clinical dialogues

Clinical Dialogues

Part 1. Woman complained of tightness in abdomen associated with belching( 嗳气 ) wind which did not relieve feeling. Symptoms usually began between 5 and 6 p.m. lasting several hours. Relieved by white mixture.(D=Doctor, P=Patient)

D: Does the pain come on in the night?[come on: to startIf a cold, headache, or some other medical condition is coming on, it is just starting.e.g. I felt a cold coming on. 我觉得开始感冒了。 ]P: Not often.

D: When it comes on, do you get up?P: Yes, I get up and walk around and it relieves.

Pain

I have a headache. I have a splitting headache. （我头痛得像要裂开了。）I have a stomach-ache.I feel a dull pain in the stomach.I seem to have pain all over. （我似乎浑身都痛。）I’m aching all over. （我浑身都痛。）

It’s a dull sort of pain, and I don’t know what’s causing it.It’s not a sharp pain; just sort of a dull ache.It all began yesterday.It started two days ago.It came on last night.It hurts terrible. （痛得很厉害。）

It’s been hanging about for nearly a week. （这已经持续了将近一个星期了。）It keeps hanging on. （这老是不好。）It sort of hung on. （这似乎不见好。）Or: Just off and on. （就是时断时续。）I’ve got a pain in my back. （背疼）

My eyes have been sore. （眼睛发痛）My left foot hurts. My tooth is aching up again. I feel shivery and I’ve got a sore throat. （我觉得怕冷发抖，而且喉咙疼痛。）The pain’s been keeping me awake.

D: Does anything but the white mixture help it?P: I’ve been on a strict diet for six months. I never touch milk.

on a diet: If you are on a diet, you are eating special kinds of food because you want to lose weight. （为减肥）节食touch: If you do not touch a particular kind of food or drink, you never eat it or drink it. 吃；喝e.g. Drink?No, she never touches the stuff. 喝酒？不，他从不喝这种东西。

D: Does any position help you?P: No, It comes on after tea, about five. I have my main meal midday.D: Have you been sick? （你呕吐过吗？）(=Any vomiting?)P: Only at the beginning I was very sick then.

A sick person has an illness or some other problem with their health.To be sick means to bring up food through your mouth from your stomach.e.g. I think I’m going to be sick.

Note that “George is being sick” means “George is bringing up food from his stomach”; “George is sick” means “George is ill”. However, “George was sick” can mean either “George brought up food from his stomach” or “George was ill”.

Vomit has the same meaning as “be sick”. Vomit is a fairly formal word.e.g. She was stricken with( 被 ... 折磨 ) pain and began to vomit.Throw up: In conversation, some people say throw up instead of “be sick”.e.g. I think I’m going to throw up.I’ve been throwing up. 我一直呕吐。

D: Do you feel sick? （恶心吗？）(= Have you got any feeling of nausea?)(=Are you feeling nausea?)

P: Yes, I feel sick but I can’t be sick. （我经常恶心，但不再呕吐。）Feel sick: To feel sick means to feel that you want to be sick.e.g. Flying always makes me feel sick.

Note:ILL and sick are both used to say that that someone has a disease or some other problem with their health.e.g. Davis is ill.Your uncle is very sick.A sick child …

Most British speakers do not use ill in front of a noun unless they are also using an adverb( 副词 ). For example, they do not talk about “an ill woman”, but they might talk about “a seriously ill woman”.… a terminally ill patient.

American and Scottish speakers sometimes use ill in front of a noun without using an adverb.We had to get medical help for our ill sisters.

D: Does the pain go through to the back?P: No, but it goes under my armpits. （腋下）D: What’s your weight been doing? （你的体重最近怎样？）(=Have you lost weight recently?)P: I’ve lost one and half stone but I’ve been on a fat-free diet for six months.(or: My weight fell from 65kg. to 50 kg.)

Stone: a unit of weight in Great Britain, 14 pounds (6.4 kilograms) 英石 [ 英国重量单位，等于 14磅 (6.4 公斤） ]

D: What’s your appetite like?（你的胃口怎样？）(=How about your appetite?)(=Do you have any appetite?)

What’s (your)/(the) … ? / What seems to be the …?What’s your appetite like?

What’s your complaint? ( 你有什么不舒服？ )=What’s your trouble?=What’s the trouble?=What’s bothering you?=What seems to be bothering you?

=What do you complain of?=What’s the matter with you?=What seems to be the matter?=What’s wrong with you?=What hurts you?=What seems to be the problem?=What seems to be the trouble?

P: Poor as ever.(=I’ve got a bad appetite.)D: What about your bowels? （大便如何？）(=Are your bowels acting properly?)(=Are your bowels regular?)P: I go twice a day, in the morning.

D: Is this a life-long habit?P: Yes.D: What do the motions look like? Well-formed, firm? （大便什么形状？成形，坚实吗？）P: Yes.D: What about the color? Has it changed?P: No.

D: Are they dark?P: Yes.D: Any sign of blood?P: No.D: Do they float on the water when you flush the lavatory? （你冲洗厕所时，它漂浮在水面上吗？）P: No.

D: Have you noticed an unpleasant smell?P: No.D: Have you noticed any difference in your water? （你排尿有无异常？）P: No.D: Do you have to get up in the night? （你夜间起来上厕所吗？）P: Once.

D: Your water hasn’t been darker?P: No. D: Do you smoke?P: 10 a day.D: Do you drink?P: Not much.

D: Have you any other trouble?P: No, my angina’s been very good. （我的心绞痛已经好了。） I’ve not had much trouble with that for two years. （这两年没大犯过。）-- Or:I feel absolutely rotten. （我觉得身体很不舒服、非常虚弱。）[If you feel or look rotten, you feel or look ill]

I feel a bit off color. （我觉得有点不舒服。）[Here, color means reddish-pink color in one’s face that shows that one’s health is good. 面色；血色 ]I feel so ill.I feel rather unwell.I feel very bad.

I really feel terrible.I think I’m dying. （我难受极了。）I’m feeling rather out of sorts these days. （这些天我觉得身体很不舒服。）[If you feel out of sorts, you feel slightly unwell, discontented, or annoyed. 身体不适；心情不佳；烦恼 ]

I’m under the weather. （我不舒服。）[If you say that you are under the weather, you mean that you feel slightly ill.]My whole body feels weak.I just feel all pooped out. （我只觉得精疲力竭。）[be pooped out: to be very tired; used mainly in informal American English.]

D: You’ve also had trouble with your leg?P: Yes, they thought it was thrombosis ( 血栓 ).D: When did you first start with your tummy trouble? （第一次胃病是什么时候发作的？）Tummy: the human stomach or belly 肚子，胃P: About 14 years ago.

D: The same, but more bothersome now? （现在是否更厉害 ? ）P: Yes, it’s tighter. （病情更重了。）Warning: 1) You do not say that someone becomes “iller” or “more ill”. You say that they become worse.2) You do not use ill or sick to say that someone has received an injury. You say that they are injured or hurt.

D: Have you ever been jaundiced? （得过黄疸吗？）P: No.D: Is your tummy swollen when you feel like this? （犯病时肚胀吗？）P: It feels as though I’m going to burst. （我觉得肚子快要爆炸了。）

D: Well, I’d like to have a look at you. （检查一下） Will you get undressed and lie on the couch please? （请脱去衣服，躺在检查床上。）Or:Lie down on the couch there. Let me just see.Lie down on the couch there. Let me examine your belly.

Would you mind taking off all your clothes except your pants (for men)/except your pants and bra 奶罩 (for women)? Lie on the couch and cover yourself with the blanket.Well, let’s see.Now slip off your coat and shirt, please.Strip to your waist, please. 把上身衣服脱掉

Roll your sleeve up.Slip your shoes off and hop up on the bed.Slip off your shoes and socks.Let me check your lungs and heart.Let me listen to your lungs and heart.

Let me examine your stomach.Let me sound your lungs. ( 叩诊 )Unbutton your shirt and let me listen to your lungs.Open your mouth and say “Ah”.Open your mouth please, and show me your tongue.

Put this thermometer( 体温计 ) under your tongue.I’ll have your temperature taken.Well, I’d better take your blood pressure.May I take your blood pressure?Let me take your blood pressure.

Clinical Examination

During the examination the doctor asked the following questions:

D: Do you suffer from heartburn?P: No.D: Have you had any children?P: No.D: Are your hands always cold and red?P: Yes. A lovely color in the winter! （冬天简直红得可爱！）

D: Just hold your breath for a moment. Breathe through your mouth. Show me where you get this pain. Your age?P: 72.D: Your periods finished when? （你什么时候停经的。）P: When I was about 52 or 3.

D: Any tenderness here?P: It’s a bit sore but not a lot. D: Does it catch you at all when you breathe? （你每次呼吸都觉得痛吗？）P: No.

D: Have you any pains in your legs?(=Do you have any pains in your legs?)P: I get cramp （抽筋） a bit when I’m in bed.D: More in one leg than the other?P: I get it in my right leg; that’s my varicose （静脉曲张） leg.

D: Apart from this, you’ve had no other serious illness in the last 14 years?P: No.D: I’m going to take a drop of your blood and I’d like you to have a stomach X-ray. You’ll have to come specially, don’t eat anything before and drink a white paste which outlines your stomach and we’ll take some pictures.

Or:I think we’d better give you a few tests.A blood test is necessary.Take your blood count first, please.You’re to have a blood test.

I’m going to take a throat culture so we’ll know for sure.You must have an electrocardiograph examination.Well, let’s take an X-ray of your chest.Go and have your chest X-rayed.

BOWELS 大便Medical words: faeces, stools, to defaecateColloquial words: motion, to have the bowels opened

Useful questions♥ How often do you have your bowels opened?♥ Is this a life-long habit?♥ What do the motions look like?♥ Are they quite well formed?♥ What about the color? Has it changed?

♥ Are they darker in color ？♥ Have you ever seen any blood in your motions?♥ Have you noticed an unpleasant smell?♥ Do you ever have diarrhea( 腹泻 ) or constipation ( 便秘 )?♥ Do you have to go in a hurry? （上厕所）♥ Can you hold your motions? （控制排便）

♥ Do you have to strain(用力 ) to pass your motions? (tenesmus) （里急后重 , 下坠）♥ Do you take laxatives(轻泻剂 )?♥ Do the motions float on the water after flushing the lavatory?♥ Do you ever have any pain on passing your motions?

♥ Do you get pain before, during or after passing your motions?♥ Do you suffer from wind?♥ Have you noticed any special food upsets your bowels?♥ Have you lost any weight?

Descriptive wordsColor: black, brown, clay-like, colorless-like rice-water (cholera霍乱 ), dark brown, green, grey, pale, pea-soup-like, putty-like(油灰样 ), porridge-like)(麦片粥样 )(steatorrhoea脂肪痢 ), jelly-like, tarry(柏油样 ), white, yellow, etc.

Form and consistency(稠度 ): bloody, bulky, dry, fatty, floating, friable, frequent, frothy(泡沫样的 ), greasy(油脂过多的 ), hard, hard dry balls, loose, purulent(脓性的 ), slimy(粘液的 ), soft, watery, well-formed, worms, etc.

Amount: copious, scantyOdor: offensive (very bad)

Useful ExpressionsGreeting♣ “Good morning, Mrs. Rayner, come and sit down.”Asking patients to describe their symptoms♣ “Well now, how can I help you?”♣ “Well, Mrs. Rayner, what’s the trouble?”♣ “Your doctor says you’ve been having trouble with your back. Tell me about it.”

Collecting casesMentioned above.Directing patients how to undress ♣ “Would you mind taking off all your clothes except your pants (for men)/except your pants and bra (for women)? Lie on the couch and cover yourself with the blanket.”♣ “Slip off your shoes and socks.”♣ “Roll your sleeve up.”

Directing patients how to assume appropriate positions ♣ “Please lie on your tummy.”♣ “Please turn over and lie on your back.”♣ “Roll over onto your left side.”♣ “Bend your knees.”

♣ “Sit up.”♣ “Lean forward.”♣ “Get off the couch and stand up.”♣ “Walk across the room.”

painful: 1) You say that something is painful when it makes you feel pain.e.g. a long and painful illness2) If a part of your body is painful, it hurts.e.g. My back is so painful that I can not stand upright.

3) When someone feels pain, you do not say that they are “painful”. You say that they are in pain. e.g. He was in pain and could not move into a comfortable position.

Part 2.

D: I see you have had several attacks of influenza(流行性感冒 ). Anything else?P: I’ve had dizziness( 头晕目眩 ) and I’ve been sick. If you feel dizzy, you feel that you are losing your balance and are about to fall.To be sick means to bring up food through your mouth from your stomach.

D: When did this start?P: Two months ago.D: How often are the attacks?P: Nearly every day.

D: How long do they last?P: Some last all day, some a couple of hours.“A couple of things or quantities” means approximately two things or quantities. You use this informal expression when you are not sure of the exact number of things or quantities you are referring to and the number is not important.

D: Does anything bring on these attacks?bring on: to cause to occur 引起（疾病、痛苦、发作等）You can use the structure “Something brings on an illness, pain, or attack”.P: No.

D: Will you describe one of these attacks?P: It starts with a headache — a throbbing(跳动 ) headache. My eyes start running. I can’t touch them, they are so sore( 疼痛的 ). And then the whole house goes round. Then it goes dark.

D: Do you see flashing lights(闪光 )?P: No.D: When you say you go dizzy, what do you mean?P: I feel I’ll fall over and the room spins(旋转 ) round. If I go to bed, the bed goes round.

fall over: If you fall over from an upright or standing position, you become unbalanced and fall to the ground, lying lengthways(纵向地 ) or in a heap. 跌倒；摔倒

D: When you move, do you stagger?stagger: to move or stand unsteadily, as if you about to fall 蹒跚；摇晃P: I’m too scared to move. （吓得一点都不敢动）If you are scared, you are very frightened of someone or something, and therefore unable to behave calmly. 吃惊的；吓坏了的

D: Have you noticed anything else?P: I cough a lot.D: Do you bring anything up? （有没有呕吐 vomit/痰 sputum ？）When you bring up food, you vomit; an informal use.P: No.

D: Is your hearing affected? Do you have buzzing(嗡嗡声 ) or ringing noises?P: Yes.D: In both ears?P: Yes.

D: When you go to bed, do you sleep?P: I just lie and it goes off within a few hours.If you go off, you fall asleep; an informal use. 入睡e.g. He went off as soon as his head touched the pillow.

D: Have you ever woken up like this?wake up: When you wake up or something wakes you up, you become conscious again after being asleep. 醒来；唤醒

You can use “like this” or “like that” when you are drawing attention to something that you are doing or that someone else is doing. 像这样（引起对正做之事的注意）e.g. Sorry to break in on you like this(原谅我这样打扰您 ), Dr. Mark.

P: No. It is always in the day.D: Does movement of the head cause it?P: No.D: If you suddenly get up out of a chair does it start?P: No.

D: How long have you been diabetic(糖尿病 )?P: Four years.D: Any other serious illness?P: I had my gall bladder(胆囊 ) removed.

“have sth. done” patternGo and have your chest X-rayed.You must have your tooth extracted.You must have your appendix (阑尾 ) removed.You’ll have to have your decayed tooth pulled out.

D: Anything else?P: I had VD[ 性病 (venereal disease)] nine years ago. I was in hospital for three weeks and had a course of injections(注射 ).

Clinical Examination

D: Take a deep breath in and hold your breath. Close your eyes gently. Not too tight. Look up to the ceiling( 天花板 ). Hold your arms out. Are your bowels ( 大便 ) all right?P: Yes.

D: No trouble with your water( 排尿 )?P: No.D: Your periods(绝经 ) finished some years ago?P: Yes. Four years ago.

D: Well, there doesn’t seem anything seriously wrong with you. I’d like you to have some X-rays through and a blood test.

Diagnosing and treating

By the look of it, it should be a rash. 从表面看，这应该是皮疹。By the sound of it, it’s bronchitis(支气管炎 ).It looks like measles. 看上去像麻疹。It looks as if it’s SLE. 看起来这似乎是红斑狼疮。

It sounds like bronchitis. 听起来像支气管炎。It sounds as if you’ve caught cold. 听上去你似乎得了感冒。I should say you’ve caught cold. 感冒I should think you’ve got the flu. 流行性感冒

You probably have contracted the flu. 你大概得了流行性感冒。You seem to have picked up some kind of infection. 你似乎已受了某种感染。It could be a case of TB. 可能是肺结核病。It’s inflammation of the skin.

You’re suffering a heart disease, I’m afraid.You’re running a temperature.你在发烧。You’ve got a drop of fever. 你稍许有点热度。I don’t think it’s anything serious. 我看这并不严重。It’s not so serious as it seems. 这并不像表面显示的那么严重。

There’s nothing to be alarmed about. 没什么可大惊小怪的。Nothing serious. 没什么大问题。Your case is not very serious.You’ve got the flu, but not very serious.

It’s nothing serious, but you’d better stay in bed.It’s nothing but a little infection in the finger tip. 这只不过是指尖有点感染。You’ll be all right soon. 你不久就会康复的。=You’ll get over it soon.

I think you need a shot to deaden the pain first. 我看你先需要打一针止痛。If your recovery goes on like this, you can leave in three days.如果你的康复情况像这样继续下去，过三天你就可以出院了。I’ll give you an injection first. 我先来给你打一针。

I’ll have to give you a shot, I’m afraid. 恐怕我先得给你注射一针。I’m afraid an urgent operation is necessary. 恐怕要立即动手术。I’m afraid you’ll have to be operated on for appendicitis. 恐怕你得手术治疗阑尾炎。

Giving prescription and advice

♥ Here’s prescription for you. Please take the medicine according to the instruction. 这是你的药方。请按指示服药。♥ Here’s a prescription. Have someone to get it filled. 这是药方。请人把药给你配来。

♥ Here’s a prescription. I’d like you to take one of these pills three times a day. 这是药方。你把这些药片每日服三次，每次一片。♥ Drink this mixture four times a day, one measure each time. 这合剂每天服四次，每次一格。

♥ One tablet each time, three times a day after meal. 每日三次，每次一片，饭后服。♥ Take a dose three times a day. 每日服三次，每次服一剂。♥ Take one capsule every four hours. 每四小时服一胶囊。

♥ Take ten c.c. each time, three times a day. 每日三次，每次 10c.c. 。♥ Put a plaster on the sore once a day. 把这药膏每日一次敷贴患处。♥ If your fever lingers( 继续存留 ), come to me again.♥ Come back and see me in two weeks if you’re not feeling better.

THANKS!