Medicine 1

OXFORD ENGLISH FOR CAREERS Student's Book
Sam McCarter
Sam McCarter
Student's Book
O XPO RD
U N IV E R SIT Y PRESS
Contents
CAREER SKILLS A N D KN O W LED G E LANGUAGE SKILLS LANGUAGE KNOW LEDGE
It’s my job Patient care Culture project/ Listening Reading Speaking Writing Language spot Vocabulary Pronunciation
Project
1 Presenting complaints • p.4
Dr Gillian Understanding Personal details Diagnosing A case report Asking short and Describing pain Medical terms:
Henderson culture: Presenting presenting gentle questions word stress
-cardiologist interpreting body complaints complaints Tenses in the
language presenting
complaint
2 Working in general practice • p.12
Short questions Research into Description of Social factors in GP statistics A referral letter Present Perfect Medical jobs Medical jobs:
in the general general practice a GP’s job general practice Case history and Past Simple Signs and main stress
history in the UK A case history role-play symptoms Questions: rising
Short questions Non-technical and falling
in the general language intonation
history
3 Instructions and procedures • p.20

Dr Franco Carulli Preparation for Preparing for the Direct Explaining a Case notes Giving Instructions
- newly qualified carrying out first ward round Observation of process(hand instructions for a procedure
doctor a procedure Giving Procedural Skills washing) Explaining
instructions Explaining procedures
a procedure Making polite
Case presentation requests
4 Explaining and reassuring a p.28
Research into Patient care Gastroscopy Explaining An explanation Explaining Adjectives Word stress:
complications Explaining a procedures of possible procedures with to describe suffixes
gastroscopy Acknowledging complications the Present procedures
visual cues Passive and be Explaining
Emphasis going to future complications and
Discussing reassuring the
complications patient
5 Dealing with medication • p.36
Joyce Carne - Prescribing drugs Research into A drug chart Concordance A drug chart Clinical incident Phrasal verbs Abbreviations
nurse practitioner in hospital clinical incident Benefits and side Explaining reporting Explaining side
reporting effects medications effects: can! may
6 Lifestyle • p.44
Sympathy and Research in Family history and Overweight Making changes An email about Encouraging Language for Word stress in
empathy medicine social history and obesity Stress dealing with patients exercise noun phrases
Being stress and making
Exam practice suggestions
sympathetic
R e a d in g b a n k • p.52
1 TV doctor' 4 The language barrier 7 Children’s sleep 10 Memories Reading bank key p.64
2 Medicines 5 The nocebo effect 8 Expressions 11 Being a midwife
3 Assessment 6 Salt caves 9 Psychiatry 12 The Maori
7 Parents and young children ® p.66

Dr Nasrin Ahmed Reassurance Baby's six-week Talking about Recommendations Empathizing Reflecting on one’s First Conditional Qualities of a good
- paediatrician check oneself for the use of the Practising for OSCE own experiences vs Second paediatrician
Applying for work Reassuring an MMR vaccine scenarios Conditional Non-technical
anxious parent language
Sharing Signs and
experiences symptoms
8 Communication • p.74
i
Understanding Information web Acknowledging Barriers to Considering what Writing accurately Open and closed Alcohol Stress in the
why patients can search: TWEAK verbal cues prevention the patient thinks for training or questions sentence
appear vague Appropriate Dealing with a work applications
Asking and responses defensive patient
responding to
open questions
9 Working in psychiatry • p.82
DrTom Turner Asking about Describing Eliciting the history Mini-mental state Extract from a The Past Simple Appearance, Weak forms
- psychiatrist self-harm patients examination mental state and the Past behaviour, and
examination Perfect manner
Wishes and
consequences in
negotiations
10 Terminal illness and dying • p.90
Frances Care in the Recognizing and Breaking bad news Breaking bad news Preferred coping Expressing likes, Reactions
MacGregor community dealing with A debate about mechanisms dislikes, and to bad news
-M arie Curie patients'emotions donor cards preferences Words and phrases
nurse Informing a related to death
Coping
relative about mechanisms
a death
11 Working in a team # p.98
Dr Omar Noori Finding out about Appropriate Syllabus and Communicating Describing an Being polite Teamwork
- phlebotomist politeness in responses Competences of with a consultant example of good Describing
different cultures Asking a senior the Foundation Interrupting practice attitude and
colleague for help Programme a colleague behaviour
Interview panel
12 Diversity at work $ p.106
Asking about Name awareness Avoiding and A multicultural UK Cultural A response to Reported speech Awareness of Saying long
culture responding awareness a report feelings sentences
Spiritual needs to tactless Reporting and
in palliative care comments clarifying
Diversity
committee
Patients'spiritual
needs
Speaking activities • p.114 Grammar reference • p.122 Listening scripts • p.132 Glossary • p.139
4 Unit 1
1 Presenting complaints
Check up 2 How im p o rtan t are accurate p atien t records?

Give reasons.
1 Work in pairs. M atch each photograph w ith w h a t th e
person is saying. 3 In your country, are p a tie n t records kept on com puter
or on paper? W hich of th ese tw o system s do you think
is better? Why?
Listening 1
Personal details
Look at th e chart containing personal details of Mr
Karlson. Then listen and correct any details 1-8 th a t
m ay be w rong. Tick ( /) item s th a t are correct.
BSSSBSlI
Surnam e: J o K m o w Karlson
First n a m e (s)'DaA'e'Icw/ Sex M
A d d ress 3 PcurhVCeMj _______
C a tfle fte l& M c u ^ c A e tte r M6 7VE
A dm ission details Vu#iccvn/W ardsa£4- p.vyi.
ovu 9 N o v e m b e r 2 0 0 8 I
Hospital No 1973604-5 ?
DOB 27 10 53 5
T elephone num ber 0 1 6 6 4 0 5 7001
Marital S ta tu s SOngle/ §
O ccupation P ojtm cuo' I
GP VrlO xcvn/ ?
C/o pcuAvO n/r-i^htarvvv
Listen again and check your answers.
3 Work in pairs. Decide w h a t questions th e doctor asks

for each piece of inform ation on th e form.
• Language spot
Asking short and gentle questions
I just need to find My hospital number?
M rJensen’s notes. It’s 3438235 and my • Ask gentle questions to p u t th e p atien t at ease. Use
GP’s name is Dr Lane. Can you tell m e w h a t/ who + n o u n + verb?
W h a t’s y o u r s u r n a m e /fa m ily name?
Can you tell m e w hat yo u r surnam e /fa m ily nam e is?
/■
Good morning, Sorry, I don’t know my m Remove w ords to m ake questions shorter.
Mrs Dean. GP’s phone number. W h a t’s y o u r first name? Yourfirst name?
My name’s Dr Bray. Can I leave that blank? Have yo u any other names? (And) A ny other names?
» Go to Grammar reference p.122
In this unit
• asking about personal details
• asking questions about the presenting complaint
• describing and asking about pain
• writing up a case report
1 Make gentle questions or short questions for th e Listening 2

questions you m ade in Listening 1,3.
Presenting complaints
2 W hen taking th e history of th e p resenting com plaint
1 Work in pairs. W hat do you th in k each patient in
(HPC), you often ask about pain. Use these w ords to
pictures a -h m ight be com plaining of?
com plete th e questions.
m akes it w orse / better? did it start?

on? you up at night?
spread anyw here else? th e pain is like?
had th e pain? get th e pain?
th e pain for me? had th e pain before?
constant?
a W here do y o u ______
b Does th e p a i n ______
c Does it w a k e _______
d Can you tell m e w h at
e Can you d escrib e___
f How long have you _
g Is th ere anyth in g w h ic h _____________________
h W h e n ______________________________________
i Is th ere an y th in g w hich brings i t _____________
j Is th e p a in __________________________________
k Have y o u ___________________________________
3 Work in pairs. M atch these w ords to a question in 2.

1 f duration
2 onset
3 severity
4 trigger
5 radiation
6 and character
7 exacerbation / alleviation
2 Listen. M atch each picture i n i w ith a conversation.
8 site
1 ______ 3 ________ 5 7_______
9 previous episode
2 ______ 4 ________ 6 8_______
10 constancy
3 Listen again. W hat three questions are used by the
4 Work in pairs. Each choose a p ain and ask each other
doctor to ask about th e presenting com plaint (PC)?
questions to identify th e pain.
1 W hat's _________________________________________?
2 Can you tell m e w h a t ____________________________ ?
3 W hat can ______________________________________ ?
4 W hat other questions can you use to ask about the PC?
5 Listen to five people statin g w here th e y are having 3 Cover th e stress pa ttern s in 1. Take tu rn s saying
a problem . W hich p a rt of th e body are th e y referring to? a w ord to your partner, w ho w ill th e n identify
a stress p a tte rn 1-4.
6 W ith a partner, th in k of non-technical term s for body
parts a-k. 4 Try n o t to look at 1. Work in pairs. Take tu rn s reading th e
sentences below by adding th e correct w ords th a t m atch
th e stress pattern.
a Mrs Evans can't w alk properly.
She’s got a pain in her • O •
b He’s very te n d er here on th e right side of th e
O • • n ear his kidneys,
c A hm ed’s • • • • fe e ls as if it’s on fire w h e n he swallows,
d He dam aged his • • • w h en he fell on th e pavem ent,
e Jam es has got a crushing pain aro u n d th e • • ,
b u t n o th in g in his arm s or legs,
f I th in k th e re is a fracture in th e # • in th e right hand,
g The pain radiates from around th e • • • • to th e back.
I Work in sm all groups. Take tu rn s describing a p a tie n t you

have tre a te d w ith a problem related to th e p arts of th e body
a-k and th e n answ er questions from th e group m em bers.
W h a t...
...investigations did
you carryout?
I ... was
wa: the treatment?
J
y
...was the prognosis?
3
j calcaneus
Vocabulary
Pronunciation Describing pain
Medical terms: word stress Work in pairs. W hich descriptions 1-10 do you associate
1 Work in pairs. W rite w ords from a -k above th a t m atch w ith th e conditions a-j? In som e cases, th ere m ay be more
each of these stress patterns. th a n one answer.
1 piercing / boring a sciatica
1 • • , , _______ 2 extrem ely severe / intense b ureteric colic
2 • • • , _______ 3 aching c acute pancreatitis
3 • • • , _______ 4 scalding / burning d appendicitis
4 • • • • ,________ 5 like a tig h t band e degenerative arthritis
around m y head f cluster headache
2 (j|~j|) Listen and check your answ ers. 6 dull / p ersistent / vague g cystitis
7 excruciating / thunderclap h tension headache
8 shooting i sub-arachnoid
9 spasm odic haem orrhage
10 crushing / gripping j angina pectoris
Presenting complaints 7
Use SO CRATES in the history of the presenting complaint to help

you remember the main questionsyou need to ask about pain:
site; onset; character; radiation; associations; timing; exacerbating
and alleviating factors; severity
differentiate (v) distinguish; tell the difference between
2 Work in pairs. Decide how you w ould differentiate

betw een th e p ain in b -e in 1. Give reasons Dr Gillian Henderson
for your answ er.
3 For each description, w rite M (mild), S (severe), or My name is Dr Henderson. I'm a cardiologist at a
V (very severe). Then say w hich condition a-j in 1 London hospital.The highly trained team of which I
each p atien t below is possibly describing. am part deals with the diagnosis, investigation, and
1 ______ I get this vague headache som etim es treatm ent of patients with all forms of heart disease,
during th e week. including cardiac transplantation and some sorts of
2 The headache is excruciating. vascular disease.
I can't bear to look at th e light. None of our work would be possible without the
3 The p ain in m y stom ach is so bad it support of other people in the hospital team - t h e
m akes m e double up. triage nurses, th e receptionists, and so on.Their work is
4 I get th is sharp pain w h en you press m y vital to the smooth running of the departm ent. When
side here on th e right and th e n let go. patients arrive for the first time, personal information
5 All m y joints hurt. I am w racked w ith pain. istaken: nam e,address,telephone numbers, next
4 You can ask a p a tien t to describe p ain on a scale of 1 to of kin for contact in case of emergency, and other
10. W hat o ther w ays can you ask a p a tie n t to assess th e information such as their GP's name and address, their
severity of pain? NHS number, and their unique hospital number.
We deal with a large catchm ent area and also deal

It’s my job with referrals from outside the area, tourists, visitors
to A&E, private patients, and so on, so the potential for
1 Before you read th e tex t about Dr H enderson, a confusion is great unless the data th a t are taken are
cardiologist, discuss w ith a p a rtn e r w h a t you th in k accurate and the systems secure.
being a cardiologist involves.
At various stages of patients'contact with the hospital,
2 All of th e statem en ts below are true. Find inform ation information is checked to make sure it is correct and
in th e tex t to support each statem en t. th a t the patients can confirm their identity. For
1 Dr H enderson's te a m is very skilled. example, on arrival at a clinic patients might be asked
2 The w ork of her te a m depends on th e support theirGP's nam eor part oftheirtelephone number,for
of other people. exam plethe lastthree numbers.
3 Details about th e closest relative are tak en from Then during the consultation
patients. a nurse or a doctor might also
4 Patients have tw o n um bers (other th a n th e ir phone ask their date of birth. All this
num ber) on th eir hospital records. is for the benefit of the patient
5 The d ata collected need to be accurate. to ensure the hospital team
6 Checks are carried out to m ake sure p atien ts are w ho does not make mistakes and
th e y say th e y are. people do not use patients'
details fraudulently.
We can then turn to
dealing with the
patients'treatm ent
in safety.
8 Unit 1
A & E (n ) Accident and

Emergency
rapport (n) relationship
• inspiratory
• crepitations
Listening 3 • Language spot

A presenting complaint Tenses in the presenting complaint
• U nderstanding th e tim e p atien ts are referring to
w h e n th e y speak is crucial to m aking a correct
diagnosis. You should be very com fortable
u n d erstan d in g th e difference betw een th e Present
Simple, Present Continuous, Present Perfect, and
Present Perfect Continuous.
1 Decide w h e th e r each sentence a -i relates to th e tim e

show n in diagram s 1,2,3, or 4 below.
PC = Presenting com plaint
PC
1 Work in pairs or groups. Decide w h a t th e abbreviations

below stan d for.
I
Time Now
PitU e 1 0 0 /n u n
BP: 1 0 0 /7 0 « / / / j 1 Present Simple
J V P N o t d e v o te d
PC
CVS N A D
O /E
W id e sp re a d e a rly U u p ir a to r y j u t e c r e p ita tio n * NK
axuU U e Time Now
a Jo d m ten - n o r m / d
2 Present Continuous
CMS - MAD
PC
2 Listen to p art of a conversation b etw een Dr M artin,

a doctor in A&E, and Mr Wood. As you listen, m ake your
ow n notes about Mr W ood’s presen tin g com plaint.
Time Now
Speaking 3 Present Perfect

1 Discuss th e signs above. PC
P R E S E N T PERFECT i
2 Discuss th e correct diagnosis for th e shoulder pain.
PRESENT CONTINUOUS
3 Decide w h a t th e diagnosis w as on arrival at th e hospital
4 Outline your im m ediate treatm en t. Time Now
4 Present Perfect Continuous

a I’ve got a headache. Speaking
b I’ve been having th is shooting p ain in m y 1 Work in pairs. Decide w h at possible conditions the
leg. notes below relate to.
I keep g ettin g th ese flashing lights around
m y eyes an d a sharp pain. ® p u i n j i u t aktrue b e lly b u tto n ; j o e s
d I have been having th ese terrible backaches. t h r o u g h to b u c k ; 'm a k e * m e d o u b le u y ;
e The p ain goes right th ro u g h you. w o r z e a f t e r c l f a t t y w a a l; d r i n k
f Have you been having any pain?
cl l o t (ulxudvoi); s h a r p p u ir i;
I'm getting these headaches off and on now.
h u d i t s e v e r a l t w i t s before;
I'm not taking an y th in g for them .
The attacks have increased. p a i n th e r e a l l t h e tw e e ;
Work in pairs. Complete th e sentences below w ith cam e ok a fte r d ttu te r

th e correct form of th e verb. If m ore th a n one ten se is L v s tu ig h t
possible, explain th e difference.
1 My m o th er _ . (have) th ese pains since last

Tuesday. She still has them .
(you norm ally go) for a ru n at th e sam e tim e
every day?
The p a in _
It's b etter now.
. (ease) a little since yesterday. □ sharp pewn/vn/the/ rig h t side/;
4 I ______(lie) in bed for four w eeks now. I h av en't makevwie/dx>uble/iXp;
been out of it once, doctor. never h a d /it before/;
5 I can see th e r a s h (get worse). It's m uch feelvnty sldo; side/very
redder. ten d er tcrtoueh;
6 I ______(not take) any m edication at th e m om ent. ordythinfy relieves
7 (pain spread) to your shoulder or is it ju st i t iv bendtnxy kneev
here? tcrchevt
IF
Work in pairs. Decide w h at questions the doctor
asked in each case. Take tu rn s asking and answ ering
questions.
Student A, go to page 114. Student B, take a history from

Student A. W rite notes as you listen and decide w hat
th e p atient's com plaint is.
Student B, go to page 116. Student A, take a history from

Student B. W rite notes as you listen and decide w hat
th e patient's com plaint is.
Culture project
Being aw are of your ow n body language and
th e body language of your p atien ts w ill help
you in tak in g a history.
1 Find a picture a-c to m atch each description of body

language 1-7.
1 a The doctor is not sure ab o u t w h a t 2 In groups, discuss w h a t th e body language in 1w ould

he is saying. m e an in your ow n culture.
2 a, b, c xhe p atien t is not com fortable or at ease. 3 Use th e in tern et to find:
3______ The p atien t is angry. 1 other fields besides m edicine w here u n d erstanding
4 __ The doctor is bored an d u n sym pathetic. non-verbal com m unication is im portant.
2 w h at a p atient-centred approach in history taking
5______ The doctor is show ing in terest an d inviting
m eans.
th e p atien t to continue speaking. 3 w h a t th e Calgary Cam bridge m eth o d is.
6___ __ The p atien t doesn’t u n d e rsta n d w h a t
th e doctor is saying.
7 __ The doctor an d p a tie n t aren ’t
com m unicating.
Presenting complaints 11
clerk (a patient) (v) take a history from a Checklist

patient and write it up
Assess your progress in this unit.
Tick (/) the statements which are true.
I can ask a patient about personal details.
I can ask about the presenting complaint.
I can ask a patient about pain.
I can understand tim e relationships
in the PC and HPC.
Writing
A case report
1 Complete th e extract from th e case report w ritte n by Dr M artin
Keywords
after th e consultation w ith Mr Wood on page 8 . Insert th e verbs Nouns
in th e correct form into th e appropriate blank space. body language
culture
present have be smoke
non-verbal communication
be w ork radiate
Adjectives for pain
A 49-year-old man presented/ i i n A & E with aching
boring
chest pain. He had had the pain for 3 hours
burning
prior to arrival . The pain I in the crushing
centre of his chest and I to his left dull
shoulder. excruciating
gripping
He a history of chest pain on intense
exercise, which has been present for the persistent
piercing
previous six months.
scalding
He _______ J> approximately 20 cigarettes severe
shooting
a day and ________ § teetotal . He has been
spasmodic
prescribed aspirin, B-blockers for the previous thunderclap
two years, and a GTN spray to use as required, vague
which is two to three times per week. His
father died of a myocardial infarction aged 65.
Useful reference
He ___________ Z as a gallery attendant.
Oxford Handbook of Clinical Medicine
7th edition, Longmore et al,
2 Complete th e clerking from th ese notes. ISBN 978-0-19-856837-7
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12 Unit 2
2 Working in general practice
Checkup
1 Work in pairs. Can you predict
w h at each person’s job involves?
W hat do you th in k are th e ir m ain
responsibilities w ith in th e team ?
In this unit
• Past Simple and Present Perfect
• askingquestions in thefam ily history
• using non-technical language
• asking questions in the general history
• writing a referral letter
2 W hat do you th in k is th e m ost stressful aspect of Pronunciation 1

m edical work? W hat is th e m ost rew arding?
Main stress
1 o Listen and m ark th e m ain stress in the words
Vocabulary and phrases.
Medical jobs 1 mmmmm
1 M atch th ese jobs to th e pictures on page 12 . 2 mmmm

1 practice m an ag er ______ 3 mmmmmm
2 receptionist ______ 4 mm
3 general practitioner ______ s mmm
4 m idw ife ______ 6 mmmm
5 district nurse ______ 7 mmm
6 h ealth visitor ______ 2 All of th e people in th e pictures in Check up work as
7 practice nurse ______ part of GP practice team . In groups, discuss how each
person supports th e GP in his / her work. W hich person
2 Add th e job titles of th e people in 1 on page 12 to th e in your opinion is th e m ost im portant besides the GP?
sentences below. You can use singular or plural nouns.
3 Discuss w ho does th e w ork of the people above in your
1 A practice is ru n by a ______
country.
2 w ork w ith individuals, fam ilies, and
groups like th e elderly and new -born babies in th e
co m m u n ity .
Listening 1
3 need very good interp erso n al skills because A CP’s job
th e y are th e first contact people have w ith th e 1 (["5) Listen to a GP talking about her w ork in an inner
practice. city area. Decide w h eth e r th ese statem ents about her
work are tru e (T) or false (F).
4 N inety-seven per cent of th e UK p opulation is
1 The GP works in th e centre of London______
registered w ith a ______
2 High crime rates do not affect th e people w orking at
5 The duties of a ______ include 'trad itio n al'
th e GP practice______
nursing skills and ru n n in g specialist clinics for
3 The w orkload is lighter th a n in rural areas______
im m unization, diabetes, and so on.
4 Patients m ove from one GP practice to
6 An im p o rtan t link b etw een hospitals, GPs, and other
an o th e r______
h ealth professionals involved in an te n a ta l care is
5 GPs receive no extra paym ent for working in
t h e ______
deprived areas______
7 visit those w ho are h o u sebound or those
recently discharged from hospital and / or dress 2 Work in pairs. Compare and contrast w orking in city
urb an and rural areas in your hom e country.
w ounds.
3 A GP's place of w ork is called a surgery. Surgery also
refers to th e tim e GPs see p atients. Do doctors work
outside hospitals in your country? If so, w here?
• Language spot 1 Use th ese w ords to m ake sentences.
Present Perfect and Past Simple 1 coughing start five days ago be so bad it wake
m e up every night.
• We use th e Present Perfect for actions w hich hap p e n 2 w h en attacks first come on?
in th e past at any tim e up to now. The exact tim e is 3 an ything m ake it w orse since start?
not know n or not defined. 4 he never take any m edication in his life.
5 w h a t h ap p e n w h e n you be near anim als as a child?
6 m y fath er die over 20 years ago.
N ow
7 you get th ese problem s every day w h en you
M/ M/ M/ ! live in Africa?
8 ever have coughing attacks like this before ?
9 your fam ily ever have illness like this as far
• We use th e Past Simple for specific tim es in th e past. as you aware?
The exact tim e is know n or defined, b u t som etim es 2 Work in pairs. Ask each other questions using
the tim e is not m entioned. th e se phrases.
□ Last year / Two days ago /
travel abroad be a p atien t
be in hospital as a p atie n t read a novel in English
Yesterday, etc. Now use th e in te rn et to study ride a motorcycle
i
BEGI N:
M/ M/ \ 1/ Haveyou / Has anyone in your fam ily ever...?

When / Where did y o u ...?
Didyou /Howoften d id yo u ....?
• W hen you take a history, pay atte n tio n to th e
Did you...?
p a tie n t’s use of th e Past Simple an d th e Present
Perfect. Look at this statem en t from Listening 1: 3 Work in pairs. Decide th e questions you w ould ask
In recent years m any developments, both patien ts about them selves or th eir fam ily in th e past to
technological and social, have occurred. find out about:
The tim e of th e occurrence of each event is not • pain. • sim ilar illness.
specific. Look at diagram A above. • cough. • headache.
• food poisoning.
I started work as a GP in this area over 20 years ago.
The ten se is th e Past Simple. The tim e is specific.
4 Role-play a p atien t and a doctor. Ask each other
questions about th e sym ptom s in 3.
Look at diagram B above.
• Now look at th e relationship in a case history

betw een th e Present Perfect an d Past Simple. Speaking
doctor : H aveyou ever had a headache like this Work in pairs. Look at th e extract from a talk about
before? (Present Perfect) general practice in th e NHS. Student A, go to page 114.
patient : Yes. I had a similar headache three m onths Student B, go to page 116. Ask each other questions to
ago. (Past Simple) com plete th e m issing inform ation in your text.
» Go to G ram m ar reference p.123 Work w ith a p a rtn e r an d discuss th ese topics.
1 The recent history of th e h ea th care system in your
hom e country
2 The m ost im p o rtan t feature of th e health care
system s w here you come from
Working in general practice 15
civil servant (n) an employee of the precipitants (adj) factors which cause
government something
like a teacher or doctor. productive (adj) producing a substance
contributory (adj) helping to cause (like sputum)
locum GP (n) a GP who stands in for siblings (n) brothers and sisters
another doctor who is temporarily away
on holiday or off sick
Listening 2 Vocabulary
A case history Signs and symptoms
1 Before you listen to th e conversation b etw een Mr 1 Decide w h e th er these are signs or sym ptom s. Some m ay be
Bloomfield, a 28 y/o civil servant, and a locum GP, both.
Dr Dickson, look at th e notes below. W ith a partner, Condition a
discuss w hy th e p ast m edical history, fam ily history, 1 blocked nose
personal and social history, and drugs and allergy 2 raised tem perature
history are im portant. 3 ten d er over sinuses
2 Listen and com plete th e notes below. 4 headache w orse on bending
5 ru nny nose
PC Condition b
1 breathlessness
C/o breakhLestroest, 3/52
tachypnoea
1, ^rocU u± vot . tig h t chest
wbtk 'HrPwte. night and m orning coughing
prolonged expiration
HPC w heeze
Att&cks worse: _J a n d . Condition c
Cough umhes 'patient a/rovut. : times/week, 1 raised pulse
Other symptoms: chest___ 2 recent vom iting / diarrhoea
3 dehydration
Contributory causes: n o . ?precigitants; 4 abdom inal tenderness
hi/lory suggests______ 5 cram py abdom inal pain
PMH Work in pairs. Discuss w hich conditions the signs and

sym ptom s in 1 m ight relate to.
No hbfbory of- attacks
On your own, m ake a list of th e signs and sym ptom s you
PagwUyHitbory w ould expect to see in a patien t w ith a) diverticular disease
Mother/sibber: _ and b) pneum onia. Compare your answ ers for both patients
w ith a partner.
3 Work in sm all groups. Discuss th ese questions.

1 W hat is th e differential diagnosis ? Speaking
2 W hat investigations w ould you do?
1 Work in pairs. Take tu rn s role-playing th e conversation
3 W hat tre a tm e n t do you th in k should be given?
betw een Dr Dickson and Mr Bloomfield. Use the notes from
4 The doctor does not take a detailed fam ily history or th e exercise to guide you.
social and personal history because m ost of th is is
2 Discuss w h a t questions you w ould ask about conditions a, t
recorded on th e p atient's notes. If a doctor is seeing
and c above.
a p atien t for th e first tim e, w h a t questions should
he / she ask in th e fam ily history about: 3 W hat investigations could you do, if any, to confirm the
1 siblings? diagnosis in each case?
2 children?
3 close relatives?
4 parents?
5 fam ily illness?
16 Unit 2
drink socially (v) consume

alcohol with friends - not on
a regular basis
waterworks (n) the urinary
system
Vocabulary Listening 3
Non-technical language Short questions in the general history
1 W hen you speak to patients, you need to use n o n (j~i) Listen to th e last p art of th e conversation betw een
technical language th a t th e p a tie n t u nderstands. Look Dr Dickson and Mr Bloomfield, w h e n he asked some
at th e tw o exam ple questions from th e case history. questions about th e general history. W rite dow n the
W hich verb m eans precipitate an d w hich m ean s start? questions he asked about:
1 W hen do th e attacks come on? 1 ap p etite 3 w aterw orks
2 Are you aw are of any th in g th a t triggers th e attacks? 2 bowels 4 sleeping
2 Work in pairs. Replace th e technical w ords in italics
w ith non-technical w ords from th e list. You m ay have
to change th e form o fth e word.
Patient care
1 Expand th e short questions.
avoid adm it have / have got
prone do to come an d go EXAMPLE
stick to book th ere all th e tim e You been o ff work at all? - Have yo u been o ff work at all?
1 We’re going to have to perform a few tests. 1 You eating well?
2 She’s suffering fr o m a very b ad b o u t of flu. 2 Your appetite OK?
3 It m ight be a good idea to refrain fr o m fa tty foods for 3 You sleeping OK?
aw hile. 4 You passing w a te r a lot?
4 He is susceptible to m any m inor illnesses. 5 Your periods OK?
5 You said th e cough is interm ittent. 6 Had any diarrhoea?
6 Your cough is persistent? 7 Lost any w eight?
7 It’s difficult to adhere to any kind of life change. 8 Been living th ere long?
8 You w o n ’t have to be hospitalized. 9 You been keeping well?
9 You’re scheduled to see th e nurse in th e allergy clinic 10 You OK in yourself?
next Tuesday. 11 You b een looking after yourself?
3 Work in pairs. Use th e phrases below to m ake questions 2 Work in pairs. Say a full question to your partner. He /
w ith th e non-technical words. Take tu rn s role-playing She should sh orten it w ith o u t looking at th e book.
a patient w ith flu or a cough, and take a short history 3 Now do it th e other w ay round and give th e short
from each other. question first.
When....? Is there...? Do y o u /D o e s it...? 4 Take tu rn s asking each other questions from th e
Did you...? Have you ever...? / Are you / Is i t ... ?
general history using any o fth e questions above.
E XA MP L E
Are yo u prone to coughs? Are yo u booked to see...?
Do you fin d it difficult to stick to medication?
Does your cough come and go? Have y o u ever h a d ...?
Pronunciation 2 2 f t Listen to te n questions and decide w hether the

speaker's voice rises or falls at th e end of th e question.
Questions: rising and falling intonation
W rite R for rise and F for fall.
• Spoken questions usually either rise or fall at th e 1 F 5 8________
end. Short questions used in taking general history
2 ___________ 6 9______ _______
usually rise. This is because th e y are m e a n t to be a
quick checklist. The doctor is asking for a quick yes 3 ___________ 7 10 _______
or no. If falling in to n atio n w ere used, it could m ake 4 ______
th e p atien t feel th a t th e doctor is expecting a certain
3 Work in pairs. Take tu rn s reading the questions in the
answer.
listening script on page 134. Does your partner's voice
f t Listen to th e extract from th e conversation in go up or down?
Listening 3.
W hen th e doctor asks th e questions, does his voice go

up or dow n at th e end of th e questions?
Reading
1 Work in pairs. Look at th e pictures and decide which
doctor : Is your appetite OK?
social problem s th ey show.
pa tien t : Yes, I never seem to have any problem s
on th a t score.
doctor : Bowels OK?
18 Unit 2
deprivation (n) poverty pronounced (adj) evident

factors (n) causes social classes I and II (n) in the
incidence (n) occurrence classification of the population
for research purposes, the two
plateau (n) level
highest social classes
Social factors in general practice

Social deprivation is associated with services and the ^ use of out-of-hours services. Evidence shows that if services
death from all causes. The most and A&E services amongst deprived are provided, homeless people will use
pronounced effect is with circulatory communities. them.
and other smoking-related diseases. Other factors which have an effect The effects of work have been
A similar trend is seen with infant are homelessness, sleeping rough, compared to effects of vitamins - we
mortality, morbidity from chronic employment and unemployment, need a certain amount to be healthy; then
illness (particularly musculoskeletal, divorce, and immigration status. The there is a plateau, where extra doesn’t
cardiovascular, and respiratory adverse effects of living in temporary work, and too much is harmful.
conditions), and teenage pregnancy. accommodation are well documented.
This is not a new problem, nor one For example, adults have a ^ incidence
unique to the UK. It may partly be due of depression than people of similar
to smoking and eating habits, but this social standing in their own homes.
disparity was in evidence 80y ago when Children are less likely to receive their
those of social classes I and II were immunizations, more likely to have
more likely to smoke, eat foods high in childhood accidents, and have higher
saturated fats, and take less exercise. incidence of minor and diarrhoeal
Disparity in health is closely related to diseases. Among those sleeping rough,
income. In the UK, an ^ proportion of poor diet, poor accommodation, and
the population is now living on < 50% lack of access to medical services are
of average income than 20y ago - the universal problems. A study done
mortality gap has grown proportionately. in 1986 in London found one third
This has an impact on general practice. are psychotic, a quarter have severe
There is higher incidence of illness physical problems, and two-thirds have
^ requirement for primary care team no contact whatsoever with medical
2 M atch th e sym bols or abbreviations in th e text Writing

to these words. A referral letter
1 years 3 less th a n
2 in cre a se d /in cre a sin g 4 leading to / resulting in 1 Work in pairs. Look at th e referral letter on page 19 w ritten
by a GP to a specialist at a hospital for one of her patients.
3 Work in pairs. A nsw er th ese questions. Tick ( /) th e features of / points covered by th e letter.
1 W hat m ain social factors are given? 1 □ clear com m unication
2 Can you give your ow n reasons w hy those
2 □ date of referral
in social classes I an d II w ere m ore likely to smoke
80 years ago? 3 □ date of b irth of th e p atien t
3 W hat reasons could you give for th e increased 4 □ hospital num ber
incidence of depression in those living in tem porary 5 □ NHS num ber
accom modation?
6 □ p a tie n t’s nam e and address
4 Why is poor diet a problem am ong those
sleeping rough? 7 □ investigations perform ed w ith results
8 □ treatm en ts tried w ith outcom es
4 In small groups, discuss w hy th e follow ing m ay be
higher am ong th e unem ployed or those un d er th e 9 □ relevant past m edical history and fam ily history
th rea t of being unem ployed in th e UK: coronary 10 □ reason for referral
vascular disease, cancers, violence, accidents. 11 □ presenting condition
5 Discuss w h at th e situ atio n is like in your ow n country 12 □ social circum stances
in deprived areas. 13 □ clear signature
OTC (adj) over the counter

= available in a shop
Piriton (proper n) an
over-the-counter medication
to treat allergies I can use the Past Simple and
volunteer (n) a person who Present Perfect.
works without payment I can ask questions in the family history.
I can ask questions in the general history.
I can understand and use non-technical
language.
NHS Number 6684335792
Hospital Number 1017786F
22 August 2007
NHS I can write a referral letter.
Dear Dr Ahmed,
Re David Hunt 17 May 1985(M)
Keywords
18 Greencross Street, London SE5 2PD Jobs
This patient has complained of a rash which has erupted on a district nurse
number of occasions in different parts of his body on and off general practitioner
for more than three years. Recently, he has also complained of health visitor
bilateral interm ittent nasal blockage, itchy nose and eyes, watery
nasal discharge. The rashes have also increased in frequency midwife
and duration, treated on occasion with antibiotics and OTC practice m anager
medication. This does not appear to be related to allergy to pets, practice nurse
nor work or other common factors. The rash has responded to receptionist
Piriton. The patient has had allergy sensitivity testing with no
conclusive result. The patient spent several years in West Africa Nouns
working as a volunteer in his early 20s. The Africa connection may practice
have some bearing and I would appreciate your opinion. referral letter
Yours sincerely, sign
symptom
/V v /w Adjectives
prone
Adrian Davidson (Dr)
runny (nose)
tender
2 Student A look at the letter above. Student B look at the letter on Non-technical verbs
page 117 only. Ask each other questions to find nine differences in
adm it
the letter.
avoid
3 Underline all the m ain verbs in the letter. What tense book
is each verb? come and go
stick to
4 Work in pairs. Discuss w hat you would include in a referral letter
to the gastroenterologist at the hospital, Dr Mason, about a
patient you suspect of having diverticular disease. Useful reference
5 Use the checklist at the bottom of page 18 to write the letter. Oxford Handbook of General Practice
2nd edition, Simon et al,
Project ISBN 978-0-19-856581-9
1 Find these on the internet. Look for information about UK GPs'

training, work, and codes of conduct.
1 the British Medical Association (BMA):
www.bma.org.uk
2 the General Medical Council (GMC): www.gmc-uk.org
3 the Royal College of General Practitioners: www.rcgp.org.uk
4 Oxford University Press: www.oup.com /uk/m edicine/
handbooks
2 Discuss the work of a GP in the UK compared w ith similar doctors
in your own country.
20 Unit 3
3 Instructions and procedures
Checkup
1 Work in pairs. Decide w h a t pictures a - f have in
common.
2 For each picture, discuss w h a t is h ap p en in g and w h a t

you th in k happens before an d after.
3 Work in sm all groups. Talk about your ow n experienci

on the w ard for th e first tim e. W hat w as th e b est or
w orst experience you ever h a d on th e w ard ro u n d as a
junior doctor?
2 Decide w hy you th in k each tip has been given.
(j~jl Listen and com plete th e reasons given for each tip.
Use no m ore th a n five w ords for each gap.
a ... as you w a n t to dem onstrate th a t you are
Listening 1 b ... to avoid w astin g tim e ... ru n n in g around
Preparing for the first ward round

c ...so th a t you can
1 Work in groups. Discuss th ese tips for a first w ard
round w ith a consultant.
a Make sure you know th e n am es of your p atien ts and d ... because th e y m ay be m ore know ledgeable about
w here th e y are.
b Find out from th e bed m anagers if any p atien ts have e ... in th a t w ay you can
been m oved an d to w here,
c Check th a t all th e case notes, investigations, an d so
on are on th e ward, 4 Discuss w h e th e r you w ould give th e sam e tips to a
d Invite a nurse w ho know s your p atien ts to come on junior colleague in this situation. W hat additional
the w ard rounds, advice w ould you give? Think about th e consultant's
e Record case histories an d results clearly and u sual questions, drug charts, and th e p a tie n t’s hom e
concisely. care situation.
Instructions and procedures 21
In this unit
• following procedures in training
• giving and receiving instructions
• making polite requests to patients and colleagues
• understanding abbreviations
• understanding case notes
Patient care • Language spot

Work in pairs. Discuss w hy you need to do these things Giving instructions
before you carry out a procedure.
• The im perative form of th e verb can be used for giving
1 O btain consent from th e p atien t for th e procedure. very clear and direct instructions. It is very direct, and
2 Introduce yourself. in certain contexts (for exam ple a doctor speaking to
3 Prepare th e trolley. a patient), it can sound abrupt or even rude.
2 Discuss w h a t else you need to do. Infinitive w ithout to
Complete the drug charts.
Negative
Vocabulary D o n 't/D o not fo rg et to complete the drug charts.
Instructions for a procedure Adverbs
1 Use th e w ords to com plete th e instructions Always complete the drug charts.
for a procedure.
Explaining procedures
prepare m ark attach
w ash sterilize drain • The Present Simple and You are used for describing
obtain w ith d raw steps in a procedure.
You wash yo u r hands. Then yo u p u t on gloves.
a _____________ th e stylet.
Adverbs
b _____________ 10 drops of CSF into th e th ree
You clean the area thoroughly.
specim en tubes.
Negative
c _____________ th e p oint b etw een L3 /4 w here th e You don't need to p u t the instrum ents away yet.
needle is to be inserted.
d _____________ your h ands and p u t on sterile gloves.
1 W rite out in th e correct order a com plete list of
e _____________ consent for th e procedure.
instructions for a lum bar puncture.
f _____________ th e area of th e p atient's back.
2 Use th e diagram and take tu rn s explaining the lum bar
g _____________ th e equ ip m en t on th e trolley.
puncture procedure to each other.
h _____________ th e m anom eter. First, yo u prepare the equipm ent on the trolley.
A fter that, ...
3 Work in sm all groups. Choose one of th e tw o diagram s

below and prepare instructions for th e procedure.
I Work in pairs. Decide w h a t procedure th e instructions

relate to and discuss any steps th a t have been left out. IM injection Arterial blood sample
dispose of (v) throw away
fingertip (n) end of a finger
interlaced (adj) joined together
thoroughly (adv) completely
Speaking 2 Work in pairs. Look only at th e diagram s and take tu rn s

explaining to your p artn er how to w ash h is/h er hands
1 Use th e w ords and th e diagram s below. W rite
thoroughly.
instructions (using th e im perative) on h ow to w ash
your hands. Then com pare your instructions w ith a 3 Work in sm all groups. Discuss this text.
partner.
Controlled studies in hospitals have followed health care
dry soap (up) p ap er tow el dispose of workers w ith video cam eras th ro u g h th eir daily routines.
forearm s w et rub rinse M any h ea lth care professionals actually do n o t w ash their
fingers interlaced m assage bin hands and, surprisingly, doctors w ere th e w orst offenders.
handle thoroughly fingertips palm s Up to 50% of doctors do no t w ash th e ir hands in betw een
locked thum bs h an d s touch patients.
take rotationally dispenser
Is h a n d w a sh in g always necessary? W hen and w hy do you
th in k it is necessary?
u
Reading
1 Work in pairs. The tex t on page 23 describes th e practical
DOPS (Direct O bservation of Procedural Skills) procedures
on w hich train ee doctors in th e Foundation program m e in
th e UK are assessed. U nderline th e n o u n w hich you think
w ill follow th e verb in th e text.
1 provide
feedback food inform ation data
2 undertake
searches procedures surveys investigations
3 assess
th eo ry attitu d e com petence cost
4 identify
people strengths p atien ts places
5 adm inister
m edications help business pun ish m en t
6 seek
property keys tim e help
7 consider
feelings age reason cost
2 Discuss how th e verb and n o u n pairs m ight relate to a text

on assessm ent of practical procedures.
3 Read th e tex t and decide w hich alternative in italics

below m akes these sentences true.
1 During th e year, train ees are exam ined by (the sam e 5 P reparation for a DOPS encounter on the p art of the
/various) assessors. trainee needs to be (fairly / very) evident.
2 The tim ing, th e procedure, and th e observer are 6 During a DOPS, a trainee (m ay / m ust not) seek help
chosen (partly / solely) by th e trainee. from anyone else.
3 DOPS w as (created / adopted) by th e RCP. 7 Com m unication skills are (considered / ignored)
4 As p art of th e Foundation program m e, it is (expected during th e exam ination.
/suggested) th a t th e w eaknesses of each train ee in a
DOPS should be improved.
DOPS (Direct Observation of Procedural Skills)

DOPS is designed to provide feedback What is DOPS? and airway care, including simple
on procedural skills essential to adjuncts and intubation.
It is essential that all trainees
the provision of good clinical care.
should be adequately assessed Each doctor needs to satisfy a number
Trainees will be asked to undertake
for competence in the practical of criteria, some of which are given
four to six observed encounters, or
procedures that they undertake. below. Apart from overall ability
procedures, during the year with a
Directly Observed Procedural to perform a particular procedure,
different observer for each encounter.
Skills (DOPS) is a method that has the trainee needs to demonstrate
The assessors include among others
been designed specifically for an understanding of relevant
experienced specialists, appropriate
the assessm ent of practical skills anatomy and the technique of the
nursing staff, or consultants in a
and was originally developed and procedure. There needs to be a
secondary care setting. The estimated
evaluated by the RCP In keeping with clear demonstration of appropriate
time taken by each procedure
the Foundation programme quality preparation before the procedure
is 20 minutes (i.e. 15 minutes for
improvement assessm ent model, takes place as well as knowledge of
the assessm ent and 5 minutes for
strengths and areas for development the appropriate analgesia or safe
feedback).
should be identified following each sedation and aseptic technique.
Each DOPS should represent DOPS encounter. Apart from the technical ability, a
a different procedure and trainees trainee needs to seek help where
DOPS includes a range of procedures,
should choose from each of the core appropriate and demonstrate post
for example venepuncture, IV
problem groups identified in the procedure management as well as
cannnulation, the use of local
F2 curriculum by the end of the good communication skills, while
anaesthetics, arterial puncture in an
year. The trainee chooses the timing, at the same time considering the
adult, blood culture (peripheral), and
procedure, and observer. feelings of the patient.
blood culture (central). Also included
are nasogastric tube insertion
4 Work in groups. Discuss th e criteria m en tio n ed in th e

last paragraph. You m ay w a n t to look specifically at
the reasons for th e criteria and / or th e difficulty in
m eeting th e standards.
Speaking
Work in pairs. Describe th e steps in a p rim ary survey.
Work w ith a p a rtn e r from a n o th er group and take
tu rn s explaining th e steps to each other.
Listening 2
Giving instructions
1 ($$> Listen. M atch each instru ctio n w ith a picture.
d ______ e
2 (j"J) Listen to th e instructions again an d w rite th e m

dow n in note form .
3 Work in pairs. W rite th e com plete instructions.
Check your answ ers by listening to th e recording again.
g
HI WtiNBmmSmmm
harsh (adj) rude or insensitive
pop (v) move quickly or for a
short time
tilt (v) move into a slanted
position
4 W hat procedure is show n below? m You can also use I f you can / Could you ju st
+ infinitive w ith o u t to + (please) and infinitive
+ if you ca n /co u ld .
I f you can/C ould yo u ju st bend yo u r head forward
fo r me?
lu st bend your head forw ard fo r me, if you can /could.
m You can also use I'd like yo u to + verb.
I'd like yo u to ju st bend y o u r head forward fo r me,
please.
• Useful expressions for softening:

now OK that's it fin e
ju st that'sfine good
1 Work in pairs. Decide w hich of these instructions are

inappropriate to use w ith a patient.
aCould you ju st lie on your left side for me?
bIf you could ju st pop off your clothes and t h e n ...
cOn your left side, please.
dJust bring your legs up to your chest. Yes, like th a t and
5 Make a list of instructions you w ould give to a p atien t relax. I'm ju st going t o ...
to carry out th e w hole procedure. e Can you ju st bend your knees tow ards your chin and
curl your neck?
6 Work in pairs. Take tu rn s giving th e p atien t f I'd like you to stand up for me, if you can.
instructions. g Take off your shirt.
2 Complete th e sentences w ith these words and your own.

• Language spot m ake tilt pop keep
stand up cough tu rn
Making polite requests to patients
1 C an _____________ screen and undress for me, please?
• Giving instructions to a p atien t by ju st using th e
2 I need to exam ine your lower back, so if you
simple im perative can sound very harsh if a p atien t
is ill. To soften im peratives, a d d f o r m e, please. Note
w ith som e verbs this still m ight sound hard, if th e 3 J u s t_____________ for me. And again. That's fine.
instruction or request is short. 4 I'd lik e Do you need any help getting
Undress fo r me, please.
up?
Compare 5 Could_____________ head to th e left? Yes. That's it.
Bend yo u r head forw ard fo r me, please.
6 Can y o u tig h t fist for me? Fine.
• Use can / could to m ake th e instruction gentler by 7 I _____________ still for me, if you can. OK.
changing it into a request. Could is slightly gentler
th a n can.
Can yo u (just) + infinitive w ithout to +(please)? Listening 3
Can yo u ju s t bend yo u r head forw ard fo r me, (please)?
Could yo u (just) bend y o u r head forw ard fo r me,
Instructions
(please)? C j) Listen. Check your answ ers for Z above.
26 Unit 3
portfolio (n) a comprehensive

record ofyourtraining.your
CV with your work record, proof
of qualifications, records of
presentations, appraisals, praise
like thank you cards.
It’s my job
Read about Dr Franco Carulli. Find:
1 th e nam e given to a m edical team . 4 w ho deals w ith p atie n t referrals.
2 w ho supervises th e practical procedures jun io r 5 w ho leads th e w eekly w ard rounds,
doctors perform . 6 w h e n th e busiest tim e of th e w eek is.
3 w ho leads th e daily w ard rounds. 7 w ho rew rites th e drug charts.
Dr Franco Carulli
I am newly qualified. I work as a junior doctor at Alderbay hectic tim es each week, as we have to make sure all the
General Hospital as part of a medical team , or'firm ’. I patient records are up-to-date and present patients to the
work with tw o other junior doctors also in th e first year of consultant. In addition to doctors at all levels of the firm,
postgraduatetraining.O ur main aim isto learn as much there may be a nurse present, as well as undergraduate
as possiblefrom our seniors.The first people we turn students and doctors doing clinical attachm ents.
to are tw o doctors in their second year of training.They
My job also involves a wide range of duties from clerking
supervise any practical procedures we do and are available
patients, keepingthe patient lists in order, requesting
to help us when we have problems.
investigations and making sure the results are received,
Above these senior doctors there are specialist registrars. and referringand liaisingwith specialists
They are usually in charge of daily ward rounds. They also as part of a multidisciplinary team ,doing
work in outpatient clinics, deal with inpatient referrals, practical procedures, administrative tasks
teach, and undertake procedures and operations.They like rewriting drug charts, and doingTTOs.
give us instructions about w hat investigations need to be
We have to keep our knowledge up-to-date
performed. Specialist registrars are training posts fo rth e
through training from our seniors and
next grade up, consultant level.They can be bleeped at any
keepa logor record of all the special
time if we need advice or to refer a patient. If nobody at
procedures we learn and cases we see.
these tw o levels is available, we refer to th e consultants
We also have to find tim e for learning
who are responsible for our posts.
to present cases to our peers and
We see each consultant when they do their weekly other colleagues. I also find tim e
ward rounds, once on a W ednesday and th e other on a to ta lk to th e patients and
Friday morning.These rounds are th e most tense and theirfamilies!
Speaking Presentation checklist
1 It is im po rtan t to be able to organize a case □ Give a title

presentation to your colleagues an d to keep a record for □ Present history and physical exam ination
your portfolio. Work in groups. Discuss w h a t happens O Invite suggestions for diagnosis and m an ag em en t
at each stage in th e presen tatio n checklist.
□ Give investigations and results
O Ask for com m ents
□ Give th e diagnosis
□ Discuss subsequent m a n ag em en t
□ Sum m arize
□ Q uestion and answ er
Checklist
I can follow procedures in training.
I can give and receive basic instructions.
I can use the simple past.
I can understand abbreviations.
2 Work in groups of three. Prepare a case p resen tatio n on I can understand and write case notes.
PowerPoint for a p atien t w ith abdom inal aortic an eurysm (AAA)
(OHCM7 p.586) or gallstones (OHCM7 p.590) or use an exam ple
from your ow n experience. You m ay presen t th e w hole or p art of Keywords
th e presentation. Nouns
USEFUL EX PRESSIONS consent
W hat do yo u think the diagnosis is? procedure
W hat do yo u think the m an a g em en t is? tip
Are there any com m ents so far? ward round
The diagnosis is....
Adjectives
W hat do yo u think the subsequent m ana g em en t is?
multidisciplinary
To sum m arize, ...
Are there any questions? Verbs
attach
I Present one of th e cases in 2 to a p a rtn e r in an o th er group.
bleep
As you listen, take notes.
drain
4 Ask th e presen ter questions w h e n you are invited to do so. mark
obtain
5 Give feedback to th e presen ter using th e form on page 119.
pop
prepare
Writing sterilize
withdraw
Case notes
Abbreviations
1 Work in pairs. Discuss th ese case notes about a young m an w ho O/E
w as ad m itted to hospital after a road traffic accident (RTA). RTA
EXAMPLE WA R D R O U N D ENTRY SpR
TTOs
S /0 9 /0 9 WP,. M r Stone, ( p p .) d e p t badly o vern ig h t WR
0800 Vay 2p o s t KTA/KTC No v o m itin g no biood tramfiM icrn
epvfbaxd P a tien t stalrilizjed
sw ellin g b ru ising n o ted Useful reference
Obs (T )3 6 .4 BP 1 Z 0/8 0p ulse 65 Oxford Handbook for the Foundation
O/E Programme 2nd edition, Hurley et al,
PiaJt ISBN 978-0-19-954773-9
1 p o stu ra l BP, EBC, clotting/ENP., LET, U+E
2 Aim ■for (H) Later today/mune (O/P in 6/52)
VrJohn B lu n t
Bleep 7859
2 W hat do th e u n derlined item s m ean?

3 W rite a sim ilar w ard round en try for th e notes you took in
Speaking 3 above or use a case you are fam iliar w ith. Rem em ber
to keep it anonym ous. Use th e en try above as a guide.
28 Unit 4
4 Explaining and reassuring
Check up Pronunciation
1 Look at th e picture. W hich procedure do you th in k is Word stress: suffixes
about to take place?
1 M atch each suffix w hich describes a surgical procedure
to th e correct description.
Suffix Relating to
1 -ectom y a an opening betw een
2 -oscopy tw o cavities or th e outside
3 -ostom y b cutting som ething open
4 -(o)tomy c rem oval of a structure by surgery
d th e act of exam ining
2 W hat is th e stress pa ttern of each of th ese words?
1 endoscope 2 endoscopy 3 endoscopic
3 Q Listen and check your answ ers.
4 f t Listen. W rite th e n um ber (1-7) of each w ord you

h ea r nex t to th e appropriate pattern.
• • • •
• • • •
5 W hich of th ese is tru e of th e stress p attern s in three- or

four-syllable words?
1 The stress is always on th e first syllable.
2 There is no clear stress pattern.
3 The stress generally falls on th e th ird syllable from
th e end ( • • • o r • # • • ) .
6 Work in groups of three. Each choose a different

in stru m en t below and explain its purpose in your ow n
words. Then discuss how you th in k each in stru m en t is
likely to develop in th e next th re e decades.
2 Work in pairs. Discuss th e questions.

1 W hat do you th in k th e p a tie n t’s reaction to th e
instrum ents an d th e situation w ould be?
2 W hat about th e doctor’s reaction?
3 Do all patients react to in stru m en ts
in the sam e way?
4 W hat specific exam ples of p a tie n ts’ an d doctors’
reactions can you give from your ow n experience?
Explaining and reassuring 29
In this unit
• understanding and using non-technical language
• explaining complications and reassuring the patient
• acknowledging a visual cue
• writing information about complications
Listening 1 1 Change th e sentences describing procedures into the

Passive. Decide w h eth e r th e y require an agent or not.
Patient care Give a reason.
1 Listen to an extract from a talk by Dr O uinn 1 The doctor inserts th e needle.
explaining how a gastroscopy is perform ed. Make notes 2 Nurses often perform this procedure.
about th e th ree pieces of advice given to p atien ts before 3 The doctor th e n applies gentle pressure to the
th e procedure is carried out. puncture site.
4 The sister explains th e procedure to the patient.
1 anti-acid th erap y
5 The nurse cleans the skin.
2 eating
6 Doctors w ith o u t training d o n ’t perform this
3 driving
em ergency procedure.
2 Work in pairs and com pare notes. 7 The doctor taps the vein.
8 Generally, nurses don't perform this procedure.
3 W hat verb form s are used by th e doctor?
Read Language spot and check your answ er. 2 Work in pairs. Use the words to label the
diagram of a gastroscopy a-e.
• Language spot
Explaining investigations/procedures
with the Present Passive
• Active sentences say w ho is doing an action. Passive
sentences d o n 't necessarily say w ho is doing th e
action, th o u g h th e y can.
Positive
Verbs not requiring objects (by not necessary)
Active: The doctor attaches the needle to the syringe.
Passive: The needle is attached to the syringe
(by the doctor).
Note: We don't need to say w ho it is done by because
it is p art of a procedure.
Negative
Active: A doctor does not use a tourniquet in this
procedure.
Passive: A tourniquet is not used in this procedure.
Verbs requiring objects (by necessary)
Active: Only experienced doctors perform this
procedure.
Passive: This procedure is perform ed only by experienced
doctors.
Negative a a flexible tube
b side channels for introducing other instrum ents
Active: Nurses don't perform this procedure.
c a grabbing in stru m e n t
Passive: This procedure is not perform ed by nurses.
d a light and cam era
» Go to G ram m ar reference p.125 e endoscope
30 Unit 4
informed consent (n) consent

for an invasive procedure which
is given by a patient after the
procedure has been explained
We want you to be comfortable while yo u wait fo r the doctor.
Look at th e statem en ts w hich are ta k e n from a 7 Using th e diagram and sentences in 2 and 3, practise
training session for doctors. Complete th e sentences by- explaining th e procedure to a partner. You m ay m ix the
choosing a w ord from eith er th e n o u n or verb list. You active and th e passive. Use th e questions and adverbs
will have to change th e form of th e verbs you use. below to help you.
Nouns • How do yo u perform a gastroscopy?

section p atien t air • W hat is done first?
consent endoscope m ucosa • W hat is do n e/happens after...?
• First..., T h en ..., N e x t..., A fter th a t...,
Verbs
blow swallow obtain anaesthetize
advance give sedate biopsy Listening 2
1 Inform ed _____ _ i s ____ Explaining gastroscopy (endoscopy)
2 The pharynx is _ . using a spray. 1 (5^ Listen to Dr O uinn explaining th e endoscopy to a
3 The p atien t is _ .to induce drow siness. patient, Mr Beacon. W hich steps 1-8 in Language spot 3
4 T he__________ . is introduced and does th e doctor m ention?
.fu rth e r dow n th e oesophagus and
into th e stom ach an d duodenum .
.is . . into th e stom ach
via a side channel in th e endoscope to allow
visualization of th e stom ach mucosa.
6 T he_____________i s ______________ a plastic m o u th
guard to bite on.
The patien t is asked to _ .th e first
.o fth e endoscope.
8 The stom ach. ____________ is ___ _________ using
a th in ‘grabbing’in stru m e n t w hich is passed dow n a
side channel.
4 Work in pairs. Change th e statem en ts in 3 into
instructions w ith th e im perative. 2 W hich w ords does th e doctor use for th e following?
E XAMP L E 1 o eso p h ag u s_____________
1 Obtain informed consent.
2 a n a e sth e tiz e _____________
5 Take tu rn s saying th e Passive sta te m e n ts to your 3 p h arynx _
partner, w ho changes th e m into th e active. Then do it
4 flexible _
th e other w ay round.
5 b io p sy __
6 Put th e statem en ts 1-8 in 3 into th e correct order. Note
6 sedative _
some of th e statem en ts relate to p art of th e sam e step.
exam ine _
eructate _
9 visualize.
3 Work w ith a p a rtn e r and find w ords in 3 w hich have Listening 3

th e stress p a tte rn • • • .
Emphasis
4 Work in pairs. Make th ese statem en ts softer
1 Listen to the statem ents 1-8 in Vocabulary]and
for th e patient.
underline the word the doctor emphasizes/stresses
1 We're doing an endoscopy. OK? in each. Why does the doctor emphasize the words?
2 We w a n t to look at your gullet and your stom ach.
E XAMPLE
3 We'll m ake you relaxed.
1 simple
4 We'll pass a bendy tu b e into your stom ach.
5 Your stom ach w ill be looked at. 2 What do you think the doctor says w hen the patient
6 We'll take a sam ple of th e stom ach lining mentions it sounds a bit scary?
7 Air is blow n into your stom ach.
3 What do you think the doctor talks about next?
5 Compare your answ ers w ith th e tran scrip t of
Dr Ouinn's conversation. Take tu rn s explaining th e
procedure to th e p atient. • Language spot
Explaining procedures with
Vocabulary be going to future
Reassuring • Doctors need to explain procedures before they
perform them so that they can obtain patient consent.
1 The doctor uses tw o adjectives to help m ake The future w ith be going to is usually used to explain a
th e procedure less frightening and th u s reassure procedure, even when the patient has not yet agreed to
th e patient. the procedure or given consent. The be going to future
EXAMPLE is used because it is the clearest and most direct way
The tube will have a tin y camera. to give an explanation. W hen the procedure is fully
It's a routine procedure. explained, the patient can give informed consent.
W hich sentences are n ot very reassuring? We're going to give yo u a mild sedative.
1 It's a very sim ple procedure. m In addition to using the be going to future, doctors
2 We're ju st going to take som e fluid from your often use fixed expressions w ith W hat to explain
backbone. procedures.
3 You'll ju st feel slightly sore after th e test. W hat we're going to do is take a tiny sample
4 All you'll feel is a tin y scratch, no th in g more. fro m your scalp.
5 It'll take te n m inutes. W hat happens then is we are going to give you
6 It only takes a few m inutes. a mild sedative.
7 It's n ot a p leasan t procedure. W hat happens next is th a t we insert the needle.
8 You'll hardly feel anything. W hat we need to do after th a t is stitch the wound.
2 W hich of th e w ords in sentences 1-8 in 1 can be » Go to G ram m ar reference p.126
replaced by these words?
a little bit a little
small ju st
barely pinprick
straightforw ard
32 Unit 4
1 Change th e explanations to be going to fu tu re and 2 Som etim es you m ay have to give a p atien t a brief
simplify th e m edical term s. W here indicated, use an explanation of a procedure. Explain th ese conditions
expression w ith What. using th e expressions below.
1 A sam ple is tak en from th e bowel. a condition w here a procedure w here
2 Next, th e end of th e in testin es is attach ed to an an illness w here a device w hich you use to
opening on th e abdom en. (W h at...)
EXAMPLE
3 A sam ple is tak en from th e cervix.
anaemia n o t enough p igm ent in th e blood
4 After th at, a tu b e is passed th ro u g h th e urethra.
It's a condition where yo u do not have enough o f a
(W hat...)
special p ig m en t or colouring in yo u r blood.
5 The glands are th e n rem oved from th e axilla.
(W hat...) 1 appendicitis inflam ed rem ove
6 Next, a sam ple is rem oved from th e lung. (W h at...) 2 Alzheimer’s disease som eone m em ory loss m ood
7 After th a t, a tu b e is advanced dow n p ast th e pro state changes cause n o t know n
into th e bladder. (W hat...) 3 haemorrhoidectomy piles tie cut out
8 A dye is th e n injected into th e pancreatic an d bile 4 diverticulitis sac / pouch w eak points gut infected
ducts to visualize them . (W h at...) inflam m ation pain diarrhoea constipation
9 The muscle is repaired w ith a m esh. 5 sigmoidoscopy look at colon sam ple
6 anaesthesia general p u t you to sleep come round
2 Work in pairs. Decide w hich sta te m e n t in 1 m ig h t be
said during one of these tests an d procedures. 3 Work in pairs. Practise explaining th e conditions above.
One p artn er begins by asking
a cystoscopy
W h a t’s (a)..., doctor?
b radical m astectom y
4 W hich situations w ould you need consent for? Discuss
c colostomy
th e im portance of explaining consent and com pliance
d colonoscopy to a patient.
e colposcopy
f ERCP Reading
g catheterization 1 The leaflet on page 3 3 gives inform ation about
h bronchoscopy gastroscopy. Work in pairs. Look only at th e headings in
bold an d decide w h a t inform ation each p art of th e tex t
i herniorrhaphy
contains.
2 Find w ords or phrases in th e tex t w ith th e sam e

Speaking m ean in g as:
1 Work in pairs. Explain tw o of th e procedures in 1 avoid food
Language s p o t! above. Use th e structures in 1 and 2 calm
rem em ber to reassure th e patient. 3 use an ything m echanical
4 a friend to take you hom e
FURTHER USEFUL EXPRESSI ONS
5 n o t ioo% reliable
Is there anything y o u ’d like m e to go over/repeat?
6 a painful pharynx
OK? Is everything clear / OK sofar?
sip (n) a very small drink of liquid
Work in pairs. Decide w h a t questions you w ould ask 1 W h at/n eed 4 -6 hours before
to obtain th e answ ers in 2. Use th e w ords 2 H ow /sedative/feel
in th e tex t to help you m ake th e questions. 3 W h at/n o t/d o
Use these notes to help you. 4 W hat /n e e d /a fte r th e operation
5 How successful/test
6 W hat/som e people have afterw ards
Are there any side effects or complications

from having a gastroscopy?
o
What preparation do I need to do?
Most gastroscopies are done without any problem.
Som e p e o p le have a mild sore throat for a day or so
afterwards.You may feel tired or slee p y for several
hours if you have a sedative. There is a slightly
The hospital departm ent will usually give you
in creased risk of d eveloping a chest infection or
instructions b efore your test.T hese com m only include:
pneum onia following a gastroscopy.
■ D on’t eat for 4-6 hours before the test. The stom ach
n eed s to b e empty. (Small sips of water may b e Occasionally, the en d oscop e cau ses som e dam age
allow ed up to two hours before the test.) to the gut.This may cause b leed in g, infection,
■ If you have a sedative, have som eb od y accom pany and rarely, perforation. If any of the following occur
you hom e. within 48 hours after a gastroscopy, consult a doctor
■ If you are taking any other m edication, tell your im m ediately:
doctor. It may n e e d to b e stop p ed b efore the test. ■ Abdom inal pain
■ Fever
What can I expect after a gastroscopy? ■ Difficulty breathing
Most p e o p le are ready to go hom e after resting ■ Vomiting blood
for half an hour or so. A small num ber of p eo p le have a heart attack
If you have had a sedative, you may take a bit lon ger to or stroke during, or soon after, a gastroscopy. These
b e ready to go hom e. The sedative will normally m ake serious com plications are rare in most p eo p le who
you feel quite pleasant and relaxed. However, you are otherw ise reasonably healthy.
should not drive, operate m achinery or drink alcohol
for 24 hours after having the sedative. You will n e e d
som ebod y to accom pany you hom e and to stay with
you for 24 hours until the effects have fully worn off.
Most p e o p le are able to resum e normal activities after
24 hours.
Is gastroscopy reliable?
Gastroscopy is a g o o d test for se e in g abnorm alities in
the upper gut. However, it is not foolproof. For exam ple,
gastroscopy may not detect a sm all num ber of ca se s of
early ulcers or early cancer.
4 Work in pairs. Take tu rn s explaining to a p atien t th e

preparation for th e procedure and th in g s to be careful
about afterw ards. Use th e answ ers 1-6 in 2 to guide you
and add other inform ation from th e text.
Vocabulary
Explaining complications
and reassuring the patient
1 Work in pairs. U nderline th e adverbs of frequency
in the sentences below an d th e n p u t th e m in order,
starting w ith th e least frequent.
1 Procedures like this are usually done u n d er sedation.
2 We often get p atien ts w ho have no com plications.
3 Fortunately, w e have never h ad a p atien t w ho has
h ad serious com plications w ith th is procedure.
4 The procedure rarely goes w rong.
5 It always takes m e a w hile to recover from an
anaesthetic.
6 Patients som etim es get a headache afterw ards.
2 W hat synonym s do you know for th e adverbs above?

1 It’s b e tter to let it all out rath er th a n bottling it up.
2 You look very hap p y to be going hom e.
Listening 4 3 I can see you’re a bit alarm ed by th e procedure.
4 You look rath er nervous about this.
Discussing complications 5 I can see you’re in pain.
1 Work in pairs. Discuss th e possible com plications of a 6 You look a bit confused by w h a t I’ve said.
gastroscopy. Complete each doctor's response above by adding the
2 Listen and list th e com plications th e doctor m ost suitable developm ent below to reassure or show
m entions. th a t h e /sh e cares.
E XAMP LE
3 Why does th e doctor point out th e side effects to th e
1 b
patient?
a W ould you like m e to get you som ething?
4 W hat phrases does th e doctor use for occasionally, b But rem em ber you are very lucky w e caught it early,
automatically, an d seldom? c But w e ’ll soon give you som ething to help you relax.
5 Listen again and list th ree w ays th e doctor m akes th e So th ere is no need to worry,
com plications less th reaten in g . d So w ould you like m e to go over it again for you?
e So I w o n ’t keep you long,
f But it w o n 't take long and it’s pain-free.
Speaking 3 Work in pairs. Discuss w hat other ways you could
1 W hen doctors see a p atien t show ing em otion, th e y acknowledge the visual cues in 2. What would you do
can m ake a com m ent or observation. This is called in your own country?
acknowledging a visual cue.
4 Work in pairs. Discuss the complications of the
M atch each picture a - f w ith a statem en t 1-6. procedures below. Give at least two common
complications in each case.
a haemorrhoidectomy e chemotherapy
b colonoscopy f pleural aspiration
c bloodtest g ERCP
d lum bar puncture
bsg.org.uk/index.php Checklist
medicinenet.com Assess your progress in this unit.
oxfordjournals.org Tick (/ ) the statements which are true.
medlineplus.gov I can explain procedures to patients.
patient.co.uk
I can explain complications and reassure
the patient.
I can understand and acknowledge visual
cues.
Project I can understand and use non-technical
Find inform ation on th e w ebsites above about th e com plications language.
involved in doing gastroscopy an d oth er procedures. I can write information about complications.
Writing Keywords
1 It is im p o rtan t th a t p atien ts are inform ed n o t ju st of benefits but
Nouns
also of possible com plications. Work in pairs. M ake a list of th e
endoscope
com plications involved in:
gastroscopy
• doing an arterial blood gas (ABG) informed consent
• IV injections instrum ent
2 In each case, m ake notes on w h y th e com plications (can) sample
occur, w h e n th e y (can) occur, an d th e chances of th e p a tien t telescope
having them . visualization
3 Choose one of th e tw o procedures an d decide th e th re e or four Suffixes

m ost im p o rtan t com plications. -ectomy
-oscopy
4 W rite a section for a w eb page en try explaining th e -ostomy
complications. Use th ese tips to help you.
Adjectives
1 Look at th e reading on page 33 an d th e script for Listening 4 on
foolproof
page 135. Use w ord an d expressions from th e se sections.
sore
2 Use bullet points if necessary.
3 W rite no m ore th a n 150 w ords in total. Non-technical words
4 W rite about each com plication separately. backbone
5 Use th e follow ing w ords an d expressions to help you: bendy
sometimes, occasionally, rarely, som e people, there are some come round
people, not everyone. go over
6 Try to use th e Present Simple Active an d Passive an d th e numb
im perative for actions. pinprick
7 Avoid using th e Past Simple. throat
5 Work in pairs. Take tu rn s explaining th e com plications. Reassure
th e p atien t w here possible. R em em ber to show em otion and
acknow ledge th e visual cues!
Useful reference
Oxford Handbook of Clinical Medicine
USEFUL E XPRESSIONS
7th edition, Longmore et al,
You sound a b i t/ a little / slightly...., if la m right.
ISBN 978-0-19-856837-7
It sounds asif...
You appear very...
You seem really...
W hat I have ju s t said seems t o ...
It looks like this news has cheered yo u up a lot.
You look as if...
36 Unit 5
5 Dealing with medication
Check up Patient care

1 Classify the drugs a -h according to type. 1 There are guidelines for prescribing any drug in the
hospital. Discuss why these are im portant and w hat might
go wrong if you do not follow them.
Paracetamol 1 Always consult the BNF when prescribing
Cyclizine for children.

2 Consult your seniors when in doubt.
3 Check if the patient has allergic reactions
Salbutanol to drugs.
□ 4 Check if the patient is a responsible person,

5 Check for alternatives to drugs.
HAmoxicillin
f Ranitidine
H Chlorphenamine
Diazapam
1 ______ antibiotic
2 ______ analgesic
3 ______ antiem etic
4 ______ sedative / hypnotic
5 ______ g astrointestinal
6 ______ an tih istam in e
7 ______ cardiovascular
8 ______ respiratory
Work in pairs. Discuss th e benefit of each drug given.

US EF UL E XP RE SS I ON S
It is used t o ...
I t’s prescribed in order t o ...
It helps...
In th e United States, drugs are approved for use by th e

Food and Drug A dm inistration (FDA) an d in th e UK by
the N ational Institu te for Clinical Excellence (NICE).
Which body licenses / approves drugs in your country?
Discuss th e argum ents for and against m aking generic W hat other guidelines do you think should be followed
versions of n ew m edicines available in every country. before prescribing on or off the ward?
Dealing with medication 37
In this unit
• talking about medications
• understanding drug charts and abbreviations
• explaining benefits and side effects
• understandingand using patient language
• completing a clinical incident report
Vocabulary Listening 1
Abbreviations A drug chart
1 M atch th ese com m on prescription abbreviations w ith 1 Study th e chart below and m ake sure you understand
th eir m eaning. th e abbreviations, headings, and so on.
1 PO a in th e m orning
Patient Dob Hospital No
2 prn b tw o tab lets
Mrs T Hawthorne 04.02.63 1834572Z
3 stat c by m o u th / orally
4 od d im m ediately Drug Date
5 g e gram
6 ft f as required
Route Dose Start Time
7 om g once a day / 24h
50 mg
Work in pairs. Say th e m ean in g of th e se abbreviations
Max Frequency Max dose / 24hr Dose
used in adm in isterin g drugs.
600 mg 50 mg
the frequency of drugs: Indications for Use Route

on, bd, tds, qds, 4-6h, 8h, 1-4h
the route of administration: Signature Pharmacy Given by

IV, IM, S C , PR , INH, N EB A S m ith /
measurements:
|jg, mg, ml
3 Work in pairs. Take tu rn s reading th is ch art aloud. Say

th e abbreviations as com plete words.
Drug Dose Freq Route 24 h M ax
paracetam ol lg qds PO 4g
loperam ide 4 mg PRN PO 16 m g
ranitidine 150 m g bd PO flOOmg
atorvastatin 10 (10-80 mg) od PO 80 m g
EXAMPLE
2 (J7> Listen to a doctor checking th e chart w ith a
Give the p a tien t one gram o f paracetam ol fo u r tim es a colleague and com plete th e m issing inform ation
day by m o u th up to a m a xim u m o f 4 grams. in th e chart.
Give betw een ... a n d ....
Give up to a m a xim u m o f....
concordance (n) a process generic (adj) general, non
whereby the doctor / prescriber specific
and the patient cooperate master’s (n) a postgraduate
in the prescribing process degree: an MA / MSc
to maximize the taking of
scope (n) range, capacity
medication
Joyce Came
I work as a nurse practitioner (NP) at New York City education, as a nurse practitioner I am able to specialize
Hospital, la m a registered nurse who has completed in an area of study I desire and provide care within the
specific advanced nursing education. I have a master's scope of my expertise.
in cardiovascular medicine and training in th e diagnosis
I may treat both acute and chronic conditions, as well as
and m anagem ent of common medical conditions in this
prescribe medications and therapies for the patient at
specialty.
hand.Thecore philosophy of the field is individualized
I provide much of th e sam e basic, non-emergency care care. Nurse practitioners focus on patients'conditions as
provided by physicians,generally o fth e type seen in well as the effects of illness on th e lives of the patients
their specific practice areas like family practice offices, and theirfam ilies. Informing patients about
urgent care centers, and rural health clinics, and maintain their health care and encouragingthem
collaborative working relationships with physicians. to participate in decisions are central
As an NP, I am licensed by th e state in which I practice to th e care provided by NPs. w B w
through th e NCC (National Certification Corporation)
A major concern for myself and other
for specialty practice. Rather than a generic focus of
medical practitioners at all levels
is concordance, once a drug has been
prescribed. Concordance involves a
process of prescribing and
medicine-taking; it is a kind of
partnership. It is not just a m atter of
explainingthe benefits of prescribed
drugs and the side effects which can
som etim es happen, but which may not.
Improvingconcordance is about
involvingthe patient in making
decisions about the treatm ent.
Speaking It’s my job

Work in pairs to practise com pleting a p a tie n t’s chart. 1 Work in pairs. Read th e te x t and th e n answ er the
Student A go to page 114. S tudent B, go to page 117. questions.
1 Is concordance a cause for concern for Nurse Carne
and her fellow NPs ?
2 W hat type of conditions can she treat?
3 W hat does she consider th e central philosophy of
w orking as a nurse practitioner?
4 W hy does she feel her p atien ts need to be involved
in tre a tm e n t decisions?
5 W hat specific post-graduate train in g has she
undergone?
6 How does her w ork com pare w ith th a t of
physicians?
In groups, discuss w ho you th in k should have th e right 2 (5^ Listen and m ake notes for each blank space in i.
to prescribe medicine. Do n o t try to w rite dow n every word.
Do you have nurse practitioners or nurses w ith sim ilar

roles in your country? Describe th e ir roles regarding
adm inistering an d prescribing m edicine.
Listening 2
Benefits and side effects
1 The sentences below are from an explanation of
th e benefits an d side effects of aspirin to a patient,
Mr Johnson, w ho is being discharged after an
uncom plicated MI. Work in pairs. In your ow n words,
com plete th e blank spaces in th e doctor’s sentences.
1 I’ve got som e good new s for you. You’ve m ade

_____________ an d w e're going t o ______________. 3 Compare your notes w ith a p artn er and th e n w rite the
2 First, I’d ju st like to have a brief chat w ith com plete sentences.
y o u _____________ 4 (jj) Listen again and check your answ ers.

3 If at any tim e you w a n t to stop m e an d ask 5 Look at th e listening script and see how close your
questions,______________T here’s a lot of answ ers were.
inform ation to take in at one tim e. 6 W ork in pairs. Take tu rn s explaining th e benefits and
4 We’re going to give you a very sm all dose of 75 mg. side effects of aspirin.
It’s a m uch sm aller dose th a n y ou’d norm ally buy
over th e counter. You take i t _____________ Speaking
5 The aspirin w ill help you a lot, a s _____________
1 W ork in pairs. A nsw er th e questions below about the
and s o ______________ doctor in Listening 2. Does th e doctor:
6 And I em phasize th e w ord possible, 1 use sim ple non-technical language?
But I ju st have to p o in t th e m out, so 2 keep th e drug regim e simple?
th a t you are aw are of th e m an d can do som ething 3 explain th e function of th e m edication clearly?
4 ask th e p atien t to repeat th e inform ation given?
about it if anyth in g happens.
7 Sometimes, people g e t______________ 2 Does th e doctor involve th e p atien t in m aking decisions
about taking th e m edication? W hy/W hy not?
Or aspirin can m a k e ______________
Or it can c a u se ______________ 3 If you th in k th a t th e doctor could have done more, w hat
could he have done?
4 Work in pairs. Take tu rn s explaining the benefit and
side effects of aspirin again. If you need help, check the
script on page 135.
• Language spot Language spot
Phrasal verbs Explaining side effects: can/m ay
• In Listening 2 th e doctor says to th e patient: • W hen you explain th e benefits of a drug to a patient,
There’s a lot o f inform ation to take in a t one time. you state w h a t th e drug does. To show th a t a drug
or m edicine causes side effects in som e people, it is
• The verb to take in m eans h ere to understand. It is a
im p o rtan t to u n d erstan d th e difference betw een can
separable phrasal verb because you can separate th e
and may. Both w ords are used to express possibility
verb take an d th e particle in:
and are often used interchangeably. However, can
It is difficult to take in inform ation. indicates a theoretical possibility w hile m ay indicates
t t
verb particle a real possibility. Compare:
That door can be locked.
It is difficult to take inform ation in.
= It is possible to lock th a t door. Right now, it is either
t t
verb particle locked or unlocked.
That door m ay be locked.
• The verb to get up is an exam ple of an inseparable = It is possible th a t the door is locked right now. I f it is
phrasal verb because you cannot separate th e verb locked, we w o n ’t be able to open it.
and th e particle:
I f you can, take the medication soon after can
you get up in the morning. • Can is used to say th a t a side effect is possible.
t t This medication can cause som e stom ach irritation.
verb particle = It is possible fo r this medication to cause some
Rewrite these sentences using th e phrasal verbs. stom ach irritation.
You m ay have to change th e form of th e verb and you Here, can indicates th a t stom ach irritation is a
m ay be able to separate th e particle from th e verb, possibility. To reassure patients, you can em phasize
tak eo u t w rite out point out cut dow n th a t th e side effect is theoretically possible, bu t not of
look at get in touch w ith get into serious concern to th e p a tie n t you’re talking to.
1 The doctor identified a few benefits an d This occasionally causes stom ach irritation in some
a few side effects. people.
2 You could keep a pill box w ith th e days of th e w eek Sometimes, people get stom ach irritation w ith this, but
on it and remove th e tab lets each day. it isn't usually a problem.
3 Completing a prescription requires great care. may
4 Don’t forget to read th e instructions on th e label.
• M ay also expresses th a t a side effect is possible.
5 Try to adopt a routine for taking m edication
This medication m ay cause som e stom ach irritation.
if you can.
= It is possible th a t this medication will cause some
6 Contact th e hospital im m ediately if any th in g
stom ach irritation.
changes.
7 It works by reducing th e w orkload of th e heart. In this case, m ay indicates th e possibility of the
sta te m e n t being or becom ing true. The w ord m ay in
this sense is frequently stressed, and indicates th a t
stom ach irritation is a strong possibility. You m ay
w a n t to em phasize this.
There’s a strong possibility th a t this will upset your
stomach.
» G oto Grammar reference p.126
feel ill (v) be nauseated
Speaking
Work in groups of three. Discuss th e benefits and side
effects of th ese drugs for a p atient at discharge w ho
has h a d a mild, uncom plicated MI. See page 34 to
review adverbs of frequency.
Atenolol GTN spray Simvastatin
Benefits
Side effects
Take tu rn s explaining the m edication to your partners.

USEFUL EXPRESSIONS
A nd like aspirin...
In som e cases the tablets ca n ...
Some p e o p le...
There are som e p eo p le...
Is everything clear sofar?
How do yo u fe e l about taking this medication?
Do yo u think yo u will be able to rem em ber to take them
as prescribed?
Also try to use som e of th e phrasal verbs from
Language spot on page 40.
The th ird stu d e n t should listen an d give feedback
1 Use th e w ords to com plete th e sentences. using this grid, w here 1 is th e highest.
possibility will probably Feedback form

m ay can m ay not 1 Using sim ple language 1 2 3 4 5
1 In som e people, it can cause a fleeting headache, 2 Deals w ith th e benefits 1 2 3 4 5
b u t it d oesn’t m ean y o u _____________ get one. 3 Deals w ell w ith the side effects 1 2 3 4 5
2 Theoretically, th is can cause low blood pressure, 4 Involves th e p atien t 1 2 3 4 5
but y o u w o n ’t have a problem . 5 Checks th e p atien t has understood 1 2 3 4 5
3 Some people get blurred vision, b u t i t ____________
hap p e n in your case.
Play back th e recording to
4 There’s a s tro n g _____________ th a t th is w ill u p set
your classm ates. Use th e
your stom ach. In fact, it m ay m ake you feel really ill. feedback form to discuss the
5 Swelling of th e ankle is n o t com m on, b u t it is conversation.
possible - i t _____________happen.
6 T his_____________ m ake you feel dizzy, so you
should be careful w h e n you drive. Readers should note that
BNFis regularly updated and
2 Work in pairs. W rite sentences like those i n i ab o u t th e that the current edition is
benefits an d side effects of th e sedative diazepam . available at BNF.org.
42 Unit 5
complementary (adj) balanced Statistics for concordance in General Practice in the UK

factor (n) cause, element Sufficient concordance to attain therapeutic objectives occurs
regimen (n) course of about 50% of the time.
treatment, schedule 1:6 patients take medicine exactly as directed; 1:3 take medication
as directed 80-90% of the time; 1:3 take medication 40-80%
of the time; the remaining 16-17% take medications directed
<40% of the time. 20% of prescriptions are never cashed.
Reading
1 Read th e tex t an d answ er th ese questions. Besides providing inform ation, w h at effective w ays
1 W hat features of n ew m edicines should m ake can im prove compliance?
people take th e m edicines prescribed to them ? W hat is m ore im p o rtan t th a n increasing com pliance
2 W hich m edicines are least likely to be ta k e n by patients? in p atien ts?
3 W hich group is m ore likely n o t to take m edicine W hat do patien ts need to be helped to make?
prescribed because th e y do no t believe th e illness W hat can be of help to b o th th e individual and th e
is there? general population?
Concordance
Non-compliance in medicine taking Factors associated with Health professionals should respect
is a long-standing problem in all poor compliance include: patients’autonomy and accept that
therapeutic areas, includingthe • complex regimens involving multiple increasing compliance with prescribing
treatm ent of cancer.There is strong doses and several medicines instructions is not as important as
evidence that, despite the introduction • unwanted side effects meeting patients’ individual needs and
of new medicines which have fewer side • concerns about the value or priorities. Patients need help to make
effects and are more convenient to use, appropriateness of taking medicines informed choices about treatm ent. For
many people still do not take them as in particular contexts example, there is a need to differentiate
prescribed-even when not doing so • denial of illness,especially among clearly between situations where
can have life-threatening consequences. younger people varying the timing or quantity of
Medicines prescribed for preventive • confusion or physical difficulties medicine doses may do little harm or
associated with medicine taking, even be beneficial, and situations in
purposes are especially likely not to
which most frequently affect which there is a high probability of
be taken as prescribed.This may be
older people adverse clinical outcomes.
because people do not feel immediately
threatened and, in the case of Effective ways of improving Improvements in self-management
symptomless conditions such as raised compliance rates involve the skills and compliance in medicine
cholesterol levels and hypertension,feel complementary use of educative, taking can generate significant benefits
no obvious benefit at th e time when practical, and emotionally and for individuals and the population
medicines are taken. behaviourally supportive interventions, as a whole. Combining medication
ratherthan the provision of information reviews with other forms of timely and
alone.There is evidence that, regardless appropriate support for patients and
of the specific knowledge imparted, carers represents an important route
self-management programmes towards better and more cost-effective
which help to raise people’s sense of use of medicines.
self-efficacy and confidence promote
better medicine taking.
2 Work in groups. Discuss th e q uestion of com pliance Project

am ong patients in your country by:
Search th e w eb an d check references to clinical
1 answ ering questions 1-7 in 1. incident reporting in UK hospitals. Find out w h a t is
2 com paring th e statistics at th e top of page 41 w ith involved in th e procedure.
those for your ow n country, if th e y are available.
1 Is such reporting a good idea?
3 giving exam ples of non-com pliance an d effective
2 W hat is it called in your country and w h a t
ways of dealing w ith it.
h ap pens there?
Checklist
Tick (/ ) the statements which are true.
I can talk about medications.
I can understand drug charts and
abbreviations.
I can talk about the benefits and side
effects of medications.
Writing I can understand and use patient language.
Clinical incident reporting I can write / understand a clinical incident
report.
1 Look at th e sam ple clinical incident reporting form below.
Name of staff involved Grade and specialty Agency/locum Key words

C.J. F lint PPHO M edicine N /A Nouns
Brief details of incident: benefit
Patient m m -prescribed angm entin 625m g/8k PO, despite side effect
pen icillin allergy (this mm stated on drug chart). This Abbreviations
m m noted by the pharm axltt and the p a tien t did n o t bd
take any angnenttn. The team PPHO m m contacted and g
an alternative antibiotic im m prescribed. IM
INH
IV
2 W ithout looking at th e form in !, expand th e notes below into
NEB
full sentences.
od
om
N otes
on
pcctLentpreM rdyccM x^menttn/62 5 wufrf 8h/pO
PO
p en ic illin / a lle r g y state/ cm d ru ty cKant. n oted/
PR
p h ccn m xM sU tp atL ert n x t ta k e /a u g m e n tin g
prn
V r Venefyteawv
qds
c o n to rt cttern u tlve/ cutdnotU>prena/dye/
SC
stat
3 Complete tw o clinical incident reporting form s from th e notes tds
below. In each case it w as a ‘n e a r m iss’incident. tt
ID N otes
patientjbuAna^ênll 200 meg U>up to 1 mg. drug Useful reference
chart / p a tien t epileptic, noted Duncan p a tien t
nottakc Jlum ciênli Vr Zhou team contort Oxford Handbook for the Foundation
alternative drug Programme 2nd edition, Hurley et al,
ISBN 978-0-19-954773-9
S3 N o tes
prescribe tetracycline 250-500 / 6k drug chart
p a tien t photosensitive noted pharm acrftp a tien t
n o t take drug Vr Harper team contact alternative
4 In groups, discuss clinical incident reporting. Give exam ples from

your experience. Discuss w hy th e procedure is im p o rtan t for th e
patient, th e hospital, an d for you an d /o r your colleagues.
5 Is it difficult to ad m it m istakes like th is in all cultures?

Give reasons an d exam ples.
44 Unit 6
6 Lifestyle
Check up
1 Work in groups. Describe th e lifestyle factors w hich th e
pictures below represent.
M atch each statem en t below w ith th e m ost Work in pairs. Discuss w h e th e r th e attitudes of the
appropriate picture. people in th e statem e n ts in 2 are positive or negative.
Discuss th e illnesses th e people in pictures a and c
When I exercise 1 I can't see anything
m ight be predisposed to. Is it easy to change people’s
regularly, I feel healthy. wrong with eating
lifestyle habits? W hy/W hy not?
s v - — — fatty food. I’ve never
been sick in my life. W hat do you th in k are th e best w ays to encourage
I wish I could stop

snacking.
y people to change th e ir exercise / eating habits?
5
I’m worn out and it's
making me ill.
V " -----
I feel eating healthy
food will help me fight 6 I can’t live without my
off infection. cigarettes and drink.
Lifestyle 45
In this unit
• asking about family history and social history
• understanding lifestyle changes from
the patient’s perspective
• encouraging and motivating patients
• talking with patients about their lifestyles
Listening 1 2 Work in pairs. Compare your choices.

Family history and social history 3 Look at th ese statem en ts and decide w hich, if any, fit
best w ith th e ranking you have given for each choice.
To help patien ts change th e ir lifestyles it is im p o rtan t
to know som ething about th e ir fam ily an d social 1 /** 5
history. Otherw ise, any en couragem ent to change I don’t see why I need I know it’s bad, but I
m ay n o t fit in w ith th e p a tie n t’s lifestyle. to change. enjoy it/them .
(j j ) Listen. Decide w h e th e r th e doctor is asking —

about th e fam ily history (F) or social history (S).
1 2 ______ 3 _______ A" ■N
It’s impossible for me to I can see the advantages
change at the moment. of changing, but I’m
2 Listen again an d w rite dow n in n ote form th e
not sure I can do it.
questions th e doctor asked in each case.
3 Work in pairs. Compare your notes an d m ake

full questions. Trying to change habits 7 *— “.............. ..................... \
like this only makes me 1 want to change.
4 W hat ten ses are used in th e questions? 1 just have to make
nervous.
5 W hat oth er questions can you ask about: the effort.
S > ------------------------'
1 hom e? 3 hobbies? 5 m oney problem s?
2 occupation? 4 alcohol? 6 changes in habits?
When I try to give up
6 If you try to advise patien ts w ith o u t know ing th e som ething (like eating
inform ation in each conversation, how could it less chocolate), I tend to
annoy or w orry th e patient? do it even more.
7 Work in pairs. Ask each oth er questions about

th e topics in 5 .
4 Look at th e pictures. W hich do you th in k reflects your

Speaking ow n attitu d e w h en people are trying to help you
change habits?
1 Choose at least tw o th in g s below w hich you yourself
find difficult to change. Rank each choice on a scale
of 1 to 5 w here 1 is easy an d 5 very difficult.
1 2 3 4 5
eating chocolate
snacking b etw een m eals
avoiding stress
drinking fizzy / sugary drinks
drinking te a / coffee
not doing exercise
smoking
driving a car
other
46 Unit 6
achievable (adj) able to be

reached
devise (v) produce / create
kick (v) give up
regime (n) plan
settle into (v) get used to
5 Askyour partner to explain the reasons behind 2 Add one of th e phrases 1-7 to th ese sentences. You m ay
the choices, the ranking, and the statem ents they use each phrase only once. You m ay need to change the
have chosen in 1 and 3. form of th e verb.
USEFUL EXPRESSIONS 1 Once y o u , you’ll begin to notice some
I t’s not easy t o ... I ’ve tried m a n y tim e s ... im provem ent.
I keep going back...
2 If y o u _____________ a n d set yourself achievable
M y friends /fa m ily / colleagues do the same, so ...
I know the advantage, b u t... aim s, you'll be m ore likely to succeed.
M y fa m ily /frien d s w ant m e t o ... 3 It is difficult t o _____________ , b u t once you have got
6 Discuss this question in groups. Why do you think it into i t ...
is necessary to consider patients’beliefs, emotions, 4 Have you th o u g h t of gettin g som eone to help you
willingness in helping them to change lifestyle habits? ?
5 Start sm all and th e n try t o _____________
Vocabulary 6 It’s b ette r t o _____________th a t fits into your daily
Language for exercise routine.

7 _____________ is no t easy, b u t it is n o t im possible to
1 Match each verb w ith the best noun phrase to create
general advice for exercising. break them .
1 take up Work in groups. Decide w h a t you th in k are th e three

a some physical activity m ost im p o rtan t ideas 1-7 from 2 .
b minor changes
Introduce m ore specific exam ples for sentences 1-7
2 kick in 2. You can choose from th is list: light or strenuous
a a new routine walking, sw im m ing, a brisk walk, visit a gym, cycling,
b old habits gettin g off th e bus one or tw o stops earlier, running.
3 stick to USEFUL PHRASES
a a new regime You c a n /c o u ld ... For example, if...
b the am ount of exercise you do gradually
Take tu rn s talking to each o th er about taking up m ore
4 settle into
exercise and th e risks and th e benefits. You can refuse
a old habits
to accept th e advice by using one of th e phrases from
b a new routine
Speaking 3 on page 45.
5 increase
a the am ount of exercise you do gradually
b a new regime
6 make
a old habits
b minor changes
7 devise
a your own exercise programme
b some physical activity
Advice for doctors taking
a social history from a patient:
Probe without prying.
— Oxford Handbook
o f Clinical Medicine
Speaking Listening 2
Work in groups. Discuss th is qu o tatio n from th e Being sympathetic
Oxford Handbook o f General Practice, 2nd edition.
Look at th ese statem ents. W hat are th e doctor
Increasing stress is a featu re of society as a w hole.
and p a tie n t talking about? Then listen and decide
GPs score tw ice th e natio n al average on stress te st
w hich statem en ts are true. Check your answ ers w ith a
scores.
partner.
Discuss w h a t you th in k are th e th ree m a in causes of 1 The p a tien t has tried to diet before.
stress faced by doctors in general practice. State one 2 The p a tie n t has tried to stop eating crisps and other
m ain effect of stress on a doctor’s clinical work, th e ju n k foods in th e past.
general practice, an d hom e life . 3 The doctor suggests a gradual approach.
W hat actions can doctors take to reduce th e stress th e y 4 The doctor is sym pathetic to th e p atie n t’s situation.
can face at work? 5 The p atien t is reluctant to try th e approach
suggested by th e doctor.
The British M edical A ssociation (BMA) offers a 6 The doctor suggests taking up yoga as an exercise.
confidential stress counselling service for m em bers. 7 The p a tie n t’s excuse is to do w ith injury.
Are th ere sim ilar services in your ow n country?
2 How w ould you describe th e doctor’s approach:
sensitive or annoying?
Writing 3 W ould th e doctor’s suggestions w ork in all cases?
Help with stress Give exam ples.
Work in groups. Discuss situations w h ere you w ere (or 4 Work in pairs. Take tu rn s role-playing th e doctor and
a colleague was) facing stress. encouraging Mr Ford, w ho is 110 kgs and 1.80 m etres
ta ll w ith a w aist size of 110 cms, to lose w eight through
Work in groups. Describe to each oth er situations
exercise. Use th e BMI chart to help you explain.
w here you h a d to deal w ith your ow n stress or helped a
W E IG H T IN KG
colleague to do so.
40 50 60 70 80 90 100 110 120 130 140 150
A fellow doctor has m en tio n ed in an em ail to you th a t .1 I I I 1 I I I I 1 I

98
he is stressed in his n e w GP practice in A ustralia. He 96
m entions: 94
92
• too m uch w ork 90
• rapid changes in technology

• th e fact th a t he never takes breaks
• he is relu ctan t to talk to his colleagues an d fam ily as
he does no t w a n t to appear weak.
W rite a reply m en tio n in g one or m ore of th e above

factors an d describe a real p ast situ atio n w h ere you
faced stress an d how you dealt w ith it.
9 10 11 12 13 14 15 16 17 18 19 2 0 21 22 23 24 25
W E IG H T I N S T O N ES
Underw eight Normal O verw eight Obese M orbidly Obese

• Language spot 2 Work in groups. Discuss w h a t encouragem ent you
w ould give to a p a tie n t w ho is trying to lose w eight.
Encouraging patients You m ight w a n t to talk about:
and making suggestions
—foods to avoid:fatty foods, salt / sugar, crisps,
• Vocabulary on page 46 show ed w ays to encourage
patients to change th e ir lifestyle. In addition to
biscuits, cakes, etc.
those, you can also use m odals to m ake suggestions. — -fibre
For tentative suggestions, you can use th e m odals — white -meat vs red -meat
could / can / might. — dairy products: skimmed miffc /
You could (for example) g et o ff the bus one stop early. sewi'skimMced
You can (for example) g et o ff the bus one stop early. — ways o f cooking:grilling, steximing,poaching,
You m ight like to try (for exam ple) getting o ff th e bus bailing, udng vegetaMe oil, notfrying
one stop early. ■
— snacking
• Should / shouldn't / ought / o u g h tn ’t to are used — 5portions and preferally -morefmit
for strong suggestions. But be careful. These can be and vegetables a. day
annoying ra th e r th a n encouraging an d are probably — (oily)fd k 2 / 3 times a. week
best avoided. — drink 2-4 Litresflu id daily, i.e. water, nottea. /
You should give up smoking. aicohoi
You shouldn’t eat fa t t y foods.
» Goto Grammar reference p.127 3 Work in pairs. Take tu rn s encouraging each other to eat
a m ore h ealthy diet.
1 Rewrite th e sentences below usin g th e w ords in
brackets.
1 You should try to take it easy for a couple of days and Patient care
have a couple of days off. (Have you th o u g h t o f ) 1 W ork in pairs. Decide w hich of th ese best explains
2 You should step up th e exercise very gradually. sym pathy and w hich em pathy.
(It’s better)
1 u n d erstan d in g th e patient's feelings because you
3 Spend m ore tim e on a physically d em an d in g form of
have seen other p atien ts in sim ilar situations before
exercise. (You could)
2 a m ixture of self-experience an d u n d erstan d in g of
4 Eat w h ite m eat or fish w here you can ra th e r th a n red
th e p a tie n t’s condition
m eat. (Instead of eatin g red m eat)
3 u n d ersta n d in g w h a t th e p a tie n t is feeling because
5 You should do som ething w hich w ill get you o u t an d
you have experienced it yourself
about. (Try and)
4 an u n d erstan d in g of w h a t th e p a tie n t is feeling
6 You should have a balanced rath er th a n a crash diet.
based on clinical know ledge
(You might)
Facts and figures on smoking
In the UK, 12 million adults smoke cigarettes and
a further 3 million smoke pipes and cigars.
Prevalence: highest aged 20-24
- Oxford Handbook o f General Practice
mini-targets (n) short-term aims or goals
2 Work in pairs. Below are five statem en ts m ade Speaking

in doctor / p a tie n t role-plays. Decide w hich are
1 Work in groups of three. Discuss h o w to deal w ith this
sym pathetic an d w hich em pathetic. Are any of th e m
role-play scenario. R em em ber to consider th e p a tie n t’s
very personal?
point of view.
1 I know it’s n o t easy to change hab its because I’ve
faced th e sam e problem s myself. A 50 year-old m ale patient, Mr Harding, is ju st about to
2 Giving up sm oking isn ’t easy, b u t have you th o u g h t be discharged from hospital. He has smoked
perhaps of cu ttin g dow n gradually? at least 20 cigarettes a day for m ost of his adult life.
3 W hen people try to m ake changes like this, at first it Talk to him about stopping completely.
seem s difficult.
4 I appreciate it’s difficult, b u t have you th o u g h t of th e 2 Decide on five criteria you th in k should be included in
advantages of giving up? th e assessm ent of a candidate role-playing the scenario
5 I know w h a t it’s like because I have b een th ere in a n exam . Use th e speaking checklist on page 120.
myself.
3 Take tu rn s role-playing th e scenario in 1 as a patient, a
3 Are th e personal statem en ts appropriate? Will th e doctor / candidate, and an exam iner. The role-play lasts
p atien t respond to them ? How could you m ake th e m 5 m inutes. The exam iner uses a stopw atch to tim e the
less personal? role-play and listens to th e role-play, checking it using
th e speaking checklist.
4 Using sym pathy w ith a p a tie n t helps you discuss an d
negotiate. In pairs, discuss strategies to answ er th e 4 At th e end of each role-play th e doctors / candidates
patient's ‘b arrier’ statem en ts below. Use or ad ap t one say how th e y have done, using th e checklist. The
of th e sta te m e n ts in 2 or one of your own. exam iner should th e n give constructive feedback.
■\ 4 5 .Work in groups. Discuss th e difficulties of encouraging

It’s impossible for me I find it difficult to stop
changes in lifestyle. You m ay w a n t to talk about these
to give up drinking eating between meals.
points: im position, n o t know ing th e w hole story,
alcohol.
annoying th e patient.
■V I I haven't
have really got the
I’ve tried to stop I time to do any exercise.
smoking, but I can’t.
y
I can't take any time
off work as we are
very busy.
5 Work in pairs. Take tu rn s replying to statem en ts

1-5 in 4. Develop th e answ er by nego tiatio n w ith th e
patient, giving suggestions ab o u t settin g m ini-targets,
m onitoring progress, an d m otivating th e patient.
6 Work in groups. Discuss w hich w ays of neg o tiatin g and

encouraging th e p a tie n t are th e best.
50 Unit 6
Overweight and obesity pose a major risk to long-term health

by increasing the risk of chronic illnesses. In 2005,7.4 million
people aged 18 years and over (54% of the adult population) were
classified as overweight or obese, an increase from 5.4 million
adults (45% of the adult population) in 1995.
-Australian Social Trends 2007
Reading
1 Before reading th e text, com plete th e sentences 3 Obesity affects long-term h ea lth b y _____________
w ith your ow n ideas. ^
The cost of obesity in A ustralia w a s _____________
1 Obesity is th e result o f_____________ 5
_____________ a higher rate of o b e sity ____________
2 Lifestyle factors associated w ith obesity g
Self-perception of ow n body w eight am ong m e n and
a re _____________
older w o m en has im plications fo r_____________
Overweight a n d obesity
Overweight and obesity have become O verw eight Perceptions of o w n w eigh t
world-wide concerns, reaching and obesity trends For many people, particularly men
epidemic proportions. Obesity is In 2004-05, more than half (54%) and older women, self-perception
caused by an energy imbalance of all adults, or 7.4 million people of acceptable weight’ differs from
where energy intake exceeds energy aged 18 years and over were either the standard BMI definitions.
expended over time. This imbalance overweight or obese, an increase This may have implications for the
has been linked to lifestyle factors from 45% (5.4 million adults) in m anagement of healthy body weight
such as increased consumption of 1995. Using age-standardized data, in adults. In 2004-05, more than half
foods with high levels of sugar and the rate of overweight adults has of adults (63% of males and 59% of
saturated fats, as well as a reduction increased from 33% in 1995 to females) considered themselves to be
in physical activity. 36% in 2004-05, while the rate of of acceptable weight. The proportion
Overweight and obesity obesity in adults has increased from of males (32%) and females (38%)
pose a major risk to long-term 13% to 18% over the same period. who considered themselves to be
health by increasing the risk of Each of the national health surveys overweight was considerably lower
chronic illnesses such as diabetes, conducted since 1995 has reported a than those who were classified as
cardiovascular disease, and some higher rate of overweight and obesity overweight / obese according to their
cancers. It has been estimated for males than for females. BMI (62% and 45% respectively).
that obesity and its associated Between 1995 and 2004-05,
illnesses cost Australian society and after adjusting for differences in
governments a total of $ 2 1 billion the age structure of the population,
in 2005. In July 2006, the Australian the proportion of people in the
Government implemented a five- overweight and obese BMI categories
year, $500 million program , the who considered themselves to be
Australian Better Health Initiative, of acceptable weight increased.
aimed at reducing the impacts of In 2004-05, almost half (47%) of
chronic disease, which includes a males and around one-fifth (2 1 %)
focus on prom oting healthy weight. of females who were overweight or
This article discusses adults who obese considered themselves to be
were classified as overweight or obese of acceptable weight. This compares
according to their body mass index with age-standardized rates of
(BMI), based on self-reported height around one-third (35%) for males
and weight. and 12% for females in 1995.
2 Now read th e tex t an d find th e sentences in 1. Compare Work in pairs. Discuss w h e th e r th e m edical profession
the tex t w ith your ow n answ ers. alone can change perceptions about lifestyle, w eight,
exercise, sm oking an d drinking.
Checklist
I can ask about family, social and personal
history.
I can understand the Past Simple.
I can encourage and motivate patients.
Pronunciation I can talk with patients about

their lifestyles.
Word stress in noun phrases
In a n o u n phrase th e stress can often fall on either th e first
or second word. The p lacem ent of th e stress usually affects th e Key words
m eaning. Listen. U nderline th e syllable in each case th a t takes Nouns
th e m ain stress. BMI (Body Mass Index)
• • • • • • • diet
1 A ustralian governm ent empathy
• • • • # • • exercise
2 A ustralian governm ent habits
hobbies
2 M atch each pronu n ciatio n in 1 to a m eaning. lifestyle
a It w as th e A ustralian governm ent, n o t th e N ew Zealand mini-targets
governm ent. obesity
b It w as th e A ustralian governm ent, n o t th e A ustralian m edia. overweight
routine
3 Work in pairs. Scan th e te x t in Reading on page 50 an d find
stress
th ese phrases.
sympathy
1 epidem ic proportions 5 associated illnesses
2 energy im balance 6 A ustralian society Verbs
3 lifestyle factors 7 chronic disease devise
4 cardiovascular disease 8 h e a lth surveys encourage
kick
4 Decide w h ere th e stress falls in each w ord in th e pair as it occurs motivate
in th e text. U nderline th e stress w hich is m ore im p o rtan t in each settle into
pair. take up
5 Listen an d check your answ ers.
6 Work in pairs. Read aloud altern ate paragraphs. Useful reference

Oxford Handbook of General Practice
Project 2nd edition, Simon et al,
ISBN 978-0-19-856581-9
Search th e w eb an d find out about conducting research in th e
m edical field.
UK websites:
• Research in th e NHS: w w w .dh.gov.uk
• N ational Research Register (NRR):
w w w .update-softw are.com /national
• Royal College of General Practitioners (RCGP):
w w w .rcgp.org.uk
• Funding: w w w .redinfo.org.uk
See also pages 92-93 Oxford H andbook o f General Practice, 2nd
edition.
52 Reading bank
Reading bank
1 ‘TV doctor’
Join these w ord com binations used in
the text. Then check your answ ers in Machines let physicians
the text.
1 develop people
make rounds from a distance
2 focus on a chest X-ray
r i e s d a n i e l was waiting in his hospital room the m orning after
3 order a cough
4 m anoeuvre th eir rounds bladder surgery w hen the door finally swung open. But it wasn’t
5 make care his doctor. Instead, a robot rolled in, wheeled over, and pivoted
6 depersonalize f th e chart its 15-inch video-screen ‘head’ tow ard the 80-year-old lying in
7 isolate th e robot his bed at Baltimore’s Johns Hopkins Hospital.
‘G ood m orning,’ said a voice from the robot’s speaker. It was Louis
2 Read th e text. Are these statem en ts Kavoussi, D aniel’s urologist. His face peered down from the screen
true (T) or false (F)? atop the 167-centimetre-tall device dubbed D r Robot. ‘So, how was
1 A robot cam e to visit Ries Daniel your evening? No problem s?’
the evening after his operation. Studying his patient through an image beam ed back to his office
2 Louis Kavoussi, D aniel’s urologist, by D r Robot’s video camera, Kavoussi was concerned because Daniel
spoke to D aniel from a m achine had ru n a fever overnight and developed a cough. ‘You’re not looking
called Dr Robot. as good as yesterday,’ said Kavoussi, zoom ing in the cam era for a
3 The p atien t developed a fever closer look after having focused on Daniel’s chart m om ents before.
during th e course of th e day. ‘I didn’t have my m artini,’ said Daniel, m anaging a smile.
4 An abdom inal X-ray w as ordered ‘Well, let’s see how you are feeling later on today,’ Kavoussi said.
by Dr Kavoussi. ‘If you’re feeling better, we’ll send you hom e, all right?’
5 Robots are being used by doctors After telling Daniel that he was ordering a chest X-ray and
to talk to each other as w ell as other tests, Kavoussi tweaked a joystick to m anoeuvre the robot
patients. back to the hallway.
6 Some people feel robots allow Such robot-assisted exchanges are being repeated in dozens
doctors to spend m ore tim e w ith of hospitals across the country by doctors who use the m achines
th eir patients. to make their rounds, m onitor intensive-care units, respond to
em ergency calls, and consult with other physicians.
3 Correct th e false statem en ts w ith
Proponents say this and other new ‘telemedicine’ technologies are
a word or words from th e text.
allowing doctors to use their tim e more efficiently and serve more
4 Find words w hich m ean: patients, often at odd hours or in rem ote places where the sick would
1 supporters or those for otherw ise have a hard tim e seeing a doctor.
2 disbelievers or those against. ‘There’s a trem endous am ount of medical care being provided
from a distance today through technology like this,’ said Jonathan
D Linkous, executive director of the Am erican Telemedicine
Association.
Sceptics, however, fear that the technology is further depersonalizing
health care, accelerating the trend of doctors spending less and less
tim e with their patients, and eroding what rem ains of the doctor-
patient relationship.
‘This is a trium ph of the m odel of m edicine that has abandoned
the idea o f personal interaction and providing com fort in favour
of a m odel of the patient-physician interaction as essentially an
exchange o f information,’ said David M agnus, a Stanford University
bioethicist. ‘You can see a face, but there’s no touch, no laying on of
hands, no personal contact. We’re increasingly isolating people in
a sea of technology.’
2 Medicines
KN O W YOUR M EDICINES
1 Look at th e title an d th e pictures
If you or someone you care for is taking medicines,
and skim th e article quickly.
it is important to have the right information.
Who is th e te x t w ritte n for?
Modern medicines are safe and effective. But to
a Pharm acists get the most out of your medicines you need
b The general public to know how to use them - and, where
c Doctors appropriate —how to choose them. But
where do you go to get the facts and advice
Z W hat is th e m ain topic of th e article ? you need? Some people turn to friends and
a Advice for p atien ts on obtaining neighbours, to books and magazines and,
m edication cheaply increasingly, the internet. But for expert advice near
b Advising pharm acists where you live, shop, or work, ask your local pharmacist.
about w h a t th e general public Ask an expert
should know Pharmacists are experts in medicines and can help
c Advising people ab o u t know ledge you to make the right choices. They are highly trained
of m edication in all aspects of medicines and their professional code
ensures that any information you share remains
3 M atch h ighlighted w ords in th e
confidential, This expert knowledge can help you
tex t w ith th ese m eanings.
understand more about your medicines so that you
1 shops can use them safely and effectively.
2 unorthodox / unconventional
Medicines matter
/ traditional
3 herpes sim plex To protect the public, all medicines must be tested and officially
authorized to make sure that they are safe and produced to a quality
4 ask for help from som ebody
standard. There are different types of medicines. Some are only
5 guarantees
available on prescription, others are only available from pharmacies, and
6 obtain th e m axim um there are a small number that can be bought from other retail outlets.
benefit from To be sure that you get the best product and advice for your needs, ask
7 insects w hich infest th e hair your pharmacist, the expert on medicines.
8 approved
Everyday health
4 A nsw er th ese questions. Your pharmacist can supply medicines for a range of minor problems
1 How are m od ern m edicines and can advise you about the best way of treating problems such as
described? coughs and colds, sprains and bruises, headlice, cold sores, and skin
2 How can people get expert advice? problems. To get the best advice, explain how long you have had the
problem and how it makes you feel. Give the names and dosages of any
3 How is public safety protected as
other medicines you are taking and don't forget to mention any herbal
regards m edicines?
or other complementary remedies.
4 How should people obtain th e best
advice from pharm acists? If you don't feel comfortable about discussing your health f l
at the pharmacy counter, you can speak to the pharmacist y X 5 -^ ''
5 W hy do som e m edications need to
in a quiet area away from other customers. v {
be ta k e n w ith food?
6 Do you th in k pharm acists Getting the most from your medicines ' i
should be allow ed to prescribe Always read the instructions on the label or in the leaflet. If you are
m edications? Why? W hy not? unsure about how to take your medicines, then ask your pharmacist.
Medicines work in different ways.
• Some are taken before you eat so they get into your system quickly.
• Some need to be taken on their own as they don't work properly
if taken with certain foods, herbal preparations, or other medicines.
• Some are taken with or after food because there is a chance that
they could otherwise irritate your stomach.
Together, you and your pharmacist can work out how best to choose and
take your medicine so that it fits in with your daily routine.
3 Assessment
CASE S T U D Y
1 Skim the tex t and m atch each
heading to th e appropriate p art of understanding assessment
the case study (A or B). D r Liam Sullivan, FI Doctor, M anchester
1 Talking about being assessed
2 Talking about filling out p a r t a Finding tim e to fill out assessment forms with my senior colleagues was
assessm ent form s quite difficult at the start o f my placement. I was too focused on getting
that perfect case w here I could perform really well. I later realized that
2 Use these sentences to fill in th e the idea of the assessments was not to score brilliantly throughout but
gaps in th e text. to show the progression during the year. Having the assessments and
receiving feedback helped me improve my practice - it’s definitely
a The feedback has helped m e better to complete some assessments early on. Keeping this in mind,
realize th a t th is can often I m ade sure I kept the assessment forms close to hand. I’ve found that
benefit th e te a m and p atien t whilst I’m on call is the best tim e to pick up cases.
care. 1
b Individual com m ents can be
Case-based discussion gives you a good opportunity to raise concerns
added in th e questionnaire an d w ith your consultant. I had adm itted an elderly lady with ascites and
are listed w ith your results, chronic renal failure w ho was suffering from dehydration. W hen I
c Being able to follow a case was trying to rehydrate her, she received too m uch fluid and slipped
you’ve ad m itted all th e w ay into pulm onary oedema. I felt guilty and thought I had given her poor
through to discharge gives you a treatm ent.
2
com plete overview,
d Being able to discuss this case
Multi-source feedback
w ith m y consultant reassured
The multi-source feedback assessment tool we used was the M ini
me th a t I h ad m an ag ed th e case
Peer Assessment Tool (M ini PAT), which I found very useful. W hen
appropriately and im proved m y starting work, fellow colleagues som etimes com m end your actions.
know ledge on th e subject for th e Occasionally a senior will be im pressed and m ention it to you. Rarely,
future. however, does anyone write it down, w hich is one of the reasons this
tool is so valuable.
3 Find w ords in th e te x t w hich are
th e opposite of: pa r t b How it works
1 junior Each foundation doctor is responsible for nom inating his or her own
2 make worse assessors. These may include any m em ber o f the team from consultants
3 possibly to FIs, sisters, and allied healthcare professionals. They each receive
4 little a questionnaire covering many aspects of your perform ance from
medical knowledge to professional attitude.
5 innocent
Once completed, they are sent anonymously to a central office. You
6 criticize also complete the questionnaire and the results are collated to present
7 m ildest your self-appraisal ratings against your chosen assessor’s ratings and
the national average.
3
The results
It can be disconcerting reading criticism, no m atter how constructive.
In my M ini PAT, I received a com m ent that I could improve my
practice by discussing clinical m anagem ent with my seniors more
frequently. I had felt that I didn’t w ant to bother my seniors with m inor
m anagem ent issues.
4
Top tips
Plan which placem ent you’ll be completing the assessment in
ahead of time, make sure that you choose the m axim um num ber of
assessors possible, and finally don’t forget the harshest assessors
are often your friends.
4 The language barrier
1 Before you read, w ork w ith a p a rtn e r and
discuss th ese questions.
Dark side of sunny Spain for
1 Have you ever used a n in terp reter
during a consultation? Describe w h a t
Britain's elderly expatriates
it w as like. Was th e in terp reter a
professional? Was it easy or difficult It is a familiar sight in any British almost a third relying on hand
to talk to th e patient? hospital - older women in blue gestures and phrase books.
2 Are th ere any advantages or sashes staffing a makeshift charity Jill Porter Smith, 75, who retired
stall in a busy corridor. But here in here from Cambridge 25 years ago,
disadvantages of using interpreters? Denia Hospital on Spain’s Costa volunteers at Denia Hospital five
2 Read th e article an d answ er these Blanca, the volunteers have no days a week. ‘Most of our clinics
time to serve tea. The expat-run now have a sign over the door
questions. charity Help is indispensable, saying, “Non-Spanish speakers will
1 W hat th ree th in g s is th e charity Help providing interpreting and not be seen without an interpreter,”
providing British patients? sometimes nursing and aftercare but with only a handful speaking
for the growing number of British fluent Spanish in a community of
2 W hat are Spanish doctors refusing
patients that pass through here. over 40,000, our volunteers are
to do? Tens of thousands of British settlers stretched to the limit. It’s not
3 How is th e lang u ag e b arrier affecting pursuing a dream retirement in the unusual to deal with British people
consultation tim e w ith expats? sun have doubled the population in who have lived here over 20 years
4 How m an y expat British p atien ts use this area in the past two years - and and complain about medical staff
put a growing strain on a creaking not speaking English. Because
h an d gestures an d phrase books to
Spanish health service. waiters and barmen speak English,
com m unicate? Now Spanish authorities say they they expect doctors to.’
5 How do expats abuse th e Spanish are placing an unbearable burden The society is now calling for
h ealth care system ? on scant medical resources and extra resources to deal with the
are demanding that the UK pays rising costs. Regional health
3 Complete these sentences using th e for their care. And in a move likely authorities complain that providing
highlighted w ords in th e text. There are to send a chill through the expat drugs, health, and social care for
m ore w ords th a n sentences. community, Spanish doctors - even more than a million ageing Brits
those who speak English - are - and to a lesser extent, Germans
1 The large num bers of British people now refusing to treat anyone who and Dutch - is crippling, prompting
settling on th e Costa Blanca are cannot speak Spanish without an the Spanish Health Minister, Elena
increasing t h e ____ interpreter present. Salgado, to demand an annual £40m
on th e Spanish h ealth service. Dr Diego Vargas, a spokesman from the UK government.
for the Spanish Society of General She says expats abuse the system
2 Research by th e Spanish Society of Medicine, says the language by using health facilities without
General M edicine indicates th a t a barrier is a medical ris k . ‘It makes registering as residents. ‘Many are
m inority of expats can diagnosis difficult - even doubling relocating to Spain and receiving
w ith staff. consultation time - and can give rise medical treatment for serious
3 The Spanish Society of General to serious misunderstandings and conditions more quickly and of a
errors, for which the doctor will be high standard unavailable to them
M edicine is now asking for e x tra ____ held responsible.’ on their own NHS but, as many of
to help w ith th e rise in expenditure. Research by the society shows a these are ‘invisible’ residents and
4 The charity Help, w hich is ru n large increase in expats presenting have no appropriate medical cover,
by expats, is ____ to th e expat with serious conditions at hospitals Spain is recouping only a fraction of
com m unity. throughout the Spanish costas, but the costs of treating them,’ she told
fewer than 10 per cent can fellow ministers.
5 Dr Diego Vargas says th a t th e lack communicate with staff, with
of clear com m unication is a m edical
6 M any expats, according to

th e Spanish H ealth M inister, d on’t
have suitable m ed ical____
56 Reading bank
5 The nocebo effect

1 Work in pairs. A nsw er these questions. T H E N O CEB O E FFEC T :
1 W hat is th e placebo effect? p l a c e b o ’s e v i l t w i n
2 Do you know w h a t th e nocebo

effect is? Scan th e first tw o A
paragraphs for negative words. en years a g o , researchers stumbled onto a striking finding: women
Predict w h a t the nocebo effect
m eans.
T who believed that they were prone to heart disease were nearly four
times as likely to die as women with similar risk factors who didn’t hold
such fatalistic views.
2 Scan the tex t and find th e words The higher risk of death, in other words, had nothing to do with the usual
w hich are described below. heart disease culprits - age, blood pressure, cholesterol, weight. Instead, it
tracked closely with belief. Think sick, be sick.
1 I am a tw o-w ord verb an d I m ean
That study is a classic in the annals of research on the ‘nocebo’ phenom
fo u n d by accident.
enon, the evil twin of the placebo effect. While the placebo effect refers to
2 I am a tw o-w ord plural n o u n health benefits produced by a treatment that should have no effect, patients
m eaning issues th a t are often experiencing the nocebo effect experience the opposite. They presume the
associated with an illness. worst, health-wise, and that’s just what they get.
3 I am a long w ord m eaning ‘They’re convinced that something is going to go wrong, and it’s a self-
something which is perceived fulfilling prophecy,’ said Arthur Barsky, a psychiatrist at Boston’s Brigham
as an occurrence orfact. and Women’s Hospital who published an article earlier this year in the
4 I am an adjective an d I am Journal of the American Medical Association beseeching his peers to pay
connected w ith predictions w hich closer attention to the nocebo effect. ‘From a clinical point of view, this is
come tru e or are certain to come by no means peripheral or irrelevant.’
tru e because th e y create th e right Barsky s target is drug side effects, which cost the U.S. health system more
than $76 billion a year, according to a 1995 University of Arizona study. If
conditions.
even a small percentage of those costs are caused by patient expectations of
5 I am a verb in th e -ing form an d
harm, addressing the nocebo effect could save a niffy sum.
I am used w ith w ords like problem, But co nvincing do cto rs th a t th e ir p atien ts’ problem s m ay be m o re th an
etc. I m ean to deal with / tackle / b iochem ical is n o sim ple trick. The noceb o effect is difficult to study, and
focus on. m edical tra in in g leads d o cto rs to seek a b o d ily cause for physical ills.
6 I am a verb an d I m ean used a term ‘Nocebos often cause a physical effect, but it’s not a physically produced
fo r the first tim e. effect,’ said Irving Kirsch, a psychologist at the University of Connecticut in
7 I am a n o u n an d I am a collection Storrs who studies the ways that expectations influence what people expe
of words. rience. ‘What’s the cause? In many cases it’s an unanswered question.’
The word nocebo, Latin for ‘I will harm,’ doesn’t represent a new idea -
3 Read the tex t and find: just one that hasn’t caught on widely among clinicians and scientists. More
1 an exam ple of w o m en dying than four decades after researchers coined the term, only a few medical
because th e y th o u g h t th e y w ere journal articles mention it. Outside the medical community, being ‘scared
likely to have h e a rt disease. to death’ or ‘worried sick’ are expressions that have long been part of the
popular lexicon, noted epidemiologist Robert Hahn from the Centers for
2 an explanation of th e w ord placebo.
Disease Control and Prevention in Atlanta.
3 the annual cost to th e U.S. h e a lth
Is such language just hyperbole? Not to those who accept, for example,
system of drug side effects. the idea of voodoo death - a hex so powerful that the victim of the curse
4 th e nam e of a psychologist w ho dies of fright. While many in the scientific community may regard voo
studies th e influence of people’s doo with scepticism, the idea that gut reactions may have biological conse
expectations on th eir experiences. quences can’t be simply dismissed.
5 the m eaning of nocebo. ‘Surgeons are wary of people who are convinced that they will die,’ said
Herbert Benson, a Harvard professor and the president of the Mind/Body
4 In groups, discuss w h eth er you th in k Medical Institute in Boston. ‘There are examples of studies done on peo
the placebo or nocebo effects have any ple undergoing surgery who almost want to die to re-contact a loved one.
influence on treatm en t. Close to 100 per cent of people under those circumstances die.’
Reading bank 57
6 Salt caves
1 Work in groups of three. Before Halt caucH
you read th e article discuss
w h e th e r you agree w ith these
Little can penetrate the solitude next door, called the Jolly Inn.
statem ents. Give reasons and
and soothing effects created from ‘They relax more easily and
examples. the roaring of the waves or the forget the things they do on a
1 Finding w ays to relax is v ital smell and feel of saltwater. But daily basis. When you come in
for people in m odern w ork exactly how is a Midwesterner that door,you leave everything
environm ents. in the United States supposed to behind you.’
2 H ealth care system s should temporarily escape the everyday Sparkling, white stalactites
fund w ays to help people relax pressures of work,family, hang down from the ceiling of
finances, and other worries? The the cave, which also features a
and change th e ir lifestyles.
answer isn’t in the Bahamas, but pillar of sea horses hand-carved
3 A lternative therap ies are
rather next door to a Polish buffet from the salt. A mermaid statue
invaluable in our m odern w ay on the north side of Chicago. sits peacefully in the corner as
of life. There, Barrington resident Ewa soft light illuminates seashells
Decide w h e th e r th ese statem en ts Chwala has successfully recreated and coloured stones on the walls.
the experience of a seaside Strategically placed black lights
are tru e (T) or false (F).
getaway, complete with comfy provide an exotic ambiance and
1 Galos Caves has not succeeded beach chairs. One 4 5 -minute a feeling that you’ve not only left
as a venture. session at Chwala’s Galos Caves Chicago, but Earth itself.
2 A session at Galos Cave is is like three days at the sea.The While breathing in the
equivalent to a w eek by th e sea. artificial cave,containing 16 tons warm, refreshing, salty air,the
3 Galos Cave is n o t a n atu ral of Black Sea salt, transports background noise of crashing
phenom enon. visitors to another world. Chwala waves, marine life, and calming
4 Salt caves are rare in Eastern decided to bring the salt therapy music removes you even further
concept to Chicago three years from the outside world.
Europe.
ago after experiencing salt caves ‘I read about how good salt
5 In Europe, salt caves are used as
in Poland during a vacation with therapy is supposed to be,’ Debie
a form of treatm en t. her husband, Stanislaw. Gajewski, 53 ,of Niles said before
6 The atm osphere at Galos Cave is Salt caves are common in trying out the salt cave for the
other-worldly. Eastern Europe, said Chwala, first time. With her was Lorraine
7 The only sounds in th e cave are who is originally from Poland. Stukenberg, 75 , of Chicago, who
th e w hispers of clients. Europeans lookingto improve also had never been to a salt cave.
their health often visit the caves Gajewski said she was hoping
3 Correct th e false statem ents. as part of rehabilitation, she said. the visit would provide some
Find w ords an d phrases in th e tex t ‘Lots of people come in and they relief from her fibromyalgia and
w ith th ese m eanings. enjoy it,’ said Chwala, 4 8 . She severe allergies. In addition to
and her husband also own the helping people recharge their
1 relaxing smorgasbord-style restaurant batteries, salt therapy may be
2 place of escape beneficial for a whole host of
3 regain th e ir stren g th health issues.These include
4 huge num ber sinus problems,asthma,chronic
5 proof pneumonia and bronchitis, and
skin conditions.
5 Look back at th e statem en ts Fox River Grove family practice
in 1 above. Have you changed physician Michael Reilly said he
your mind? isn’t aware of any hard evidence
on the healing powers of sea salt.
Still, the idea that salt therapy
helps people feel better makes
sense, said Reilly, who specializes
in holistic medicine.
7 Children’s sleep
C h ild re n 's sle ep
Complete these questions w ith a w ord
from the text. Once u p o n a tim e, n o t so long ago, w h e n th e clock struck the
m agic hour, in a land w here th e bedroom ’s centrepiece w as indeed
1 W hat u sed to h ap p en w h en th e clock
th e bed, children w ould quietly lis te n 1 to a story u n til th e sleep fairy
th e m agic hour?
carried th e m off to th e lan d of nod. There th ey s le p t 2 peacefully
2 W hat have electronic____ done to th e
th ro u g h th e night, w aking up feeling alert next m orning, to liv e 3
bedroom s of m any children?
h appily ever after.
3 Are there n a tu ra l____
in sleep need? Alas, today, th e electronic parap h ern alia of m any a kid's bedroom
4 W hat is th e effect o f____ children off have tran sform ed it into a tim e-free extension of cyberspace, w ith
to bed too early? th e sleep fairy and th e lan d of nod having been zapped by aliens
5 Is during th e day necessary from p lan et 'm essenger-m sn’.
beyond four years? Why?
Are w e too lax w ith th e ir sleep? W hen should th e y go to bed
6 W hat is th e ____ to adequate sleep
an d how m uch sleep do th e y need? At all ages th ere are natu ral
for kids?
differences in sleep n e e d - th e r e ’s no fixed am ount. H ealthy
7 W hat comes w ith a regular
five year olds need 10-12 hours, eight year olds, 9-11 hours, and
b e d tim e ?
for early teens it's 8-10 hours. The earlier to bed, th e sooner th e y ’ll
2 A nsw erthe questions in i. w ake up, and th e re ’s no point in packing th e m off too early unless
others w a n t peace an d quiet; otherw ise it’s an early m orning
: Work w ith a partner. Are th e
w a k e -u p 4 - probably for all concerned. D aytim e napping is not
highlighted words used in th e te x t as a
usually necessary beyond four years, especially as it delays bedtim e
verb, an adjective, or a noun?
an d shortens night-tim e sleep.
verb adjective noun
The key to adequate sleep is w h eth er kids get u p 5fairly easily in
1 listen □ □ □ th e m orning, are alert and happy for m ost of th e day, and not too
2 slept □ □ □ grouchy. Younger children persistently sleep deprived (even having
3 to live th e ir sleep in terru p ted by snoring an d breath in g difficulties) seem
□ □ □
n o t to be sleepy, b u t irritable, ‘overactive', seek constant stim ulation,
4 w ake-up □ □ □ an d can’t concentrate for long. Such sym ptom s can be m istaken
5 get up □ □ □ for m ild ADHD (attention deficit hyperactivity disorder). For older
6 switch-off □ □ □ children and teenagers, though, sleep loss ju st m akes th e m sleepy
an d grum py.
4 Work in groups. W hich paragraph
m entions w ays for children to obtain Sound sleep comes w ith a regular bedtim e routine, quietening dow n
a sound sleep? Are th ese solutions and, ideally, having had plenty of m ental stim ulation and exercise,
effective? Why? W hy not? Are th ere as th is fatigues b o th body and brain, w h en th e ow ners will be w orn
others? out an d pleased to go to bed anyway. Ban th e electronic fu n at
bedtim e for th e youngsters, an d have an agreed sw itch-off 6tim e for
th e teenagers. Reading in bed is fine - it probably w o n ’t be for long
as sleep w ill soon overtake them .
M ost kids have th e occasional bad night, often th ro u g h worry. TLC

usually does th e trick, and only a p a rt of th a t lost sleep needs to be
recovered anyw ay - obtained from an early night. N ightm ares are
com m on b u t best forgotten, only of concern if th e y cause distress
th ro u g h o u t th e day.
As for th a t bedtim e snack, it can be fun, b u t d o n ’t overdo it, as kids
d o n 't suffer from 'night-tim e starvation’ and, by th e way, neith er do
adults - it’s largely a m yth.
8 Expressions
What a half-smile xeally means
Work in pairs. In each section 1-7 of
th e text, a w ord is in th e w rong place. Simple annoyance or outright rage?
Move it to th e right place. Think you're good at reading people? th a t signal w hen a person is wilfully
Most people feel th ey are, but actually suppressing or unconsciously
2 Find th e nou n s in th e te x t w hich miserably at it, fail confusing a half repressing an emotion.
com plete th ese phrases. smile w ith approval w h en it signals In conjunction w ith his book
1 facial_____________________ co n tem p t,' or accepting an expression E m otions Revealed, Ekman has produced
of apparent confidence while missing tw o CD-ROMs to train anyone, in under
2 true _____________ th e concealed fear th a t lies ben eath it. an hour, to spot fleeting expressions and
3 nonverbal _____________ M isreading facial expressions interpret emotions they m ight miss
and th e em otions underlying th e m if otherwise th e y were distracted by a
4 em otional _____________ in a lot of m isunderstandings and person's gestures or tone of voice .6
5 recognition _____________ results m iscom m unication ,2 Often The Micro Expression Training Tool,
th e failure comes from an inability to or METT, covers concealed emotions,
6 train in g _____________ recognize m inute expressions - micro and th e Subtle Expression Training
expressions th a t flash across a face for Tool, or SETT, explores more subtle
5 Choose one of th e phrases 1-6 less th a n a 15th of a second - th a t reveal expressions th a t occur w hen someone is
to com plete th ese sentences about th e true em otions a person m ay be ju st beginning to feel an emotion.
th e text. uncom fortable expressing conceal or is Both CD-ROMs are easy to use and
simply trying to } cover expressed th e seven emotions
a Ekman is an expert in
'These expressions ten d to be very universally by all cu ltu res 7 - anger, fear,
th e physiology of em otion and extrem e and very fast,’ says Paul disgust, surprise, sadness, happiness,
Ekman, professor of psychology at th e and contem pt (interpreted as moral
b According to Ekman, a University of California, San Francisco, superiority).
can im prove people’s ability School of Medicine and an expert in th e The METT CD offers a pretest to help
physiology of em otion and nonverbal viewers score their recognition skills
to recognize em otions.
com m unication.' Eighty to 90 per cent by view ing fleeting expressions of 14
c People’s _____ m ay only flash of people we don’t see th e m tested ,'4 people and choosing th e corresponding
quickly across th e ir faces. Micro-expressions represent ‘the emotion. Then a training session shows
d The failure to re a d is m ost extrem e expressions hum an and describes th e characteristics of the
frequently th e result of not being beings can make in a very fast period expression related to each emotion,
of tim e ’and usually involve th e entire w ith a practice session using 28 faces.
able to see very sm all expressions.
face. Subtle expressions are After the pretest, users can retake the
e refers to th e facial overlooked because easily th ey involve test w ith 14 new faces and compare the
expressions th a t show w h en m inor m ovem ent in parts of the fa c e 5 tw o scores.
som eone is hiding an em otion on - raised eyelids th a t m ight signal the Ekman said th a t in his tests of about
purpose or unconsciously, beginnings of fear or surprise, or the 10,000 people, m ost correctly read
angled u p tu rn of th e inner eyebrows em otional expressions only slightly
f Ekm an’s METT CD allows people to
th a t m ight signal th e beginnings of more th a n half th e time. People who
te st th e ir _____ by looking at th e sadness. take th e CD-ROM test, he said, tend to
expressions of 14 people quickly. But a new set of CD-ROMs developed score 50 to 60 per cent. But after doing
by Ekman can help people recognize th e training and practice th ey score
Work in groups. W hy is it im p o rtan t em otional ‘leakage’- facial expressions 80 to 85 per cent.
to un d erstan d how people show
th eir em otions? Give exam ples from
your ow n experience of reading or
m isreading p a tie n ts’ em otions.
9 Psychiatry
Understanding psychiatry
1 Skim all th e questions an d th e text.
Decide w hich of th ese is th e best title 1 Psychiatry is undeniably a branch of W estern m edicine and
for the text. our conception of psychiatric illness (and how best to tre a t it) is
u n d o u b tedly heavily influenced by W estern social and cultural
a Depressive, stress-related, and
factors. However, th e scientific validity of th ese concepts can be
anxiety disorders
readily te ste d if th e y can be show n to cross cultural b o u n d a rie s.
b Psychiatry across cultures
c Psychiatry as a branch of W estern 2 Emil K raepelin recognized this arg u m en t w h en he visited
medicine Java in 1896 and found th a t th e clinical sym ptom s of'd em en tia
praecox' could be seen in p atien ts he m et there, ju st as th e y were
2 Use the highlighted w ords in each
m an ifest in his ow n patien ts in Germany. It w as no t u n til the
paragraph to com plete th e paragraph
WHO International Pilot Study of Schizophrenia in 1973 th a t
headings below.
th e incidence of schizophrenia (defined by narrow criteria) w as
1 of psychiatry fo u n d to be 0.7-1.4 per 10,000 aged 15-54 across all nine countries
and cu ltu ral_____ studied worldw ide. Despite th e variations in th e content of
2 T he o filln e sse sfo u n d to b e delusions and hallucinations (which w ere culturally derived)
the sam e in various countries th e form w as found to be th e sam e. These conclusions have been
3 C ultural in supported by a large num ber of epidem iological studies and
certain disorders sim ilar results have been found for bipolar disorder.
4 The im pact of globalization on
3 The m anifestations of depressive, stress-related, and anxiety
5 The im portance of cultural disorders show th e greatest cultural v a ria tio n s. The m y th th a t
th ese are predom inantly W estern diseases held sway for a long
tim e, based on view s of W estern civilization articulated m ost
3 Work in pairs. Locate th e answ ers eloquently by Freud in Civilization and its Discontents (1930).
below in th e passage an d m ake
appropriate questions for each, 4 Certain m anifestations of em otional distress, term ed 'culture-
using th ese question words: b o u n d syndrom es' by PM Yap, a form er professor of psychiatry
how m any / when / (by) what. in Hong K ong, are particular to different cultures. These present
as m ixed disorders of behaviour, em otions, and beliefs and
1 (by) W estern social and cultural
m ay have local nam es. Some are clear sym ptom -correlates
factors
of disorders found in ICD-10 and DSM-IV; others have no
2 in 1896
W estern equivalent b u t appear to be variations of som atoform ,
3 nine
conversion, or dissociative disorders. Some W estern disorders (e.g.
4 (by) a large nu m b er of
anorexia nervosa, deliberate self-harm) are rarely seen in non-
epidem iological studies and
W estern countries . However, as w e move tow ards a more
sim ilar results for bipolar disorder
global so ciety , ‘W estern influences’ appear to be m aking these
5 ‘culture-bound syndrom es’
types of disorder increasingly frequent in non-W estern societies.
4 Work in groups. Do you th in k
5 D ebate continues as to w h e th e r W estern diagnostic
aw areness of cultural issues needs
categories are universally valid. U nderstanding the
to be tak en seriously w h en treatin g
biological und erp in n in g s of th e com m on disease entities
patients? Why? W hy not? Give
(e.g. schizophrenia, bipolar affective disorder, depression,
reasons and exam ples from your ow n
anxiety) and th e developm ent of trea tm e n ts based upon our
experience.
u n d erstan d in g of neurophysiological and neuropharm ocological
m echanism s w ill inform this debate. However, aw areness of
cultural issues as th e y im pact upon an individual, th e ir illness
(and illness beliefs), and th e relationship betw een psychiatry and
p atient, is critical if w e are to successfully provide appropriate
interventions.
Reading bank 61
10 Memories
I Work in pairs. Skim th e te x t quickly
Keeping the m em ory o f loved ones alive
and decide w hich four out of th e six A The thought of losing loved ones can be unbearable. The idea of never
paragraphs A-F deal w ith: again seeing their faces or hearing their voices can intensify the sadness that is
1 m aking videos felt when someone close is diagnosed with a terminal illness. Having advance
warning that time is limited, though, can provide terminally ill patients with
2 ______ creating shadow boxes
opportunities to create memorabilia for their loved ones so that they can leave
an d w ritin g
behind a few smiles and maybe even a kind word or two.
3 p u ttin g to g eth er
m em ory books B Most people enjoy leafing through old photo albums - the tattered snapshots
are sure to elicit many memories of days gone by. For those who know
4 ______ m aking audio recordings
that they will not be able to be a part of their family’s lives for much longer,
Work in pairs. Decide th e p art creating memory books for loved ones can be a way to preserve cherished
of speech (noun, verb, or adjective) memories for years to come. Memory books range from simple photo albums
of each m eaning. Then find th e to highly detailed scrapbooks. Most books include photos, of course, but
w ord(s)in th e text. including ticket stubs, menus from special dinners, or personal notes can
make the books even more special.
1 highlights, significant events
2 p u t (quickly) C While familiar faces are easily captured in photographs, loved ones often miss
3 stren g th en hearing the voices of their departed friends and family members. By making
4 tu rn in g th e pages of a book, etc. audio recordings for those they leave behind, terminally ill patients can
(w ith curiosity) know that whenever their survivors are missing them, they can simply play a
5 things th a t people have given you recording and hear their voices. Parents of young children may choose to read
w hich you save to rem in d yourself favourite bedtime stories, sing lullabies, or simply talk about the love that they
of th e m have for their children. Tapes can be made for assorted friends and family
6 special, treasu red members, individualizing the messages for each recipient.
7 photographs
D If photos are nice and tape recordings are even better, videos are the ultimate
8 able to be touch ed physically
way for the terminally ill to leave their loved ones with little pieces of
3 Complete th ese sentences w ith w ords themselves. Again, different videos can be produced for each loved one, with
from th e text. Use one w ord for each the emphasis being on making them as personal as possible. Parents who
blank space. know that they will miss important milestones in their childrens lives can
1 If people w ho are term inally ill prepare videos offering the advice they had hoped to deliver in person. For
know in advance th e y are dying, example, a dying parent may prepare videos of themselves talking to their
th ey can m ake th in g s th e ir _____ children about the importance of education, being true to yourself, finding
can rem em ber th e m by. lasting love, or prioritizing the important things in life. More than anything,
M ost m em ory books contain these videos should be used for the terminally ill to express themselves and
snapshots b u t you can also include the feelings that they have for those they will be leaving behind.
certain th in g s lik e_____ E There are also what are called shadow boxes where people display a few
to rem in d you of dinners. treasured items, creating keepsakes that can be kept in view for survivors to
Listening to audio tap es m ade by enjoy and serve as remembrances of those lost. And of course few things are
term inally ill p atien ts can help more powerful than the written word, especially when notes and letters are
survivors w h e n th e y a r e . handwritten, rather than typed.
th e loved one th e y have lost.
Videos can help th e term inally ill F It has been said that as long as one person holds memories of someone, they
show t h e th a t th e y have for are not really gone. Losing a close friend or family member is one of life’s
those w ho w ill survive them . difficult realities, but most people keep their departed loved ones forever
Provided one p e rso n ___________ of near by thinking back over the times that they shared. Creating tangible
som eone, th e y are no t really gone. memorabilia can reinforce those memories, helping survivors to keep loved
ones a part of their lives.
62 Reading bank
11 Being a midwife
1 Work in pairs. Words can have m ore Being a midwife
th a n one m eaning. Find w ords in
In Malawi, all hospitals, especially government hospitals, are greatly
the tex t w hich have these general
understaffed T For example, one qualified nurse with the assistance
m eanings. They are not in order.
of a patient attendee (similar to the nursing assistants in the UK) looks
1 to be responsible for or to take after a 75-bed tuberculosis ward in a busy city hospital.
care of:____ Poor p a y 2 drives the qualified nurses out of government hospitals
2 financial benefits or a parcel: to work in the private sector or to take their skills to other countries.
Here at St Luke's, we are a mission hospital and it's difficult to keep
very com m on an d ordinary or staff, for similar reasons of a poor w age and allowances package,
norm al and not in te re stin g :__ I am a nurse tutor and work 50% in the classroom and 50% in the
4 discover by searching or discover clinical area. My role incorporates the task of teaching in the classroom
by chance:____ and also follow ing the students into the clinical area to carry out the
5 to be th an k fu l for som ething or teaching of skills, general supervision, and performing assessm ents of
to recognize th e value of:____ competency. In the UK, tutors very rarely go into the clinical area, as
6 not connected w ith there are alw ays plenty of members of staff to mentor stu d e n ts3
som eone’s work or public while they are on their practical placements. This is not the case in
life or ow ned by individuals Malawi; you will often find students on their own in a ward full of very
or businesses:____ sick patients.
2 Underline th e m ean ing in 1-6 i n i Through training I try to emphasize the importance of ensuring
w hich is used in th e text. individualized 4 care is carried out. I also stress that nursing is a
partnership between the nurse, patient, and their friends and family,
3 M atch th e questions below to th e and that good nursing care is achieved in collaboration with these
highlighted answ ers in th e text. individuals and other health professionals in the multi-disciplinary
a W hat kind of care does th e nurse team .5
attem p t to stress? Ensuring that patients are cared for with respect, in a non-
b W hat forces people aw ay ju dgem ental6 manner, is a very important aspect of my job
governm ent hospitals? here in sub-Saharan Africa, where a high percentage of patients
c How does she describe her on the wards are HIV positive.
m an n er in treatin g patien ts in I have learnt to cope in a clinical area that is very p oo rly7 resourced.
Malawi? I have had to become very inventive and utilize everyday items in
d How does she describe nursing? an attempt to solve the problems that I come up against. I have also
e How w ell equipped is th e learnt to appreciate the NHS in the UK, and hopefully I will never
hospital she works in? complain about the lack of resources again!
f W hy do tu to rs in th e UK rarely go
into th e clinical area?
Helen Browning
g W hat are governm ent hospitals
is a volunteer
in M alawi like staff-wise? midwife in Malawi
4 In groups, discuss w h e th e r you
think volunteer w ork is of any
value. Give exam ples an d reasons
from your ow n country and
experience.
iwi (n) tribe / people/ nation / grouping of people with the same ancestry
kaupapa (n) meaning / philosophy
te reo (n) the Maori language
whanau (n) extended family
12 The Maori
1 Skim th e passage and decide w h a t Maori Health Providers in New Zealand
type of w ords (nouns, verbs, or
adjectives) are required in th e blank
Similar to education, health services vary notably in th eir size and the
spaces 1 - 12 .
in New Zealand have b e e n 1 services th a t th ey provide, which
2 Work in pairs. Decide w h e th e r these to M aori thro u g h th e grow th of include clinical services, comm unity
words can be u sed as nou n s (N), verbs alternative M aori providers, as well as health programmes, public health
efforts to improve h ealth services for campaigns, vaccinations, disability
(V), or adjectives (Adj).
M aori w ith in m ainstream services. support programmes, m ental health
1 concentrated ______ Maori health providers are defined as services, including residential care,
2 traditio n al ______ ‘providers th a t are contracted to deliver com m unity support, a n d §
h ealth and disability services th a t Maori healing services. Maori health
3 incorporates ______
2 Maori clients or communities; providers also provide services in
4 concepts ______ are led by a M aori governance and multiple geographic sites, and in some
5 reaching ______ m anagem ent structure and express cases mobile health units (Crengle et
Maori kaupapa (philosophy); and al., 1999). Most are sm all in size and
6 targ e t________ ______
consider th e w ider issues of Maori scope, but some have broader regional
7 constitute ______ developm ent and how it m ig h t 2 ?, such as Ngati Porou Hauora on
8 em phasis ______ to th eir ow n organization’. th e East Coast.
M aori providers are variously Because of th eir lim ited num ber
9 appropriate ______ arranged, set up by iwi and Maori and size, Maori h ealth providers
10 apply ______ organizations. There are currently only cover a sm all share of th e total
around 250 providers, up from population. Geographically, they are
11 tailored ______
20 in th e mid-1990s. Maori health 12 in th e North Island, w here the
12 coverage ______ providers t a relatively sm all share majority of Maori live. The majority of
of to tal health services. In 2004 an patients of Maori providers are Maori,
3 Insert th e w ords in th e m ost
estim ated 3 per cent of th e to tal health however non-M aori also access the
appropriate place in th e text.
budget w as spent on M aori health services. Nearly 60 per cent of patients
4 A nswer th ese questions. providers (M inistry of Health, 2004). of the Maori providers included in
M aori health providers aim to the NatMedCa survey were Maori
1 How have h e a lth services in
provide services th a t a r e 5 and them selves, w hile 22 per cent were
New Zealand b een shaped? New Zealand European, and the
responsive to M aori h ealth needs. This
2 W ho are M aori h e a lth providers? includes a focus on M aori values and rem ainder Pacific (Crengle et al., 2004).
3 Do M aori h e a lth providers m ake 2 of h ealth and w ellness w ith in a Maori providers appear to do well in
up a large or sm all proportion of Maori kaupapa. Service d eliv ery Z 11 populations w ith poorer health
to tal h ealth services? aspects of M aori customs, including status and high need. According to
4 W hat is th e goal M aori h e a lth care use of te reo in consultation and for th e NatMedCa survey, th e majority of
providers hope to achieve? h ealth prom otion m aterials. Maori p atients w ere from areas of high socio
5 W hat is th e philosophy of th e h ealth providers te n d to be smaller economic deprivation.
M aori h ealth providers from a th a n other providers and have a strong Because of th eir greater___ 1?
com m unity-based and not-for-profit on holistic and w h a n a u -based
financial point of view?
philosophy. approaches, Maori providers are
6 W hat is th e focus of M aori
Maori providers focus on prim ary m ore likely to provide services w hich
providers? are multi-sectoral and go beyond
services and public h ealth prom otion
7 W hat percentage of M aori h ealth as w ell as m ental health and disability. basic health services, such as
providers' p atien ts are them selves There are no Maori providers in physiotherapy and social services.
Maori? secondary and tertiary care. Providers
Reading bank key
1 ‘TV Doctor’ (p.52) 5 The nocebo effect (p.56)
1 lc 2f 3b 4 g 5d 6 e 7a 1 1 A tre a tm e n t th a t should have no effect can produce
2 IF 2T 3 F 4F 5T 6 F a benefit because th e p a tie n t believes it will.
2 S tudents’o w n answ ers.
3 1 (evening) m orning
3 (during the course of th e day) overnight 1 stum bled onto 5 addressing
4 (abdominal) chest 2 risk factors 6 coined
6 (more) less and less 3 p h en o m en o n 7 lexicon
4 self-fulfilling
4 1 proponents
2 sceptics 3 1 W om en w h o believed th a t th e y w ere prone to
h e a rt disease w ere n early four tim es as likely to die as
2 Medicines (p.53) w o m en w ith sim ilar risk factors w ho d id n 't hold such
1 b fatalistic views.
2 c 2 H ealth benefits produced by a tre a tm e n t th a t should have
no effect.
3 1 retail outlets 5 ensures
3 More th a n $76 billion.
2 com plem entary 6 get th e m ost ou t of
4 Irving Kirsch.
3 cold sores 7 headlice
5 I w ill harm .
4 tu rn to 8 authorized
4 S tudents’o w n answ ers.
4 1Safe and effective
2 They can ask th eir local pharm acist. 6 Salt caves (p.57)
3 All m edicines m ust be te ste d an d officially authorized. 1 S tu d en ts’ ow n answ ers.
4 They should explain how long th e y have h a d th e problem
2 IF 2F 3T 4F 5T 6T 7F
and how it m akes th e m feel; give th e n am es an d dosages
of any other m edicines th e y are tak in g an d n o t forget to 3 1 It is successful.
m ention any herbal or o th er com plem entary rem edies. 2 It is equivalent to 3 days.
5 So th ey don’t irritate your stom ach. 4 They are com m on.
6 Students’own answ ers. 7 There is music, th e so und of waves, an d sea-life.
4 1 soothing / calm ing 4 h ost
3 Assessment (p.54) 2 getaw ay 5 evidence
1 1 B 2A 3 recharge th e ir batteries
2 a4 b3 ci d2 5 S tu d en ts’ow n answ ers.
3 1 senior 5 guilty
7 Children’s sleep (p.58)
2 im prove 6 com m end
3 definitely 7 h arsh est 1 1 struck 5 napp in g
4 too m uch 2 p a rap h ern alia 6 key
3 differences 7 routine
4 The language barrier (p.55) 4 packing
1 1 Students’ow n answ ers. 2 1 C hildren w ould quietly listen to a story u n til th e sleep fairy
2 Students’ow n answ ers. carried th e m off to th e la n d of nod.
2 1 Interpreting and som etim es nursing a n d aftercare. 2 They have tran sfo rm ed th e m into a tim e-free extension of
2 To tre a t anyone w ho can n o t speak Spanish w ith o u t an cyberspace.
interpreter present. 3 Yes.
3 Doubling consultation tim e. 4 They w ake u p early.
4 Almost a third. 5 No. It delays bedtim e an d sh o rten s n ig h ttim e sleep.
5 By using health facilities w ith o u t registering as residents. 6 Kids g ettin g up fairly easily in th e m orning, being alert and
h ap p y for m o st of th e day, a n d n o t too grouchy.
3 1 strain 4 indispensable
7 Sound sleep.
2 com m unicate 5 risk
3 resources 6 cover 3 1 verb 3 verb 5 verb
2 verb 4n o u n 6 adjective
4 Fifth paragraph. S tu d en ts’ow n answ ers.
8 Expressions (p.59) 10 Memories (p.61)
1 1 ...actually fail m iserably at it... 1 ID 2E 3B 4C
2 ... th e m results in a lot of m isu n d erstan d in g s and 2 1 noun m ilestones 5 noun m em orabilia
m iscom m unication. 2 verb pop 6 adj cherished
3 ... expressing or is sim ply try in g to conceal. 3 verb reinforce/intensify 7 noun snapshots
4 ...we te ste d don’t see th em .’ 4 verb leafing (through) 8 adj tangible
5 Subtle expressions are easily overlooked because th e y ...
3 1 loved ones 3 m issing 5 holds m em ories
6 ... th e y m ight otherw ise m iss if t h e y ...
2 m en u s 4 feelings
7 ... th e seven em otions universally expressed b y all
c u ltu re s... 11 Being a midwife (p.62)
2 1 facial expressions 1 1 to look after 3 everyday 5 to appreciate
2 tru e em otions 2 package 4 find 6 private
3 nonverbal com m unication
2 1 to be responsible for
4 em otional leakage
2 financial benefits
5 recognition skills
3 very com m on an d ordinary
6 training session
4 discover b y chance
3 13 (nonverbal com m unication) 5 to be th an k fu l for som ething
2 6 (training session) 6 ow ned by individuals or businesses
3 1 (facial expressions)
3 a4 b 2 c6 d5 e7 f3 gl
4 2 (true em otions)
5 4 (em otional leakage) 4 S tu d en ts’ow n answ ers.
6 5 (recognition skills) 12 The Maori (p.63)
4 S tudents’ow n answ ers. 1 V 7 V
2 V 8 Adj
9 Psychiatry (p.60)
3 V 9 N
1 b 4 V 10 V
2 1 Validity, boundaries 5 Adj 11 V
2 form 6 N 12 N
3 variations 1 V/Adj 7 V
4 non-W estern societies 2 Adj 8 N
5 aw areness 3 V 9 Adj
3 1 W hat heavily influences our conception of psychiatric 4 N 10 V
illness (and how b est to tre a t it) ? By w h a t are our 5 V 11 V/Adj
conceptions of psychiatric illness (and h o w b est to tre a t it) 6 N/V 12 N
heavily influenced? 1 tailored 5 appropriate
2 W hen did Emil K raepelin visit Java? 2 targ e t 6 concepts 10 concentrated
3 How m any countries took p a rt in th e WHO In tern ation al 3 apply 7 incorporates
Pilot Study of Schizophrenia in 1973? 4 constitute 8 trad itio n al
4 W hat supported th e conclusions of th e WHO pilot study?
By w h a t w ere th e conclusions of th e WHO pilot study
4 1 Through th e gro w th of alternative M aori providers
an d efforts to im prove h e alth services for M aori w ith in
supported?
m a in strea m services.
5 W hat did PM Yap call certain m an ifestatio n s of em otional
2 Providers th a t are contracted to deliver to th eir ow n
distress?
organization.
4 S tudents’ow n answ ers. 3 A sm all proportion.
4 To provide services th a t are appropriate and responsive to
M aori h ea lth needs.
5 A not-for-profit philosophy.
6 Prim ary services an d public h e a lth prom otion as well as
m e n ta l h e a lth an d disability.
7 N early 60% of patients.
66 Unit 7
7 Parents and young children
Check up
1 Work in groups. Describe w h a t is h ap p en in g in
each picture. In particular, describe th e interactions
betw een th e adults and th e children.
4 W hich areas do you th in k should have priority in any

m odern h e alth spending, e.g. child health, geriatrics,
technology?
Vocabulary
Qualities of a good paediatrician
1 Work in pairs. Complete th e table below w ith the
relevant positive or negative adjective describing the
qualities of a good paediatrician.
Positive Negative
1 p atien t
2 diffident (nervous)
3 efficient
2 The environm ent for tre a tin g children needs to be 4 reliable
m ade different from th a t for tre a tin g adults. Why? 5 sensitive
How? 6 honest
3 Patients w ho are less th a n 15 years of age m ake u p 20% 7 disrespectful

of the average GP practice in th e UK an d th e under-
4s consult th eir GP m ore th a n any oth er age group
except th e elderly. Is th is p a tte rn th e sam e in your ow n
country? W hy/W hy not?
Parents and young children 67
In this unit
• understanding and using non-technical language
• using the First Conditional for real future events
• using the Second Conditional for reassurance
and reflection
• reassuring parents
• reflecting in speaking and writing about one’s experience
2 Complete th ese sentences usin g an appropriate It’s my job

adjective from th e table in 1 on page 66 .
1 Dr M ansour is v e ry _____________ in everything she
Dr Nasrin Ahmed
does. She prepares for h er w ard rounds m ethodically
and everything is w h ere it should be an d in order.
My name is Dr Nasrin Ahmed and I work as a
2 D rM u b arek is a v e ry _____________ sort of person. paediatrician in a central Auckland, New Zealand hospital.
He does th in g s quickly an d often m akes th e parents I have always enjoyed working with young children and
and children nervous by show ing he w an ts th e their parents. One of the main factors that led me to
consider specializing in this field was my own experience
consultation to end.
of bringing up my two young children.The understanding
3 Dr Andrew s is v e ry to all patients. this has given me has helped me to empathize more with
He greets th e m properly an d takes th e ir w ishes into parents when they become very anxious.
account. Bringing up my own children has made me acutely
4 Dr Chandos is not v e ry _____________ w ith him self. aware of the parental fear of potential threats
He finds it difficult to adm it his w eaknesses w hile throughout childhood from infant diseases-illnesses like
infectious parotitis, varicella, morbilli, rubeola, pertussis,
show ing off his strengths. Being realistic about
acute laryngotracheobronchitis, rubella, meningitis,
w eaknesses helps us to learn an d develop our skills. poliomyelitis, and tetanus. And then there is the parents’
5 My colleague can be v e ry _____________ apprehension associated with
She annoyed th e p a tie n t w h e n she referred to h er vaccinations like MMR. If I were
not a doctor myself, I would
husb an d an d she w a sn ’t m arried. The p a tie n t w as
probably feel as concerned
quite upset. and fretful about my own
6 It’s no t easy to fe e l_____________ th e first tim e you children as many ofthe
do som ething new, b u t w ith practice you b eg in to parents I see who want
to discuss combined
feel very good about it.
vaccinations for
7 Dr K am ara sensed th a t th e te a m th o u g h t she w as theirchildren.
_____________ , because she let th e m down: she
m ade m istakes on th e w ard an d w as late on several
occasions.
3 Give a n o u n for each quality th e doctor is describing in Work in pairs. Change one w ord in each sentence below
sentences 1-7 in 2 . using w ords from th e passage to m ake th e m true.
4 Work in pairs. M ake a list of other qualities you th in k 1 Dr A hm ed has never enjoyed w orking w ith young
a good doctor, n o t ju st a paediatrician, needs to have. children an d th eir parents.
Say w hy each quality is essential. 2 Dr A hm ed has no children of h er own.
3 The experience of raising her ow n children m eans Dr
5 Are th ere any qualities th a t a paed iatrician needs to
A hm ed is fairly conscious of th e fears faced by parents
have m ore of th a n oth er doctors? W hy/W hy not?
th ro u g h o u t th eir children’s childhood.
4 Dr A hm ed feels th a t being a doctor possibly
m akes h er less w orried about vaccination for
h er ow n children.
5 All of th e parents Dr A hm ed deals w ith are anxious
about vaccinations.
68 Unit 7
come out in (v) become scab (v) to form a crust / scab

covered with on a wound or a sore
German (m easles) (adj) stridor (n) an inspiratory
German comes from germane, sound which is due to partial
i.e. closely related to obstruction of the upper
jab (n) vaccination injection airways
up (adj) swollen runny nose (n) coryza
Listening 1
Talking about oneself
1 Listen to Dr A hm ed talking about herself and
answer these questions.
1 Why was it difficult for Dr A hm ed to talk about
herself?
2 What does she describe as a w eakness in herself?
3 Does she have th e w eakness now?
4 W hat exam ple does she use to explain h er
weakness? Describe ho w an d w h e n she used th e
example.
5 W hat does she now feel about recording and
analysing her w eaknesses?
2 Dr Ahm ed m entions h ow she recorded b o th th e 'good 2 Use th e non-technical w ords in 1above to com plete
and bad’ experiences as p art of h er daily reflection. th ese sentences.
W hat do you u n d erstan d by reflection? Have you been
1 If he had epiglottitis, he w ould have stridor
asked to keep a record of your learning experiences?
all th e tim e and n o t ju st w h e n he is upset,
Would this be acceptable in all cultures?
so I th in k it’s _____________
3 Is it easy for you to talk about your stren g th s and
2 The glands beh in d his ear are up, b u t th ere are usually
weaknesses? W hy/W hy not?
no com plications w ith _____________ .
4 Work in pairs. Describe your ow n stren g th s and
3 If you have ju st been vaccinated fo r_____________ ,
w eaknesses. W hen you are speaking, m ake sure you
talk about genuine qualities th a t relate to yourself: I y ou’ll need to avoid getting preg n an t for th e next
fee l th a t I am... six m onths.
4 If he h a d , he'd have several sym ptom s
Vocabulary like fever, conjunctivitis, cough, and a ru n n y nose.
I th in k it's ju st a viral rash h e ’s got.
Non-technical language
5 If he h a d all his j abs, th e n he is w ell protected against
1 W ithout looking back to th e tex t in I t’s m y job on
_____________ , even if he broke th e skin w ith the
page 67, w rite th e m edical equivalent of these
non-technical term s. dirty needle.
1 chickenpox _____________ 6 I th in k he's g o t____________ , doctor. He had fever
2 G erm an m easles _____________ an d th e n he cam e out in spots on his body in clumps

3 w hooping cough _____________ and th e n th e y started to scab over.
4 m um ps _____________ 7 If he h a d , w o u ld n 't he have a strong
5 measles _____________ b reathing-in sound and coughing fits w ith vom iting?
6 croup____________ _____________ 3 Work in pairs. Discuss how to differentiate betw een
7 lockjaw _____________ croup and epiglottitis.
4 H ow w ould you m anage a case of chickenpox in a child?

5 Are th e childhood illnesses listed above com m on in your
country? W hat other diseases are common?
elicit (v) obtain

GCS (n) Glasgow Coma Scale
shy away from (v) avoid
Vocabulary 3 Work in pairs. You are in A& E w h en Mr Peters, the

Signs and symptoms fath er of a child, Andrew, w ith th e above signs and
sym ptom s rings. Make a list of questions you would
Work in pairs. Check th a t you u n d e rsta n d a m o th e r’s ask to elicit inform ation.
statem en ts below an d decide w h a t condition th e y
m ight relate to. 4 In pairs, take tu rn s phoning th e A&E and asking each
other questions about th e child, w hom you suspect of
having m eningitis.
Speaking
Role-playing doctor and p a tie n t scenarios helps you
to em pathize w ith patients. Work in groups: A and B.
Group A study th e role-play card on page 114 and
Group B study th e card on page 117.
1 He keeps touching his head.

2 H e’s b een shying aw ay from b rig h t lights. Listening 2
3 He can’t m ove his head very much.
4 He’s not him self at all. I've never seen him Reassuring an anxious parent
like th is before. Listen to an extract from a conversation betw een
5 He’s been ru n n in g a h ig h tem p eratu re. Dr T hom pson in A&E w ho is reassuring a mother,
6 H e’s come out in a rash around his m iddle. Mrs Allen, w ho is anxious th a t her child has meningitis.
7 H e’s been m aking odd crying noises. Complete th e sentences below using no m ore th a n
8 He’s been m aking th e se odd m ovem ents. four words.
M atch each sta te m e n t in 1 w ith one of th e signs an d 1 I th in k h e ’s actually g o t_____________
sym ptom s below. 2 Well, if you use steam , it _ ___________ the cough.
Sym ptom s Signs 3 If it were, I'd___________ . him to be very unwell.
headache raised pulse ... and he_ . a rash and shy away from
neck stiffness + - decreased blood pressure
th e light more.
photophobia raised tem p eratu re
seizures decreased GCS or abnorm al m ood That's w h a t ___ . in th e circumstances,
unw ell neck stiffness and you’re very right to be cautious.
+ - rash Keep a n _____________ , and don’t hesitate to
focal neurology
contact your GP im m ediately, o r ...
... come an d see us if th ere a re ______________
Check your answ ers w ith a partner. Then listen again
and add any m issing words.
W hich of th e statem en ts in 1 does th e doctor use

to reassure th e patient? W hich statem en t shows
em pathy?
Take tu rn s reassuring th e paren t th a t his or her child

does not have m eningitis.
70 Unit 7
reflect on (v) think over,

consider
Language spot 7 If you give h im th e solution in little sips,

First Conditional vs Second Conditional
8 If I had to talk to th e m o th er again,
• First Conditional: I f + subject + Present Simple form,
subject + will + infinitive w ith o u t to.
• The doctor in Listening 2 uses th e First Conditional a she stare norm ally back,
to talk about a situ atio n w h ere th e result is a real b I certainly be a lot m ore sym pathetic,
possibility in th e future. c w e carry out th e 6 -week check,
I f you use steam, it'll help to ease the cough. d it be easier to carry out th e procedure,
e I prepare for th e consultation better,
• Second Conditional: I f + subject + Past Simple form, f increase th e risk of p e rm a n en t dam age,
subject + would + infinitive w ith o u t to. g she have a really bad barking cough,
• The Second Conditional is used for hypothetical h it help stop him from bringing it up.
/ unreal situations. The doctor in Listening 2 uses
th e Second Conditional to reassure th e m o th er
by show ing th a t th e child is n o t suffering from a
Project
particular condition.
I f he had meningitis, I would expect him to be very
unwell.
I f it were m eningitis,...
• W hen you reflect on your experience, you can also
use th e Second Conditional to show w h a t you w ould
do to improve on your experience.
I f I faced the sam e situation again, I would do things
very differently.
» Go to G ram m ar reference p.128
Decide w h eth er th e If clauses below are real or

hypothetical. Then com plete th e sentences w ith a-h,
putting th e verbs into th e correct tense. Find out at w h a t ages checks are done on a child in the
1 If it w ere croup, first six years in th e UK.
WEBSITE
2 If w e do not do these screening tests, DoH Children’s N ational Fram ework (2004 )
www.dh.gov.uk
3 If you get th e p atien t to relax, OHGP2 pp.816-823
Find out w h a t developm ental screening you w ould do

4 At six weeks, if you stare at th e b ab y ’s face, at th e six-week check for gross m otor developm ent and
fine m otor developm ent and vision.
5 If I had a chance to do th e w hole th in g again, Work in pairs. Take tu rn s explaining th e checks to

paren ts w ith a six-week-old baby girl.
6 If you bring th e child in on th e 23rd November,

bout (n) attack, episode

criteria (n pi) standards,
measures, principles
feedback (n) comments to help
you improve.They can
be positive and negative,
prick (v) pierce, puncture
Patient care 2 Make a list of possible statem ents you m ight use to
reassure th e parents in this situation.
Reassuring p aren ts w ith young children an d babies in
order to relieve anx iety is a challenge. In groups, decide M r and Mrs Barton are anxious th a t th eir child, Robert,
w h eth er these doctors’statem en ts m ade to paren ts are w ho has had several bouts of febrile convulsions, m ight
reassuring or not. Give reasons for your answ ers. develop epilepsy.
■N 5 %
Fortunately, only a very I can assure you if there
small percentage of is a fracture of the femur Speaking
babies go on to develop from the delivery, it’s
1 Practise for OSCE scenarios. Use-the speaking checklist
y
permanent damage. nothing to worry about.
Let’s hope Jane is not on page 120 and addîve of th ese criteria to help you
oneofthem ! give feedback.
Reassurance Sensitivity
Epiglottitis is very rare Fluency Organization
■s here now; but we’ve had Em pathy Addressing th e p a tie n t’s concerns
Rashes are very a few cases recently.
common, and not every Sym pathy Using the p atie n t’s nam e
rash leads to meningitis,
2 Take tu rn s reassuring Mr / Mrs Barton th a t their
but it is good that you
arealerttothis. three-year-old child is not suffering from epilepsy and
V If he had a brain tumour, reassure th e m about th e future.

the rise in pressure in
3 Work in pairs. Take tu rn s role-playing th e doctor and
his head would be much
slower. a parent. Choose one of th e scenarios below foryour
y
If he were about six and partner. Then w ith o u t any preparation, your partner
a half and couldn’t say should reassure you.
certain consonants like
s,f,and th,we’d probably
A mother or father, Mr / Mrs Lennox, presents
have to look into it.
y
with a child:
1 who has pricked his finger on a dirty needle
in the park.The parent is anxious the child might
get HIV/AIDS.
Many parents recently
2 who is about to have an MMR vaccination
have broughttheirchild
in with exactly the same 3 who has swallowed a small silver coin.
rash, but there is a viral
rash going around. 4 Give feedback using th e checklist you created for 1.
72 Unit 7
confer (v) give

inhibit (v) stop, prevent
replication (n) copying
Listening 3
Recommendations for the use of the vaccine
Sharing experiences with colleagues
The objective of th e im m unization program m e
Q Sharing experiences w ith colleagues to obtain
____________ 1for all eligible individuals. Over 90% of
feedback an d advice is a necessary p a rt of th e
learning process. individuals w ill seroconvert to m easles, m um ps, and
rubella antibodies after th e first dose of th e MMR vaccines
Listen to a doctor train in g in paediatrics talking to a
colleague about a child w ho h ad febrile convulsions. currently used in th e UK (Tischer and Gerike, 2000).
Answer these questions. A ntibody responses from pre-licence studies m ay be
1 Was th e doctor confident or nervous initially? higher, however, th a n clinical protection u n der routine
2 Was the doctor organized or disorganized? use. ____________ I confers protection in around 90%
3 Was th e doctor em pathetic or insensitive at first?
of individuals for m easles (Morse et al., 1994; Medical
4 Did the parents and th e child becom e less or
more tense? Research Council, 1977). A single dose of a rubella-
5 Did th e doctor feel th e consultation generally w e n t containing vaccine confers aro u n d 95 to 100% protection
w ell or badly? (Plotkin an d O renstein, 2004). A single dose of a m um ps-
6 Did th e doctor learn a little or a lot from th e
containing vaccine used in th e UK confers betw een
experience?
7 Would th e doctor change an y th in g in his approach 61 and 91% protection against m um ps (Plotkin and
or do th e sam e again n ex t tim e? O renstein, 2004, C hapter 20). A m ore recent study in th e
UK suggested th a t a single dose of MMR is around 64%
Reading effective against m um ps (Harling et al., 2005). Therefore,
1 Work in pairs. Use th e extracts a -g to com plete th e text,

MMR is recom m ended w h en protection against
a because th e y have pre-existing im m u n ity th a t
inhibits replication of th e vaccine viruses, m easles, m um ps, an d /o r rubella is required. MMR vaccine
b tw o doses of MMR are required to produce can be given irrespective of a history of m easles, m um ps,
satisfactory protection against measles, m um ps, or rubella infection or vaccination. There are no ill effects
and rubella,
from im m unizing such in d iv id u als____________ f .
c ideally at 13 m o n th s of age
d tw o fu rth er doses given at th e recom m ended tim es
after th e first birthday an d pre-school, Children under ten years o f age
e Evidence shows th a t a single dose of m easles- The first dose of MMR should be given at any tim e after
containing vaccine
th e first b irth d a y , 5. Im m unization before
f is to provide tw o doses of MMR vaccine at
appropriate intervals 13 m onths of age provides earlier protection in localities
g but residual m atern al antibodies m ay reduce th e w here th e risk of m easles is h ig h e r,____________ §.
response rate to th e vaccine. The optim al age chosen for scheduling children is
therefore a com prom ise b etw een risk of disease and level
of protection.
If a dose of MMR is given before th e first birthday, either
because of travel to an endem ic country, or because of
a local outbreak, th e n this dose should be ignored,
a n d ____________ Z.
com petitive (adj) determined Checklist

by a competition (between
applicants)
I can understand and use non-technical
language.
I can ask use the First Conditional for real
future events.
I can use the Second Conditional for
2 A second dose of MMR is norm ally given before school en try reassurance and reflection.
b u t can be given routinely at any tim e from th ree m o n th s after
I can reassure parents.
th e first dose. Is it b e tte r to w ait th ree m onths? Is th ere any
reason for this? I can reflect about my performance.
3 Do you know w h a t th e im m u n izatio n schedule is in th e UK?

W hat are th e differences b etw een th is an d th e one in your
ow n country?
Keywords
Nouns
4 Does im m unization cause concern am o n g p aren ts in your hom e
croup
country? Why? How do you overcome th is unease?
immunization
job application
Culture project process
reassurance
5 Work in pairs. Decide w hich of th ese sta te m e n ts about applying reflection
for w ork you agree or disagree w ith. scenario
In m y co u n try sensitivity
strength
1 finding a job is very competitive.
weakness
2 it is n o t considered acceptable to talk about th in g s you are
good at. Verbs
3 talking about w eaknesses w ould be a sign of failure. not be yourself
4 reflecting about your w ork w ould be considered run (a temperature)
a w aste of tim e. shy away from
5 discussing gaps in o n e’s know ledge helps on e’s personal
Adjectives
developm ent.
efficient
2 Work in pairs. Compare an d contrast th e culture of job interview s honest
in th e UK an d your hom e country. patient
reliable
respectful
Writing sensitive
Reflecting on one’s own experiences
1 Part of th e personal developm ent aspect of train in g is reflecting Useful reference
on your own experience. Work in groups. M ake a list of n o uns to
cover your stren g th s and w eaknesses.
2 Work on your own. Choose a difficult or challenging experience ISBN 978-0-19-856581-9
you have ha d recently relatin g to dealing w ith a child or the
parents o f a child. W rite a short reflective description of w h a t
happened. Note th a t th is should be totally about y o u r own
experience and not fr o m a textbook. Use th ese questions as
headings.
• W hat m ade th e experience m em orable an d w o rth recording?
• W hat effect did th e experience have on you an d th e patient?
• Did it affect your colleagues? How?
• W hat did you learn from th e experience?
• W hat w ould you do differently if you h a d a sim ilar case?
74 Unit 8
8 Communication
Checkup
1 Look at th e pictures a - f an d decide w h a t
difficulty, if any, th e doctors m ig h t have in
dealing w ith each patient.
I w ant to ta lk a b o u t how
I feel. But I don’t know
how to. I’m depressed for
no reason I understand
and I’m em barrassed
His colleague made
about it. I ju st feel
a m istake and now
awkward.
he’s covering it up.
H e’s ju st like m y
paren ts.Thin ks he
know s everything.
2 M atch th e doctor’s th o u g h ts 1-6 w ith a picture in 1.

1 Jennie is quite shy and finds it difficult to talk to an
adult auth o rity figure.
2 Mr Jones is defensive and evasive about his illness.
I need to elicit th e inform ation carefully w ith o u t
□ u p settin g him .
3 Sheila appears reluctant to stay in hospital.
I feel and look fine.
I don’t understand But I need to get her to stay in for her ow n safety.
4 I can see Carol is very know ledgeable, b u t she
w hy I have to stay in
doesn’t know everything.
hospital.
5 I need to be careful w h a t I say because I m ight
p u t a colleague in a difficult situation.
6 John looks very dow n. It’s n o t easy to speak to him,
b u t I know he w an ts to talk.
3 Work in groups. List at least th re e strategies to deal

w ith th e situations in th e photographs.
Ifin d it d ifficu lt to talk
4 Do th e strategies w ork across all situations or are
about m y d rinking.
th e y specific to a particular situation? Give relevant
I feel quite g u ilty exam ples from your w ork / in tern sh ip w here possible.
5 Do th e strategies w ork across cultures? Is there

poten tial for m isunderstanding? How? Why?
Communication 75
In this unit
• dealingwith patients from a psychological point of view
• clarifying general and vague statements
• asking and responding to open questions
• helping patients to be more specific
• writing about personal achievements
Patient care Listening 1

Being aw are of w h a t th e p a tie n t w an ts an d says Acknowledging verbal cues
from th e psychological poin t of view can help you
A verbal cue is som ething patients say w hich gives
u n d ersta n d your patients.
you a clue about w h a t th e y are th in k in g or helps you
1 People often speak generally an d use ap p aren tly vague probe gently for inform ation. Often th e cues are vague
language. Work in pairs. From th is list of p a tie n ts’ or general w ords an d phrases. To overcome a p a tie n t’s
feelings, choose th e th re e m ost com m on reasons in vagueness and to build trust, you can probe by taking
your opinion w hy p a tie n t language appears vague. sm all steps tow ards th e inform ation you w ant.
1 1 Work in pairs. Look at th e statem en ts below m ade

I do not know what I don’t want to say by patients. Decide w h at you th in k is th e context
to say in answ ertothe anything negative an d w hich inform ation you w ould like to ask about
doctor's question. about myself. in each case.
a p a t ie n t : I h a v e , m a y b e , a c o u p le of d rin k s a day.
DOCTOR: ______________________________________________
b p a tie n t: I have quite a lot to eat, I think.

lam not sure what the DOCTOR: ______________________________________________
I have difficulty thinking
doctor expects as
of specific examples. c p atie n t: Occasionally, I’ll have m ore drugs
an answer.
th a n that.
DOCTOR: ______________________________________________
d p a tie n t: It’s quite bad at w ork at th e m om ent.

DOCTOR: ______________________________________________
I don't know this doctor; I always speak in
I need to test her to see if a vague way; e p a tie n t: M y boyfriend said I h a d a w eight
she can be trusted. English is always vague. problem.
DOCTOR: ______________________________________________
2 Work in pairs. W hat question w ould you ask to clarify

each statem ent?
2 Work in groups. Decide w h a t you yourself
do w h e n you are talking to som ebody you 3 (n) Listen an d m atch a p a tie n t’s statem en t in 1 to each
do n o t know well, in a professional situ atio n o fth e doctor’s questions.
or any situation. 1 _________ 3 5______
3 Give exam ples of your ow n experience. 2 _________ 4___ _
4 Q Listen again and w rite dow n as far as you can w hat

th e doctor says.
5 Give your ow n answ ers to th e doctors’questions,

e.g. m aybe3 0x4 a day.
6 Work in pairs. Student A says one ofth e statem ents

above and Student B asks an appropriate question.
Use th e questions from th e recording or use your ow n
w ords an d th e n develop th e conversation in your ow n
way, probing gently.
76 Unit 8
Holt’s ‘law’ prescribed (adj) drugs on

People want to present themselves in a good light, so be inclined prescription from the doctor as
to double any stated quantities (of food, drink, drugs, and so on). opposed to over-the-counter or
recreational drugs
Speaking 6 Work w ith a different partner. Take tu rn s being

th e p atie n t and saying th e above statem en ts and
Work in pairs. Student A go to page 115. Student B go to
responding.
page 118. Do the two role-plays.
Pronunciation Speaking
Stress in the sentence
Patients sometimes give a hint about w hat they are
thinking or w hat they w ant to talk about. They can
stress certain words in the sentence.
1 Work w ith a partner. Look at the short conversation
below between a doctor and a patient. Decide
which word you think is going to be stressed
in each exchange 1-5.
doctor : Have you taken any drugs?1
patient : Mmm, I haven’t taken any prescribed drugs.2
doctor : What about recreational drugs?3
patient : No,... at least not recently.4
doctor : You’ve taken them in the past, th e n ? 5
2 (j~}) Listen and check your answers. Why do you think

the doctor asked the questions in lines 3 and 5?
3 (nil Listen to the patient speaking and underline the
word which the speaker emphasizes in each sentence.
1 I haven’t taken any prescribed drugs.
2 I was in a cafe when the palpitations came on.
3 The first tim e I had the pain was on a cold morning.
4 My work’s not giving me any problems at the
moment.
5 My partner was standing near the child,
but it was me th at picked the child up.
6 Well, I have a normal breakfast like everyone else.
7 Well, I suppose at the weekends I might have
a few more.
4 Work in pairs. Compare your answers. Then decide
what you would say next to the patient.
5 Work in pairs. Make sure you can say the statem ents
above w ith the correct stress. Then say the sentences
w ith a different stress. How is the m eaning changed?
For example, I haven’t taken any prescribed drugs (but
I’ve taken illegal drugs).
Communication 77
Unless you are patient centred

your patient will never be
fully satisfied with you or fully
cooperative.
— Oxford Handbook
o f Clinical Medicine
1 Work in pairs. Look at th e scenario below. M ake a list of • Doctors usually use a com bination of open and
th e m ain points you w ould talk about. (Please n o te th a t closed questions to help clarify vague answ ers th a t
in this case th e p a tie n t is n o t suicidal.) p atien ts give and to build up a relationship of tru st
th a t encourages th e p atie n t to explain fully and
A 37'yeM'fftcL w ale -patient presents -with clearly.
-wfuplasltjr&m. a. roaA traffic Accident two d o c to r: Tell m e more about your work.
p a tie n t: Well, there’s an awful lot o f it! A t the
■weeks ago. He is depressed.
m o m en t I have to cover fo r people and I
am run o ff m y fe e t with no help a n d ...
2 Look at th e p a tie n t’s th o u g h ts in th e pictures on d o c to r: You sayyou have no help. W hy is that?
page 76. M ake a list of som e th in g s th e patien t p a tie n t: Another m anager is o ff sick.
m igh t be concerned / th in k in g about. d o c to r: D oyou fe e l stressed about it?
p a tie n t: Yes, I guess I do.
3 Work in groups. Com pare your answ ers to 1 a n d 2 .
d o c to r: Stressed a b o u t...
4 Work in pairs. Take tu rn s role-playing th e doctor p a tie n t: Deadlines,paperwork, sales targets...
and th e patient.
• Language spot 1 Use th ese w ords to m ake open questions.

1 Can / details / pain?
Open and closed questions
2 Tell / w ay / injury / affects you.
• A closed q uestion can usually be answ ered w ith one 3 W hat h a p p e n e d /w h e n /a c c id e n t?
or tw o words. 4 How / th in k / things / develop / after this?
d o c t o r : Are yo u sleeping well? 5 Can / tell / w h a t w orries / here?
P ATI E NT: Yes. 6 Describe / typical day / me.
7 W hat about / jo b ? H ow / th in g s th e re ?
• Closed questions are used to elicit specific pieces
of inform ation. However, som etim es th e answ er is 2 Look at th ese questions and decide w h eth er th ey are
vague, an d doctors n eed m ore inform ation to m ake open or closed.
a diagnosis. 1 How are you?______
doctor : Is everything OK a t work? 2 Did you take an y thing for it? ______
P AT I E NT : Sort Of.
3 W hen you say it h u rts a lot, w h a t do you m ean
• An open question usually can’t be answ ered w ith by th a t? ______
ju st one or tw o words, so it encourages a p a tie n t to
4 In w h a t w ay ?______
explain more.
5 W hat about your studies ?.
Can yo u tell m e more about y o u r work / the pain /
the headache? 6 Are you eating OK?______
7 W hat hap p en ed exactly?______
• Often an open q uestion is form ed as a gentle
im perative statem en t. 3 Work in groups. W hen do you use open questions?
Tell m e more about y o u r work / the pain / the W hat is th e function of open questions? W hat is the
headache. function of closed questions? Give exam ples. Which do
A nd w hat about y o u r hom e life? you find easier to ask?
4 W hat is th e relationship betw een open and closed

questions?
5 W hat h appens in th e case history if all your questions
are closed?
DTs (n) Delirium Tremens
Patient care Listening 2

One w ay to encourage a p atien t to cooperate is to ask Appropriate responses
open questions. W hen patien ts answ er open questions, ^
Listen and circle th e m ost appropriate response to
th ey provide a lot of inform ation at one tim e.
th e p atien t in each case.
1 a W h a tk in d o fp a in is it?
b W h at’s your appetite like?
c And has it been getting worse?
2 a Have you taken an y thing for it?
b How long have you h ad th e ru n n y nose for?
c If it’s n o t a cold, w h a t do you th in k it m ight be?
3 a It's th e n atu re of life th ese days. We ju st have to
get on w ith it.
b It sounds as if you don’t need any help,
c It sounds as if you are u n d er a lot of pressure
an d need som e help.
4 a W hen did it start?
1 A doctor has asked w h a t b ro u g h t th e p a tie n t to th e b So you've started sm oking again recently?
hospital. In pairs, decide h o w you w ould develop th eir c Have you tak en an y th in g to relieve it?
conversation. Note th a t th ere m ay be m ore th a n one 5 a Have you h a d a headache like this before?
possibility. b So y o u ’ve h ad a headache like this before?
p a tie n t: My h e a r t ’s b e e n b e a t i n g l i k e m a d t h i s c I'll ju st get you a few painkillers.
m orning. 2 Work w ith a partner. Check your answ ers an d decide
d o c to r: Can you tell m e how it started? w h y th e alternatives are suitable / n o t suitable.
p a tie n t: (Hand to chest over heart) Well, it cam e on
at about 8.30 on m y w ay to w ork ju st now. (l~}) Listen again and take notes about w h a t th e patien t
I w as sitting in a cafe reading w h e n m y says in each case. Then check your notes w ith a partner.
h eart started beating like m ad an d I got 4 Work w ith a partner. Take tu rn s responding to th e
really scared. I’ve never h ad an y th in g like it p atien t using notes from 3.
in m y life.
DOCTOR: _________________
1 Does th e doctor n eed to ask w h e n th e problem

Vocabulary
started? Alcohol
2 Does th e doctor need to ask w h e th e r th e p a tie n t has j Use th ese w ords to com plete th e sentences.
had this problem before?
m oderate binge social drink
3 W hat inform ation is given th a t you w ould like to
heavy guilty annoyed teeto tal
know m ore about?
4 Is th e cafe significant or not? 1 I w o u ld n ’t say I w as a _____________ drinker.
5 Does th e p a tie n t’s fear need to be addressed? I do n ’t get th e DTs or anything.

2 Have you ever fe lt_____________by som eone
criticizing your drinking?
3 I’m com pletely_____________ I h aven’t touched a
drop since I cam e off tw o years ago.
Communication 79
denial (n) refusing to plastered (adj) drunk

acknowledge something treatm ent options (n)
out w ith friends choices given to a patient
away from home, e.g.
in a restaurant / cinema
4 I w ould say I'm m ore of a _____________ drinker. Speaking

I only drink w h e n I’m out w ith friends. 1 Work in pairs. Decide w h a t questions you w ould ask
5 I’ve b een done several tim es fo r_____________ th e p a tie n t in this scenario. Rem em ber CAGE and
driving. TWEAK and th e question from 5 in Vocabulary.
6 Ever felt bad o r _____________ about your drinking?

A 45 - y e a r - o ld /p a tie n t, H r C a i r n s p r e s e n ts
7 _____________ drinking? Yeah, som etim es I get
w ith /a /p r o b le m /o f atcxrholism /. H e -w a n ts h e lp
really p lastered w ith m y friends at th e w eekends.
gtvOng/Up. H e-ty d e fe n s iv e a b o u th P s d r in h in # -.
8 I’m a v e ry _____________ drinker - less th a n
T a k e tK e /h ls to r y .
7 u n its a week.
2 W hat do you u n d e rsta n d by th e m nem onic CAGE ?

2 Take tu rn s role-playing th e doctor and p atien t and
W hich sentences 1-8 in 1 relate to CAGE? W hat do
asking / answ ering questions. Rem em ber to ask
th e other letters stan d for? How sensitive is CAGE at
questions to clarify any vague statem en ts m ade by the
detecting alcoholism?
patient. Try to avoid using technical language in both
3 How can p a tie n t denial prevent treatm en t? roles. If th e doctor uses technical language, th e patient
should ask th e doctor to explain.
4 In som e cultures, drinking alcohol is n o t acceptable.
How can you approach th e topic sensitively w ith a 3 Work in pairs. W hat tre a tm e n t options can you
patient? m en tio n w h en you counsel Mr Cairns to cut dow n or
cut out drinking? How m any should you give?
5 W rite som e open questions, w h ich you can use to probe
th e p atie n t about drinking. Use th ese notes to help you: 4 W hat criteria should you use for choosing th e options?
Use your ow n m edical knowledge.
1 how drM rit&driAdUncy? 5 Use th e speaking checklist on page 120. Decide w h at
2 hind- o f drIn ker? jiv e criteria to use to give feedback to each other. In
3 te tl d r tn h in ^ recen tly pairs, role-play th e counselling session.
4 w h a t cdyout drirdrXnufr ea rly day? w h en 6 Do tw o m ore role-plays. Student A, go to page 115.
fir s t d r a ok/? Student B, go to page 118.
5 c u tv a rta g e r ofi c o tta s # (low rv? y o w th o u c jh t o f
a d va n ta g es?
6 how fa m ily / fr ie n d s /' fettdrO nhing-?
7 How fe e ta b o u t d r tricing-?yow w antto-stop?
Project
1 A nother screening m eth o d is TWEAK. Find w h a t th e
m nem onic stands for. Search th e w eb or look at OHCM7
page 275. W here is it m ore sensitive th a n CAGE?
2 W ho are th e AA an d Alcohol Concern?
W hat do th e y do?
7 Give feedback to your partner. Then list th ree difficulties
3 Find other w ords from th e w eb related to plastered to faced by th e doctor in em pathizing w ith th e p atient and
describe being drunk. th ree faced by th e patient.
Reading 2 A nsw er th ese questions about th e text.
1 Work in pairs. Look at these headings an d guess th e 1 W hy do doctors need to get to know th e ir patients
contents of th e tex t below. Then m atch th e headings to psychologically and genetically?
an appropriate nu m b er 1-5 in th e text. 2 W hat approach should doctors take once th e y have
done this?
• Cognitive barriers
3 W hat is th e effect on som e p atien ts of'stro n g '
• Biological and genetic barriers
advice?
• Psychological barriers
4 W hat should help persuade patien ts to act? Does it
• M etaphysics at th e bedside
work?
• Barriers to prevention
5 W hat does know ledge of th e destructive pow er of
alcohol do?
__________ i w as th e 'w orld’s w orst p a tie n t’, th e poet Samuel Taylor

2 Coleridge, w ho answ ers our question in this way:
To love our fu tu re Self is alm ost as hard as to love our
Not everyone responds to preventive m easures. Neighbour.
Some of us, because of our genes, are 'im m une'
to the benefits of exercise, for exam ple. As our
understanding of genetic advances improves, All of us at tim es are prone to prom ote our ow n
our habitual advice of'take m ore exercise’looks destruction as keenly as w e prom ote our ow n survival.
increasingly old fashioned. W hat w e should really Knowing th a t alcohol m ay bring about our ow n
do is get to know our patients psychologically and destruction gives th e substance a certain appeal
genetically and tailor advice, such as 'for you, diet w h en w e are in a certain fram e of m ind - particularly
advice is m ore im portant th a n exercise’. if w e do not know th e sordid details of w h a t d eath from
_________________ 3 alcohol involves.
When, if ever, w e think about devastating but

preventable ill h ealth in ourselves, w e m ay either
believe th a t 'it w o n 't h ap p en to m e’ or w e im m ediately
dare fate to m ake it happen. To som e people, over-
enthusiastic and ‘in tim id atin g ’ advice from bodies
such as th e UK H ealth Education Authority, creates
cognitive barriers to prevention, provoking anger
and rejection by those w ho resen t th e ir taxes being
spent by a state w hich assum es th a t all its citizens
are five-year-olds w ho cannot be tru ste d to th in k for
themselves.
_________________ 4
We often find ourselves sitting on beds try in g to

persuade w ayw ard patients to courses of preventive
action, w hich will clearly benefit them . We thin k
this very clarity should be enough to persuade th e
person to act. But w e resign ourselves to th e fact th a t
action will not follow. W hy is this so often th e case?
The first person to know th e answ er to th is question
Communication 81
Checklist
I can deal with the patient from a
psychological point of view.
I can clarify general and vague statements.
I can ask and respond to open questions.
I can help patients to be more specific.
3 Work in pairs. A nsw er q uestion 1 in 2 from your ow n and your
colleagues’ experiences. I can write about personal achievements.
4 Does an u n d erstan d in g of psychology have a role to play in

m edicine?
Key words
Nouns
Writing achievement
barriers (to prevention)
Writing accurately for training or work applications CAGE
1 Accuracy is one of th e criteria used in assessing an applicant metaphysics
for train in g or work. Look at th e sentences 1-6 below w hich are social drinker
tak en from an answ er to a question on non-m edical achievem ent treatment options
w hich m ay be relevant to fu tu re training. Work in pairs an d find Verbs
nine spelling m istakes. clarify
1 I w orked as a volunter on a n inner-city train in g project cooperate
try in g to m otivate young people facing a range of problem s, TW EAK
including drug addction, alcohol abuse, an d so on.
Adjectives
2 M y g reatest acheivem ent w as settin g u p an d ru n n in g train in g
annoyed
on barriers to prevention for th e volunteers.
awkwa rd
3 In th e project, I w as m ainly in trested in helping to
binge
develop various psycological in terventions tailored
cognitive
to each individual’s needs.
defensive
4 The w ork is relevent to th e tra in in g I p lan to do for
guilty
a num b er of reasons.
moderate
5 I learn t h ow v ital p a tie n t com itm ent to tre a tm e n t w as in order
psychological
to prevent relapse.
teetotal
6 The insig h t into th e com unication skills I gained w as
vague
invaluable because I developped a g reater u n d e rstan d in g of
th e dynam ics of interactio n b etw een people.
2 W rite a short piece of no m ore th a n 100 w ords on an achievem ent Useful reference
of your ow n outside th e form al m edical field.
Oxford Handbook of Clinical Specialties
3 Check w h a t you have w ritte n for m istakes, especially spelling 8th edition, Collier and Longmore,
m istakes. ISBN 978-0-19-922888-1
4 Give your te x t to a colleague to read for m istakes.

82 Unit 9
9 Working in psychiatry
Checkup Vocabulary
1 Work in groups. Can you m atch th e pictures w ith th e Appearance, behaviour, and manner
descriptions? Check your answ ers below.
1 Work in pairs. Make sure you u n d e rsta n d th e nouns
1 introduced cognitive behavioural th erap y below. Use a dictionary if necessary. Then change each
2 described his structural m odel of th e m ind n o u n into an adjective.
3 w as th e first to use th e te rm psychiatry
4 introduced lithium for tre a tm e n t of m an ia N oun Adjective
1 aggressiveness
2 restlessness
3 w ithdraw al
4 distraction
5 flam boyance
6 anxiety
7 carelessness
2 Complete each sentence below w ith an adjective

fro m l.
1 John w a s _____________ about his appearance. He
w as shabbily dressed and his hair w a sn ’t combed.
a Reil, 1808 c Cade, 1949
2 Jane w a s She barely said a word.
W hen she spoke, she did n o t look at me.
3 H arry w a s ______________He couldn't sit still and
kept tw itch in g all th e tim e.
4 M ary w as v e ry ______________ She w as focused, but
you could tell she w as w orried about som ething.
5 Pat i s _____________ She dresses in quite
extravagant and form al clothes w ith bright colours.
6 Susan w as v e ry ______________ She w as very
argum entative. I did n o t feel safe and sat w ith m y
seat near th e door.
7 He a p p e a re d _____________ th ro u g h o u t the
b Freud, 1923 d Beck,1963
interview , looking out of th e w indow as if he w as
hearing voices.
oh b£ qz pi
3 W hich nouns from th e list have corresponding verbs ?
2 Do any of th e contributions m ade by th e above or other 4 Decide w h e th e r th e descriptions in 2 are related to

people rank as th e m ost im p o rtan t in th e history of m ania, psychosis, depression, or anxiety. Are these
psychiatry? W hy/W hy not? four affective or organic disorders?
3 Is it im portant to be aw are of th e history of m edicine in

general and psychiatry in particular? W hy/W hy not?
Working in psychiatry 83
In this unit
• describing and assessing psychiatric conditions
• using the Past Perfect and using weak forms in speech
• asking about self-harm
• expressing wishes and negotiating with /
persuading patients
• writing descriptions of a patient’s mental state
Listening 1 Work in pairs. Look at th e list of questions below.

Decide w hich section of th e exam ination th e questions
Describing patients relate to: orientation or language.
1 (j~j) Work in pairs. Look a t th e tab le below an d m ake sure
th a t you u n d e rsta n d all th e words. Then listen to th e W hat day of th e w eek is it? 1 point
doctor describing th e th ree p atien ts an d m ake notes W hat is th e date today? 1 point
about each p atien t usin g th e appropriate featu res 1 - 6 . W hat is th e m onth? 1 point
W hat is th e year? 1 point
Mr Jones Miss Rigby Mr Dickson W hat season of th e year is it? 1 point
1 Appearance W hat country are w e in? 1 point
W hat to w n or city are w e in? 1 point
2 Eye contact
W hat are th e tw o m ain streets nearby? 1 point
3 M anner W hat floor of th e building are w e on? 1 point
4 Mode of speech W hat is th e nam e of this place? 1 point
Note: Give one point for each correct answer.
5 Insight
6 Doctor’s feelings
2 Look at th e full exam ination list on page 121. Decide
2 Compare your notes w ith your partner. w hich of th ese phrases is suitable for introducing each
section an d w hich you can use at th e beginning of the
3 (n!) Listen again an d check your answ ers. Decide th e assessm ent.
likely diagnosis in each case.
I need to askyou some I’m now goingto askyou
some questions about...
Speaking routine questions as
I part of an assessment.
2 aingtogiveyou ...
Some of the questions
may seem a bit simple,
but if you just bear with
won’t take long.
I want you t o ...
A mini-mental state examination is used to

assess dementia.
84 Unit 9
Psychotherapy denotes treatment of mental disorders ' (n) hostility,

and behavioural disturbances using such psychological unfriendliness, distancing
techniques as support, suggestion, persuasion,
f .: (adj) expert,
re-education, reassurance, and insight in order to alter
gifted, capable
maladaptive patterns of coping and to encourage
personality growth.
— Dorlands Medical Dictionary
3 W hich doctor’s responses below are appropriate w h en

a p atien t answ ers a question?
Dr Tom Turner
My name is Dr Tom Turner and I have been asked many
times why I chose psychiatry. I had chosen a period
in A&E for my next undergraduate rotation when an
opportunity to work on a psychiatric ward came up,
and it seemed like an interesting option. So it wasn’t
som ethingl had planned fora longtim e.
Now I work as a locum psychiatrist, which fits in

perfectly with my lifestyle. I have followed a range of
courses and training in various areas of psychotherapy,
cognitive behavioural therapy and so on. But the most
important skills I think I have learnt and that have
Role-play th e test on page 121 w ith a partner. Before
carried me through these years a re those emphasized
you take th e te st as a patient, decide w h a t result you
in my internship by my mentor and which still hold
w ant to achieve, an d h ow m an y deliberate m istakes
true today.
you w ill m ake to pu t your score in one of th e th ree
bands: First of a II, there is being able to a Ilow time to help in
>28 = norm al; 25-27 borderline; < 25 dem entia. the healing p ro cess-fo rthe patient,thefamily,and
the doctor. Coming from the hectic life of my previous
5 W hen you are interview ed as a patient, give th e
department, I now seemed to be moving in another
num ber of incorrect answ ers th a t w ill give your chosen
dimension. I soon found that impatience was not
outcome. As a doctor, m ark only th e answ ers w hich are
going to help me or the patients and that the whole
wrong.
process began with the first contact through to
6 At th e end of th e interview , com pare th e doctor's result discharge from a ward.
w ith th e p atient's in ten d ed score. Are th e y th e same?
Listening is another but no less valuable skill.
I hadofcoursedonea lotin m ytraining,
It’s my job but working on the ward impressed
upon me the effect on the patient of just
1 Work in pairs. Try to predict w hich five skills are having someone taking time to listen.
m entioned by Dr Turner. Then find th e five skills And through this came trust. Being
m entioned by Dr Turner. non-judgemental as we listen to patients
1 know ing how to use one’s ow n daily life skills is another important technique, as
2 speaking clearly and carefully otherwise there is a
3 listening to th e patient dangerof patient alienation.
4 using sym pathy and em pathy
Finally, there is the ability to
5 developing th e p a tie n t’s tru st
use our skills of daily
6 stopping oneself from m aking jud g em en ts
living which we can re-teach
about th e patient
to patients as they
7 letting tim e ru n its course
prepare for discharge.
8 being proficient in psychotherapy
2 Why is each of th e skills m entioned by Dr Turner

im portant?
Kafka’s law In youth we

do examinations to get into
institutions, in old age to get
out of them.
• Language spot
The Past Simple and the Past Perfect
• Use th e Past Simple a n d th e Past Perfect to describe
an event or period w hich hap p en ed before a point
or period in th e past.
I had chosen a period in A& Efor m y next
undergraduate rotation when an opportunity
to work on a psychiatric ward cam e up.
• These expressions are com m only used.

A fter I had eaten, I returned to work.
The shift was over by the tim e I had written Pronunciation
up the notes.
Weak forms
I had already left the ward when he arrived.
I fe ll asleep before I had fin ish ed studying. W hen th e Past Perfect is used in speech, it is generally a
Once I ’d fin ish ed washing m y hands, I was ready w eak form, i.e. th e w ord is not stressed or is combined
to begin. w ith a preceding word like I.
» Go to Grammar reference p.128 1 Listen to th e beginnings of sentences 1-7 below

from people talking about th eir experience and
1 Complete th ese sentences by p u ttin g th e verbs in th e
decide w h e th er th e w ords and syllables underlined
correct tense.
have a w eak stress or a strong stress.
1 Dr Glover already (finish) his w ard rounds w h e n th e 1 After Td learnt to take a detailed history from
consultant (telephone). th e patient, I ...
2 The doctor (rush) to th e w ard, b u t th e patien t already 2 Before Id w orked in psychiatry, I ...
(disappear). 3 Td w orked for five years in m y ow n country in the
3 I (do) som e assessm ent tests before, so I (know) field of psychiatry before I ...
w h a t to do. 4 I dealt w ith all th e new p atien ts as soon as Td se e n ...
4 Mrs Scott (be) w ell-know n to th e police. They (arrest) 5 Once Td com pleted m y u n d ergraduate degree, I ...
her once before an d (bring) her to th e hospital. 6 I h a d n ’t m oved into psychiatry because I ...
5 You (make) up your m in d ab o u t your fu tu re career 7 W hen I'd left m y hom e country, I ...
w h en you (be) at secondary school?
6 He (not complete) his in tern sh ip by th e tim e he 2 Work in pairs. Check your answers.
(leave) his hom e country. 3 Complete one sentence from 1 w hich is relevant to you.
7 In 19 60, a year after Roche (first synthesize) Say and th e n explain your sentence to your partner
diazepam , Roche along w ith M erck an d Lundbeck and ask questions about each o ther’s experiences and
(introduce) am itriptyline to th e m arket. feelings about them .
2 In th e sentences in 1, u nderline th e action w hich 4 Make five questions about your ow n train in g and work
hap pen ed first. experience th a t you w ould like to be asked.
USEFUL LANGUAGE
A fter yo u h a d ..., did you... ? Before y o u ..., had you... ?
H a d y o u ... b efo reyo u ... ? H adyou ever th o u g h t... ?
O nceyou had..., w hat did y o u ... ?
5 Exchange your list w ith som eone in another pair and

ask each o th er th e questions. Develop th e conversation
from your ow n experience.
Reading Eliciting the history
1 Work in pairs. Before you read th e text, m ake a list Introduce yourself, explain to th e patien t how long
of th e points you w ould ask about in th e presen tin g th e interview w ill take, and explain its purpose. Find
sym ptom s in tak in g a psychiatric history. Use your out how th e p atien t cam e to be referred and w h at
ow n know ledge an d experience. his expectations are (e.g. about treatm ent). If the
p a tie n t denies having any problem or is reluctant
to start talking about him self, do not hurry him. Try
If only I could get a job. asking 'How are you?’' W hat has been happening to
you?’'W hat are th e m ost im p o rtan t things?’A nother
approach for hospital patients is to indicate w hy
th e GP referred th e patien t and th e n ask w h a t the
patien t thinks about this. Sit back and listen, w ithout
I wish I were well. interrupting, noting exact exam ples of w h a t the
patien t is saying. Take m ore control after about 3
m inutes to cover th e following topics.
Presenting sym ptom s. Agree a problem list w ith

th e p atien t early and be sure it is comprehensive,
e.g. by asking 'If w e w ere able to deal w ith all these,
w ould th in g s th e n be all right?’or ‘If I w ere to help
you, how w ould things be different?' Then take each
problem in tu rn and find out about th e onset; the
duration; th e effects on th e p a tien t’s life and family;
events coinciding w ith th e onset; th e solutions tried;
reasons w h y th e y failed. The nex t step is to enquire
about m oods and beliefs during th e last w eeks (this is
different from th e m en tal state exam ination w hich
refers to th e m en tal state at th e tim e of interview).
Specifically check for:
• suicidal thoughts, plans, or actions - th e m ore
specific th ese are th e greater th e danger. Discussing
suicide does n o t increase th e danger.
• depression - low mood, anhed o n ia (unable to feel
pleasure), self-denigration (‘I am w orthless’, ‘Oh, I
w ish I h ad n o t been bo rn ’); guilt ('It’s all m y fau lt’);
lack of in terest in hobbies an d friends plus biological
m arkers of depression (early m orning waking,
decreased appetite and sexual activity, w eight loss).
• m ania; sym ptom s of psychosis (persecutory beliefs,
delusions, hallucinations); drug and alcohol use;
obsessional thoughts; anxiety; eating disorders
(e.g. young w om en; often n o t volunteered and
Everything is my I'd rather do anything im portant). Note com pulsive behaviour
own fault. than be depressed. (e.g. excessive han d w ash in g ).
2 Find phrases in th e te x t w ith exactly th e sam e Patient care

m eanin g s as:
1 Complete th e questions about self-harm by using one
a state th e len g th of th e interview , w ord from each box. You m ay have to change th e form
b w h a t th e p a tie n t hopes to gain, of any verbs and th ere m ay be m ore th a n one answer.
c does not w a n t to begin speaking,
d find out th e p atien t's opinion of this, m ade end go feel take harm
e m ake sure th a t you cover everything.
3 A nsw er th e questions about th e text. life (x2) bed future yourself preparations
1 W hat approaches are suggested for dealing w ith
p atien ts w ho are h e sita n t ab o u t talk in g to th e 1 Have you ever felt so low th a t you have considered
doctor? ?
2 W hat should you check for specifically
2 H ow do y o u _____________ about the
in th e history?
3 W hen are suicidal th o u g h ts, plans, or actions m ore ?
dangerous? 3 Have you ever w ished you could_____________ to
4 W hat are th e biological m arkers of depression? _____________ and n o t w ake up in th e morning?
5 Using your ow n experience, h o w w ould you identify
4 Have you ever th o u g h t o f_____________ your
anxiety from a p a tie n t’s behaviour?
?
4 W hat questions w ould you ask about th e p a tie n t’s
5 Have you th o u g h t ab o u t ho w you w ould do it?
present circum stances, early years an d developm ent,
and pre-m orbid personality? Have y o u _____________ a n y _____________ ?
6 Have you tried t o _____________ your ow n
5 Using your ow n experience, describe exam ples of
cases you have encountered. R em em ber to ensure ?
confidentiality w h e n you are talking. 2 W hat o ther questions m ig h t you ask about harm ing
oneself an d life n o t being w o rth living?
3 W hy w ould you ask each of th e questions above?
Speaking
1 Student A go to page 115. Student B go to page 118. Read
th e tw o scenarios an d use th e advice and questions in
th is u n it to th in k about w h a t you m ight say.
2 In pairs, use th e speaking checklist on page 120.

W rite dow n five criteria for giving feedback.
3 Role-play b o th scenarios. Patients should give feedback

to doctors after each scenario. Rem em ber to be positive
and give constructive criticism.
• Language spot Speaking
Wishes and consequences in negotiations 1 Read these notes. Then w ork in pairs. To help you
u n d erstan d w h a t th e p atien t m ight feel, w rite seven
« To say w e w ish th e past h ad been different, w e use
sentences about th e pa tie n t’s w ishes from 1-7 below.
I wish + th e Past Perfect.
I wish I had gone/com e to the hospital sooner.
I wish I hadn't had the operation. A 3 0 - y e a r -o ld p a t ie n t , Susan P r ic e , has taken
an o verdose o f paracetam ol and w ish es to go
• To say we w ish a p resent situ atio n w ere different, home. She lo o k s and f e e ls w e ll, but you want
we use I wish + th e Past Simple form. to keep her in f o r an o th er 24 hours to keep
an eye on her in case th e re are any p h y s ic a l
I wish m y wife were here.
r e a c t io n s . (She i s no lo n g e r a s u ic id e r i s k . )
Iw ish m y wife weren’t in hospital.
• To say w h a t w e w ish w e could do now, w e use 1 go home now 2 nottakingtablets

I wish + could. in first place
I wish I could go home. 3 see my family
9 To m ake an em phatic w ish, w e use I f only in stead
of I wish. 4 not stop me going 5 doctor see I am OK
I f only I had come to the hospital sooner. home now
• To talk about an im aginary situation, w e use

Im agine / (Let’s) Suppose / W hat if /L et's say. 6 be at work 7 be out enjoying
myself
Suppose you fe ll and hurt yo u rself and nobody was
around. (W hat would yo u do?)
1 Complete these sentences by p u ttin g th e verbs in th e

correct form and adding any necessary words.
1 I w ish come to see him yesterday.
2 If only th e y let m e go hom e fam ily th is afternoon.
3 Im agine you have a fit w h en you are alone in
sw im m ing pool.
4 I w ish he recover completely.
5 Suppose go hom e. W ho w ould look after you?
6 I w ish not lose te m p e r p atien t last night.
7 I w ish visitors go aw ay an d leave us in peace. 2 Use th ese notes to w rite seven w ays th e doctor m ight
persuade her to stay in hospital.
2 Work in pairs. W rite seven questions about your
career w ishes / work. Then ask an o th er p a rtn e r th e 1 you collapse in th e street
2 relapse on your ow n at hom e
questions an d develop each conversation in your ow n
way. 3 you fall
4 you drive and collapse
E X A MP L E S
5 cause accident
Do you w ish y o u ... had chosen psychiatry?
6 dam age your liver
had done more psychiatry?
7 nobody around and passed out
didn’t have to g et up so early?
3 Work in pairs. Take tu rn s and try to persuade th e
p atien t to stay in hospital. Keep in m ind th e patient's
u nspoken w ishes.
Some patients with mania are cheerful.They laugh, play, dance day Checklist
and night. Sometimes they wear flowers on their head as if they
had been a winner in a game.These patients do not bring worries
to their relatives. But others fly into a rage ... Tick (/) the statements which are true.
— Quotation from Artaeus ofCappadocia, AD90, in OHCS I can describe and assess psychiatric
conditions.
I can use the Past Perfect and weak forms
in speech.
I can express wishes and negotiate
Writing with / persuade patients.
Extract from a mental state examination I can talk about self-harm.
1 Work in groups. W rite u p th ese notes. I can write descriptions of a patient’s

mental state.
A former p a tie n t ofyoury, M r Thompson/,

who-ly25 yearyold/, way found/ wandering'
in/ they ytreet confuted/.
Key words
Nouns
found/by police/2 tn/the/morning/ affective disorders
p a tie n t adm itted/ one/year earlier yimllan anxiety
ctrcumytancey cognitive behavioural therapy
concentration
aggreyyiwe/ and/ confuted/ depression
talking/ rapidly He/yald/the/transportyyytem mania
iya/vneyyand/he/need&tofuoCt now and/ mini-mental state examination
concentration/poor psychosis
psychotherapy
notproperly dretyed/though/pret/loayly atwayy self-harm
form ally dreyyed/ and/ very tid y
Adjectives
I nylght Impaired/; n o t aware/ o f w hathe/ way doing/ aggressive
anxious
way making/ inappropriate/geytureytothe/police/
argumentative
and/naryey
careless
careful/ ah ou t being/ alone/ w ith/the/patlent w ithou t distracted
a/ clear eycape/ route/ flamboyant
non-judgemental
restless
withdrawn
Useful reference
Oxford Handbook of Psychiatry 2nd edition,
Semple et al, ISBN 978-0-19-923946-7
2 Count how m an y tim es you used th e Past Perfect and

com pare your answ er w ith oth er groups.
90 Unit 10
10 Terminal illness and dying
Checkup Vocabulary
1 Work in pairs. Describe in your ow n w ords w h a t is Reactions to bad news
happening in each picture.
1 Work in pairs. Cover th e w ords in th e right-hand
colum n and try to give th e m eaning of th e w ords 1-7.
1 shock a n o t being able to /
2 disbelief refusing to accept som ething
3 resignation b fear, loss of control
4 num bness c surprise, being stu n n ed
5 isolation d acceptance of a bad situation
6 panic e n o t being able to feel anything at all
7 denial f n o t believing som ething
g separation, loneliness
2 M atch th e w ords w ith th eir m eanings a-g.
3 Complete th e sentences 1-7 below using a form of the
w ords above.
1 The new s left m e feeling to ta lly _____________
I couldn’t feel an y thing at all.
2 W hen I found out th a t m y fa th er h ad cancer, I w as
stunned. The n e w s _____________ m e deeply.
3 M y fa th er has refused to accept th a t anything is
w rong w ith him . I th in k he j u s t_____________ th a t
2 M atch th e statem ents below m ade by fam ily m em bers
to th e pictures. he has anything serious. It is his w ay of coping w ith
1 Our palliative care nurse, Nurse Thomas, is highly th e situation.

trained. My m o th er has enjoyed being looked after 4 I felt angry at first, b u t I suppose I knew all along
in her ow n home. som ething w as w rong so I quickly_____________
2 It w as difficult for th e doctor to tell us th a t th e
m yself to th e fact th a t I h ad cancer.
m achine w as going to be sw itched off. It w as our
son’s w ish an d he is helping oth er people to live. 5 I felt s o somehow. It w as as if the
3 I don’t know w h a t w e w ould do w ith o u t th e help of diagnosis h ad cut m e off from m y surroundings
th e staff at th e p ain clinic. and family.
4 My father prefers being in th e hospice rath er th a n
6 W hen w e h ea r bad news, a com m on reaction is to
at hom e alone w h en I’m at work. We have both
accepted th e situation, b u t w e have b o th gone doubt o r _____________ w h a t w e have heard.
throu g h a w hole range of em otions. 7 I w as so afraid I lost control of myself. I didn’t know
3 Work in pairs. Is it b etter for p atien ts w ho are w h a t to do. I ju s t_____________

term inally ill to be cared for m ainly by th e ir fam ilies in 4 Do people in all cultures express th e ir reactions to bad
the com m unity? W hy/W hy not? new s in th e sam e ways? Give examples.
4 W hat is th e function of a pain clinic?
Terminal illness and dying 91
In this unit
• recognizing and dealing with patients’emotions
• expressing likes,dislikes, and preferences
• breaking bad news about terminal illness and death
• talking and w riting about coping mechanisms for doctors
Listening 1 3 W hat em otions do p atien ts and / or th eir families

experience w h en th ey are first told about term inal
Recognizing and dealing illness?
with patients’ emotions
Listen to th e th ree extracts from doctors breaking
bad new s to patients.
Frances MacGregor
2 Work in pairs. Decide w hich em otions 1-7 in I’m a Marie Curie nurse. I work in the community with
Vocabulary 1 th e p atien ts are exhibiting. There m ay be
terminally ill patients. I normally do nine-hour shifts at
m ore th a n one answ er in each case.
night, arriving mid-evening and then working through
1 _______________________________________ to the next morning.
2 ___________________________________________
I enjoy doing my workenormously because I find it
3 _______________________________________________ very rewarding. You might think that dealing with
3 Complete th ese statem en ts from each of th e th ree terminally ill patients would be very depressing but
conversations. it is not as bad as it seems. First of all,from both the
patient’s and the fam ily’s point of view the work we do
1 Yes. I’m sorry to say it’s a s _____________
is very valuable because it allows them both to exercise
2 It’s not easy t o _____________ , b u t I’m afraid th e some control over their lives. The majority of terminally
results are correct. ill patients prefer to spend their remaining days at
3 It’s very upsetting. W ould you like u s ____________ ? home ifthey can ratherthan in a hospital or hospice.
Or can I get you anything? In the morning, we sometimes hand over to Macmillan
nurses if we are dealing with cancer patients, which
Listen again. Does th e doctor’s voice go u p or dow n
allows for round-the-clock care.The care we provide is
at th e end of each sta te m e n t 1-3 ? Does th is m ake th e
free and we work in conjunction with GPs and other
doctor sound sincere or casual?
health professionals.
Yet such work is not without its difficulties.

It’s my job Not keeping enough distance from the situation
1 Work in pairs. In th e text, h ow does Frances M acGregor -esp ecially the emotions of the patient and the
describe th ese aspects of her job? fa m ily-a n d getting personally involved are common
problems.Theyoungerthe patient, the less easy it is
1 dealing w ith th e em otions of th e p a tie n t an d fam ily
for me personally. While no death is easy at least with
2 going to th e fu n eral of p atien ts
an elderly person they have had 'a good innings’, which
3 w orking w ith o th er h e a lth care professionals
can make it easierto bear.
4 helping people have som e control over th e ir lives
You always need someone to talk to at
2 Classify each piece of inform ation, 1-4, according
times or something to do to relieve the
to w h a t Frances says, as an exam ple of: team w ork;
stress, but what suits me personally is
a healing experience; a w orthw hile experience; a
swim m ing which I like doing as often
difficulty.
as I can after a shift. It surprises me
that it is often minor incidences that
triggerthe greatest reaction, while the
major events are easierto bear. Frequently
my colleagues and I are invited to
funerals which is a cathartic experience
for the families and ourselves.
92 Unit 10
care in the com m unity (n)

looking after patients in their
homes rather than in a hospital
or a hospice
hospice (n) a hospital or rest
home which provides specialist
care for terminally ill patients
Project • Would prefer + infinitive w ith to

1 Look on th e w eb for inform ation on care in th e I would prefer to stay at the hospice (than go home).
community. * W ould rather + infinitive w ith o u t to
• Marie Curie nurses - w w w .m ariecurie.org.uk I ’d rather stay in the hospice.
• M acm illan nurses - w w w .M acm illan.org.uk
• Gold Standard Fram ew ork in Palliative care » Go to G ram m ar reference p.129
— Liverpool Care Pathw ay for th e dying p a tie n t (LCP) 1 Work in pairs. Put th e verbs into th e correct form
— page 746 OHPC and in th ese sentences. Some m ay have m ore th a n one
w w w .m cpcil.org.uk/liverpool_care_pathw ay possible answer.
2 W hat m ain areas of w ork are b o th th ese organizations 1 Mrs Jones prefers (be) in her ow n hom e rather th a n
involved in? th e hospital.
2 W ould you like (spend) tim e abroad over the
3 Look for sim ilar organizations in Australia, New
next few years?
Zealand, and th e USA.
3 I’d hate (live) at th e hospital.
4 Work in groups. Describe th e em phasis on care of th e 4 He’d like (go) to th e respite hom e this w eekend.
term inally ill in your ow n country. 5 I w ould prefer not (have to) get up so early
• Is it com m unity based or hosp ital based? every m orning.
• Does th e fam ily receive any help from specialist 6 Do you dislike (start) early in th e m orning?
nurses at home? If not, how do you th in k care of 7 He'd rath er n o t (take) an ything for th e pain
elderly patients can be im proved in th e country in at th e m om ent.
w hich you are living / in your hom e country? 8 As a rule, I like (get) to bed around 10 p.m.
5 Is com m unity care of such p atien ts a cheap option 2 Work in pairs. W rite seven questions using th ese forms.
com pared to hospital / hospice care?
Do you like t o ... ?
• Language spot
Expressing likes, dislikes, and preferences Doyou like or h ate.... ?
Doyc Doyou prefer to... ?
• like, hate, can’t bear + verb + -ing OR + to infinitive is
used to talk about a general preference or a m a tte r
of routine.
I like / h a te /c a n ’t bear being a t hom e alone. Doyou enjoy... ? j
o r I like / hate /c a n 't bear to be a t hom e alone.
• enjoy, dislike, can’t stand, detest + verb + -ing only

I enjoy / dislike / can’t stand being at the hospice.
• Would like / hate / love + infinitive w ith to
I would like / hate / love to stay in the hospice.
• Prefer + verb + -ing o r infinitive w ith to

1 Change your p artn e r and ask your questions.
I prefer staying in the hospice (to staying a t home).
o r I prefer to stay in the hospice (rather than (to) (stay)
at home).
warning shot (n) statement Trust is necessary precisely
to prepare the patient for where we cannot be certain.
bad news If we had certainty, we
wouldn’t need to trust.
— Onora O’Neill, Reith Lecture
Speaking 2 Look at th e picture and decide how you w ould react to

th e patient's daughter crying.
1 Work in groups. Read th is scenario an d check if you
w an t to add any steps to th e p lan below. 3 Decide w hich of th ese you th in k th e p a tie n t’s
d aughter m ight say and w here th e y fit in th e plan.
Mr Jo n e s , a 6 8 - y e a r -o ld p a t ie n t , has been 1 I don't really know w h at m esotheliom a is.
d iagno sed w ith m esotheliom a. He has o n ly 2 Well, I th o u g h t it m ight happen like this.
got s e v e ra l months l e f t to l i v e . You have 3 He hates being in hospital.
to in fo rm h is d augh ter about t h is and 4 He’d rath er be at hom e.
t a lk about p ain management. The f a th e r 5 I’d like to look after h im at home.
has g iv e n co n sent f o r h is d augh ter to be 6 Is th ere anything you can give h im for th e pain?
i nform ed. 7 How long has he got?
8 Thank you for asking, doctor, b u t I’d rather you
continued.
9 Yes, it's very difficult. I ju st didn’t th in k it would
m ake m e feel so lonely.
10 W hat about nursing help at hom e ?
4 Use th e speaking checklist on page 120. Choose five

criteria (e.g. sincerity, em pathy, simplicity) for giving
feedback.
5 Work in pairs. Take tu rn s role-playing th e doctor and

th e p a tie n t’s daughter.
USEFUL PHRASES
P LAM It’s better to let it all o u t a n d ...
I w tr o d A x c tL o v x / f G jr e e t u r g ' I t’s not easy t o ...
‘W arn ing-fh of I t’s a m atter o f ...
InformPntytfoe'cltMAxflxter Would yo u like m e to s to p ...
L e n g t h o f toyne' l e f t ( b e / v a g r t e ) We all go through a range o f em otions....
SyvnpotffoPfrvng'/' eympathCÎrtg^ 6 W hen you have finished, th e doctors should give
C a r e / Lrv th e / Korney feedback about th e ir ow n perform ance first. Give a
Pouw ryicvnagemeyxt grade 1-5, w here 1 is very good.
fiexM/Lngpthescloxyr open/ for thesfuture/ 7 For fu rth e r practice, use your ow n experience to create
a scenario about liver, prostate, or bowel cancer w hich
has spread. Work w ith a p a rtn e r and role-play one of
th e scenarios.
Reading 4 Work in groups. How can you em pathize w ith the
p a tie n t w h e n breaking bad new s ? Consider:
1 Work in pairs. The text below describes a process
for breaking bad new s to patients. Using your ow n 1 asking yourself w h a t it w ould be like to be
knowledge and experience, decide w h a t you th in k th e th e patient.
m ain steps m ight be. 2 how th e p atien t is feeling.
3 th e p atient's concerns w hich th e y are not
2 There are ten steps given in th e text. Scan th e te x t for m entioning.
words th a t indicate a step is about to be m entioned, 4 th e patient's p ast coping m echanism s.
e.g. Thefirst p h a se ... in p arag rap h 2. 5 th e p atient's outlook on life, cultural or otherw ise.
3 Make a list of th e te n steps. 5 Describe how fam ilies are inform ed about d eath in
your country / culture and others you are fam iliar w ith.
BREAKING BAD NEWS
There is no easy way to break bad news, nor is there

any fixed way of doing so. A starting point is, per
haps, to find out how other people deal with the situ
ation and take the best from their experiences to suit
yourself.
One veryuseful approachis Kaye’s ten steps to break
ing bad news (Kaye P, 1996 , Breaking Bad News, A 1 0 -
step approach, Northampton EPL Publications). The
first phase in the process is preparation for the inter
viewwith the patient, reading all the notes, making sure
you know who should be present, making sure that the
setting forbreakingthe news is suitable andprivate. The
second stage in the interviewis finding out what the pa
tient or family knows about the situation. Following
this comes a ‘warning shot’like ‘I amafraid the news is
not good’to help prepare the patient forwhat is coming.
The fourth step is denial with the patient controlling the
situation by the amount of information he / she wants
to be given. Next comes anyfurther explanation, check
ing the patient understands using simple diagrams and
simple language.
The patient may be afraid of asking for more infor
mation so ask gently if you think they would like you to
give more. And then, the seventh step is to listen to the
patient s concerns (physical or emotional health or to
social or spiritual issues).
The next step is to allow the patient to express their
feelings. This may be the key phase in the interview
from the patient’s point of view. The final two steps in
the process are summarizing concerns and making a
treatment plan, and then making sure you offer yourself
for further explanation and possibly a family meeting.
Vocabulary 3 Complete th ese phrases using w ords and phrases m ade
from and related to th e w ord die.
Words and phrases related to death
1 After a person is , w h a t ceremonies
1 Work in pairs. Check th a t you know all th ese verbs and
...?
th e n add th e m to th e appropriate sentences below. You
w ill need to change th e form of th e verb. 2 Traditionally, how long do people m ourn, after the
_____________ of a relative?
m ourn pass pass aw ay bottle up
fade la y o u t perform die of 3 W hen a p e rso n _____________ in your cu ltu re,... ?
1 H e _____________ a h e a rt attack. 4 I s a _____________ p atien t usually looked
2 He is _____________very fast, I’m afraid. after a t ... or i n ... ?
You need to com e now. 5 W hen a person h a s _____________, is it com m on
3 We need t o a post-m ortem . Do you to perform a post-m ortem ?
u n d e rsta n d w h a t th is m eans? 4 Procedures surrounding d eath differ from culture to

4 He peacefully th is m orning. culture. Work in pairs. Ask each other th e questions
using th e phrases above an d develop your answ ers in
5 People_____________ for different lengths of tim e.
your ow n way.
6 The body has b e e n _____________ in th e chapel of
rest, if you w ould like to visit it.
7 Please accept m y sincere condolences an d
_____________ th e m on to your family.
8 Rather t h a n _____________ th e em otion, it is
perhaps b etter to let it out an d have a good cry.
2 Find w ords in th e sentences above w ith th e sam e

m eanin g as th ese words.
1 do 5 suppress
2 decline 6 sym pathy
3 die 7 autopsy
4 give
96 Unit 10
abuse (n) misuse

bereaved (adj) having lost
a loved one or close member
of the family
unethical (adj) not acceptable
morally
Listening 2 Speaking
Informing a relative about a death 1 Work in groups. Look at this proposal and decide
w h e th e r th e argum ents below are for (F) or against (A)
it. Note any other opinions you th in k are relevant.
People should be m ade to carry donor cards stating

th a t th e y do n o t w ish to donate th eir body parts for
(p) Listen to Dr M asood talking about how he

inform ed Mrs M ann about th e d e a th of h er husband,
w ho had been brought into th e hospital after a road
traffic accident.
2 (j~j) Listen again and com plete w h a t th e doctor said

from his description.
1 Mrs M ann? Good afternoon. My n am e is Dr M asood
and I have ju st come from th e theatre.
Could_____________ here for a m om ent?
2 I am afraid so_____________ is n o t good.
3 l a m _____________ w e w ere n o t_____________
2 Decide w hether your group is for or against the
your husband.
proposal and give reasons. Choose a group m em ber to
4 And I am very sorry th a t he h a s _____________ record your argum ents and m ain reasons.
5 Would you lik e_____________to get you som ething?
3 As a class, debate th e issue. N om inate one class
6 Are there any relatives you w o u ld _____________ m em ber to record th e argum ents given and reasons.
or w ould y o u _____________ yourself?
4 Work in pairs. W rite seven statem en ts or questions
7 It is n o t_____________w ith this. I ju st w a n t again to you th in k you w ould use in this scenario.
say I am very sorry.
You have to ask Mr and Mrs G raham if you can
3 Work in pairs. Compare your answ ers.
use th e organs of th e ir 21-year-old son David
4 W hat else do you th in k th e doctor probably asked? for tran sp lan t purposes. He is on a life support
m achine and has been declared clinically brain-
5 Decide how you th in k th e p atien t reacted to th e
dead. David w as carrying a donor card in his wallet.
statem ents and questions in 2 .
6 Take tu rn s role-playing th e conversation b etw een Dr 5 Take tu rn s role-playing th e scenario.

Masood and Mrs M ann.
coping m echanism s (n) ways or strategies to help deal Checklist
with (difficult) situations
When faced with situations that generate strong
emotion, it is difficult for doctors to maintain the
doctor-patient barrier and not be affected and/or I can recognize patients’ emotions.
absorb the emotion expressed by patients.The same I can deal with patients’ emotions.
applies to most if not all health professionals.
I can express likes, dislikes,
and preferences.
I can break bad news about terminal
Speaking illness and death.
1 Work in groups. Explain h o w th ese tips can help you cope w ith I can talk and write about coping
th e em otional dem ands of your work, especially w h e n dealing mechanisms for doctors.
w ith patien ts w ho are term in ally ill or dying. Choose w hich you
th in k is th e m ost effective an d why.
1 Talk to colleagues / a senior nurse. Keywords
2 Eat an d sleep properly.
Nouns
3 Take regular exercise or take up a hobby.
coping mechanisms
4 Socialize w ith friends an d colleagues.
denial
5 Be conscious of your o w n physical health.
disbelief
6 Get aw ay from th e hospital.
donor card
7 Reflect on o n e’s o w n em otions after th e p a tie n t interview .
isolation
2 Are th ere any o th er coping m echanism s th a t you have found MarieCurie nurse
useful from your ow n experience? numbness
organ transplant
1 Report w h a t you th in k to th e w hole class.
panic
resignation
Writing shock
Preferred coping mechanisms Adjectives

rewarding
1 Make notes ab o u t activities you do or m echanism s you use terminally ill
to take your m in d off th e em otional stresses at work. M ention
som e you have trie d an d d id n ’t like. Try to m ake your activities Verbs
realistic an d p ersonal to you, w hich w ill help distin g u ish you bottle up
from other people. dislike
fade
pass away
N o te s
prefer
Ply/tiaU
Phrase
M ental / U vteiletloud I'd rather
Social
2 Work in groups. Com pare th e strategies you like an d give reasons.

Useful reference
Oxford Handbook of Palliative Care,
3 On your own, w rite about 150-200 w ords reflecting on w h a t
Watson et al, ISBN 978-0-19-850897-7
activities you like doing in your spare tim e to help you relax.
98 Unit 11
11 Working in a team
Check up
1 Work in groups. Describe th e attitu d e of th e people
to each other in th e pictures a-d. W hat do you th in k
th e y are doing?
Culture project
1 Work in pairs. Make sure you u n d e rstan d each
situation below. Describe how you w ould deal w ith
each situation in your ow n culture / language.
2 In th e pictures, w ho is: 1 in terru p tin g a conversation betw een tw o nurses
2 m eeting a colleague you don’t know w ell in the
1 engaged in sm all talk?
corridor at work
2 asking for advice / help ?
3 asking a colleague on th e w ard for help
3 interrupting a conversation?
4 asking a consultant for help
4 requesting help from a consultant?
5 apologizing for being late for th e w ard handover
3 W hy is it im p o rtan t to develop an d m a in ta in good 6 asking perm ission from som eone you don’t know to
working relationships w ith colleagues? use equipm ent
7 offering help to a colleague you see in trouble / busy
4 Describe th e m ost effective w orking relationship(s)
you have developed up to n ow in your career. W hat has 2 Make a question for each item : Have yo u ever... ?
m ade it / th e m special?
3 Work w ith a p a rtn e r from an o th er group and ask
each other questions about 1-7 above. Find out w h at
happened: D oyou rem em ber w hat yo u said? W hat
happened? Did it ever happen inEnglish?
4 Give an exam ple for each item 1-7.

Working in a team 99
In this unit
• understanding politeness in different cultures
• working as part of a team with colleagues
• writing about team work as an example of good practice
• interrupting colleagues politely
• working with different colleagues
Vocabulary
Teamwork
1 M atch each adjective w ith as m an y nou n s as possible.
.te a m cy0se
_cooperation
^ ec ^ e c°runru n ity
joWt
-spirit P o e t ic a l
- ro le y e l w u lt iA is c iP lir v a t Y
^ soaai tearn£
.p a rtn e rsh ip Writing
Describing an example of good practice
2 Complete th ese sentences u sing a n o u n an d an 1 Think of an exam ple of a situation w here you worked
adjective p air from 1. Use each n o u n once only. w ell as p a rt of a te a m in your professional or private
life. Make notes about th e various steps using the
1 W hen group m em bers cooperate closely w ith each
diagram below. For exam ple, you could describe a
one playing th e ir p art responsibly, it helps foster a m edical em ergency involving various colleagues,
_____________________ am ong th e m edical and non-m edical, and how th e y fitted into
various
m em bers. th e sequence of events.
_is required b etw een

T EA M W O R K : STEPS
all th e m em bers in th e clinical team .
He built up a ______________________ 1
of different specialists.
4'
4 Everybody plays a ____ 2
in th e team . 4^
5 A genuine te a m bears _ 3
for its errors w ith o u t p ointing th e finger of blam e. 4.
4
6 It is im p o rtan t to give each o th er m oral as w ell as
4.
5
7 The consultant established a _
4.
_____________ w ith colleagues in an o th er hospital.
6
3 Work in groups. Discuss w h a t experience you have had 4,
of w orking in your hom e country as p a rt of a 7
te a m an d /o r in a hierarchical structure. Talk about
other countries’ system s you know. Are th ere any 2 W rite th e steps in a continuous piece of w riting. Try to
differences / sim ilarities? Give exam ples. fit as m an y of th e w ords from Vocabulary 1 as possible.
W hen you have finished, underline th e w ords you have
used from th e list.
3 Work in pairs. Swap your texts and check th a t each of
you has described th e steps you listed in i.
100 Unit 11
carer (n) person who looks

after a family member, friend,
or client at home
core (adj) central, main
Reading
1 Work in pairs. Before you look at th e te x t from Section • takes le a d e rsh ip ro le in the context
4: Syllabus and Competences of th e Foundation o f own competence when necessary
Program m e Curriculum, m ake your ow n list of w h a t • tre a ts a l l members o f the h ealth care team
you think are th e m ain skills an d attrib u tes required in with re sp e ct, whatever t h e ir p ro fe ssio n a l
w orking w ith colleagues. q u a lific a tio n s , l i f e s t y l e , c u ltu re ,
r e lig io n , b e lie f s , e th n ic background,
2 Find words an d phrases in th e te x t w ith th e sam e gender, s e x u a lit y , d i s a b i l i t y , age, or
m eaning as these. s o c ia l or economic s ta tu s .
• understands the c l i n i c a l s e t tin g and
1 show
the in te r a c tio n s w ith in i t and shapes
2 result
p ra c tic e e f f e c t iv e ly in the l ig h t o f such
3 points of view understanding and in s ig h t s
4 und erstan d / recognize th e value of • puts g o a ls o f the c l i n i c a l team before
5 show consideration for personal agenda
6 take note of / pay a tte n tio n to • can show le a d e rsh ip s k i l l s where
7 m ould ap p ro p riate, but a t the same time
works e f f e c t iv e ly with o th ers towards
a common goal
5.0 Working with colleagues • encourages an atmosphere o f open
Outcome: demonstrates e f f e c t iv e teamwork s k i l l s communication and app ro priate d ire cte d
w ithin the c l in i c a l team and in the la r g e r communication w ith in teams
medical context • d is cu ss e s the ro le o f the vo lu n tary
s e cto r in supporting p a tie n ts , c a re rs ,
Subject and fa m ilie s
( i ) Communication with co lle a gu e s and teamwork
Knowledge
Understands:
• who needs what inform ation
• o th e rs ’ p e rsp e ctiv e s in co n trib u tin g to
management d e cisio n s
Attitudes / behaviours
• app reciates the p e rsp ective o f d iffe r e n t
d is c ip lin e s , medical and non-medical
• resp ects a ll those with whom doctors work
whatever th e ir p ro fe ssio n a l q u a lific a tio n s ,
l i f e s t y l e c u ltu re , r e lig io n , b e lie f s , e th n ic
background, gender, s e x u a lity , d is a b ili t y ,
age, or s o c ia l or economic sta tu s.
Core competences and skills

• lis t e n s to other health care p ro fe s s io n a ls
and heeds th e ir views
• has a good understanding o f the ro le
o f other team members in the c l i n i c a l team
and understands t h e ir competences and care
p h iloso p hies
3 Answer th ese questions.
1 W hat does Understands who needs w hat inform ation
m ean?
2 A doctor in train in g needs to show th a t h e /sh e
appreciates th e perspective of different disciplines,
m edical and non-m edical. Give an exam ple of th is from
your ow n experience.
3 Give an exam ple of a situ atio n w here you heed ed th e
view s of others in a clinical or non-clinical setting.
Did you find it difficult or easy to accept th e advice?
Give reasons for your answ er.
4 W hy is it necessary to p u t th e aim s of th e clinical
te a m first?
5 W hy do you th in k th a t an atm osphere of open
com m unication should be encouraged w ith in team s?
Give exam ples from your ow n experience.
Listening 1
Appropriate responses
Listen to seven statem en ts by m edical professionals
and decide w h a t is h appening, for exam ple in terru p tin g
3 How w ould you respond to each of th e polite answers
a colleague. There m ay be m ore th a n one activity
you have chosen?
happening in each conversation.
EXAMPLES
2 (j~i) Listen again an d decide w hich of th ese is a m ore polite Thanks fo r being so understanding.
response in each case. That’sfine.
1 a □ I’m a bit tied up at th e m om ent. Thankyou.
b □ Yeah, sure. No problem . N ot a t all.
That’s really kind o f you.
2 a □ Yes, by all m eans.
M y pleasure.
b □ Mm. H aven’t you got your own? I hope it stays th a t way.
3 a □ Oh, it h ap p en s to us all. I w as late myself. That would be great.
b □ I know, an d I w a n te d to get aw ay on tim e. 4 How w ould you respond to each of th e im polite
I've h eard th a t one before. answers?
4 a □ W hat do you th in k I am, a m achine?
b □ I can do it in a few m om ents, if th a t’s OK.
5 a □ Busy, b u t I am enjoying it, th a n k you.
b □ It’s horrible.
6 a □ Oh, th a n k you. T hat’s very kind of you.
b □ Yeah, here, take that.
7 a □ I w as try in g to have a rest.
b □ T hat’s OK. It’s not a problem . How can I help?
102 Unit 11
• Language spot 5 In terrupting a colleague you know well

and asking for help
Being polite
a EH Excuse me, b u t could you help m e here?
Asking for permission
b EH Hi. I’d like som e help here.
• If you are w ith a group of people, it's generally
m ore polite to ask perm ission to do som ething 6 In terru p tin g by acknow ledging w h a t th e person is
rather th a n to ju st do w h a t you w a n t to do. doing and th e n m aking a request
You think: I w ant to m ake a p h o n e call. a EH I can see th a t you are very busy, b u t could you
You say: Is it OK if I m ake a phone call? help me?
b □ You look busy, b u t I need help.
Asking for help
• W hen you need help, it’s generally m ore polite to 7 Offering help to a colleague you do not know w ell
ask for help th a n to d em an d it. a EH W ould you like m e to help you?
You think: I need help lifting this. b EH Here. Let m e help you.
You say: Would yo u m ind helping m e lift this?
2 Complete th e sentences by using a w ord or phrase
Offering help from each box below.
• W hen you can see th a t som eone needs help, it’s
do you th ink is it OK excuse me
generally m ore polite to m ake your offer as a
w ould you m ind I can see sorry to
question rather th a n a statem ent.
You think: I can help yo u w ith that.
You say: Would yo u like som e help w ith that? closed use bother
clear w riting come and have
» Go to G ram m ar reference p.130
1 Deciding how to approach different people for help or 1 I’m ___________________________ you, b u t could
to offer help in another language can be tricky. Decide you give m e a hand?
w hich of th e tw o alternatives below is m ore polite.
2 _____________ , b u t could y o u _____________
1 Asking close colleagues if you can do som ething a look at this?
a □ Is it OK if I open th e window ? 3 _____________ very m uch if I _____________
b EH I w a n t to open th e w indow . OK? th e door as th e re ’s a draught?
2 Asking close colleagues if you could do som ething 4 _____________ th a t you a r e _____________
th a t is m ore personal u p your notes, b u t can I ju st check som ething
a EH Is your laptop free? I need it for a second, w ith you?
b □ Do you th in k I could possibly use your laptop? 5 _____________ if I _____________ th e things
3 Asking som eone you do n o t know very w ell if you off th e table?
could do som ething g _____________ I could possibly_____________
a □ W ould you m ind if I borrow ed th is notepad? your office for th is afternoon?
b EH I w a n t to borrow this notepad.
4 Interrupting colleagues you do n o t know w ell and
asking for help
a EH I know you’re busy, b u t I need help.
b EH I’m sorry to disturb you, b u t could you help m e
here?
bo ttle ad d itives (n) chem ical health and safety gu idelines

substances that are in each (n) rules and regulations to
blood sam ple bottle.The protect the workers' and the
bottles are colour coded patients’ health and safety
according to the additives. order o f draw (n) the order
in which the different blood
sam ples are taken
3 W hich sentences in 2 can th ese responses be used for? 2 Read about Om ar Noori and answ er these questions.
a It’s n o t a problem at all. d Yes, sure, 1 W hich country does Om ar come from?
b By all m eans. e Not at all. 2 W hat does train in g to be phlebotom ist involve?
c Certainly. 3 W hat are O m ar’s m ain languages?
4 To w h a t does he com pare speaking to different
4 Practise polite sta te m e n ts an d responses.
people?
Student A go to page 116. Student B go to page 118.
5 W hat w arn in g does he give about being slow to
react or being rude?
Speaking
Oesophagus, stomach, duodenum, heart Dr Omar Noori
Liver,gallbladder, Stomach, spleen,
My name is Omar Noori and I work as a phlebotomist
duodenum, right lung _ _ _ ^ | __ left lung
at a hospital in Birmingham in central England. I am an
Right kidney, colon, ureter, 9 M _ _ _ _ _ Left kidney, colon,
overseas doctor from Afghanistan who has to go through
musculoskeletal m I ureter,abdominal, re-qualification known as the Professional and Linguistic
aorta, musculoskeletal Assessments Board (PLAB) test,administered bythe
General Medical Council (GMC) of the United Kingdom.
Caecum, appendix, right________________ ^ ___Colon, left ovary and
ovary and right fallopian left fallopian tube, left I cannot work as a doctor in the UK until I pass the
tube, right testicle, ureter [ ' testicle, ureter PLAB test, but being a doctor helped me to become a
phlebotomist. I followed a course covering information
Small bowel,appendix,
S on health and safety guidelines, order of draw,
Bladder, uterus, rectumn I IA
Meckel’s diverticulum
bottle additives, infection control, labelling, and
documentation, with many opportunities to practise
1 Work in groups. Look at th e diagram an d choose a cause
both in an out-patient setting and on the wards.
of pain. You are a doctor in A ccident an d em ergency
During my training I was assessed on obtainingthe
and a p a tie n t p resents w ith an acute abdom en. You
minimum of 50 bloods. As well as clinical skills, the
need th e help of a consultant, w ho is very busy. Prepare
needforgood communication skills was impressed
w h a t you w ould say to ask h im / h er to come. Use your
upon me.
ow n know ledge an d experience. Create a n a m e for th e
patient, an age, an d signs an d sym ptom s, an d explain On the job itself, working with other people has improved
w hy you need help. my speaking skills. I have found that having a cheerful
disposition certainly helps and an ability to get on with
2 Work w ith a p a rtn e r from an o th er group an d take other people no matter what their rank or status. Being a
tu rn s telep h o n in g th e consultant. second language speaker of English, I feel as if I’m driving
3 W hen you have finished, check th e differential a car, switching gears where the gears themselves are
diagnosis of th e pain. professionals of different status and functions. One
minute you are havingto deal with a nurse, next a
manager,then a doctor, and maybe a consultant,
It’s my job all requestingyour help and attention.There is
no time to think in Dari or Pushto, my main
1 Before you read, discuss th is q uestion w ith a partner. languages, or to be bad-tempered or rude.
M any doctors in th e U nited Kingdom w ork as doctors If you don’t react quickly and politely,
and nurses as th e y go th ro u g h th e process of re get on with colleagues, and play the game,
qualification. Do you th in k th is is a valuable w ay of the job is unbearable. It’s good trainingfor
spending tim e? Give reasons for your answer. my work as a doctor in the future.
104 Unit 11
Vocabulary Speaking
Describing attitude and behaviour 1 Work in groups. Look at this scenario. Think of tw o
different th in g s you can say for each step below.
Work in pairs. U nderline tw o adjectives in italics w hich
m atch th e description.
You are in a busy children's w ard and a 5-year-old
1 Dr M uir w as bad m an n ered an d impolite. He
child is in a critical condition.
shouted at th e patient.
Ask th e phlebotom ist, Mr Sanjay Kumar, w ho is
offensive frien d ly rude
older th a n you, very experienced, and very busy,
2 Nurse D unn gets on w ith everyone; h e ’s very good to take a blood sample.
company.
1 In terrupt him and apologize.
reserved frien d ly sociable
2 Ask politely if he could help you.
3 Mrs Paterson know s w h a t she w an ts to do in life 3 Explain th e situation briefly.
and is som etim es aggressive. 4 Give h im th e priority form and ask him to
ambitious determ ined m odest send it off.
4 Mr Conway can be sharp an d frank w ith 5 Thank h im and ask him to contact you by bleep
colleagues at tim es. if th ere are any problem s.
abrupt gentle blunt
5 Dr Bedford’s attentive an d considerate to all her
p atien ts and colleagues.
thoughtful kind cruel
6 Outside work, h e ’s different: h e ’s very easy-going
and relaxed.
strict calm carefree
7 He’s always sm iling an d positive about everything,
even w h en stressed.
sad cheerful lively
Choose tw o o rth re e sets of adjectives from 1-7 to
describe yourself. Give exam ples from your personal
and professional life.
Work in pairs. Ask each o th er questions about your 2 Use the speaking checklist on page 120. Add five
personalities. criteria to check in the role-play.
US EF UL P HRAS ES
3 W ith a different partner, take turns asking Mr Kumar
H ow w ouldyou describe yo u rself ?
to take blood.
I think I a m ... b e c a u s e /s in c e /a s ...
W hat I think makes m e ..., is ...
4 Give three reasons w hy it m ig h t be difficult to talk

about yourself.
Checklist
I can understand politeness in different
cultures.
I can work as part of a team with
colleagues.
I can write about teamwork as
Listening 2 an example of good practice.
Asking a senior colleague for help I can interrupt colleagues politely.
1 Listen to a telep h o n e conversation b etw een a doctor I can work with different colleagues.
in A&E an d a consultant. W rite dow n th e exact w ords for:
1 Doctor’s apology for in terru p tio n
Key words
Nouns
2 C onsultant’s reply
colleague
cooperation
3 Request for help good practice
partnership
perspective
2 Compare your answ ers w ith a partner. Listen again and take
politeness
notes for th e rest of th e conversation. responsibility
3 Work w ith a p a rtn e r from an o th er group an d take tu rn s role- role
playing telep h o n in g th e consultant. support
teamwork
Adjectives
Speaking close
1 Practise facing an interview panel. Work in groups and collective
describe exam ples of situ atio n s in your w ork or train in g w hich key
dem onstrated your ability to w ork in a team . polite
sociable
2 Make a list of questions w hich you th in k w ould be asked about
team -w orking w ith in a clinical setting. Verbs
USEFUL PHEASES apologize
... where the com m unication broke down? breakdown
... you dem onstrated leadership qualities? interrupt
... qualities / skills necessary fo r working in a team? Phrase
... improve if y o u did it again? excuse me
3 Take tu rn s interview ing each other about being a te a m player.
Useful reference
Oxford Handbook for the Foundation
Programme 2nd edition, Hurley et al,
ISBN 978-0-19-954773-9
106 Unit 12
12 Diversity at work
Checkup 2 Is one aspect m ore im p o rtan t to a culture th a n another

or are th e y inextricably linked? Give reasons for your
1 Work in groups. Explain w h a t aspects of culture th e
answer.
pictures below represent.
3 W hen you are taking a history or counselling, w hy is
it im p o rta n t to tre a t p atien ts w ith in th e context of
th e ir beliefs and n o t yours? Use th e aspects of culture
discussed in 1 and 2 to illustrate your opinion.
4 People are m igrating around th e w orld at a faster rate
th a n at any tim e in h u m a n history. W hy is this so? Is it
possible for us all no w to try to u n d erstan d each other
more? Give reasons.
Speaking
1 Below is a list of th in g s w hich people som etim es do
w h en you talk w ith them . Are you annoyed by any of
th e se behaviours? W hich ones? W hich are th e m ost
annoying for you?
1 m ake assum ptions because of age
2 ignore th e im portance of festivals, celebrations,
holidays
3 ignore people's diet
4 m ake assum ptions about professional status
5 m ake assum ptions about or be ignorant
of oth ers’beliefs
6 m ake assum ptions about professional abilities
7 m ake assum ptions about m arital status
8 m ake assum ptions about level of education,
qualifications, language
9 label or stereotype because of disability, clothes,
skin colour
2 Compare your answ ers w ith a p a rtn e r and explain them .
3 Choose th e th ree th a t are m ost annoying and explain
th e reasons for your choice.
Diversity at work 107
In this unit
• understanding culture and religion
in a multicultural society
• avoiding and responding to tactless comments
• using reported speech
• speakingfluently
• assessing religious / faith / spiritual needs
Listening 3 (]"}) Listen an d m atch each statem en t 1-8 to a response

a -h in 2.
Avoiding and responding
4 Listen to each sta te m en t in turn. How could th e speaker
to tactless comments
have rephrased each sta tem e n t to make it less annoying?
1 Look at th e p oster from a London hospital. W hy do you
th in k th a t th e poster w as displayed?
Patient care
1 Work in pairs. Decide w hich questions you m ight ask a
p a tie n t to ob tain th ese responses.
1 I live w ith m y p artn er and m y tw o children.
2 No. My parents b o th passed aw ay fairly recently.
3 It’s Doctor, b u t you can ju st call m e Sheila.
4 Yes. M y su rnam e is originally from Sierra Leone, in
W est Africa, b u t I w as born here.
5 Yes. M y h u sb a n d ’s in a w heelchair now, b u t he is
w orking full-tim e.
6 The only tim e I can’t come is during th e end of
Ram adan.
7 M mm. I can’t take any m edicines th a t have beef in
them .
Ageism is everywhere and can be so
insulting. Think about w hat you say.
USEFUL PHRASES
Think about w hat you do.
Are there any festivals or celebrations th a t you need t o ... ?
Canyou tell m e who ...you a t home?
W hat about y o u r ... ?Are th e y ... ?
2 Work in pairs. Look at th e list of responses a - h an d try Tell m e about y o u r....
to w ork out w h a t th e speaker is responding to in each Is there anything else yo u think I... ?
case. Are there any medicines y o u can’t take fo r any reason?
a Actually, I’m n o t a m e a t eater. I’m vegetarian, Could yo u tell m e w hat norm ally happens... ?
b I am not m arried. W hat should I call yo u (Miss, Mrs, Ms, Doctor)?
c I'm sorry, b u t m y nam e is Sivapalan an d it’s n o t Miss, Is y o u r fa m ily nam e f r o m ... ?
it’s Professor, I know y o u r husband is in a ..., but is h e ... ?
d I'm n o t a patient. I’m an h onorary consultant, W hat about y o u r ... ?
e I'm teetotal.
2 Take tu rn s asking each other th e questions you have
f I m ay be blind, b u t I ru n a very successful business,
created. Give your ow n answ ers to th e questions - real or
g I’m n o t sure th a t you do.
im aginary.
h No. I go to prayers on th a t day.
Reading
1 Read these com m ents about som e issues relating
to cultural background th a t are im p o rtan t for h ealth
professionals in th e UK to know about.
Being originallyfrom the West I am a Muslim, and for us alcohol is

Indies, I feel uncomfortable prohibited, so we cannot take tonics.
answering intimate questions We eat meat that is prepared in the
even though my doctor has halal fashion and do not eat pork.
explained that everything Some Muslims may refuse to take
between us is confidential. their medication during Ramadan,
I have also been misinterpreted but accordingto Muslim rules,ill
because of lack of eye contact. people must not fast. As for death,
Here in the UK it is a negative the body should not be touched by
thing. But where I come non-Muslims and all Muslims
from it's to do with showing are buried. We do not agree to
respect. post-mortems being done unless
they are legally required.
I'm Hindu. Like other My fam ily are Jewish.

cultures, we have dietary We have certain dietary
restrictions,for example not restrictions. Pork, rabbit,
eating beef or veal.The cow and shellfish are forbidden,
is sacred to Hindus, so we and meat must be prepared
cannot take beef insulin. We in the kosher fashion. Some
also prefer to die at home liberal Jews may not adhere
ratherthan in a hospice and to dietary restrictions. No
the Hindu body should not post-mortems are agreed
be touched by non-Hindus. to unless legally required.
All adults are cremated.
I'm British. What things would means invasion is threatened. I am a Sikh. We have no family
I point out? It is important Some strict Christians are nam es.Singh and Kaurindicate
not to assume that everyone teetotal and some approve only sex and religion, so that
drinks alcohol. And mutual of natural methods of birth we often need to give extra
gaze is a sensitive issue with control only. identification for hospital notes.
u s -n o t enough indicating As regards diet, beef is forbidden
shiftiness and too much and most of us are vegetarian.
meaningyou are making Alcohol is forbidden, so we can’t
unwelcome advances. As really take any tonics.
regards interpersonal space,
for many people of different
backgrounds here in England,
just as in other Western
countries, getting too close
rota (n) schedule, list
a V P s r w z 0 t u k r
2 Work in pairs. U nderline th e alternatives
th a t are correct in th e sentences below. V a 1 u e P 1 i z V r e
1 A m ong W est Indians, n o t m aking eye contact d X i r s 0 h j t q 1 g
is a sign of respect /disrespect. s y g t P g 0 t V 0 n r
2 Beef insu lin should n o tb e /c a n be offered to Hindus.
w s n w e k m z f f g e
3 Sikhs are m ainly / in som e cases vegetarians.
4 A ll/S o m e M uslim s w ill n o t take m edicine c 1 0 P c h e z X f b t
during R am adan b c r i t i c i z e z s
5 In England, people generally can feel uncom fortable n t e d V y e q k n 0 f
if others com e too close / m ove aw ay fr o m them .
6 All /S o m e Jew ish people follow certain dietary
q k z u P s e t a d r X
restrictions. d i s c r i m i n a t e
3 Give exam ples of aspects of your ow n culture. 2 Use a form of each verb to com plete th e sentences
Say w h y th e y are im p o rtan t to you. below. Use a dictionary if necessary.
1 He felt he w as being u n ju stly _____________ w hen
Project he th o u g h t he should be praised.
1 Work in pairs. A nsw er th ese questions. 2 No applicants should b e _____________ against
1 W hen a n d h o w do you th in k th e m ispronunciation because of th e ir background.
and m isspelling of n am es can cause problem s from th e 3 My sensibilities w ere com pletely_____________
cultural point of view?
w h en th e rota w as draw n up.
2 Have you ever u sed som eone’s n am e w rongly in speech
4 He did n ’t m ean t o _____________ th e p atien t by
or in w riting? W hat happened?
3 Has anyone ever used your n am e w rongly? W hat calling her Mrs.
happened? 5 W hat th e doctor said left th e p a tien t feeling really
4 Are nam es an d titles im p o rta n t in dealing w ith
colleagues of sim ilar / different status? Give reasons.
6 He trea ted p atien ts and colleagues alike w ith the
5 Is it polite to call an adult by th e ir su rn am e alone in
your language culture? Is it th e sam e in th e UK an d u tm o s t_____________
other English speaking cultures? 7 All m em bers of th e m edical te a m play a(n)
2 Look a t th e inform ation ab o u t Sikh nam es. Then use your _____________ role.
ow n know ledge or check th e in te rn e t to find out exam ples 8 H e _____________ th a t he didn’t check th e p a tien t’s
of nam es from th e other groups in th e reading.
n am e before th e consultation.
3 Rewrite th e sentences in 2 so th ey have th e same
Vocabulary m eaning, b u t use one of th ese w ords in th e form given.
Awareness of feelings up settin g critical regretful ignorant
1 Find eight verbs. You can read vertically an d horizontally. respected offensive discrim ination invaluable
The first letter of each verb is given. 4 Think about your ow n professional and personal
1 v _________________ 5r ___________ experience. Make th ree questions beginning Have you
ever innocently... ?
2 i _________________ 6d _________
3 o _________________ 7c___________ 5 Work in pairs. Give your questions to your partner. Ask
each o ther th e questions an d explain w h at happened
4 r _________________ 8u _________
in each case.
• Language spot
Reported speech When will you be here?
e We use reported speech form s to talk about th in g s

th a t other people have said.
At 10:00.
Dr Singh says he'll be
late today. He can’t
find his car keys.
Hesavs he’ll be hereatioroo
Monday, 9:00 a.m.
Dr Singh wasn’t at work on Monday,

but he’s here today. Is it OK to plan
a m eetingthis afternoon?
Monday, 10:15 a.m. Wednesday
Dr Singh phoned atg-.oo.H esaid he’d be late. John asked 1 Work in pairs. Change these sentences into
when h e’d be there. He said he’d be there a t 10:00. reported speech.
Ann told Lorenzo th a t Dr Singh had phoned again. He 1 'Mr Jones has ju st telephoned to say he can’t come
had said he w ouldn’t be a t work today. Lorenzo asked for th e afternoon clinic,’ said Nurse Burnes.
what the problem was. 2 ‘Is it OK to call you by your first nam e, Mrs Hall?’
Gill told Ella th a t Dr Singh h a d n ’t been at work on asked th e nurse.
Monday, but th a t he was a t work th a t day. She asked 3 'Ahmed, could you tell me how this is done in your
ifitw a s O K toplan a m eeting th a t afternoon. hom e country?’ asked Dr Ono.
4 ‘It w ould be b e tte r to give up eating red m eat like
Ella said it would be better to plan the m eeting
pork and beef,’ said Dr Sind.
forFriday.
5 'W hat is his p atien t num ber?' asked th e nurse.
» Go to Grammar reference p.130 6 ‘I left m y app o in tm en t card at hom e,’ said Mrs Taylor.
7 'I am not sure how to pronounce your nam e,' he said.
2 Work in pairs. One stu d en t says one of th e sentences

above or th e reported speech and th e p a rtn e r changes
it to direct or indirect speech as appropriate.
We must learn to live together come up w ith (v) produce

as brothers or perish together
as fools.
— Martin Luther King, ig 64
' - 4T / , r .
Speaking Speaking
W hen you listen to people reporting w h a t oth er 1 Work in groups of six (three pairs of two). Look at this
people say it can be difficult to follow an d it can lead to graph about th e num ber of w om en in medicine. W hat
m isund erstan d in g s an d w rong assum ptions. Student is your reaction to th e data?
A go to page 116. S tudent B go to page 118. Practise Female Other Rank
reporting w h a t’s b een said an d clarifying to avoid 6% (6,912)
m isunderstanding.
Male Other Rank
7% (7,421)
Pronunciation Female Assistant
Saying long sentences Professor
15% (16,152)
W hen trying to speak fluently an d clearly, it helps to
say sentences, especially long sentences, in phrases or Male Assista nt Male Associate
Professor Professor
chunks of language. You can use a rising to n e to show
26% (27,896) 16% (17,423)
you are continuing to speak an d take a very shallow
Female Associate Professor
breath. At th e en d of th e sentence, you can th e n use a 6% (6,074)
falling tone, or rising to n e if it is a question.
2 Read this scenario.
1 Work in pairs. Divide th e se sentences into chunks of
language. The first one has b een done for you. Note You are part of a diversity committee in a hospital whose
there m ay be m ore th a n one answer. aim is to promote equality and diversity among the staff
at your hospital. Today your purpose is to come up with
1 Do you th in k / th a t it w ould be a good idea / to
recomm endationsforthe hospital’s personnel department
display posters / in all th e clinics? to increase the representation in the workforce of women
2 He suggested going for w eekends aw ay so th a t or people with disability or older people or any other group
people could get to know each other. you want to choose.
3 He asked w h a t tim e th e clinic norm ally opened in
th e afternoon. Work in groups of six (three pairs of two). The
4 The patien t w a n te d to know w h e th e r she w as able com m ittee consists of th re e people. They m ake a list of
to book an in terp reter for h er ap pointm ent. five possible suggestions w ith reasons. They th e n have
5 Dr W en denied tak in g th e eq u ip m en t out of th e to agree on one w hich th e y th in k should definitely be
w ard during th e last shift. adopted. Each com m ittee m em ber has a p artn er w ho
6 I th in k you said earlier th a t one w ay to prom ote w atches h im /h e r speaking th ro u g h o u t th e exercise.
diversity is to hold lunchtim e displays in th e The partn ers use th e speaking checklist on page 120
hospital for p atien ts an d m edical staff. an d give feedback on participation, listening, and
7 He apologized for th e m isu n d erstan d in g an d even inviting other com m ittee m em bers to speak.
boug h t m e som e flowers.
Change roles. The m onitors can now become
2 Listen to speakers 1-7 an d check your answ ers. com m ittee m em bers and choose a different group of
people in th e workforce to increase th e representation
3 Practise saying th e sentences w ith your partner. Check
of. Follow th e sam e procedure.
th a t you are speaking com fortably an d clearly.
USEFUL PHRASES
W hat do yo u think about... ? Can I ju st a d d ...?
I think y o u said earlier... W hat a b o u t...?
I f la m right, y o u /so m e b o d y said... But...
Would it be a good idea to... ?
Have y o u got any suggestions about... ?
112 Unit 12
spiritual (adj) relating to

religion, the spirit / soul TNH0I
SEAYTON
‘Know thyself.’
— Inscription on the Temple o f Apollo at Delphi
Writing 2 Use th ese phrases to com plete th e sentences in 1and

com pare th e m w ith your ow n answ ers.
A response to a report
you like to see h im / h er
1 You have seen a report on th e recom m endations
to arrange a m em ber of your
m ade by th e Diversity Com m ittee. W rite a le tte r to th e
th a t w e can support you
comm ittee, agreeing or disagreeing w ith th e proposals.
spiritual or religious beliefs (x2)
Use the ideas from Speaking on page 111.
your notes th a t you describe
2 Use as m any of these phrases as possible. helpful to you
The report sa y s/sta te s that... w e need to know
The com m ittee recom m ends / recom m ended th a t ...
... puts forw ard the suggestion /proposal /
recommendation that...
I agree / disagree w ith /s u p p o r t the
recom m endation that...
... they should (not) be adopted
3 W hen you have finished, exchange tex ts w ith a

partner. Underline all th e exam ples of indirect speech
your p artn er has used.
4 Check th a t you agree w ith your partner.
Patient care
1 Work in pairs. Using your ow n words, try to com plete
th ese exam ples of initial assessm ent questions
relating to spiritual needs in palliative care.
1 I can see fro m ________________________
your religion a s .... Can you tell m e about this?
2 Do you have a n y ________________________ ?
Can you tell m e about them ?
3 Is your faith / sp iritu ality / religion
?
4 Are th ere w a y s________________________
in your fa ith / spirituality / religion?
5 Are th ere any th in g s ________________________
about your faith / spirituality / religion th a t w ould
help us in caring for you?
6 Would you like to talk to som eone about your 3 Work in pairs. Divide th e questions into phrases
? th a t w ill help you say th e m m ore comfortably, as in
Pronunciation on page 111.
7 We have a chaplain w ho is p a rt of our team .
W ould________________________ ? 4 Practise saying th e questions to each other and check
w h e th e r you are saying th e questions clearly.
8 Would you like u s ________________________
faith com m unity to come an d see you?
Checklist
I can understand culture and religion
in a multicultural society.
I can avoid and respond to
thoughtless / tactless comments.
I can use indirect speech.
Speaking I can breathe while speaking.
1 Work in pairs. You have to assess a term in ally ill p a tie n t’s I can assess religious / faith
spiritual needs. Prepare w h a t you w ould say in th e scenario / spiritual needs.
using these steps.
1 Give th e p a tie n t a n am e an d age.
2 Give th e p a tie n t a fa ith or religion or spiritual needs. Keywords
3 Decide w h a t th e p a tie n t’s needs are.
Nouns
4 Ask th e relevant questions above.
assumption
5 Offer help in th e future.
awareness
2 W ith a p a rtn e r from an o th er pair, take tu rn s assessing diversity
th e p a tie n t’s spiritu al needs. Develop th e conversation initial assessment
in your ow n way.
Adjectives
3 As a w hole class, debate th e n eed for th e doctor to be aw are of his critical
/ her ow n spiritual beliefs an d values in order to help patients. halal
Is it necessary? W hy/W hy not? kosher
multicultural
prohibited
regretful
spiritual
tactless
Verbs
discriminate
ignore
offend
respect
stereotype
upset
value
Useful reference
ISBN 978-0-19-856581-9
114 Speaking activities
Speaking activities
Student A • The average p a tien t w ill visit th e ir GP about four
tim es a year, w ith 78% of people consulting th e ir GP
U nitl p.9 at least once during each year.
• Com pared w ith 25% te n years ago, about 40% of the
You are: GP workforce in England is female.
Surnam e M adeline (F)
or M aurice M atthew s Unit 5 p.38
Sex M /F 1 Ask and answ er questions w ith Student B to com plete
Address 66 M onkton Avenue th e chart for th e sam e patient.
Northfields, London SW 15 5BP 2 W hen you have finished, read th e chart aloud to your
Ward Guys W ard at 2 p.m. partner. Make at least tw o deliberate m istakes as you
on 17th luly 2008 read and see if your p a rtn e r can spot them .
Hospital No 211538966 USEFUL EXPRESSIONS
DOB 19 06 43 ... d a te d ... ... by...

... signed by... ... prescribed by
Telephone No 02071117893
...for... N ot applicable
M arital Status Single
Occupation Teacher Patient Dob Hospital No
Mr Andrew Marks l 59731127B
GP Dr Payne
Complaint Kidney stones Drug Date
2 18.05.09
W orst p ain ever; throbbing;
nearly passed out; in side; Route Dose Start Time
doesn’t go anyw here else; IM 50 mg 3
vom ited - p ain so bad; n o th in g
leaves; try n o t to m ove Max Frequency Max dose / 24hr Dose
4h 5 50 mg
Unit 2 p.14 Indications for Use Route
In . I, th e N ational Insurance Act provided analgesic IM
free GP care for all w orking m en. Signature Pharmacy Given by
In __________ ?, th e N ational H ealth Service (NHS) B V o h e r ty
w as form ed, g iv in g__________ I for th e entire
population.
In th e UK, th e re are a b o u t _ GPs w orking Unit 7 p.69
in __________ I, surgeries.
There are m ore GPs th a n all consultants in all Parti
specialties com bined. Of all practices in th e UK, Play th e role of a doctor in A & E. A nswer th e phone call
about a __________ ®are single-handed (one GP). from an anxious p aren t (Student B), take th e history,
Annually, over 250 m illion consultations take place, and explain in non-technical language th e likely
w ith 15% of th e population seeing a GP in an y tw o- diagnosis an d w h a t to do next.
w eek period.
Each GP looks after around 2,000 p atien ts on Part 2
average, and will conduct about 7,000 consultations
1 Spend 3-5 m inutes checking w ith other Student As
per year.
th a t you u n d e rsta n d th e notes below.
GPs refer 14% of th e population to hospital
specialties, m ean in g th a t 86% of all h e a lth needs are 2 Decide on seven technical w ords w hich you (as th e
m anaged w ith in prim ary care. patient) an d th e doctor should avoid in th e role-play.
3 Pretend to be th e p aren t of th e child described below. 3 I can get a bit low at times.
Phone A & E (Student B). A nsw er th e questions th e • m ost days
doctor asks you, b u t rem em ber th a t you are a parent. « every day in fact
Give non-technical answ ers. If th e doctor uses technical • quite depressed
words, you should say: Sorry, I d o n ’t understand w hat • in fact very depressed
you mean. 4 I d o n ’t get the pain th a t often.
4 Use th e checklist to give feedback on th e technical « m aybe once a w eek or so
w ords used. • actually once a w eek
5 I’ve not fe lt like harming m yself fo r a while now.
You are Mr / Mrs Pembroke and you are very anxious
s 2 or 3 weeks
about your one-year-old child.
• actually 2 weeks ago
Signs an d sym ptom s: • felt like this several tim es before
• crying
2 You are a doctor. Listen to w h a t th e p atien t (Student B)
a diarrhoea (the runs)
says, an d th e n probe for m ore inform ation.
a w atery stools (poo is w atery)
« no blood (in th e stool)
Unit 8 p.79
a not v om iting (throw ing up / bringing up)
a sta rte d during th e nig h t 1 You are 25-year-old Charlie Chadwell (M or F)
a first tim e th is has hap p en ed p resenting w ith a ru n n y nose. You are a cocaine addict
a no skin tu rg o r (skin retu rn s to norm al w h en and w ish to give up. A nsw er th e doctor’s (Student B’s)
pinched) questions.
a no sun k en eyes
2 You are a doctor. 30-year-old Andy (M) / H eather
a no sun k en fontanelle (skull is norm al)
(F) Knox (Student B), presents w ith insom nia and
a n o th in g else ap p aren tly w rong
depression. Take a brief history and suggest treatm en t
a w eaned, so on dairy m ilk
options.
a posseting?
a (doesn’t know diarolyte -ORS)
Unit 9 p.87
Use your ow n know ledge an d experience to help you
1 You are Mr / Mrs Brown, aged 47. You are anxious about
as you role-play. As you are th e parent, try to avoid
financial problem s. Use these w ords to tell the doctor
using technical language. Ask th e doctor to explain any
(Student B) about your problem.
technical language th a t he / she uses.
• 2 m onths
• anxious / w orried / depressed
Unit 8 p.76 • fru strated
1 You are a patient. Tell th e doctor (Student B) th e • fam ily argum ents
inform ation below, b u t only give th e clarifying • w ife / children u n h ap p y
inform ation w h e n asked so th a t th e doctor has to probe • loss of job
for it. • loss of self-esteem
« tried an o th er job, part-tim e work, didn’t succeed
1 I suppose I ’m quite lazy really. I g e t up quite late.
• age
e usually after noon
0 no specific skills
• about 4 days a w eek
• w a n t com puter skills
• never before 11 a.m.
2 I e a tfa tty fo o d now and again. 2 You are a doctor. Listen to Mr / Mrs Green (Student B),
• a few n ights a w eek aged 25, w ho has h a d th o u g h ts of self-harm. Talk w ith
• 3 -4 n ig h ts a w eek th e p atien t about th e problem. Use th e questions for
« fried m eat self-harm in Patient care, page 87.
• bread
• eggs
Unit 11 p.103 Student B

1 Spend several m inutes th in k in g about th e scenarios in
each statem en t below. U nderline th e im p o rtan t w ords
Unit 1 p.9
in each statem ent. The first one has been done for you. You are:
Think w h a t you w ould expect for th e answ er.
Surnam e Terence (M) or Tanya Becks
1 I’m sorry I've lost th e ch arts.
Sex M /F
2 You seem to be g ettin g on very well. Everything’s
ru n n in g very smoothly. Address 255 Adelaide Drive
3 I’m sorry for in terru p tin g you, b u t could you tell m e Glasgow GA91VF
w here I can find th e blank drug charts? Ward Steele W ard at 5 a.m. on 25th January
4 Excuse me. You are very busy, I can see, b u t could 2008
you have a look at th is patien t for me? H ospital No 378839127
5 How is it going? Everything okay? Not too
DOB 23 03 55
overwhelmed?
6 Do you need any help in here ? Telephone No 02071114731
7 Do you th in k I could possibly use your phone? M arital Status M arried
2 Work w ith Student B. Take tu rn s saying your sentences Occupation Bank M anager
in 1 and responding politely. Use th e und erlin ed w ords GP DrLegge
to try to say th e sentences rath er th a n ju st reading Complaint: Caffeine-induced palpitations
them . Use th e responses in 2 on page 103 w here
H eart b eating very fast; w orried me; started as w as coming
possible, or m ake u p your ow n polite responses.
out of a cafe; double espresso - drink a lot of coffee; has
h ap p en ed before in th e m orning on w ay to w ork
Unit 12 p.111
1 Read these statem en ts w hile Student B listens and Unit 2 p.14
takes notes about w h a t is being said.
• In 1911 th e N ational Insurance Act provided free
1 Dr Jones asked w h eth er th e p a tie n t drank or GP care for all w orking m en.
smoked. « In 1948 th e N ational H ealth Service, or NHS, was
2 The p a tie n t said she d id n ’t do either. form ed, giving free com prehensive care for th e entire
3 Dr Jones asked if th e p atien t had any special dietary population.
requirem ents. • In th e UK there are about 42,000 GPs w orking in
4 She said she could eat pork b u t not beef. 10,500 surgeries.
5 The doctor asked if she w as able to do exercise • There are m ore GPs th a n all consultants in all
during th e pregnancy. specialties com bined. Of all practices in th e UK, about
6 She said th ere w as no problem as she w en t a q u arter are single-handed (one GP).
sw im m ing every day. • Annually, over__________ 1consultations take place,
7 The doctor advised h er to avoid certain foods such w ith I % of th e population seeing a GP in
as blue and soft cheeses like Brie and C am em bert. any tw o-w eek period.
2 Answer Student B’s questions. • Each GP looks after around 2,000 patien ts on average,
and w ill conduct a b o u t__________ I consultations per
3 Listen w hile Student B reads seven statem ents. Take year.
notes about w h a t is being said. e GPs re fe r__________ 5 % of th e population to hospital
4 Check any doubts about w h a t S tudent B said: Did the specialties, m eaning th a t 86% of all health needs are
doctor a sk ... ? M ention any assum ptions you m ade m anaged w ith in prim ary care.
while listening and state w h a t th e extract w as about. • The average p atien t w ill visit th e ir GP about four
tim es a year, w ith __________ 5 % of people consulting
th e ir GP at least once during each year.
• Com pared to 25% te n years ago, a b o u t__________ § %
of th e GP workforce in England is female.
Unit 2 p.l9
Patient Dob Hospital No
Referral letter 17.07.80
NHS N um ber 6784335792
Drug Date
Hospital N um ber 101778 6S
Pethidine 18.05.09
22 A ugust 2007
Route Dose Start Time
Dear Dr Ahmed, 50 mg 17.05.09 7.40
Re David Hunt 17 May 1975(M) Max Frequency Max Dose 1 24hr Dose
_______________4 n /a 50 mg
18 Greencross Street, London SE17 2PD
Indications for Use Route
This p atien t has com plained of a rash w hich has
analgesic
erupted on a nu m b er of occasions in different
parts of his body on and off for m ore th a n th ree Signature Pharmacy Given by
m onths. Recently, he has also com plained of bilateral S N Ahmed
in term itten t n asal blockage, itchy nose an d eyes,
w atery nasal discharge. The rashes have also decreased
in frequency an d duration, tre a te d on occasion w ith Unit 7 p.69
antibiotics and OTC m edication. This does n o t appear
to be related to allergy to carpets, nor w ork or other Parti
com m on factors. The rash has responded to Piriton. 1 Spend 3-5 m inutes checking w ith other Student Bs th a t
The patien t has h a d allergy sensitivity testin g w ith you u n d e rsta n d th e notes below.
no conclusive result. The patien t spent several years in
East Africa w orking as a teach er in his early 20s. The 2 Decide on seven technical words w hich you as the
Africa connection m ay have som e bearing an d I w ould p atien t should avoid in th e role-play.
appreciate your opinion. 3 Pretend to be th e p aren t of th e child described below.
Yours sincerely, Phone A & E (Student A). Answer th e questions the
doctor asks you, b u t rem em ber th a t you are a parent.
Give non-technical answ ers. If th e doctor uses technical
A drian D avidson (Dr) words, th e p atien t should say: Sorry, I d o n ’t understand
w hat yo u mean.
Unit 5 p.38 4 Use th e checklist to give feedback on th e technical
Ask and answ er questions w ith Student A to com plete w ords used.
th e chart for th e sam e patient. You are Mr / Mrs Deng and you are very anxious about
W hen you have finished, read th e chart aloud to your your six-m onth-old child.
partner. M ake at least tw o deliberate m istakes as you Signs and sym ptom s:
read and see if your p a rtn e r can spot them . • abdom inal colic (pain in th e tum m y)
USEFUL EXPRESSIONS
• spasm s of p ain in th e tum m y
... d a te d ... • child draw s knees to chest and scream s
...by... « pale
... signed by... • attacks 10-15 m inutes apart
...prescribed by... • last 2-3 m inutes and becom ing m ore frequent
...for... • vom iting
N ot applicable • no rectal bleeding
• started this m orning
Part 2 2 You are 30-year-old Andy (M) / H eather (F) Knox. You
have been tak in g am p h etam in es and w ish to give up,
Play th e role of a doctor in A & E. A nsw er th e phone call
b u t have been suffering from insom nia and depression.
from an anxious p a re n t (Student A), take th e history,
A nsw er th e doctor’s (Student A’s) questions.
and explain in non-technical language th e likely
diagnosis an d w h a t to do next.
Unit 9 p.87
Use your ow n know ledge an d experience to help you
1 You are a doctor. Listen to Mr / Mrs Brown (Student A),
as you role-play. As you are th e parent, try to void
aged 47, w h o ’s got anxiety about financial problems.
using technical language. Ask th e doctor to explain any
Following th e advice of th e Reading on page 86, talk
technical language th a t h e /sh e uses.
w ith h im / her about th ese difficulties.
Unit 8 p.76 2 You are Mr / Mrs Green, aged 25. You have h ad thoughts
of self-harm an d th o u g h t about taking your ow n life,
1 You are a doctor. Listen to w h a t th e p a tie n t (Student A)
b u t you have n o t m ade any detailed plans. Use these
says, an d th e n probe for m ore inform ation.
ideas to tell th e doctor (Student A) about your problem.
2 You are a patient. Tell th e doctor (Student A) th e * th o u g h ts of self-harm
inform ation below, b u t only give th e clarifying • h e sita n t w h en speaking (e.g.Er,... no.Er,... not really.)
inform ation w h e n asked so th a t th e doctor has to « no firm plans for harm ing self
probe for it. # last th ree or four days
1 I don 't sm oke m a n y cigarettes a day. « anxious about exam s
• about 20 or so • problem s w ith friend / relationships
• m aybe more som e days « loss of confidence
• 30 0 angry w ith self an d w orld
• five days a w eek or so # w orried about failure
2 I eat a norm al breakfast, like everyone else, m ost days. • w orried about th e am o u n t of studying
• black coffee an d a slice of to ast # anxious about th e future
• 5-6 days a w eek # only studying
3 I’d have one or two snacks during the day.
• 2, som etim es 3 in th e m orning
Unit 11 p.103
• th e sam e in th e afternoon 1 Spend several m inutes th in k in g about th e scenarios in
• crisps each sta te m e n t below. U nderline th e im p o rtan t words
« chocolate biscuits in each statem ent. The first one has been done for you.
e sw eets Think w h a t you w ould expect for th e answer.
4 I walk rather than take the car quite a lot. 1 Do you need any help w ith th e paperw ork befo reth e
9 2-3 tim es a w eek consultant does his ro u n d s?
• w alk to th e shop 2 I’m sorry for b u ttin g in like this, b u t I need som e help
• 100 m etres aw ay w ith a patient.
5 M y husband /w ife can g et on m y nerves now 3 Is it OK if I open th is w indow ? It's a bit stuffy in here.
and again. 4 W ould you m ind if I sw itch off th e equipm ent? I
• 3-4 tim es a w eek can ’t h ea r w h a t’s being said.
e m aybe every day 5 It’s suddenly tu rn e d very cold. I can ’t get w arm ed up.
• nagging m e to do th in g s 6 Can I give you a h a n d w ith preparing th e trolley?
7 Do you th in k I could possibly pop out for a few
Unit 8 p.79 m om ents?
1 You are a doctor. 25-year-old Charlie Chadwell (Student 2 Work w ith Student A. Take tu rn s saying your sentences
A), presents w ith a ru nn y nose. S/he is a cocaine addict in 1 an d responding politely. Use th e underlined words
and w ishes to give up. Take a brief history an d suggest to try to say th e sentences ra th er th a n ju st reading
treatm en t options. them . Use th e responses in 2 on page 103 w here
possible, or m ake up your ow n polite responses.
Speaking activities 119
Unit 12 p.111
1 Listen w hile S tudent A reads seven statem en ts. Take
notes about w h a t is being said.
2 Check any doubts ab o u t w h a t Student A said: Did Dr

Jones a s k ... ? M ention any assum ptions you m ade
w hile listening an d state w h a t th e extract w as about.
3 Read these statem en ts w hile Student A listens an d

takes notes about w h a t is being said.
1 The nurse said th a t th e patient, a 25-year-old male,
w as found staggering aro u n d th e to w n centre late
th a t n ig h t by th e police.
2 The doctor asked if he sm elt of alcohol.
3 The nurse confirm ed th a t he d id n ’t.
4 The doctor asked if th ere w as any record of sim ilar
incidences.
5 The nurse said th e y h a d fo u n d a n am e in his w allet.
6 The doctor asked if th e y h ad contacted th e n am e in th e w allet.
7 The nurse has ju st received a call from anxious paren ts w hose son w e n t out hours
ago to buy som ething an d h a s n ’t yet returned.
4 A nsw er Student A’s questions.
Unit 3 p.26
Presenter feedback
Tick th e relevant box an d give reasons for your decision.
Always use positive / constructive feedback first.
A dequate Good Very Good Excellent

Presentation
O rganization
Fluency
Clarity
Speaking checklist
Unit 6 p.49
Unit 7 P-71
Unit 8 p.79
Unit 9 p.87
Unit 10 p.93
Unit 11 p.104
Unit 12 p.lll
Date C andidate:
Criteria Grade* Com m ents
‘ Grades
A Good
B Satisfactory
C Needs im provem ent
This Page Photocopiable © Oxford U niversity Press

Speaking activities 121
Unit 9 p.83
Mini-Mental State Examination (MMSE)
Give one point for each correct answ ers. A score h igher th a n 28 indicates a norm al m en ta l state. A score of 25-27 is
borderline an d a score of less th a n 25 indicates dem entia.
W hat day of th e w eek is it? 1 point

W hat is th e date today? 1 point
W hat is th e m onth? 1 point
W hat is th e year? 1 point
W hat season of th e year is it? 1 point
W hat country are w e in? 1 point
W hat to w n or city are w e in? 1 point
W hat are th e tw o m ain streets nearby? 1 point
W hat floor of th e building are w e on? 1 point
W hat is th e n am e of th is place? 1 point
Read th e follow ing an d th e n offer th e paper: 1 p o int for each of th ree actions.
‘I am going to give you a piece of paper.
Take it in your right hand, fold it in half, an d place it on your lap.’
Show a pencil an d ask w h a t it is called. 1 point
Show a w ristw atch an d ask w h a t it is called. 1 point
Say: ‘Repeat after me. No ifs, ands, or buts.’ 1 point
Say: 'Read w h a t is w ritte n here an d do w h a t it says.’ 1 point
Show th e m a card w hich reads:
‘c l o s e y o u r e y e s .’
Say: ‘W rite a com plete sentence on th is sheet of paper.’ 1 point

Say: 'Here is a draw ing. Please copy it.’ 1 point
Say: 'I am going to nam e th ree objects. 1 point for each object repeated
W hen I have finished, repeat th e m back to me, an d rem em ber th e m
as I am going to ask you to say th e m again in a few m inutes.
Apple, penny, table.’
Say: 'I w a n t you to take 7 aw ay from 100. Take 7 aw ay from th a t 1 point for each of 5 subtractions
num ber an d keep subtracting u n til I say stop.
W hat w ere th e th ree objects I asked you to rep eat (Apple, penny, table) ? 1 point for each object repeated
122 Grammar reference
Grammar reference
1 Asking short and gentle The w ord order after th e qu estio n w ord is th e sam e as
for yes / n o questions.
questions, Tenses in the
W here does it hurt?
presenting complaint
We also use W h a t... like? w h e n w e ask som eone to
Asking short and gentle questions describe som ething.
There are tw o types of q u estio n s,yes / no qu estions N ote th a t w e alw ays use th e verb be, a n d th a t like
and w h -questions. d o esn ’t change.
W h a t is the pain like?
yes I no questions not W h a t dees the pain like?
o r W h a t is the p a in Ukes?
We use y es / no q u estions w h e n w e only n eed a
simple yes or no answ er. N ote th a t w e can use Can y o u tell m e ...? or C anyou
describe...? to ask for m ore inform ation. We w o u ld not
Do you feel an y p a in in y our abdom en?
expect ay es or no response.
Do / Does + subject + infinitive
A fter th e se expressions, w e use th e affirm ative
O ther verbs, such as be, have got, a n d m o d al verbs w ord order.
d on’t use th e auxiliary do.
C anyou tell m e where it hurts?
Is th e p a in w orse now? not Ca n y o u tell m e where does it hurt?
Present Simple of be + subject W ith b o th yes / no questio n s a n d wh- questions w e
Have you got your m ed icatio n w ith you? u se th e P resent Simple or P resent C ontinuous to
ta lk ab o u t th e p re se n t situ atio n . However, w e use
Present Simple of have + subject + got
th e Present Perfect or P resent Perfect C ontinuous
Can you feel y our legs ? to ta lk a b o u t a situ a tio n th a t b eg an in th e p ast and
Can + subject + infinitive w h ich continues up to th e present. It’s im p o rta n t to
rem em b e r th a t w e d o n ’t use th e P resent Simple or
We can also begin a y es / no q u e stio n w ith P resent C ontinuous to express this.
Is it...? or Is there...?.
yes / no question: Have y o u had these dizzy
Is it difficult to raise y o u r leg? spells before?
Is there anyone we can contact fo r you? H ave y o u been having difficulties
w ith y o u r breathing?
wh- questions
wh- question: H ow long have y o u had these
We use qu estio n s b eg in n in g w ith a qu e stio n w ord dizzy spells?
w h en w e w a n t som eone to give us m ore in form ation. H ow long have y o u been having
Often, th e se com e a fte r ay es / no question. difficulties w ith y o u r breathing?
Q uestion w ords include w hat, which, who,
when, where, why, a n d how. The w ord how can be
used in expressions such as how long, how much, breathing?
and how m any, an d is u sed w ith a n u m b e r of
adjectives an d adverbs. Tenses in the presenting complaint
H o w fa rc a n y o u exten d y o u r arm? N ote th e d ifferen t tim escales re p resen te d by th e
How well ca n yo u see? follow ing tenses.
The questio n w ords w hat, which, how m uch,
and how m a n y can be follow ed b y a noun.
Present Simple
Which doctor did y o u speak to? This te n se is u sed to ta lk about:
How m uch p a in are y o u in? • so m eth in g th a t is tru e at th e m o m e n t of speaking.
I've g o t chest pains.
I fe e l better.
• so m e th in g th a t is h a p p e n in g on a reg u lar basis Present Perfect Continuous
aro u n d now.
We use th is te n se in a sim ilar w ay to th e Present
I g et these headaches in th e m orning.
Perfect, b u t th e C ontinuous form describes a
• a process. progressive change in a situ a tio n u p to now.
W hen I lean forw ard, th e p a in goes away. M y headaches have been decreasing.
The p a in starts in m y chest a nd m oves up
to m y shoulder.
2 Present Perfect and Past Simple
Present Continuous
This te n se is u se d to ta lk about:
Present Perfect
Positive
• so m eth in g th a t is h a p p e n in g at th e m o m e n t of
speaking. I’ve had th e se p ain s before.
His blood pressure's rising. Subject + h a s /h a v e + p a st participle
I ’m having difficulty breathing.
• so m e th in g th a t is h a p p e n in g aro u n d now , th o u g h Negative

n o t necessarily at th e m o m e n t of speaking. She h asn ’t seen a doctor.
Are y o u ta kin g a n y m edication?
Subject + h a sn ’t / h a ven ’t + p a st participle
I ’m having chest pains.
• so m e th in g th a t h a s b e e n arra n g e d for a d ate in th e Questions

n e a r fu tu re.
Have you felt sick today?
I’m seeing a p h ysiotherapist n e x t Wednesday.
H a s/H a v e + subject + p a st participle
Note th a t w e can use have (got) in th e P resent Simple
an d have in th e Present C ontinuous to ta lk ab o u t We use th e Present Perfect to talk ab o u t som ething
so m eth in g th a t w e are exp erien cin g e ith e r a t th e th a t h ap p e n e d at an y tim e in th e p a st up to th e
m o m e n t of sp eak in g or aro u n d now. present.
However, th e use of have in th e P resent C ontinuous In th e qu estio n form , w e o ften use ever, w hich m eans
to refer to th e m o m e n t of sp eaking is m o re lim ited a t a n y tim e in y o u r life. N ote th e position ju st before
th a n in th e P resent Simple. It is g enerally restricted to th e p a st participle.
expressions such as have difficulty + -ing form , have Has this ever happened before?
som ething to eat, a n d have a shower.
We use th e negative fo rm never in positive sentences.
Compare: N ever also goes before th e p a st participle.
M O M E N T OF S P E A K I N G :
I ’ve never had a headache like this one.
I’ve g o t a p a in in m y chest.
AROUND NOW: fo r /s in c e
I’m having p ains in m y chest.
We o fte n use fo r a n d since w ith th e Present Perfect.
Note th e difference.
Present Perfect
fo r + tim e period = h o w long a situ a tio n lasted
We use th is te n se to ta lk ab o u t a situ a tio n th a t begins
in th e past, an d w h ic h e ith e r co n tin u es up to th e H e’s had a headache fo r fiv e days.
p re sen t or is related to th e p re se n t in som e way. It since + specific p o in t in tim e = w h e n a situ atio n
does n o t tell us h o w slow ly or h o w quickly so m eth in g sta rte d
h as h app en ed , only th a t th is is th e w ay th e situ a tio n I’ve been like this since Christmas Day.
stands now.
M y headaches have decreased.
Past Simple Present Perfect: The coughing has becom e worse.
(= it’s definitely w orse now)
Positive
Therefore it is alw ays h elp fu l to estab lish a period of
The coughing becam e w orse th is m orning.
tim e w h e n u sin g th e Past Simple.
Subject + Past Simple
Negative
3 Giving instructions,
The doctor didn’t come.
Subject + did n 't (did not) + infinitive
Explaining procedures,
Questions
Making polite requests
Did you take an y th in g for th e pain?
to patients and colleagues
Did + subject + infinitive Giving instructions
Rem em ber th a t be is irregular. The m o st direct w ay of giving a n in stru c tio n or order is
Positive th e im perative.
I / He / She / It w as Imperative
You / We / They w ere
Positive
Questions
Listen.
Was I / he / she / it? Keep still.
Were you / w e / they? Infinitive (+ com plem ent)
Negative Negative
I / He / She / It w a sn ’t D on’t move.
You / We / They w e re n ’t D on’t get ou t of bed.
We use th e Past Simple to ta lk a b o u t so m e th in g th a t D on’t + infinitive (+ com plem ent)
h ap p e n ed at a specific p o in t in th e past. The full negative fo rm Do n o t is m ore em p h atic an d is
It is very com m o n to use tim e expressions w ith th e m ore co m m on in signs an d notices.
Past Simple, for exam ple: We can, how ever, use always an d n e ver+ im perative
at 10.00, this m orning,yesterday, last week, an d to m ake a n in stru c tio n stronger. N ote th a t always an d
expressions w ith ago. never refer to a gen eral rule ra th e r th a n a n in stru ctio n
th a t applies only on one occasion.
Note th e position: tw o m inutes ago, three years ago.
Always wash y o u r hands.
We can use fo r w ith th e Past Simple, b u t n o t since. Wash y o u r hands.
I was in pain fo r hours.
n o t : I was in pain since io .o o th is m orn in g . It is co m m on to use R em em ber to + infinitive an d D on’t
fo rg e t to + infinitive in instructions.
Note th a t even w ith o u t a n y tim e expression, th e Past
R em em b er to com plete the drug charts.
Simple alw ays suggests a fixed p eriod of tim e in th e
D o n ’t fo r g e t to com plete the drug charts.
past, w hile th e P resent Perfect refers to a p eriod of tim e
leading up to th e present. One w ay to so ften th e effect of th e im perative is
to add please, e ith e r at th e beg in n in g or end of th e
Note th e difference b etw een:
instruction.
Past Simple: The coughing becam e worse.
D o n ’t g et o u t o f bed, please. / Please d o n ’t
(= it’s possible th a t it is n o w better)
g e t o u t o f bed.
Explaining procedures • I ’d likeyou to (+just) infinitive
I ’d likeyou to fle x y o u r wrist.
W hen w e w a n t to ex p lain a procedure, w e p u t y o u
before th e im perative. It is possible to a d d /o r me, please to all
You wash y o u r hands a nd p u t on th e gloves. of th e se requests.
You d o n ’t need to p u t th e in stru m en ts aw ay yet. I ’d likeyou to ju s t fle x y o u r w ristfo r me, please.
W hen describing an y seq uence of events, it is o ften
c lea rerto u se w ords such as first, next, before, before
that, after, a fter that. N ote th e difference b e tw e e n
4 Explaining investigations/
after a n d a fter that. procedures with the
A fter y o u wash y o u r hands, y o u p u t on y o u r gloves.
First y o u wash y o u r hands. A fter that, y o u p u t on
Present Passive and with
y o u r gloves. be going to future
A fter refers fo rw ard to th e n e x t action w h ile a fter th a t
refers back to th e previous action. This is im p o rta n t to
Explaining investigations/procedures with
u n d e rsta n d in order to exp lain precisely th e correct the Present Passive
sequence of events. Positive
Adverbs A needle is a tta c h e d to th e syringe.

Subject + am / is /a r e + p ast participle
Adverbs are n ecessary in order to describe h o w
so m eth in g is to be done. N egative
Form The p a tie n t isn ’t sed ated for th is procedure.
adjective +-ly sm o o th -> sm oothly Subject+ 'm n o t / isn ’t / aren't + p a st participle
careful -> carefully
Questions
adjective -e- + -ly g en tle -> gen tly
Is th e syringe sterilized before th at?
en ding in -e
A m / I s / A r e + subject + p ast participle
adjective y +-ily h e a v y -> heavily
en ding in -y We can use th e P resent Passive to describe ho w a
procedure is carried out. W hereas in th e Active it is
Exam ine him carefully. n ecessary to say w h o perform s a n action, th e Passive
avoids doing this. The Passive is preferred w here
Making polite requests to patients th e ag en t of th e action is irrelevant, n o t know n, or is
and colleagues understood.
A sim ple w ay to m ake a positive im p erativ e less direct If w e do w a n t to say w h o is p erform ing an action, w e
is to a d d /o r me, please at th e end. add th is in fo rm atio n w ith by.
Get undressed f o r me, please. Compare:
O ther w ays to so u n d less direct are: The procedure is carried o u t under anaesthetic.
(= w e are in te re ste d in h o w th e procedure is carried
• A dd ju s t a t th e b eg in n in g
out, n o t w h o is perfo rm in g it).
Just fle x y o u r wrist.
The procedure is carried o u t by experienced doctors.
• Can / C ouldyou [+just) + infinitive
(= w e are in te re ste d in w h o is perform ing th e action).
Can y o u ju s t fle x y o u r wrist?
• I f y o u c a n /c o u ld (+ju st) + infinitive
I f y o u could ju s t fle x y o u r wrist.
Future Passive Short answ ers
The Passive can be u se d in te n se s o th e r th a n th e Yes, I am.
Present Simple. W h en ex p lain in g procedures, w e te n d you / w e / th e y are.
to use th e P resen t Passive. However, w e can also use h e / she / it is.
th e Future Passive to describe w h a t w ill h a p p e n to a
No, I'm not.
patien t. Unlike th e Present Passive, th e Future Passive
you / w e / th e y aren’t,
can be used w h e n th e subject of th e Passive sen ten ce
h e / she / it isn ’t.
is a person.
We u se be going to to talk ab o u t in ten tio n s, th a t is,
Positive w h e n a course of action h as b e e n decided upon.
You’ll be given a sedative. I ’m going to take som e flu id fr o m y o u r backbone.
Subject + ’11 (will) + be + p a st participle We also use be going to w h e n w e can predict th e
You'll be asked to sign a consent fo rm . outcom e of a c u rren t situation.
You're going to fe e l a bit sore.
Explaining procedures with We can also use th e expression W hat w e ’re going to
be going to future do is (to) to introduce a n explanation. This helps focus
th e liste n e r’s a tte n tio n .
Positive
W hat w e ’re going to do is (to) have a look a t y o u r
I am (’m) going to give th e stom ach w ith a bendy telescope.
injection.
Som etim es it is necessary to give a m ore involved or
You / We / They are (’re) going to give th e tech n ical ex p lanation. To do this, w e often change
injection. to a m ore im p erso n al form . This involves usin g th e
He / She / It is (’s) going to give th e Present Passive th ro u g h o u t th e description an d a
injection. linking device such as W h a t happens then / n e x t is ....
W hat happens then / next is (that) + procedure
subject + am /are / is + going to + infinitive
The p a tie n t is sedated to induce drowsiness. A thin,
Negative flexib le tu b e is p a ssed into th e stom ach. W hat
I am not (’m not) give th e happens then is th a t a sam ple o f the stom ach lining is
going to injection. taken.
You / We / They are not (aren’t) give th e

going to injection. 5 Phrasal verbs, Explaining
He / She / It is not (isn’t) give th e side effects
going to injection.
subject + 'm n o t / aren't / isn’t + going to + infinitive

Phrasal verbs
Questions Phrasal verbs are very co m m on in English. They
consist of a verb + particle such as in, on, at, out, down,
Am I going to give th e injection? up. These com bine to fo rm a single m eaning.
Are y o u /w e /th e y going to give th e injection?
Is h e /s h e /it going to give th e injection? The m e a n in g of th e tw o w ords is n o t alw ays obvious,
for exam ple p u t off= to po stp o n e or delay.
A m /A r e / I s + subject + going to + infinitive
Some p h rasal verbs have m ore th a n one m eaning,
e.g. cu t down.
T hey’ve cut down th e tree th a t was in the hospital car
park.
You need to cut down on alcohol.
Some verbs com bine w ith b o th an adverb an d a

preposition, e.g. g e t in touch with, look fo rw a rd to. A n other w ay to express a possibility m ore rem otely is
w ith expressions such as no t all people / som e people
The sam e verb can be com bined w ith a n u m b e r of
/ in som e people / there are som e people who.
particles, e.g. g e t into, g et over, p u t up with.
N ot all people experience this side effect.
W h en a p h ra sa l verb h a s a n object, th e object can go There are som e people who sail through the treatm ent.
eith er before or a fte r th e adverb.
They’re going to close th e u n it down. may + infinitive
They’re going to close down th e unit.
To express a m ore d istinct possibility to a n individual
If th e object is a p ro n o u n , th e p ro n o u n alw ays goes w e use th e m ore direct You + m ay.
before th e particle. You m a y experience som e swelling.
They’re going to close it down.
n o t They’re going to close down it. may not + infinitive
Note, how ever, th a t w e g enerally p u t a long object The negative fo rm of m a y also conveys different
after th e particle. degrees of certainty.
We d o n ’t w a n t to switch o ff the eq u ip m en t th a t’s m a y n o t = It is possible th a t som ething w o n ’t happen.
keeping him alive.
You m a y not experience paralysis w ith this treatm ent.
W here a p h ra sa l verb has no object, th e verb an d = It is possible.
particle are nev er separated. Exam ples are g e t up, g e t
N ote th a t m a y n o t is only ever used in its full form.
in touch (with), stand out.
n ot It m a y n 't cause blurred vision.
He ha sn ’t g o t in touch (with us) yet.
Nurse G raham cam e in abo u t h a lf an hour ago.
6 Encouraging patients
Prepositional verbs
and making suggestions
In English, m a n y verbs are follow ed b y a p rep o sitio n
before th e object, e.g. look at, go in, listen to, ask fo r. can / could / might
N ote th a t in p rep o sitio n al verbs th e prep o sitio n is We u se can, could, a n d m ig h t to m ake ten tativ e
never se p a ra te d from th e verb. suggestions.
Could y o u look a t these x-rays? We c a n / could / m igh t try a different treatm ent.
not Could y o u look these x rays a t?
You could give up sm oking.
You m ight try ta king up a sport.
Explaining side effects
You can cycle to work.
Can a n d m a y are b o th u sefu l in ex p lain in g side
effects, as b o th are u se d to express possibility. should/shouldn’t, ought/oughtn’t
However, th e y have slightly d ifferen t senses.
Generally, th e se verbs are u sed in order to give advice.
They express m u ch m u ch stronger suggestions
can / may
th a n can, could, a n d m ight, how ever, a n d can convey
We use can a n d m a y to express g reater or lesser disapproval.
degrees of certainty. You ought to g et m ore exercise.
You shouldn’t eat so m uch red meat.
can + infinitive
W h en u se d e ith e r in th e im p erso n al fo rm or in th e
m ore direct y o u form , can relates to situ a tio n s in
general ra th e r th a n to a specific instan ce.
This procedure can lead to partia l paralysis.
You can g e t headaches w ith this m edication.
Each of th e sen ten ces above expresses a th eo retical

outcom e.
7 First and Second Conditionals 8 Open and closed questions
First Conditional We ofte n u se yes / no questions for closed questions
a n d wh- qu estio n s to ask for fu rth e r inform ation.
We use th e First C onditional to ta lk ab o u t th e realistic
consequence of a p o ten tia l situ atio n . yes / no qu estio n Are y o u in pain?
wh- q u estio n W here does it hurt?
If th e p a in gets an y w orse, y o u ’ll n eed to com e
back in. We can use o th e r expressions for op en questions
th a t encourage som eone to describe a situ atio n or
If+ subject + P resent Simple, subject + will (’11)
experience m ore fully.
+ infinitive
Tell m e m ore abou t + object pronoun + com plem ent
= z/clause = m ain clause
Tell m e m ore abou t the m edication y o u ’re taking.
R em em ber th a t th e verb in th e if clause is alw ays in C a n / Could yo u describe... + com plem ent
th e Present Simple or P resen t Continuous. We never C a n /C o u ld yo u describe how y o u ’refeeling?
use will.
H ow abou t / W hat abou t + com plem ent
not I f th e pain will g et a n y worse... H ow a b o u t / W hat a b o u t yo u r diet?
The verb in th e m a in clause can be a m odal We can also use b rief q u e stio n form s th a t encourage
in stead of will. o p en answ ers. We use th e se to follow u p on a specific
I f we prolong this treatm ent, his condition m ight piece of in fo rm atio n . We use expressions such as
actually deteriorate. Like...?/H o w + adjective or adverb.
A: One o f m y moles has changed.
Second Conditional B: H ow much?
We use th e Second C onditional to ta lk ab o u t a A: I keep seeing things in fr o n t o f m y eyes.
consequence of a h y p o th etical situation. b : Like ...? /L ike
what?
If he h a d th e operation, he'd feel m u ch better.

If+ subject + Past Simple, subject + w ould + infinitive 9 Past Simple and Past Perfect,
= z/clause = m ain clause Wishes and consequences in
Note th a t w e never use would in th e z/clause. negotiations
not I f he would have the o p era tio n ...
Past Simple
We can use th e P ast C ontinuous in th e z/clause. We
can also use th e subjunctive were in ste a d of was. R em em ber th a t w e norm ally use th e Past Simple to
refer back to a p o in t in th e p ast. We often do th is w ith
If the baby was / were suffering fr o m m eningitis, she
tim e expressions.
would be extrem ely ill.
He started w orking a t the hospital a yea r ago.
W hen giving advice, w e o ften b eg in w ith I f I were yo u. The nurse gave him an injection.
If I were you, I ’d g e t a second opinion.
The verb in th e m a in clause can be could or might.

Past Perfect
I f we operated on him, he m ight have a b etter chance. Positive
The p a tie n t had died du ring th e night.

Order of clauses
Subject + had + p a st participle
The z/clause u su ally com es first, b u t it can com e after
Negative
th e m a in clause. N ote th a t w e do n o t u se a co m m a to
separate th e tw o clauses in th is case. I h adn’t finished m y train in g .
You’ll need to com e back in i f th e p a in gets a n y worse. Subject + h a d n ’t (had not) + p ast participle
He'd fe e l m uch better i f he had th e operation.
Grammar reference 129
Questions • W ith th e verb be, w e can use th e subjunctive were

in ste a d of was.
Had you taken th e w ro n g dose?
I wish th e hospital were nearer.
H ad + subject + p a st participle
If only I were m ore diplomatic.
We can com bine th e Past Simple w ith th e Past
• We u se w ould + infinitive in ste a d of th e Past
Perfect to describe a situ a tio n th a t h a p p e n e d before
Simple w h e n w e express a w ish for a n o th er person
a p o in t in th e past. We use th e Past Perfect for w h a t
or a g e n t to be different.
h a p p e n e d earlier.
I wish y o u would listen to the p a tie n t more.
The m an was very ill. He had taken an overdose.
If only she w ould m ake a decision.
P AS T S I M P L E P AS T P E R F E C T
e We use could + infinitive to express a w ish about
In th e sen ten ce above, th e m a n took a n overdose
a n ability or opportunity.
before h e becam e ill.
I wish I could go home.
N ote th a t w h e n one sh o rt action im m e d ia te ly follows If on ly I could m ove m y legs.
another, w e use th e Past Simple.
To express a supposition, w e use several
I w ashed m y hands a nd p u t on th e gloves.
expressions. These are generally follow ed by
However, w e can also use w hen + Past Perfect or after subject + p a st te n se verb.
+ Past Sim ple / Past Perfect. Suppose..., Let's sup p o se..., Im a g in e ..., Let’s sa y ...,
When I had w ashed m y hand, I p u t on th e gloves. W h a t if...
A fter I w ashed / had washed m y hands, Suppose y o u had to callfo r help?
I p u t on th e gloves. W hat if y o u were calling fo r help and nobody came?
We can u se w hen or by th e tim e before th e Past All th e se expressions can be follow ed by W hat would
Simple. y o u do then?
I had already left th e ward w h e n /b y the tim e he Im agine y o u had an accident. W hat would
arrived. yo u do then?
Be careful w h ic h te n se y ou use w hen w ith , as
it affects th e order in w h ic h events h a p p en . Compare:
10 Expressing likes, dislikes,
W hen he arrived, I left. (= I left a t th e sam e tim e
h e arrived.) and preferences
W hen he arrived, I had left. (= I left before h e arrived.)
There are several w ays of talk in g ab o u t th in g s w e like
or d o n ’t like.
Wishes and consequences
We use th e follow ing verbs to talk about our general
To express a w ish w e us e l wish or if only. I f only is
preferences.
m ore em p h atic th a n I wish.
• like, love, hate, can’t bear + -ing / infinitive w ith to.
0 I wish a n d i f only are u se d w ith th e Past Perfect to
express a w ish ab o u t th e past. She likes having her independence.
He can’t bear to be interrupted w hen he's speaking.
I wish I had listened to y o u sooner.
If only th e nurse h a d n ’t m ade th a t error. • enjoy, dislike, can’t stand, d etest + -ing only
0 We u s e l wish a n d i f o nly w ith th e Past Sim ple to She enjoys talking to th e other patients.
express a w ish for th in g s to be different. I detest staying on this ward.
I wish we had m ore tim e. • prefer + -ing or infinitive w ith to

If on ly the hospital w as nearer. I prefer being exam ined by a fe m a le doctor.
I prefer to be exam ined by a fe m a le doctor.
We use th e follow ing verbs to talk ab o u t preferences Asking for help
in a m ore specific situ atio n . They are sim ilar in
Could y o u help me, please?
m ean in g to w a n t or d o n ’t want.
W ould y o u m ind helping me, please?
• would like, would hate, w ould love + infinitive
We can e x te n d th is as follows, especially if you are
w ith to
in te rru p tin g som eone w h o is busy. The expression
We o ften sho rten w ould t o 'd in th e positive form . The I ’m sorry to disturb y o u is qu ite form al.
negative an d questio n form s of w ould hate a n d w ould
I’m sorry to disturb you, b u t could y o u help me?
love a re n ’t used very frequently.
Would yo u like to see y o u r fa th e r now? W hen w e w ish to in te rru p t som eone in a less
I’d hate to cause a n y inconvenience. fo rm al way, w e can b eg in o u r re q u est for help w ith
She’d love to have m ore visitors. Excuse me.
Excuse me, could y o u help me?
• would prefer + infinitive w ith to
A n o th er w ay of in te rru p tin g som eone in order to ask
Would prefer suggests a choice b e tw e e n tw o or
for help is to acknow ledge th e interru p tio n .
m ore options.
I can see th a t y o u ’re (very) busy, but...
We’d prefer to operate sooner rather th a n later.
le a n see th a t y o u ’re very busy, but could y o u answer
Would y o u prefer to have m ore tim e to th in k a b o u t it?
this q u estio n fo r me?
(= rath e r th a n to m ake a decision now)
The negative form is w ould prefer + n o t + infinitive Offering help

w ith to.
We so m etim es n e e d to be sensitive to people w e
I’d prefer not to be given a n y m ore drugs. k n o w w h e n offering to help, as th e y m a y feel th a t a
• would rather + infinitive criticism is im plied. We therefo re use a polite form
even w h e n w e kn o w th e perso n quite well.
Would rather has exactly th e sam e m e a n in g as
W ould y o u like m e to + infinitive
w ould prefer.
W ould yo u like m e to try fo r you?
I’d rather have th e operation now.
Would y o u rather rest f o r a while?
The negative form is w ould rather + n o t + infinitive.
12 Reported speech
She’d rather not give her consent. Reporting statements
W hen rep o rtin g w h a t som eone h a s said, w e m ake
11 Being polite changes to th e tense, as follows:
There are a n u m b e r of expressions w e can u se for Tenses

functions such as asking for perm ission, asking for P resent Simple -> Past Simple
help, or offering to help. The follow ing are th o se th a t P resent Continuous -> Past C ontinuous
w e use w h e n w ish in g to be polite. It is generally tru e Present Perfect -> Past Perfect
th a t m ore direct sta te m e n ts are considered im polite, Past Simple -> Past Perfect
e.g. Give m e ... or I n e e d .... b u t Past Perfect -> Past Perfect
Asking for permission M odal verbs

Is it OK if I + infinitive m u st -> h a d to
Is it OK if I close the door? can -> could
w ill -> w ould
Do yo u th in k I could (possibly) + infinitive
Do you think I could (possibly) take a look
W h en rep o rtin g a sta te m e n t, w e use a rep o rtin g verb
a t y o u r notes?
such as say, tell, explain, or advise.
W ould y o u m in d if I + Past Simple
Would you m ind if I took this book?
Present Simple Past Simple
DIRECT SPEECH DIRECT SPEECH
'The tre a tm e n t is quite radical,’said th e doctor. 'I had an appendectom y w hen I was younger.’
REPORTED SPEECH REPORTED SPEECH
The doctor said th a t th e tre a tm e n t was quite radical. He said th a t he had had an appendectom y when he was
younger.
Present Continuous
N ote th a t w h e n a sta te m e n t is still tru e w h e n w e ’re
DIRECT SPEECH rep o rtin g it, w e often d o n ’t need to change th e tense
‘D r Sm ith is still doing her rounds,’said N urse Jones. of th e m a in verb. W h en th e sta te m e n t h a s b ee n m ade
REPORTED SPEECH very recently, w e o ften do n ’t need to 'change th e ten se
Nurse Jones said th a t Dr Sm ith was still doing her of th e rep o rtin g verb.
rounds.
DIRECT SPEECH
N ote th a t it m a y so m etim es be n ecessary to change M r Brown: ‘I like being on this ward.’
p ro n o u n s a n d adverbs of place an d tim e. REPORTED SPEECH
M r Brown says he likes being on this ward.
Modal verb
DIRECT SP EECH Reporting questions
‘I ’ll call y o u tom orrow ,’said the nurse.
W hen rep o rtin g w h a t som eone h a s asked, w e m ake
REPORTED SPEECH changes to verb te n se s and w ord order.
She nurse said she would call h i m / h e r / m e
the next day. yes /n o questions
W h eth er w e n e e d to m ake th e se changes dep en d s W h en rep o rtin g ay e s / n o question, w e use th e
o n changes in th e situ atio n , i.e. if w e are rep o rtin g re p o rtin g verb ask a n d change th e te n se of th e
so m eth in g in a different place or a t a d ifferen t tim e. m a in verb. However, n o te th e stru c tu re if+ positive
These are th e changes th a t m a y n e e d to be m ade. w ord order.
PRONOUN I -> h e / s h e DIRECT SPEECH
my -> his / her ‘H aveyo u taken any medication?’
PLACE here -> th ere, at th e ... REPORTED SPEECH
The doctor asked if I had taken an y m edication.
TIME n ow -> th e n , a t th a t tim e
DIRECT SPEECH *
to d ay -> th a t day,
D o y o u w a n t to ask a n y questions?’
on W ednesday, etc.
yesterd ay -> th e day before, REPORTED SPEECH
th e previous day She asked (me) if I w an ted to ask any questions,

to m o rro w -> th e n e x t day,
on Thursday, etc. wh- questions
th is w eek -> th a t w eek W hen re p o rtin g a wh- question, w e keep th e question
la st w eek -> th e w eek before w ord, change th e te n se of th e m a in verb, a n d use
a n h o u r ago -> a n h o u r before positive w o rd order.
Note th a t after tell a n d advise w e m u st u se a n object DIRECT SPEECH
pronoun, such as me, her, him, us, etc. ‘W here were y o u treated before, M r Taylor?’
REPORTED SPEECH
Present Perfect She asked M r Taylor where h e ’d been treated before.
DIRECT SPEECH
‘I ’ve never tried th a t before,’he told th e nurse.
REPORTED SPEECH
He told the nurse th a t he had never tried th a t before.
132 Listening scripts
Listening scripts
U nitl 5 D Can you tell me what seems to be P A t th e m o m e n t, it’s ju s t h e re in th e
bothering you? c en tre o f m y chest, b u t it w a s in m y
Listening 1 P I've got this gnawing kind of pain left sh o u ld er before.
right about here in my stomach. D Can y o u describe th e p a in for me?
D = doctor, P=patient
6 D What can we do for you? P It’s all over here. It's n o t a sh arp pain.
D I'd like to check som e in fo rm atio n
P Well, I’ve got this sharp pain up and It’s like a tig h tn e ss, as if so m eo n e’s
ab o u t y o u r p ersonal details, if I may.
down my leg. squeezing m y chest.
P OK.
7 D What can we do for you? D A nd w h e n did th e p a in s ta rt first?
D Can you tell m e w h a t y ou r fam ily
P I feel as if there’s a tight band P It cam e o n first w h e n I w as ben d in g
n a m e is?
squeezing all the way round my o v e r... in th e g ard en a b o u t tw o
P It’sK arlson.
head. w eek s a g o ....
D Karlson. A nd y o u r first nam e?
8 D What’s brought you here? D It’s OK. Take y o u r tim e.
P It’s Dave.
P I’ve got this crushing pain right here P A nd th e n I g o t t h i s ... dull p a in a n d I
D Any o th er nam es?
in my chest. h a d sh o rtn e ss of b reath .
P My m iddle n a m e ’s Ian.
Exercise 5 D So it sta rte d w ith y o u b e n d in g over
D OK. That's m ale. A nd can y o u te ll m e
in th e garden. A nd th e sh o rtn ess of
w h a t your address is? 1 It’s just here around my belly button.
b re a th sta rte d a t th e sam e tim e?
P It’s 3 Park V iew M ansions, Castlefield, 2 The pain is just here on my heel.
P Yes.
M anchester, M 6 7DE. 3 My wrist hurts.
D Have y o u h a d th is p a in before?
D W hen w ere you adm itted? 4 It’s just here below my ankle.
P N ot th e p a in in th e chest, no. I h a d
P Yesterday, th e 9th, at 2 p.m. 5 It feels as if my tum m y is on fire.
a p a in in m y le ft sh o u ld er a n d arm
D OK. 9 th of N ovem ber 2008 a t 2 p.m.,
Pronunciation w h e n I w as w alk in g to w o rk one
D uncan Ward. A nd do you k n o w y o u r
1 sternum, talus, carpus m o rn in g a b o u t a m o n th ago.
h ospital num ber?
2 clavicle, abdomen, tibia D OK. I see fro m th e n o tes th a t y o u ’re a
P Yes. It’s here. It’s 19733045.
3 patella, intestines b u s driver.
D OK,er... 33045.
4 umbilicus, calcaneus, oesophagus P Yes, th a t’s right. N ot th e b e st o f jobs to
D A nd w h a t’s y o u r d ate of birth?
be sta rtin g a t five o n a fro sty m orning.
P 7-9-53.
Listening 3 D No, defin itely n o t. Did y o u do an y th in g
D Your te lep h o n e num ber?
D=doctor, P=patient a b o u t th e pain?
P 0166405 7001.
D Good morning, Mr Wood, I’m Dr P I th o u g h t it w as a to u c h o f arth ritis.
D OK. Are you m arried or single?
Martin, one of the doctors in A & E. There'd b e e n a h eav y frost, a n d I ju s t
P I’m single.
W hat’s brought you here today? ru b b e d som e lin im e n t in to it.
D Right. Single. W h at do you do for
P I've ...I’ve got this chest pain. D H ow long did it last?
a living?
D And you seem to be having some P Off a n d o n for ab o u t a w eek, an d th e n I
P I’m a p ostm an.
trouble catching your breath. d id n ’t th in k a n y m o re of it.
D A nd lastly, w h o ’s y o u r GP?
P Y... Yes. D OK. A nd have y o u felt sick a t all?
P Dr Jones.
D Would you like me to give you some P Yes.
D OK, M r Karlson. T hank you.
painkillers before we go on? D A nd have you b e e n sick at all?
Listening 2 P Yes, please. P No. I h a v e n ’t b ro u g h t a n y th in g up.
D = doctor, P=patient D OK. We’ll get some for you. D OK. I’d like to ask y o u som e q u e s tio n s ...
Exercise 1 And I’ll be as brief as I can.
1 D W hat's b ro u g h t y ou h ere ? P Thank you, doctor. Unit 2
P M y w rist is th ro b b in g since I fell in D Can you show me exactly where the
th e street. pain is?
Pronunciation 1
2 D Can yo u tell m e w h a t seem s to be P I’ve been getting it right here in the
b o th erin g you? centre of my chest. 1 p ractice m a n a g e r
P I’ve got a really sore th ro a t. D Right.Isee.Andhowlong’ve 2 recep tio n ist
3 D W h at’s b ro u g h t you here? you had it? 3 g e n eral p ra c titio n e r
P I’ve been gettin g a kind of borin g P For the past hour. 4 m idw ife
p a in rig h t here, w h ich goes th ro u g h D The past hour. 5 d istrict n u rse
to m y back. And is the pain constant? 6 h e a lth v isito r
4 D Can you tell m e w h a t seem s to be P Yes. At the moment it’s there 7 p ractice nu rse
b o th erin g you? all the time.
P Well, it feels a b it te n d e r ju s t h e re on D And does it go anywhere else?
m y rig h t side.
Listening scripts 133
Listening 1 D How frequently do you get them? P Mmm, work’s been getting me down
My name is Dr Choudhary, and I am a GP P The first week there was only one I recently.
think, and then they started getting D In what way?
working in an inner city area in London,
just on the edge of the East End. I started worse, three, four times a week. It's P Well, there’s been a lot of changes
work as a GP in this area over 20 years not being able to get my breath th at’s going on recently and I suppose I’m a
ago. In recent years many developments, really worrying. bit anxious what w ith the mortgage
both technological and social, have D And so the attacks, have they and that.
occurred, affecting the practice increased in the past two weeks? D Mm-hmm. And this has been getting
enormously. P Yes. They’re much more frequent. to you?
D OK. When do the attacks come on? P Yes... more and more.
I enjoyed my work here a lot at the P At any time, but they seem to be worse D I see. And does the wheezing et cetera
beginning and I still do now. But there at night. And in the morning. continue over the weekends ?
are many problems an in area like D Have you noticed any change in the P Erm, no. When I come to think about it,
this, which you would not find in rural severity of the attacks, especially in it doesn’t.
communities in this country or in my the morning? D OK. Some general questions. Have you
home country - India. The crime rates P Yeah. ever had anything like this before?
are high, which affects the morale of the D Do they wake you up at night? P No, never.
patients we serve and ultimately the P About three times a week. D Do you have other illnesses?
morale of the GP practice. The workload D I see. You been off work at all? P Erm...
is heavier than in most rural districts, P No. But I nearly didn’t go in yesterday. D High blood pressure, diabetes or heart
which sometimes puts potential GPs off D Was that the worst so far? problems?
moving into the area. However, I have P Yeah. P No. Nothing like that. This is the first
always found the job very rewarding. D And have you had anything else time I’ve been ill in my life.
Another feature of an inner city GP with it? D Has anyone in your family had
practice is that patients move around a P Erm, I’ve felt a bit tight across anything similar?
lot. As regards compensation for working the chest. P No. Not as far as I know.
in deprived areas in the inner city, D Any pain w ith it? D What about eczema? Anyone in your
sometimes GPs receive extra payment. P No, just tightness. family with that ?
Listening 2 D Are you aware of anything that P Both my sister and my mother have it.
triggers the attacks?
D=doctor, P=patient Listening 3
P Erm, like what?
D Good morning, Mr Bloomfield. My D=doctor, P=patient
D Dust, feathers, new carpets?
name’s Dr Dickson, I’m a locum GP P No, I can’t really say I am. D OK. Do you smoke?
standing in for Dr Wright. What can D OK. Have you had any infections P No.
we do for you? recently, like flu or sore throat or chest D You drink?
P I’ve been having some problems w ith P Just socially. Maybe a couple of beers a
infection?
my breathing. P No. Not for a long time, except this. week, nothing more than that.
D Mm-hmm. Can you tell me a little bit D Is your appetite OK?
D And w hat about medications?
more about this? Are you taking anything? P Yes, I never seem to have any problems
P Well, I keep getting breathlessness on that score.
P No.
and wheezing in my chest. It all D No aspirin? D Bowels OK?
started about three weeks ago, and P No. P Yes.
I’ve been coughing a lot w ith it, some D Are you doing any exercise, D Waterworks OK?
white phlegm. I thought it might be a jogging for instance? P Yes.
cold coming on, but then after about P No. D Sleeping OK?
another week I started finding it more D What about pets? Do you have pets at P Yes.
and more difficult to catch my breath. home? D General health OK otherwise?
D Right, so you’ve had the wheezing and P Erm no, but my neighbours have a cat. P Yes.
the breathlessness for roughly three But I don’t see it that much. D I think we’d better have a look at
weeks. D Everything OK at home? you. Could just pop behind
P Yes, give or take a day. the screen a n d ...
P Yeah, things are fine.
D And do you get these bouts of
D And w hat about work? I see you’re a
wheezing and shortness of breath civil servant. Any stress or problems at
every day? work or anything like that?
P No, they come and go.
Pronunciation 2 3 Now roll your sleeve above your elbow. regards driving, the patient is advised
Exercise 1 Yes. That's fine. not to drive if sedation is involved in the
D Is your appetite OK? 4 Would you just pop up on the couch procedure. A leaflet about the procedure
P Yes, I never seem to have any problems for me? That’s it. is always given to the patient and follow-
on that score. 5 Could you lean forward a little bit for up is also...
D Bowels OK? me? Good. That’s it.
6 If you could just move towards the
Exercise 2
edge of the couch. Yes. That’s it. Listening 2
1 Can you tell me a little bit more about 7 Now, I w ant you to just turn over onto Exercise 1
this? (F) your tummy. D=doctor, P=patient
2 Have you been eating properly? (F) D I need to explain the procedure to you
3 Your appetite OK? (R) Listening 3 and get you to sign the consent form.
4 Are your sleeping OK? (R) 1 Can you just pop behind the screen P OK.
5 How frequently do you get them? (F) and undress for me', please? D So w e’re going to do something
6 Are you passing water a lot? (R) 2 I need to examine your lower back, so called a gastroscopy. Do you know
7 You had any diarrhoea? (R) if you could turn onto your tum m y for w hat that is?
8 Have you lost any weight? (R) me, please. Thank you. P No, I don’t. No.
9 How long’ve you been living there? (F) 3 lust cough for me. And again. D Well, w hat we are going to do is have a
10 You been keeping well? (R) That’s fine. look at your gullet and your stomach
4 I’d like you to stand up for me. Do you to see w hat’s going on there.
Unit 3 need any help getting up? P OK.
5 Could you just tilt your head to the D It’s a routine procedure. What we
left? Yes. That’s it. are going to do first is to give you
Listening 1
6 Can you make a tight fist for me? Fine. something to help you relax, and then
There are many things that will become 7 I’d like you to keep nice and still for me, we're going to numb your throat with
obvious once you have done your first if you can. OK. a spray. Then we are going to pass a
ward round, but I can give you a few tips bendy tube, which is no thicker than
that helped me on my first day. The first your little finger, down through your
thing is: make sure you know the names Unit 4 throat into your stomach. OK?
of all your patients and where they are P I see.
in the ward, as you want to demonstrate Pronunciation D The tube will have a tiny camera
that you are familiar with your patients. Exercise 3 on the end so that we can look at
The next tip is always check w ith the 1 endoscope your stomach. And if we see anything
bed managers if any patients have 2 endoscopy there w hat we can do is take a tiny
been moved, and if so where to, in order 3 endoscopic tissue sample.
to avoid wasting time, especially the Exercise 4 P Right.
consultant’s, running around looking 1 endoscopy D We’re also going to blow some air
for patients. Also make sure you have 2 proctoscope into your stomach to help us see a bit
all the case-notes, X-rays, and so on 3 gastroscopy better, so you will feel a bit full and
on hand so that you can refer to them 4 colposcopic possibly want to belch.
quickly. It is useful to invite a nurse who 5 gastrectomy P It sounds a bit scary.
knows your patients-to come on rounds 6 proctoscopic D I agree it can ...
with you, because they may be more 7 gastroscopic Listening 3
knowledgeable about the patients on the
ward than you are. Listening 1 Exercise 3
Once the procedure is explained to the 1 It’s a very sim ple procedure.
As regards the case histories and results,
patient, advice is given about what 2 We’re just going to take some fluid
record them clearly and concisely; in that from your backbone.
way you can access information easily. preparation is required before it is
carried out. The patient is asked to 3 You’ll just feel sligh tly sore after
Listening 2 stop anti-acid therapy for two weeks the test.
beforehand if possible. For eating and 4 All you'll feel is a tin y scratch,
1 Canyoujustbendyourheadslightly
drinking, the patient is advised to take nothing more.
to the left? OK.
nil by m outh for 8 hours before the 5 It’ll take ten minutes.
2 I'd like you to raise your arm above
procedure is done, but note that water 6 It on ly takes a few minutes.
your head for me.
up to 4 hours pre-op may be OK. As
7 It’s n o t a pleasant procedure. Listening 2 rem em b er, I’m ju s t p o in tin g th e m out
8 You’ll hard ly feel anything. D Good aftern o o n , M r Johnson. M y n a m e to y o u so th a t y o u ’re aw are of th em .
is Dr H ow ard. H ow are y o u today? Also look a t th e leaflet th a t com es w ith
Listening 4 th e tab lets. If y o u do get anything,
P I’m fine, doctor.
D=doctor, P=patient ju s t g et in to u c h w ith yo u r GP. Is
D T h at’s good. W ell,... I’ve got som e
D Now, I ju s t have to go th ro u g h som e e v ery th in g OK so far?
good n ew s for you. You've m a d e very
possible side effects of th e gastroscopy, P Yeah.
good pro g ress an d w e ’re going to let
if th a t’s OK w ith you. D OK. W ould y o u like to go th ro u g h
y o u go hom e.
P Yes, fine. ev ery th in g an d ex p la in it to me?
P Really?
D First of all, I can assu re you th a t in
D Yes. B ut before y o u go, th e re 's ju s t one
m o st cases th e procedure is problem -
free. B ut I have to p o in t ou t to you
or tw o th in g s to do. I can see y o u ’re Unit 6
v e ry p leased a b o u t going hom e.
som e side effects so th a t you are aw are
P Well, I am . Listening 1
of th e m before you sign th e co n sen t
D Well, w e w o n ’t keep yo u lo n g th e n .
form . Is th a t OK? D=doctor, P=patient
First, I’d ju s t like to have a b rie f ch at
P Yes, fine.
w ith y o u a b o u t y o u r m edication. Conversation 1
D Right. Well, som e people can have a
P OK.
m ild sore th ro a t for a day or tw o after D W h at a b o u t work? Do you have any
D W e’re going to give y o u lots of ta b le ts
th e procedure. A nd if you have b e en problem s there?
to ta k e w ith y o u ... a n d m ak e y o u ra ttle
given so m eth in g to m ake yo u drowsy, P A t th e m o m en t, yes. It’s a bit stressful.
a bit.
yo u m ay feel a b it tire d afterw ard s D A nd can y o u te ll m e a b it m ore a b o u t
P OK. I th o u g h t th a t m ig h t h a p p e n .
as w ell. A nd som e people can g et a this?
D Right. Now, if a t a n y tim e y o u w a n t to
ch est in fectio n or p n eu m o n ia . But P Well, I'd say it sta rte d ab o u t tw o
sto p m e a n d ask q u estio n s, feel free to
rem em b er th is does n o t m e a n th a t m o n th s back. A colleague resigned
do so. T here’s a lo t of in fo rm a tio n to
you w ill n ecessarily g et th e s e as well. a n d h e w a s n ’t replaced. So I’m k in d of
ta k e in a t one tim e.
P OK. I h o p e not. doing tw o jobs a t th e m om ent.
P Yeah, fine.
D A nd on th e odd occasion, th e
D The first tab let, w h ic h I am sure y o u ’re Conversation 2
endoscope can cause som e b leed in g
fa m ilia r w ith , is th is little w h ite one,
or in fectio n in th e gu t an d can also D Are yo u r p a re n ts still alive a n d well?
aspirin.
p u n c tu re th e gullet or stom ach, b u t P M y m o th e r is, b u t m y fa th e r died 3
P Yeah.
th is h a p p e n s very rarely. years ago.
D W e’re going to give y o u a v ery sm all
P I see. D Do you k n o w w h a t th e cause
dose of 75 m illigram s. It’s a m u ch
D Is th e re an y th in g th a t y ou w o u ld like of d e a th w as?
sm aller dose th a n y o u ’d n o rm ally b u y
to ask m e or go over again? Or are you P It w as lu n g cancer.
over th e counter. You ta k e it b y m o u th
OK w ith all this?
once a d ay a fte r a m e a l fro m n o w on. Conversation 3
P OK. W hy do I n e e d to ta k e it? D Do y o u sm oke a t all?
Unit 5 D The asp irin w ill h elp y o u a lot, as it P Yes.
th in s th e blood a n d so h elp s to p rev en t D H ow m a n y do you sm oke norm ally?
Listening 1 fu rth e r attacks. P I’d say a b o u t 20.
P OK. T h at’s good. D W h en d id you sta rt sm oking?
Let’s see now , M rs T H aw th o rn e, d ate
D N ow as w ith ev ery th in g w e ta k e th e re P I h a d m y first cig arette w h e n I w as er
of b irth fo u rth February 1963, h o sp ita l
are som e possible side effects. fifteen.
n u m b e r 1834572Z. She w as prescrib ed
P M m -hm m ? D Fifteen. OK, a n d have you ever
T ram adol to d a y - fifte e n th O ctober
D A nd I em p h asize th e w o rd possible, as stopped?
2009, given intram uscularly, fifty
y o u m a y n o t g e t an y o f th e m . B ut I ju s t P Y es.M anytim es!
m illigram s, sta rte d on th irte e n th
have to p o in t th e m out, so th a t y o u are D W h en w as th e la s t tim e?
O ctober a t eleven th irty . All OK. M m m .
aw are of th e m a n d can do so m eth in g P I q u it la st year. B ut it only lasted
M ax im u m freq u en cy every fo u r hours,
a b o u t it if a n y th in g h a p p en s. a m o n th .
m a x im u m dose six h u n d re d m illigram s.
P OK.
OK. To be ad m in iste re d as req u ired
D S om etim es, people g e t a n u p se t
in tram u scu larly a n d given b y Senior
stom ach. Or a sp irin can m ake th e
N urse Bond.
stools of som e peo p le d ark a n d smelly,
or it can cause b leedin g like n o se
bleeds or sh o rtn e ss of b re a th . But
Listening 2 6 Australian society to run around the way he is;

D=doctor, P=patient 7 chronic disease he’d maybe be a bit more listless.
D It isn’t easy to lose weight, as there are 8 health surveys P Mmm.
so many ways to do it that people find D And he’d maybe have a rash and, er,
shy away from the light.
it difficult to choose from them. And Unit 7 P I’ve seen on one of the posters that
there are so many temptations as well.
Have you tried to diet before? difficulty moving his head is related to
Listening 1 meningitis.
P Yes, but none of them worked.
D What did you do? This brings me to an aspect of the D Ah. Yes, it is. But, Mrs Allen, if he had
P I've tried various diets like the training and job application process in neck stiffness, he wouldn’t be able to
Atkins diet and I’ve bought various New Zealand which I initially found move about the way he is.
commercial diets, but I found I alien to my cultural background: talking P I was just scared it might be
couldn’t stick to them. about oneself, especially about strengths something serious.
D What do you think the problem is? and weaknesses. A weakness I used to D Mmm. That’s what every mother
P I tend to snack a lot during the day have was over-empathizing with the might feel in the circumstances, and
with crisps and fizzy drinks and parents and becoming upset when you’re very right to be cautious.
biscuits and sweets. Er... I’m sitting something w ent wrong w ith one of P Thank you, doctor.
around a lot at work, and I’ve tried the children. In the recent interview for D Keep an eye on him, and don’t hesitate
to cut out all these things, but it’s my present post, I related a case where to contact your GP immediately or
impossible. a child almost didn’t recover from an come and see us if there are any
D It’s difficult to break habits like this, attack of meningitis and I became very changes or if he starts crying in an odd
but there are ways round it. Rather upset even in the presence of the mother. way.
than cutting out everything suddenly, I mentioned how I recorded both the P OK. Thanks. I feel a bit more relaxed
it’s perhaps better to do it gradually. ‘good’and ‘bad’experiences as part of about it.
You could have diet cola instead of the my daily reflection and how I talked to D Ah. Is there anything else you’d like to
normal cola, or better still fresh fruit colleagues afterwards and soon realized ask before I w rite...?
juice, low-fat crisps and introduce that they had faced the some problems.
I now see recording and analyzing Listening 3
some fruit. The danger is trying to
do everything at one time and then my weakness in a more positive light In the end, I felt I handled the situation
giving up. Then when you get used to as a means for self-education and better than at the beginning. At first,
it, you can make more changes. advancement. I got the child’s name wrong. I was
P Maybe I could give it a go. very nervous and unsure of myself, as
Listening 2 I didn’t have time to look at the notes
D What about exercise?
D=doctor, P=patient made by the nurse or talk to her; this is
P Well, I spend most of my day at a desk.
D Mrs Allen, from our examination, just down to bad organization. I felt the
When I was younger I used to swim
and I did some yoga, but not anymore. and from w hat you’ve told me, it parents didn't like this, and it made them
D We’ve all been a bit more active in the
doesn’t really look like meningitis. a bit edgy, but I recovered myself very
past. Have you thought of taking up But w hat he has got is a barking cough quickly and as I became more confident
swimming again? and a touch of fever. I think in what I was doing, the parents became
P Yes. But it’s time. After work, I’m too
he’s actually got croup. relaxed and the child became less
P Mmm. agitated. I was very pleased because
tired to do anything, and it’s difficult
D You said he's had this once this year in they thanked me for being sensitive and
to cut down eating, as it makes me
irritable. the spring. being gentle w ith the child. I could see
P Yes, around March I think, and I went they appreciated the fact that I made an
Pronunciation to my GP then. effort to make them feel comfortable.
Exercise 1 D What did he say it was then? While overall everything went well, I
1 Australian government P The same as you, I think. learnt quite a lot from this experience.
2 Australian government D Did you use steam the last time ? I should be more patient and prepare
P A little. myself before talking to a patient. If I
Exercise 5 D Well, if you use steam, it’ll help to ease were short of time again, I would speak
1 epidemic proportions the cough. to the nurse first and get the basic details
2 energy imbalance P So you don’t think it's meningitis ? right. It is in the end all about teamwork
3 lifestyle factors D No. If it were, I’d expect him to be very and respecting the contribution of
4 cardiovascular disease unwell. He probably wouldn't be able colleagues.
5 associated illnesses
Listening scripts 137
Unit 8 2 P I’ve got this runny nose. 2 Although Miss Rigby is in her late
D Can you tell me some more 40s, she wears really bright clothes,
Listening 1 about this? which are suitable for someone much
P I’ve had it for the past couple of younger. When she was admitted
Exercise 1
months and I’ve taken everything she was in a highly elevated mood,
1 Can you tell me what quite a lot
there is from the chemist and hyperactive, and was awake all night.
is for you?
nothing seems to work - cold, Her thoughts are all over the place. She
2 So occasionally.... Can you tell me
allergy tablets. I’ve had no other did not appear to be aware of anything
what you mean by that in days per
symptoms at all and I don’t think abnormal in her behaviour.
week?
it’s a cold. 3 Mr Dickson was well-dressed, but
3 You said a couple. Could you tell me
3 D What about at home? looked very worried and anxious.
exactly how much that is for you?
P Everything there is just as bad. I He sat on the edge of the chair, was
Two or three? Three or four?
have to look after two teenage boys quite agitated, and couldn’t sit still.
4 When you say a'w eight problem’, can
as well as doing a full day’s work. He was fidgeting all the time and had
you tell me w hat he said?
They’re a real handful. I have to very poor concentration, though he
5 Do you w ant to tell me w hat has
do the cooking, washing, ironing, looked at me when he spoke and was
changed at work to make it so bad?
everything, and get them off to spoken to. I felt safe with him, but a bit
Pronunciation school. There’s no end to it. 'nervous' after the interview.
D=doctor, P=patient
4 D You have a dry cough. Can you tell
Pronunciation
Exercise 2 me about it?
P I’ve had it for about the last ten days 1 After I’d learnt to take a detailed
D Have you taken any drugs?
or so, and nothing I take seems to history from the patient, I ...
P Mmm, I haven't taken any prescribed
relieve it. I thought it might be the 2 Before I’d worked in psychiatry, I ...
drugs.
smoking. I used to smoke several 3 I’d worked for five years in my own
D What about recreational drugs?
years ago, but then I started up country in the field of psychiatry,
P No,... at least not recently.
again in the past few months. before I ...
D You’ve taken them in the past,
5 D I understand you've got a bad 4 I dealt with all the new patients
then?
headache. as soon as I’d seen....
Exercise 3 P Yes, doctor, I have. 5 Once I’d completed my undergraduate
1 I haven't taken any prescribed drugs. D Can you describe it for me? degree, I...
2 I was in a cafe when the palpitations P It’s really bad. I always get them 6 I hadn’t moved into psychiatry,
came on. here around my left eye. This one because I ...
3 The first time I had the pain was on a started about two days ago and I 7 When I'd left my home country, I...
cold morning. was just passing the hospital and I
4 My w ork’s not giving me any thought I’d just come in.
problems at the moment.
Unit 10
5 My partner was standing near the
child, but it was m e that picked the Unit 9 Listening 1
child up. D=doctor, P=patient
6 Well, I have a norm al breakfast like Listening 1 D The situation looks rather serious,
everyone else. 1 Mr Jones had the appearance of I'm afraid.
7 Well, I suppose, at the weekends I self-neglect. He did not appear to P It’s bad then.
might have a few more. be paying attention to what was D Yes. I’m sorry to say it’s as
being said. He looked as if he had we had feared.
Listening 2 P It’s not what I w anted to hear, but
withdrawn completely from his
D=doctor, P=patient surroundings and was preoccupied I suppose I knew it all along. It's
1 P I’ve been getting this pain just here. w ith his own thoughts with no eye difficult to come to terms with it,
D Tell me a little bit about it. contact whatsoever. He sat hugging but I just have to accept it.
P Mmm, it seems to come on just himself during the interview. He did D Would you like me to get you
after I’ve eaten usually fried food not interact much w ith the nurse nor anything? A cup of tea?
or something. It starts here near look at anyone else. He left me feeling P I’d rather have some water.
my belly button and bores right in quite a low mood myself.
through to my back. I’ve been
getting it off and on over the past
month or so.
2 D The results of the test have come consciousness. I asked if there were any C Have you been able to take any more
back. Would you like to have relatives she would like us to contact or of the history?
someone w ith you at the moment? if she’d prefer do so herself. She said she D Not really. She’s in too much pain and
P No, not really. I’d rather you gave me would like us to do it and asked if she her husband is very anxious. He thinks
the results on my own. could see the body. I told her it wasn’t she’s pregnant. Could you possibly
D I’m afraid the news is not as good easy to come to terms with this and come and see her?
as we had hoped. It shows that the again that I was very sorry. She was very C OK. I’m on my way.
lump has got some harmful cells. dignified and I felt quite upset by the D Many thanks.
P I just can’t believe this is happening experience.
to me; it’s just not possible. There
must be a mistake.
Unit 12
D It is not easy to come to terms
Unit 11
with this, but I’m afraid the results Listening
are correct. Listening 1 1 Can I ask you how much you drink?
3 D How are you today? 1 I can see that you are very busy, but 2 I think it would be better if you cut out
P A bit anxious about the results, but could you help me? all meat products.
otherwise OK. 2 Do you think I could possibly 3 It’sM issPalan,isit?
D The results I’m sorry to say, are borrow a pen? 4 Is Friday OK for the next visit?
not good. It’s as we feared. 3 I’m sorry I’m late. I got caught in the 5 Congratulations on your new baby,
P I’m completely devastated. What traffic. I should have left earlier. Mrs Willetts.
am I going to do? Who’s going to 4 Excuse me. I know you are busy 6 How long have you been unemployed?
look after the children? but is there any chance that you 7 I know w hat it is you’re going through.
D It’s very upsetting. Would you like could take some blood from some 8 Which ward is your bed in?
us to stop for a moment? Or can I get patients for me?
you anything? 5 How’s it going? Everything OK? Pronunciation
P I’d like to be on my own for a little Not too overwhelmed? 1 Do you th in k /th a t it would be a good
while if th at’s OK. 6 Oh, dear. Would you like me to give idea / to display posters / in all the
you a hand w ith those files? clinics?
Listening 2 2 He suggested going for weekends
7 I’m very sorry to have to ring you at
I asked one of the nurses to be present, this hour, but Mrs Jones has had a away / so that people / could get to
as it was my first time doing this, and relapse. know each other.
I thought I would be nervous, but my 3 He asked what time / the clinic
concern for the patient’s wife was Listening 2 normally opened / in the afternoon.
greater than my own fears. When I C=Consultant, D=Doctor 4 The patient wanted to know / whether
saw Mrs Mann she was sitting in the C Hello. Dr McClaren here. she was able to book an interpreter /
corridor, and I asked if we could go D Hello. It's Dr John Duncan in A&E. for her appointment.
into a side room. I think she could tell C Yes? 5 Dr Wen denied taking the equipm ent/
from my manner that the news was D I’m really sorry to disturb you, b u t... out of the ward / during the last shift.
not good. I introduced myself, and she C That’s perfectly OK. 6 I think you said earlier / that one
immediately asked if the news was bad. D Thank you.... We have an emergency way to promote diversity / is to hold
I had prepared what I was going to say and I’m on my own, as someone’s lunchtime displays in the hospital / for
and her question threw me off-balance. off sick. patients and medical staff.
I managed to compose myself and say C Tell me w hat’s happened. 7 He apologized for the
that it was, and I was sorry to say that D A 25-year-old patient, Mrs Trench, misunderstanding / and even bought
we had not been able to resuscitate her has just come in w ith abdominal pain. me some flowers.
husband on the operating table and that She has had some vaginal bleeding
he had passed away. She started to cry. and pain on passing water and
I waited a few seconds and asked her defecation. There has also been some
if she wanted to be alone or stop for a shoulder-tip pain.
C OK. Anything else?
while. I also asked if she wanted Sister
D She’s a bit faint and feeling nauseous
Jones or me to get something for her.
I gave her atissue. She asked if he had w ith tenderness in the right iliac fossa.
been in pain, but I said that he was pain- On examination, there was extreme
free when he died. He did not regain guarding on touching the cervix.
Glossary
Vowels
i: needle u book ai sign
i runny u: routine au round
i sym ptom u im m unize 01 avoid
e stress A dull 13 piercing
as practice 3: nurse ea careless
a: heart 3 polite U3 reassure
d body ei patient
o: ward 3U throat
Consonants
p therapy f clarify h health
b bandage v vaccine m numb
t telescope 0 strength n backbone

d adm it Q w ithdraw p aching
achievement /s 'tjn v m s n t/ n som ething awareness /s 'w e sn s s/ n know ledge body language /'b o d i laepgwid;?/ n the
that som ebody has done successfully or understand ing of an issue or a w ay you place and move your body
aching / 'e ik u j/ adj (of a pain) continuous situation and w hat th is show s about your
and unpleasant but not particularly awkward /'o rk w sd / adj difficult thoughts and feelin gs
strong to deal w ith book b u k / v to m ake an appointm ent
admit /s d 'm it/ v to receive som ebody backbone /'b a s k b a u n /n the spine to see som ebody,for exam ple a doctor
into hospital for m edical treatm ent barriers (to prevention) /'bierisz t 3 or a nurse
affective disorders/a'fek tiv dis,o:d 3 z /n p rp v e n fn / n situations, w ays of boring ;bo:riq/ adj (of a pain) passing
types o f m ental illness in w hich a person th in kin g, etc., th at prevent people through one part o f the body to
has extrem e m oods and em otions,such from behaving in a w ay th at would another
as depression or m ania reduce their risk o f developing an bottle up /,botl !Ap/ v to hide your
aggressive /s'g re siv / adj angry, and illness in the future feelin gs of anger, sadness, etc. from
behaving in a threatening w ay bd /,bi:'di:/ abbrev tw o tim es a day. other people, over a long period of
annoyed V n o id i adj slightly angry From the Latin phrase bis (in) die. tim e
anxiety /aeg'zaisti/ n the state o f feelin g bendy /'b e n d i/ adj able to be bent easily break down /.b re ik 'd a u n / v to fail to
worried or nervous benefit/'b e m ftt/n the helpful and useful continue
anxious /'seq k jss/ adj feeling worried effect you receive from a m edicine or burning /'bsinrrj/ adj very painful, sim ilar
or nervous treatm ent to the feelin g of tou ch in g som ething
apologize /a 'p o lsd ja iz/ v to say that binge b in d j/ n a short period of tim e very hot
you are sorry for doing som ething w hen som ebody does too m uch of CAGE /k e id j/ n a series of questions used
w rong or causing a problem a particular activity, especially eating to ju d g e w hether a person drinks too
argumentative ^ a ig ju 'm e n ta tiv / adj or drin kin g alcohol m uch alcohol.The name CAGE refers
having the tendency to often argue bleep /b li:p / v to call som ebody on their to som e o f the words used in these
w ith other people bleeper (= a sm all electronic device questions: Cut, Annoyed, Guilt, Eye
assumption /s'sA m p Jn /n som ething that you carry w ith you and which opener.
th at you believe to be true even makes a sound w hen som ebody is careless /'k e slas/ adj not paying
though you have no proof tryin g to contact you) attention to or show ing interest in
attach i s 'tretJ/ v to fasten or jo in one BMI (Body Mass Index) /'b i: em ,ai/ w hat you are doing
th in g to another /'bD di mass 'in d e k s/rr a m easurem ent clarify 'klaersfai/ v to make som ething
avoid /s'v o id / v to stay away from th at com pares a person’s height and clearer or easier to understand
som ething; to try not to do som ething w eigh t in o rd e rto ju d g e w hether close k ls u s/ adj very involved in the
they w eigh too m uch, too little, or an activities of som ebody else and
appropriate am ount com m unicating w ith them regularly
140 Glossary
c o g n itiv e /'kognstiv/ a d jconnected w ith d e p ression /di'prejn/ n a m edical e xcru c ia tin g ik‘skru:Jieitii]/ adj
mental processes o f understanding condition in w hich a person feels very (of a pain) extrem ely severe
cognitive b ehavio ral th e rap y sad and anxious, w ith little energy or e xcu se m e /ik'skju:z m i/ phrase used
/.kognotiv bi'heivjsrol .GerspiIn interest in life politely to get som ebody's attention,
a form of treatm ent for m ental illness d e v is e /di'vaiz/ v to invent or create a especially som ebody you do not know
that attem pts to treat the condition new w ay o f doin g som ething e xe rcise ’eksosaiz/ n physical activity
by ch an gin g the w ay a patient thinks die t /'daist/ n 1 the food th at a person th at you do to stay healthy or become
and behaves usually eats and drinks each day stronger
c o lle a g u e /'kD li:g/ n a person th at you 2 a reduced am ount o f food th at a fa d e /feid/ v to become very w eak
work with person eats because they w ant to lose and die
co lle ctiv e /ko'lektiv/ adj done or shared w eight; a tim e w hen a person only fla m b o y a n t /flaem'boiant/ adj (about a
by all m em bers o f a group o f people eats th is reduced am ount person) ten d in g to attract attention
com e and go ,kAm an gau/ v to be d isb e lie f jdisbi'liif/ n an inability because they dress or behave in an
present for a short tim e and then go or a refusal to accept th at som ething e xcitin g or unusual way
away is real or true fo o lp ro o f / ‘fu:lpru:f/ adj (of a plan,
com e round /,kA m raund/ v to become d iscrim in a te di'skrimineit/ v to unfairly method, etc.) certain to succeed
conscious again treat one person or group worse/ g /d 3 i:/ abbrev gra m
concentration .qkonsn'treijn/ n the better than another ga stro sco p y gae'stroskopi/ n a m edical
ability to direct all your attention on dislike /dis’laik/ v t o not like som ebody exam ination o f the stom ach u sing an
one thing or som ething endo scop e
c o n s e n t /kan'sent/ n perm ission from a d istra cte d di'straektid/ adj unable to pay ge n e ral p ractitio n e r
patient for a doctor to do a particular attention to so m eth in g because you /,d 3enrsl praek'tijano^)/ n a doctor
medical procedure are th in k in g about som eth in g else w ho is trained in general medicine
cooperate /kau'opareit/ v to work d istrict nurse /.distrikt 'n3:s/ n a nurse and w ho treats patients in a local
together w ith another person in order w ho w orks in a particular area and com m unity rather than at a hospital
to achieve som ething w ho visits patients in their hom es g o o v e r / .g s u 'auvsjr)/ v t o explain
cooperation /kau.Dpa'reiJn/ n the act d iv e rsity dai'v3:s9ti/ n the quality or som eth in g carefully, especially by
of w orking together to ach ieve fact of in clu d in g a range o f people of repeating it
a shared aim different race, class, religion, etc. go od practice /,god 'praektis/ n a way
cop ing m e ch an ism s d o n o r card 'doono ka:d/ n a sm all card o f doin g so m e th in g th a t is a good
/'kaupii] .mekanizamz/' n ways or th at a person carries w hich gives exam ple o f how it should be done and
m ethods for dealing w ith difficult perm ission for doctors to use parts of w hich can be copied by other groups
situations their body after their death or organizations
critical ' kritikl/ adj saying w hat you drain /drein/ v to remove liquid g rip p in g 1gripirj/ adj (of a pain) feelin g
think is bad about a person o rth in g du ll !d\\ adj (of a pain) not very severe, as if som eth in g is squeezing or
c ro u p /kru:p/ n a disease affecting but continuous holding a part o f your body very hard
children that makes them cough a lot -e cto m y ektsmi/ su jfix concerning the g u ilty /gilti/ adj fee lin g asham ed
and have difficulty breathing surgical removal of an organ or a part because you feel that you have done
cru sh in g 'krAjir)/ adj (of a pain) feeling of the body som eth in g w rong
that som ething is pressing down e fficie n t /i'fijnt/ adj doing som ething h a b its /'haebits/ n actions or activities
extrem ely hard on a particular area of well and th o ro u gh ly w ith no w aste of th at you often do frequently, usually
your body tim e, money, or energy w ithout th in kin g
culture ' ’k A l t J o f r ) / n the custom s, beliefs, e m p a th y '‘empsGi/ n the ability to h a lal /'haelael/ adj (of meat) from an
and way of life of a particular country understand another person’s feelin gs anim al th at has been killed according
or group N ote:The words e m p a th y and sym p a th y to M uslim law
defensive /di’fensiv/ adj behaving in an are often confused, h e alth v isito r /'helG vizits(r)/ n a trained
angry or offended m anner because e n c o u ra g e /in 'k A rid j/ v to give nurse w ho visits people in their
you feel that people are criticizing you som ebody hope and support hom es in order to give them advice
denial /di'naiol/ n a refusal to accept en d o sco p e /'endsskaup/ n a sm all on m edical care,for exam ple advising
that som ething unpleasant or painful camera on a lo n g th in tube w hich can new parents on h o w to look after
is true be put into a person’s body in order to their baby
view the areas inside
hobbies 'hobi:z/ n activities that you mania /'m einis/ n a m ental illness in numb / n A m / v to make a part of
do for pleasure w hen you are not w hich a person has extrem e moods your body unable to feel anything
w orking during w hich they become very active (= to make it numb); anaesthetize
honest /'m ust/ adj alw ays te llin g the and high ly excited numbness / ' n A m n s s / n the inability to
truth Marie Curie nurse /.maeri k ju s r i n3:s/n feel an yth in g
I’d rather/,aid ra:83(r)/ phrase I would a type of nurse w ho takes care of O/E/su \'J abbrev on exam ination
prefer to people w ho are dyin g from illnesses obesity /s u 'b k s s ti/ n th e condition of
ignore /ig'no:(r)/ v t o pay no attention such as cancer being very fat, in a w ay that is not
to som ething mark / m a :k / v to indicate the position of healthy
IM/,ai 'em/ abbrev intram uscular so m eth in g,fo r exam ple by d raw ing or obtain /s b 'te in / v to get som ething, such
immunization jim junai'zeijn/ n the w ritin g on a person’s skin in order to as consent from a patient for an
action of protecting a person from show where to insert a needle operation
a disease, usually by injecting them metaphysics /.m e ts'fiziks/ n the branch od ' p u 'di:/ abbrev every day; once a day.
w ith a vaccine o f philosophy th at deals w ith the From the Latin phrase omni die.
informed consent /m.foimd kon sent/ nature of existence, truth, and offend /s 'fe n d / v to make som ebody feel
n perm ission for a m edical procedure know ledge upset or angry because of som ething
that is given by a patient after the midwife /'m idw aif/ n a person w ho is you say or do
procedure has been explained by a trained to help w om en give birth to om/,3 u 'em abbrev every morning.
doctor, nurse, etc. babies From the Latin phrase omni mane.
INH jai en 'eitj/ abbrev by inhalation mini-mental state examination /.m ini on /,3U 'en abbrev every night. From the
initial assessment /I'nijl s.sesmsnt/ n m entl steit igzaem i'neijn/ n a short Latin phrase omni node.
the form al ju d gem e n t of a doctor test th at is used to ju d g e if a person organ transplant 'otgsn traenspla:
or a nurse concerning w h at illness has dem entia (= a severe decline in nt/ n a medical operation in which
a patient is su ffe rin g fro m and w hat m ental fu n ctio n in g, usually due to a dam aged organ, such as a heart
is the best w ay to treat this, made old age) or kidney, is replaced w ith one from
after they interview the patient for mini-targets 'm in i taigits/ n a sm all another person
the first tim e aim or objective th at you try to -oscopy /'D sk s p i/ suffix concerning the
instrument /'mstram snt/ n a tool achieve in the near future act of exam in in g o rv ie w in g a part of
or device used for a particular task, moderate /'m odcrat/ adj eating or the body
especially for delicate or scientific drin kin g sensible am ounts; not -ostomy /‘ostsm i/ suffix concerning the
work extrem e act of creating an opening in a part of
intense /in'tens/ adj very great; very motivate /'m sutiveit/ v to make the body
strong som ebody w ant to do som ething overweight /.s u v s 'w e it/1 adj w eighing
interrupt /.in ts'rA p t/ v to say or do that requires hard work or effort more than is healthy
som ething that m akes som ebody stop multicultural m \lti kAltjbrol adj for or 2 n the condition o f w eigh in g more
w hat they are saying or doing in clu d in g people o f several different than is healthy
isolation /.aiss'leijn n the state or races, religions, lan gu ages and panic /'paem k/ n a sudden feeling of
feeling of being alone or separate traditions great fear that makes you unable to
from other people multidisciplinary /.m A ltid iss'p lin sri/ th in k calm ly
IV/,ai vv.l abbrev intravenous adj involving several different areas of partnership /'p a itn s jip / n a relationship
job application /'d 3 Db .aspli'keijn/ n m edicine between tw o people or two
a form al, usually w ritten, request NEB /,en i: 'b i :/ abbrev by nebulizer organizations w ho work together
for a job non-judgemental /'non d 3 Ad 3 ,mentl/ on a particular activity
key /ki;/ adj m ost im portant; essential adj (used about a person’s attitude) pass away /,p a :s s'w ei/ v to die. Pass
kick/kik/ v to stop doing som ething not critical o f other people away is used instead o f the word die
harm ful that you have done for a long non-verbal communication /,nDiiV3:bl in order to avoid upsetting somebody
tim e, for exam ple a bad habit k sm ju m i'k e ifn / n the expression of patient /'p e ifn t/ adj able to w ait for
kosher /’kaujajr)/ adj (of food) prepared ideas and feelin gs w ithout the use of a long tim e or accept difficulties
according to the rules o f Jew ish law words or speech w ithout becom ing angry
lifestyle /'laifstail/ n the w ay in w hich a not be yourself/.not bi jo fse lf/ phrase persistent /p a 'sista n t/ adj (of a pain)
person lives, for exam ple the type of to not be in a norm al state of body or continu ing for a long period of tim e
jo b they have or the type o f hobbies mind w ith ou t interruption or occurring
they enjoy regularly
142 Glossary
perspective/po'spektiv/ n a particular process / 'p r a u s e s / n a series o f th in gs respectful /ri'spektfl/ adj show ing
view or w ay o f th in k in g about that are done in order to achieve respect and consideration for
som ething a particular result other people
piercing piasu]/ adj (of a pain) feeling prohibited p r a 'h i b i t i d / adj not allowed responsibility/ri spDnsa'biloti/ n a duty
as if a sharp object is being pushed or perm itted, especially by law to deal w ith or take care o f som ething,
into the body prone p r a o n / adj having the tendency so th at you m ay be blamed if
pinprick 'p in p rik/ n a short, m ildly to suffer from a particular illness or som eth in g goes w rong
sharp sen satio n ,sim ilarto that condition restless /'restlas/ adj unable to stay still;
produced by a pin when it breaks your psychological / ,s a ik a 'lD d 3i k l / adj m oving continuously
skin connected w ith a person’s m ind and rewarding /ri w o;diq/ adj (of an activity)
PO ',pi: '3U/ abbrev by m outh. From the the w ay in w hich it works satisfyin g because you th in k it is
Latin phrase per os. psychosis/ s a i 'k a u s i s / n a serious m ental useful or im portant
polite /pa lait/ adj having good m anners illness in w hich the patient loses role/roul/ n the function or position of
and show ing respect for the feelin gs contact w ith reality, for exam ple by som ebody or som eth in g in a group, an
of others hearing voices organization, a situation, etc.
politeness /pa'laitnas/ n the fact of psychotherapy j s a i k a o 'O e r a p i / n the routine /ru:'ti:n/ n the w ay you norm ally
having good m anners and sh ow in g treatm ent o f m ental illness by talk in g do th in gs, especially when th is follow s
respect and consideration for the w ith a patient rather than by givin g a fixed order
feelings of others them drugs RTA a: ti: 'ei/ abbrev a road traffic
pop/pDp/ v to go som ew here or put qds/.kju: d i: 'e s / abbrev four tim es each accident, such as a car crash.This is
som ething som ewhere quickly or for a day. From the Latin phrase quater die also referred to as an RTI (= road traffic
short tim e.This verb is norm ally used sum endus. incident).
with a word such as up, off, etc. 0 Pop reassurance / j r i i s 'J u s r o n s / n the act of run (a temperature) jrAn a tem protjo(r)/
up on the table, please. 0 C ould y o u g ivin g advice or help th at removes a v (used about a person’s body) to have
please pop y o u r clothes off. person’s doubts or fears a higher tem perature than is normal
PR ,pi: 'a:(r)/ abbrev through the receptionist/ r i 's e p j o m s t / n a person due to illness
rectum. From the Latin phrase per w hose jo b is to deal w ith patients as runny (nose) 'rA ni n a u z / adj producing
rectum. they arrive at a doctor’s practice, take a lot o f liquid, for exam ple w hen you
practice /'prasktis/ n the place where appointm ents over the telephone, etc. have a cold
a doctor of general m edicine (= a referral letter/r i'f 3 : r o l lc ta ( r ) / n a letter sample /'s a :m p l/n a sm all am ount of
general practitioner) advises and w ritten by a doctor that directs their m aterial taken from the body and
treats their patients; the w ork or patient to another person in the tested in order to obtain inform ation
business of a general practitioner m edical service for further treatm ent about a patient’s physical condition
practice manager ''prasktis reflection /n 'fle k jn / n careful th ou gh t SC/,es 'si:/ abbrev subcutaneous
,maenid33(r)/ n the person w ho is in about so m e th in g,fo r exam ple about scalding 'sk o d d iq / adj (of a pain) very
charge of running and o rgan izin g a your w ork or behaviour; a w ritten strong and givin g a feelin g o f burning
practice, for exam ple by m an agin g the record of these th ou gh ts scenario /ss'n cu riau / n a possible
staff, dealing w ith financial matters, regretful T T gre tfl/ adj feelin g sadness situation, especially one that you
etc. or disappointm ent because of im agine in order to discuss w hat you
practice nurse /'prasktis ,n3:s/ n a nurse som eth in g th at you have done or not would do in that type o f situation
who works in a practice, and who done self-harm /.self 'h a :m / n the practice
performs routine m edical procedures reliable / n 'l a i s b l / adj able to be trusted o f deliberately injuring yourself, for
such as givin g injections to do som eth in g w ell; th at you can exam ple by cu ttin g yourself
prefer /pri'f3:(r)/ v to like one th in g or rely on sensitive "sensotiv/ adj aware of and
person better than another resignation / .r e z ig ’n e i j n / n the state able to understand other people and
prepare/pri'p esjr)/ v to make of having accepted an unpleasant th e irfe e lin g s
som ething ready to be used situation because it cannot be sensitivity /.se n sa 'tiv sti/ n the ability to
prn/.pi: a :r 'enJ abbrev as needed; w hen changed understand other people’s feelin gs
required. From the Latin phrase pro re respect/ r i 's p e k t / n polite behaviour that and ta k in g care not to offend them
nata. show s th at you consider som eone settle into setl 'in tu / v to begin to feel
procedure/pr3'si:d33(r)/ n a m edical im portant com fortable w ith a new w ay of life or
operation a new w ay o f doin g th in g s
severe /sTvra(r)/ adj (of a pain) extrem ely sterilize /'sterolaiz/ v to kill all the throat /Grout/ n a passage in the neck
bad or serious bacteria in or on som eth in g in order through w hich food and air pass on
shock /jo k/ n a strong and unpleasant to make it clean their w ay into the body; the front part
feeling of surprise as a result of an stick to /'stik to/ v to continue doing o f the neck
unexpected event som eth in g in spite o f difficulties or thunderclap 'GAndoklasp/ adj (of a pain)
shooting ''Ju d ip / adj (of a pain) used problems sudden and very intense
to describe a sudden sharp pain that strength streijG/ n a good quality or tip /tip/ n a sm all piece o f advice about
moves quickly across an area o f the ability th at a person has som ething practical
body stress/stress/ n anxiety or w orry caused treatment options/'triTm ont ,DpJnz/ n
shy away from, J a i o'wei from/ v to by pressure at w ork or problem s in the different m ethods of treating an
avoid som ething som ebody’s life illness that are available and offered
side effect 'said i.fekt/ n an extra and support /so'po:t/ n encouragem ent and to a patient
usually bad effect th at a treatm ent help th at you give to som ebody or f t /,ti:'ti:/ abbrev tw o tablets
has on you, as well as curing illness som ething TTOs /,ti: ti: 'ouz/ abbrev to take out.
or pain sympathy /'simpoGi/ n a feelin g of M edicines that a patient is given to
sign /sain/ n a physical or m ental feature understand ing for som ebody; the act take hom e w ith them when they leave
of a particular illness that is observed of sh ow in g that you understand and hospital
by a doctor but w hich the patient is care about som ebody’s problems TW EAK /tw i:k/ n a series o f questions
not aware of Note:The words empathy and sympathy used to ju d g e w hether a person drinks
sociable /'soujobl/ adj enjoying spending are often confused, too much alcohol.The name TWEAK
tim e w ith other people symptom /'sim ptom / n a physical or refers to som e of the words used in
social drinker /'soujl/ n a person who m ental change that is noticeable to a these questions: Tolerance, Worried,
drinks alcohol only w hen they meet patient and w hich indicates th at they Eye-opener, A m nesia, and K/Cutdow n
other people in a bar, restaurant, etc. m ay have a particular illness upset/Ap1set/ v t o make som ebody feel
sore /so:(r)/ adj (of a part o f the body) tactless /'trektlos/ adj saying or doing unhappy, anxious, or annoyed
painful and tender th in g s th at are like lyto annoy or to vague /veig/ adj 1 not clear or precise
spasmodic/spaez'm odik/od/l (of a pain) upset other people 2 (of a pain) mild; not very severe
caused by your m uscles becom ing take u p /.te ik 'Ap/ v to start to do a new value /'vaelju:/ v t o th in k that somebody/
tig h t in a w ay th at you cannot control activity, such as a sport or hobby som ething is im portant
2 (of a pain) happening suddenly for tds /,ti: di: 'es/obbrevthree tim es each visualization /.v iju o la i'ze ijn n the act
short periods o f tim e; not regular or day. From the Latin phrase ter die of seeing som eth in g
continuous sumendus. ward round /' wo:d ra u n d / n a regular
spiritual /'sp irit Jual/ adj connected w ith teamwork /'ti:m w 3:k/ n the activity of visit th at is paid by a doctor or a group
the hum an spirit, rather than the body w o rking well togeth er as a team o f doctors in a hospital to each of the
or physical th in gs teetotal/,ti: 'toutl/ adj never drinking patients in their care
SpR/ ,es pi: 'a :(x)l abbrev specialist alcohol weakness /'w i:kn ss/ n a bad quality or
registrar. A senior doctor w ho works telescope /'teliskoup/ n a piece of la c k o fa b ility th a t a person has
in a hospital and w ho is an expert in a medical equipm ent, con sistin g of a withdraw /wid'dro:/ v to remove
particular area of m edicine, thin tube w ith lenses, that you look som ething from som ewhere
stat /staet/ abbrev im mediately. From the through in order to exam ine areas withdrawn fw i5'dro:n adj very quiet
Latin phrase statim. inside the body du rin g an operation and not w an tin g to com m unicate
stereotype 'steriotaip/ v to form an tender /'tend3(r)/ adj (of a part o f the with other people
opinion o f a person based on fixed body) painful w hen you touch it W R /,d A b lju : ’a :(r)/ abbrev ward round
ideas about their class, race, etc. rather terminally ill /'t3:m inoli ,il/ adj suffering
than considering th at person as an from an illness th at cannot be cured
individual and w hich w ill lead to death
OXFORD pp7 (doctor and patient/Bob Pardue), 8 (Robert Llewellyn/
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o r tra n s m itte d , in a n y fo rm o r b y a n y m e a n s, perm ission o f the Co-Publishers, BMJ Publishing Group 7th edition (2007); p26 Oxford Handbookfor the Foundation
and RPS Publishing, th e p ublishing division o f th e Royal Programme (2006); p27 Oxford Handbookfor the Foundation
w ith o u t th e p rio r p e rm is sio n in w ritin g o f O xford
Pharm aceutical Society o f G reat B ritain (readers should Programme (2006); p36 Oxford Handbookfor the Foundation
U niversity Press (w ith th e sole e x c e p tio n o f Programme (2006); p37 Oxford Handbookfor the Foundation
note th a t the BNF is regularly updated and that the current
p h o to co p y in g c a rrie d o u t u n d e r th e c o n d itio n s edition is available a t www.BNF.org) p41; Corbis pp4 Programme (2006); p38 Oxford Handbookfor the Foundation
stated in th e p a ra g ra p h h e a d e d ‘P h o to c o p y in g ’), (shaking hands/Em m a Rian/zefa), 4 (files/Scott Stulber), Programme Saunders et al (2006); p38 www,wikipedia.org
o r as ex pressly p e rm itte d by law, o r u n d e r te rm s 4 (filling form/Artiga Photo), 7 (Dr Gillian A nderson/ p41 Oxford Handbook of General Practice 2nd edition (2006
Somos Images), 9 (woman/Bloomimage), 12 (receptionist/ p49 Oxford Handbook of General Practice 2nd edition (2006
a greed w ith th e a p p ro p ria te re p ro g ra p h ic s rig h ts
Scott Stulberg), 16 (social drinking/Somos Images), 19 p5 Oxford Handbook of Clinical Medicine 7th edition (2007)
o rg an izatio n . E nq u iries c o n c e rn in g re p ro d u c tio n p52 w w w .w ashingtonpost.com ; p53 www.rpsgb.org.uk
(Jose Luis Pelaez, Inc./Blend Images), 28 (procedure
o u tsid e th e scope o f th e above sh o u ld b e s e n t to trolley/Leif Skoogfors), 30 (Dr Quinn/Jose Luis Pelaez, p54 w w w .foundationprogram m e.nhs.uk;
th e ELT R ights D e p artm e n t, O xford U n iv ersity Inc.), 38 (New York hospital/Peter Morgan/Reuters), 39 p56 w w w .w ashingtonpost.com ; p58 www.lbro.ac.uk;
Press, a t th e ad d ress above (doctor/Steve Prezant), 67 (Visuals Unlimited), 74 ((a)/Rick p59 w w w.wired.com; p61 w w w .term inalillness.co.uk;
Gomez), 74 ((b)/H. Benser/zefa), 74 ((d)/Ted Horowitz), p62 www.vso.org.uk; p63 www.siteresources.worldbankorg
You m u s t n o t circ u la te th is b o o k in a n y o th e r p69 Oxford Handbook of Clinical Medicine 7th edition (2007);
74 ((f)/Robert Llewellyn/zefa), 99 (Randy Faris), 104
b in d in g o r cover a n d y o u m u s t im p o se th is sam e (happy group/Artiga Photo), 108 (Caribbean m an/Pinto/ p7 w w w .londondeanery.ac.uk; p79 Oxford Handbook of
c o n d itio n o n a n y a c q u ire r zefa), 108 (Sikh man/Hugh Sitton/zefa); © Dr Michael A Clinical Medicine 7th edition (2007); p82 Oxford Handbook
Fenichel/www.fenichel.com p82 (Beck); Galos Caves of Psychiatry (2006); p84 Oxford Handbook of clinical
Photocopying p57 (www.galoscaves.com); Getty Images pp9 (man/Todd Specialties 7 th edition (2007); p91 www.mariecurie.org.ul'
The P u b lish e r g ra n ts p e rm is sio n fo r th e Pearson/Photodisc), 17 (sm oking m other/im age Source), p94 Oxford Handbook of Palliative Care (2006);
26 (Somos/Veer), 33 (LWA/Riser), 36 (medicine bottle/ plOOw w w .foundationprogram m e.nhs.uk;
p h o to c o p y in g o f th o s e pages m a rk e d
D orling Kindersley), 37 (Jose Luis Pelaez Inc/Blend p i 03 www .phlebotom y.org; p i 08 Oxford Handbook of
‘p h o to c o p ia b le ’ a cc o rd in g to t h e fo llo w in g General Practice (2006); p i 12 Oxford Handbook of Palliative
Images), 38 (Joyce Came/Siri Stafford/Riser), 39 (pills/
c onditions. In d iv id u al p u rc h a se rs m a y m a k e Thom as Northcut/Photodisc), 40 (DreamPictures/Blend Care (2006).
copies fo r th e ir o w n u se o r fo r u se b y classes Images), 44 (snacking a t work/A. Chederros/ONOKY), 44 Oxford University Press m akes no representation,
th a t th e y te a ch . School p u rc h a se rs m a y m a k e (shopping basket o f vegetablesfTetra Images), 44 (smoking/ express o r im plied, th a t the drug dosages in this book
copies fo r u se b y s ta ff a n d stu d e n ts, b u t th is M att Cardy), 44 (businessm an/Patrick Ryan/Stone+), 46 are correct. Readers m ust therefore always check the
p e rm issio n does n o t e x te n d to a d d itio n a l (Bernd Fuchs/First Light), 47 (Jose Luis Pelaez Inc/Blend product inform ation and clinical procedures w ith the
Images), 49 (smoker/Nick Koudis/Photodisc), 53 m ost up to date published product inform ation and
schools o r b ra n c h e s
(3D4Medical.com), 54 (Reza Estakhrian/Stone), 70 (baby/ data sheets provided by th e m anufacturers and the
U n d er n o c irc u m stan c e s m a y a n y p a rt o f th is SAKIstyle), 74 ((c)/Jon Feingersh/Blend Images), 74 ((e)/ m ost recen t codes o f conduct and safety regulations.
b o ok be p h o to c o p ie d fo r resale O ppenheim Bernhard/Stone), 79 (man w ith cold/Halfdark/ The a uthors and publishers do n o t accept responsibility
fStop), 84 (Somos/Veer), 85 (Hulton Archive), 86 (Bill or legal liability for any errors in th e text or for the
Any w ebsites re fe rre d to in th is p u b lic a tio n a re R eitzel/Photographer’s Choice RR), 89 (Andersen Ross/ m isuse o r m isapplication o f m aterial in this work.
in th e pu b lic d o m a in a n d t h e ir ad d resses are Digital Vision), 94 (Doctor Stock/Science Faction), 103 (Paul The author and publisher would like to thank the following
p rovided b y O xford U n iv ersity Press fo r Bums/Digital Vision), 106 (couple on beach/Celia Peterson/ people who assisted in the development of this title: Dr Mark
arabianEye), 106 (Chinese signs/Paul Souders/Riser), 106 Fenton MA (Oxon) PhD MB BS MRCP(UK), Consultant
in fo rm a tio n only. O xford U n iv ersity Press
(Indian food seller/Jochem D W ijnands/The Image Bank), Cardiologist, Kent and C anterbury Hospital, East Kent
disclaim s any re sp o n sib ility fo r th e c o n te n t 106 (G uatem alan festival/Kim Steele/The Image Bank), Hospitals Trust; Dean Wang, Escola d’ldiomes, University
108 (Muslim woman/Tom Le Goff/Digital Vision), 108 o f Vic, Spain.
is b n : 978 o 19 402300 9 (Jewish woman/Barbara Penoyar/Photodisc), 111 (Michael
Ochs Archives); iStockphoto p48 (carbohydrates/Morgan Special thanks are also due to: Eileen Flannigan (author:
P rin te d in C hina G ram m ar Reference), Ben Francis (author: Glossary,
Lane Photography); Photolibraiy pp30 (backbone/Ralph
K erpa/imagebroker.net), 44 (four people eating/im age Website).
This b o o k is p rin te d o n p a p e r fro m c e rtifie d a n d Source); Punchstock pp4 (Blend Images), 17 (children The author would like to thank the following people for their
w ell-m anaged sources. eating/D igital Vision), 73 (Ben Edwards/Corbis Prem ium help: Tony Fitzgerald, Dr A dbulkadir Hadi, Dr Murray
RF), 75 (moodboard), 90 (b/Sean Justice/Corbis Super RF), Longmore, Dr Geoff Norris, Karen Peter, Dr Penny
100 (meeting/Stockbyte), 105 (Charles Gullung/Zefa RF), Trafford.
ACKNOW LEDGEM ENTS
110 (Gill an d Ella/Jupiterimages/ Brand X); Reuters p50 The author would also like to thank the editorial and design
Images sourced by: Pictureresearch.co.uk (overw eight people/Lucas Jackson); Rex Features p p l7 team at OUPfor their considerable help: Luke Baxter,
Illustrations by: Mark Duffin p28; Melvyn Evans p80; (cram ped housing/Richard Jones), 82 (Freud/Everett Peter Burgess, Mark Tilley-Watts, Suzanne Williams,
Andrew H am m ond/Illustration pp31, 34, 41,102; Ian Collection), 83 (Alix/Phanie), 87 (Con Tanasiuk/Design Neil Wood and a special th a n k you to Helen MacKinlay
Moores pp 6 , 21, 22, 23, 25, 29; Tony Sigley p p 5 ,10, 20, Pics Inc), 93 (woman/Phanie Agency), 96,104 (phlebotomist/ for h e r patience and help, and to Lewis Lansford whose
24, 45, 69, 76, 96, 98. Phanie Agency); Science Photo Library pp4 (receptionist guidance and insight has b een im m easurable. I would
Cover image courtesy: Getty/LWA/The Image Bank Collection. an d computer/G ustoim ages), 12 (m anager in m eeting/ also like to say a separate th a n k you to Bob McLarty for
We would also like to thank the followingfor permission to Jim Varney), 16 (doctor and patient/Mendil/Bsip), 32 having faith.
reproduce the following photographs: AKG p82 (Reil); Alamy (CNRI), 66 (young child being carried from am bulance/
ii
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OXFORD ENGLISH FOR CAREERS Student's Book

3 Instructions and procedures • p.20

7 Parents and young children ® p.66

Check up 2 How im p o rtan t are accurate p atien t records?

Listen again and check your answers.

3 Work in pairs. Decide w h a t questions th e doctor asks

1 Make gentle questions or short questions for th e Listening 2

m akes it w orse / better? did it start?

3 Work in pairs. M atch these w ords to a question in 2.

I Work in sm all groups. Take tu rn s describing a p a tie n t you

Use SO CRATES in the history of the presenting complaint to help

2 Work in pairs. Decide how you w ould differentiate

We deal with a large catchm ent area and also deal

A & E (n ) Accident and

Listening 3 • Language spot

1 Decide w h e th e r each sentence a -i relates to th e tim e

PC = Presenting com plaint

1 Work in pairs or groups. Decide w h a t th e abbreviations

2 Listen to p art of a conversation b etw een Dr M artin,

Speaking 3 Present Perfect

4 Outline your im m ediate treatm en t. Time Now

4 Present Perfect Continuous

Work in pairs. Complete th e sentences below w ith cam e ok a fte r d ttu te r

1 My m o th er _ . (have) th ese pains since last

Student A, go to page 114. Student B, take a history from

Student B, go to page 116. Student A, take a history from

1 Find a picture a-c to m atch each description of body

1 a The doctor is not sure ab o u t w h a t 2 In groups, discuss w h a t th e body language in 1w ould

clerk (a patient) (v) take a history from a Checklist

0/^ sweaty but mr nfnxrrvviiitbes isi C£T. PP »iS/Sz pfL

2 Working in general practice

2 W hat do you th in k is th e m ost stressful aspect of Pronunciation 1

1 M atch th ese jobs to th e pictures on page 12 . 2 mmmm

M/ M/ \ 1/ Haveyou / Has anyone in your fam ily ever...?

• Now look at th e relationship in a case history

PMH Work in pairs. Discuss w hich conditions the signs and

3 Work in sm all groups. Discuss th ese questions.

drink socially (v) consume

Pronunciation 2 2 f t Listen to te n questions and decide w hether the

W hen th e doctor asks th e questions, does his voice go

deprivation (n) poverty pronounced (adj) evident

Social factors in general practice

2 M atch th e sym bols or abbreviations in th e text Writing

OTC (adj) over the counter

1 Find these on the internet. Look for information about UK GPs'

3 Instructions and procedures

2 For each picture, discuss w h a t is h ap p en in g and w h a t

3 Work in sm all groups. Talk about your ow n experienci

2 Decide w hy you th in k each tip has been given.

Listening 1 b ... to avoid w astin g tim e ... ru n n in g around

Preparing for the first ward round

Patient care • Language spot

3 Work in sm all groups. Choose one of th e tw o diagram s

I Work in pairs. Decide w h a t procedure th e instructions

Speaking 2 Work in pairs. Look only at th e diagram s and take tu rn s

2 Discuss how th e verb and n o u n pairs m ight relate to a text

3 Read th e tex t and decide w hich alternative in italics

DOPS (Direct Observation of Procedural Skills)

4 Work in groups. Discuss th e criteria m en tio n ed in th e

2 (j"J) Listen to th e instructions again an d w rite th e m