A Dialogue in the Hospital

1
A Dialogue in the Hospital
Clinical Dialogue Three

• Jay Zhuang
• General Surgical Department
• Ren Ji Hospital

2
Sentences Commonly Used by Medical Personnel

• What can I do for you?
• May I help you?
• Please take a seat!
• Wait a moment, please.
• Sorry to have kept you waiting.
• It is not serious.
• Dont worry. / There is nothing to worry about.
• You need a thorough examination.

3
Sentences Commonly Used by Medical Personnel

• You will have to stay in hospital for several
  days. / We think that you had better be
  hospitalized.
• You should stay in bed for a few days.
• You can keep on working. / You can carry on with
  your work.
• You should be very careful for a week or two.
• Try to relax and keep calm.

4
Sentences Commonly Used by Medical Personnel

• Youll soon be all right.
• Im sure this medicine will help you a great
  deal.
• Feeling well again is a rather slow process, Im
  afraid.
• You will have to wait for twenty minutes.
• Complete recovery will take a rather long time.

5
Sentences Commonly Used by Medical Personnel

• If you feel worse, please come back to the clinic
  right away.
• If you feel worried, dont hesitate to go to the
  clinic anytime, day or night.
• Ill come right away.
• Im going to make arrangements for your admission

6
Sentences Commonly Used by Medical Personnel

• Please come with your interpreter next time.
• Do you understand what Im saying?
• Is there anything else you would like me to
  explain to you?
• Shall I explain it again?

7
Sentences Commonly Used by Medical Personnel

• If the trouble persists, come back again.
• There doesnt seem to be anything serious, but
  well take an x-ray just to be certain.
• Please wait until we get the result of the x-ray
  (blood-test).

8
Sentences Commonly Used by Medical Personnel

• Its difficult to say just now exactly whats
  wrong.
• This is quite common among people of your age. /
  This often happens to people of your age. / This
  often occurs at your age.
• This kind of illness usually occurs among people
  whose work requires a lot of concentration (who
  undergo a lot of stress).

9
Sentences Commonly Used by Medical Personnel

• I suggest you do some light exercises.
• I suggest you have a course of acupuncture.
• I suggest you take Chinese herbs.
• I suggest that you get physiotherapy treatment.
• I would like to transfer you to the gynecology
  (surgery,dermatology, urology) department.

10
Sentences Commonly Used by Medical Personnel

• Your WBC (RBC, hemoglobin, urine, stool, sputum)
  should be checked.
• A smear should be taken. A culture should be
  done.
• Please dont eat anything tomorrow morning before
  blood test.
• Please wait for the result of your hemoglobin
  test.

11
Sentences Commonly Used by Medical Personnel

• Whats your trouble?
• How long have your been feeling unwell?
• What medicine did you take?
• Have you taken any medicine?
• Did you take your temperature?

12
Sentences Commonly Used by Medical Personnel

• Do you smoke (drink)?
• Have you any temperature (a cough, a bad
  headache)?
• Have you ever had jaundice (low grade fever, any
  chronic ailments, cold sweats at night, attacks
  of asthma)?

13
Sentences Commonly Used by Medical Personnel

• Do you suffer from heartburn stomachaches (loose
  bowel movements, chest pains)?
• Do you want to have your tooth extracted (tooth
  filled, dressing changed, blood pressure
  checked)?
• Let me examine you please.

14
Sentences Commonly Used by Medical Personnel

• Please take off your shoes and lie down.
• Please unbutton your shirt and loosen your belt.
• Please take off your trousers.
• Please lie on your back (stomach, right side,
  left side).
• Please bend your knees.

15
Sentences Commonly Used by Medical Personnel

• Please relax.
• Please breathe deeply (normally).
• Please stick out your tongue.
• Please let me feel your pulse.
• Let me take your blood pressure.
• Please lift your left leg (right leg).

16
Sentences Commonly Used by Medical Personnel

• Please open your mouth and say Ah.
• It is normal (essentially normal).
• Have you ever received any treatment before?
• Has it gotten worse?
• Has it happened before?

17
Sentences Commonly Used by Medical Personnel

• Are you feeling better?
• Is the pain getting less?
• Does it still hurt?
• How long have you had this pain?
• What kind of pain is it?
• Please tell me something of your past illnesses.
• Is there any blood in your stool (urine, sputum)?

18
Admission and Discharge

• Doctor We are going to do the operation on you
  tomorrow. I hope you dont worry.
• Patient I will try not to, but will it hurt?
• DWell give you anesthesia. If you feel any pain
  during the operation, just let us know. Have you
  handed in your consent yet?

19
Admission and Discharge

• P How should I write it?
• D I (name) the undersigned have requested and
  consented to a certain operation. Thats all. We
  need the seal of your embassy and the signature
  of your Ambassador on the consent form.

20
Admission and Discharge

• Nurse Id like to shave off the hair around the
  operation area.
• P I have never been in a hospital before. Im so
  scared.

21
Admission and Discharge

• N There is nothing to worry about. The doctor
  who will operate on you is very experienced and
  considerate. If you have any discomfort during
  the operation, please dont hesitate to tell him.
  
• I will give you an enema tonight. After that
  please dont take any food or water before the
  operation.

22
Admission and Discharge

• P How do you do it? Does it hurt?
• N I will insert a rubber tube into your anus and
  let the soap suds solution flow into your rectum.
  Please let me know if you feel distension. Ill
  stop the flowing. Hold it for several minutes
  before you expel it. That may produce a better
  result.

23
Admission and Discharge

• N The operation went very well. Please turn from
  side to side every two or three hours.
• P I only feel a mild pain. I dont think a
  pain-killer is necessary.
• The pain is very severe. I cant stand it.
  Please give me a pain-killer at once.

24
Admission and Discharge

• N Ill help you get up. You can try walking
  around the room or corridor.
• P I think Im quite all right now.
• N You are going to be discharged the day after
  tomorrow.
• P Is that so? Im so happy.
• N You have been in the hospital for two weeks,
  Havent you?
• P Exactly, but the doctor told me I still have
  to rest for one more week.

25
Admission and Discharge

• N The doctor has written a certificate for you.
  There are two suggestions. First, avoid any
  mental stress and have a good rest. Secondly,
  examinations fasting sugar and an EKG should be
  done regularly.
• P My organization (doctor) needs my medical
  history. May I have it tomorrow?
• N Certainly.

26
Open Injury

• Doctor How were you injured?
• Patient I tripped and fell, banging my forehead
  quite hard. My wife wrapped a bandage around it
  to stop the bleeding.
• D Did you lose a lot of blood?
• P Not too much.
• D Were you unconscious?
• P No.

27
Open Injury

• D Did your nose or ears bleed after the
  accident?
• P No.
• D The wound is rather large, so Ill stitch it
  up.
• P Will it hurt?
• D Oh, no. It wont be painful. Well give you a
  local anesthetic. Youre a brave fellow. Well,
  were all finished. That wasnt so bad, was it?

28
Open Injury

• P No, not very.
• D Have you had an anti-tetanus injection lately?
• P I think the only one I have had was about five
  years ago.
• D Well, I think youd better have another one.
• P Whatever you say, Doctor.
• D Come again after three days and well examine
  the wound.

29
Fracture

• D Hello, Im an orthopedic surgeon. What
  happened to your leg?
• P I fell down the stairs. Immediately, I felt a
  bad pain in my left hip and I couldnt stand at
  all.
• D When did it happen?
• P Two hours ago.
• D Have you taken any pain-killers?
• P No, I came directly here.

30
Fracture

• D Please lie on the bed, loosen your belt. Point
  to the spot where you feel the most pain.
• P Its here, Doctor, around the left hip.
• D Im afraid your femur is broken. Wed better
  x-ray it, just to be sure. Take this paper to the
  office the nurse will show you the x-ray
  department.
• The x-ray shows a fracture of your left femur.

31
Fracture

• P Doctor, will it heal properly?
• D Of course, it will, dont worry. I think you
  should be admitted to hospital. You need an
  operation to fix it.
• P I have hurt my right elbow. I cant move it
  because of the pain.
• D How did it happen?
• P When I was getting into the bus, I fell on my
  elbow. That happened this morning.

32
Fracture

• D Is it still painful?
• P Yes. Since the accident it has been stiff and
  looks black and blue. At times it feels numb.
• D Can you feel this, when I put it in your hand?
• P Yes.

33
Fracture

• D Im afraid you may have broken your elbow,
  Ill send you to the x-ray department to check.
• The x-ray reveals a fracture of the lower
  humerus. Well give you a U type plaster cast
  on your elbow and shoulder.
• P How long will I have to have it?

34
Fracture

• D About six weeks.
• P Is there anything else I should do?
• D Youd better rest in bed and keep your elbow
  higher than your heart. Move your finger joints
  from time to time. Keep an eye on the color of
  the fingers. If you have pain and numbness or if
  the color of the fingers turns pale or dark, come
  right away.

35
???

• ????,??????????.
• Patient Doctor, I suddenly felt a pain in the
  right upper side of my stomach.
• ??????????
• Doctor When did it first start?
• ????????.
• P About three days ago.

36
???

• ????????????
• D Does the pain move anywhere else?
• ????,?????.
• P Yes, it goes towards my right shoulder.
• ????????????
• D What kind of pain is it?
• ??????,???????????.
• P Its colic at first, but soon it became
  constant.

37
???

• ??????????
• D Have you had any chill or temperature?????????
  ?.
• P I feel as though I have a temperature.
• ????????????
• D Which came first, the temperature or the pain?
• ?????.
• P The pain.

38
???

• ????????
• D How is your appetite?
• ???????????.
• P When I look at food, I feel sick.
• ??????????
• D Have you vomited in the past three days?
• ????,????10?15?.?????
• P Yes, about 10 to 15 times. I always felt pain.

39
???

• ???????
• D Have you vomited blood?
• ????,???????????.
• P No. Just a kind of whitish, thick stuff.
• ?????????????????
• D Did you feel full after eating heavy or
  greasy food?
• ????,?????????????.????????.??????????.?????????
• P Yes, I went to two parties in succession three
  days ago. I felt bloated. Heavy eating seems to
  bring on the pain. Could this be the reason for
  it?

40
???

• ??????????????. ????????????
• D overeating or drinking too much can cause
  these symptoms. Have your skin and eyeballs
  turned yellow?
• ????.
• P No.
• ??????????????
• D Have your stools been light in color?
• ????,??????????????.
• P Yes, I found my stool was a sandy color
  yesterday.

41
???

• ?????????
• D Has your urine been dark?
• ????,????.
• P Yes, just like tea.
• ??????????.???.??.???.?.?????????.??????X???????.
  
• D Let me examine you. Please lie down. Relax.
  Take a deep breath. Fine. You may have
  gallstones. Well do an x-ray to see if thats
  so.

42
???

• ?????????
• P Would an operation be necessary?
• ???????X?????????,???????.???????????.
• D I cant say until Ive seen the x-rays and
  done some tests. Youd better come into hospital
  for a few days of observation.

43
Coma, Extradural Hemorrhage

• Women Doctor, my husband tripped and fell,
  hitting his head quite hard. He has a headache,
  so I thought Id better bring him in and see
  whats wrong with him.
• Doctor When did it happen?
• W This morning. About two hours ago.
• D Does he have high blood pressure or diabetes?
• W No.

44
Coma, Extradural Hemorrhage

• D Did he lose consciousness after the injury?
• W Yes, he did. He blacked out for about half an
  hour. Then he regained consciousness.
• D (asking the patient) Do you remember how you
  were injured?
• P Oh, oh. (patient vomits)
• D Well, he is unconscious again now. Has he been
  vomiting all the time before coming to hospital?
• W Yes.

45
Coma, Extradural Hemorrhage

• D Now, let me have a look at him. The pupil on
  the right is dilated and does not react to light.
  Theres no reaction to pain in the left
  extremities. Im afraid your husband has torn a
  blood vessel when he hit his head, and the blood
  is compressing his brain, causing his present
  condition. Ill talk over his problem with the
  neurosurgeon and decide what to do.
• W Thank you, Doctor. Im so worried. Do you
  think my husband will live?

46
Coma, Extradural Hemorrhage

• D Dont worry. Well do everything we can to
  save him.
• Ive just finished talking to the neurosurgeon.
  Your husband is in a coma due to extradural
  hemorrhage. In order to save him, we think we
  should operate on him. (In order to be more
  certain what has happened to him, a lumbar
  puncture is necessary). We need your permission
  to do this.
• W Anything you say, Doctor, as long as he gets
  well.

47
Coma, Extradural Hemorrhage

• D Well, the operation has certain risks with the
  anesthetic and your husband may not be able to
  stand the operation. Post-operative complications
  could also occur. But well do all we can for
  him.
• W Yes, I understand. Please help him. I agree to
  the operation.
• D Well. Could you sign this paper to give your
  consent for the operation? I think everything
  will be all right.

48
Coma, Extradural Hemorrhage

• W Shall I stay here?
• D If you want to, you can wait, and Ill let you
  know the result of the surgery. (Please wait in
  the sitting room. Ill keep you informed of what
  is going on).

49
Intestinal Obstruction

• Patient Doctor, Ive had abdominal pains and
  vomiting for the past three days.
• Doctor What kind of a pain is it?
• P Like colic, with spasms every 4 or 5 minutes.
• D When did the vomiting first start?
• P Two days ago. Ive had about five bouts of
  nausea and vomiting up to now.

50
Intestinal Obstruction

• D How about your bowel movement?
• P Nothing for two days.
• D Any wind?
• P No, not since last night.
• D Have you ever had any abdominal surgery?
• P I had my appendix out, but that was a long
  time ago.

51
Intestinal Obstruction

• D Have you had anything like this before?
• P No, its the first time.
• D Now, please lie on your back, bend your knees
  and relax. Let me examine you. Im afraid you
  have an intestinal obstruction. Well do some
  x-rays to confirm this.
• P Will an operation be necessary?

52
Intestinal Obstruction

• D Since you have a fever and some muscle rigidly
  in the abdomen, there is the possibility of
  intestinal strangulation. Immediate surgery is
  necessary.
• P Is there any danger?
• D No, dont worry, just leave everything to us.
  Everything will be all right.

53
Hemorrhoids (Piles)

• Patient I bleed quite a bit when I have a bowel
  movement. Im really worried about it.
• Doctor What color is the blood?
• P Its bright red.
• D Is it mixed with the stool?
• P No, it isnt.
• D Do you have constipation often?
• P Yes, all the time.

54
Hemorrhoids (Piles)

• D Have these been any change in the pattern of
  your feces?
• P No.
• D Now, lets have a look at you. Please undress
  and lie in the knee-elbow position. Im going to
  examine you with an analscope. Youve got
  hemorrhoids and a prolapse of the rectal mucosa.
• P Is there any way to cure it? If possible, Id
  rather not have an operation.

55
Hemorrhoids (Piles)

• D Dont worry. Heres a prescription. Use the
  suppositories and laxative. The bleeding should
  stop in two or three days.
• P Anything else I should do?
• D Eat more fruit or vegetables. Sit in warm
  water when you feel pain and if possible, avoid
  alcohol and spicy food.
• P Thank you. Ill follow your advice.

56
Tumor of the Breast

• Doctor Is there anything worrying you?
• Patient Yes, I have a lump (mass) in my left
  breast.
• D How long have you felt it?
• P About three weeks.
• D Have you had any pain in this area, especially
  during menstruation?
• P No.

57
Tumor of the Breast

• D Have you had any accident to this area?
• P No.
• D Have you had any discharge from it or any
  itching of the nipple?
• P No.
• D Have you noticed any swelling under your left
  armpit?
• P No.

58
Tumor of the Breast

• D Has anyone in your family ever had a lump or
  tumor of the breast?
• P No, not that I can remember.
• D Do you mind if I examine you briefly?
• P No, not at all.
• D Would you please take off your blouse. Thats
  fine. Sit up straight. Now rest your arm on mine.
  Let me examine your armpit. Put your right arm
  over your head. Now lets do the same with the
  left. Good. Thats all. How old are you?

59
Tumor of the Breast

• P Im fifty. Is serious?
• D No. Nothing serious. Just a cystic disease of
  the breast (Adenofibroma). Its a benign
  hormone-dependent disease.
• Do you have any relatives here?
• P Yes. My husband is just outside, shall I ask
  him to come in?
• D Yes. Will you please go to the laboratory to
  check up a white blood cell count?

60
Tumor of the Breast

• Doctor to patients husband
• As you know, your wife has a lump in her left
  breast. I think it could be a carcinoma of the
  breast. The only way to be certain is to do a
  biopsy. If she has cancer, she ought to have her
  breast removed. Thats called a radical
  mastectomy.
• Husband Please do everything you can to help
  her, Doctor.

61
???

• ??????????.?????.
• Patient Ive got an awful pain in my stomach. I
  feel like vomiting.
• ??????????
• Doctor How long have you had it?
• ?????????,????????,????????????.
• P Since last night, it was in the middle at
  first around my belly. But this morning it moved
  to the right.

62
???

• ?????????
• D Has it moved again?
• ?????????????.
• P No. Its been steady for 4 hours.
• ???????????
• D Is it there all the time?
• ???,?????,???.
• P No, it just comes and goes.

63
???

• ???????
• D Have you had any diarrhea?
• ????,??????????.
• P No, I havent had a bowel movement for two
  days.
• ??????????
• D Have you had any nausea and vomiting?
• ????????.?????????2?????,????.
• P Well, now its a bit better. But last night I
  vomited every two hours, soon after the pain
  began.

64
???

• ????????
• D Have you had a temperature?
• ????????380C.
• P Last night I took my temperature. It was 38oC.
• ????????????.
• D Show me where it hurts most right now?
• ??????.
• P Just here.

65
???

• ?????.??????????.??????????????????????????????.?
  ?????.
• D Please lie down. Let me examine your abdomen.
  Do you feel any pain when I press here? Does it
  hurt you when I withdraw my hand suddenly? I
  think that you have appendicitis. You must have
  an operation
• ??????
• P Is it serious?
• ????????,?????.
• D It could be if we dont operate.

66
???

• ????,???.
• P All right, I agree.
• ???????????,????????????????!
• D We must have your consent. Please sign this
  paper consenting to have the operation.
• ????.
• P All right.

67
???

• ??????,????????.
• D Dont worry, everything will be OK.
• ???????,??.
• P I hope so, Doctor.