Dealing with the patient / taking the medical history

DEALING WITH THE PATIENT / TAKING THE MEDICAL HISTORY

Lead-in

Read the dialogues and determine the topics of the conversations

past illnesses complaints personal details

occupation drug taking family information

1. 2.

Dr.: Mary: Dr.: Mary: Dr.:

I’m now going to ask you some questions. What do you do, Mary? I’m a cleaner at a big hotel in town, part-time. Uh, if you could just describe what you exactly do? Well, it’s much the same as any other cleaning job, I’m afraid, Doctor. Um, I understand, but it’s important to know this to give me an idea about why you’re suffering……

Dr.: Patient: Dr.: Patient: Dr.: Patient: Dr.:

So, what brings you here today? Um, I’ve been having these really bad headaches. Go on… Well, I keep getting them. Ah-huh? Can you describe them? Um, yeah. I’d say it’s like a pneumatic drill. Mm. Could you explain what you mean by “pneumatic drill”?......

3. 4.

Dr.: Tony: Dr.: Tony: Dr.: Tony:

Good evening, I’m Dr. Marsden. I wonder if you could give me your full name. Yes, My name’s Tony Patchett. Good. What’s your date of birth? Yeah, 30^th May 1956. Married or single? Married and have two children.

Dr.: Patient: Dr.: Patient: Dr.: Patient:

Are you allergic to any medications – some people are allergic to penicillin, for example? No. And finally, are you currently on any medication at all, Ms. Martin? Ah, I was taking antibiotics, but I didn’t finish the course, it didn’t seem to be doing anything. I’m not on anything else. Right. Can I ask you what you were taking them for? Oh, I had a very bad cold…..

5. 6.

Dr.: Patient: Dr.: Patient:

Could you tell me about any illnesses you might’ve had in the past? I had my tonsils out when I was a little kid, I remember that. Any other children illnesses? Don’t remember, to be honest.

Dr.: Patient: Dr.: Patient: Dr.: Patient:

Can I ask you about your parents? They’re both dead now. I’m sorry. What did you father die from? I’m not sure, just old age, I think. What about your mother? She had a heart attack.

Topic text 1

When a patient is admit ted to the hospital or seen by a doctor at the polyclinic for the first time his full case history is record ed by the nurse and the doctor. A full case history consists of the following:

· social or personal history

· family history

· past medical history

· presenting complaint s.

Social history involve s the data about the patient’s age, marital status, the number of children, his education, occupation, and the condition s in which he lives and works. It is essential to get the information about his lifestyle and his personal habit s includ ing recreation, physical exercise, alcohol and tobacco.

Active Vocabulary

1. to admit (to) · admission	[əd`mıt] [əd`mıʃn]	1. поступать, госпитализировать · приём, поступление, госпитализация больного
2. case history	[`keis `hıstǝrı]	2. история болезни
3. to record	[rı`kɔ:d]	3. записывать
4. to complain (of) · complaint	[kǝm`plein] [kǝm`pleint]	4. жаловаться (на) · жалоба
5. to involve	[ın`vɔ:lv]	5. включать в себя, содержать
6. data (pl.)	[`deitǝ]	6. данные, сведения
7. marital status	[`mærıtǝl `steıtǝs]	7. семейное положение
8. occupation	[ˏɔkju`pǝıʃǝn]	8. занятие, профессия
9. condition · conditions	[kǝn`dıʃǝn]	9. состояние, положение · условия
10. essential	[ı`senʃǝl]	10. важный, основной, необходимый
11. habit	[`hæbıt]	11. привычка
12. to include	[ın`klu:d]	12. включать
13. recreation	[ˏrekrı`eıʃən]	13. отдых, времяпровождение

Ex. 1 Make the pairs of the words with the same meaning. Find two odd ones.

admit condition recreation involve information write essential entrance occupation complaint

data admission enter important time spending question include state record profession

Ex. 2 Use the most appropriate word or word combination

1. He’s always ___ing of his neighbors as they are too noisy.

2. Nobody knew his ___ whether he was married or single.

3. This information was really ___ for the company so it was kept a secret.

4. He tried to give up his bad ___ but wasn’t strong enough to do it.

5. When we saw the ___ of his living we were terribly shocked.

6. When his partner was ___ed to the hospital he became the head of the company.

7. The doctor looked through the patient’s ___ and decided to leave him in the hospital for several days.

Ex. 3 Find and correct the mistakes

1. The man complained on constant headaches.

2. They received the necessary date and could finish the project.

3. He retired because of harmful condition in which he had worked.

4. Helen wasn’t aware of his marriage status.

5. After his last admission in the hospital he tried to be very careful.

Ex. 4 Taking the social history the doctor asks many questions. Make these questions complete using the correct auxiliary verb (is; are; do; have).

1. ___ you work?

2. ___ you married or single?

3. ___ you have a partner?

4. What ___ your occupation?

5. ___ you smoke?

6. How much ___ you drink in a week?

7. How old ___ you?

8. What kind of house ___ you live in?

9. How old ___ your children?

10. ___ you have any financial problems or problems at work?

11. ___ you ever tried to give up smoking?

12. ___ you take any exercise?

13. ___ you have any hobbies or interests?

Ex. 5 Match the question with the answer

1. Can I ask how old are you?	a. About twenty a day.
2. How long have you been married?	b. One or two glasses of wine in a week.
3. Do you take any exercise?	c. I’m fifty-five.
4. How many cigarettes do you smoke?	d. Nothing more than the usual daily problems.
5. What do you do?	e. I cycle to work normally.
6. How much do you drink?	f. I work in a clothing factory.
7. Is there anything worrying you at the moment?	g. Twenty-five years. It’s our silver wedding this year!

Ex. 6 Study the social history of Mr. Black. Write the questions the doctor asked to obtain the numbered information. Ex. 4 may help you.

Social history: Mr. G. Black

Home – Lives in a detached house with a large garden ⁽¹⁾.

Family – Four children: two girls aged 3 and 4, two boys aged 6 and 8. All are being taught at home by his wife ⁽²⁾.

Occupation – manager of a warehouse. Stressful job involving dealing with frequent staff problems ⁽³⁾.

Personal interests – Has little time for exercise or interests outside work ⁽⁴⁾.

Habits – Presently smoking 20 per day ⁽⁵⁾. Has tried nicotine patches without success ⁽⁶⁾. Average alcohol intake 3 units per day at weekends ⁽⁷⁾. No problem with alcohol withdrawal ⁽⁸⁾.

Ex. 7 Answer the following questions about yourself

1. When are you usually seen by a doctor?

2. Who records your full case history at the polyclinic?

3. Are you complaining of anything at the moment?

4. What are your usual complaints?

5. What is your marital status?

6. What’s your education?

7. What’s your occupation?

8. Do you live alone?

9. Who shares your home with you?

10. Do you have any hobbies or interests?

11. Do you smoke? How many a day?

12. What about alcohol?

13. How much do you drink in a week?

14. Do you take any exercise?

Ex. 8 Translate into English

1. Когда пациент поступает в больницу, врач и медсестра задают ему много вопросов.

2. Что медсестра записывает в историю болезни? – Она записывает ваше имя, адрес, телефон, семейное положение и образование.

3. Из чего состоит полная история болезни?

4. На что вы жалуетесь? – Я ни на что не жалуюсь (У меня нет жалоб) в настоящий момент.

Topic text 2

Obtain ing a history of the patient’s members (a family history) is important for two reason s. Firstly, the patient may suffer from a genetically determin ed disease, for example, hypertension, diabetes or cancer. Secondly, the patient’s concern s about his presenting complaints may be relate d to the experience of other family members, for example, someone in the family had similar symptoms was diagnosed cancer.

Taking family history a doctor asks about any chronic illnesses of the immediate family, the circumstance s surrounding the death of an immediate family member. Family history can sometimes be crucial and must be done sensitive ly.

Active Vocabulary

1. to obtain	[əb`teın]	1. получать, добывать
2. reason	[`ri:zn]	2. причина
3. to suffer (from)	[`sʌfə]	3. страдать (от чего-л)
4. to determine	[dı`tə:mın]	4. определять, устанавливать
5. hypertension	[`haıpə`tenʃən]	5. гипертония, высокое кровяное давление
6. diabetes	[ˏdaıə`bi:ti:z]	6. диабет
7. cancer	[`kænsə]	7. рак
8. concern	[kən`sə:n]	8. беспокойство, опасение
9. to relate (to) · relation · relative	[rı`leıt] [rı`leıʃǝn] [`relǝtıv]	9. относиться к, иметь отношение · отношение · родственник
10. to experience · experience	[ıks`pıǝrıəns]	10. испытывать · опыт
11. similar	[`sımıla:]	11. подобный, схожий
12. chronic	[`krɔnık]	12. хронический
13. immediate	[ı`mi:djət]	13. прямой, непосредственный, ближайший
14. circumstance	[`sǝ:kəmstəns]	14. обстоятельство
15. crucial	[`kru:ʃǝl]	15. ключевой, решающий
16. sensitive	[`sensıtıv]	16. чувствительный; точный

Ex. 9 Match the words in bold with the words which mean the same

1. to suffer from hypertension – to take / to have / to get

2. immediate relative – far / close / the best

3. sensitive approach – accurate / careful / attentive

4. similar symptoms – different / the same / various

5. to obtain information – to require / to take / to receive

6. crucial moment – useful / standard / important

7. reason – cause / case / course

8. circumstances – cases / conditions / events

Ex. 10 Use the correct word from the box

chronic crucial obtained reason experience circumstances immediate concerns diabetes determined

1. John was the ___ family member so he was given the right to speak.

2. The experiment was quite long and difficult but they ___ the necessary results.

3. The chief wanted to know the ___ of his being late for the meeting.

4. Is there a family history of ___? – I suppose, no. But I’m not sure.

5. The police officer investigated the ___ the accident.

6. If you have any ___ diseases, don’t forget to mention them in the form.

7. Her ___ about the coming operation were groundless.

8. The doctor ___ the cause of his death very quickly.

9. The ___ moment of their relations was his business trip abroad.

10. Specialists without any ___ are not admitted to this company.

Ex. 11 Give the Russian equivalents of the following word combinations

Страдать от генетической болезни; опыт члена семьи; схожие симптомы; беспокойства по поводу жалоб; получать информацию; хронические заболевания; решающий момент; составлять историю болезни точно; обстоятельства смерти; ближайшие родственники; определять причины; страдать от рака.

Ex. 12 Obtaining family history doctors ask special questions. Fill in the missing part of the question

children old illness alive cause have medication die relatives

1. Do you ___ any brothers or sisters?

2. Do you have any ___?

3. Are all your close ___ alive?

4. Are your parents ___ and well?

5. Is anyone taking regular ___?

6. How ___ was he when he died?

7. Do you know the ___ of death?

8. Does anyone in your family have a serious ___?

9. What did he ___ from?

Ex. 13 Write the doctor’s questions. Ex. 12 may help you.

Doctor:	(1) ___________________________________________________?
Patient:	My father dies twenty years ago but my mother is in good health still. She’s seventy now.
Doctor:	(2) ___________________________________________________?
Patient:	I was still at school. He was forty-one.
Doctor:	(3) ___________________________________________________?
Patient:	He had a heart attack.
Doctor:	(4) ___________________________________________________?
Patient:	I’ve got a sister of forty-five and a brother who’s thirty-six.
Doctor:	(5) ___________________________________________________?
Patient:	No, I had an elder brother but he died in his forties. He was forty-two.
Doctor:	(6) ___________________________________________________?
Patient:	Like my father, a heart attack.
Doctor:	(7) ___________________________________________________?
Patient:	Not that I know of.
Doctor:	(8) ___________________________________________________?
Patient:	Apart of me, no.
Doctor:	(9) ___________________________________________________?
Patient:	Yes, a boy and a girl. He’s fourteen and she’s twelve.

Ex. 14 Ask your partner the questions from Ex. 12, make notes of his / her family history and then report to the group.

Ex. 15 Answer the questions to the topic text 2.

1. What is the first reason for taking family history?

2. What about the second one?

3. What genetically determined diseases do you know?

4. What may patient’s concerns relate to?

5. What does the doctor ask the patient while taking his family history?

6. How must the doctor make family history?

Topic text 3

The past medical history (PMH) is the information regard ing the patient’s previous health before the presenting complaint. This involves: major acute and chronic illnesses, childhood illnesses (mumps, measles, chicken pox, etc.), immunization, surgical procedure s, accident s and injuri es, pregnanci es (for women), allergi es (including to food, medicines) and medication. A complete PMH is taken when the origin of the symptoms is unknown.

It is essential to obtain full details of all the drugs and medications taken by the patient. It is necessary to determine the name of the drug, the dose and the frequency of administration. The doctor must ask about drug allergies and drug reaction s.

Active Vocabulary

1. to regard · regarding to	[rı`gɑ:d]	1. относиться, касаться чего-л · относительно, касательно
2. previous	[`pri:vjəs]	2. предыдущий, предшествующий
3. major	[`meıʤə]	3. главный, основной
4. acute	[ə`kju:t]	4. острый
5. mumps	[`mʌmps]	5. свинка
6. measles	[`mi:zlz]	6. корь
7. chicken pox	[`ʧıkən `pɔks]	7. ветряная оспа
8. immunization	[ıˏmjunaı`zeıʃn]	8. иммунизация
9. procedure	[prə`si:ʤə]	9. процедура
10. accident	[`æksıdənt]	10. несчастный случай, авария
11. injury	[`ınʤərı]	11. повреждение, рана, ушиб
12. pregnancy	[`pregnənsı]	12. беременность
13. allergy	[`æləʤı]	13. аллергия
14. origin	[`ɔrıʤın]	14. происхождение
15. frequency	[`fri:kwənsı]	15. частота
16. to administer · administration	[əd`mınıstə] [ədˏmınıs`treıʃən]	16. прописывать (лекарство) · назначение, применение
17. to react to · reaction	[rı`ækt] [rı`ækʃən]	17. реагировать на ч-л · реакция

Ex. 16 Match the words with their definitions

1. injury 2. allergy 3. origin 4. major 5. immunization 6. pregnancy 7. previous 8. mumps 9. accident 10. procedure

a. an infectious disease that causes painful swelling in the neck and slight fever b. a set of actions c. something bad or unexpected which often damages something or injures someone d. cause or beginning of something e. child-bearing period f. happening before something g. unusual reaction of the organism to something h. physical damage to the body caused by an accident i. procedure of introducing a vaccine j. main

Ex. 17 Scrambled letters. Guess the spelling of the words.

a. d a n c i t e c b. r j i n y u c. g i r o i n

d. s l e s m a e e. c g p r a n y n e f. m p u s m

Ex. 18 Put in the most suitable word

1. Jumping from the roof I got a bad ___.

2. Do you have ___ to penicillin?

3. Could you tell me some details about your ___ illnesses?

4. How many ___ did you have prior to the present one?

5. The most common childhood illness is ___.

6. After that car ___ he was performed two serious operations.

7. Such childhood illness as ___ is quite dangerous for boys.

Ex. 19 Give English equivalents to the following word combinations

Определить название лекарства; полная история перенесённых заболеваний; аллергия на пищу или лекарства; реакция на лекарство; хирургические процедуры; основные острые и хронические заболевания; происхождение симптомов; частота применения лекарства; получить все детали о препаратах; детские болезни; предыдущее состояние пациента; доза лекарства; несчастный случай и повреждения.

Ex. 20 Answer the questions

1. What childhood illnesses did you suffer?

2. Do you have allergy to any medicines?

3. Did you have any injuries?

4. What past illnesses did you have?

5. Did you have any previous surgical procedures?

6. Are you taking any medicine at the moment?

Case history: Adel Martin, 44 has just moved into the area. She is complaining of irregular bowel movements.

Ex. 21 You’re going to read Dr. Tran interviewing about her PMH. As you read, number the components of the PMH as you read them.

Past illnesses Medication Immunizations Allergies

Accidents and injuries Childhood illnesses Pregnancies Surgical procedures

Ex. 22 Read again and complete the doctor’s questions (1-7) in the dialogue.

Dr. Tran	As this is your first visit to the practice, I’d like to have a more detailed picture of things. Could you tell me about (1) ___________?
Ms. Martin	I had my tonsils out when I was a little kid.
Dr. Tran	Did you (2) __________________?
Ms. Martin	Don’t remember, to be honest – my mother would know, I’d expect. Mumps, measles, that kind of thing, usual staff.
Dr. Tran	Regular childhood illnesses, then? And how (3) _______________ in general since then?
Ms. Martin	No real problems, to tell the truth.
Dr. Tran	Good. Did you (4) __________________, apart the tonsils?
Ms. Martin	No, no. Like I say, I’m pretty healthy.
Dr. Tran	Any other visits to the hospital?
Ms. Martin	Yes, for the birth of my son, and then a couple of years ago I had to go in for some tests.
Dr. Tran	Mm-hm? What kind of tests, Ms. Martin?
Ms. Martin	Don’t remember exactly.
Dr. Tran	How old (5) _________________ when you gave birth?
Ms. Martin	It was just before my 40^th birthday.
Dr. Tran	Going back to those tests, Ms. Martin, can I ask to elaborate on those a little?
Ms. Martin	Oh, those, well, I lost my second baby, a little girl apparently.
Dr. Tran	I’m sorry to hear that. I understand this must be a painful memory for you. Moving on, if we can. Are you fully immunized?
Ms. Martin	I think I’m OK. I had most of those when I was at school.
Dr. Tran	Do you (6) _________________________?
Ms. Martin	No, not that I know of.
Dr. Tran	Any food allergies?
Ms. Martin	Mm… Strawberries, I suppose.
Dr. Tran	Are you (7) _______________________?
Ms. Martin	Ah, yes. I was taking antibiotics, but didn’t finish the course. Didn’t seem to be doing anything. I’m not on anything else.
Dr. Tran	Well, so I’d like to sum up your history briefly to make sure I have all the details correct before we proceed……….

Ex. 23 Read again and make notes on the following points.

1. Past illnesses: ________________________________________________

2. Medication: __________________________________________________

3. Immunizations: _______________________________________________

4. Allergies: ____________________________________________________

5. Childhood illnesses: ____________________________________________

6. Pregnancies: __________________________________________________

7. Surgical procedures: ____________________________________________

Ex. 24 Correct the mistakes in the following questions

1. When you started taking the antibiotics?

2. Are you ever X-rayed your chest?

3. What childhood illnesses did you had?

4. Do you taking any medication now?

5. How long has you been taking these pills?

6. Have you had any operations in the past?

7. When was you last immunized?

8. Did you ever had any injuries?

Topic text 4

After taking the patient’s social, family and past medical histories the doctor starts interview ing or question ing him. The patient reports his presenting (chief) complaints. This description includes the location, intensity, degree, duration any radiation and frequency of these complaints. The problems which a patient reports to the doctor are called symptoms or complaints, for example pain or nausea. Signs or findings are what the doctor finds on examining the patient, for example high blood pressure or rapid pulse rate.

While interviewing the patient the doctor should determine what preced ed the complaints, what exacerbate d and alleviate d them. He also should ask about any associated symptoms or similar symptoms. The doctor must be quite attentive, careful and accurate while taking the patient’s full case history.

Active Vocabulary

1. to interview · interview	[`ıntəvju:]	1. опрашивать · беседа, опрос
2. to question	[`kwesʧən]	2. задавать вопросы, опрашивать
3. chief	[`ʧi:f]	3. главный, основной
4. to describe · description	[dıs`kraıb] [dıs`krıpʃən]	4. описывать · описание
5. location	[ləu`keıʃən]	5. положение, размещение
6. intense · intensity	[ın`tens] [ın`tensıtı]	6. интенсивный, сильный · интенсивность, сила
7. degree	[dı`gri:]	7. степень, уровень
8. duration	[dju`reıʃən]	8. длительность
9. to radiate to · radiation	[`reıdıeıt] [ˏreıdı`eıʃən]	9. распространяться куда-л · распространение
10. nausea	[`nɔ:sjə]	10. тошнота
11. sign	[`saın]	11. признак, знак
12. findings (pl.)	[`faındıŋz]	12. данные, сведения
13. high	[`haı]	13. высокий
14. blood pressure	[`blʌd `preʃə]	14. кровяное давление
15. rapid	[`ræpıd]	15. быстрый
16. pulse rate	[`pʌls `reıt]	16. частота пульса
17. to precede	[pri:`si:d]	17. предшествовать
18. to exacerbate	[eks`æsə:beıt]	18. обострять
19. to alleviate	[ə`li:vıeıt]	19. облегчать, смягчать
20. associated	[ə`səuʃıeıtıd]	20. сопутствующий
21. attentive · attention	[ə`tentıv] [ə`tenʃən]	21. внимательный · внимание
22. care · careful	[`kɛə] [`kɛəful]	22. забота · заботливый
23. accurate · accuracy	[`ækjurıt] [`ækjurəsı]	23. точный, скрупулезный · тщательность, скрупулёзность

Ex. 25 Use the necessary word to make the phrases complete

interview radiate attentive nausea rapid chief duration associated

1. to feel ______ 2. ____ pulse rate 3. ____ of the pain 4. ____ complaints

5. ___ doctor 6. ___ the patient 7. ___ to the back 8. ____ symptoms

Ex. 26 Complete the sentences using the phrases from Ex. 25

Coming home Jane suddenly felt unwell: a sharp headache and abdominal pain appeared, she (1) ______ and vomited twice. After a day lying in bed she went to see a doctor. First Dr Tran started to (2) ______ her and asked about her (3) _______. Jane reported everything to him. The doctor questioned her long asking about (4) ____________, its location and intensity, about any other (5) ____________ and if the pain (6) _________. After that he took her blood pressure and told she had (7) ___________. He was really worried about it. Dr. Tran was very accurate and (8) ___________. Finally he wanted Jane to make her blood analyses and prescribed her some medicines.

Ex. 27 Find six pairs of the opposites

exacerbate slow similar ignorant findings high alleviate chief associated different rapid unimportant careful attentive low

Ex. 28 Match the words with their definitions

degree intensity alleviate associated

interview precede duration exacerbate

1. to ask a lot of questions to get some information ____________________

2. to make something much worse ____________________

3. to be or go before something in time ____________________

4. amount or level of something _____________________

5. the length of time that something lasts _____________________

6. connected with something _____________________

7. the strength of something that can be measured _____________________

8. to make something less severe _____________________

Ex. 29 Make the phrases “verb + adjective + noun” using the words from the columns.

verbs	adjectives	nouns
to complain of to describe to exacerbate to alleviate to cause to develop to prevent	acute chronic similar physical unusual	pains illness complaints symptoms suffering injuries

Ex. 30 Complete the sentences with the question words (one of the questions doesn’t need any question word). Find out what the doctor wanted to learn about the patient’s pain.

description; location; frequency; duration; intensity; radiation; beginning

1. ___ was the pain yesterday after taking the drug? More or less severe?

2. ___ exactly did you feel this pain?

3. ___could you tell a bit more about this pain?

4. ___ did the pain move?

5. ___ did the pain first appear?

6. ___ did the pain last?

7. ___ do you have this pain? Twice a day or more?

Ex. 31 Use the questions from Ex. 30 for each of these answers.

1. Dr.: _________________________________________?

P: Oh, it wasn’t as bad a migraine but it was the pain of stage before.

2. Dr.: _________________________________________?

P: Here, around the front, here, around the forehead.

3. Dr.: _________________________________________?

P: Oh, goodness, anything up to six, seven hours.

4. Dr.: _________________________________________?

P: Let me think, about two or three week ago, right just before my husband’s birthday.

5. Dr.: _________________________________________?

P: Once it radiated to the neck, but no more.

6. Dr.: _________________________________________?

P: Some day, only in the morning. Some days in the evening as well. It depends.

7. Dr.: ________________________________________?

P: I suppose, a bit less severe but not for a long time.

Presenting complaints

Active Vocabulary

loss of energy	to feel tired – уставший to feel completely worn out – измученный to feel exhausted – изнурённый, обессиленный
general feeling of being unwell	to feel unwell to feel off-colour – неважно выглядящий, нездоровый to be out of sorts – быть не в духе, плохо себя чувствовать
loss of appetite	to have poor appetite – иметь плохой аппетит to be off smb’s food – быть без аппетита (еды)
increase / decrease in weight	to put on weight (five kilos) – набрать вес (5 кг) to gain five kilos – набрать 5 кг to lose weight (five kilos) – сбросить вес (5 кг)
nature of pain	severe – сильный sharp – острый dull – тупой, приглушённый cramping – схваткообразный stabbing – пронзительный, острый throbbing – пульсирующий nagging – ноющий
common complaints	sleeplessness / insomnia – бессонница headache – головная боль cough – кашель nosebleed – носовое кровотечение out of breath – одышка runny nose – насморк sore throat – больное горло stomachache – боль в желудке temperature / fever – температура, жар

Ex. 32 Complete the following complaints.

1. When I climb the stairs I am __________________.

2. I don’t want to eat; I’ve got ___________________.

3. At night I go to bed but I have _________________.

4. I fell down the stairs and now I’ve got a _________.

5. After I eat I regularly get a ___________________.

6. Last time I had a cold I had a ___________ and a ________________.

7. After a very hard day at work I usually feel _____________________.

8. You look miserable. – Yes, I really feel ________________________.

9. Why aren’t you eating? – I have a ____________________________.

Ex. 33 Translate into English

1. После этой экскурсии он чувствовал себя измученным, и у него болела голова. Боль была не сильной, но пульсирующей.

2. Когда у вас появляется боль в желудке? – Обычно после жирной пищи.

3. Я плохо себя чувствую. У меня кашель и болит горло. А вчера у меня была высокая температура.

4. У неё регулярно носовое кровотечение, и врач обеспокоен этим симптомом.

5. После второй беременности она набрала 15 кг и не может сбросить вес.

6. Почему у тебя такой плохой аппетит? – У меня постоянно ноющая боль в желудке.

7. Этот пациент жалуется на одышку во время ходьбы и пронзительную, острую боль в сердце.

8. Каждый раз, когда я чувствую себя уставшей, я страдаю от бессонницы.

Ex. 34 Answer the questions to the topic text 4.

1. What does the doctor do after taking the patient’s history?

2. What does the patient report to the doctor?

3. What must the doctor ask about?

4. What is a symptom?

5. What does the doctor find on examining the patient?

6. Does the patient present symptoms or signs?

7. What else must the doctor ask the patient about?

8. How should the doctor treat the patient while taking the full case history?

Ex. 35 Complete the sentences

1. After taking the patient’s _______ the doctor starts ________ him.

2. The patient reports his _________.

3. It’s important to describe the ____, ____, _____, _____, _____, _______ of the complaints.

4. The patient presents _____.

5. On examining the patient the doctor _______.

6. The doctor must know what ____ these symptoms, what ____ or ____ them.

7. The doctor also asks about the ____ and ____ symptoms.

Ex. 36 Use the correct preposition among the following

to of about from

1. When were last admitted ___ the hospital?

2. The pain didn’t radiate ___ the left shoulder.

3. What do you suffer ___ at the moment?

4. The doctor obtained all the data ___ the patient’s present state.

5. He had allergy ___ some tropical fruits and non-typical reaction ___ antibiotics.

6. The patient complained ___ a severe pain in the right lower part of the abdomen.

7. What does the procedure of taking the patient’s case history consist ___?

8. Dr. Smith asked ____ the location and duration ___ the pain.

9. They knew nothing about the origin ___ this disease.

10. Ms Martin reported her chief complaints ___ the doctor.

TOPIC

DEALING WITH THE PATIENT / TAKING THE MEDICAL HISTORY

When a patient is admitted to the hospital or seen by a doctor at the polyclinic for the first time his full case history is recorded by the nurse and the doctor. A full case history consists of the following:

· social or personal history

· family history

· past medical history

· presenting complaints.

Social history involves the data about the patient’s age, marital status, the number of children, his education, occupation, and the conditions in which he lives and works. It is essential to get the information about his lifestyle and his personal habits including recreation, physical exercise, alcohol and tobacco.

Obtaining a history of the patient’s members (a family history) is important for two reasons. Firstly, the patient may suffer from a genetically determined disease, for example, hypertension, diabetes or cancer. Secondly, the patient’s concerns about his presenting complaints may be related to the experience of other family members, for example, someone in the family had similar symptoms was diagnosed cancer.

Taking family history a doctor asks about any chronic illnesses of the immediate family, the circumstances surrounding the death of an immediate family member. Family history can sometimes be crucial and must be done sensitively.

The past medical history (PMH) is the information regarding the patient’s previous health before the presenting complaint. This involves: major acute and chronic illnesses, childhood illnesses (mumps, measles, chicken pox, etc.), immunization, surgical procedures, accidents and injuries, pregnancies (for women), allergies (including to food, medicines) and medication. A complete PMH is taken when the origin of the symptoms is unknown.

It is essential to obtain full details of all the drugs and medications taken by the patient. It is necessary to determine the name of the drug, the dose and the frequency of administration. The doctor must ask about drug allergies and drug reactions.

After taking the patient’s social, family and past medical histories the doctor starts interviewing or questioning him. The patient reports his presenting (chief) complaints. This description includes the location, intensity, degree, duration any radiation and frequency of these complaints. The problems which a patient reports to the doctor are called symptoms or complaints, for example pain or nausea. Signs or findings are what the doctor finds on examining the patient, for example high blood pressure or rapid pulse rate.

While interviewing the patient the doctor should determine what preceded the complaints, what exacerbated and alleviated them. He also should ask about any associated symptoms or similar symptoms. The doctor must be quite attentive, careful and accurate while taking the patient’s full case history.

Дата добавления: 2015-11-05