Doctor: Hi, Mrs. Long. Hello, Sara.
Mrs. Long: How-do-you-do, Physician.
Doctor: Please take a seat.
Mrs. Long: Thanks. Sara, sit hither next to me, sweetheart[ane].
Doc: Right, and so can y'all tell me what seems to be the trouble?
Mrs. Long: Um, Sara has been complaining of stomach cramps[2] and she�s off her food[3].
Dr.: I encounter. And when did the cramps begin?
Mrs. Long: Yesterday. She felt poorly in the morning, didn�t yous, Sara?
Dr.: Any thought what might accept caused the cramps?
Mrs. Long: I retrieve it might exist some kind of bug. A few of the children in her class have the same thing.
Md: Correct, well, I�ll have a look at her. Sara, could yous prevarication on the bed and I�ll look at your stomach?
ane. Does the physician try to constitute rapport with the child?
2. Does he develop information technology?
iii. Who does the dr. direct the conversation at?
four. Does the doctor include Sara in the chat?
5. Does Sara feel comfortable? Requite your comment.
six. What examples of good practice can you find in the chat?
vii. The way in which a doctor receives a patient can make or break the consultation that follow. A doctor needs to treat their patients with respect, of course, just establishing rapport within the first few minutes is besides about how doctors greet the patients and introduce themselves, clarifying their role, making certain patients are comfortable. Expect at these phrases and give each fix of objectives a heading[4]:
| Objective 1 ∙ Hi, [Sara], take a seat please� ∙ Good morning time, [Billy], come up in � ∙ Hello, can I just check information technology�southward [Nick]? Nosotros�ve not met before� | Objective ii ∙ My proper noun is Dr. Smith. ∙ I�m Dr. Brown. ∙ Dr. Linley has referred y'all to me for farther investigation. My proper name is Dr. Quinn. |
| Objective 3 ∙ I�m a student dr. working with Mr. [House]. ∙ I�k one of the registrars on the discussion this night. ∙ My colleague, Dr. [Taylor], has asked me to come up and see you nearly � | Objective 4 ∙ Do you desire to sit down here next to your mummy? ∙ If I could just inquire you to sit here next to me. That�due south great. Are you comfortable? ∙ Yes, it�southward a chip absurd here. Permit me just shut the window earlier we begin. |
8. Read and translate some other dialogue. Some other medico is talking to a 7-year-sometime boy and his mother:
Doctor: Hello, Billy. How-do-you-do, Mrs. Jones. My proper noun�southward Dr. Gordon. I�k one of iii partners who makes up this family unit practice. Now, Billy, practise yous desire to sit here next to your mummy, and I�ll sit hither. Just let me raise your chair upwardly a bit and so y'all can see me. That�s better. That�due south a great football game shirt, Baton. So, you�re a Manchester United supporter?
Billy: Yes.
Doctor: And do you support Manchester United also, Mrs. Jones?
Mrs. Jones: Oh, yeah. The whole family does.
Billy: My dad is their biggest fan.
Medico: Does he accept yous to whatsoever matches?
Billy: I�ve been to 3 matches this year.
Dr.: You�re very lucky. And who�s going to win the league?
Billy: Human being U, of course!
1. Does the md cover all four objectives? Give examples.
2. Does he include Mrs. Jones in the small talk?
3. Can the doc gain Billy�s trust and co-operation? Give your comments.
4. What topics put Billy at ease? Make up a list of things that make Billy comfortable. (Consult Ex. 4).
peel both dialogues. Tick the stages both doctors include:
| Md 1 | | Doctor two | |
| Greets the kid | V | Greets the child | Five |
| Calls the child by her proper noun | | Calls the child past his name | |
| Introduces himself | | Introduces himself | |
| Clarifies his office | | Clarifies his part | |
| Makes sure the child is comfortable | | Makes certain the child is comfortable | |
| Pays the child a compliment | | Pays the child a compliment | |
| Asks questions well-nigh the child�s personal inertest | | Asks questions near the child�s personal inertest | |
x. Work in pairs. Brand up a micro dialogue. Information technology should cover beginning 3 objectives: greeting the child and his/her mother/ father, introducing yourself and clarifying your role.
eleven. There are ii approaches to gathering information: a patient-centered (patient-led) approach and a dr.-centered (doctor-led) ane. They are quite different from each other in the respect of doctor-patient relation. Written report the table and answer the questions below.
| Doctor-centered approach � Doctor takes the dominant role � Tightly controlled state of affairs � Patient has limited participation | Patient-centered arroyo � Triangular form of consultation � Medico shows more empathy � Patient is the main source of data |
1. Which approach does the offset doctor use during his consultation?
2. Which approach does the second doctor prefer to apply in his practice?
3. Describe the beginning of the consultation of the second md.
Model: The doctors model consultations in 2 different ways. The first doctor tries to interview Sara�southward mother in a tightly controlled way. He neither applies the small talk nor includes Sara in the conversation. Of course, within first few minutes he learns the trouble Sara is having with her breadbasket and is ready to examine her. But all these things don�t make Sara feel comfy and she�southward probably scared.
12. Engaging in some small talk with a kid, such as paying them a compliment or checking that they are comfortable, are important points for a doctor to call back.
a) Focus on language that will put the kid at ease.
Think! It�s important to use softeners such as only to constitute and develop rapport with the patient in English-speaking cultures. Phrases with the softener just are more polite, non-threatening, and therefore more patient-friendly. An absenteeism of simply can mean a lack of warmth and tact.
1. Read and compare the examples below:
1. a) Information technology�southward a bit common cold here. Let me just shut the window before we brainstorm.
b) It�s a chip cold here. Permit me close the window before nosotros begin.
two. a) If I could but ask you to sit hither side by side to me.
b) If I could ask you to sit here next to me.
three. a) Just let me heighten your chair up a flake so you tin can run across me.
b) Let me heighten your chair upwardly a bit so you tin can see me.
plete the sentences using the softener just:
i. Can y'all � turn your head to the side so I can come across your ear?
2. Permit me � assistance you.
3. Sara, could you � lie on the bed?
4. I � want to look at your tummy.
5. I�k sure it�s � a slight problems.
6. I�k � going to listen to your heart.
3. Translate into English:
i. ��� ����� ���� ��������� ����� (cut).
two. � ������ (����� ����) ���� ��������� �� ���� ����.
3. ������� ��� ������ ��������� �� ���� ����.
four. � ��������� ����� ���� ���������� ���� ������� ������.
five. ��� ����� ���� ��������� ��������.
6. ��� ����� ���� ��������� (stethoscope). �� ������ ��������� ���.
4. Give your own examples.
b) Focus on language you tin can use to pay the kid a compliment.
Remember! Paying a child compliment is an important point for doctors to remember. It�s i of the best manner to become their co-operation
1. Study the following constructions:
one. That�due south a + adjective + substantive
Instance: That�s a cracking football shirt, Billy.
2. They�re + adjective + noun (plural).
Example: They�re cool trainers, Jim.
2. Read and translate:
| 1. That�south a lovely apparel, Mary. 2. That�southward a absurd car, Nick. 3. That�southward a pretty doll, Kitty. 4. That�s a beautiful toy, Sam. 5. That�s a squeamish skirt, Helen. 6. That�s a not bad T-shirt, Joe. | 7. They�re beautiful sunglasses, Ann. 8. They�re lovely shoes, Sara. 9. They�re great jeans, Mike. ten. They�re pretty stickers, Lily. 11. They�re nice pencils, Ed. 12. They�re cool transformers, Dick. |
plete the sentences:
1. � lovely hat, Dolly
two. � pretty smile, Tom.
3. �cute jeans, Willy.
4. � nice bows[five], Kitty.
five. �. great teddy bear, Billy.
half dozen. � absurd sneakers[6], Harry.
4. Practice other expressions to pay a compliment.
I like your + noun
Instance: I like your jeans, Ed.
What a + adjective + noun
Case: What a cute teddy bear!
13. Work in pairs. Practise using the phrases in Exercise 11 (b) in these scenarios:
1. Kitty, a v-year-old daughter, is very shy. She�southward come with her favourite toy, a teddy bear.
2. Mike, a six-year-old boy, has brought a new transformer.
3. Dolly, a vii-year-old girl, is wearing a mode pink skirt and blouse. She has a new model of Barbie in her mitt.
4. Nick, an 8-year-old boy, is very proud of his jeans and trainers his parents presented him for his birthday.
xiv. As the interview progresses, information technology is of import for a md to acknowledge a kid�s feelings, to show empathy, and to ask a kid for a permission before examining them. Heed to the continuation of the dialogue in Exercise 7 and fill in the gaps:
Md: OK, Billy, now your mummy tells me that yous have a nasty cough and it keeps you lot awake at night. Is that right?
Billy: Yes.
Md: Are you _______ sad?
Billy: Yep, I�thousand tired.
Doc: I can understand why you�re feeling sad.
Mrs. Jones: And you can�t swallow your favourite cereal in the forenoon at the moment because information technology ______ you cough, doesn�t it, darling?
Billy: Yeah.
Dr.: Oh, dear, that is a nasty cough, isn�t it? _____ ____have yous had information technology for?
Billy: I got information technology on Fri and I couldn�t _____ ______ all weekend.
Doctor: You must have missed that, Billy. Well, what I need to do is to have a look at your chest to ______ _____ where that nasty cough of yours is coming from. Will you let me look at your chest, Billy?
Billy: OK.
1. How does the doctor show empathy and support?
2. Does the physician share Baton�s thoughts and feelings? Give examples.
3. Does the doctor explain why an examination is necessary?
4. Does the doctor ask for permission to examine him?
5. Does the doctor gain Billy�due south trust and co-operation? Give your comments.
15. Study the following constructions. Practise to evidence empathy:
one. That/You lot must + infinitive
Example: You must exist tired.
2. That/You must + perfect infinitive
Example: Yous must take missed that, Billy.
1. That must exist difficult for you.
2. Y'all must experience a lot of pain.
3. You must feel sad.
4. You lot must have been disappointed.
5. Y'all must accept been upset.
16. Work in pairs. Practise using these phrases in the following situations:
1. A nine-twelvemonth-onetime male child has come to see you because he has a nasty cough. He tells that he had to miss the school football game title.
2. A ten-yr-old girl has come to see you because she has stomach cramps and a runny tummy. She�southward upset she tin�t go to her friend�south birthday political party today.
iii. A 6-year-old male child has come to come across you lot considering he has an earache. It kept him awake at night.
17. Read the dialogue in Exercise 5 and make changes to ameliorate the consultation. Role-play the improved dialogue.
Recollect to:
� Innovate yourself and clarify your role.
� Make sure the child is comfortable.
� Pay the child a compliment.
� Bear witness empathy and support.
eighteen. Make upwards your ain dialogues.
19. Read the text I and discuss the difference betwixt the ii visits:
Text I. Two Consultations
When I was xiv years former my female parent took me to see a physician near some skin lesions on my face and neck. The doctor was reputed to be ane of the best in town. At his clinic, we paid consultation fee and waited in a queue. Subsequently about 20 minutes, somebody called out my name and asked us to enter the doc�south room. During the check up, I explained all my issues to him. He examined my lesions, quickly wrote down a prescription of drugs and asked us to come up for follow-up subsequently a week. It hardly took a minute for him to see us off.
I hadn�t expected such a curt consultation and felt he hadn�t given me plenty fourth dimension to explain about my problems and treatment in item. Though he gave me a prescription, he failed to requite whatsoever assurance or encouragement. I know my mother felt the aforementioned. I used the drugs that he had prescribed, and they cured my trouble. Merely I never came back to him for follow-upwardly.
Near a year ago, I accompanied my sick female parent to another doctor for a very different consultation. Firstly, my mother explained all her bug in item. The doctor listened carefully and, after thoroughly examining her, told the states all about the disease she had and the treatment he was going to give. Finally he asked her if she understood everything. My female parent nodded happily. I could see from her face how happy and relieved she felt afterward this consultation.
Now I am in my concluding twelvemonth at medical school. Looking back at those two consultations, I think they epitomize bad and good doctor-patient relationships. I come across many patients daily; as a student, I can�t give them anything merely assurance, back up, hope, and my time to heed to their concerns. I know it helps them. This reinforces my conventionalities that the best management strategy for a patient can exist fabricated stronger when laid on a strong foundation of a good md-patient relationship.
(Taken from Good Do, McCullagh and Wright, 2008)
20. Read the text II and give its summary:
Text II. History Taking
Children and Doctors
The history
A structured approach to history taking is important to avoid forgetting things, but this must not become also rigid, as information technology is sometimes necessary to pursue a different line of questioning to gain essential data. The table opposite is a listing of useful headings in pediatric history taking, and this should be memorized.
Talking to the child
Children should be asked to give their account of events with parental corroboration. Children nether 5 years old volition lack the vocabulary and advice skills to describe their symptoms, but will be able to indicate to parts that hurt.
Talking to the parents
Most of the history is likely to be gained from the parents or guardians.
Ask if they have the infant medical record book �this contains information about height and weight centiles, immunizations, evolution, and illnesses in the first few years of life. Ask whether the parents have any views on what the cause of the kid'south trouble is. Listen carefully to the parents; they are acute observers of their children. Ensure that all terms used are appropriately defined and yous should be gleaning data from the parents' observations and non their interpretation of the symptoms. Further, the parent may interpret a baby's cries every bit hurting when, in fact, it is your task to constitute the circumstances of the cries and, therefore, the cause. Equally children go older, the parents may have a hazy retentivity for early events. Establishing symptoms in relation to easily remembered events (e. g. first walked) may clarify the timeline.
Outline of paediatric history
� Presenting complaint and history of presenting complaint.
� Nativity history:
o Place of birth.
o Gestation and pregnancy.
o Birth weight.
o Commitment.
o Perinatal events and SCBU admission.
� Feeding methods and weaning.
o If bottle fed, note how the bottle feed is mixed (how many scoops/number of ounces).
� PMH including hospital admissions, infections, injuries.
� Developmental history.
� School progress.
� Immunizations.
� Drugs.
� Allergies.
� Family tree with sibling'south ages, including deaths, miscarriages, and stillbirths.
� Parental age and occupation.
� Family illnesses and allergies.
� Housing.
o This should include a discussion near the child's bedchamber equally they may spend 12 hours of each mean solar day there.
� Travel.
� Systems review
You can do anything with children if you only play with them.
21. Interpret the text III, give its abstract:
Text Iii. The Test: an Approach
Exam in children varies depending on the age and co-operation of the kid. School-age children and babies may be examined on a couch with a parent nearby, whereas toddlers are best examined on the parent'southward lap. If the child is asleep on the parent's lap, much of the test should be completed before waking them upwardly.
Undressing
Allow the parent undress the child: and only betrayal the office of the trunk yous will exist examining.
Positioning
Some children may prefer to be examined continuing upwards. Only lay the child down when you have to, every bit this can be very threatening.
Putting the child at ease
Slowly introduce yourself to the child'due south space during the exam by exchanging toys, for case.
Explicate what you are going to practice and be repeatedly reassuring, children tin can be embarrassed by silence afterwards a doc's question, but will be comforted by endless nattering. And recall-don't enquire permission, as this will often be refused!
The examination
Firstly, employ a hands-off approach. Allow the child to look at you lot, and let them play in your presence. Sentinel the child. How practise they collaborate with their parents? Do they look well or ill? Do they look clean, well nourished, and well cared for?
Kneel on the floor so that you are at the child's level. Use a manner and language appropriate to the age of the child, a toddler will sympathise the word ˜�tummy� better than the give-and-take ˜�abdomen�.
Be opportunistic
Exercise not adhere to a rigid examination schedule, e. yard. you lot may have to heed to the heart get-go while the child is tranquillity, then look at the hands later on. Never examine the presenting part only. Be thorough and railroad train yourself to be a generalist. Get out unpleasant procedures, such as examination of the tonsils, until last.
Presenting your findings
When presenting your findings, translate what y'all see into appropriate terminology. Informing a senior that a child looks funny is not very helpful but the saying the child is dysmorphic, followed by a detailed clarification is adequate. Describe in simple terms the relevant features that make the child look unusual, e. g. low fix ears, wide set eyes.
There is no substitute for examining lots of normal children.
Paediatrics is a specialty spring by historic period and not by system. Some distraction techniques to aid with examination
Playing peek-a-boo. Letting toddlers play with Letting toddlers play with your stethoscope. Giving infants something to agree. Request mum or dad to wave a bright toy in forepart of them.
Unit 2. Wellness Care Away
Health Care in the The states
one. Read and larn the words by heart:
ACTIVE VOCABULARY
| private doc | ������� ���� |
| Resident | ����-����� (���������� �������������� ����������� ���������� ����� �����������) |
| to inoculate | ������ �������� |
| inoculation | �������� |
| consulting physician | ����-����������� |
| dsability | ������������������, ������������ |
| the disabled | �������� |
| retirement benefits | ���������� ������� |
| emergency unit | ��������� ���������� ������ |
| the injured | ������������, ������� |
| the bullheaded | ��������, ������ |
| Medicare | ����������������� ���������, ����������������� ��������� ������ ������������ ������������ ����������� �� ���� �����������, ��������� ����� � �� ���� ����������� |
| Medicaid | ���������� ����������������� ���������, �������������� ���������� ����������� ������������ �������� � ��������� |
| dependent children | ������������������ ���� |
| the aged (syn. the elderly) | �������, ������ ���� |
| Stroke | ������� |
| mental diseases | ����������� ����������� |
| drug addiction | ����������� � ����������, ���������� |
| staff | ���� |
| Trauma | ������ |
| insurance | ����������� |
| to regard | ��������, ����� ��������� |
| employee (employe (����.)) | ��������; ���������� �� ����� |
| Price | ����, ��������� |
| to forcefulness smb to exercise smth | �������� (����-�.) ������� ���-�. |
| Income | ����� |
| Expense | �����, ������ |
2. Translate the discussion combinations with the given central-words:
 | �� �� �������� ������ ���� �������� �������� �� ���������� ���������:
one two 3 4 5 6 7 |
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