Dialogues in a medical practice with tasks "At the doctor"
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At the doctor

Dialogues in a medical practice with tasks

1

D= Doctor, P= Patient

D Hi, Mr White, I’m Dr Brown, one of the doctors in the First Aid Department. How are you?

P I’m OK, but I’m a bit worried about my wife.

D Your wife is OK.

P That’s good.

D The paramedic says you were walking along the street when your wife collapsed. Can you tell me a bit more about what you actually saw?

P Yes, sure. We were shopping in a Mall, when Barbara, my wife, just fainted. We tried to get her upright and she started twitching quite violently. It was quite scary.

D Yes, it certainly can be, but it can happen when people faint like this. Did anything else happen?

P No. nothing at all. She came round very rapidly. But we dialed 999 (112) and a paramedic appeared almost instantly and then the ambulance almost immediately afterwards. Do you think she had a seizure or something like epilepsy?

D We don’t think so. But can I ask you a few more questions? Did she complain of anything before that?

P She had been complaining of feeling a bit unwell, and had almost fainted and she felt a bit woozy. She was a bit dizzy and she was yawning repeatedly and then all of a sudden, there she was, lying on the ground.

D Anything else? Was she ill or anything before she felt?

P No. Just tired.  

D What about her eyesight?

P Nothing, but she said her hearing was a bit funny – she wasn’t hearing clearly.

D Any vomiting?

P No.

D when she fell, how did she fall?

P She just crumpled to the ground slowly. In fact, it all happened so abruptly and silently I didn’t realize it happened.

D So she didn’t cry out or anything?

P No, there was no warning sign at all.

D Just a few more questions?

P OK.

D Has she ever had anything like this before?

P When I come to think of it, she passed out once before about a month ago. She hasn’t been feeling well off and on over the summer. We thought it was the heat.

D At the moment it looks like…

Task

• Take turns role – playing a doctor asking questions to elicit the information from the patient who fainted in the street.
• What are the main signs and symptoms in a case?

2

D= Doctor, P= Patient

D You look as if you are in quite a lot of pain.

P Yes, I think I’ve hurt my hip badly. It’s giving me a lot of pain.

D I think we need to get you some painkillers. So can you tell me a bit more.

P Oh, I slipped on the kitchen floor. I must have spilled some water and I was coming into the living room with a cup of tea and I just went down on my bottom and twisted my leg.

D Oh, dear. That sounds bad.

P It was. I couldn’t move. Fortunately, I had my mobile in my apron pocket and I phoned my neighbor who had the key to come in. She called an ambulance.

D Falls like this happen so easily. You may just pulled a joint out of place rather than breaking anyting.

Task

• Take turns role – playing a doctor asking questions to elicit the information from the patient who had an accident.
• What accident prevention measures should be done?
• What other precautions need to be taken at home?

3

D= Doctor, P= Patient

D What’s brought you here today?

P My wrist is really hurting. I think I’ve broken it.

D OK. How did it happen?

P Well, I was coming out of a shop and I didn’t notice the paving stone was raised and I just tripped and of course I put out my hands to protect myself and break my fall. My wrist took the full force of my fall.

D It certainly looks quite bad, yes. I think we need to do X-ray.

Task

• Take turns role – playing a doctor asking questions to elicit the information from the patient who had an accident.
• What accident prevention measures should be done?
• What other precautions need to be taken in the street?

4

D= Doctor, F= Patient’s father

D What’s happened here?

F She felt down from a tree at school and they called me and I came here from work as the ambulance was bringing her here.

D Oh, I see.

F She is crying a lot and I think she’s fractured something in her leg.

D she may not have broken anything, but let’s have a look at her.

Task

• Take turns role – playing a doctor asking questions to elicit the information from the patient who had an accident.
• What accident prevention measures should be done?
• What other precautions need to be taken at school?

5

D= Doctor, P= Patient

D So what has happened to you, Mrs Skinner?

P Well, I’ve hurt my hand.

D Right. When did it happen?

P I’ve had it since the week before last.

D Where do you get the pain?

P Here on the heel of my hand.

D Is that both hands?

P No, just this one.

D And have you taken anything for it?

P I’ve tried painkillers and that, but they haven’t worked. When the tablets wear off, it’s still there. I don’t have a touch of arthritis, do you think?

D At this stage it’s difficult to say. It’s something we have to try and rule out. But I can just ask you what you think caused it?

P I don’t really know.

D Anything at work?

P I don’t know. It may be the work. I type a lot.

D OK. So you sit at a desk all day.

P Yes.

D Now the pain, does it?

Task

• Take turns role – playing a doctor asking questions to elicit the information from the patient who had pain in the hands.
• What instructions do you think the doctor might give the patient to check the wrist?

6

D= Doctor, P= Patient

D Alex, you’ve had a bang on your head.

P Yes, and I’m surprised I feel OK. I thought it might give me a really bad headache or something, bu I really feel fine. I’m just a bit shaken, really.

D Yes, these things can knock you quite a bit. You still need to be careful over the next 24 hours, even though you feel fine.

P What? You mean I have to stay in the hospital?

D Oh, you don’t need to stay in the hospital, but we need you to look after yourself and rest for the next 24 hours.

P Rest? But I can’t. I have to go to my best friend’s party this evening. I just can’t miss it. He is getting married tomorrow.

D But, I’m afraid you do need to be careful. And you need to have someone to go home with you and stay with you for the next 24 hours as well.

P But I feel OK. I mean why all the fuss?

D Yes, you may feel well, but some things may develop afterwards.

P Like what?

D You may have a headache.

P Well, I can take a paracetamol.

D Yes, but other things could happen like blurred vision or vomiting.

P OK, but I can come back if anything goes wrong.

Task

• Take turns role – playing a doctor asking questions to elicit the information from the patient who had a minor head injury.
• Describe the patient’s attitude towards the head injury.

7

D= Doctor, P= Patient

D Good morning, Mrs Black. How are you enjoying this fine weather we’re having.

P I love it. It’s the best we’ve had for a long time.

D Yes, it’s been remarkable. Let’s hope it continues.

P Well, I think it may.

D Yes. It looks like it. So, what can we do for you?

P Well, doctor, it’s not really trouble, I think I’m expecting.

D I see, and are you happy about that?

P Yes, we’ve been trying for ages.

D OK. Well, let’s take some details. Can you remember when your last period was?

P Not exactly, but probably about 6 weeks ago.

D So you think you’ve missed one.

P Yes. I’m as regular as clockwork.

D Any other changes you’ve noticed?

P I do feel a bit sick most mornings, and my breasts feel a bit tender.

D Right, if I give you a little bowl, can you just pop to the toilet and bring back a sample for me?

10 minutes late

D Well, congratulations, Mrs Black, you were right, you are expecting, and if your dates are correct you’re probably about 4 weeks ago.

P Oh, so the baby’ll probably be born in October.

D Around then, yes. We’ll be able to be more precise after you’ve had a scan.

P When will that be?

D It’s usually done at about 12 weeks. By that time we can usually get a clear picture of the baby. Now, I take it you’ll have your baby in hospital?

P I haven’t really thought about it.

D Well since it’s your first, it’s probably best. We’ll check your details later and sort out the hospital.

P So you’ll let me know which hospital it’ll be.

D Yes, that’s right. Now I just want to ask you a few questions about your lifestyle. Do you east sensibly?

P Generally yes, though I do skip meals sometimes when I’m rushed.

D Well, it’s very important now that you make sure you eat nutritious food regularly.

P I realize that. Does it matter what I eat?

D Yes, there are certain things you need to steer clear of, shellfish and sort of cheese. You don’t want to risk any kind of food poisoning. Now what about alcohol?

P A couple of glasses now and then, but I haven’t been on a binge for ages.

D Good, well keep it that way. Alcohol should really be avoided in pregnancy, but the occasional drink will do no harm. Do you smoke?

P Occasionally, but it’s not a real habit.

D Well, try to cut down, if not give up altogether. With a growing baby inside you, you need to be very careful what you are putting into your body. Are there any questions you’d like to ask?

P No.

D And congratulations, Mrs Black.

P Thank you very much.

Task

• Take turns role – playing a doctor asking questions to elicit the information from the patient who is expecting.
• If necessary, how would you evaluate the doctor’s manner and what improvements would you make?

8

D= Doctor, P= Patient

D Can you tell me how it affects you, Mrs Day?

P I don’t know where to start. I feel tired a lot of the time because the pain keeps me awake at night. And at work I can’t sit for a long. I have to get up and walk around. At work people don’t know how bad it is and it upsets me when they make comments.

D Unfortunately, unless people have things like these themselves, they don’t realize how bad it is.

P No, I’m afraid not.

D Is there anything else?

P It stops me doing certain things, like I can’t catch the bus, because I’m afraid of falling if the bus suddenly jolts, and I can’t really go out and enjoy myself.

D What about the tablets your GP prescribed? Have you been taking them?

P Not really. Sometimes.

D Sometimes.

P Yes.

Can you tell me why that is?

P I don’t like taking them in case I get hooked or anything like that or in case they affect my stomach.

D But when you do take them, do they help?

P Yes, for a while. When the pain is so bad I can’t bear it, I take them.

D So you take them when the pain intolerable.

P Yes.

D Have you been doing any physiotherapy?

P No, not really.

D What about exercise?

P When I start to do anything it hurts a lot. So it puts me off.

D Well, you know, to help improve your strength and build up your muscles, exercise like swimming really helms.

Task

• Take turns role – playing a consultation between a doctor and a patient.
• Write a map of the consultation.

9

D= Doctor, P= Patient

D Good morning, John. How are you today?

P Fine, doctor, except for the weather!

D Yes, it’s a bit uncomfortable at the moment. We’re not used to the heat. We want it, but when we get it, we can’t cope.

P yes, you are right there. We’re never happy.

D So what can we do for you?

P Well, I’ve got this rash with big wheals all over. And it’s quite itchy and getting worse.

D Oh, yes. It does look quite dramatic.

P Well, I just  suddenly came out in it last night. It started on my back and then it just spread. I put some lotion on it, and it helped for a while and then I thought they are getting so bad, I’m itching allover. And with the heat it’s unbearable.

D So you have them everywhere? OK, we’ll have a look at the moment. But can you just tell me what lotion have you used?

P Calamine lotion. It was all I had, and then this morning I came straight here.

D you said itching. Is there any pain with it?

P No, just itching.

D OK, just itching. Have you had it before?

P Yes, once I had it, and I came here and they gave me some antihistamine, and it went away, but it wasn’t as bad as this. I should have kept the name of the tablets or kept some as they helped before. They just seem to be spreading all over.

D Were the tablets PIRITON?

P Yes, I think they were.

D OK. Is there anything you think that might have triggered this?

P Not that I’m aware of.

D Pets?

P I don’t have a pet, and I haven’t been near any.

D What about drugs?

P No, I’m not on anything.

D Are you aware of being allergic to anything?

P No, I don’t think so.

Task

• Take turns role – playing a consultation between a doctor and a patient.
• Map the doctor’s questions: open, closed, leading, etc.

10

D= Doctor, P= Patient

P I’ve got this really bad cough, doctor, and I can’t shake it out.

D OK. So the cough has been getting worse. Tell me a little bit more about it.

P Well, I’ve had this cough for a week or so, and it’s been getting worse. I didn’t think anything of it as I tend to get something at this time of year. But it’s there all the time and the phlegm I bring up – it’s a greenish- yellow colour and it’s steaked with blood. And I have a touch of fever.

D You said the phlegm was steaky?

P Yes, but only a little.

D And how much phlegm do you produce?

P Not that much. It would be less than a teaspoon each time.

D So not much.

P No. And it comes up quite easily. I try to get it up to try and keep my chest clear.

D And is there any smell?

P No. Not that I’ve noticed. It’s just the look of it that’s not nice. It’s rubbery or sticky like mucus from the nose. It’s horrible.

D Any pain?

P No, not really.

D It sounds as if you’ve got a touch.

Task

• Take turns role – playing the conversation between a doctor and a patient.
• What do you think the patient’s condition is? Why?

11

D= Doctor, P= Patient

D You haven’t had any problems for quite a while, have you?

P No, nothing serious. I’ve been quite lucky, really. I keep myself nice and warm, especially at this time of year, and I make sure I eat properly and drink well. I’ve never been a big coffee drinker, but I like a cup of tea, and I drink plenty of water as well. And even though I’ve had a flu jab, I keep away from people. And I always take vitamins every day without fail, so it keeps my folic acid up. My friend had leg ulcers, so I’m very careful – I’m trying to avoid that, but my hip is bad at times, so I have to use a walking stick.

D You seem to be doing very well. You’ve been doing all the right things we talked about when you first became a patient here.

P Well, yes, I’ve done my best.

D looking through your notes you’ve only had one blood transfusion, am I right?

P Yes. That was a while back. The only thing really is my hip and now this pain.

D OK, first we’re going to give  you painkillers.

P OK.

Task

• Take turns role – playing a consultation between a doctor and a patient.
• Write the questions down in note form.

12

D= Doctor, P= Patient

 OK, Mary. Your blood pressure is quite high, 140 over 85. I think the last time it was fairly normal.

P Yes, it was. That was about a year ago.

D It was a year ago last July.

P At least  I‘ve been healthy all this time, apart from these headaches.

D Yes. Well, everything else seems to be OK, so there may be no other cause. I’ll run a few tests just to make sure that your kidneys, etc. are OK and we can refer you to ECG at the hospital.

P OK.

D Is there anything you think might be the cause of the high blood pressure?

P Well, since I took early retirement I’ve been less active and I’ve put on quite a bit of weight. I used to be quite active, but I’ve let things slip a little.

D So when did you retire?

P About a year and a half ago.

D Do you know how much your weight now?

P I weighted myself about 2 weeks ago and I was 120 kilos which for my height I think is quite heavy, I know.

D OK, let’s just check your weight and height.

…

D For your height your weight is quite high, if you look on this chat.

P Oh. That is quite a lot over. I do need to get it down.

D Yes. I see from your family history, your father had heat problems and there’s a family history of heart disease.

P Yes, on my father’s side all his brothers and sisters had problems with angina.

D If nothing shows up in the test, you seem to be generally quite healthy, but the problem is hypertension, which can lead to other problems.

P I’m aware of that.

D Do you think you can get your weight down easily?

P I can try.

D Did you do any sport before?

P Well, I used to swim and walk a lot.

D Have you thought of starting up again?

P Yes, I suppose I could.

D You’ll feel a benefit of it quite quickly and if you’re careful withwhat you eat, you’ll be back to what you were before.

P I hope so.

Task

• Take turns role – playing a consultation between a doctor and a patient.
• What other lifestyle changes could the doctor encourage the patient to make?

13

D= Doctor, P= Patient

D Now, I want to ask you about some experiences which sometimes people have but find it difficult to talk about. These are questions I ask everyone. Is that OK?

P Yes.

D Have you ever had the sensation that you were unreal or that the world had become unreal?

P It’s like… I don’t know how to explain it. I suppose it’s like being in a play somehow. That maybe sounds as if I’m going mad.

D Have you ever had the experience of hearing noises or voices when there was no one there to explain it?

P Yes, sometimes.

D Is it OK to talk about it further?

P Yes, if you want.

D When did it happen?

P The last time was a couple of days ago.

D Were you fully awake?

P Yes, it was during the day.

D How often did it happened?

P Recently only once or twice.

D And where did the sound appear to come from?

P I don’t know. From someone in the room.

Task

• Take turns role – playing a doctor asking a new patient as part of the mental state examination.
• What other details would you want to know about for the examination?