Oxford English for Careers : Medicine 1, Teacher's Resource Book, Volume 1 ( PDFDrive )

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OX.FORD ACKNOWLEDGE MENTS lJNIVERSITY PRESS Theauthorandpublishear regratefultothosewhohavegivenpemissiontortproduce the Jol,lc^ringextractosnd adaptattotrsofcoryishttnoteri^l: p20 Excerpt frompp767 Great Clarendon Street,Oxford ox2 5DP fromoxfordHandbookoJC:linicalMedici7nteh Edition, edited by Longmore et al (2007).Reproducedby permission ofOxford University Press;p43 Excerpts Oxford University Pressis a department ofthe University ofOxford. fiom pp159 from OxfordHandbookofilinicalSpelialitie7sth Edition, edited by It furthers the University's objective ofexcellence in research,scholanhip, Collier et al (2006).Reproducedby permissio/ ofOxford University Press: and education by publishing worldwide in p101 Excerptsfrom pp28 from OxfordHandb(okofPsychiatreyd, ited by Semple et al (2005).Reproducedby permission ofO:fford University Press. Oxford New York Soilrcesp:20, 27, and 3o OxfordHandbookof ClilicolMedianeTthEdition (2007); Auckland CapeTown Dar es Salaam Hong Kong Karachi p28 OxfordHandbookfotrheFoundationProgratmeznd Edition (20081;p45Oxford Kuala Lumpur Madrid Melbourne Mexico City Nairobi HandbookoJGennalkaaice Znd Edition (2006). NewDelhi Shanghai Taipei Toronto Althoughewry efrorthasbeenmodeto troceand conna coffight holdersbefore with offices in publication,thishosnot beenpossiblein somecase.sWeapologinfor onyapparent inftngemnt of copyight and if notifed,the publisherwillbepleasedtorectifyany Argentina Austria Brazil Chile Czech Republic France Greece errorsor omissioflsot theearliestoryortunity. Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Oxford University Pressmakes no representation,expressor imPlied, that the drug dosagesin this book are correct. Readersmust therefore always oxFoRDand oxrono ENGLIsHareregisteredtrademarks of check the product information and clinical procedureswith the most up Oxford University Pressin the LK and in certain other countries to date published product information and data sheetsprovided by the manufacturers and the most recent codesofconduct and safetyregulations. @Oxford University Press2oo9 The authors and publishers do not acceptresponsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. The moral rights ofthe author havebeen asserted Databaseright Oxford University Press(maker) Wewould alsoliketo thankthefollowingfor permissiontoreproducethefollowing plnttgrapls: Namy pp103 (man in wheelchair/Asiaselects),105(HeleneRogers); First published zoog Corbis p103 (woman in wheelchairflH-Foto/zefa);Getty Imagesp107 (Thomas 2Or3 2012 2oaa zOtO Northcut/Lifesize);Punchstockpp88 (DougMenuez/Photodisc),103 (black 1098765432 mother and sick child/JeffRandall/DigitalVision), 103(three teenagers/ Ableimages/DigitalVision); SciencePhoto Library p103 (nursewith child/ All rights reserved.No part ofthis publication may be reproduced, Gustoimages). storedin a retrieval system,or transmifted, in any form or by any means, without the prior permission in writing of Oxford University Press(with Imagesourcedby:Pictureresearch.co.uk the soleexception ofphotocopying carried out under the conditions stated in the paragraph headed'Photocopying'),or asexpresslypermitted by law or C$rerifiwge courtesy:Getty/LwAffhe Image Bank Collection. under terms agreedwith the appropriate reprographicsrights organization. Enquiries concerning reproduction outside the scopeofthe aboveshould be sent to the ELTRights Department, Oxford University Press,at the addressabove Youmust not circulate this book in any other binding or cover and you must impose this samecondition on any acquirer Photocopying The Publisher grants permission for the photocopying ofthose pagesmarked 'photocopiable' accordingto the following conditions. Individual purchasers may make copiesfor their own use or for useby classesthat they teach. Schoolpurchasersmay make copiesfor use by staffand students,but this permission doesnot extend to additional schoolsor branches Under no circumstancesmay any part ofthis book be photocopied for resale Any websitesreferred to in this publication are in the public domain and their addressesare provided by Oxford University Pressfor information only. Oxford University Pressdisclaims any responsibility for the content tsnu: 978o 194oz3or6 Printed in China

Introductionp.+ Backgroundte, achlngnoter,tlps,andaddltionalactlvltler 1 Presentingcomplaipn.tos 7 Parentasndyoungchildrenp.+r 2 Workingingenerapl racticep.rr 8 Communicatiopn.+a 3 fnstructionasndprocedureps.LT 9 Workingin psychiatryp.so 4 Explaininganredassurinpg.zl 10 Terminailllnesasnddyingp.oz 5 Dealingwitmh edicationp.zs 11 Workinginateam p.oa 5 Lifestylep.r+ 12 Diversityatworkp.z+ Grammatrerts andcommunicatlonactMties Instructionfsor communicatioanctivitiesp.ao 1 Presentingcomplaipn.tasz 7 Parentasndyoungchildrenp.sa 2 Workingingenerapl racticep.a+ 8 Communicatiopn.ee Ii 3 Instructionasndprocedureps.s6 9 Workingin psychiatryp.e8 4 Explainingarnedassurinpg.aa 10 Terminailllnesasnddyingp.roo 5 Dealingwitmh edicationp.so 11 Workinginateam p.roz 5 Lifestylep.sz 12 Diversityatworkp.ro+ Grammartestksey p.roo r Symbolasndabbreviationsp.rro

4lntroduction lntroduction Topmargin Medicineis aimed at preparingtrained and trainee Thistop part ofthe pagecontainsfacts,statistics,and doctors,and trained nurses,who intend to get ajob in quotes.Theseareoptional extrasand canbe usedto add medicine.It presentsthem with Englishfrom a wide variety and interest to your lessonso, r provide additional variety of medicalfields and situations,develops material for strong studentswho are'fastfinishers'.Ways their communication skills,and providesthem with of exploitationincludeaskingwhether your students backgroundin major medical and careconceptsT. his are surprisedby the factsand statistics,or whether they Teacher'sBookassumesthat a teacherof Englishfor agree,disagreeo, r canidentify with the quotes. medicine is unlikelyto be a doctor,and information is giventhroughout to helpwith medicalterminology. Thereare alsodefinitions for difficult words or phrases which areimportant to understandatext which appears C h e c ku p on the samepage. Thisis designedasa warm-up activity to the unit. It Vocabulary usually consistsof a number of picturesand often introduceskey vocabularyor conceptsI.t shouldbe used Studentsmeet a largeamount of vocabularyduring the to get studentsto focuson the topic. course.Itis important to encouragegoodlearning skills from the start,for example: It'smyjob * organizing vocabulary into word setsand word groups Theseoccurregularly and areall basedon authentic rather than simple alphabeticallists interviews and sourcesT. heyare designedto be of interest to the studentsasthey standwith only minimal tasks. * understandingthe contextofvocabulary and StudentswiII readabout a variety of peoplein different whether it is a keyword neededfor production or for medicalenvironmentsand gain insight into the skills comprehension required. Generalfocusquestionsfor'It'smy job'are:Whatdoyou x checkingand learning the pronunciation of a word or thinh his/ herjob involves?What skillsand experiencedoes phrase. he/ sheneed?Wouldyouliketo do it? [anguagespot As an ongoing project,encouragethe classto build up a portfolio of other'lt's my job'features.Forexample, Thisfocuseson the grammar that is generatedby if studentshavecontactwith someonewho is fully the topic ofthe unit and concentrateson its practical qualified and works in medicine,they canwrite their own application. 'lt'smy job'article or interview,with photos. If your studentsneedrevisionafter completingthe Patientcare Languagespot,directthem to the Grammar reference, which providesa handy check. Thereis alsoone photocopiableGrammartest for each unit inthis Teacher'sResourceBook. Increasinglyin medicine,it is not enoughto have ListeningR, eadingS, peakingW, riting technicalskills,qualifications,and knowledgeof the field. Doctorsand nursesmust alsobe skilledcommunicators- Theseactivitiesgive realisticand communicativepractice not only with fellow careprofessionalsb, ut with patients of languageskillsneededin medicine. and their family and friends - often about difficult or sensitivematters.They alsoneedto be ableto convey * In the listening activitiesstudentsare exposedto instructionsto patientsin a sympatheticbut clearway, situationsrelatedto medicine,including doctor- which canbe extremelydemanding.ThePatientcare patient consultations,conversationswith colleagues, featuregivesstudentspracticein theseimportant'soft and presentationsT. hey alsohear a variety ofEnglish skills'. accentsb, oth native-speakerand non-nativespeaker.

I n t r o d u c t i o 5n r In the reading sectionsstudents meet a variety of Usefulleference medicine-basedtexts (seeReadingbank). This sectionprovides students with useful references r Inthe speakingsections,tryto ensureuseof English to key medical handbookswhere they canfind further during activities, particularly those involving some information on the topics discussedin the unit. discussionE. ncouragethis byteaching or revising anyfunctional language students may need.The Readingbank photocopiableactivitiesin this Teacher'sResourceBook alsoprovide additional, freer discussionactivities. This is in the middle of the book and givesspecific skills practice in reading.The ability to read and understand r Writing practiceinthe units is designedas texts in Englishhasneverbeenmore important in consolidationand extensionof the topic with medicine than it is today with the amount of written structured, meaningful writing tasks. lnformation available on the internet, the majority of which is in English.The reading texts are accompaniedby Pronunciation pre-readingtasksand comprehensionquestions.They can be usedthroughout the course,either in class,or asself- This practisesaspectsof pronunciation which are of study or homework. There is alsoan Answer key in the maximum importance for intelllgibility. Student'sBookto encouragestudentsto checktheir work. Youcanrepeat the recordings in Pronunciation asoften as Speakingactivities you like until you and your students feel confident they have mastered a particular sound or feature. Project This section contains one or more parts of the information gap activities from Speakingin the main units (see This encouragesstudents to take an active role in the Speaking). learning processb, oth in terms of their Englishlanguage work andthe subjectof medicine itself. Grammar eference Projectscanbe set ashomework assignments,but it is This canbe usedtogether with the Languagespot,asa worth spending time in classpreparing students for the handy checkor revision. It showsthe form of a particular task.Studentsareusuallyrequiredto usesearchengines grammar point, briefly explains its use,and provides such aswww.google.com to find information, aswell as example sentencesaswell asindicating likely student websitesdedicatedto medicalissues.Help canalsobe errors. givenbybrainstorming somestandardplaceswhere they can gather information. listeningscripts Checklist Thisisacompletetranscriptof alltherecordingsD.irect studentsto it for checkinganswersafterthey have Thisallowsstudentsto checktheir own progressY. oumay completeda Listeningtask,or allow weakerstudentsto want to getstudentsto gradeor asseshsow well they can readit asthey listento aparticularrecordingp, erhapsfor p e r f o r me a c ho f t h e ' C a nd o 's t a t e m e n t se,.g . ' e a s i l y ' , ' w i t h afinaltime. difficulty',or'not at all'.Theycanalsotesteachotherin pairs,by givingexamplesfrom thetrnit of eachofthe'Can Glossary do'statements. This is an alphabetical list of all the Keywords. Eachword Keywords is followed by the pronunciation in phonetic script,the part of speech,and a definition in English. Thesearethe main items of medical vocabulary The sectionbegins with a phonetic chart,with an introduced inthe unit. A definition of eachof thesewords example word from medicine to illustrate eachof the appearsin the Glossary.Youshould certainly check sounds. students' pronunciation, including the stress,of words Iikelyto be usedorally. Abbreviations A list of common medical abbreviations is included at the end ofthis Teacher'sBookfor easyreference.

6 Unit1 Background personaldetails,and questionsrelating to pain arethe basictools of any doctoror nurse. Patientsarevulnerablewhen they comeinto contact with medicalprofessionalss, owhen taking a history In a patient-centredapproachto history-taking,which doctorsand nursesneedto learn to askquestionsin a way is increasinglythefocusof history-taking inthe UK and that instils confidencein patients and elicitsaccurate in many other countries,the patient is at the heart of the information. health careprovision.AII carerevolvesaround the patient, not the doctor.In this situation,taking a history is not just Thecasehistory beginswith the presentingcomplaint about askingthe questionsthat a doctoror nursefeels (PC)and the recent history. Doctors have different ways they haveto ask,but about relating the history to each of askingabout the PCand probably stickto one or two patient asan individual,not asa hospital number.As your ofthese.Thetensesthat areusedin the recenthistory studentsgo through this book,they will learn the skillsto relateprimarily to the presentand recentpast:the Present be abieto becomemore patient-centred. PerfectContinuous,the PresentContinuous,the Present Simple,the PresentPerfect.ThePastSimplealsooccurs,of As the first stepin helping your doctorsand nursesto course,aswlll other tenses.It is asimportant for doctors becomemore awareof the patient and of their own to be ableto usethesetenseseffectivelyat a simple level behaviourin the patient'seyes,a basicanalysisof body asit is for doctorsto be ableto understandpatientswhen languageis introduced. they usethem. Any misunderstandingcanaffectthe doctor'sor nurse'sability to makethe correctdiagnosis. Foryour own further reading about askingquestions Youwill therefore have to balance accuracywith fluency, read p.4,5,and 22in Oxf ord Handbook of ClinicaI encouragingthe latter without sacrificingthe former. Medicine(Murray Longmoreet al.,7thedition, OUP, 2007)and refer your studentsto the samepages.The It is saidthat 80 per cent of the diagnosiscomesfrom handbooksarevery accessibleand useful sourcebooks taking the casehistory and the other 20 per centfrom for you andyour students. investigationsand soon.Sobeing ableto asksimplepolite questionsusing the word Can,beingableto askabout Usefulreference:OxfordHandbookof ClinicalMedicine, 7th edition,Longmoreet aL x Tip Checkup C /o= comp lain inogf Beforestudentsdo the matching task in l, askthem to describewhat is happening in eachpicture and to comparethe sceneswith similar situationsin their own countries. Ask studentsto brainstorm answersto 2 in pairs or groups(e.g.inaccurate information couldleadto giving the wrong treatment,performing the wrong operation,etc.).Collatethe information on the board.Encourage studentsto give at leastone reasonfor eachanswer.Followon with an open classdiscussionfor 3.Seta time limit. OF la2 b3 cl d4 listeningI Personaldetails Q for I and 2,askstudentsto look at the chart beforelistening and decide what possiblemistakescouldbe made.Letthem listen againto checktheir answers.

P resenti ncgompl ai nt s7 El ldditional activity * For3,askstudentsto look at the Listeningscript on page132M. ake surethey Askstudentsoaskyouquestionussing write the answersdown asthey wlll usethem inlanguage Spotl. Youcan get them to usethe headingson the chartto askeachother questions,using gentle questions and / or a mixture of fictitious detailsif thev wish. gentleand shorterquestionsasinthe conversationin Iistening 1.Makethe O? | 1 Karlson 3 2p.m. 5 7953 7 correct names / numbers simple or difficult 2 correct 8 DrJones accordingto the levelofyour students.Ask 4 19733045 6 correct them to write dovunthe details and then comparethem with a partner beforeyou Languagsepot checkthe answerswith the whole ciass. Askingshortandgentlequestions * Tip Studentsdol-l in pairs.Setatimelimit of 10mlnutesfor f, andencourage Lookat the Listeningscript o seewhich anyearlyfinishersto doit again. typeofquestionsthe doctorasked. E xperie ncewillte llthset udent showt o O'r I Possibleanswers mixthe moregentleandshortquestions. Canyoutemll e: A'safe'wayisto startwith the moregentle y o u rf a m i l yn a m e/ w h a t y o u r f a m i l yn a m ei s ? ouestionsandthen mix What..?. and short yourfirstname(s/ )whatyourfirstnameis? question se,n din gwith gent leCan. . .B/ utit youraddres/swhatyouraddresis ? alldepe ndos nthe in div idual! w h e ny o uw e r ea d m i t t e dt?h ed a t e y o uw e r ea d m i t t e d ? yourhospitanlumbe/r whatyouhr ospitanl umbeirs? El Additionalactivity yourdateof birth/ whatyourdateof birthis? y o u rt e l e p h o nneu m b e/rw h a t y o utre l e p h o nneu m b eirs ? With the whole class,allow the students w h e t h e r y oaur em a r r i e do rs i n g l e ? a chanceto take a history from you. Start yourjob/whatyourjobislwhatyoudofora living? with a volunteerand then chooseanother thenameofyourCPlwhoyouGr Pis? student to follow on 2 a Wheredolou getthepain? * Tip b Doesthepainspreadanywherelse? c Doesitwakeyouupatnight? Yourstudentswill needto beableto usethe d Conyoutellmewhatthepainislike? questionsrelatingto pain frequentlyand e Canyoudesoibethepainfor me? accuratelyT.ohelp them remember,refer f Howlonghaveyohuadthepain? them to the mnemonicSOCRATEsSit:e, g lsthereanythingwhichmakesitworse/ better? onset,characterr,adiationa, ssociations, h Whendidit start? t i m i n g ,e x a c e r b a t i nagn da l l e v i a t i n g i lsthereanythingwhichbringsit on? factorss, everityA.skthemto workin pairs j lsthepainconstant? anddothe followingexercisoer do it with k Hoveyohuadthepainbefore? the wholeclassS. aythe letter5 or'site'and askstudentsto giveyouthe appropriate t 1f 2h 3c(d/e) 4i sb 6dande 7g 8a 9k 10j questionasquicklyaspossibleT.ryit again asa w arme rinth e ne xtles s onandt hen s e v e r alle s s o n sl a t e r . * Tip Listening2 Encouragsetudentsto learntwo orthree PresentingGomplaints questionsinitiallyforthe presenting comp lain(tPCs) oth atth ey donot m ix O Studentsgivetheir orrrmanswersto l, then complete2-6. PIaythe them andmakemistakes. recordingasnecessary. E additionalactivity O'r 21f 2a 3d 4e 59 6b 7c 8h 3 1 What'sbroughtyohuere? Youcanusea skeletonand attachthe non- 2 Canyoutellmewhatseemstobebotheringyou? technical names for the various parts of 3 Whatcanwedoforyou? the body,e.g.the ribs,the skuil,the elbow, I Possibleanswers etc.byway of follow-up.Or askstudents Whatseemtso betroublingyouW?hat'stroublingyouW? hat to draw an outline of the body and write bringsyohuere?What'stheproblemW? hat'sthematter?What the namesagainsteachpart they know c a nI d o f o r y o u ? in pairsand then comparewith other 51e 2i 39 4k 5d students.Fromthis,make a master diagram labelled with the various parts of the bodv.

6 a col l arbone E navelb, elly-button i shi nbone b gullet f gut,bowels j heelbone c breastbone g wrist(bone) k ankl e(bone) d tummy,belly h Kneecap x Tip Pronunciation N o t eA m e r i c a np r o n u n c i a t i oann d s t r e s so f M e d i c a lt e r m s :w o r d s t r e s s umbiIicus: /,,rmbrl'arkas/. O ask studentsto completeI in pairs,then listen to checktheir answers. Followonwith3. & Studentscando 4 in pairs.Themissing words arefrom t. w For5,put studentsin groupsof 3 or 4.Seta time limit of 10-15minutes,but if the discussionis going well, allow it to continue.Make a list of points to corrector discussat the end.When you havefinished discussingany follow- up, do a quick checkof pronunciation by pointing to parts of the body. Or | 1 sternum,talus,carpus 3 patella,intestines 2 cl avi cl ea,bdoment,i bi a 4 umbi l i cusc,al caneuos,esoph agus {a calcaneus d patella f carpus b abdomen e sternum g umbilicus c oesophagus fl Additionalactivity Vocabulary Put students into groups and askeach Describingpain groupto chooseone ofthe conditions in 1and describehow they would Studentsmay givemore than one answerfor | - the important thing is that differentiate between this condition and they understandthe correctmeaning of the descriptivewords.AIIow them something similar.Getthem to discuss to justify their choices. eachchosencondition in turn. Seta time Iimit, but allow the discussionto continue Getstudentsto do 2 in pairsand discusshow to differentiate betweenthe if it looks asif it is developing well. Try different typesof pain.Theycandothis by askingasmany pain related not to interfere,and usethe discussionto questionsaspossibleor by encouragingpatlentsto talk about the pain build your knowledge, which wiII increase following SOCRATEaSt the top of p.7.SeealsoOHCM7,p.22.Asking about your confidence.Givefeedbackon points the siteof the pain,the nature of the pain,and whether it spreadsanywhere like pronunciation,tenses,question elsearethe most obviousways to differentiate betweentypes.Students formation, and vocabulary. remain in pairsfor 3and4. x Tip Or | lc 2f 3e 49 5h 6d 7i 8a 9b 10j 2V 3V 45 5V Pointout to studentsthat,with regardto pain,what isconsideremd ildbyoneperson ' l MThepossibleconditionsdescribedcouldbe: maybeseverefor another.Thereare many 1 tensionheadache factorsinvolvedin assessinpgain,suchas 2 sub-arachnohi daemorrhage ageand culture;somild,severea, ndvery 3 acutepancreatitis severe atesubjectiveinterpretations. 4 appendiciti(sorburstappendix) 5 degenerativaerthritis 4 Exampleanswer Youcanaskthe patientto compareit to the worstpainhe/shehas e v e rh a d . It'smyjob * Ask studentsto discussI in pairs,then readthe text, and complete2.

P resenti ncgompl ai nt s9 Otr 21 Thehighlytrainetedam... z Theiwr ork(thetriagenursesre, ceptionisetstc, .)isvitaltothe 3 ...nextof kinforcontac(tistakeni)ncaseof emergency. 45 ...thepotentiafol rconfusioinsgreaut nlestshedatathatare t a k e na r ea c c u r a t.e. . ...informatioinschecketdo makesureit iscorrecatndthatthe p a t i e n tcsa nc o n f i r mt h e i ri d e n t i t y . Listening3 A presentingcomplaint O C\"t studentsto do I in pairs or small groups.For2,askthem to write noteswhile listening to the recording and then comparethem with a partner or in groups.Letthem listen againto checktheir notes.Theywill needto keeptheseto referto in the Speakingexercises. Or | 100/min l00beatsperminute BP bloodpressure mm / H g mi l l i metreos f mercury JVP j ugul arvenouspressure CVS cardiovasculasyr stem NAD n o a b n o r m a l i t yd e t e c t e d O/E onexamination CNS c e n t r a ln e r v o u ss v s t e m x Tip Speaking Seta time limit of 15-20minutesforthe Getstudentsto discussl-4 freely in groups. SpeakinegxerciseA.llowstudentsto discuss freelywithout interferingand usethe Or Possibleanswers discussiotno buildyourknowledgeA. void 2 angina 4 administrationof aspirinandoxygen;painrelief answeringquestionsat th isstageand 3 Anginaor myocardiailnfarction c o l l e c ti t e m sf o r f e e db a c k . Languagsepot * Tip Tensesin the presentintcomplaint Usediag rams1-4 to he lpex plaint he tensesO. ftenthe tensesoverlapb, ut the key Ask studentsto match the statementsand diagramsin l, then complete2 pointisa cha ng eof e mph as is . with a partner. x Tip Or I al b4 c'l d4 el f4 92 h2 i3 2 t hasbeenhavi ng B e f o r e y o usr t u d e n t ss t a r t ,r e m i n dt h e m 2 Doyounormallygo of the mnemonicSOCRATEanSdthe 3 haseased quest ion sre latin gto the p r es ent ing 4 havebeenlying complaintE. ncou ragteh emt o int r oduc e 5 isgetting/ hasbeengettingworseLookat the diagroms.The t h e m s e l v ecsl e a r l y . PresentContinuousemphasizesthat the action isstill happening around the time of the presentingcomplaint.ThePresentPerfect * Tip Continuousemphasizesthat it hasbeenhappeningbeforeand around the presentingcomplaint. Encouragsetudentsto form discussion 6 amnottaking groupsoutsidethe classto discustshe 7 Has/ Doesthe painspreadThePresenPt erfecrtelatesto the time exerciseisn the unitsandto do role-plays up to now ond coversthe recenthistory.ThePresentSimplecovers similartothe scen arioisnt he c las sor at the recenthistoryand asksabout eachtime the pain happens. work.lf youcan,providea placeinthe institutionwheretheystudyT. hemeeting caneit he rb einfo rmaal n dat any t im eor formalat a p articula rtim e ac hweek . The studentscouldrotatethe responsibilitfyor organiz atio n.

lO Unit1 E ndditionalactivity Speaking lJter SpeakingI and 4, ask students to * Ask studentsto work in pairsfor I and 2.In 2,questionsrelating to pain explain to eachother what they think needto be askedfor both notes,aswell asquestionsrelating to general, the diagnosisis in eachcaseand to give family, and socialhistory and to diet and drinking habits.Studentsremain evidencefrom the patients'answers. ln pairsfor 3and4. Then allow a whole-classdiscussionat the end aboutthe diagnosisand possible O.r I a Possibldeiagnosisa: cutepancreatitisg,astritisd, uodenitisp, eptic examplesof cases- but emphasizethe utcer confidentiality of the patient.Seta time Iimit, but allow the discussionto continue b Possibldeiagnosis(:acutea) ppendicitisc,holecystitisg,allstones, if necessary. u r e t e r i cc o l i c * Tip Cultureproiect Donot beafraidto allowfreetalkinghere Beforestudentsdo t, askthem to explain in their own words what they anddo notworryaboutnot knowing think is happening.This canbe doneasa group or pair work exercise. t he m ed ica lde taiCl.onc ent r atoent he Explainhow body languagecanmean more than onething and how it languageandpickup a few relevandt etails canbe opento misinterpretation,evenwithin cultures.Referstudentsto to feedbackon.Neverbeafraidof saying Reading8 intheReading bank,'What a half-smile reallymeans'. youdon'tknowthe answerT. hestudents will respectyoufor it. Ask eachgroup to producea list for 2 and then together make a classlist.As 3 requirescomputer accessy,ou can setit ashomework and askstudentsto E ndditionalactivity feedback at the beginning of the next lessonby way of revision. Byway of revision,askstudentsin pairs Or lla 2 3 4 5 67 to role-playone ofthe scenariosfrom the unit again.Ask them to concentrate | 1 Everyareaof lifewherepeoplecommunicatewith eachothel on their own and the patient's body language.Ifyou haveaccessto a camera, for examplebusinessd,iplomaticservicet,eachingc, ounselling, video someof the role-plays and play them backwith and without the sound; shopsb, uyingandsellinge, tc. concentrateon the body languageonly. Youmay find the students will want to do 2 l t i sanapproachw hi chmeansthatthedoctonreedstodea l the role-playagain. with the patientasa personr,atherthanjust the illnessg, iving E ndditionalactivity them the opportunityto speakandmakedecisionasbouttheir Youcan turn the internet researchinto a projectby putting studentsinto groups treatment.Thedoctorneedsto beableto interpret he patient! and askingthem in the classor at home to collect information. Ask for volunteers to bodylanguageandmood,notjusttheir illness. presentthe information to the classwith or without visuals. 3 TheCalgaryCambridgemethodisa patient-centreadpproachto communicatingl.t teachestoolssuchasaskingopenquestions, dealingwith patients'concernasndexpectationsa,ndnon- v e r b a l c o m m u n i c a t i osnu c ha s b o d yl a n g u a g e . E Additionalactivity Writing As a quick checkofyour students'abilityto A casereport make questionsa, skthem in pairsor asa classto make a verballist of the questions Studentsdo I and 2 aloneor in pairs. asked,using the text in l,4/ritingl. Or llpresented 3radiated Ssmoked Tworked 2 was 4 had 6 was Onexaminatiohne,wassweatyb,utnoabnormalitiewserefoundin thecardiovascuolarrrespiratosry stemsH.isbloodpressurweas 138/82andhispulseratewa1s10m/ inregulaHr.ewasgiven analgesaiandstreptokinaisnetravenouslyahnidsbetablockerwsere continuedH.ispainsettledandaftertwodayhsebegantomobilize. ChecklistK, eywolds Seesuggestionson p.5.Gothroughthe iist of words to checkstudents' pronunciation and understanding.Remind studentsto transfer useful words and phrasesto their vocabularynotebooks.

Unit2 11 ,.1 .rrir.l;1tu ::i ,,r]::;liriul{ll...,i,tiiri Background r have a working knowledge of the whole breadth of Inthe UK,privatehealth careprovision exists,butmost medicine peopleare treatedwithinthe National Health Service (NHS),which provides free health care.Primary care a maintain ongoing relationships with their patients - they arethe only doctorsto remain with their patients within the NHS is provided by general practitioners (GPs) through sicknessand health who work in practices / clinics calledsurgeries.Secondary * focuson patients'responseto illnessrather than the careis providedby hospitals.Thegeneraldoctorswho illness itsell taking account of personality, family work in hospitalsare cal,ledgeneraplhysicians.Most patterns,and the effectofthese on the presentationof people in the UK are registered with a GPT. here are symptoms just over40,000GPsin the UK and about 250million r be interestedin the ecology(i.e.the scienceof consultations everyyear. (Seepairwork activitles on organisms asaffected by their environments) of health Student'sBookpp.114and 116for more facts about GPsin and illness within communities and the cultural theUK.) determinants of health beliefs In someGPpracticesthere is only one GBbut this is r be able to draw on a far wider range of resourcesthan increasingly rare asmany now work in teams with other are taught in medical school,including intuition, GPsand health professionalslike practicenurses,district knowledge of medicine, communication skills,business nurses,and midwives. skills,and human empathy. GPsdiagnoseilbress,treat minor illnesswithin the Therearethree commonly-useddefinitions of general community, promote better health,prevent diseasec, ertify practicecoveringmany of the points in the list above: diseasem, onitor chronicdiseasea, nd referpatientswho Leeuwenhorst1974M, cVt/hinney1997,Olesen2000. needspecialistattention or teststo ahospital.General Forfurther information on these seep.3of the Oxford practiceis the primary point of accessto health careserrrices. Handbook of GeneralPractice(ChantalSimon et al,2nd Although 80%of patients have seentheir GPwithin the edition, OUB2006)and for more generalbackground on the Iast year,only 137\"arereferred for hospital care.In order to work of GPsinthe UK seepp.1-98of the samepublication. do this GPsmust: Useful referencetOxford Handbook of GeneralPractice, 2ndedition.Simonet al. E additionalactivity Checkup (weakesr tudents) After2,getstudentsin their pairsto close r Askstudentsto work in pairsanddiscussthe picturesin I andthe questions their booksandaskeachotherquestions in 2.Thiscouldalsoforma classdiscussion. aboutthe differencesbetweenthejobs discusseed.,gW. hatdoesa healthvisitor Vocabulary do? Medicaljobs * Tip * Askstudentsto matchthejobtitlesto thepicturesa, ndcompletethe Askstudentsto compareprocedures sentenceisn 2,makingsurethey usethe pluralwherenecessaryT.heycan betweencountriesthey haveknowledge t h e nd o3 a sa p a i ro r g r o u pe x e r c i s eo,r d i s c u s sa sa c l a s s . of.Forexampleh, eretheycoulddiscustshe relativefunctionosf medicaol ersonneiln Of, llf 2a 39 4d 5e 6b 7c hospital/s clinicsintheirown countries. 2 1 practicemanager 5 practicenurse 2 Healthvisitors 6 midwife 3 Receptionists 7 Districtnurses 4 generaplractitioner

12 Unit2 PronunciatioIn * Tip Mainstress Ceneral 'd3enarails/ often pronouncedas O tn l, askstudentsto listen and identify the main stress. a two-syllableword:/'dSenralN/.otealso the differencein emphasisbetweendistrict Ask studentsto discuss2 and 3 in groups,then feedbacktheir answersto nurse and practicenurse. the class.Thebestansweris probablythat they areall equally important, as the team would not work without everybodyperforming their respective tasks! GF 1 practicemanager(O....) 5 districtnurse{' o) 2 reegptionis(t.o..) 6 healthvisitor(O'r) 3 generapl rac[tioner(oorooo) 4 mlelwife (o.) 7 gggticenurse(o..) listeningI A G P ' sj o b O ask studentsto do I individually,then discuss2 in pairs and feedbackto the whole class. Or 1T 2F 3F 4T 5F E additionalactivity Languagsepot Encouragestudentsto askeachother PresenPt erfecat ndPastSimple questionsandto developthe conversation by explaining, giving reasonsand Studentscando I on their own and comparetheir answerswlth a partner or examples.Time limits exerciseslike this, work in pairs. but allow somefreedom for them to develop.Let students askyou questions Ask studentsto work in pairsfor 2 and askeachother questions,using Have - but you don't haveto revealthe truth ...andWhat ...etg giving asfull answersasthey can.Then askthem to make about yourself. a list of questionsfor 3.Youcouldthen createa masterlist which the whole classcanreferto when doing the role play in 4. x Tip O'r t 1 Thecoughingstartedfivedaysagoandit hasbeensobadit has lf necessargye, tstudentsto lookbackat the wokenme up everynight. questionsin Unit1LanguagSe pot. 2 Whendidthe attacksfirstcomeon? 3 H asanythi ngmadei tw orsesi ncei t started? 4 H ehasnevertakenanymedi cati oni n hi sl i fe. 5 W hathappenedw henyouw erenearani mal sasa chi l d? 6 Myfatherdiedover20yearsago. 7 Didyougettheseproblemseverydaywhenyoulivedin Africa? 8 Haveyoueverhadcoughingattacklsikethisbefore? 9 Hasanyoneinyourfamilyeverhadan illnesslikethisasfaras you areaware? x Tip Speaking Varytheactivityby puttingstudentsinto Studentsdo I in pairs and remain in pairsfor the discussionsin 2.Getthem groupsandaskingthemto makea listof to feedbackto the whole class,allowing asmany studentsaspossiblea theirideason a flip chartor a computerT. ell chanceto speak.Encouragestudentsto talk to eachother rather than just to groupsto appointonepersonto feedback addressyou asthe teacher. to th e wh olecla ss.

W orki ngi n generapl racti ce13 Or I StudentA: StudenBt : 1 1911 4 42,000 1 250million 414 2 1948 5 10.500 2 15 5 78 3 freecomprehensivceare 6 quarter 3 2000 6 40 Listening2 E ndditionalactivity A casehistory Asksyourstudentsoresearch O Beforestudentslisten,askthem to work in pairsto discussthe topic in information about asthma,COPDa, nd l. Usethis asan opportunity to bulld your own knowledge.Thenplay the pulmonary oedemathe day beforeyou recordingfor 2 sostudentscan completethe notes. do Listening2 in class.Givethem the referencesfor the OxfordHandbooks Put studentsin groupsofthree or four to discussthe questionsin 3 and listedin the answerkeyto listening 2, 4. Seta time limit, but allow extratime if the discussionseemsto be exercise3,or askthem to searchon the going well. Again,usethe discussionasan opportunlty to build up your intemet. knowledgeof the subject.Don't be afraid of sayingyou don't know specific medical answers.Make a list of grammar and pronunciation mistakesto * Tip feedbackto the class. Appointsomeonefrom eachgroupto feed Or 2lbreathlessness 5atnight. 9 known backtheiranswersto the wholeclass. 2 wheezing 6 inthe morning. 10 asthma x Tip 3 cough 7 three 11 previous COPD= chronicobstructivepulmonary disease 4 phlegm 8 tightness 12 eczema PgPB= peakexpiratoryflowrate FBC=full bloodcount 3 1 intrinsicandextrinsicasthma,COPpDulmonaryoedema. U&E= ureaandelectrolytes CRP= C-reactivperotein 2 PEFRs,putumculture,FBCU, &E,CRBABCanalysis. ABG= arteriabl loodgas 3 Teachthe patienttousea peakflowmeterto monitorPEFR * Tip twicea day.Usea step-by-steappproach:Ste1pB-2agonistas Studentsneedto becarefuwl hentheyask aboutserio usilln esselsikem alignanc y requiredfor symptomrelief. (cancerb)ecaustehe patientmaythen th inktheyaresufferingfromthis.See (SeeOHCM7,p.l 64-167). OHCM7,p.22. I Examplequestions: x Tip Doyouhaveanybrothersandsisters/childrenA?retheyin good Bepreparedfor disagreemenatndallow it to happenA. skstudentsto checktheir health/ aliveandwell?Areyourparents/closreelativesaliveand answersin a medicaltextbooikf necessary, well/ in goodhealth?Havetheyhadanymajorillnesseisn the e.g.oneofthe OxfordHandbooks. past?H asanyonei nyourfami l yhadanythi ngl i kethi s? Vocabulary Signsandsymptoms Ask studentsto do I and 2 in pairs.A sign is an indication of particular disorderthat the doctorseesbut which is not apparentto the patient.A symptom is what the patient noticeshim / herself.Sometimes,signscanbe classedassymptoms and vice versa.Allow sufficient time for discussion and givefeedback about grammar and pronunciation. Tohelp expand your knowledge, askthe classto explain the answersto you afterwards. Studentswrite answersfor 3 on their onm,and comparein pairs. Or I Conditiona: Conditionb: Conditionc: 1 Symptom 1 Symptom 1 Sign 2 Sign/Symptom 2 Sign 2 Symptom 3 Sign/Symptom 3 Symptom 3 Sign 4 Symptom 4 Symptom 4 Sign 5 Symptom 5 Sign 5 Symptom 6 Sign/Symptom 2 a sinusitis b asthma c gastroenteritis. (SeeOHFP2forfurtherdetoilsoneochof theseconditions.)

14 Unit2 rcTip I a)Diverticulardisease:5ympatobmdosm: inaplaincramp(susually left-sideidm, provewsithbowelopeninigr)regulabrowehl abit, flatu s= bre aking wind flatusb, loatingP, RbleedingS.ignsin: creasetedmperaturein,creased pp= psrrectum pulse+, decreaseBdBLIFtendernes+sp, eritointis,distension. LIF= leftiliacfossa (SeeOHFP2for moreinformationoboutthisdisease.) sats= oxySensaturation b)Pneumon:iaSymptomsc:oughin, creasesdputum(greenp),leuritic chestpain,breathleshsa, emoptysifse,veru, nwellc, onfusionS.rgns; I n c r e a s et edm p e r a t u rien,c r e a s eRdRi,n c r e a s epdu l s ed, e c r e a s e d satsu, nequaalirentryb, ronchiablreathingd,ullpercussiorne,duced expansion. Speaking * Tip I Askstudentsto workin pairsto dotherole-playin I (weakerstudents) a Putstudentsin groupsfor 2 and3.Askthemto makeamasterlistof gentle Allowstudentsto readthe Listeningscript andshortquestionsfor 2to feedbackto theclassS. etatime limit andask f romListenin2gor practisereadingit aloud. onepersonto beresponsiblfeor ensuringthequestionsarewritten down. A differentstudentcangivefeedbactko thewholeclass. El additionalactivity Encourasgteudentsokeepalistof OF 2 Possibqleuestions: a Canyoudescribethpeainforme?Haveyohuadanyfeverl?s technicalwords and their non-technical thereanythingthat makesthepain better/wors?e equivalents.Youcould createa master list b WhatseemstobebotheringyouC?anyoudescribethetightness on a computer, which the whole classadds a bitmoreforme?lsthereanythingelseassociatewdiththe to periodicallyasa revisionexerciseE. very tightnessW? henisthecoughinwg orse? time you update it, an electronic or paper c Areyoubr owelOs K?Anydiarrhoea/vomitinWgh?atisthepain version can be given to eachstudent. like? * Tip 3 Maininvestigations: a CTscanb, utrarelynecessary Pointout non-technicaelquivalentosf b PEFRsp, utumcultureF, BCU, &E,CRbBloodculturesA,BGanalysis technicawl ordsandpurelymedicawl ords c ,IWCC4, CRBstoolcultureasn, dpossiblaynabdominaXl-ray e a c ht i m e y o u c o m ea c r o s st h e m . Vocabulary * Tip Non-technicalal nguage 4 =increased PSPB= peakexpiratoryflowrate Askthe whole classto answert asa warm-up. Then get studentsto work FBC= full bloodcount in pairsfor 2 and 3.Listento asmany pairsasyou can and givefeedbackon U&E= ureaandelectrolytes question formation. CRP= C-reactivperotein ABC= arterialbloodgas WCC= whitecellcount OF llstart 2precipitate 7 stickto 21do 4orone 8 admitted 2 hasgot 5 comesandgoes 9 booked 3 avoid 6 thereallthetime Listening3 Shortquestionsin the generalhistory 6) Ask studentsto listen and write down the questions. OF | 1 lsyourappetiteokT 3 WaterworkOsK? 2 BowelsOK? 4 SleepinOgK?

W orki ngi n generapl racti ce15 E ldditionalactivity PatientGare Ask students to work in pairs and take a StudentsdoI ontheir own,then compareanswerswith apartnerbefore historyfrom eachother about pneumonia youcheckwith thewholeclass. or another condition oftheir choice. If you can,video one or more of the Askstudentsto workin pairsfor 2 andI to practiseshorteningand conversationsand playthem backto the lengtheningthequestionsY.oumaywantto playtherecordingagain students.If this is the first time you usea beforethey do4. video with your students,be positive in giving feedback.Allow students to feed Or | 1 AreyouH/ aveyobueeneatingwell? back about themselvesfirst. 2 lsyourappetiteOK/Hasyouar ppetitebeenOK? 3 AreyouH/ aveyobueensleepinOg K? E ldditionalactivity 4 AreyouH/ aveyoubeenpassingwatera lot? 5 Areyoupr eriodsH/ aveyoupreriodbseenOK? Checkat the end ofthe classthat 6 Haveyohuadanydiarrhoea? studentscanmake short questionsas 7 Haveyoluostanyweight? automaticallyaspossibieA. sk them to 8 Haveyobueenlivingtherleong? listen out for examplesof short questions 9 HaveyobueenkeepingwellT on TV / radio,etc.Point out that they are 1 0 A r e y o u /h a v e y o ub e e nO Ki n y o u r s e l f ? usedin all types of communication. You 11Areyouh/ aveyoubeenlookingafteryourself? canbegin your subsequentcheckingwith: Foundany? Pronunciation2 Questionsr:isingandfallingintonation I O Readthe introduction asa classbeforestudentslisten to l. * 6) llay the recordingin 2.Letstudentscomparetheir answerswith a partner beforelistening again.They can stayin thesepairsfor 3,readingthe questionsfrom the listening scriptto eachother. Or 1 Thedoctor'svoicerises. 2lF 2F 3R 4R 5F 6R 7R 8R 9T lOR rcTip Reading Insomeclassdiscussionyso, u maywantto Studentsdo I in pairs.For2,askthem to the scanthe text individually for makethe discussioansfreeasoossibleand the symbols/ abbreviations,then readthe text in full, and answerthe not providefeedbackat the end. questionsin lwith a partner. * Tip Put studentsin small groupsto discuss4, and then feedbackto the whole class.This canleadinto a classdiscussionof 5.Seta time limit and SociaI classI refersto peoplewith encourageasmany studentsaspossibleto participate. p r o f e s s i o nIao c c u p a t i o n se,. g .d o c t o r s , charteredaccountantse,ngineersS. ociaI Or I a homelessnesosr sleepingrough classll refersto peoplewith manageriIa b crampedhousing/accommodation or technicaol ccupationse,.g.managers, c smoking(infront of children) j o u r n a l i s t ss,c h o otl e a c h e r s . d eatingtoomuch (SeeOHGP2p, p.222-3.) 21y 24 3< 4) 3 t homelessnesssl,eepingrough,employmentandunemployment, d i v o r c ea n d i m m i g r a t i o ns t a t u s 2 80 yearsago,tobaccowasfashionableand moreaffordablefor thosein higherpaidjobs. 3 Somegenerarl easonsaregeneraal nxietyaboutliving conditions,lackof securityw, orry aboutthe future. 4 Somereasonsaretheyprobablyhavelittleor no money;no accestso cookingfacilitiesl;ackof a balanceddietwith fresh vegetablesn; ofi xed routine.

l5 Unit2 4 Possiblaenswers: Poodr ietandstresisncreasteheriskofcoronrayvascluar diseases a n dc a n c e rTs .h o s ew h oa r eu n e m p l o y eodr u n d e r t h et h r e a t of unemploymemntaynotbeableto affordto eatproperloyrmay besufferinhgighlevelosf stresdsueto uncertaintaybout heir future,thereforearemorelikelyto sufferfromthesediseases. Violencaendaccidentms ayoccufrorvariousreasonlsikefrustration andangear sa resulot fworklossO. nestudyshowedthatafterthe announcemenotf afactoryclosureC, Pconsultatiornatesincreased by2O%andreferralratesby6O%.(SeOeHGP2p,.223) Writing A referralletter Ask studentsto work in pairsto readthe letter and completeI to 5. Encouragethem to make notesin 4 for usein completing 5,which couldbe donein classor ashomework. O'r t All pointsin the listarecoveredexcept9,12,and13. 2 I NHSNumber6784335792 2 HospitaNl umber10177855 3 ReDavidHunt17May1975(M) 4 l8CreencrosSs treetL, ondon5E172PD 5 ...onandoff for morethan threemonths. 6 Therasheshavealsodecreaseidn frequencyand 7 ...to berelatedto allergytocarpets,norwork or othercommon factors. 8 Thepatientspentseveralyearisn EastAfricaworking 9 ...asa teacherin hisearly20s. I hascomplained- PresentPerfect haserupted- PresentPerfect hasalsocomplained-Present Perfect havealsoincreased* PresentPerfect doesnot appear- PresenSt imple hasresponded-PresentPerfect hashad- PresenPt erfect s p e n t - P a s tS i m p l e may have-modalverb+ infinitivewithout to would oppreciate- SecondConditionaI Proiect I canbe donein classor ashomework,individually,in pairs,or in groups. Tohelp structure the activity, make sure students understand they will be requiredto givefeedback.In class,setatime llmit and askstudents to competeto seewho finds the information first. Thenuse2 asan opportunity for a whole-classdiscussion. Checklist,Keywords Seesuggestionson p.5.Gothrough the list of words to checkstudents' pronunciation and understanding.Remindstudentsto transfer useful words and phrasesto their vocabularynotebooks.

Unit3 17 Background may needto aska patient to get undressedI.t is not advisableto sayUndress/ Takeyour clothesoff aslhis In a training environment,doctors,nurses,and other would soundrude in English.Instead,your studentsneed health professionalsneedto be ableto give and receive to learn and observepolite conventionsin English,for instructionsabouthow to perform awide rangeof exampleCouldyou takeyour clothesoff,please? proceduresIn. suchsettingsi,t is possibleto bevery direct and usethe imperativeform of the verb Insertthe needle In many casesa, sin all languages,politenessdepends between...T.hiscanbevariedby addingthewordyou: on the speakerA. native speakermay be ableto givean Youinsertthe needle....Theimperativedoesnot sound instruction which for someoneelsemay seemrude.If a impolite here,aseachcommand forms a stepwhich is doctorkeepsrepeatingCanyou / Couldyouwithout any part of an acceptedprocedurethat is learnt like a formula variation it canendup soundingrather artificial and Thepersonreceivingthe instruction wiil perhapspasson possiblyinsincere.It is important to encouragestudents the stepsto someoneelseaspart of their teachingor as to learn to start with Couldyou / Canyouandthenvary part of revisinga procedure. theserequestswith expressionsthat softenimperatives like-Iust[lift up your I eg)for me,if you can/ pleaseI;'d like However,when it comesto talking to patients in a you to ...;or I needyou to ...,if you can. patient-centredenvironment,it is essentialto take a more gentle and more indirect approachto fit in with the Politenessand gentlenessaredifferent in different conventionsof politenessin EnglishT. hisis especially languages.A literal translation from onelanguageto important when peoplearefeeling vulnerableand another canseemstrange.Studentsneedto learn that it is perhapsill at ease.Commonways to expresspollte the meaning that they needto translate,not the words. requestswhen askingpatientsto follow instructlons are by using Couldyou / Canyou...?Forexample,a doctor Usefuireference:OxfordHandbookfor the Foundation Programme,2ndedition,Hurleyet al. * Tip Checkup lfyouthink it bettertoconcentratoen the Studentscando I and 2 in pairsandthen form groupsfor the discussionin 3. studentsb' estexperiencetsh,enencourage this.Howeveri,t isimportantfor students Or I Theyalsl how anew l yqual i fi ed/j uni ordoctoratw ork. t otalk abo utdifficultsitua t ionas ndc as es 2 a A new l y-qual i fi e/jduni ordoctori saski ngapati enttoget sothat theycanlearnfromthem.They undressedT.hedoctorperhapstooka casehistorybeforethe mightfindso meb od yin the irgr oupwho scenein the pictureandafterwardsexaminedthe patient. f aceda s imilarp rob leml.t isals oim por t ant b A newly-qualifie/djunior doctoriswritingup casehistorynotes. f or pers on adl evelo pme nat ,swellasinjob Thedoctorperhapstooka casehistorya, ndafterwritingupthe interviewsto, reviewdifficultsituations n o t e s ,s a wan o t h e rp a t i e n t . t h e y h a v ed e a l tw i t h . c A slightlyolderdoctorisexplaininga procedureto newly qualified/ juniordoctorsT. heseniordoctorperhapsaskedthe studentswhat they knewand,afterdemonstratinga,skedfor volunteersto showwhat they learnt. d A new l y-qual i fi e/ dj uni ordoctori stal ki ngw i th a consul tant andthe teamduringa wardround.Theconsultanmt ayhave askedthej uni ordoctorquesti onas boutthe pati entsandthen a d v i s e do n t r e a t m e n t ,i n v e s t i g a t i o n se,t c . e A newly-qualifie/djuniordoctorisaskinga phlebotomistto take somebloodfrom a patient.A seniordoctormayhaveaskedfor the test.Thejuniordoctormayhavehaddifficultyandthen calledthe phlebotomistto takethe bloodinstead.

18 Unit3 6 A newly-qualified/ j uniordoctoris handing overat the endof a shift.Hemayhavewrittena listof particulajrobsto bedone, h a n d e do v e ra n d g o n eh o m e . E ldditionalactivity listeningI Youcan askgroupsto preparea list oftips, Preparingfor the first wardround on paperor on a computer,and then rank them in orderofimportance.Eachgroup Ask studentsin groupsto discussthe tips in l, for example,which they canthen presentthe information to the havefound useful themselvesor wish they'd beengiven,or any they might whole classand comparetheir rankings. disagreewith or wish to amend.Getfeedbackfrom the classfor 2,with Invite students to give examplesfrom exampleswhere possible. their own experience. 6) Studentscan do 3 on their own, then comparetheir answerswith a partner beforeforming groupsagainfor the discussionin 4. Encgurage them to discussother tips from their own experiencei,n addition to those given. Or 3 a familiarwith yourpatients. b lookingforpatients. c refertothemquickly. d the patientsonthe ward. e accessinformationeasilv. El additionalactivity Patientcare Toencouragethe inclusion of Getstudentsto discusIsand2in pairsandfeedbackto thewholeclass. introductions in procedures,whenever you do a role-play,always askstudents to Or | 1 Consentfromthepatienlteisgaarlequirementwherethe introduce themselves and givetheir title proceduriseinvasivTeh. econsenmt aybenecessairnywriting. and positionin greetings:Goodafternoon, ( S e e O H C Mp .I5 5 4 . ) Mrs [ ...], my name is..., and I'm .... 2 lt isimportantthatthpeatienkt nowswhothedoctoirs,toput thepatienat tease.Thdeoctomr aybewearinga namebadge, butthepatienmt aynotbewearinghis/ier glasses;thpeatient maynotbeableto reade, tc. 3 AllnecessaryequipmneenetdstobepresenAt.missing instrumenint themiddleofa procedurmeaycauseproblems, 2 Possiblaenswers Explaitnheprocedurtoethepatienst implyandclearly. Explaiwn hyit isnecessary Explaiwn hattheproceudrewillbelikeforthepatient. T h i n ka b o u tp r e v i o ussu c c e s s fpurlo c e d u r yeos uh a v ed o n e . P r e p a rt eh e p r o c e d u rbeyt h i n k i n gt h r o u g he a c hs t e pa n du s et h i s procestso chectkhoughtheequipment. Decidwe hethevr ouneedanassistant. Vocabulary * Tip Instructionsfor a procedure CSF= cerebrosDinfalul id Studentscando I on their own, then form pairsto discuss2. E additionalactivity OF laWithdraw cMark e Obtain g Prepare Ask students in pairs to take turns saying b Drain d Wash f Sterilize h Attach the verbs to eachother and eliciting the completeinstructions.Usethis exerciseto 2 Theinstructionrselateto thefirststageosfa lumbapr uncture(F. or checkvocabularv with the whole class. thefullsetof instructions,eeOHCMpTp.756-7.)

E additionalactivity Languagsepot Forhomeworka,skstudenttso choose Givinginstructions their own procedureto explain stepby step.If possible,they could do this in Gothrough the introduction asa class.Ask students to work in groups or pairsor groups.Ask them to present pairs to do I using the imperative, and 2 using the present simple with You. their procedureto the classat the Invite students to suggestother linking words: then, before,after, when following lesson.Allow 5-10minutes for once,immediately,assoonas. presentation and 5minutes for feedback and discussion. Put students in small groups for 3.They can write down the instructions together, or they can prepare the list verbally,then write it dornmon their E additionalactivity own, and comparewith eachother.Youcan checkstudents areusing the correctlanguagewithout needingto knowwhatthese stepsare.(TheOHFP As an alternative to asking a studentto givesfull descriptionsof both IM injectionsand ABG.) talk through the set of instructions, ask for volunteers to do it in front ofthe class Speaking or for a student to do it with you. Invite feedbackfirst from the student or from Studentsdo I on their own, form pairsto comparetheir answers,and then the volunteers themselves;then askthe explain the procedurein 2.Allow students to look at the vocabulary the classand then give your own feedback. first time they do this. Then askthem to do it againwith referenceto the Ifyou then have other volunteers,allow diagram only. severalto do it. Always encourage constructive feedback. Students could be encouragedto think about 3for homework. Put them into groupsof three orfourto discuss.Allowabout 15minutes.Onegroup * Tip member shouldtake notesfor feedbackto the class.Beforefeedbackis given,askeachnote-takerto summarizewhat the group discussedG. ivea Allowabout15minutesforthe discussion. time warning after 10minutes. Make sureyou vary the note-taker and the Settinga time limitencouragesstudents group members eachtime you do this type of activity. Setatime limit for to focusandorganizetheirdiscussionlt. feedback. alsohelpsyouto organizeandcontrotlhe c l a s s r o o ma c t i v i t i e s . O? | a Wet handsandforearmsunderrunningwater. b Takesoapfrom dispenser. c Soapup,rubbingpalmto palm. d Rubwith fingersinterlaced. e Massagebetweenfingers,right palm over backof left hand,left palmoverbackof righthand. f Rubwithfingerslockedi,ncludingfni gertips. g Rubrotationallywiththumbsinterlocked. h Rinsethoroughly. i Dryhandsthoroughlyusinga papertowel. j Disposeof towel intofoot-operatedpedalbin.Donot re-contaminatheandsbytouchingthebin lid. Eladditionalactivity Reading Ask students to usethe notes made Ask students to do I in pairs.Then for 2 they talk briefly about how the verb from their discussionto write r5o words and noun pairs might relate to the text. This will help them to predict parts explaining the notes taken. This canbe a ofthe text and developthe general gist before reading.They canthen do I classor homework activity. on their ornrnbefore comparing answerswith their partners. Put students in groups for 4. Either follow the procedurefor group discussionasin the Speakingsectionor make this a whole-classactivity, where a student volunteer writes the notes on the board.When you have finished,askseveralstudentsto volunteerto summarizethe notestaken.

20 Unitl O; | 1 providefeedback 5 administemredications 2 undertakperocedures 6 seekhelp 3 assescsompetence 7 considefer elings 4 identifystrengths 5 very 3 1 various 6 may 2 solely 7 considered 3 created 4 expected rcTip Speaking Askfor a volunteetro typeupa master Studentsdescribethe steps,either verbally or in writing. Theythen swap list ofin stru ctio nstsohar ewit hhis/ her partnersandtaketurns explainingthe procedure. colleaguesC.hoosea differenst tudent Or Possiblaenswers r, askfor volunteertso typeup PrimarySurvey ;:::J'.\" Airwav Protecthe cervicaI spine. E additionalactivity Assesfsor anysignsof obstruction. Ascertainpatencye,stablisha patentairway Collectphotographs of different Breathing proceduresor askstudentsto collectthem D e t e r m i n er e s p i r a t o r rya t e . for you.Usethem for group discussion/ Checkbilateracl hestmovement. pairwork / randomtesting / class (Forafuller description,seeOHCMTp.767) E ldditionalactivity listening2 Beforeplaying the recording,students Givinginstructions canusethe illustrations to givetheir own instructions (without referring to the O StudentscandoI and2 ontheir own,thenform pairsto dol. Elicitthe Listening script). answerto 4.Thenput studentsin pairsorgroupsfor 5and6.Remindthem to usepoliterequests. x Tip Or la4 b7 c2 d3 e5 f6 gl lf youhaveaccestso a clinicadl ummy,ask 4lVcannulation studentsto useit for role-play. 5 Possibleanswers Canyousitinanuprighpt ositiofnorme?That'fsine. El additionalactivity C a ny o ul i ed o w nf l a t f o rm e ? Askstudentsto giveinstructionsto a NowI'dlikeyouto rollupyourrightsleevaebovetheelbowO. K, patientfor alumbarpunctureorprimary t h a n ky o u . survey. lUlikeyouto raiseyour elbow- that'sit.(toapplythetourniquet) Canyouliftyourarmforasecondfor me?(toputapapertowel underneatthocollecat nybloodspills)hI ankyou. AndjuststretchoutyourarmandrelaxT. hankyou. J u s tr e l a xa n dk e e pn i c ea n ds t i l l f o rm e ,i f y o uc a n . C a ny o uc l e n c ha n du n c l e n cyho u rf i s tf o r m e ? CanyouwaitforasecondwhileIgetaseniocr olleague(?ifthe connulacan'tbeinserted). (See1HCMIpp.748*9)

l nstructi onasndorocedure s21 languagespot Making polite requeststo patients ReadthroughtheintroductionasaclassS. tudentsthendoI and2 in pairs. Or I candgareinappropriateastheyareveryabrupt. 2 Possiblaenswers 1 Canyojuustpopbehindthescree.n.. 2 ...soifyoucouldturnontoyousr tomach(forme)(, please()T. hank you)' 3 Justcoughforme. 4 ld likeyoutostanudpforme. 5 Couldyou(just)tiltyouhr ead... 6 Canyomu akeatightfist... 7 ld likeyotuo keepniceandstill... listening3 lnstructions O Ask studentsto listen and correcttheir sentencesfromLanguage spot2. It'smyjob Studentsreadthetext in I andfind the information. Or | 1 afirm 2 twoseniodr octors 3 specialisret gistrar(sSpR) 4 specialisret gistrar(sSpR) 5 theconsultant 6 theconsultantrso'unds 7 thejuniordoctor * Tip Speaking Seta time limitof aboutan hour forthe Ask studentsto work in groupsfor l. Geta student from eachgroup to give wholeactivityb, ut beflexible.6oround feedbackfrom their discussionsothat you coverthe whole classW. hen helping5 tud en tasndg ivea t im e r em inder you havegonethrough the checklist,askif anyonewants to add anything. every10minutesto encouragtehem to Somesuggestionsfor discussionwould be why eachstageis important o r g an i z et h e m s e l v e s . and usefui (for audienceand presenter)h, ow much information to give and when, and how to handle comments.(SeeOHFPsectionon'Case * Tip presentation'.) R e m i n ds t u d e n t sa b o u tc o n f i d e n t i a l i tayn d For2,put studentsin groupsof three.Encouragethemto useasmany of the anonymityat a lltimeswh ent alk ingabout Usefulexpressfonlsisted aspossible.Theywill needto referto the detail of particulacr ases. this casein Writing?. * Tip For3 and 4, eachstudent presentsthe casehistory he/shehasprepared to a partner in another group,who takesnoteswhile listening.Again, Encouragsetudentsto reviewtheir encouragethem to usethe UsefulexpressionsT.helistening studentswrite p r e p a r a t i o an n d p r e s e n t a t i oann d k e e pa down questionswhich they then askthe presenterswhen invited to do logofany significanpt ointsA. skstudents so.For5,studentsgiveconstructivefeedbackto the presenter,considering to revieweachother.lfyou havea video factors such asorganization, clarity, and fluency. camerar,ecordthe presentationps,layback, anddiscu ss.

22 Unit3 Wdting tr Tip Casenotes FBC=full bloodcount r Fort, students discussin pairs what eachnote means and what the epistaxis= nosebleed patient's condition is. Checkthat students understand the underlined items in 2.Then get themto do 3 on their own. Or IWR WardRound RTA/RTC roadtrafficacciden1trsadtrafficcollision Obs Observation(s) (r) temperature BP bloodpressure olE onexamination INR internationI naormalizerdatio LFT liverfunctiontest U+E ureaandelectrolytes (H) home mane tomorrow ( O / Pi n 6 / 5 2 )O u t - p a t i e nitn 6 w e e k s Che*list, Keywords Seesuggestionson p.5.Gothroughthe list of words to checkstudents' pronunciation and understanding. Remind students to transfer useful words and phrasesto their vocabularynotebooks.

Unit423 Background Whentalkingto patients,it isnotjust the vocabulary Yourstudentsmaybeusedto listeningto procedures which isdifferent,but alsothe grammaticalstructures beingdescribedtothem but maynot befamiliarwith that areused.Beforeapatientsignsaconsentform or describingproceduretshemselvesa,sthey mayhaveto do givesverbalconsenth, eor sheneedsto understandclearly inteachingsettingsT. heymaybeevenlessfamiliarwith whatis goingtobedoneU. singbegoingtoimpliesthat explainingproceduretso patients. the intentionisto carryoutthe procedureb,ut it depends onthe patientgivingwritten orverbalconsent. Thelanguageusedin explainingproceduretso patientsis very differentfrom that usedwhen onehealthprofessional Anotherfeatureof explainingproceduresto patientsis is explainingsomethingtoanother.Themostobvious structuressuchasWhatwearegoingto do nextisto / differencethat comesto mind isin vocabulary-the use Whathappensnextiswe... Theseencouragestudentsto oflaytermsinsteadof sub-technicalwordasndtechnical usesimplelanguageandhelpto avoidusingthe passive. wordsthat arepure\"medicatel rminologyS. ub-technical Someprocedures,likceolonoscopoyr colposcoptinvolve wordsarewordslikevisualize,insert,attache,tc.i,.e.words talking aboutintimateareasof the body.Medicalstudents that aretechnical,but which maybefound in othernon- shouldnot beembarrasseds,oit isimportantthat youare medicaltechnicaflieldssuchaschemistryorengineering. not embarrasseedither. Medicatlerminologyalsoconsistsoftechnicawl ordslilce UsefulreferenceOt xfordHandbookof ClinicaMl edicine, diverticulitisg,astroscopaen, aesthesiae,tc.w, hich arewords 7thedition,longmoreet al. that youwould expectto find only in amedicalsetting. E additionalactivity Checkup As a whole-classactivity, askstudents to r Elicitthe answerto I from the classT. henput studentsin pairsto do2.For discussthe similarities and differences questions1-3of 2,encouragestudentsto think aboutthe patient'sphysical in proceduressuch asgastroscopyin their own countries.Is the equipment andemotionalreactioncomparedto their onm.Forquestion4,encourage different? Who carries out the procedures? studentsto talk aboutproceduretshey havedone.Remindthemthat not tr Tip onlyisthis goodlanguagepracticeb, ut alsogoodpracticeforjob interviews, wherethey needto beableto givespecificexamplesoftheir own rather Remembearlwaysto keeppatient than anexamplefrom atextbook. confdi entialitiynmind.Teslltudents OF t anen .Mgpg!msmul ,,r, whentheydiscuscsasedetailsnotto usereanl ameos rsayanythin(gmedical o r o t h e r w i s ew) h i c hw o u l di d e n t i f yt h e Pronunciation patient. rcTip Wordstress BeforyeoustartthePronunciatioenxercise, a O StudentsdoI and2.Thenthey listenandchecktheir answersfor 3. checkstudentsremembewr hatismeantby a Getstudentsto identify the stresspatternsin 4 andthen decidewhich wordstresas ndknowwhatasuffixis. of the statementsin I istrue.In medicinem, anywordsthat studentswill encounterhavemorethantwo syllablesw, herethe stressusuallyfallson thethird syllablefrom the end.A usefulguideisto usethis asa'rule'and find exceptionse,.g.endoscopicW. ith wordsendingin -scopicthe stressis alwaysonthe secondsyllablefrom the end. Putstudentsin groupsof threeto discuss5.Theinstrumentsarea proctoscop/eirrokteskaupa/,colposcop/ekolpeskeopa/,ndabronchoscope /bro4keskeopc/;heckthepronunciationasstudentsaretalking.

24 Unit4 El ldditional activity Or llc 2d 3a 4b Getstudentsin groupsto list asmany 2 endoscope(o..) endoscopy(roor) endoscopic(rooo) words aspossiblewiththe suffixes 1-4 fromPronunciation l. Write their answers 4 (O..) 2 (ooor)1,3,5 (..a.) 4,6,7 on the board,and askstudentsto explain to you what eachprocedureor item is. 5 3 i strue Askfor a volunteerto type up a master list for the whole class.Examplesmight listeningI include appendectomy,tonsillectomy, lump ectomy, nep hrectomy, mastectomy, Patientcare Iaparotomy,laparoscopy, tr acheotomy, ileectomy I iliektemil,ileostomy, ileotomy, f) Studentslisten and make noteson their own for l, then comparewith a hysteroscopy, hysterectomy. partner for 2.They canstayin pairsto do 3. x Tip Or | 1 Thepatientisaskedto stopanti-acidtherapyfortwoweeks beforehandif possible. Beforethe lessonc,ollectpicturesofthe lat estinstrume ntas n d/ or old ins t r um ent s 2 Thepatientisalsoadvisedto takenil bymouthfor elghthours or askstudentseachto bringin a picture. beforethe procedureisdone,but notethat waterupto four hours Getstudentsto discustshem anddecide beforethe operation(pre-op)may beOK. what they are/ were usedfor. 3 Thepatientisadvisednotto driveif sedationisinvolved. x Tip 3 Themostcommonverbform isthe PresenSt implePassive. Fora weakerclasss, topthe recordingafter Languagsepot e a c hp i e c eo f a d v i c ea n da l l o ws t u d e n t s to comparenotesT. henplaythe whole Expaf ininginvestigationIs procedurews ith the Present r e c o r d i n gs t r a i g h t h r o u g ho n c ea g a i n . Passive A l t e r n a t i v e l yp,l a y t h er e c o r d i n ga n da s k studentsto dictatenotestoyou to writeon Gothrough the introduction asa classif studentshavenot alreadyreadit the board.Avoidcorrectingthe answersat f.orListening1,3S. tudentscanthen do l. thisstag e.An oth erw ay tdoot hisis t owr it e the a nswersonth e b oa r db, ut addingin Put studentsin pairsfor 2.They canthen do 3 on their own beforepairing somemistakes(e.gn. umber1:stopanti-acid up againfor 4 and 5.Don't let them write the answersdown for 4 sothey therapyforthreeweeksa) nd askstudentsto haveto think about the answersfor 5. l i s t e na n dc o r r e c t . Studentscando 6 onthelr own,then comparewith a partner.Theyremain tl additionalactivity in pairsfor 7.Theymay want to addto or expandthe stepsin the procedure. Ask studentsin groupsto make similar O? | 1 Theneedleisinserted(bythedoctor). statementsabout one ofthe procedures carriedout with the instruments in the 2 Thisprocedureisoftenperformedbya nurse/ nurses. picturesyou brought in for Pronunciation 3 Centlepressuriesthenappliedtothe puncturesite(bythedoctor). 6.Don't let them write the statements dor,rrni:nstead,askfor them to be written 4 Theprocedureisexplainedto the patient(bythe sister). outforhomework. 5 Theskiniscleaned(bythenurse). E ldditionalactivity 6 Thisemergencyprocedureisnot performedbydoctorswithout When students have doneIa nguagespot 3-7,askthem to tell you the verbs usedin training. order.Listthem vertically on the board, then askstudentsto make a complete 7 Thevei ni stapped(bythedoctor). sentencefor eachverb without referring to the book. 8 Generallyth, is procedureisnot performedby nurses. l n sentenceIs,3,4,5,and7the agenti sl eftout w henexpl ai ni nga procedurebecauseit isnot necessariyt:isclearfrom the context who the agentis.In2,6,and8 the agentisnecessarbyecause namingthe agentisthe purposeofthe sentence. 2le 2b 3a 4c 5d I 1 consent/obtained 5 airlblown 2 anaesthetized 6 patient/given 3 sedated 7 swallow/section 4 endoscopefadvanced 8 mucosa/ biopsied 4 1 Obtaininformedconsent. 2 Anaesthetizetphhearynuxsingaspray. 3 Sedatethpeatienttoinducedrowsiness. 4 Introducetheendoscopaendadvancietfurtherdown...

E xpl ai ni nagndreassuri ng25 5 Blowairintothe stomachviathe sidechannelin the endoscooe... 6 Givethe patienta plasticmouth guardto biteon. 7 Askthepatienttoswallowthefirstsectionofthe endoscope. 8 Biopsythe stomachmucosausingthethin'grabbingi'nstrumen.t.. 6 1,2/ 3,6,7/ 4,5,8 Note:2 and 3 occurcloselytogethera, sdo7 and4. Listening2 S ldditionalactivity Explaininggastroscop(yendoscopy) Givestudentsthe lay terms for parts of O Studentslisten and do I and 2.For2,the lay words may be phrases the body,and askthem to giveyou the rather than a singleword.Youmay needto play the recordingagain.They medicalname.Ask studentsto write canthen do3-5 in oairs thesemedicalnameson piecesof paper andtaketurns stickingthem on to a O ? I S teps1,3,2,4,8,and5. skeleton.Then askthem to write the lay terms onto the labels(orsupplythem 2l gullet 4bendy 7 lookat yourselfif necessary)M. ake surestudents distingulsh betweenfingers and toes.If 2 numb 5 (take)ati nyti ssuesampl e 8 belch you don't havea skeleton,you couldusea rough outline onthe boardor a largesheet 3 throat 6 somethi ngtohel pyourel ax 9 see of paper.Ask for a volunteerto collatethe list and type it up for the whole class. I o..: flexibleb,iopsys,edativvei,sualize 4 'l We'regoingtodosomethincgalledagastroscopy. * Tip 2 Whatwearegoingtodoistohavealookatyourgulletandyour A gastroscopiysa typeofendoscopy. stomactho seewhat'sgoingonthere. * Tip 3 Firstw, e'regoingtogiveyousomethingthoelpyourelax. Allow weakerstudentsto readtheListening scnpttogetherbeforethey do l. 4 Wearegoingtopassa bendytube,whicsnhothickerthanyour littlefingerd, ownthroughyourthroatintoyourstomach. 5 Thetubewillhaveatinycameraontheendsothatwecanlook atyour stomach. 6 We'realsogoingto blowsomeairintoyousr tomactho helpus seea bit better 7 lfweseeanythingw,hatwecandoistakeatinytissuseample. Vocabulary Reassuring Studentsdo I and 2.Youmay want to askthem to givereasonsfor their answersin t, for example,how would eachstatementmakethe patient feel, how couldit havebeensaiddifferentlv? E add:tionalactivity O.r t sentence5s and7 4 toi nn Yl y-- - smalls, c r atc hP i n P r i ck 2 1 simple*straightforward 6 +j u s t Takeone ofthe sentences1-8,for example We'rejustgoing to takesomefluidfrom 2 some-alittle 8 hardly+ [31s1y your backboneW. rite the sentenceon the 3 slightlY- a littlebit board and sayit withthe main stresson different words:j ustf,luid, your, backbone. listening3 Ask studentsto identifythe main stress and giveyou the meaning in eachcase. Emphasis Oncethey are familiar with this, ask them to work in groupsto vwite their O Studentsllsten and do I on their own, then discuss2 in pairs.Ask own sentencesusing words like simple, them what they would sayand discussthe needfor and implications of or other reassuringwords.Goround explaining detail in suchsituations.They remain in their pairsfor 3. checkingthe sentencesA. sk them to work with a partner from another group and O.r I l simple 3 just 5 ten 7 pleasant saytheir sentencesto eachother.The partner saysthe word which is being 2 just 4 tiny 6 only 8 anything stressedand explainsthe meaning. Thedoctoer mphasizethsewordsto reassurtheepatient.

25 Unit4 Possibleanswer Thedoctorcouldacknowledgethaitt isscaryandthen emphasize that it won'ttakelongorthat it isn'tasbadasit soundsT. hedoctor needsto explainthe proceduresothat he/ shecanobtaininformed consentb, ut givingallthe detailcanscarethe patient! P o s s i b l ae n s w e r Thedoctormighttalkaboutthefeelingafterwardsp, ointoutthe risksof the procedurea,ndanswerthepatient'squestions. E ldditionalactivity Languagsepot In groups,askstudentsto write another Explainingplocedureswith begoingto future sentencedescribing a different part of eachprocedurein 2,beginningWhat.... Readtheintroductionasaclassbeforestudentsdol, eitherontheirownor This canbe set ashomework. in pairst,akingturnsto saya sentencfeortheirpartnerto transformP. ut themin pairsto do2. E ldditionalactivity O.r I 1 We'regoingto removeatinypieceoftissuefromyourbowel. Usingtheir own knowledge,askgroups 2 Whatwe'rgeoingtodothenisattachtheendoftheguttoan of studentsto preparea brieftalk lasting o p e n i nigny o u rt u m m yw a l l . no more than five minutes on any aspect 3 We'regoingto takeatinypieceoftissuefromtheneckofyourwomb. ofone ofthe proceduresin 2.Theyshould 4 Whatwe'regoingtodoafterthaits(to)passthistubethrough appoint someoneto leadthe discussion theurethra. and someoneto take notes.Givethem 5 Whatwe'regoingto dothenis(to)removteheglandsinyourarmpit. about 15minutes to prepare.Then ask 6 Whathappennsextisthatatinypieceofyourlungisremove,d/ eachgroup to presenttheir talk to the Whatwearegoingtodonextis(to)removaetinypieceofyourlung. class.Allow questions and comments 7 Whathappennsextisatubeisthenpasseddown/Whatweare after eachpresentation. goingto donextisto passatubedownpast heprostateinto y o u rb l a d d e r . * Tip 8 Whathappennsextisthatwe/Whatwearegoingtodonextis (to)injecat dyeintothepancreataicndbileductssothatwecan ERCP= endoscopicretrograde s e et h e m . cholangiopancreatography 9 We'regoingtousea meshto repairthemuscle. /ke,lrendSieo,pagkridtrnegfi/ 2a7 b5 c2 d1 e3 f8 g h6 i9- * Tip Speaking I n r o l e - p l a yp r a c t i c er,e m i n ds t u d e n t st o Put studentsin pairsto do l. Encouragethem to use What .../ begoing to seekconsenwt herenecessarv and the UsefulexpressionsF.or2,askstudentsto expandthe notesinto full sentencesusing the expressionslisted.Theywill be practisingthese sentenceswith a partner in the next exercise. Studentswork in pairsfor 3,taking turns askingquestionsabout the conditionsin 2,and answeringusing the explanationsthey havedevised. Theycanremain in pairsto do4 or you coulddoit asawhole class. OF 2 1 appendicitisit:'sa conditionwheretheappendixisinflamedand it hasto beremoved. 2 Alzheimer'dsiseasei:t'sa conditionwheresomeonehasmemory lossandmoodchangesf,or whichthe causeis not known. 3 haemorrhoidectomyit:'sa procedurewherepilesaretiedorcutout. 4 diverticulitisi:t'sa conditionwheresacsor pouchesform at weak pointsin the gut.Whenthe sacsareinfectedi,nflammation occursandcausespain,diarrhoeaa, ndconstipation. 5 sigmoidoscopyi:t'sa procedurewherewe lookat the colonand take a sampleif necessary.

E xpl ai ni nagndreassuri ng27 6 anaesthesita's:a procedurwehereyouaregivena generaalnaesthettiocputyouto sleepbeforeanoperatioannd thenyoucomeroundafterit isover. { Informecdonsenist givenafterthepatienht asbeenmadeawareof whatisgoingtohappenandwhy.lmpliedconsenist notexplicitly statedbutcleafrromthepatient'asctionsfo, rexampleif,the patienot ffersyoutheirarmwhenyouareabouto takeblood. Expressevedrbacl onsenist wheninformatioanbouta procedurise explaineadndthepatienvt erballaygreetso haveit doneE. xpressed writtenconsenitswhenanextensiveexplanatioinsgivenandthe patienat ndthedoctorbothsignaconsenfot rm.Consultant consenist givenbytwoseniodr octorws herea patienltacks capacitytcoonsentthemselvfoerse, xampliencaseosf severe mentalillness. (Forfu rtherinformation,seeOHCMpTp.5545- .) x Tip Reading A goodintroductionto anyreadingexercise Getstudentsto predictthe content of the text in l, e.g.what information canbeto get studentsto predicthe about the preparation,after-effectsr,eliability,and side-effectsof contentofthe text fromtitles,headings, gastroscopymight be givento patients. picturese. tc. Studentscando 2 on their own, then form pairsfor 3 and 4. Thevshould do 4 with booksclosed. Or 2 1 Don'teat 4 somebodytoaccompanyyouhome 2 relaxed 5 notfoolproof 3 operatemachinery 6 a mildsorethroat I 1 Whatdoyou needto dofor 4-6 hoursbeforetheprocedure? 2 Howwill the sedativemakeyoufeel? 3 Whatshouldyou not dofor 24hoursafterthesedative? 4 Whatdoyou needaftertheoperation? 5 How successfualretheresultsofthetest? 6 What do somepeoplehaveafterwards? Vocabulary Explainingcomplicationasndleassuringthe patient Studentscando I and 2 in pairs. O? llusually 3never 5 always 2 often 4 rarelv 6 sometimes O r d e ro f f r e q u e n c yn:e v e rr,a r e l ys,o m e t i m e so,f t e n ,u s u a l l ya,l w a y s 2 rarelysreldoma,lmostnevern, otoften sometimeosc: casionalnlyo,wandthen often:frequentlyr,egularly usuaIly:typicaIly,habituaIly,generaIly,commonly E additionalactivity Listening4 At the end ofthis section,askstudentsin Discussincgomplications pairsto taketurns selectinga procedure and describingthe possiblecomplications O Studentscando t in pairs.Theylisten and do 2-4 on their own. PIaythe to a patient.Ask them to describetwo or recordingagain if necessaryT. heythen listen againto do 5. three procedureseach.

28 Unit4 * Tip Or 21 amildsorethroat lf studentsneedpromptingfor l, referthem 2 you mayfeela bittiredafterwards to the lastsectionofthe Readni gtext on p.33. 3 [somepeoplecanget]a chestinfectionor pneumonia 4 somebleedingor infectionin the gut * Tip 5 [i t]canal sopuncturethe gul l etor stomach W hilestud en tsareta lk ingaboutm edic al mat te rsl,iste nan dusethisasa lear ning I Sothepatientisawareofthembeforehesignstheconsentform. opportunityto buildyour understandingof thesubiect. I occasi onal-l Yonthe oddoccasi on automat i cal l y- n ec e ss alryi s e l d o m+ rar el y 5 I I canassureyouthat in mostcasesthe procedureisproblem-free. 2 B utrememberthids oesnotmeanthatyouw i l l necessarigl ye t theseasw el l . 3 ...butthis happensveryrarely. Speaking Studentscando I and 2 on their own or in pairs.Getthem to discuss3with a partner.Thenaskfor suggestionsfrom the whole classT. heycanremain in pairsto do4. Orlalb6cld2e5f4 2 1b 2e 3c/f 4f/ c 5a 6d { a constipationi,nfection b abdominadl iscomfortp, erforatlon c pain,bleeding d headachen,auseap, aralysis e (dependi ngonthedrugs):vomi ti nnga/useah,ai rl oss f pai n,bl eedi ng,col l apsleudng g pancreatitisb,leeding S ldditionalactivity Proiect Collecta range of pictures showing Youcansuggeststudentsuseother websitesthey know of and suggest different emotions to bring to the class. other proceduresfor them to investigate,for example,colonoscopyor Putthe students into groups and give bronchoscopyY. oucould askthem to briefly presenttheir findlngs to the eachgrouptwo or three different pictures. classusing someof the languagelearnt in this unit, asif explaining the Ask them to discussthe emotionsbeing procedureto a patient,i.e.gentle,reassuring,etc. shown and how they would dealwith them. Ask the groupsto presenttheir Writing picturesto the ciassand describehow they would dealwith eachsituation.Ask Studentscando I and 2 in pairs and 3 and 4 on their own. For4, askthem to them to taik about visual cuesin their uselayterms and reassuringlanguage. own cultures/ countries. Put studentsin pairsfor 5,with one of them acting asthe patient. E ldditionalactivity O ; l A B G:bl eedi ngh,aematomaa,rteri al damagaendperi pheral Youcanaskstudentsto explain the ischaemiain, fectionp, ain,localtendon/ nervechange complicationsto you in lay terms. lV injectionsa: naphylaxisd,rugoverdoselo, calirritation, thrombophlebitisle, akageof drugfromtissuedcannulah, aematoma * Tip ChecklistK, eywords lf st ude ntsarerelu cta nt t o' acat oar t ' in role-playsre, mindthemthat it isbetterto Seesuggestionson p.5.Gothroughthe list of words to checkstudents' oractisenow andmakemistakeson each pronunciation and understanding.Remind studentsto transfer useful ot her th anon a rea lp atient ! words and phrasesto their vocabularynotebooks.

Unit5 29 Background Explanationsabout benefitsand sideeffectshaveto befinely balancedsothat the patient canmake an Theadministration of drugsrequiresattention on a informed choiceabout whether or not they will take number of levels.Firstof all,there is a needfor accuracy the medication.If patientsunderstandthe benefitsto about the dosage(for children and adults)and the themselveswithout being frightened offby the side frequencyand the method of delivery.Which patients effects,they may be more inclined to take the medication. shouldbegivena drug andwhetherthey haveany Soit is crucialfor doctorsto know how to communicate allergiesalsoneedsto betakeninto considerationT.here effectivelyin this area. aresafetyconsiderationsabout drug dependencyand possibleharm,sodoctorsneedto know when to seek Thereare,of course,other factorswhich canaffect adviceabout the administration of drugs,especiallyif whether a patient will comply with a prescription,such they areunfamiliar with them. asthe patient'ssituation or ability to follow a regimen. Theelderly,for example,may find compliancedifficult. Another important aspectof drug treatment is Thetiming of the dosesmay alsoaffectthe patient compliance,or concordanceI.t is onething for a doctoror beneficiallyor adversely- seethe Readfngtext on p.42. nurseto prescribea medicatlon,and anotherthing for the patient to comply with the advicegiven.Thefirst factor Lastly,safetyis of coursea major considerationwhen which hasa bearing on complianceis the way in which administering medication,soany mistakes(orpotential the doctorpresentsthe benefitsand sideeffectsof any mistakes),howeverminor, needto be carefullymonitored. medicationto the patient. Usefulreference:OxJordHandbookfor the Foundation Programme,2ndedition,Hurley et al. S ldditionalactivity C h e c ku p Checkthe pronunciationand stressofthe Studentsdo I on their own. Note that aspirin is considereda cardiovascular medications; drug,which may be a point for discussionL. etthem do 2 in pairs.They can a paracetamo/lpcrr si:telnol/ discusslasaclass. b qyclizine/'sarklrzi:nr c salbutamol/siel'bju:tanrnl/ '::,Studentsdiscuss4 in pairsor groups.Pointsto consider:Iossof income for d aspirin/'iesprrn/ drug manufacturers;costof researchingdrugscouldleadto increasedcost e amoxiciliin/a,moksr'srlrn/ to patient or reductionin future researchfor other drugs;resultingbenefits/ f ranitidine/rr'nrtrdi:n/ detrimentsto poor/ wealthy countries. g chlorphenamine/kb:'fenemi:n/ h diazepam/dar'ezapem/ Or t le 2ald 3b 4h 5f 6b/g 7d 8c 2 a rel i evepai n Orthe categories: b reducenauseaandvomiting 1 antibiotic/,&ntibar'otrk/ c w i denthe bronchi 2 analgesic,aenel'd3i:zrk d relievepain;thin the blood/ helpthe bloodflow moreeasilya, nd 3 antiemetic/,anti:e'metrk/ help preventheartattacks 4 sedatlve/'sedatrvh/,ypnotic /hrp'notrk/ e fight infection 5 gastroin!99tinal/,grstraorn'testrnl/ f treatgastro-oesophageraelfluxdisease 6 antih:igtamine/,tenti:'hrstami:n/ g treat reactiontso drugsor anaphylactischock 7 cardiov4gcula/r,ko:diaii'veskjala/ h makepatientslessagitated 8 respiratory/'resprrtrrie, s'prratri/ Patientcare E ndditionalactivity StudentsdiscussI and 2 in pairsor groups.Ask eachgroup to make a list of Dividethe classinto two groupsand turn all the guidelineson largesheetsof paperor flipcharts,or the computer. the discussionon genericforms of drugs into a debate,for and against.

30 Unit5 Or | 1 Thedosesmaybedifferentforchildrenandadults.lfyouare unfamiliar with a drug,you maygivethe wrongdose. 2 lt isimportantnotto usea drugifyou areunsureaboutanything. Youmaygivethe wrongdosageA. seniorcolleaguceanadviseyou. 3 Checkthetypeofthe reactione, .g.trueallergy,toxiecffect, predictableadversereactioni,diosyncratirceactionl.f the reactionismild,it ispossibleyoumaydenyapatienta life-saving drug,e.g.penicillinC. onverselgyi,vinga drugto whicha patient isallergiccancauseanaphylaxisa,taxiae, tc.Refetro the dictum primum nonnocere(=First,do no harm)first advocatedby Hippocratese;xaminethe balancebetweenthe seriousnesosf the complaintandthe degreeof allergicreaction. 4 Thepatientmight not understandhowtotakethe medication; for exampleh, e/ shecouldtakeall of the tabletsyou prescribaet oneti me. 5 lt is importantnotto createdependenceodnrugs.Therme aybe homeremediesavailabled; rugsareexpensivea,ndin somecases adviceaboutlifestylemayworkjust aswell. (OtheranswersarepossibleS. eeOHCMTp.8.) 2 Otherpossi blgeui del i nems i ghti ncl ude: . di sti ngui shbetw eenmi norandmaj ori l l nesses . decidewhetheryourprescriptionmaybemisused . listthe benefitss, ide-effectsa,ndcontraindicationosfthe medication . tryto ensurethatthepatientunderstandsthebenefitsandside effectssothat theywill agreeto takethe medicationandthen a c t u a l l y t a k ei t . Vocabulary S ndditionalactivity Abbreviations .A.skstudents to give you additional Studentsdo I on their own, then comparewith a partner.Theycanthen abbreviations to write on the board and remain in pairsfor 2 and f. then askthem to givethe meaning.Try to limit theseto prescribingmedication. Or l1c(peros) 4g(omnidie) 7 a(omnimane) 2 f(prorenata) 5 e 3 d(statim) 6b 2 on(omnni octe)a:t night bd (bisdie):twicea day t d s( t e rd i es u m e n d u st o) :b et a k e nt h r e et i m e sa d a y q d s( q u a t edri es u m e n d u s ) :bt eot a k e nf o u rt i m e sa d a y 4 - 6 h :e v e r y 4 - 6h o u r s 8 h :e v e r ye i g h th o u r s 1-4h:everyl*4 hours l V :i n t r a v e n o u s l M :i n t r a m u s c u l a r 5 C :s u b c u t a n e o u s PR(perrectum)b:ytherectum INH:byinhalation NEBb: ynebuliser F8:mlcrogram m g :m i l l i g r a m m l :m i l l i l i t r e paracetamoCl: ivethe patient1gramof paracetamofol urtimesa day,bymouth,upto a maximumof 4 grams. loperamideC: ivethe patient4 milligramsof loperamideasrequired, bymouth,upto a maximumof 16milligrams. ranitidineC: ivethe patient150milligramsof ranitidinetwicea day, bymouth,upto a maximumof 300milligrams. atorvastatinC: ivethe patient10milligramsof atorvastatinoncea day,bymouth,upto a maximumof 80 milligrams.

DeaIingwith medication3 l ListeningI A drugchart C) irnatesurestudentsunderstandthechartin l. TheythenIistenanddo2. h I 1 Tramadol 64h 215/10/09 1 prn 3tM 8rM 413/1O/O9 9 SNBond 5 r1.30 * Tip Speaking Whilestudentsaredoingthe role-play, PutstudentsintoA / BpairsY. oumaywantto puttheAsandBsin groups watchdiscreetlyb, ut don't interfere.Make firstto studytherole-playcardsC. heckthattheyunderstandtheprocedure notesaboutlanguagep, ronunciation, andall the answers. bodylanguagee,tc.Askstudentsto give feedba cktoth eior a rtne randr em indt hem It'smyjob w hythisisimp orta nt-to helpunder s t and t h e i r s t r e n g t h sa n dw e a k n e s s e isn, o r d e r t o Put studentsin pairsto do l, then in groupsto discuss2.Suggestdifferent helpthem improveS. tudentsmaywantto angles,e.g.safetyof the patient,up-to-dateknowledge,misuseof dotherole-playagain. medication.Ask studentshow they might feel if they were patients.Also Discustshe role-plawy ith the classasa point out the availability of drugs on the internet. whole.Youcould invitestudentsto dothe exerciswe ith you-this benefitsyou both, Still in their groups,studentsdiscuss3.Askthem what they think about b u i l d i n gu p y o u rc o n f i d e n c ae n d k n o w l e d g e other health professionalssuchasnurses,pharmacists,and dentistsbeing whilstallowingthe studentsto interact ableto prescribemedication. with a morefluentsoeaker. Or t't yes 2 acuteandchronic 3 individualizceadre 4 Tohelpimprovceoncordance A masteri'nscardiovascumlaerdicinaendtraininginthediagnosis a n dm a n a g e m eonftc o m m o nm e d i c aclo n d i t i o ni nst h i ss p e c i a l t y . Sheprovidems uchofthesamebasicn,on-emergenccayreas physicians. rcTip listening2 Ml = myocardiainl farction Benefitsand sideeffects O pr.tstudentsin pairsto doL Theythenlistenanddo2 ontheirown, comparingwith apartnerfor 3. O ror 4 and5,studentslistenandcheckanswersandcomparethemwith theListeningscript.Theycanwork in pairsto do6. Or 2 1 verygoodprogress/letyougohome 2 aboutyoumr edication 3 feelfreetodoso 4 bymouthonceadayaftera mealfromnowon 5 itthinstheblood/ helpstopreventfurthearttacks 6 asyoumaynotgetanyofthem 7 anupsest tomac/hthe stoolsof somepeopledarkandsmelly/ bleedin(ge.gn. osebleedso)rshortnesosf breath

32 Unit5 * Tip Speaking Seta time limitof 2-3 minutesforthe role- * Studentsworkinpairstodol-4. playA. fterwardsd,iscussit with the whole classl,ookingat it firstfrom the patient's O'r llYes 2Yes 3Yes 4Yes pointof view(i.ew. hy the patientmight behavein a certainway),andthen howthe 2 Yest,he doctordoesinvolvethe patientin makingdecisionas bout doctorhasto dealwiththis takingthe medicationbyaskingthe followingquestions/:s eveything OKsofar?/OK.Wouldyou liketo go through everything andexplainit to me? Thisisto ensurethe patienthasunderstoodandthat theyare happyw i th taki ngthemedi cati onw,hi chw i l l i ncreastehe l i kel i hood of compliance. I Possiblaenswers Thedoctorcould haveaskedhowthe patientfelt abouttakingthe medicationw; hetherhewould beableto takeit everyday;whether hewasableto keepto a routinein takingmedicationw; hetherhe alwaystookallthe medicationgivento him. languagespot Phrasalverbs Readthe introduction asa classbeforestudentsdo the exercise. O'r 1 Thedoctorpointed(out)afew benefitsandafew side-effect(sout). 2 Youcouldkeepa pillboxwith the daysof the weekon it andtake (out)the ta blets(out)eachday. 3 Writing(out)a prescription(out)requiresgreatcare. 4 Don'tforgetto lookat the instructionsonthe label. 5 Trytogetintoa routinefortakingmedicationifyou can. 6 Getin touchwith the hospitalimmediatelyif anythingchanges. 7 lt worksbycutting(down)theworkloadof the heart(down). Languagsepot EIldditionalactivity Explainingsideeffects.can/ may Ask studentsto selectother drugsthat Readtheintroduction asa classbeforestudentscompleteI ontheir ornm. they arefamiliar with and explain the Thenform pairsto do 2. benefits and sideeffects. OF | 1 will 3 maynot 5 can H ldditionalactivity 2 probably 4 possibility 6 may Your students may want to discussother Speaking drugs suchasdiuretics,vasodilatorso, r ACEinhibitors. s Put studentsin groupsofthree to discussl. x Tip * For2 and l, asktwo of the studentsin the group to taketurns explaining the medicationto eachother while the third givesfeedback. lfnecessaryre, ferthemto p.34fora review o f a d v e r b so f f r e q u e n c y(.S e eO H C M T For4, ifyou haveaccessto video recordingequipment,let studentsrecord pp.100-11f0or listsof benefitsandside their dialoguein 2 and useit asfeedbackto help them improve. effects.)

D eal i ngw i th medi cati on33 Reading a Studentsdo I on their own, then work in groupsfor 2.Encouragethem to givetheir own opinions and reactionto the statistics,and to searchfor more of their own if possible.Theycanuseexamplesfrom their own experience, whilst always maintaining patient confidentiality. O r 1 1 Fewersideeffectsandimprovedconveniencoef use 2 Medicinesprescribefdor preventivepurposes J Youngepr eople 4 A combineduseof educativep, racticala,ndemotionallyand behaviouraIly supportiveinterventions Meeti ngpati entsi'ndi vi duanl eedsandpri ori ti es 6 Informedchoices 7 l mprovi ngsel f-managemesnkt i l l sandcompl i ancien medi ci ne t a k in g Proiect Ask studentsto searchfor the information on the web in classor at home, in particular reiating to how incidentsof drugsbeing prescribedwrongly aredealtwith. Thequestionscanbe usedfor discussionor aspart of their research. * Tip Writing T hisisa se nsitiviessu ea, ss t udent sm aynot Studentsdo l-3 on their own, then discuss4 and 5 in groups.In 4, you could likeadm ittin gto ma kin gm is t ak esit: m ay highiight the patient'ssafetyand the needto beconstantlyvigilant. For5, seemt o in dicatewe akne sasnda lac kof get studentsto discussthe relationshipbetweenmistakesin medicine and professionalism.Ymouayneedto reassure culture. studentsthat in a patient-centreadpproach to medicine ,thoepp ositeist r ue. Or 3 1 Thepatientwasprescribefdlumazeni2l 00mcglVupto 1mg, despitethe patientbeingepileptic(.Thiswasstatedon the drug * Tip chart.)ThiswasnotedbyDr DuncanT. hepatientdid nottake flumazenilT. heteamdoctorresponsiblweascontactedandan A microgram(pg)is1/1,0OO,0o0f0a gram, alternativedrugwasprescrbi ed. or 1/1, 00o0f a milligra m.Thaebbr ev iat ion ltgisoftenusedin scientificliterature, 2 Thepatientwas prescribedtetracycline25O-5O0/ 6h despite but it isrecommendetdhat hospitalsdo beingphotosensitive(T. hiswasstatedonthe drugchart.)T. his not usethisabbreviatioinn handwritten w asnotedbythepharmaci st.Thpeati entdi dnottakethe ordersdueto the riskthat the Creekletter t e t r a c y c l i n eT.h et e a m d o c t o rr e s p o n s i b lwe a sc o n t a c t e da n d an prcouldbemistakenfor an m,resultingin a l t e r n a t i v ed r u gw a s p r e s c r i b e d . a thousandfoldoverdoseT.heabbreviation mcgis recommendedinstead. ChecklistK, eywords Seesuggestionson p.5.Gothroughthe list of words to checkstudents' pronunciation and understandlng.Remindstudentsto transfer useful words and phrasesto their vocabularynotebooks.

34 Unit6 Background example,in encouraginga patient to exerciseby getting off abusonestopearlywhen goingto work if the patient People'slifestylescanhavea hugeimpact on their health. doesnot usebusesor no busesgo near their work. Patients From a lifestylepoint of view,the major health issuesare might then begin to losefaith in the doctor'sattempts obesity,smoking,alcohol,stress,and lackof exerciseI.f we to helpthem.Sothe optionsneedto be patient-centred, think from our own personalexperiencec, hangingthe taking into accountthe patient'sway of life.Another way peoplebehaveis far from easy. strategyis to involvepatientsby finding out what they think they can do and / or if what you suggestwould work Any attempt at modulating patients'behaviouris a for them, and if not,whether they couldadaptit. matter of negotiation,using strategiesthat involvethe patientsthemselves.Thisis achievednot through forcing Effectivenegotiation on the part of a doctoror nursealso one'sown opinion on the patient or orderingthem to requiressympathy (feelingfor the patlent from your do somethingby usingshould/ oughtto / musl but knowledgeof other people'sexperience)and empathy by coaxingand encouragingpatients,and presenting (feelingthat is basedon personalexperience)T. he optionsfrom which the patient is likelyto makea choice. distinction betweentheseis often biurred.Careneedsto be taken not to makethe empathy too personalto oneself, Another issue,of course,is whether the patient wants to by giving examplesfrom one'sown life which may draw makethe choicesbeing offered.It is worth remembering attention awayfrom the patient. that if too many options arepresented,the patient may be paralysedby indecision. Usefulreference OxfordHandbookof GeneralPractice, 2ndedition,Simonet ai. Choicesneedto be presentedin a way that fits an individual patient'slifestyle.Thereis no point,for E ndditionalactivity Checkup Youcanusethe photographsasa resource e Putstudentsin pairsto do l-5. for student presentationse: achgroup canchoosea photographand do a mlni- O'r I a An officejob canleadto a sedentarylifestyleandsnackingon presentationon people'sattitudesand unh e al t h y f o o d s . lifestyles. b Buyinghealthyfood x Tip c S moki nganddri nki ngal cohol d Eatingfattyfood I t canb eh elp fultoseta t im e lim it f orany e Busyandstressed discussiosnu chastha t in l, ands eta t ar get f Healthyactivitiesandexercise fort he nu mbe rofa nswer sv ouex oec t 21f 2a 3b 4d 5e 6c studentsto comeuowith. 3 Thestatementsin 1and3 showa oositiveattitude. I Peopleleadinga sedentarylifestylee, atingtoomanyfattyfoods andsmokingmightbepredisposetdo diabetesh, ypertension, heart diseasea,nd cancer.lt isverydifficult to changepeople's lifestylehabitsbecauseof theirdailyroutine,pressurferom work, time managementc,ost,paceof life,changesin work practices to a moresedentarylifestylewith advanceisn technologya,n increasein wealth,andthe availabilityof moreprocessefdood. Howevelthesefactorsvaryfrom countryto country 5 Inthe doctor/ patientconsultation,thbeestwaysmightinclude engagi ngthe pati enti n hel pi ngto deci dew hatto do;presenting the patientwith optionsto choosefrom; makingsuggestions that fit the patient'slifestyleu; singlanguagewhichencourages

L i f e s t y l e3 5 the patientratherthan givesorderst;akingintoaccounthe patient'sfamilyandfinanciasl ituationandpasthistory;advising moderateexercise/ lifestylechangesandgraduatedincreases; andprescribinegxerciseA.t a governmen/t communitylevel, m o r el e i s u r ec e n t r e sc o u l db e b u i l t ;s p o r ta n d e x e r c i s ec o u l db e encourageidn schoolsa; ndtransportsystemscouldbetter e ncouragceycl i ngor w al ki ng. ListeningI E additionalactivity Familyhistoryandsocialhistory If possiblek, eepan eiectronicmasterlist 6) Readthrough the introduction asa classbeforeyou play the recordrng of questionsand addto it with students' for l. Studentswill hearthree short conversationsand answerthe ouestion answers.Givecopiesto the students. in eachcase. O flay the recordingagainfor 2 then askstudentsto work in pairsfor 3 and makefull questionsfrom their notes.If necessaryshow them the questionsfrom the Iistening script. Studentsremain in their pairsfor 4-7. In 7 they practiseaskingeach other questionsaboutthe family / socialtopicsdiscussedin 5.Allow for variationsin the topicsif they areappropriate,and remind studentsthey don't haveto answerthe questionstruthfully for this roleplay.Theycan evenadopt charactersif theywish. Or 115 2F 35 { 1 openquestionusingWhatoboutfollowedbythe PresenSt imple; questionwith modalverbcan. 2 P resenSt i mpl eP; resenSt i mpl e 3 PresenSt imple;PresenSt imple;PastSimpleP; resenPt erfect; P asSt i mol e I Possiblqeuestionasbouthome:Wheredoyoulive?Doyouliveonyour own?Whattypeof accommodatiodnoyouhave?Arethereanystairs? PossiblqeuestionsaboutoccupationA: reyouworking?Whatdo youdofor a living?What'syouroccupation/jobH? aveyoueverbeen unemployedH? ow longhaveyoubeenunemployed? Possi blqeuesti onas bouthobbi esD: oyouhaveanyhobbi es/l ei sur e activitiesW? hatdoyoudoto relax? PossibqleuestionasboutalcoholD: oyoudrinkalcoholH? owmanyunits? Whatdoyoudrink? P o s s i b lqeu e s t i o n sa b o u tm o n e yp r o b l e m sl:s e v e r y t h i n gO Ka t home?Doyou haveanyfinanciadl ifficulties? Possi blqeuesti onas boutchangesi n habi ts:H aveyouchanged anythinginyour liferecentlyA? reyoudoinganythingdifferently from before? 6 Theadvicemight beannoyingorworryingif it doesnottakeinto accounthe patient'sfamilysituationo, r his/herlivingorwork conditionsI.nconversatio1n,it mightnotworkto advisethe patient to relaxmoreif the doctorisunawareof the work situationI.n conversatio2n,the doctormightappeardismissivoef a patient's concernasboutl ungcanceirf thefami l yhi storyi snottakeni nto considerationIn. conversatio3n,the doctormight not be sympatheticor empatheticto the patient'sattemptsat givingup smokingif he/ shedoesn'tknowhow longthey'vebeensmoking andhow manytimesthey'vetriedto giveup.

36 Unit6 El Additionalactivity Speaking Studentscanusethe grid to askother Ask studentsto do I on their own.If they want to,Iet them rank all of the studentsin the classto rank habitsthev items.Thenget them to comparetheir answerswith a partner for 2. find difficult to change. For3,allow studentsto modifu the statementsand addtheir own answers if theywant. Encouragediscussionof4 in pairsor groups,especiallyabout the effectof bodylanguagepresentedby patients,and oftheir own body language. In 5,get studentsto asktheir partnersto explain the reasonsfor their answersto I and 3,using the tJsefuel xpressionlsisted.Youcanfollow this with a classor group discussionof 6. OF 6 Beliefsp: atientsmayhavecertainbeliefsthat arerelatedto theirown knowledge(frombookst,he internet,leafletse; tc.)and theirown experiencoef theirfamily,peersc, ommunityandculture generallyT.hesemaybedifficult for patients(andthereforethe d o c t o r ) t oc h a l l e n g e . Emotionsp: atientsmaynot likebeing'toldwhat to do'andrebel againstchangeO. rthey mayfind it verydifficultto stopthemselves from doingwhat theyaredoing,asthey relyon it for emotionaI comfort. Willingnessp: atientsmaynot wantto changeasthey maynot seea needto changeU. nlesstheywant to change,it is unlikelythey willdoso. E additionalactivity Vocabulary Studentscanmake questionsto askeach Languagefor exercise other using the phrasesin l: Haveyou taken up anyphysical activity recently?Do Studentsmatch the verbsto the noun phrasesfor l, then addthem to the you think it'simportant to take up some appropriatesentencesin 2. form oJphysical activity? For3,put studentsinto groupsto decidewhich arethe three most important * Tip ideasin 2,giving reasonsfor their choicesT. henfor 4, askthem to give more specificexamplesfor eachof the generalideasin 2,using th e Useful Civefeedbackto the classontheirrole- phrases.Youcouldgivethe following example:Onceyou settleinto a new playso, r askstudentsto givefeedbackto routine,you'IIbeginto noticesomeimprovement.Ifyou walk a shortdistance eachother.Aspartofthe feedbacklookat regularly,after awhileyou'IIbe abletowalkfaster and maybestartrunning. the scenariofromboththe oatient'sand the doctor'spointof view. Studentswork in pairsfor 5,taking turns asdoctor and patient. Thedoctor should practiseadvisingthe patient, explaining the risks and benefits of * Tip exerciseT. hepatient canusethe phrasesinSpeakingl asreasonsnot to take the doctor'sadvice.Possiblerisksinclude:the dangersof moving from a E a c ht i m e t h e ys p e ak ,e n c o ur a g es t u d e n t s sedentarylifestyle to strenuousactivity, orthe risk of injury. Possiblebenefits to expandon what theysaybygiving include better mood, improved health in general,reducedweight, greater e x a m p l e sa n d r e a s o n sT.oi l l u s t r a t et h i s , mobility, and reducedrisk of diseaseslinked to inactivity and obesity. givethem anexampleof a causeor effect ofstressu, singonlygeneraildeasT. henuse Or I la 2b 3a 4b 5a 6b 7a t he sa meide asa ga inb, u t t his t im eex pand 2 1 settleintoanewroutine t h e m ,g i v i n gs p e c i f i ce x a m p l e sa n d r e a s o n s . 2 makeminorchanges Askthe classwhichversioniseasierto 3 stickto a new regime un d e r s t an d . 4 deviseyouor wn exerciseprogramme 5 increasetheamountofexerciseyoduo gradually 6 takeup somephysicaal ctivity 7 Kickingold habits

In groupor classdiscussionlse,arnto stand Speaking backandallowstudentsto speak freelyand makemistakes-thisispartof the learning Ask students to work in groups to discussthe quotation in l, which comes processN. otedown mistakesasyoulisten from pp.94-95inthe OxfordHandbookof GeneralPractices,econdedition. andcorrectthem with the wholeclassat Youcould combine this with 2 and 3,and then ask groupsto report back to the end(notidentifyingindividualsa!)s the whole class.Youcould start the discussionoffby encouragingstudents constructivefeedback. to talk about the nature of the work of GPs:the workload, the hours, patients' attitudes, and the concentration required. In 4, askstudents to give information about organizations they know of which help doctors.If there are no organizations,you could have a class discussionabout whether they think there shouldbe. Or 2 Possiblecausesof stressi,solation,insecurityo, verbookingpatients, time managementf,astconsultationratesc, hangingdemands suchasnewtechnology/ increasedbureaucrac/yadministration, difficult Datients. Possibleeffectson ... - a doctor'sclinicalwork:taking short-cuts -the generalpractice:mistakesa, rguments,presgureon colleagues - homelife:problemsin familyrelationships. I Possiblseolutionst:akingexercisee,njoyinghobbiest,akinga holidaya, skingfriends/ colleaguefsor advicet,akingtime ofi askingto havethe workloadreduced. E ndditionalactivity Writing Youcanhave a debate about the long Helpwith stress hours that doctorswork. Divide the class into two groups:one in favour of working Put students in groupsfor I and 2 - you could combine thesetwo situations long hours to meet demands and gain in the samediscussionI.f studentsdon't want to talk about their own experience,and one against.Give each experiencesa, skthem to talk about a colleagueb, ut remind them to group time to prepare,limit the debateto keepany identities confidential.Studentsshoulddescribetheir personal a fixed time, and give a free vote. strategiesfor dealingwith stressY. oucouldencouragethem to talk about both mental and physicalapproaches. * Tip For3,askstudentsto write a reply email on their own. Theyshouldinclude Aswith anyactivitywhichinvolvestudent someof the following points:sympathy for their colleague;understanding discussionu,sethisasa wayof buildingup of the situation and his difficulties;a recommendationof somethingthat yourown knowledgeto usewith the next might help and why; an example of a similar situation they have dealt with, c las s . what strategiesthey used,and what the results were. Write these items as a checkliston the boardfor studentsto include in their replies. Listening2 Beingsympathetic Q nefore playing the recording in l, askstudents to considerthe statements and decidewhat the doctor and patient aretalking about.Then askstudents to listen and decidewhich aretrue, and comparetheir answers with a partner. They canthen answer 2 and l. In 4, studentsin pairstake turns to role-playthe doctorand patient,using the BMI chartto helpthem explain. O? | Thepatientistalkingtohisdoctoraboutdietingandexercise. 1T 2T 3T 4T 5F 6F 7F 2 Sensitive

38 Unit6 3 Not always.Thepatientmaynot bewillingtoacceptthechanges, andtheremaybesomeunderlyingemotionalreasonsthat stop the patientfrom listeningto the advice. languagespot Encouraginpgatientsandmakingsuggestions Readthrough the introduction asa classbeforestudentsdo t. Put studentsinto groupsto discuss2.Thenfor 3 they canwork in pairsto practisegivlng the encouragementthey havediscussedY. oucouldsuggest they usephrasessuchas: Tryto avoid... Whatabouttryingto ... I f y o uc a n. . . Youmightliketo try ,.. Youcouldhave...instead H a v ey o u e v e rt h o u g h to f . . . I t ' sb e t t e rt o . . .r a t h e rt h a n I n s t e a do f . . . Or | 1 Haveyouthoughtoftryingtotakeiteasyforacoupleof d a y sa n dh a v i n ga c o u p l eo f d a y so f f ? 2 lt'sbettetro stepuptheexercisveerygradually. 3 Youcouldspendmoretimoenaphysicallydemandingofofermxercise. 4 Insteaodfeatingredmeate, atwhitemeatorfishwhereyoucan. 5 Tryanddosomethinwghichwillgetyououtandabout. 6 Youmight(liketo)tryhavingabalancerdatherthanacrashdiet. E additionalactivity Patientcare Ask studentsto make more'barrier' Ask studentsto do l-5 in pairs.For4, you could prompt them with someof sentencesa, sin 4.Encouragethem to use the following phrasesif necessaryto help them developtheir strategies: examplesfrom their own experience. But haveyou thought of the advantagesto giving up? Haveyouthought of cutting downgradually? E ldditionalactivity Tryingto makechangeslikethisseemsdifficult atfirst, but haveyou thought abouthowit might helpyou? Aswell ashaving studentsdo5 in pairs, It'snot easyto changethings,but howdoyou think you coulddo it? you can askfor volunteersto do the role- YesI.t canbedifficult, but what about trying tofit it intoyour daily routine? play in front of the class,possiblywith you aspatient.Choosea different pair As a round-up to theseexercisesa, skstudentsto discuss6 in groupsor as eachtime you do this. Giveconstructive a whole class.Encouragestudentsto comeup with suggestionsfrom their feedbackand always bear in mind that own exDerience. at first 'performing'in front of otherscan affect fluency. Or I I sympathy 2 empathy 3 empathy 4 sympathy 2 1 empathetic sympathetic 5 empathetic 2 sympathetic 4 sympathetic 1a n d5a r ev e r yp e r s o n a l . 3 ThepersonasltatementasrenotappropriatTeh. epatienmt aynot necessarrileyspontdo them.In'1t,hereasocnouldsimplybeleftoff orthedoctocr ouldaddbutweoreheretohelp.ln5,thestatement couldberephrasedI k: nowit canbehardbecausIehaveseenmany patientsin thesamesituation. tl i Iappreciatiet'sdifficult,buthaveyouthoughtoftheadvantages to givingup?Youcouldf,orexampletr,ytoreduciet graduallsya, y bydrinkingmoreslowlyordrinkinghalfpints/ smallegrlasseosf wineA. ndthencomebacktoseemeintwoweekst'imetosee h o w y o ua r eg e t t i n go n .H o wd o e st h a ts o u n d/?D o y o ut h i n k t h a tw i l lw o r kf o r y o u ?

L i f e s t y l e3 9 2 Doyouwanttogiveup?Doyourfamilywantyotougiveup? Civingupsmokingisnteasyb,uthaveyotuhoughot f cutting downgraduallyF?orexampleif,youhavefoundit difficulto stop w i t h o u ta n yh e l p , y ocua nt r y c u t t i n gd o w no n ec i g a r e t taed a y f o ra w e e ka n ds oo n .Y o uc o u l ds e t y o u r s e l f t a r g teot sa c h i e vaen d p u t t h em o n e y y osua v ei n t oaj a r . 3 Tryingtomakechangelsikethis,atfirst,seemdsifficultb, uthave youthoughat bouthowit mighthelpyou?Youmightliketo try makingyoursestlfopataspecifitcimeeachdays, ay5/ 6 pm,and nottakeanyworkhomeW. ouldyoubeableto dothis?/ Wouldthis workforyoud, oyouthink?I Orwouldyoufindthisdifficulttodo? 4 lt'snoteasytochangethingbsu, thowdoyouthinkyoucould doit?Thetemptatiotno eatisallaroundus.Whatthingdsoyou thinkyoucouldcutouteachday?/ Haveyotuhoughat bouwt hat t h i n g sy o uc o u l dc u to u te a c hd a y ? 5 Yesl.t canbedifficultb, utwhatabouttryingtofit intoyour dailyroutineB? yclimbingstairswherepossibloerwalkingpartof thewayhome?Smalcl hangelsikethiscanmakeabigdifference. l st h e r ea n y t h i n ge l s e y o tuh i n ky o uc o u l dd o ? Speaking Put studentsinto groupsofthree for l-4. Youcando 5 asa classor group discussion. Forl, encouragestudentsto think of all the languageand strategiesthey haveusedsofar inthis unit, andto cometo an agreement. In 2,possiblecriteriato choosefrom might be sympathy,empathy, negotiation,monitoring progressa, ccuracyf,luency,encouragement,and motivation. Reading Beforestudentsreadthe text, askthem to work on their own to complete the sentencesin I in their own words.Thevthen readthe text and compare their answersfor 2. Forthe discussionin 3,studentsin pairscan considerother possible influencessuchasthe media,teachers/ schoolsp, oliticians,health campaigns,the government,and parents. Or t I an energyimbalancewhereenergyintakeexceedes nergy e x p e n d e do v e r t i m e 2 increasecdonsumptionoffoodswith highlevelsof sugarand saturatedfats,aswellasa reductionin physicaal ctivity 3 increasingtheriskofchronicillnessesuchasdiabetes, c a r d i o v a s c u l ad ri s e a s ea, n d s o m ec a n c e r s 4 $ 21bi l l i oni n 2005 5 Eachofthe NationalHealthSurveysconductesdince1995has reported...for malesthan forfemales 5 the managemenot f healthybodyweightin adults

4O Unit6 Pronunciation Wordstressin nounphrases O elay the recording in I so students can identify where the stressfalls in eachnoun phrase.Then askstudentsto work in pairsto do 2-4, scanning the previous Readinglertto find the phraseslisted and underlining where the stressfalls in each. 6) PIaythe recordingfor 5.Studentslisten and checktheir answers,then read aloud alternate paragraphswith their partner in 6 to practiseword stress. O-r 5 Themainstressof eachphraseis identifiedin bold. 1 epidemicpropltions 5 asgaciatedillnesses 2 energyimbalance 6 Aus!@liansoglety 3 lifestylefagtors 7 chronicdisease 4 cardioySsculdairsease 8 healthsurvevs Proiect Studentsshouldusethe websiteslisted asa starting point for their researchn, ot a completeresourceY. oumight want to specifythat the project should look at conducting researchinto the lifestyle topics covered in the unit. Youcould alsoencouragethe students,individually or in pairs / groups,to prepareshorttalks basedon their research. Checklist,Keywolds Seesuggestionson p.5.Gothrough the list of words to checkstudents' pronunciation and understanding. Remind students to transfer useful words and phrasesto their vocabulary notebooks.

UnitT 41 Background Regardingthe world of work and training, the art of reflection and the identification of strengths and Thisunit looksat the setting in which children aretreated. weaknessesarelookedat in this unit. Yourstudentsmay In many casesthis may be the sameasfor adults,but not be familiar with assessingtheir own performances there are settingssuchaschildren'swards that canbe from theseviewpoints.Bothmay be usedasuseful made more relaxingto put children at easef,or example tools to improve performance.Theformer allows using bright colours and providing toys.There are often health professionalsto review their performanceand toys and picture booksin clinicsand GPsurgeriesfor perhapsidentify areasfor improvement;the latter childrento use. allowsthem to build on their strengthsandtackletheir weaknessesthrough training or seekingadvice.As you This unit alsocoverssomecommon childhoodillnesses give constructive feedback and teach feedback skills to and talking to anxiousparents.Thelatter requirescareful your students,it is useful to remind themof. reJlectionand reassurancew: ith suspectedmeningitis, for example,it is strengthsand weaknesseosn a broaderprofessionalscale. difficult for parents,who are not medical experts and may be in a stateof anxiety,to distinguish between different Foryourself asa teacher,it is important that you realize illnesses.Soteaching studentsto usethe symptoms that you do not haveto know all the medical detail.At the child doesn'thavein orderto reassurethe parent is all times, usethe role-play scenariosas a way of building useful,e.g.fyour childhad...,he/ shewouldhavex,y,or z your backgroundknowledge.However,asyou build symptoms. this knowledge,be careful not to seekto influence the medical knowledge of studentsasyou may not be aware Theunit looksalsoat the checksdoneon young children. ofthe full details. If you haveaccessto the OHGPzr,efer to pp.814-823, which give you information about paediatric surveillance. Usefulreference:OxfordHandbookof GeneralPractice, Thereis alsoa full table of UK immunizatlons on p.480. 2ndedition.Simonet al. E additlonalactivity Checkup As an additional exerciseto 2-4, you can Put studentsin pairsor small groupsto do l-4. askstudentsto compilea'wish list'of facilities they think should be available Forl, encouragestudentsto identify photographswhere the children are for children's wards or when treating at ease,and saywhy this might be.The instruments visible may intimidate children. Studentscantalk about what the patient,but this dependson the doctor's/ nurse'smanner,evenif the facilitie,sthey have usedthemselves in procedureis scaryfor the child or parent. their own work and remember from their ovvnchildhood. In 3,students might not know exactfigures for their own countries,but they may havea rough idea,and they cantalk about reasonswhy statistics may vary. If possible,you could get statistics for different countries from the internet beforethe classto discuss. For4, encouragethe studentsto defendthe priorities that they suggest with reasonsand examplesfrom their own countriesand experience. O r 2 l t needstobegentl erandl essi nti mi dati ngsothatchi l draerne not frightened.Toysc, olourfulbedcoveringsp, osters,brightcolours, andan informalatmospherecanall helpchildrenfeelrelaxed.

42 UnitT Vocabulary Qualitiesof a goodpaediatrician & Studentswork in pairsto completethe table ln l, then do 2 and 3on their onm. & Put students in pairs to make a list for 4. Then asa whole classsaywhy each quality is essential.Ask a pair to report backtwo or three qualities on their list and then haveother pairs addto it. Write them on aflipchart or directly onto the computer.Studentscanuseadjectivesand nouns alreadydiscussedand add someof their orrrmO. ther adjectivesto describequalities could be caring, humorous,sympathetic,empathetic,hardworking,conscient ious,thorough. x Tip Studentsremain in their pairsto do 5. Createa masterlistfor4andaskstudents Ort Positive Negative to rankthem aIl,orjustchoosethe th ree I patient impatient mostimoortantT. hiscanbedoneasa 2 confident d i f f i d e n t( n e r v o u s ) wholeclassor in groups/ pais followed 3 efficient inefficient bywhole-classfeedbacKke.epa recordon 4 reliable unreliable a flipchart forthe classwall-you could 5 sensitive insensitive evenaskstudentsto turn it intoa ooster. 6 honest dishonest Alternativelyo, ucouldputthe master 7 respectful disrespectful listonthe computerandprintit out for s t u d e n t sf'u t u r e r e f e r e n c e . 1 efficient 4 honest 7 unreliable 2 impatient 5 insensitive 3 respectful 6 confident 1 efficiency 4 honesty 7 unreliability 2 impatience 5 insensitivity 3 respect 6 confidence Possiblaenswer Thesamequalitieasrecommonacrostshemedicaplrofessiobnu, t doctordsealingwithchildrenperhapnseedto begentlerm, ore p a t i e nat ,n db ea b l e t o t a l k taoc h i l da t t h e i rl e v e l . It'smyjob + possib{y probably 5 All Many D r N a s r i nA h m e d Studentsdo the activity in pairs. Or 1 nener always 2 no two 3 fuit}y acutely listeningI Talkingaboutoneself O Studentslisten and answerthe questionsin l. Theydon't needto write down the exactwords,aslong asthey understandthe meaning. Studentscandiscuss2 and 3 asa classor in groups.Theywill havetheir own answersto the questions in 2,but very simply, reflection involvesthinking about something.In the medical / educationalcontext it includesstudents thinking about what they havedonein their work and life to seehow they canimproveon both goodandbad experiences.

P arentsandyoungchi l dren 43 x Tip Thisprocessis now encouragedin medicaltraining in the UK,asis the recordingof one'slearning experiencesS. tudentswill find it helpful,both D uringt hecou rse ,yocua nas ks t udent s for their ornmpersonaldevelopment,and in providing a recordof the to discusscasestheyhavedealtwith and highlights (goodand bad)of their careerin preparationfor work. However, e x p l o r eh o w t h e yc o u l dh a v ei m p r o v e d it might not be the casein other countries;studentsmay haveexamplesof on whattheydid.Alwaysremindthem of where and why, and you candiscussthis asa class. patientconfidentialitey,specialliyf the p a t i e n tm a yb ee a s i l yi d e n t i f i e db y y o uo r Bearin mind for 3 that talking about one'sstrengthsand weaknessesmay t h e i rc o l l e a g u e sl f.t h e r ei sa n yd o u b t ,a v o i d be very difficult in many cultures.The idea that a doctor can admit to a discussintghe situationspecificalloyr, weaknessin a particular areamay not be professionallyacceptablein some discussiustpartofthe case. places.However,being awareof your own weaknessessothat you can improve yourselfshouldperhapsbe seenasa sign of strength.In UKjob x Tip interviewsthis is a common question-the answershouldnotbe:I don't haveany weaknesses! Manydoctorsfind it difficult o talk a b o u tt h e i r s t r e n g t h sa n dw e a k n e s s e s Put studentsin pairsto do 4. Encouragethem to talk honestlyabout particularliyf it isnot partof theirculture genuinequalitiesthat relateto themselves.Seethe ftp about this if they andtraditionT. alkingaboutweaknesseis find it difficult. seenasa sig no ffailu rean dtalk ingabout strengthsisconsiderebdoastingH. owever, Or 1 Shefoundit aliento herculturalbackground. from anotherviewpointn,ot beingaware 2 Over-empathizinwgith the parents(andbecomingupsetwhen of one'sweaknesseosr actingto improve somethingwent wrongwith oneof the children) them canalsobeviewedasfailureT. he 3 No-she sayslusedtohave. realweaknessliesin notacknowledging 4 A casewherea childalmostdidn'trecoverfromanattackof anyf ailing sin o ne se laf ndnot s eek ingt o meningitisS. heusedthe examplein a recentinterview e x p a n do n e ' sk n o w l e d g ea n de x p e r i e n c e . 5 A meansfor self-educatioanndadvancement Asfor acknowledginsgtrengthsk,nowing wheretheylieisan importantpartof Vocabulary un d e r s t a n d i nogn e ' sp r o f e s s i o nI ap r o g r e s s - and stu de nts ho uldre mem ber t hat t her e Non-technicalal nguage isalwaysroomfor improvementl Studentsdo I and 2 on their own, then discuss3-5 in pairs.In 5,someof E ldditionalactivity the childhoodillnesseslisted (e.g.measles)may be very common or very rare accordingto whether vaccinationsare available.In tropical countries, A.skstudentsin pairsto describeto their malaria and otherdiseasesmavbe common. partner the childhoodiilnessesin 2,using their own words.Their partner hasto Or | 1 varicella 5 morbillir/ubeola identifythe illness. 2 rubella 6 acutelaryngotracheobronchitis E additionalactivity 3 pertussis 7 tetanus S t u d e n t sc a n r o l e - p l a ye x p l a i n i n g t h e managementof chickenpoxto a patient. 4 infectioupsarotitis Beforethey split into pairs,you couldgive them five minutes to selectthe points 2 1 croup 5 lockjaw they would like to talk about. 2 mumps 6 chickenpox E ndditionalactivity 3 Cermanmeasles 7 whoopingcough When you havefinished the unit, by way of revision you couid selectone of 4 measles the childhoodillnessesdiscussedhere and askstudents to take the initial case 3 Croupo: nsetoverafewdayss; tridoronlywhenupsets; tridor history. This will help you to revise asking questions. soundhs arshc;answalloworalsecretionvso; icehoarseli;kelytobe a p y r e x i abl ;a r k i n gc o u g h Epiglottitis:uddenonsetc; ontinuousstridors; tridorsofters,noring; droolingosf ecretionvso; icemuffled/whisperingt;oxicandfeverish (e.gT. >39Cc);oughnotprominent NoteT: hedistinctiomn aynotbecleacr ut;if indoubta, dmitto hospital. (SeeOxfordHandbookof Clni icaI Specialtie8st,heditionf,orfu rther details.) 4 Managemenst:upportiv-eparacetamfolul,idst,opicaIcalamine lotionto lesionsA.dmitif complicatioanrsesuspected. (SeeOHGPp2.494F. ormoredetoilaboutdrugsseeOHCS8.)

44 Unit7 x Tip Vocabulary lfyou haveaccestso telephoneso,r if Signsandsymptoms s t u d e n t sh a v ef r e ec a l l so n t h e i r m o b i l e s , askstudentsto telephoneeachother.They * Studentsdo I and 2 on their own, then form pairsfor 3 and 4. When they do canthen sit in differentpartsofthe room the role-playin 4, encouragethem to askother questionsusing their own sothat theycan't seeeachother'sfaciaI knowledgeand experienceof the illness. expre ssionwsh, ichad dst o t he c hallenge andmakesthe role-playmorerealisticl.f Or I meningitis 5 raisedtemDerature youdon'thaveaccestso telephonesa,skthe 2 'l headache studentsto sit backto backsothevcan't see e a c ho t h e r ' sf a c e s . 2 photophobia 6 + /-rash (canalsobea symptom) Studentsmaywantto repeatthesame 3 neckstiffness 7 abnormalmood c o n v e r s a t i o nsse v e r a l t i m elsi k et h i s .F o l l o w up with a discussioanboutthedifferences 4 abnormaml ood 8 seizures b e t w e e nf a c e - t o - f a cceo mm u ni c a t i o nan d t alkin go n th e ph on e. 3 1 D oeshehaveaheadachel?shi sheadsore/hurti ng? 2 Doesheavoidorshyawayfrombrightlights? 3 lshisneckstiff?Canhemovehisneckfreely? 4 How ishegenerallyl?s hehisnormalself?Hasheeverbeen/ had anythinglikethis before? 5 lshefeverishls?herunningatemperaturHea?shegotatemperature? 6 Hashegot a rash?Whereisit?What happenswhenyou pressa gl assonthe rash? 7 Hashebeenbehavingdifferentlyin anyway? 8 l shemaki nganyabnormaml ovements? Speaking Put studentsin groupsfor the role-play.Eachrole-playhastwo parts:Group A studentsrole-playa doctorfirst and then a patient; GroupB role-playa patient first, and then a doctor.Referto the Tipfor 4inListening 2 below for suggestionsabout giving feedbackon theserole-plays. * Tip listening2 Teachinsgtudentshowto giveandreceive Reassurinagn anxiousparent feedbackhelosthemto understand themselvesn,ot leastbecauseit isoften O Studentsllsten and completethe sentencesin l, then compareanswerswith easiefrorthem to criticizeeachotherrather a partner for 2.Playthe recordingagainfor them to addany missingwords. t hant he mse lve slt.isa s k illt heyc ant hen developin'givingfeedbackt'o the patient Youcould do 3 asa whole class.Ask studentswhich of the statementsin I the aboutth eirillne ssr,a the r t hanalway s doctor usesto reassurethe patient and which statement showsempathy. soundingnegativel.t alsohelpsto develop self-awarenesasndthe abilitytotalkabout Put studentsin pairsfor 4. While they are doing the role-plays,watch oneselifn a balancedway. discreetlywithout interfering. Make notesabout language,pronunciation, body language,'roleunderstanding / playl etc.Youmight want to focus x Tip on the empathy that the studentsrole-playingthe doctorsshow.At the end of eachrole-play,askstudentsto giveeachother feedback,ailowing Discustshe role-plaiyn4 with the class eachstudent to assesshis/her own performancefirst. In giving feedback, asa whole,lookingat it from different studentsshould alwaysbegin with the positivepoints first, followed by angles- whattheyfoundenjoyable, constructivecriticism for development. difficult,etc.Youcantakedifferenat ngles eachtimeyougiveyourown feedback, Or | 'l croup 5 everymothermightfeel focusingon oneelementor severaal t a 2 'll helptoease 6 eyeon hi m time.At firstyoucouldfocusjust on non- 3 expect 7 anychanges technicavl ocabularypronunciationa,nd 4 U maybehave the importanceoffitting intothe roleofthe patient,i.e.whatth isteachesthe student I reassuri ng3:,4,7 doctora, nditsimportancein achieving empathy:5 empathywiththe patient.Yocuanthen buildonthiseachtimeyoudo a role-play.

P arentasndyoungchi l dren45 languagespot FirstConditionavl sSecondConditional s Readthe introduction asa classT. hen get studentsto do f on their own. Or1 g shewould havea reallybadbarkingcough(hypothetical) 2 f it will increastehe riskof permanendt amage(real) 3 d it will beeasierto carryout the procedure(real) 4 a shew i l l normal l ystareback(real ) e I would preparefor the consultationbetter(hypothetical) 6 c we will carryout the 6-weekcheck(real) h it will helpstophimfrom bringingit up (real) 8 b I wouldcertainlybea lot moresympathetic(.hypothetical) Project Studentscanwork in pairs,groups,or individually to do I and 2,then form pairsto role-playexplainlng the checksin 3.(SeeOHGP2pp.816-23.) Or I 1 Theneonatacl heck(bya doctor):performedwithin the first 28hoursof birth 2 Thesix-weekcheck(bya doctor):includesphysicael xamination, healtheducationa, nddevelopmentaslcreeningi.,e.grossmotor developmenfti,ne motordevelopmenvt,ision,hearingand speecha, ndsociabl ehaviour 3 The8-and'18-montchhecks(bya HealthVisitor)i:nclude physicaI examination,healtheducationa, nd developmental s c r e e n i n ga sa b o v e . 2 Crossmotordevelopmenstcreening: Headcontrolrpullingthebabyup holdingthe handsfrom a lying positionB. abyshouldkeepheaduprightandnot wobble. Mororeflex(0-6months)s:upportthe headandshouldersabout 15cmfrom the examinationcouchS. uddenlya,llowthebaby'shead to dropbackslightly.Threesponse-extensioonf the armsfollowed byadductiontowardsthe chest- should bebriskandasymmetricla. Thereflexdisappearbsy6 months. VentralSuspensio(nO-10months):suspendthe babyhorizontally, facedown.Theheadshouldbein lineor slightlyhigherfrom the bodyandthe hipssemi-extended. Proneposition(frombirth):placethe babyfacedownon a flat surfaceH. e/sheshouldbeableto lift his/herheadmomentarily fromthe surface. Finemotor developmentandvisionscreeningS: taresf,ollows horizontaIlyto 90 (degrees). Patientcare Putstudentsin groupsto doL Thenletthemworkontheirownto makea listfor2. Or i Notreassuring.Tpahreentswoupldrobablybeafraidthattheir childwouldbeoneofthatsmalpl ercentage. 2 Reassuring.Tshtaetemenhtelpstheparenrtealizethahtavinga rashdoesn'mt eanhavingmeningitis.

45 Unit7 x Tip 3 Reassuring.Tshtaetemenist fairlytechnicbaul,tit isreassuring that it isnota problemnoryasthechildisnotsixanda half. Invitethe studentsto askyouquestions aboutlanguageD. on'tbeafraidto say 4 Reassuring.Thedoicstsoyrmpathizingwitthhepatienut sing thatyoudon'tknowtheanswerif it isa medicaql uestion.Yocuouldasktherest e x a m p l eosf w h a t i ss e e ni nt h e s u r g e r y . of the classa, llowingthestudentstimeto 5 Notreassuring.Thpehraselcanassureyomu aybequitestrong, discustshe questionmedicallyfromtheir own experienceS.eta time limit,asthese b u td e n y i ntgh e p a r e n ttsh e' r i g h t ' t ob ew o r r i e di f t h i si sh o wt h e y discussioncsangoonfor a longtimel f e e li sv e r yd i s m i s s i vaen dp a t r o n i s i n g . 6 Notreassuring.Tphaerentasrelikelytothinkthatthisanothercase. 7 Reassurinltgis. technicablutissayingthattheevidencseuggests it isnota braintumour. x Tip Speaking A n O b j e c t i v eS t r u c t u r e dC l i n i c a l Studentschoosefive criteriafrom the list for l. \\ /here possibleallow the E x a m i n a t i o (nO S C Ei s) u s e d t o t e s t students to make the choiceof criteria they feel areimportant, but with skillssucha scommu nic at ionc,linic al guidanceif necessary. examinationm, edicapl rocedures, prescrbi ing,and interpretatioonf results. Put students in pairs to do 2 and 3.The instruction for the role-play in I says It normallyconsistsof a numberof short it should be done'without preparation',but judge how much information ( 5 - 1 0m i n u t e )s t a t i o n s( p r a c t i c a l t e s t sa)n d you needto give the students. eachisexaminedon a one-to-onebasis with eitherrealor simulatedpatients Pointsto consider: (actors). Scenario1:The parent is anxious about the child; he/she thinks that the * Tip child is at high risk and doesn'tknow howfragile the virus is.Doctors should think about: Wasthe skin broken?Did the child bleed?Where is Aftertherole-plaiyn 3,youcouldofferto the needlenow? Wasthere blood on the needle?Who usesthe park?Was actasthe patientfor the classT. hishelps there anyonearoundthe areaof the needle?HIVvirus cannot suruivefor y o u d e v e l o p y o urro l e - p l a sy k i l l sw i t h i n t h e long outside the body.Isthe child high risk or low risk? Isthe child fully contextof medicine6. et the wholeclassto vaccinated?Boosterneeded?Is reassuranceneeded? askyou,the patientq, uestionsaboutoneof the scenarios. Scenario2:Theparent is concernedabout autism and whether the vaccine Alternativelyy,ou could asktwo studentsto is safe.Doctors should think about: Is there a confirmed connection with role-plaay scenarioinfrontofthe classI.n autism?Isthere a dangerto leavingthe child unprotected?Is there greater thiscasedividethe restof the classintotwo dangerfrom, say,measles?Canyou empathize/ sympathize? groupso: neto Sivefeedbackonthe doctor andoneonthe Datient.seat time-limit Scenario3:Theparent is worried about the coin getting stuck or poisoning a n df o l l o w t h es a m ep r o c e d u r ae sa b o v e f o r the child. Doctors should think about: Isthe parent feeling guilty? Is f e e db a c kan d d i s c u s s i o n . reassuranceneeded?Doesthis sort of situation happenfrequently?What Notethat asyou developthe role-plays, normally happens?Is it better to let nature takesits course?Is an X-ray yourknowledgeof the subjectareawill necessary?What happensif the parent doesn'tseethe coin comeout? increaseH. owevera,lwaysremindthe Shouldthe parent watch for it coming out? students(andyourselft)hatyou arenot a doctorandthatthey mustcheckany Forf, studentsgivefeedbackon the role-playusing the checklistthey medicadl etailsthemselves createdin t. As in Listening2,they shouldgivepositivefeedbackfirst, followed by constructive criticism for development. Remind students that giving feedback is a skill that can be developed,and which will help them to develop self-awarenessand to give patients feedback about their illness. Listening3 O StudentslistenanddoI ontheir own. Or ll nervous 3 insensitive 5 well 2 disorganized 4 lesstense 6 alot 7 Hewouldchangehiswayofdoingthingsb- emorepatient, preparebeforespeakingtoa patlents, peaktothenurseg, etbasic detailsright.

P arentasndyoungchi l dren Reading * Put students in pairs for t. They can do 2-4 individually, in groups,or asa c l a s sd i s c u s s i o n . Orllf2e3b4a5c697d 2 Allowingthreemonthsbetweendosesislikelytomaximizethe responserate,particularlyin youngchildrenundertheageof '18monthswherematernalantibodiesmayreducethe responsteo vaccinationW. hereprotectionagainstmeaslesis urgentlyrequired, the seconddosecanbegivenonemonthafterthefirst.lf the childis giventhe seconddoselessthan threemonthsafterthefirst doseand at lessthan18monthsof age,thenthe routinepre-schoodlose(athird dose)shouldbegivenin ordertoensurefull protection. 3 SeeOH C P 2p.4S Oforful l tabl eoi mf muni zati onisn the U K . | |mm unizationmaycauseconcernfor parentsdueto factorssuchas culture,literacym, ythsabout / ignoranceof / fear of vaccni esand generaal vailabilitoy f medicationsM. easuretso overcomethiscan includenationaIeducationprogrammetshroughschoolsth, e media, andhealthworkersA. t an individualevelexplanations,ympathy, a n de m p a t h vc a na l s ow o r k . Cultureproiect * Studentswork in pairsto answerI and 2.Encouragethem to talk aboutthe different procedurest,he easeor difficulty of organizingwork,the processof referencesa, nd the changingjob market in their ornmcountry and the UK. OF t Answersvarybycountry/ culture,but inthe UK,the answerswould be: I True 2 False 3 False 4 False 5 True Wfting * Tip Reflectingon one'sown experiences Beingableto self-analysiesa very s* Put studentsin groupsfor l, then let them work on their own to do 2.They import antskilla, n dre levantto job- s eek ing canhelp eachother,but they needto make this a personaland individual asit showsthat studentsareawareof their pieceof writing. For Writing 2,remind studentsthat there shouldbe no own abilities(strengthsa)swellasareas detailssuchasnamesthat couldidentify any patients. w h e r e t h e ym a yn e e df u r t h e rd e v e l o p m e n t or help(weaknessesH).owtheyhavedealt/ ChecklistK, eyWords proposeto dealwithboththeseareasis a n indica tionof th eirpo ten t ialabilit y t o * Seesuggestionson p.5.Gothrough the list of words to checkstudents' developon ajob andwhethertheywould pronunciation and understanding.Remind studentsto transfer useful fit intoa teamenvironmentl,earningfrom words and phrasesto their vocabularynotebooks. a ndt eac hin goth ers.

48 Unit8 Background Vaguenesslike this cancomein other ways.When patientstalk abouthabits suchassmokingor drinking, Thisunit focuseson a patient-centredapproachto they may usevaguelanguagelike a coupleof drinks,not communication in medicine, looking from different many,sometimesI.n fact,a couplemay mean three or four, viewpoints at the communication between doctor and and more on certain daysof the week.Sodoctorsneedto patient. be ableto extractclarificationby asking:Whenyou saya couple,whatdoyou mean?Seekingclarificationlike this Oneway of developingpatient-centredcommunication is probing gently,not prying. Thesestrategiesenablethe is to approachany conversationor consultationfrom doctorto help the patient be more specificsothe doctor a psychologicalpoint ofview Studentscan do this by canmake a diagnosismore easily. consideringwhat the patientsthemselvesmight be thinking, and what barriers there areto communicating Another way to practisepatient-centredcommunication clearly,which apply to all of us.It is not really an option to andhelp improvestudents'consultingskillsisby tell the patient to 'just sayit'! teachingthem about the differencebetween closedand openquestions.In a doctor-centredapproach,doctors Patientsmay want to saysomething,but they may not may be more usedto askingclosedquestions,which havethe words to sayit, or they may be too embarrassedto canonly be answeredyesor no.Asking openquestions sayit directly.So,for example,they may hint at something helpsthe patient to'paint a picture'of their illnessor in away they think is fairly direct,by stressingaword. situation,which the doctorcanthen expandon by asking If students are not sensitiveto theseverbal cues,they closedquestionsand other openquestlons.Fromthe may misunderstand the patient. Thisln turn couldlead students' point of view, the difficulty initially with asking to conflict with the patient if theseverbal cuesarenot openquestionsis what to do with the answers- a lot of acknowledged.Oneexample usedin the unit is a patient information seems'thrown' at them by the patient in saying:I haven't taken anyprescribeddrugs.If the patient's responseT. heymay feel at a lossasto how to continue. hint is missed,it is possiblethat the statement would be Simplestrategiescanbe adoptedto overcomethis, Iike taken to mean that the patient doesn'ttake any drugs at all, Iearningto respondappropriatelyby summarizing and but the hint maybe:I do takerecreationadl rugsbut I don't focusingon onemain issueor checkingspecificpoints know how to saythis directly.The patlent might think the using closedquestions. doctor may not approve,sois cautious.Patientsmay also usethis asa strategyto test whether they feel comfortable Usefulreference:OxfordHandbookof ClinicalSpecialties, talking with a doctor or not. Raisingawarenessof this will 8th edition,Collierand Longmore. help studentsto negotiate patients' language. E ndditionalactivity Checkup Ask students to give exampleswhere they Studentsdo I and 2 on their own or in pairs,then form groupsfor 3_5.For3, havefaced similar situations to those in the samestrategiesmight be suitablefor more than one situation. Checkupl. When studentshavediscussed4, askeachgroup to presenttheir x Tip suggestionsto the classone at a time. Askthestudentstomakea listof strategies Getthe whole classto discuss5 together.Ask for any personalexamples on a flipchartor on a computerandthen of misunderstanding.As discussedin Unit 7,studentsmay find it difficult printout a copysothat theyhavethisfor to talk about their difficulties or mistakes,but remind them that we all reference. learn from our mistakesand they canbecomebetter doctorsasa result. Rememberto bring body languageand facial expressiong, ender,age,and other relevantfactorsinto the discussion. O? | Allof the situationswill dependon the ageandthe genderof the doctorandthe patient,accompanyingparentsand relativesa, nd family status.

E ncouragi ncgommuni cati on49 a Thedoctormighthavedifficultyencouragingthpeatienttospeak, eventhoughhehascometo seethe doctorandprobablywants to talk.Thepatientisembarrasseadbouthisconditionandmay not know howto articulatewhat hewantsto say. b Thissituationissimilartoa,but the patientmaybeuncooperative andmayfindit difficultto dealwithan adult. c lt maybedifficulttopersuadethepatientofthe needto stayin hospitalif shecannotseeorfeelanythingwrongwith herself. d Thepatientmaybeverydefensiveabouthisdrinkingo, r in a state of denialH. emayfeeltooguiltytoadmitthe extentofthe problem andmaybefearfulof addressinigt. e Thepati entmayknow al otorthi nkthatsheknow severythi ng. It maythen bedifficultor evenimpossibleto convinceherof somethingT. hisisa commonproblemresultingfrom greater accestso informationt,hroughthe internetin particular. f Thedifficultyhereisbeingimpartial.Thpeatientmayfeelthatyou arecoverni g for your colleague,howeverfair you aretrying to be. 21b 2d 3c 4e 5f 6a 3 Possiblaenswers Encouragpeatientsto talk byaskingopenquestionse; ncourage patientsto givetheirown answersto a situationor problem; agreewith patients'suggestionwsherepossibleandthen add yourown ideas;listencarefullytowhat patientshaveto sayand invitethem to developanythingwhichappearsto beverygeneral orvague;besympathetice,mpathica, ndsincere. * Tip Patientcare Encouragestudentsto th ink of examples Readthe introduction asa class;Thenput studentsin pairsto do l. Themain in theirown livesfo r 3 ,b othins ideand issuehereis to encouragethem to adopt a patient-centredapproachby o utsidem e dicineT. h efo rmerm aybe m or e trying to understandwhat the'thinking'is behind the way patientsspeak. helpf ulin ge tting the mto u nder s t andt he difficulty patientshavein sayingwh at they Studentswork in groupsto do 2,then cometogether asa classfor 3.This is a want to say. chancefor you to clarify the issueand give examplesin the front of the class A skt hemalsoto th ink ofth eir own (seeTrp).Youmay want to giveexamplesof your own. perf orma ncienthe lan gu ag ec las sT. his will helps tud en tse mpa thiz ewit h t heir Or 2 With friendsi,t is likelythatpeoplearemoredirect,butthere pat ientsan da lsoh elp the min r ole- play ing aretimeswhen peoplehint at thingsratherthan saythemdirectly. patientsin pairworkexercises. Forexample,lt'scoldin herecouldreallymeanClosethe window. SimilarlyM, y tea iscoldcouldbe hintingtheyt likeanothercup. Thesearesimpleexamplesto illustratethat it is notjust patients who havedifficultybeingdirectsometimesI.n professional situationss, tudentsmaysometimesfind themselvetshinkinglike the patientsin 1-6. ListeningI Acknowledgingverbalcues Readthe introduction asa class.Thenput studentsin pairsto do I and 2.Ask studentsto readthe text about verbal cues,then decidewhat they think the contextis and which information they would like to askabout in eachcase. O PIaythe recordingfor the matching task in 3,then againfor studentsto do 4. Theycan checktheir answersagainstthe Iistening scripfon p.137of the Student'sBook.