smoking: {Tm glad you've made the decision to quit smoking. The good news is that itis possible wo give up smoking. T'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 sill, [Now to the challenging part: how to quit, The best way to stop smoking is to go cold turkey. I suggest you reduce the numberof cigarettes ‘gradually, say by three day und aim to stop smoking completely within to weeks, Does that sound realistic to you?Don't worry if you feel ivtable or tired oF sweaty a Fist. After about 10 days these unpleasant Fel Feel great. Let me give you some good tips for quiting 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 tel {you that it has helped many patients succeed in giving up smoking, ‘Would you like to do that? It's good idea to avoid smoking situations and do activities that can distract you from smoking. Im 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 ata 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 alcohols anonymous, o I ean contact them on your behalf, and arrange ‘an appointment. How does that sound? 6, Starting insulin: understand that sel-injecting insuin can be challenging at frst, but at ‘ur cline we run weekly training programs which are run by our nurses, “They can take you through the process step by step and help you gai confidence. Would you like me to make an appointment for you? {You wll nave to rl the bot of insulin well between your hands 2-3 times. "You must mix well and you shouldnt shake the bottle, as his wil form air Duables which ‘wl affect the amount of insulin withdrawn. Draw exactly the same amount ofinsulin as required into the syringe; always measure frm the top ofthe plunger and check the syringefor air bubbles. Wel, ar bubbles in the syringe wll ot harm you but sti this may reduce the amaunt of insulin drown ito the syringe Here, the Insulin injection i being prescribed just 2. a precautionary measure..justto bring the blood sugar level tothe normal postion. Heart Disease Before you leave hospital today 1 would like to give you some _Buidelines 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 sonts of obesity related disorders. You ‘will also look and fee! much beter. ‘As you know itis very important to quit smoking. Ican give you some advice about tha? 4, Care of Wounds Now let's talk about the care of y ‘wound clean and dry I you notice any swelling, redness or discharge please gets on medical advice. You may need some antibiotic treatment Don't forget to denk plenty of Muids. This important that you get adequate rest and eat a healthy diet high in prowin. ‘As you know, it is vital that you wash your hands regularly and pay attention to personal hygiene. IF.you ean, try to get some sun to your wound. wound. Firstly always keep thethe wound develops a scab, dont pull t off as it may cause scarring, Speaking of scarring, you could use of vitamin E ol or eream which should help the wound to heal nicely. 5. Overcoming burnout ‘Tm glad that you have come to tak about burnout, Just talking about the problem can itelp sometimes. Let me reassure you that burnout is no a terminal condition, but itis 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. Als, i'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 fi ‘A ot 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 tlk about keeping your blood pressure under control [t's vital to have regular blood tess to check your cholestrol levels. ‘Your doctor will record your blood pressure each time you vist. He will probably aim to keep your blood pressure around 120/80. "The most important thing you need to remember is vo take all your medications as prescribed It’s also helpful to eat a healthy dit and to exe hhealth. Do you think you can manage that? for general good 7. Importance of exercise ‘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 fd lke to reassure you that memory problems are commonSecondly, memory can be affected by a range of things such as common illnesses, nutrition and ageing. ‘anay be helpful if I give you some tips for preventing memory loss. Is that okay with you? Thave 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 socal is important. Being with other people helps you tos alert and engaged with life. ‘Try to eat plenty of fruits and vegetables in Omega thre 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 ‘This advice should help you a great deal with your memory. Ifyou 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 y Sore joints Tm sorry to hear that you have sore joints. Itis a common problem but rma 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, pin? Firstly, you can use a hot or cold peck alternatively om the affected area of your body, This can be very effective in helping to reduce the pai. ‘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 io retain ther strength, ‘You can also buy some over-the-counter creams such as Voltaren which can hep reduce the pain ‘You might need to take some painkillers such as Nurofen which also acts as an antiinflammatory. Do think you will be able to try these therapies I have talked about? I think dhey wil help you quite a lot There are many home services that can help you in your transition to hhome 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, tthe end : Had saab ‘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 dea