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

50 Unit8 r For5,studentsgivetheir own answersto eachof the doctor'squestions,as if they were the patient.Ask studentsto prepareoneor more answersfor eachof the questions.If they havedifficulty, encouragethem to givesimple answersor give somesuggestionsof your own. e Put studentsin pairsto do 6. Or I aalcohol/drinkinghabits d work b weightproblems e weightleating c recreationaldrugs t 1b 2c 3a 4e 5d 5 Possibleanswers 1 th reeor four mealsa dayf severasl nacksbetweenmeals/ three orfour barsof chocolatebetweenmeals 2 about2or3daysperw eek/atl easttw i ceaw eek 3 usuallytwo but sometimesthreeor four/ four orfiveatthe weekend 4 HesaidIwasfat/overweight/that I shouldlosesomeweight/ that myfriendisslimmer. 5 There'smoreworktodo./Peopleareoffsick./| run myown business/l. am on my own./ | havejust starteda newjob. lI additionalactivity Speaking Getstudentsto do the Speakingexercise Put studentsin pairsto do the role-play.Youmay want to put the As and with you asthe patient. Startwith the Bsin groupsfirst to studythe role-playcards.Checkthat they understand role-play cardfrom the Student'sBook, the procedureand all the answers.Encouragethe patientsto bevague, then give your own answers and seeif but not difficult. Encouragethe doctorsto probe gently until they obtain students can developit. Youcan askthe a satisfactoryanswerthat is specific.Followthe samebasicprocedureas classto do this asa whole or ask several SpeakinginUnit 7 (Teacher'Bs ookp.46).At the end,you can askpatientsto students to do it in turn. Studentsmay tell doctorsany piecesof information they didn't manageto get,and ask want to do the role-play again after this. studentsto suggestquestionswhich would haveelicitedthat information. Pronunciation E Additionalactivity Stressin the sentence Ask students in groups to createfive a Q rut studentsin pairsto do I and Iisten and checkfor 2. simple sentencesof their own, e.g.Isaw Mrslonesthis morning.Thenaskthem I Studentslisten and do 3 on their own, then comparewith a partner for to show their sentencesto a partner in 4. They shouldtry to respondto the verbal cuegivenin the emphasisthe another group.They saythe statements patient hasused. to their partner and the partner identifies the stressedword. Theyremain in their pairsto do 5.Make surethat the stressedword is clear; studentsmay haveto exaggerateslightly at the beginning.Ask them to E ldditionalactivity work with a different partner for 6. Youmay want to put the list on the board / Or | 1 drugs 3 recreational 5 past computerscreento show students.You couldalsoturnthe exerciseinto a mini- 2 prescribed 4 recently talk by writing or revealing the points one at a time andthen discussinpthem 2 Line3:becausethpeatienitndicatehdehadtakesnomething elsebystressingthewoprrdescribei.de,n. otprescribebdu, tsome o t h e rk i n d . Line5:the patientstresserdecentlyi.,e.not recentlyb,ut p e r h a past s o m et i m ei nt h e p a s t . t1t 3 first 5 me 7 few 2 caf€ 4 work's 6 normal

E ncouragi ncgommuni cati on5l 4 Possibleanswers 1 B utw hataboutyoupr artner? 2 Whatwereyoueating/ drinking? 3 W henw asthefi rstti me?H owmanyti meshaveyouhadi tsi nce? 4 Whataboutyourfamily/ homelife? 5 Didyourpartnerattemptto help? 6 W henyousay' normal ' ,w hatdoyomueanbythat? 7 C anyoutel l mew hat' afew ' meansforyou? Speaking Putstudentsin pairsto dol. Belowis a list of someareasto talk about,but you may needto suggestsomeof theseto the whole classaspart of the discussion. Studentscando 2 on their own or in pairs,then comparetheir answersto I and 2 with the whole classfor l. Followthe procedureasinSpeakinqabove and in Unit 7.Beforestudentsstart,allow them to askyou any questions.As a way to bulld students'confidence,allow them to do the role-playwith you beforeor after they do the exerciseA. t the end,you could askfor volunteers to do the role-playin front of the classA. fterwards,allow time for discussion about the content and the performancefrom the doctor'sand the patient's points of view. Emphasizethe needto hold a conversationwith the patient ratherthan just thinking aboutmedicine. ; Studentsremain in their pairsto do 4. Or I Areasto askabout:work,home,familyrelationships,tress. D i dthe depressi opnre-datethecaracci dent? I Somepoi ntsthe pati entmi ghtbethi nki ngabout:hi sacci denth; is injuryandpain;hislow mood;hisdivorcei;tseffecton hischildren a ndhi msel icopi ngw i th bei nga si ngl eparent;hi schi l dren' s behaviourt;heirwell-beingandfuture;copingwith a heavy workloadc; opingwith householdchores. Allowthe studentsto exploremajorissueslikethoseaboveaswell a sspeci fitch i ngsl i kedoi ngthe shoppi ngi,roni ng,w ashi ng,etc. languagespot E ldditionalactivity Openandclosedquestions Tohighlight the differencebetweenopen Readthe introduction asa classbeforestudentsdo I and 2.Thevcanthen do and closedquestions,do a role-playwith 3-5 in groups. the whole classwhere you arethe patient with (e.g.)a headachea, nd studentshave Or | 1 Canyoutellmeafewmoredetailsaboutthepain? to'diagnose'you.Getthem to askyou closedquestions,which only have the 2 Tellmeaboutthe waythe injuryaffectsyou. answersyesor no.Refuseto giveanswers to openquestions. 3 What happenedwhenyou hadthe accident? Ask the classto begin with:Are you OK? (No),Haveyou got a pain?Is thepain ...? 4 Howdoyouthinkthingswill developafterthis? When you havefinished,dothe role-play againbut with open questions.Youcan 5 C anyoutelml ew hatw orri esyouhavehere? emphaslzethe point by giving more information in your answersto these. 6 Describeatypicaldayforme. 7 W hataboutyourj ob?H owarethi ngsthere? 2 1 Open 3 Open 5 Open 7 Open 2 Closed 4 Open 6 Closed 3 Openquestionasreusedinapatient-centraepdproacthotakinga historyw,herepatientasreencouragetodtalkabout heirillness, mu c hl i k ec r e a t i nagn ar r a t i v eT.hi sal l o w sp a t i e n ttsh eo p p o r t nui t y to saythingstheymightotherwisoemit.Thereforoep, enquestions aregeneralluysedatthebeginninogfthehistoryandlaterw, hen

52 Unit8 the doctorwantsto encouragepatientsto talkaboutsomething vaguetheyhavesaidor hintedat. 4 Cenerallyspeakingo,penquestionsareusedto obtaingeneral informationfrom the patient'spointof view,andclosedquestions areusedto checkandelicitdetail.Closedquestionstendto beeasier to dealwith buttheyarenot aseffectiveasopenquestionsin obtainingan overalpl icture. 5 l f al lthe questi onisn the hi storyarecl oseidtc, ansoundl i kean interrogationlt. alsodoesn'tgivethe patientthe chanceto elaboratew, hichmaygivethe doctorimportantinformation h e / s h eh a d n ' ts p e c i f i c a l lays k e da b o u t . El ldditionalactivity Patientcare Ask two studentsto role-playthe dialogue Readthe introduction asa class;then put studentsin pairsto do l. Theaim in I while the restof the ciasswatch and is to get the studentsto focuson the most significant pieceof information. Iisten.Youcould role-play the patient In this case,sitting in the cafeis significant becausedrinking coffeecan yourself. leadto raisedheart rate,which canbe mistaken for a heart problem.Unless When they havefinished, askthe rest the doctorasksopenquestionsand considerscontext,he/shecouldmiss of the classto do the samein pairs, this vital information. Studentsoften latch on to the wrong information developing the role-play dialogue further and overlookthe important point. in anyway they like but encouraging doctorsto askopen questions. Or | 1 No-the patienthasalreadygiventhis information. 2 N o-the pati enthassai di t' sthefi rstti me. 3 Informationaboutwhatthe patientwasdoingin the caf6;what the pati entw asdri nki ng. 4 lt couldbe.Forexamplet,he raisedheartratecouldbefrom the caffeinein a strongcoffee. 5 YesT. hedoctorcouldsaysomethinglike Whenthesethingscome on suddenly,theycanseemfrightening,but canyou tell me ... Listening2 Appropriateresponse 6) Studentslisten and do I on their own, then do 2-4 in pairs. Or I lc 2c 3c 4b 5b 21 Alternativespossibleb,ut cseemsthe mostlogicalnextstepasthe patienthasalreadymentioneda andb.Howevert,he doctormight wantfurtherdetailsaboutthetypeof painandappetitea littlelater. 2 Alternativesnot suitable-the patienthasalreadyanswereda andb. 3 Alternativens ot suitable- a is not helpfuland b iswrong b e c a u s e t h ep a t i e n ts o u n d sl i k eh e d o e sn e e dh e l p . 4 Alternativens ot suitable-the patienthasalreadyanswereda andc. 5 Althougha andb aresimilarb, isthe mostappropriatea;has a l r e a d yb e e na n s w e r e da,n dw h i l e t h ep a t i e n tm a y w a n tp a i n k i l l e r s , the statementisratherdismissivaendnot appropriate. Vocabulary Alcohol Studentsdo I on their own. They candiscuss2-4 in pairs,groups,or asa whole class.

E ncouragi ncgommuni cati on5 3 El ldditional activity Askthem to do 5 on their own. Youcould suggestthey add openquestions of their own. Ask studentsto work in pairsand describe an imaginary patient to eachother Or llheavy 3teetotal 5 drink 7 Binge without using one of the words 1-8.The partner hasto saywhich word the student 2 annoyed 4 social 6 guilty 8 moderate is tryingto avoid saying. 2 CACEisa mnemonicforascreeningtestfoar lcoholismS. entence2s x Tip and6 relatetoCACE.Thlettersin CACEstandfor: DTs= DeliriumTremensa,severeform of alcohowl ithdrawawl hichcausesbody Haveyoueverfeltyou ought to cut down onyour drinking? tremorsandchangesin mentalstatesuch asconfusiona,gitationa, ndanxiety. Havepeopleannoyedyou by criticizingyour drinking? :xTip Hoveyou everfeltbodorguilty aboutyour drinking? Besensitivteo culturaI attitudesto alcohol Haveyou everhadon eye-openetro steadyyour nervesin the morning? atalltimes. CACE(twoor moreyesanswersi)squitegoodat detectingalcohol abuseanddependenc(esensitivit4y3-94%)(. SeeOHCMTp.274.) 3 lf patientsdenyto themselvetshat theyhavea problemt,hen it maybedifficultto treatit.Thefirst stepisto proveto patientsthat thereisa problemT. hentheycanaccepthey needto makechanges. | 5 tudentscanaskcol l eaguehsow theyhavedonei t.Onesi mpl e approachisfirsttoaskthe patientif he/she drinksalcohoal,ndthen askanopenquesti onaboutthedri nki ngP. robeanyvagueansw ers or hintsto findout how muchthe patientdrinksw, hat he/ shedrinks, the regul ari toyf dri nki ngw, hetherhe/ shedri nksal oneor w i th friendsa, ndwhetherthe drinkingpatternisthe same at weekends. Askthe patientif he/ shekeepsa countof units(oneunit = one smallglassof wine,halfa pintof beera, singlemeasureof spirits) andhowmanyunitshe/ shethinkshe/ shedrinksin aweekC. ompare thisto the recommendedailymaximum(inthe UK,this isthreeto four unitsperdayformen,two to threeunitsperdayfor women). At a pointwherethe patientappearscomfortablewith your questionsa, skthe CACEquestions. 5 1 H ow w oul dyoudescri beyourdri nki ng? 2 What kindof drinkerwouldyousayyouwere? 3 Tellmeaboutyourdrinkingrecently. 4 W hataboutdri nki ngearl yi nthe day?W hendoyouhaveyour f i r s td r i n k ? 5 Arethereanyadvantageosf cuttingdown?Haveyouever thoughtofthe advantageosfcuttingdown? 6 Howdoyourfamily/ friendsfeelaboutyourdrinking? 7 Howdoyoufeelaboutyourdrinking?Doyouwantto stop? Proiect Ask studentsto find the information for I and 2.For2,askthem about similar organizationsin their ovrrncountries- if there aren't any,should they exist?Sensitivityto national attitudestowards alcoholshouldalways bebornein mind. Getstudentsto research3.Ask them to giveexamplesfrom other English- speakingcountriesand examplesfrom their own languages. Or I TWEAKstandsfor: Haveyouan increasetdoleranceto alcohol? D o y o uw o r r ya b o u t y o u rd r i n k i n g ? Haveyoueverhadalcohoal saneye-openeirn the morning? D o y o ue v e rg e t a m n e s i aa f t e rd r i n k i n ga l c o h o l ? Haveyoueverfelttheneedto c(k)utdownonyourdrinking? Twopointsaregivenfor a yes'answerto the fi rsttwo questionsa, nd

54 Unit8 o n ep o i n t f o r t h eo t h e r t h r e eA.s c o r eo f t w oo r m o r es u g g e s tasn alcohopl roblemlt.maybemoresensitivtehanCAGiEncertain sectionosfthepopulatione,.gp. regnanwt omen. 2 AA(AlcoholiAcsnonymouasn) dAlcohoCl onceranreorganizations w h i c hh e l pa l c o h o l i ct os r e c o v ef rro ma l c o h o l i stmh r o u g hg r o u p therapyandself-hepl.Seewww.alcohoilcs-naonymous.rog.ukand w w w . a l c o h o l c o n c e r n . o r g .tuhke.UI nK ,t h e r ei sa l s oa g o v e r n m e n t - s p o n s o r ehde l p l i ncea l l e dD r i n k l i n e . 3 SomewordsusedintheUKforbeingdrunkare: merry(slightlydrunk) paralytic(verydrunk) sozzle(dverydrunk) tiddly(slightlydrunk) welloiled(verydrunk) Someonwehoisonthebottleisa habitualdrinker. * Tip Speaking Remind studentsto varythe type of s Put studentsin pairsto do t-3, then elicit answersfrom the classfor 4. ouestionsoit doesn'tsoundlikean interrogation:Conyou / Couldyou ...?What * Studentsdo 5 on their ornmt,hen work in pairs for the role-play.They can use a b o u t. . .?A n d t h e . . .? criteriasuchasJluency,sympath/yempathy,askingquestions,clarity,using non-technicalanguagep, robing vagueanswerse, tc.Thishelpsthem work Additionaal ctivity out what they needto incorporatein their role-play. Youcould give students words like srp/ Put studentsin pairs againfor 6. Therole-playhereis in many respectsvery gulp / buyinga round / measureof alcohol similar to the previousone. and askthem to find the meaningsin a dictionary if they don't know them. After the feedbackon the role-play,do 7 asa whole class.'Doctors'may havedifficulty in understandingthe exactmeaning of the'patients';not * Tip using technicallanguage;and trying to put themselvesin the patient's position.'Patients'mayhavedifficulty thinking aboutthe scenariofrom Remindstudentsofthe ouestionsabout the patient'sand not the doctor'spoint of view in a role-play;avoidingthe alcohoiln I andaskthemto role-platyhe useof medicallanguage;and giving answersthat areunrealisticallydirect scenarioin 5,eachtakingtu rnsat being becauseof medical knowledge(wherea patient would be more vague).Ask the patient.Duringthe role-plafyollow the studentsto givestrategiesfor overcomingthesedifficulties. the sameproceduraesintheSpeaking earlie rinth isun it.Wa lkar oundlis t ening Of, | Possiblequestions andcol ectingpointsfor discussionA.void Canlaskyousomequestionsaboutyourpersonahl istory? interferingevenifthe studentsarefacing C anl askyousomequesti onas boutyourdri nki ng? difficulties(it can beverydifficultto resist Canyoutell me aboutyourdrinking? d o i n gt h i s ) ! H owmuchdoyoudri nk?W hatdoyoudri nk? H o w o f t e nd o y o ud r i n k ?W h e r ed o y o u d r i n k ? Doyoudrinkaloneor with friends? Doyoudrinkthesameat weekendsasduringtheweek? Doyouknowhow manyunitsyoudrinkin a week? D o y o uk n o w w h a t t h er e c o m m e n d elde v e l sa r e f o rm e na n dw o m e n ? D oyouthi nkyoucancutdow n? Q u e s t i o n s f r o mC A C Ea n d/ o r T W E A K . I Offeroptions(choicetshe patientcanmake)thatfit intothe ManagementStrategy(theplanfor managingthe patient).Doctors shouldgivetwoorthreeoptions(morethantwo orthreemaybe confusingandcounterproudctive)A. skpatientswhat theythink theycando realisticalloyr want to do.Askthemwhat the difficult situationsareforthem,andhowtheywill copewith those situationsP. ossibloeptionsare: * avoidingsituationswheredrinkingalcohoilsinvolved. - askingfriendsandfamilyto help,i.e.notto offeralcohol. - not keepingalcohoal t home. - sippinga drinkslowlyn, ot gulping.

E ncouragi ncgommuni cati on55 - dri nki ngsmal l ermeasures. - not buyingoneselfa drinkwhen buying'a round'in a bar. - avoidingdrinkingon certaindaysor at certaintimesof the day. 4 Theoptionsgivenneedtofit intothe patient'slifestyleand ManagemenSt trategyS. uggestiontshat havebeentriedbythe patientbeforeandthat havefailedmayneedgreaterinputfrom the doctoror shouldbeavoided. Reading Put studentsin pairsfor l. Then askthem to do 2 on their own.They can form pairsagainfor 3,and you coulddo 4 asa whole class. Of, | Thetext isaboutthe barriersto preventingillness. 1 Barriertso prevention 4 Metaphysicast the bedside 2 Biologicaalndgeneticbarriers 5 Psychologicbaal rriers 3 Cognitivebarriers 2 1 Noteveryonerespondtso preventivemeasuresin the sameway- if we knowpatients'psychologyandgeneticsw, e canassesswhich d i f f e r e n tm e a s u r e sa r em o s ts u i t a b l e . 2 Tomodifyadvicetothe patient le.g.foryou, adviceismore important than exercise.). 3 lt createscognitivebarriersto preventions,uchasangerand r e j e c t i o no f a d v i c e . 4 Theclearbenefitsof preventiveaction,but thisdoesn'twork. Coleridgeq'suotesuggesttshat we find it hardto careaboutour futurehealth. 5 lt givesthe substancea certainappeal. 4 lt islikelythatpsychologyhaaslargeroletoplayinmedicine, especilalywhen it comesto tryingto understand patients' b e h a v i o u ras n d a c h i e v i n gs u c c e s s f uclo m m u n i c a t i o n . * Tip Writing E mphasizteh at an yexamp les t udent sgiv e WritingacGuratelfyor trainingol work applications needt o bepe rso na li;njo bapplic at ionosr i n t e r v i e w st h e yc a n n o tu s eo t h e rp e o p l e ' s Studentsform pairsto do l, then work on their own for 2 and 3.Getthem to ideas. proofreadeachother'swork for 4. Or t I volunteera; ddiction 2 achievement 3 interestedp; sychological 4 relevant 5 commitment 6 communicationd;eveloped ChecklistK, eywords Seesuggestionson p.5.Gothrough the list of words to checkstudents' pronunciation and understanding.Remind studentsto transfer useful words and phrasesto their vocabularynotebooks.

55 Unit9 Background itself.It is an important subjectto discussin orderto assesswhether the patient hashad thoughts of suicide, In psychiatry,studentsneedto be observantofthe whether thesewishesdevelopedinto detailedplans,and patient'sappearanceb, ehaviour,and manner,asthese whether the patient made any actualsuicideattempts. will help in their diagnosis.Excessiveiyflamboyant Thisenablesthe doctorto assestshe severityofthe clothesor fast speechcansuggestmania,while a patient situationand decideon an appropriatecourseof action. who fails to look at the doctorand sayslittle might s u g g e s td e p r e s s i o n . Studentsin any field of medicine may find themselvesin a situation where they haveto talk to patientswho want As well asbeing ableto assessvisual cues,students to leavehospitalagainstthe doctor'sadvice.lnsomecases, in psychiatryneedto be ableto employ all the the patient may beableto leaveof their ornmfreewill; in communication skills acquiredsofar in this book. othersthey will belegaliydetainedin hospital.In either Psychiatrycanbe particularly demanding of students, casen, egotiatingskills,suchasbeingableto helpthe patient asthey haveto dealmore with verbalthan physical imagine situationsthey might find themselvesin if they left, examination.Studentsneedto be ableto carryout demandhypothetical anguage(Imagineyou...P).atients standardverbal assessmentslike checklngfor self-harm might alsousehypothetical languagein casesof depression, and the mini-mental stateexamination,both of which wherethey might expressself-denigration(Iwishlwasa give studentsgoodpracticein askingquestions. betterperson)or anhedonia(Iwishlwerehappy). The subjectofsuicide is coveredin this unit. Talkingabout Useful reference: Oxford HandbookofPsychiatry,2nd self-harmand suicidedoesnot increasethe risk of suicide edition, Sempleet al. E additionalactivity Checkup Ask studentsto searchfor more details , Put studentsin groupsto do l-3. Tohelp studentsdecidein 2,you couldrefer aboutthe four peoplein Checkupl. them to the OxfordHandbookof Psychiatryfor further information. Theycould alsofind information about the following peopleand their specific r For3,your students may havedifferent views,which could createa lively contributionsto medicinein generalor discussionO. nepoint to rememberis that althoughhistory itself may not be psychiatry in particular: Hippocrates,Plato, of interestto somedoctorsk, nowledgeof where developmentsin medicine DescartesB, raid,and Pavlov /SeeOHCP2.) and psychiatry havecomefrom helpsto put the presentin perspective, trigger ideas,and inform our understandingof currentpractices. E ndditionalactivity Or ld 2b 3a 4c Givesfudentsother nouns (e.g.hallucination, dependencem, ood,delusiond, epression, Vocabulary hysteia,confusion)and askthem to give adjectivesorverbsfor eachnoun.Thenask Appearanceb,ehavioura, ndmanner themto write their ornrnsentencesusingthe words.Theycoulddothis in pairsor groups, ,, Put studentsin pairsto do l. Theythen usethe adjectivesto complete2. or asa classdiscussiona, nd you couldwrite Theycando3and4 on their own or in pairs. allthe sentencesonthe board. Or I Adjective * Tip 1 aggressive 2 restless Affectivedisorderasrementaldisorderws hich 3 withdrawn predominantlayffectmoodandalsohavean 4 distracted effectonthoughtsb, ehaviouras,ndemotions. 5 flamboyant Majordepressivdeisorderb,ipolardisordear,nd 6 anxious anxietydisorderasrethe mostcommon. 7 careless A norg an icmen tald iso r deirsoneinv olv ing diseased,ysfunctiono, r damageaffectni g the brain.

Workingin psychiatry57 2 I careless 3 restless 5 flamboyant 7 distracted 2 withdrawn 4 anxious 6 aggressive I withdrawal-withdraw d i s t r a c t i o-nd i s t r a c t 4ldepression 3anxiety 5mania Tpsychosis 2 depression 4 anxiety 6 psychosis Allfourareaffectivdeisorderbsu, ttheycanallhaveorganicauses. * Tip [istening Askthe studentsto workinth reegroups Describingpatients andeachcreatea historyfor oneof the threepatientsin Listenin7g.Thenaskthem O pr.rtstudentsin pairsto do l. Theycompareanswerswith a partner for 2 to find a partnerfrom anothergroup and beforelistening againto do 3. taketurnstakinga historyStudents hould givefeedbackatthe end;it maybehelpful Orl to agreecriteriato evaluatethe role-play with beforetheystart,e.g.bodylanguage, M rJ o n e s M i s sR i g b y Mr Dickson questionformations, ympathy/ empathy. 1 Appearance Self-neglect W e a r sr e a l l y Well-dressed * Tip brightclothes, s u i t a b l ef o r Insight= doesthepatientunderstandhis/ s o r n e o n em u c h herexoerienceasrethe result of i||ness? younger 2 Eyecontact Noeyecontact Lookeadt doctor whatsoever w h e nh es p o k e a n dw a ss p o k etno 3 Manner N o tp a y i n g Highly W o r r i e ad n d attention, elevatemd ood, anxious,aton withdrawn, hyperactive, edgeofchairq, uite preoccupiewdith awakeallnight agitatedc,ouldn't h i so w nt h o u g h t s , sitstillF. idgeting, h u g g i n gh i m s e l f verypoor concentration. 4 Modeof Didnotinteract H e rt h o u g h t s speech m u c hw i t ht h e areal loverthe nurse 5 Insight Prace D i dn o t a p p e a r to beaware ofanything a b n o r m ailn h e rb e h a v i o u r 6 Doctor's Inquitea low Safebut nervous feelings mood afterwards 3 1 depression 2 mania 3 anxiety E Additionalactivity Speaking At the end ofthe role-play,get studentsto Studentscando l-6 in pairs.In 4,you could askthem to role-playa difficult, work in pairsto think of responsesto the uncooperativec, onfused,and / or depressedpatient.Ask'patients'to think difficult reactionsthe patient had.Then about how they might reactto the questions(e.g.Why areyou askingme repeatthe role-playto practisethese. thesestupid questions?Are wefinished yet? Wherearewe?I want to go home now),and'doctors'to think about how they might respondto possible difficulties (e.gI. just need to askthese questionsaspart of an assessment.It won'ttakelongifyou'Il justbearwithme.)

58 Unit9 O'r I Orientation 2 Beginninogftheassessment 1 I needto askyou someroutinequestionasspaft of anassessment. 2 Someof thequestionms oyseemo bit simpleb, utifyoujust bear withme,it won'ttakelong. Introducinegachsection 3 I'mnawgoingto askyousomequestionasbout... 4 t'mgoingtogiveyou... 5 wontyouto... , 2,4,s E additionalactivity It'smyjob Askstudenttsoworkin groupsand Putstudentsin pairsto doI and2. explain what they know about the following therapies:group therapy, OF | 1,3,5,6,7 cog nitiv e behavioural therapy,rat ional 2 1 Tore-teachskillsof dailylivingto thepatientsastheypreparfeor emotion aI therapy.When they have discharge. finished, askone personfrom eachgroup 3 Takintgimeto listento thepatienht elpsthepatienat nd to chooseone therapy and explain it. Then d e v e l o pt rsu s t . invite other students in the classto add 5 Nospecifirceasonisgiveninthetext,butthepatientmaythen any additional information. (SeeOxford bemoreco-operativaendopentotreatment. Handbook of Psychiatryfor further details.) 6 Toavoidalienatingthpeatient. 7 Thehealingprocestsakestime,andimpatiencweon'thelp. E ldditionalactivity Languagsepot Ask studentsto write severalsentences ThePastSimpleandthe PastPerfect describingpossiblestepsup to and including the admission of a patient to ReadtheintroductionasaclassT. henaskstudentsto doI and2 ontheir h o s p i t a l .E a c hs e n t e n c es h o u l d c o n t a i n own.Theyshouldusethe PastPerfectonlywhereit isnecessary. two steps:onewith the verb in the Past Simple and the other in the PastPerfect. O'r t t hadalreadyfinished;telephoned Examplepairs to get the students started 2 rushedh;adalreadydisappeared arc:bring in bypolice/ admit;sedate/ calm 3 haddonek; new down. 4 was;hadarrested{;had)brought 5 Hadyoumadeup;were 6 hadn'tcompletedle; ft 7 (had)firstsynthesizeidn;troduced 2 'l finishedhiswardsrounds 2 thepatienht adalreaddyisappeared 3 | haddonesomeassessmetnetstsbefore 4 theyhadarrestedheroncebefore 5 madeupyourmindaboutyourfuturceareer 6 hadn'ct ompletehdisinternship 7 hadflrstsynthesizeddiazepam Pronunciation Weakforms O Studentslistenanddol, thenformpairsto do2-4.For4,encourage studentsto usephrasesfromthe UseluL/ anguageinthe Student'Bs ookto formtheirquestions.

W o r k i n gi n p s y c h i a t r y * Tip s Ask studentsto form new pairsto do 5. Medicineand medicalanguagehaslotsof O.rlrrO secondarsytressews ith manypolysyllabic 1 AfterId learnttotakeadetailedhistoryfromthe patient,1... words (e.g.myocardiol infarction) whilstgenerasl pokenEnglishismore z eeforte:dworteail pryir,,v,! monosyllabiwcith lotsof unstressewd ords (Canyou tell me how it all cameabout?). 3 ld workedforfiveyearisnmyowncountryinthefieldof Evenat advancedlevelss,tudentsoften psychiatrbyefore| ... eitherleavethe stresseosut or trip over t h e m .T h i se x e r c i s seh o u l di n c r e a steh e i r 4 IdealtwithallthenewpatientasssoonasI'dseen... awarenessand offeropportunitiesfor practice. ..O E additionalactivity 5 OncelUcompletedmyundergggluatdeegree|,... Playthe recordingagain and get students O. to underlinethe otherunstressed syllablesin the sentences. 6 I hadn'mt ovedintopsychiatrbyecaus1e... Then askstudents in groupsto vwite sentencesoftheir own and underlinethe oO unstressedsyllablesW. hen they have finished,they canreadthe sentencesto 7 Whenl'dleftmyhomecountry1, ... the class. I Samplqeuestions A f t e r y o uh a df i n i s h e du n i v e r s i tdyi,dy o uf i n daj o b i m m e d i a t e l y ? Hadyoueverworkeidn[e.gp. sychiatryorotherfiebledf]oreyou c a m eh e r e ? Beforeyolueftyourcountryh,adyoudoneanypostgraduacteourses? Hadyoueverthoughotfdoinganythingelsewhenyouwereyounger? Onceyouhadgraduatewd,hatdidyoudecidteo specializine? * Tip Reading pre-morbidpersonalit=y a patient's Put studentsin pairsto do L Then askthem to do 2 on their or,rrnT.heycan personalitypriorto the onsetof a do !-5 in pairs or groups.In 5,allow freetalking without interruption. Try p s y c h o l o g i cdails o r d e r to avoidanswering questionsand correcting;savethis until the end of the discussion. * Tip OF 2 a explaintothepatienthowlongtheinterviewwilltake Afteryouhavefinishedthe reading b what hisexpectationasre exerciseas,skstudentsto practiseverbaIly c isreluctanttostarttalking the questionsdescribedinthe firsttwo d askw hatthe pati entthi nkas boutthi s p a r a B rpah s . e besureit iscomprehensive I 1 Donot hurryhim.TryaskinBH:owareyou/What hasbeen happeningtoyou?/What arethemostimportantthings?Indicate why the CPreferredthe patientandthen askwhat the patient thi nksaboutthi s. 2 everythinglistedin the bulletpointsatthe endofthetext 3 whentheyarespecific 4 earlymorningwaking,decreaseadppetiteandsexuaal ctivity, weightloss 5 Studentso' wn answers. (See2HCMTp.322) 4 Possiblqeuestions: Howareyou?What hasbeenhappeninginyourliferecently? Canyou describewhat lifewaslikeforyou whenyouwereyounger/ a child?Canyoutell mewhat lifewaslikeforyou asyougrewup? How would you describeyourselfbeforeyou becamei||?

5O Unit9 E additionalactivity Patientcare Ask studentsto underline the stressed o Put studentsinpairs to do l-3. syllablesin the questionsin Patientcarel, then readthe questionsout loud using the O? | t harmingyourself correctstress. 2 feel:future 3 go;bed 4 endi ngortaki ng;l i fe 5 made;preparations 6 endortake:l i fe 2 Possiblequestions H a v ey o u a c t u a l l yh a r m e dy o u r s e l f ? Whatstoppedyou harmingyourself? Haveyoueverthoughtthat Iifewasnot worth living? 3 Youneedtoaskaboutthepasttofindout ifthereisa patternof thoughtsaboutself-harmA. skingaboutplansa, ndwhethera patienthaseverharmedthemselvesw, ill tellyou how seriouslay p a t i e n th a st h o u g h t a b o u td o i n gi t . Speaking Put studentsin pairsto dothe role-playin l. Youmay want to put the As and Bsin groupsfirst to study the role-play cards.Checkthat they understand the situations describedfor both their patient and doctor roles.Encouragestudentsto try to empathizewith the patient and think about their body languagebeforethey start.Encouragethe doctorsto probe gently,consideringthe stateof the patient. Givethem time to look at the questionsand adviceon pp.86and 87of the unit, to plan what they might sayasthe doctor. While studentsaredoing the role-plays,watch discreetlywhat is happeningwithout interfering.Make notesabout language,pronunciation, body language,empathy,etcto feedbackat the end.Discussthe role-play with the classasa whole, Iooking at it from the patient's point of view first, i.e.why the patient in eachcasemight behavein that way,and then how the doctorhasto dealwith this. Studentsremain in their pairsfor 2 and 3. Languagsepot Wishesandconsequenceins negotiations Readthe introduction asa class.Studentsdo I on their own, then form pairsto do 2.Beforethey switch partnersfor 2,you might want to check the questionsfor accuracyand you could askstudentsto saythe questions aloudto checkthe stressis correct. Or | 1 | wish I hadcometo seehim yesterday. 2 lf onlytheywouldlet mego hometo myfamilythisafternoon. 3 lmagineyouhada fit whenyouwerealonein a swimmingpool. 4 I wish hewould recover/ had recoveredcompletely. 5 Supposeyouwent home.Whowould lookafteryou? 6 lwish I hadn'tlostmytemperwiththe patientlastnight. 7 | wishthe visitorswouldgo awayandleaveusin peace.

Workingin psychiatry6l E ldditionalactivity Speaking Referstudents to the secondbullet point Put studentsin pairsto do l-f. For2,note that the cuesarenot direct in the introduction and to the thought responsesto the patient'swishesin l. Encouragestudentsto usea variety of bubbleson p.86.Ask them to write more phrasesfrom the lan guagespot:Imagine/ Suppose/What if / Let'ssay. sentencesexpressinganhedoniaand self-denigrationrelating to a depressed O.r | 1 lwish lcouldgo homenow. patient,using wish:Iwish I werehappy,I 2 | wish I hadn'ttakenthetabletsin thefirst place. wishI didn't feellikethis.etc. 3 | wish/ lf onlylcouldseemyfamily. 4 lwishtheywouldn'tstopme goinghomenow. 5 | w i shthedoctorcoulsdeeI am OK . 6 |wish/ lfonly Iwereatwork. 7 lwish lwereout enjoyingmyself. 2 Possibleanswers 1 lmagineyoucollapsedin the street. 2 What ifyou hada relapseonyourown at home? 3 Supposeyofuell. 4 Let'ssupposeyouweredrivingandcollapsed. 5 lmagineyoucausedan accident. 6 What ifyoudamagedyourliver? 7 Let'ssupposetherewansobodyaroundandyoupassedout. Wdting Extracftrom a mentalstateexamination Put studentsin groupsto do I and 2. Or I A formerpati entofmi ne,MrThompson,w ho2i s5yearsol d,w as foundby policeat 2 a.m.wanderingin the street,confusedT. he p a t i e n th a db e e na dm i t t e do n ey e a re ar l i e ru n d e rs i m i l a r c i r c u m s t a n c e Hs .ew a sa g g r e s s i vaen dc o n f u s e da n dt a l k i n gr a p i d l y . Hesaidthe transportsystemwasa messandhe neededto fix it now.HehadpoorconcentrationH.ewasnot properlydressed thoughpreviouslhy ehadalwaysbeenformallydressedandvery tidy.Hisinsightwasimpairedand hewasnot awareof what hewas doing.Hemadeinappropriatgeesturesto the policeandnurses. Wewerecarefual boutbeingalonewith the patientwithout a c l e a re s c a o er o u t e . 2 Therearetwo instanceos f the PastPerfecitnthe answerabove: had beenadmitted; hehad olwaysbeenformally dressed. ChecklistK, eywords Seesuggestionson p.5.Gothrough the Iist of words to checkstudents' pronunciation and understanding.Remindstudentsto transfer useful words and phrasesto their vocabularynotebooks.

62 Unit10 :iii:i,l rr: r:i.a:ilii i;r Background emotional stages,from shock,to guilt, to acceptance,but this will vary from patient to patient. The reading passage Dealing with situations related to terminal illness and givesa step-by-stepapproachto breakingbad news. dying is difficult in any language,soit follows that dealing with it in a secondor eventhird language is ThepicturesinCheckup andthe Webproject onp.92 probably more complex.Apart from having to consider canhelp introduce a discussionabout careofthe dying, appropriate vocabulary (whether to usewords like pass especiallyfrom a socialand cultural point of view. away or die),intonation, manner, and turn of phraseare Supportoutsidethe hospitalthrough community care, crucial.Other areasthat doctorsneedto pay attention suchashelp from palliative carenursesor hospicecare, to arerecognizingand dealingwith patients'emotions, may take different forms in different cultures,or may not allowing patientsto expresstheir emotions,breaking be available at all. bad news,and establishinga copingmechanismfor themselvesin dealing with such emotional situations. In all of this,the effecton the doctoror other health Thesetopicsare aIIcoveredin this unit. professionalneedsto betaken into considerationP. atients may encounterterminal illnessa number of ti.mes Thereare a number of establishedpatternsof behaviour throughout their lives,but doctors,nurses,and other and emotional processesassociatedwith dying,which health personnelmay facethis more than oncea day in are important for students to be aware of.When patients certainspecialties. arefacedwith unpleasant situations such asdealing with their own or a relative'sterminal illnessor approaching Useful referenceIOxford H andbook of PaIIiat ive Care, death,they areIikely to gothrough variousspecific Watsonet al.,especiallypp.19-25,625-635a,nd pp.699 onwards. * Tip Checkup Introducethe ideaof communitycareto o Students can do l-l in pairs.For3,encouragethem to think about issues t he stud en tsan daskth emt o ex olainit in such assafety,availability of medication and treatment, patient comfort, relationto a nucleaor r extendedfamilv. and strain on the family. Youcanthen do 4 asa whole class. Or 21c 2d 3b 4a I Tohelppatientsto managechronic(long-lastingp)ain. E additionalactivity Vocabulary As an alternative in 2,get one student Reactiontso badnews in eachpair to readaloudthe meanings of a-g and his/her partner to givethe * Putstudentsin pairsto do1and 2.Theycanthen do 3 on their own. definitions l-7. For3,students can read alternate sentencesto eachother, saying t Studentsdiscuss4 in groupsor asa whole class.Considerthat in some blankwhere the spacelies,and their cultures,public expressionof grief is considerednatural,but in others partner can supplythe missing word in people do not feel comfortable with it. Ask students to compare and say the appropriate form. what the benefits of eachare. Or l1c 2f 3d 4e 59 6b 7a I 1 numb 4 resigned 6 disbelieve 2 shocked 5 isolated 7 panicked 3 denies

Termi nail l nessanddyi ng 63 x Tip listeningI Afterthe studentshavedone1-4,getthem Recognizinagnddealingwith patientse' motions to readthe threeextractsinthe Listening scrpi t to you,usingthe correctintonation. O Studentslisten to the extractsfor l, then form pairsto do 2.Theymay Theycanthendo it in pairsandthen role- needto listen againto completethe statementsin 3. playthe same situationsusingtheirown woros. Playthe recordingagainfor studentsto listen to the intonation in 4. Or 2 1 resignation 2 shockd, isbeliefd,enial 3 shockp, anic I I wehadfeared 2 cometotermswiththis 3 to stopfor a moment I Thedoctor'svoicegoesdownat the endof eachstatement.This makesthe doctorsoundsincere. * Tip It'smyjob A goodinnings= a longlife Studentscan do I and 2 in pairs,then discuss3 in groupsor asa whole class. For3,studentsmay be ableto describetheir own professionalor personal experienceand shouldexpecta rangeof emotions,often starting with shockand disbelief. O? | 1 Not keepingenoughdistancefrom theiremotionsandgetting p e r s o n a l l iyn v o l v e da r ec o m m o np r o b l e m s . 2 lt isa catharticexperience. 3 MarieCurienurseswork in conjunctionwith Macmillannurses, CPsa, ndotherhealthprofessionals. 4 lt is rewarding andveryvaIuablefrom the family'spoint of view. 2 teamwork-3 a heal i ngexperi ence2- a worthwhileexperienc-e4 adifficulty-1 E Additionalactivity Webploiect Youcanturn the arguments for ForI and 2,askstudentsto downloadthe information and look at any links. community care/ hospicecare/ hospital Youcould suggestparticular areasto find out about,for example,what each careinto a classdebate.Or you can ask organizationdoes,their main aims,how they help patients and families, students to discusswhether a servicelike howthey are different from eachother. Marie Curie or Macmillan nurseshas a placein their own countries,if similar Youcouldaskstudentsto do 3 in pairsor restrictthem to one or two organizations don't already exist. organizationsfrom eachcountry.Ask them to identify two or more similarities or differencesbetweentheseUK organizationsand any they find. Put students in groups for 4. The caremay be radically different from that in the UK.Youcould askthe groupsto summarlzetheir discussionsand comparetheir answersand suggestionswith the restof the classY. oumay want to combinethis with 5:encouragestudentsto think of the bestand worst aspectsof both community and hospital careand the coststhat might be involved in each. O.r 2 palliativecare/careoftheterminallyill

64 Unit10 * Tip languagespot Asa variations,tudentscanworkon their Expressinlgikes,dislikesa, ndprefelences own to write sevennegativestatements expressni g dislikese, .g.I wouId prefernot * Readthe introduction asa classbeforestudentsdo I and 2 in pairs.Check t o . . ., l d o n ' t l i k e . ...T h e y t h e ns a y t h e i r their questionsbeforeaskingthem to form new pairsfor 3. statementstoa partner,whocanquestion them aboutwhat thevsaid Or | 1 MrsJonesprefersbeing/ to bein herown homeratherthanthe hospital. 2 Wouldyou liketospendtime abroadoverthenextfewyears? 3 ld hateto liveat the hospital. 4 He'dliketo goto the respitehomethisweekend. 5 I would prefernot to haveto get upsoearlyeverymorning. 6 Doyoudislikestartingearlyin the morning? 7 HeUrathernottakeanythingforthepainatthe moment. 8 Asa rule,I liketo get to bedaround10p.m. * Tip Speaking Mesothelioma= a form of cancerthat Put studentsin groupsto do l. Checkthat they understandthe meaning affectsthe liningofthe lung of 'warning shot'(e.g.I'mafraidthe newsis notgood.)and'leavingthe door open'for the future (e.g.PIeaseget in touchif y ou have anyfurthe r E ldditionalactivity questions.).Theycanremain in groupsfor 2 and 3. Ask students to give a presentation on Studentschoosefive criteriafor 4,then form pairsto do 5.Checkthat one ofthe three scenariosin 7.They studentsall understandthe Usefulphrasesbeforethey begin and canprepareit ashomework usingtheir encouragethem to practiseusing them. As before,while studentsaredoing own experienceor imagination. The the role-plays,watch discreetlywithout interfering.Make notesabout presentationcanbe aslong or asbrief as language,pronunciation,body language,'roleunderstanding / play',etc. you havetime for, but set a cleartime Iimit and tell students what equipment they For6, at the end of eachrole-play,askstudentsto giveeachother feedback, canuse,e.g.chalkboard,projector,etc. allowing eachstudent to assesshis / her own performancefirst. In giving feedback,studentsshouldalwaysbegin with the positivepoints first, followed by constructivecriticism for development.Remindthem that giving feedbackis a skill that canbe developedand which will help them to developself-awarenessand to givepatientsfeedbackabout their illness. If you havetime, you coulddiscussthe role-playwith the classasa whole, Iooking at it from different angles- what they found enjoyable or difficult, etc. Studentsremain in their pairsto do 7.Askthem to role-playone of these scenariosfor further practice,taking on boardthe feedbackfrom the previous role-play,and making improvements or trying different phrases where possible. O.r 2 Somedifferentreactionsto discussmight beto staysilent,to say somecomfortingwords,to offer a tissue,to offerto stopfor a minute. 3 Possiblaenswer Informingthe daughter/ son 1 | don't reallyknowwhat mesotheliomais. 2 Well,Ithought it might happenlikethis. 8 Thankyouforasking,doctobr,ut I'dratheryoucontinued. Lengthof time left 7 How longhashegot?

Termi nail l nessanddyi ng 65 Sympathizing/ empathizing 9 Yesit'sverydifficult.ljust didn'tthink it would makemefeel solonely. Carein the home 3 Hehatesbeingin hospital. 4 Hed ratherbeat home. 5 lU liketo lookafterhim at home. l 0 W hataboutnursi nghel pat home? P a i nm a n a g e m e n t 6 l sthereanythi ngyocuangi vehi mforthe pai n? * Tip Reading Civethe studentsa chanceto discuss Beforethey readthe text, put studentsin pairsto think aboutthe stepsin I the stepsdescribedandto comparewith (theseare listed in the key for 3 below).Theycando 2 and I on their own or examplesfrom theirown experience. in pairs,then form groupsfor 4 and 5. E ldditionalactivity Or 2 Thefirst phase Thesecondstage Thephotographson p.95illustratea F ol l ow i ntghi s variety of rituals relating to death in Thefourth steo different cultures (clockwisefrom top left): Next a young Cambodianwoman holding a A n dt h e n , t h es e v e n t hs t e p protrait of her grandmother during the Thenextstep funeral,Mexico's'Dayof the Dead',ajazz Thefinaltwo steps funeral in New Orleans,a cremation in (Step6 hasno markerin the text.) Bali,and a traditional Europeanfuneral. Youmayfind these useful for stimulating I 1 Preparatiofnorthe interviewwiththe patient discussionamong your students,starting 2 Findingoutwhatthepatientorfamilyknowsaboutthesituation by asking them to identify what is 3 A'warningshot'topreparethem forwhat iscoming happening in each,and which country 4 Denia-l the patientcontrollingthesituationbytheamountof it might take placein, and then coming informationhe/ shewantsto begiven up with othertraditions they mayhave 5 Furtherexplanatiotno checktheyunderstand encountered. 6 Askingif theywouldlikeyouto givemoreinformation 7 Listeningto the patient'sconcerns E ldditionalactivity 8 Allowingthe patientto expresstheir feelings 9 S ummari zi ncgoncernasndmaki nga treatmentpl an Oncestudents have done 3,givethem 10 Makingsureyouofferyourselfforfurtherexplanationand another word like sympathy or suppress possiblya familymeeting. and askthem in groups to find asmany forms of the word asthey canthat can Vocabulary be made from or arereiated to the word. Then askthem to make sentenceson a Wordsandphrasesrelatedto death flipchart or an OHI using the word in its different forms. Putstudentsin pairsto do l-4. O - r l 1 diedof 4 passeadway 7 pass 2 fading 5 mourn 8 bottlingup 3 perform b laidout 7 post-mortem 4 passon 21 perform q bottleup 5 died 2 fade 6 condolences 3 passaway 3 dies 4 dying l1 dead 2 death

66 Unitl0 E ldditionalactivity listening2 Sothat students can appreciatewhat lnforminga relativeabouta death goodpractice is,role-play the scenario between Dr Masood and Mrs Mann with r 6) Studentslisten and do I and 2 on their own, then comparewith a a student, deliberately badly or clumsily. partner for 3.Theyremain in pairsto do f-6. For5,remind them of some Then askstudents to do it asbestthey of the reactionsdiscussedinVocabularyon p.90of the Student'sBook.Ask can and compare.Discussasa whole class them to givefeedbackfor 5 asin the previousSpeakingexercise. what went wrong in the first role play. OF 2 1 wegoin 2 Thenews 3 sorryto saythat / ableto resuscitate 4 passedaway 5 SisterJoneosr me 6 likeusto contact/ prefertodo so 7 easytocometoterms I Possiblequestions Wouldyou likesomeoneto bewith you? Wouldyou likea nurseto bepresent? Wouldyou liketo bealone? Wouldyou likemeto stopfor a minute? Wouldyou liketo seethe body/ yourhusband? 5 Possiblequestions 1 Thepatientprobablyhadan ideathat somethingwas wrongandperhapscriedor wasin shock. 2*7 Thepatientperhapscried,expresseddisbelief,felt guilty,or r e m a i n e ds i l e n t . t* Tip Speaking Encouragsetudentsto varythedifficulty Studentswork in groupsto do I and 2.Theremay be an imbalancefor ofthe scenarioin 4 bymakingthe parents one sideof the argument orthe other in 2.If this is the case,encourageor moreo rlessre luctan t t oagr ee. Asakpair nominate somestudentsto arguefor the other side. to volunteetro dothe role-plaiyn frontof the classwith otherstudentstakingnotes. Studentsdiscuss3 asa whole classt,hen form pairsto do 4 and 5.Remind Youcouldaskthe volunteerws hat they them to think about how the parentsmight be feeling,how they might w o u l d p a r t i c u l a r l lyi k ef e e d b a c ka b o u t . react,why it is important to ask,and what their son may havewanted. Askthe classto givefeedbackat the end (rememberto askthe volunteersto givethe O? | For f e e d b a c kab o u tt h e m s e l v efsi r s t ) .En s ur e saveslives t h e f e e d b a c ki sc o n s t r u c t i v e . s h o r t a g eo f o r g a n s givescomfortto bereavedfamilies Against isopento abuse isunethical isunnatural isdangerous is insensitiv/etraumaticsubject o dealwith afterdeath I Possibleanswers 'l I havetoaskyoua verydelicate/ sensitivequestion. 2 YoursonDavidwascarryinga donorcardin hiswallet,but we still needyour permissionif we areto carryout hiswishes. 3 Thisisa verydilTiculttimeforyou andyourfamilyb, ut... 4 Wouldyou likesometime to think aboutit with the family? 5 lf this isdistressing,wceantalkaboutit a littlelaterwhenyou areready.

Termi nail l nessanddyi ng 6 7 6 8ydonatingorgansyouwill behelpingotherpeopleto live. , 7 Butdonotfeepl ressureindanywaytodonateyousron'sorgans. x Tip Speaking Whilstit isimportantandhelpfulfor Put studentsin groupsto do I and 2.All the optionsin 1 arevalid answers; studentsto collaborateinthe writing, somemay work better for different students and at different times, and a remindthe mth at in a nyjo b orjob combination of severalis likely to be helpful.As the studentsdiscusst,ry not applicationth, eirworkmustbepersonaIto to take part in the discussionyourself,but encouragethem to givereasons themselves. and examples,and give feedbackafterwards. For3,studentsreport what they havediscussedT. hisis a chancefor the whole classto air ideas.Allow full expressionb, ut try to make it aslight as possible,becauseit canbe difficult talking about the situationscoveredin the unit. Forexample,encouragestudentsto shareamusing or uplifting anecdotesof ways they havecoped.Note that if the discussionbecomes morbid, you should bring it to an end.Youmight like to warn students of this possibilitybeforehand. Writing Preferredcopingmechanisms Studentsdo I on their own. Ask them to think of familiar mechanismslike reading,sport,and visiting friends,but alsoactivitiespersonalto them. Theythen form groupsfor 2. Try to encouragestudentsto help eachother in 3.If you collectsamplesof student writing, askthe student'spermission.Ifyou usethem in future classesasexamples,remind studentsnot to copy. ChecklistK, eywords Seesuggestionson p.5.Gothrough the list of words to checkstudents' pronunciation and understanding.Remindstudentsto transferuseful words and phrasesto their vocabularynotebooks.

58 Unit11 Background establisha rapport within the team.Thequalitiesthat doctorsand nursesrequireto beteam playerswill vary In this unit, the valueofteamwork in a medicalcontextis from situation to sltuation,but there arecertain qualities explored,alongwith someof the skillsthat arerequrred suchascooperationr,espectp, olitenessa, ndtaking for membersof ateam to function properlytogether. responsibilityw, hich arenecessaryon all occasions. Surprisingly,it is lessoften the big lssuesthat cause Any kind of exerciseyou giveyour studentswhere they problemswithin teams,but the small exchangeswrth haveto work togetherwill helpto fostera grouporteam another health professionalwho may not be a nurse mentality.Youcangivestudentsproblemsto solvetogether, or a doctor,and whom onehasperhapsneverhad suchasthe photocopiablecommunicationexercisefor this contactwith before.Learninghow to interrupt a work unit (p.103)A.nothertechniqueis to aska studentto actas colleagueyou don't know in orderto askfor advrce a monitor when you do groupactivitlesand getthem to or borrow something,or learning how to approacha givefeedbackon the group'sability to lnteractwith each seniorcolleaguesuchasa consultantm, ay seemminor other smoothly.Alternatlvely,if you haveaccessto a video interactions,but they are skillsthat canmake or breaka cameray, ou canrecordstudents'workin groups.This p r o f e s s i o n arle l a t i o n s h i p . allowsyou to showthem examplesof their interactionsand givefeedbackon team collaborationa, swell aslanguage. Somestudentsmay find it hard to talk to peoplein By showing studentsa video of themselvesworking in a different positions,for example,a radiologistor a nurse. team,you can askthem to identify for themselveswhat Othersmay find ageor genderdifferencesaffecttheir workswell or couldbeimproved,whichwill helpthemtake ability to communicateand function well in a team. this on boardin their clinicalwork. If studentsarenot usedto working in a collaborative framework or aspart of a hierarchy,simpletechniques Usefulreference:OxfordHandbookfor the Foundation suchasbeing ableto engagein small talk at the Programme,2ndedition,Hurleyet al. appropriatetime with colleagues(andpatients)canhelp * Tip Checkup A phle bo tomisstp ecializ einsex t r ac t ing * Put studentsin groupsto dol-4. bloodfrom patientsfor laboratoray nalysis. E ldditionalactivity Or I Theattitudesof the peopleto eachotherareopento interpretation b y s t u d e n t s . T hsei t u a t i o n sa r e : 'Smalltalk'is an important a Aj uni ordoctori stal ki ngto a seni ornurse.Thdeoctori saski ngf or communicationskill to put peopleat ease advice. and help interactionswith colleaguesand b A youngdoctori stal ki ngto a consul tanot nthe phonea, ski ng patientsto run smoothly.Ask studentsto work rn pairs and createminidialogues herto comeandseea patient. focusingon'safe'smalltalk subjectslike c Threecolleagueasrechattingin a relaxedmanner. the weather,family,hobbies,etc.Ask them d Ajuniordoctoristryingto interrupttwo nurses. to think what other subjectspeoplemake 21c smaIItalk about.Discussthe function of 2 a,bandd small talk, and remind studentsof its use 3d in putting the patient at ease. 4b I Becauseverybodny eedsthe helpofothersto do theirjob effectively.

W orki ngi n a team 69 E additionalactivity Cultureproiect A group discussionofattitudes to Put students in pairs to do I and 2,then get themto form new pairs for L politeness canusefully belinked to this Encouragethem to developthe conversationasmuch asthey can.Make the topic to encouragestudents to think aim either to ask all the questions or to develop severalfully. about their interactions with colleagues. Forexample,askstudents to talk about Do 4 asawhole class,and allowthe studentsa chanceto askyouthe questions. their views of what it means to be polite and howimportant they considerit Vocabulary in different situations. They can malce a list of similarities and differences Teamwork in perceptions of politenessbetween cultures.They canthink about verbal StudentscandoI and2 ontheir oumorin pairs.Theymayofferother responsesb, ody language/ gestures,and possibleanswersfor l; youcanexplorewhat they meanby eachsuggestion general behaviour. to checktheir understandingT. heimportantthing isfor studentsto understandeachof the adjectivesandnounssurroundingteamworkandbe El ldditional activity ableto usethem correctlyF. or2,the adjectivescanbeusedmorethan once. Ask students to write sentencesof their Putstudentsin groupsto do3.Askthem to think in particularaboutthe own using the nouns and one ofthe elementsof teamworkdiscussedsofar,e.g.attitudestowardsresponsibility, adjectivesnot usedinthe sentencesin 2: co-operationsu, pporte, tc. working,effectivem, oral,public,social, community,joint. Or | 1 team:keym, ultidisciplinarcylo, sew, orking,effectir,e 2 cooperationp:racticapl,ublicc,ommunity,teamso; cial;joint, * Tip c l o s ee, f f e c t i v e 3 spiritp: ublicc,ommunittye,amw, orking At the end of Vocabulary,assktudents 4 role:practicapl,ublicc, ommunity,teamm,oral,social,joinket,y, to closetheirbooksand recapS. ayan mu l t i d i s cpi l i n a r ye,f f e c t i v e adjectiveandaskstudentsto supplythe 5 responsbiIity:public,community,team,morals, ociajlo, inl noun,e.g.team- spirit,practicol- support. colectivek,eym, ultidiscpi linary Alternativelyg,ivethe noun and ask 6 supportp:racticapl,ublicc,ommunitlr,teammo, ral,social, studentsto telIyouat leastonesuitable multidisciplinary,effective adjectiveS. tudentscouldalsodothisin 7 partnership: public,social,joint,keyc, losew, orking,effective oairs. 2 1 teamspirit 2 Closecooperation 3 multidisciplinateryam 4 keyrole 5 collectivreesponsilbitiy 6 practicalsupport 7 closepartnership * Tip Writing Writethe examplegivenhere Describingan exampleof goodpractice on the boardifstudents have difficultygetting startedin l. Studentswork on their own to do I and 2,then form pairs for 3. An example for I might be:1patient admitted to A&E from RTA--+2 ambulance crew briefed me (junior doctor) --+3nurse checkedvital signs--+4 I askedconsultant's advice--' 5surgeonperformed emergencysurgery...etc. In 2 they shouldexpandthesenotesinto full sentencesand try to build in the words relating to teamwork, e.g.A patient was admitted to Accident & Emergencyfrom a RoadTraffic Accident. The ambulance crew briefed me, ajunior doctor,then handed over responsibility for the patient's careto me. I worked closelywith the nurse while she checkedthe vital signs- this is a key partnership in caring for patients. I askedthe consultant's adviceand shewas ableto offer me practical and moral support...etc.

70 Unit11 Reading r Put students in pairs to do I and 2.They then work on their own for 3.For question 2,encouragestudents to think of the dynamics of working in a team.Forquestion4,askthem to considerwhat happensif one personis acting on their own and what the consequencesarefor the patient and for colleaguesD. oesit put pressureon other people? O'r 2 'l demonstrate 2 outcome 3 perspective 4 appreciate 5 respect 6 heed 7 shape | 1 (Agoodteamworker)understandswhicphieceofinformation needsto beconveyedto which particularperson. E ndditionalactivity listeningI Oncestudents have done t, you can play Appropriatreesponses the recording again and askthem to give their own responsesbefore you do 2.You o O StudentlsistenanddoaI nd2ontheirown.Theycandaon3d4inpairs. coulddo the sameagainbeforedoing 3. OF | 1 Askingacolleagufeorhelp/ interruptinagcolleaguew'sork E ndditionalactivity 2 Askingtoborrowapen 3 Apologizing Put studentsin groupsto createtheir own 4 Askingacolleaguetotakbelood/ interruptingcaolleague'swork initial statementsor requestsmatching 5 Checkinhgowsomeoniesfeelinganwdhetherthenyeedhelp the polite responsesT. henget them to 6 Sympathizin/ ogfferinghelp role-playsomeof the exchanges. 7 Apologizin/gconveyinimg portanitnformation 2lb 2a fa 4b 5a 6a 7b I Possiblaenswers 1 Thankyou/T. hat'sreallykindofyou. 2 Thankyou/T. hat'sreallykindofyou. 3 Thankfsorbeingsounderstanding. 4 Thatwouldbegreatl.That'sfine. 5 | hopeit staysthat way. 5 Notatall./Mypleasure. 7 Thankyou. I Possiblaenswers 1 That'sOKN, oproblem. 2 ActuallyI,haven'tb, utit'sOK.Thankyou. 3 lamsorry.lwagsenuinehlyeldup. 4 |amsorryto askwhenyou'rebusy. 5 Oh,sorryto hearthat. 6 OK,noproblem. 7 Ohl'mreallysorryS. halIlcall...?

W orki ngi n a team 71 languagespot Beingpolite * Readtheintroduction asa class.Studentscando l-3 ontheir own or in pairs.For4, askthem to work separatelyto underline the important words in eachof their statements,and to think of brief polite responsesthat might be appropriatefor each.Theythen take turns readingtheir statements aloudto eachother.Theycanthen swapoverand readeachother's statements,and saythe brief responsesthey thought of for each. O-r l1a 2b 3a 4b 5a 6a 7a 2 1 sorryto/bother 2 Excuseme / comeandhave 3 Wouldyou mind/ closed 4 | cansee/ writing 5 lsit OK/ clear 6 D oyouthi nk/ use t 1 cord 2 cord I bore 4 borc 5e 6 b,c,ord E ndditionalactivity Speaking Studentswork in pairs and choosea pain Put studentsin groupsto do 1.Theyfind a partner from a different group relating to one areaof the diagram. Their for 2 and 3.Settime limits:10-15minutes for preparationin l, 5minutes partner takes a history to find out what for eachdoctorin 2 and 3.At the end,allow for generaldiscussionofthe the problem is and makesa diagnosis. exerciseand more open generalfeedback.Studentsmay want to repeatthe exercisei;f you havetime, allow them to do soto practiseand improve.If tr Tip you haveaccessto telephones,you canusethem to add authenticity to the exerclse. Allowstudentsto exolorethe valueof doingoth erjo bslikeDr No or ior doing It'smyjob volunteewr orkfor theirown personal develooment. StudentsdiscussI with apartnerbeforetheyreadthetext anddo2. Or 2 1 Afghanistan 2 informatioonnHealthandSafetgyuidelineosr,deor fdraw bottleadditiveisn,fectiocnontrola, bellinagnddocumentation, p r a c t i s i nign a no u t - p a t i e nste t t i n ga n do nt h ew a r d s , a s s e s s m e n t o bn t a i n i n g am i n i m u mo f 5 0b l o o d s , g o o d c o m m u n i c a t isokni l l s 3 DariorPushto 4 drivingacarc, hangingears 5 Youneedto reacqt uicklyandpolitelya,ndgetonwithcolleagues, o rt h e i o bi su n b e a r a b l e .

72 Unit11 Vocabulary E Additionalactivity D e s c r i b i n ga t t i t u d ea n d b e h a v i o u r EIicitother adjectivesto describe * Put studentsin pairsto do 1-3.Encouragethem to usethe Usefulphrases behaviour.Thiscanbe doneasa whole- given in 3.Youcanthen do 4 asa whole class. class,group, or pairwork activity. Allow studentsto usedictionaries.Youcould Or | 1 offensive,rude turn it into a competitionbetweengroups, 2 friendlys, ociable with a time limit to seewho can make 3 ambi ti ousd,etermi ned the longestlist.Thenmake sentences 4 abrupt,blunt together using the examples students 5 thoughtful,kind have come up with. 6 calm,carefree 7 cheerful,lively I Therecanbea varietyof culturalp, rofessionaaln, dpersonarleasons. Theconceptof talkingaboutboth positiveandnegativequalities maybeunusuailn somecul tures. Speaking Put studentsin pairsto do I and 2. Askthem to work with a different partner for 3.At the end of eachrole- play,askstudentsto giveeachother feedbackbasedon the agreedcriteria, allowing eachstudentto assesshis/her own performancefirst. Or I Possibleanswers 1 Excuseme,l'msorrytobotheryoub, ut... I'msorryfor interruptingyoub, ut ... 2 ...wouldyou mindhelpingmewith this? ...couldyoudothisfor mewhenyouget a minute? 3 Weneedan urgentbloodsample. Thechildisin a criticacl ondition. 4 Couldyousendthis priorityformoff with the sample? Here'sa priorityform;it will needto go offwith the sample. 5 Thankyoul.fthereareanyprobl ems,canyobul eepme? ThanksA. nyproblems,jusbt leepme. listening2 Askinga seniorcolleaguefor help C) Studentslistenanddol, thencomparewith apartnerfor 2.Students shouldworkwith adifferentpartnerfor 3andtaketurns asconsultantand d o c t o rr,o l e - p l a y i n gt h e p h o n ec a l lf r o m t h e i r n o t e s . O? | 1 I'mreallysorrytodisturbyoub,ut... 2 Thatl perfectlyOK. 3 Couldyoupossiblcyomeandseeher?

W o r k i nignat e a m 7 3 Speaking * Put students in groups to do F3. Encouragethem to usethe tJsefuIphrases where possible.Seta time limit (suggest15minutes)for preparationin I and 2.Ask studentsto decideon two or three criteriato help them judge the interviewee'sperformance.Suggestedcriteria might be organization, relevance,and fluency. They can usethe Speakingchecklistonp.12O. Therole-playcanbe donein pairsor in threesaspanelsof two interviewers and one interviewee. Setatime limit of 7-10 minutes maximum for each candidate.Ask the interviewers to take notes asthey interview and give feedback asper the criteria on th efi Speakingchecklist.Allow eachstudent to have a turn. At the end, give general feedback and allow classdiscussion. If you havetime,youcould offeryourselfto beinterviewedwiththe whole classasthe panel. ChecklistK, eywordr r Seesuggestionosnp.5G. othroughthelistofwordsto checkstudents' pronunciationandunderstandingR. emindstudentsto transferuseful wordsandphrasesto their vocabularynotebooks.

74 Unit12 Background ability are all areasin which differencescanieadto In a multicultural societylike the United Kingdom, stereotypingand making assumptionswhich can cause students'awarenessof the cultural backgroundof their colleaguesand patients is crucialfor them to be ableto offence.It is important to rememberthat what may seem function weil at all levelsof primary and secondaryhealth care.With the increasingmovement aroundthe world of smali or insignificant to onepersonmay haveenormous peoplein general,and of professionalssuchasdoctorsand nursesin particular,more and more societiess, ystems, importanceto another,soit is crucialnot to make and institutions of health provisionlike hospitalshave a culturally diverseworkforce and patient body.With 2 q<r lmntrnn < this comesa needfor otherpeopleto understandyour students'backgroundasndbeliefsa, nd equallyfor your If we takesomethinglike namesandtitles,we can studentsto understandthe peoplewho they areworking seehow offencecanbe causedand createtensionor a with andfor. breakdownin communication.Forexample,one of your studentsmay addressa female patient with a newborn Foryour studentsa, warenesstakesthe form of child as'Mrs'assumingsheis marriedwhen infact sheis understandingeveryonethey meet asindlviduals, not.Toretrievethe situation,they may addressher as'Ms', who may havevery different cultural and religious oniy to betold that sheis not a 'Ms'nor a 'Miss'but in fact backgroundsor belief systems.Thesemay havean impact a'Dr'! on the way that patientsbehave,and the way that they expectyour studentsto behave.The sameappliesin Thisunit will help your studentsin the important dealingwith colleagues. taskof getting to know andunderstandthe different beliefsand cultural backgroundsoftheir patients and Justbeing awareof the differencesis not enough- but it colleaguesB. eingawareof other peopleandtheir cultures is a start.But which differencesdo they needto be aware is essentialin medicine.It helpshealth professionalsto o f ? A g e ,g e n d e r ,r a c e ,r e l i g i o n ,n a t i o n a l i t y , p r o f e s s i o n a i be sympatheticand empathetic.But aboveall,students status,marital status,and levelof educationand language shouldbearin mind the inscription on the temple of Apollo at Delphi:knowyourself.Ultimately,to understand oneselfis to understandother humans aswell. UsefulreferencetOxfordHandbookof GeneralPractice, 2ndedition,Simonet ai. x Tip Checkup A skstu de ntsto b ringin pic t ur etshat * Put studentsin groupsto do l-4. t heyth inkre flectthecu lt ur eof t heir own O; I Thepicturesrepresenctlothing,religion,festivalsa,nguage, countrie s.Thecyou ldbr ingin a s elec t ion andfood. relatingto the themesin Checkup.Students 3 P ossi bl eansw el tri:si moortanttotreatoati entsw i thi n the contextof their beliefsbecauseit ispossibletooffendthem or couldp rep arethe se lec t ioansgr oup provideunsuitabletreatmentoptionsby,forexamplem, aking suggestionasboutfoodtheyshouldeat,whichthe patientmay homeworkandt henshowt heirpictures not beallowedfor religiousreasons- to the classasa five-minutepresentation. 4 Possibleanswers Increasemd igrationhasmanycauses-flexible international A lte rna tive ly,yocuou ldlinkt hes e job marketsand moreaffordabletravelf,or example.International understandingandco-operatioanrenow moredesirablethan ever presentationtsol of Readinogn p.108ofthe asthew orl d' becomeassmal l erol ace' and i fferenct ul turesmix andlivealongsideeachother.lt is possiblefour stotryto S t u d e n t ' sB o o k . understandeachothermoreasa resultalthoughit canrequire will andeffortto resoecot thers'beliefs.

Diversityat work 75 Speaking * Put studentsin groupsto discussthe behavioursin I beforethey choosethe most annoying ones.They cando 2 in pairs,then cometogether asa class for 3. El additionalactivity listening Studentsaketurnssayingthestatements Avoidingandrespondingto tactlesscomments in the Iistening scrrpton p.138of the Student'sBook,and sayingthe responses Studentscando I in pairs,groups,or asa whole classA. skthem to do 2 with from 2.Youcould then play the sentences a partner. in the recording one at a time and ask students to give their own response. O Studentslisten and do 3 on their own. Theycando 4 in groupsor asa whole class. rcTip O; I Thisposterwasusedto encouragerespecat ndraiseawareness Teetota=l doesnot drinkalcohol a b o u td i v e r s i t yi s s u e sl i k ea g ea n d g e n d e r . 2 a a doctorrecommendintghat a patienteithershouldstopeating meator shouldeat moremeat b somebodyexpectingsomeoneof eithersexto be married, perhapsaddressinag singlemotherlfemale asMrs c somebodygetting someone'snameandtitle wrong d somebodymistakinga consultantforapatient e a doctorrecommendinag patientto cut downor giveupdrinking, or aski nghow muchhe/ shedri nks f somebodyassumingthatbecausesomeonehasa disabilitythat theyarenot a capableperson g someoneexpressinegmpathy(e.gI. canunderstandwhatyou're feeling)b, ut not beingin a positionto do so,forexamplea male doctortalkingto a womanaboutlabourpains h somebodyaskingsomeoneto do somethingon a dayof worship 3le 2a 3c 4h 5b 6f 7g 8d I Possibleanswers I C anI aski fyoudri nkat al l ? 2 Doyoueat meatproducts?Ordoyou havea speciadl iet? 3 HaveI got yourright namehere?(Showit writtendown.) 4 Arethereanydaysof the weekyoucan'tcome? 5 Congratulationosnyournew baby. 6 CanI askif youareworkingor unemployed? 7 lt'snot easyto gothroughthis. 8 Excuseme,areyoubyanychance[patient'sname]? Patientcale Putstudentsin pairsto doI and2.Encouragtehemto usethe Usefupl hrases andto developtheconversatioanstactfullyaspossible. Or t Possiblaenswers 1 Canyoutellmewholiveswithyouat home? 2 Whatabouyt ourparentsA?retheystillalive? 3 HowshalIlcallyouM, issorMs?/ WhatisyourpreferretditleT 4 lsyourfamilynamefromAfrica? 5 | knowyouhr usbanidsinawheelchabiru, tisheableto work? 6 Arethereanyfestivaolsrcelebrationsthatynoeuedtoobserve? 7 Arethereanymedicinesyocuan'ttakeforanyreason?

75 Unit12 * Tip Reading Youcanlinklwith the mini-presentations * Studentsdo I on their own, then form pairsfor 2.They canremain in their suggestedinthetipfor Checkup. pairsfor 3 or cometogether asa whole class. O'r 2l respect 3 mainly 5 cometoo close 2 shouldnotbe 4 Some 6 Some Proiect Put students in pairs to do l. Theythen researchthe namesfor 2 on their or,rrn. O ? | 1 Mi sspel l i nagndmi spronunci ati oonf namessoundsasi f the speakecr an'tbebotheredto learna nameproperlylt. canbe interpretedasa lackof respect. 4 YesS. omeseniorcolleaguems ayliketo keepa professional distanceandpreferto havetheirtitle,e.g.Mr,Dr,Professour,sed w i th thei rnamee, speci al liyf theydo not know youw el l oryo u aremeetingthem for the firsttime. 5 S tudents' owannsw erstothefi rsqt uesti onI.nthe U K ,i ti sno t politeto callpeoplebytheirsurnamealone,exceptin certain professionalcircles. E Additionalactivity Vocabulary When you havefinished Vocabulary,geI Awarenesosf feelings studentsto producethe relatednouns and adjectivesfrom the verbs.Then askthem Studentscando l-4 on their own, then form pairsfor 5. in groups to make their ow-nsentences using the words asadjectivesn, ouns,or e; | 1 value 4 respect 7 criticize verbs.Thencanthen sharethem wlth the 2 ignore 5 regret 8 upset classand transform them, e.g.from verbs 3 offend 6 discriminate to nouns. avps r wzotu valu e p li z v dx i r 5 oh j tq sy g t p gotv o w5 n w e kmzf f cl o p c hezx f b c t I t lctz e zs n t e dv -iy-e?ql k n of q k z Gp a d rx iscriminat 21 criticized 4 offend 7 valuable 7 discriminated 5 upset 8 regrets/regretted 3 ignored 6 respect 31 Hefeltthattheywerebeingunjustlcyriticawl henhethoughthe s h o u l db ep r a i s e d . 2 Noapplicantsshouldsuffedr iscriminatiobnecausoeftheir background. 3 Theywerecompleteliygnoranot f mysensibilitiewshendrawing u p t h er o t a . 4 Hedidn'tmeanto beoffensivteo thepatienbt ycallingherMrs. 5 Whatthedoctosr aidwasreallyupsettintgo thepatient.

Diversitvat work 77 6 Herespectedpatientsandcolleagueaslike. 7 All membersof the medicalteamplayaninvaluablerole. 8 Hefelt / wasregretfutlhat hedidn'tcheckthe patient'sname beforethe consultation. 4 Possiblequestions Haveyoueverinnocentlycriticized/ offended/ upset/ ignored/ d i scri mi nateadgai nsat col l eague? El ldditional activity languageipot Ask studentsto write on stripsof paper Repo*edspeech sentencessomeonemight say.Then dictatethem to the classfor them to write Readthe introduction asa class.Thenput studentsin pairsto do I and 2. asreportedspeech. O'r | 1 NurseBurnessaid(that)MrJoneshadjust telephonedto sayhe E l n d d i t i o n aal c t i v i t y couldn'tcomefor the afternoonclinic. Put studentsin pairs.Usingreported 2 ThenurseaskedMrsH al li f i tw asOK tocal lherbyherfi rsnt ame. speechg, et them to relatea short 3 D rOnoaskedA hmedtotel l hi m how i t w asdonei n hi shome conversationbetween two doctors or a doctorand patient.Useone of country. the listening scrrptsat the backofthe 4 DrSindadvised(thepatient)togiveup eatingredmeatlikepork Student'sBookfor ideasif necessarv. andbeef. 5 Thenurseaskedwhat hispatientnumberwas. 6 MrsTaylosr aidthat shehadleft herappointmenct ardat home. 7 Hesaid(that)hewasn'tsurehowto pronouncehisI hername. Speaking Put studentsin pairsto do the role-play.Encouragestudentsto examine any assumptionsthey made during the role-play,for exampleabout the patient'sreligion,age,or lifestyle,or any of the other things they discussed inSpeakingon p.106of the Student'sBook. * Tip Pronunciation Cetstudentsto practisebreathingduring Sayinglongsentences sentenceisn a role-play,e.g.students cansimplygreeta patientandintroduce s Readthe introduction asa classT. henput studentsin pairsto do l. themselvesb,ut without racingthroughthe i n t r o du c t i o n . * O Stud\"r,tsiisten and checkfor 2 and remain intheir pairsto do 3. O? | Possibleanswers 1 D oyouthi nk/that i tw oul d beagoodi dea/todi spl ayposters/ i n a l l t h ec l i n i c s ? 2 Hesuggestedgoingfor weekendsaway/ sothat peopleI could get to knoweachother. 3 Heaskedwhat time / the clinicnormallyopened/ in the afternoon. 4 Thepatientwantedto know/ whethershewasableto bookan interprete/r for herappointment 5 D rW endeni edtaki ngtheequi pment/outofthew ard/ duri ng the lastshift. 6 | thinkyousaidearlier/that onewayto promotediversity/ is to holdlunchtimedisplaysin the hospita/l for patientsand medicalstaff. 7 Heapologizefdor the misunderstadningI andevenboughtme s o m ef l o w e r s .

78 Unit12 ll additionalactivity Speaking Youcanturn I into a debateor a much Put students in groups of six (three pairs of two) to do these exercises. longer classroomactivity. Thisfuller Encouragestudents to usethe Uselulphraseswhere possibleduring the discussioncanbe done at the beginning discussionin ! and 4. or the end ofthe Speakingsection. Seta time limit of 15-20minutes for the discussion and then 10minutes for r*Tip feedback.Stickto the time limit and remind students of the time Ieft and the fact that they must havean outcome at the end.Getstudents to write Thetype of committeeexercisein ! isoften down their recommendations and keepthem for the following Writing usedin trainingandin assessmentforjob exercise. interviews. Although this is the first time students are likely to have donethis type of exercise,they will have done plenty of pairwork and feedback exercises by now. Youcan askthem to talk to their respectivepartners individually to give feedbackon their participation and then talk together asalarger group. If you havetime, allow students to talk about their reactionsto this exercise. Or I Possiblerecommendations culturaldisplays/ posters talks/ workshops positivediscrimination job quotas celebratingpositiverolemodels equalopportunitylaws/ regulations Writing A responsteo a report StudentsdoI and2 ontheir own,usingthe ideasfromSpeaking.They shouldtrytouseasmanyofthephrasesin 2 aspossibleT.heythenform pairsto do3and4. If thereistime,askstudentsto readeachother'slettefsandcheckif they reflectwhat wassaidin the previousSpeakingexerciseI.f youfeelit is appropriatein yourclassy, oucouldaskonestudentto readaletteraloud while the otherslistenandmakenotesof anythingtheywant to discuss, includinganydiscrepanciefsrom the committeediscussion.

Diversityat work 79 PatientGare * Putstudentsin pairsto dot. ThereismorethanonepossibleanswerA. void givingstudentstheanswersin 2 beforetheyhavecompletedthispartof theexerciseS.tudentscanremainintheir pairsfor 2-4. O.r 2 1 yournotesthatyoudescribe 2 spiritualorreligioubseliefs 3 helpfultoyou 4 thatwecansupportyou 5 weneedto know 6 spiritualorreligioubseliefs 7 youliketoseehim/ her 8 to arrangaemembeor fyour I 1 lcanseefromyournotes/thatdyeosucribeyourreligaiso.n..,l canyoutellmeabout his? 2 Doyouhaveanyspirituaolrreligioubseliefs/?Canyoutellme abouthem? 3 lsyourfaith/ spiritualit/yreligionhelpfultoyou/? 4 Aretherewaysthatwecansupporytou/ inyourfaith/ s p i r i t u a l i/t yr e l i g i o n ? 5 Aretheraenythingswneeedto know/aboutyourfai/th spiritualit/yreligion/ thatwouldhelpusincaringforyou? 6 Wouldyouliketo talkto someon/eaboutspirituaolrreligious beliefs? 7 Wehaveachaplai/nwhoispartofourteam/, wouldyoulike to seehim/ her? 8 Wouldyoulikeusto arrange/ amembeor fyourfaithcommunity/ to comeandseevou? Speaking Put studentsin pairsto do l. Theythen work with a partner from another pair to do 2,beforecoming together asa whole classfor 3. ChecklistK, eywords Seesuggestionson p.5.Gothrough the list of words to checkstudents' pronunciation and understanding.Remind studentsto transfer useful words and phrasesto their vocabularynotebooks.

8 0 Ins t r uc t ions f ocro mmu n i c a ti oanc ti v i ti e s lnstructionfsorcommunicatioanctivities Unit1 technical terms, without saying what it is.Their partner should guesswhat is onthe card. 1 Divide the classinto pairs. Stage 2 2 Give one student in eachpair CardsA and D and the 1 Mix up the cardsand placethem face down again. other CardsB and C. 2 Students go through the cardsagain,role-playing 3 Tell students that they needto checkthe details on conversationsbetween a doctor and a patient. their cards.Tellthem that cardsA and Chave the They should alternate roles.The doctors pick up a correct details and CardsB and D have mistakes. card and explain in non-technical terms and in a reassuring manner a procedurethe patients are 4 Oncethey havefinished asking questions,students about to undergo or the details of a diseasethey are should comparetheir cardsto make surethey have sufferingfrom. found allthe mistakes. Unit5 Unit2 1 Divide the classinto pairs. 1 Divide the classinto pairs. 2 Giveone student in eachpair CardsA and D and the 2 Giveone student CardA and the other CardB. other CardsB and C. Studentswith CardA are GPsand students with CardB arereceptionists. 3 Tell students that they needto checkthe details on their cards.Tellthem that cardsA and Chavethe 3 Tellthem they are going to role-play a conversation correct details and CardsB and D have mistakes. between the GPsand the receptionists.The GPs want to checkif the housekeeping issuesin their 4 Oncethey havefinished asking questions,students notes havebeen dealt with. The receptionists should comparetheir cardsto make surethey have should answerthe GPsfrom the informationthev found allthe mistakes. havein their notes. Unit5 4 At the end of eachrole-play give feedbackabout tensesand intonation. 1 Divide the classinto pairs,A and B. Follow-up 2 Givestudents two cardseach- one doctor card and When they have finished, you could askthe students one patient card.Student A is Doctor L and Patient 2; to work in groups and create a situation for another Student B is Doctor 2 and Patient 1. scenario with or without prompts fromyourself, e.g.asking a health worker / practice nurse / health 3 Setatimelimitforthe role-play. visitor about a patient. 4 ,AskDoctor 1to give adviceto Patient 1 using the Unit3 notes on the cardand adding any adviceofhis / her own. The patient canbe ascooperativeashe / she 1 Divide the classinto pairs. wishes.They should try to agreea plan that suits the patient. 2 Giveeachpair a copy of the cardsplacedface down betweenthem. 5 Repeat he processfor the secondscenario. 3 Studentstake turns to pick up a card and explain Unit7 or describein technical terms what is on the card.Their partners haveto guesswhat they are 1 Divide the classinto two groups,A and B. explaining / describing. 2 Giveeachstudent in GroupAa copyof Cardl and Unit4 eachstudent in Group B a copy of Card2. ThisactMty hastwo stages. 3 In their groups,students should discussthe medical conditions on the card.They should draw up a list StageI of symptoms of the conditions and alsodiscuss 1 Dividethe classinto pairs. other minor conditions that alsohave someof these 2 Giveeachpair acopyof the cardsplacedfacedown symproms. betweenthem. 4 When they havefinished, students should pair with 3 Studentstaketurnsto pickup a cardandexplain a student from the other group and role-play the scenarios. or definethe procedureordiseaseontheir cardin 5 Studentsplayingthe parents should give some,but not all, of the symptoms typical of the presenting

Instructi onfsorcommuni cati oancti vi ti es81 complaint. Studentsplaying the doctors should may then developthe description of the interview askabout all the possiblesymptoms and reassure in anywaytheywish. the parents that, asthe child doesnot have the symptoms, he / sheis not seriously ill. 8 Encouragethe trainersto askquestions,suchas What did you do after you had ...?Did you ...afier you Unit8 had ...?Is thereanythingyou didn't do? 1 Divide the classinto four groups,A, B,C,D. Unit1O 2 Giveeachstudent in a group a copy of the 1 Dividethe classinto small groups. correspondingcard. 2 Giveeachgroup a copy of the sheetwith pictures 3 Tellstudentsto discussthe detailson their cards of the different settings for patients who are and decidehow much of this information a patient terminallv ill. might give when the doctor asks:Canyou teII me m o r ea b o u t t h i s ? Ask studentsto analysethe picturesfrom the patient's viewpoint, thinking about patients' wants 4 Givestudentscompletefreedom in the discussion and needs:socialneeds,patientsmaintaining to add or discussinformation they want relating to controlof the situation,comfort,patientscontrolling the possiblediagnosis.Encouragethem to givelay who isaround them, respectfor thepatient, safety. terms for any medical conditions and try asfar as Encouragestudentsto comment from their own possibleto think how the patient would feel (to help cultural viewpoint. develop empathy). 4 Seta 2O-minutetime limit for the discussions. 5 Seta time limit of about ten minutes. Ask eachgroup to appoint a spokespersonto collect 6 Ask students to find a partner from another noteson eachpicture. group; one in eachpair takesthe role of doctor and they role-play taking a history from the patient: Thespokespersonshouldgivea short presentation introducingthemselvesa,skingwhat thepresenting on the resultsof their group'sdiscussions. complaint is,askingthepatient to tell them more about thepresentingcomplaint,and then developing Unit11 thepatient'sanswer. 1 Divide the classinto groups of four. 7 When they havefinished, they should changeroles and repeatthe role-play. 2 TeIlstudents that they are going to solvea problem and comeup with a decision/ decisionsabout 8 Studentsshould then circulate and find partners spending money on improvingthe waiting room of from other groups until they havefinished role- a GP'ssurgery. playing all the different complaints. Giveeachstudent in the group a different role card, 9 Seta time limit of five minutes for eachrole-play. a copy ofthe list of suggestionsa, nd the photograph. Unit9 Ask eachgroup to discussthe options,examining any possibleproblems,and cometo an agreement 1 Divide the classinto pairs. about how the money should be spent. 2 Giveeachpair a copy of the cardsplacedface down Studentsshouldfollowthe preferencesstatedon betweenthem. their cards. 3 Explain that they are going to role-play a review of a Unit12 practiceinterview in psychiatry on setting the scene when meeting a patient for the first time. 1 Divide the classinto groups of four. 4 Thecardscontainthe sequenceof stepsin eachof Tell students that they are going to solvea problem the four stagesof setting the sceneT. hecrosseson and comeup with a decision / decisionsabout the cardsarethings the trainee doctordid not do. improving diversity in their hospital. 5 Studentsshould alternate playing the trainee doctor Giveeachstudent in the group a role card,a copy of and the trainer. the agenda,andthe photograph. 6 Thetrainee selectstwo cardsand describesthe steps Ask studentsto discussthe items on the agendaand they carriedout to the trainer.Theythen swaproles. cometo decisionsabout asmanv of the items as possible. 7 Encouragethe trainees to think aboutusingAfter / Seta time limit of 20-30 minutes. When/ OnceI had ...and I didn't ...to describewhat they did,and I wishI had ...to describethe stepsthey b Ask eachgroup to appoint a spokespersonw, ho didn't take and wish that they had.Tellthem they should take notes and report back to the whole class at the endofthe discussion.

82 Photocopiabl@e OxfordUniversityPress I Grammatlest I Completethe sentencews ith the correctform of theverbsin the box. teach wait check talk get 1MrsMilic-toseetheconsultantforoveranhournow.She,sstiIl sitting there. 2 | -my lastclassfor the day.I'm goinghomenow. 3He'snotavai]ableatthemoment.He-thecasenotestomakesure they areupto date. 4 I canseeyourrash-better. 5I-theseheadachesforthepastweeknowThepainissobadIhadto comeintoday. 6 Patientsusually- in this areato seethe consultant. 7NurseHenderson-thatdassallday.That'swhyshelookstirednow. 8HenormaIly-onthephonetothetechnicianatleastonceaday' 9 Who- thetestresultswhenthey comein? 10DrSingh-withNurseEvansonthephoneatthemoment. 2 Rewritethequestiontso makethemmoregentleS. tartwith Canyoutellme... 1 Howlonghaveyouhadthe painin yourchest? 2 Haveyoueverhadanoperationbefore? 3 Howlonghasyourbackbeentroublingyou? 4 Wheredoesthe pain startoff? 5 What'sthepainlike? 6 Wheredoyougetthepain? 3 YouoverheardtheseshortquestionsW. riteadirectandagentlequestionfor each to makeit clearwhatthespeakermeant. EXAMPLE What'syouraddfess/? Canyoutellmewhatyouraddresiss? Andyourfamily name? 6 f A\"dy\"*j\"btl '-\\-

P h o t o c o p i a b@l eO x f o r dU n i v e r s i Pt yr e s s8 3 I Communication Surname: .9rg.rpi.\".r Surname: Bre.nton Firstname: Firstname: flartafte Se*F..... n?.rs:n*, Sex:F DoB: l4/O7/77 DoB: 4/O7/7? MaritdStatus: Sin4te- MaritdStatus: Sir'gle. Address: aa..o....aaaa Stret, Address: (o(oaBroad Street, 2bba Broad 9.:!.*x].9..1913.f....... Oxlord, OX15RL Ward: Hastinqs Dard Ward: Hastirvs U)ard .....aa.uaaa .....orotAor. at 5.3Oa.m. at 5.3Op.m. a a a a a a.... al. a l?th M,ca,&r 2OO'l l?th Dle,c,e-nltcr 2OO7 a Hospitalno: lb7 (D'128215 Hospitalno: t7b1822t5 Telno: Ol8(oS227 11bb Telno: O|1(DS227 '18(ob Occupation: Occupation: Architect Arehite-ct GP: V Chatham GP: Dr /(assi.n Cloz Severe lea-dac-le Cloz Severe headaehe- Surname: Surname: Firstname: Patrick Firstname: Patrick S\"*'fl..... DoB: l3/O7/bO Sex:H DoB: 3O/O1/bO MaritalStatus: Harrie.d MaritdStatus: fin!* Address: !!.9**!nAn!L*s,.... Address: 17Rockin4ham t)ar4, W,!F!1. 9.fF......... o o o o e o o r e r o e rJ Ward: Luttleton l)ard .J........... !e*r,.sJL.q*......... at 7.15Pn. .........J.... Ward: Littlestorel)ard 2r-r) Julu 2OOl 2r+.|*U.?99.1 ...........,J.. Hospitalno: t7151<37 Hospitdnoz 15231885t Telno: 0208 1'll 08872 Telno: 0207 81t8872 Occupation, ?hqfryp_i:! Occupation: Phar,r:p,cist GP: Dr Irelarrl GP: Cloz Coreussion Cloz Cort-ussion

84 Photocopiabl@e OxfordUniversitvPress 2 Grammattest I In eachsentenceoneverb hasbeenusedincorrectly.Underline and correctit. 1 My children have registered with the GPpractice last year,but I have been registeredwith them longer. 2 The health visitor has gone out an hour ago,but shehas Ieft this note for you. 3 Did you live here for a long time now, or did you only arrive last month? 4 Eventhoughtheywere sent a week ago,I didn't receivethe resultsyet. 5 My waterworks havegiven me a few problems lately,and my bowels were not regularfor sometime either. 6 First,the student hasglventhe differential diagnosis,and then sheput forward the reasonsfor her choice. 7 Haven'tyou beenfeeling well sinceI last haveseenyou? 8 FirstI havetaken the history from Mrs Simons,and then I examinedher. 9 Thepain cameandwent alot at the beginning of lastmonth, andthen it has suddenlystopped. 10 Haveyou giventhe receptionistthe new leafletswhich havearrivedyesterday? 2 Completethe sentenceswith the PastSimpleor the PresentPerfectform of the verbsin brackets. 1 Mrs Purnell - in hospital for five daysnow. (be) 2Myhusband-anappointmentformewiththeGPyesterday.(book) 3 Dr Joneshasgone.The clinic- at 2p.m.(finish) 4 Theswellingin my leg- a week ago.(begin) 5 Howlong (you)-this painnow? (have) 6 I (just)- my tenth appendectomy.(perform) 7 I -a referralletter yet. (not receive) 8I-allthechildhoodillnessesatanearlyage.(catch) 9 -you-this patient before?(meet) 10 She- her ward rounds at 10a.m.(start) 3 Expandthe notesto make questionsand answersin a conversationbetween a doctorand a patient.Make surethe verbsarein the right tense. 1 Doctor:be/abroad/thisvear? 2 Patient:yes 3 Doctor:where / go? 4 Patient:go/India 5 Doctor:be / sickwhile vou / bethere? 6 Patient:no 7 Doctor:feel / sickeversincevou / return? 8 Patient:no 9 Doctor:when / start feeling sick? 10 Patient:I start / feeling sick/ two weeksago

2 Communication CardA Youare a GPY. ouneedto checkwith the receptionist if the housekeepingissuesin your notes havebeen dealt with. . patie-nts booked to se-e-gott nextTue;dag (gou uant to ao to a mee-tind? . test results re-ce-ive-cI1or a patient (Hr Hartte-il? J . reierrat tetter 1or Hr Hartle-g sent to the- hospital? . ti,re- o1 computer training coniir,ne-cL? . practice- ntlrse arrivecl get? . letters arrived lor uou? . lxnchtime tea.m rne-etinq rearranqecl? . ca.se notes lor Hr TocIcLlourr)? CardB Youare a receptionist.The GPneedsto checkifthe housekeepingissuesin the notes have been deait with. . ne^tT*e-sdag Kept lre-e . test results lor Hr Hartleg arrive-d this n'orning, 6*t rele-rral tette-r not se-nt outt get . trainer booKe-dlor c,omp*ter training tomorrow at 2p.m. . practice ntlrse a.rrive-d live- minute-s ago . six lette-rs re-ce-ived . neu) time lor lunc-htime te-am me-etinq stilt not dec-ided . case note-s lor a. patie-nt, Hr Todd, put in trag last niqht

85 Photocooiabl@e OxfordUniversitvPress t Grammatrest I Usethe promptsto makeinstructionsabouttakingblood.Useeitherthe imperativeorthe PresenSt implewithyou. Re-ordetrhe instructionsandadd additionalwordswherenecessarv. EXAMnLE hands/ wash/ non-sterile/ gloves/ put on (You)washyour handsandput on non-sterilegloves. 1 ask/ fist / patient/ times/ clench/ several 2 forget/ to / equipment/ prepare 3 tourniquet/ apply/ near/ site/ vein 4 forget/ identity / check/ patient 5 stretch/ out / ask/ patient/ arm / rest/ on / pillow 6 select/ vein / appropriate 7 introduce/ patient/ yourself 8 clean/ swabI areaI alcohol 2 Usethewordsin bracketsto makethe instructionsgentler.Addadditionalwords andchangethe punctuationwherenecessary. 1 Keepyourlegstill.(Id like / nice/ for me/ if youcan) 2 Tilt yourheadforward.(could/ slightly/ for me) 3 Raiseyourarm abit more.(now/ I d like / for me/ if youcan) 4 Popup onthecouch(.can/just /forme) 5 Rollup yoursleeve(.could/ for me/ please) 6 Bringyourkneesup further fiust / abit / for me.) 7 Tellmewhat yourdateof birth is.(Can/ please) 8 Leanforward(.if youcan/ just/ slightly/ for me) 9 Movemoretowardsthe edgeof thetrolley.(can/ just / alittle / for me / please) 10 Standup.(can/ for me/ please)

3 Communication Photocopiabl@e OxfordUniversityPress87 I Explainhow to measure bloodpressure. I I .l Explainhow alumbar x- \" 1r I punctureis performed. I Explainhow to wash Explainhow an your handseffectively. arterialbloodgas ! sampleis obtained. I Explainhow ablood Explainhow to give t e s ti s p e r f o r m e d . anIM injection. F-- t-- rr-rl Describewhat is Describehow to containedin award administera local roundentry. anaesthetic. I I I I Describethe Describehowto I preparationfor a performIV cannulation. I wardround. I I I I rrrr rrr-rl ---l-

88 Photocopiab@leOxfordUniversityPress 4 Grammatrest I Circlethe correctform. 1 Thetrolley prepared / isprepared / preparesbefore the procedurecarried/ have beencarried/ iscarriedout. 2 We rarely areperformed / perform / areperforming operations like this under generalanaesthetic. 3 Theweekly ward rounds are leading / Ied/ are ledby a consultant. 4 \\ /hat isdone/ isdoing / aredonenext isthe most important part of the procedure. 5 Thetube inserts/ is inserted/ is inserting very carefully. 6 Normally patients aregiven / give / giving a leaflet about the procedure. 7 Sheis used/ used,/usea swab to cleanthe wound. 8 Thedoctor isobtaining / obtained/ isobtainedconsentandthenanaesthetize/ anaesthetized/ anaesthetizingthe area. 9 Whathappen / happens/ is happenednext is the labeliing of the bottles. 10 A considerableamount of time spent/ isspend/ isspenton planning the operation. 2 Usethe prompts to make sentencesin the PresentSimple,activeor passiveU. sethe words in the order given. 1 procedure/ perform / nurse / in / this / practice 2 nurse / use/ spray/numb / patient's / throat 3 doctor / repeat / explanation / patient / if / necessary 4 patients/ rarely/react / instruments 5 appointments/ arrange/ receptionist 6 wound / clean 7 painkiller / inject / as/ required 8 doctor / explain / procedure/ patient 9 syringe / insert / into / the / training / manikin / just / here 10 nurse / examine / patient / first I Someof the sentencesbelow aretechnical and somearenon-technical.Rewritethe technicalsentencesasnon-technicaland the non-technicalastechnical. 1 What we needto dothen is take a tissuesample. A tissuesampleneeds 2 What we're going to do after that is give you something to help you relax. After that a sedative. 3 Resitsobligatoryforabout an hour aft erwards. Whatyouneedtodo 4 What we're going to do after that is schedulea follow-up appointment After that a follow-up appointment 5 What happens next is that you write down the various steps. Next,the various steps 6 Thenatubeisinserteddownintothe stomach. What happens then is 7 What'sgoingto happennextiswe'regoingto numbyourarm. Next,your arm is 8 Youareaskedtolieona couch on your Ieft sidefacing the wall. What happens next is

Photocopiab@leOxfordUniversitPy ress89 4 Communication JL, herniorrhaphy Alzheimer's gastroscopy disease colostomy tonsillitis lumbar puncture radical mastectomy colposcopy I biopsy I I I I I I I I I I I appendicitis catheterization MRSA tt ---1 --1 tt sciatica colonoscopy anaesthesia trrr J-- --L ------rrrt

90 Photocopiabl@e OxfordUniversityPress 5 Grammatest I Completethe sentenceswith one verb and one particle from eachbox. Verbs: looked get cuts take got wrote pointed wastaken Particles: at down up out into in out out 1 It's not easyto - all this information - at once. 2 Thedoctor- - the prescriPtion. t He quickly - - the habit of doing the ward rounds. 4 This tablet can help becauseit - the workload of your heart 5 Areyou sureyouc;rn--without anyhelp? 6 He- - thepatient'snotescarefuIly. 7 Thenurse the mistake onthe drug chart. 8 His appendix--whenhe was a child. Usethe notes to inform and reassurea patient about the possible side effects of ACEinhibitors. dry cough po.rtural hypoteacion re na I inpa irmext a nd Agperk< laeuia taste dbturbanee '' urttcaria .: Completethe sentenceswith may or can Where you think side effects are being pointed out,usecan. 1 In some people,the tablets - make them feel drowsy,sobe careful. 2 It looks asif you - reactto this tablet aswell. 3 Sometimest,his - make peoplefeel dizzy.Ifthat happens,stoptaking it. 4 There- be somebruising after the blood test,but it will go away. 5 With somepatients, atenolol penicillin - causeproblems. 6 Simvastatin - affect the liver, but it - not happen in your case. 7 The pain is unlikely to go away,but it - just easea little. 8 Someof these- causesome mild side effects.

Photocopiable@OxfordUniversityPress91 5 Communication PatientDrugDetails PatientDrugDetails l Mrslohnson l Mrslohnson Mse Fre-qP,oute-24h nax Dose Fre-q Route- 21h tlax Ibuprole-n looq ahfr a.2g Tbuproie-n 4OOmgteShfr 2.49 2 Mr CHaslam 2 Mr CHaslam Dose fre-q Route- 24h Hax Dose.Freq Route.24h Hax Paraeetatrct [email protected]) *t\"h fr <g Paracetalal $*t\"h fr 59 3 MrsDHardwick 3 Mrs D Hardwick Dose,F.ug Route- 21h Hax Dose.Freq Routc.24h nax Diaze.p.m 21$:2-q shtu t2ry Diaze.pa,m2\"1$:bil th n 214 4 MrTSmythe 4 Mr T Smith Dose.Freg Route- 21h Hax Dose,Fre-qP,oute-24h Hax Ranitidirc. tiomg tzh tu Soory Ranitidir:r--3OOnylzh fr tooom3 PatientDrugDetails PatientDrugDetails 5 MrsPTaylor 5 Mrs PTaylor Dose Freq P,oute- 24h Hax Tranpdot 2OOng{So4od 4h Dose, Fre-g Roatte-24h Hax Tranpdol 50 mqGGlOO 4h n/rH/rv.tooq tu/rH/rvbooa 6 MrlWestbrook DoseFre-gRoute.24hHax 6 MrlWestbrook Cgc-tizire5.0 ry8h tu/rV/IH t5o4 Dose F.ug Route- 24h nax Cgc-tizire50 q$h fi/IV/IH t?ory 7 Mrs CSheridan Dose Fre.q Route- 21h nax 7 MrsTSheridan pethiaire- t5o (gtod 4h fr/rH/IV Dose.F.eg Routn- 24h Hax Pethidire- 50 (*too th fr/m/rv n/a n/a 8 lVkMThomas Dose Freq Route- 24h Hax 8 MrNThomas U-2) Co-codatrcl 30/ 5OO2 tablets U-2) +bh fu lo tablets Dose Freg Route.24h Hax Co-codarrcl 30/ 5Oo 2 tablets +(Dh N 8 tabtets

92 Photocopiabl@e OxfordUniversityPress 6 Grammatrest Underlineandcorrecthe mistakein eachsentence. 1 Youcouldtry getawayfrom yourdeskatwork at leasttwicea day. 2 Youcantotrytocycleonceortwiceaweek. 3 Youshouldliketo try spendingmoretime walking. 4 Doyouthink youcould,for examplet,ookup somethingmorestrenuous? 5 Youshouldn'tto overdothe exercise. 6 Peopleoughtbemoreawarethanthey areof the damageexercisecancause. 7 Youmight liketry startingby givingup thefirst cigaretteofthe day. 2 Decidewhich of the piecesof adviceaboutgivingup smokingaremorepatient- centred. 1 a Yououghtto stopsmoking. b Haveyoueverthought abouthowyoumight giveup smoking? 2 a Ifyoucan,beginbymakingsmallchanges. b Youshouldbeginby makingsmallchanges. 3 a Youcould,for examplec, utoutthefirst cigarettein the morning.Wouldthat workforyou? b Youshouldn'thavethe first cigarettein the morning. 4 a Yououghtn'tto stopin onego.Youshouldsetyourselftargetslikereducing by onecigaretteaday. b Insteadof stoppingin onego,youmight liketo try settingyourselftargets likereducingby onecigaretteaday. 3 Rewritethe suggestionsusingthewordsin brackets. 1 Youcouldtry to eatleanmeatwherepossible(.oughtto) 2 Haveyoueverthoughtof cuttingout chocolategradually?(might) 3 Youcan,for examplew, alk upthe stairsratherthan usingthe lift. (should) 4 It'sbetterto reducethe amountof foodyoueatgradually(.cbn) 5 Youmight liketo try goingfor awalk with afriend.(couldf,or example,) 6 If youcan,alwaysgoshoppingby bus,or evenonfoot,ratherthan by car. (shouldn't;should) 7 Tryto getinto thehabit of walkingeveryday.(might) 8 Insteadoffryingfood,trytosteamorbakeit. (shouldn'ts;hould) 4 Whichof the rewritten statementsin 3 cannolongerbeconsideredpatient- centred?

Photocopiabl@e OxfordUniversityPress 6 Communication StudentA-Doctor1 StudentA-Patient 2 haYouarea doctorgMng adviceto anoverweight Youarea patientwho is sufferingfrom stressY. ou patientwho doesn'tseeanyneedto reduceweight. areinitially reluctant,but willing to trythe doctor's Thepatient hasexcusesfor your suggestionsbut suggestions. try to persuadehim / her.Usethe BMIchart onp.47 in your Student'sBook. Responses . I can't,becausework istoobusyatthe moment. Suggestions . Id liketo,andmaybea dayhereandthereis . eatlessfattyfood . eatmorefruit andvegetables possible. . grill ratherthanfrythe food . Theywon't like it. . goonadiet . I couldmaybedothat no morethan onceaweek. . walk asmuchasyou can . I cantrynotto. . takethe busto work . It'sdifficult when it isbusybut I couldtry. . joinagym o lt's not easyexceptfor weekendsb, ut I couldgo . Other swimming. Agreedoutcome/ managementplan: (Wouldany . Other of thesework for you?) Agreedoutcome/ managementplan: (Ican tll definitelytry to takeadayoff now andagainand tll not doovertimemorethan onceaweek.) StudentB-Patient 1 StudentB-Doctor 2 Youarea patientwho needsto loseweight.Youare Youarea doctorgiving adviceto a patientwho is I reluctantto makeanychangesto your lifestyle. sufferingfrom stressat work. I I Excuses/ Barriers Suggestions I . It'svery difficult asI havemeat everyday. . takeaholiday I . I d.on'tlike many fruit or vegetables. . taketime off I . I don't like grilled meat. . talk to your Human ResourceDs epartment I . I havetriedto diet manytimes. . don't work overtime- work only from nine to I . I getout ofbreath easily. . Therearen't anybuses. five . I can't afford a gym. . don'ttakework home . Other . taketime to havea properlunch break . setasidetime for leisureactivities Agreedoutcome/ managementplan: . Other (MaybeI'll think aboutcutting down onfatty food anddoingsomeexercise.) Agreedoutcome/rnanagementplan:(Wouldany of theseworkforyou?)

94 Photocopiabl@e OxfordUniversitvPress 7 Grammatlest I Match the two parts of the sentences. she'llbookanother 1 If he were well enough to cope appointment. unaided, b he'll needto stoptaking them. 2 If wehave abedfree ontheward, c we'II let you know it's available. 3 If her condition changed, d I'll go in and askhim. 4 If the consultant becomesavailable, e we d admit her straightaway. 5 If you askthe receptionist, I it would help his coordination. 6 If thesetablets make him dizzy, g we dtake him out of 7 If I were in any doubt about intensive care. thejob, I wouldn't applyfor it. 8 If Jamesplayed a bit more, 2 Usethe prompts to write First Conditional sentences. 1 Jane/ developfever / you / need / be careful 2 Timur / loseany more weight / it / be better / bring him in 3 doctor arives / I / let vou know 4 you / notice / change / Amir's condition / switchboard / be able / bleep me 5 Tom / get worse / we / transfer him / intensive care 6 Juan / stabilize / make / speedyrecovery / we / dischargehim soon 3 put the verbs in bracketsinto the correcttense 1Ifitwereappendicitis,Charlie'spain-(be)ontherightside. 2 If the rash- (notgo)away,we'll sendhimto a specialist. 3Ifit-(be)somethingsinister,theheadachewouldprobablybe constant. 4Ifyourfathergetsanyworse,we-(probablyadmit)him. 5IfI-(do)theoperationagain,Iwouldtakegreatercare. 6Ifit-(be)meningitis,yourchildprobablywouldn'tbesolively. 7 If I satthe exam again,I (prepare)myself better. 8 If your mother - (need)any medication, we would give it to her. 9Ifyourchild-(be)verydehydrated,youneedtobringhimintoA&E. i0IfyourchiIdstaysinthehospital,we-(keep)acloseeyeonhim. 4 In which four statements in I is the doctor reassuring the patient that they are not sufferingfrom a seriousillness?

P hotocccrac3te3r' :' : - - 7 Communication *aCARD1 Situation C SituationA PAREITTT DOCTOR Youareworried that your 2-year-oldchild A parentpresentswith his / herchildwho haschickenpox. he / shethinks hasasthma.Thechild hasa mild chestinfection.Reassurtehe parent. SituationB SituationD PARENT DOCTOR Youthink your 5-year-oldboyhas A parentpresentswith his/ herbabywho appendicitiso, r evenperitonitis. isbringingback5-10mls of eachfeed duringor soonafter(posseting).Thcehild a- is otherwisewell andgrowing normally. Theparentisworried that the child hasa !- s.F stomachproblem.Reassurheer / him. I SituationC PARTNT I Youthinkyour childhasdeveloped asthma. I SituationD I CARD2 PARENT I Youareworriedthat your babyisbringing back5-10mls of eachfeedduring or soon I SituationA after (posseting)Y. outhink your childhas I a stomachproblem.Thechild is otherwise well andgrowingnormally. I DOCTOR I I A parentpresentswith his / her child t who he / shethinks haschickenpoxA. fter I I examiningthe child,reassurethe parent I that it isjust arash. I I I I SituationB I I DOCTOR I A parentpresentswith his / her 5-year- I t oldboyhe / shethinks hasappendicitis, I orevenperitonitis.Afterexaminingthe I I child,reassurethe parents. I L--' rrrl

95 Photocopiabl@e OxfordUniversityPress 8 Grammatlest I Decidewhetherthequestionsareopen(O)orclosed(C). 1 a Howdiditcomeon? b Did it comeon suddenly?- 2 a Doyougettiredafterphysicalexercise?- b Tellmeaboutthe patternofthetiredness-. 3 a DoyousleepOK?- b Whataboutyoursleepingpattern?Canyoutell meaboutthat? 4 a Youmentioned musclepain. Canyou saysomething more about that? b Doyou get pain inyour muscles? 5 a AreyourbowelsOK?- b What aboutyourbowels?- 6 a TeIIme about your general health b IsyourgeneralhealthOK?- 2 fill eachgapwith oneword to completethe openquestions. 1 Could-tell-more- -work? right-home,what-you 2 When-saythings-not mean? 3 Tell- -yourrelationshipwithyourcolleagues. 4 What- -familylife? How-thingsthere? 5 -you describe- discomfortin a little - detail? 6 How- -accidenthappen? 7 -yourdailyroutine-me. 8 Can-tell- -bitmore- -exerciseroutine? 9 And-diet?What-that? 10 In- -doesrelaxationhelpyou? I put the conversationin the correctorder. a Patient Well,they started about a couple of months agoaround the knuckles and went away,but they came on suddenly about 10days h Patient agoand the joints are swollen this time. - c Patient I've been getting these pains in my hands,Doctor.- No.I haven't taken anything for them becauseI don't like taking too manytablets d Doctor Sothere was no swelling the first time and that was two or three e Doctor months ago.Am I right? - Canyoutellmewhatbroughtyouhere?- f Doctor Canyoutellmeabitmoreaboutthepains?- g Patient Yes.that'scorrect.- h Doctor Haveyoutakenanythingforthepain?-

P h o t o c o p i a b l eO O x r o r d l J 6 i v g r 5 i r vp-'e s s 97 8 Communication I PATIENTB:'I've got this pain in my .l stomach,Doctot.' I PATIENT Az'I'm tired all the time.' I o severepainforweek or so ! I o not dehydratedn, ot pregnant,not diabetic I o no othersymptoms I ),i ' tired all the time - tried differentthings o wife / husband/ partner saysshouldcome I I ool a fatiguenot worseinthe morning to doctor I a not worried aboutanything . upperabdominalpain I o nopain o radiatesto back/ shouldertip I o severalviral infections- can't shakeoff o lastsmorethan half an hour I o fatigue- abruptonset o takenOTCmedications- nothingworks I a tiredon exertion- sometimesgoeswith rest o feelingrestless I a someweight loss o nausea/ vomiting I a breathless/ not sleepingwell a tendernesstouchright upperquadrant I a sawlocumaboutsixweeksago- no change I a feelinglowwJhit Possiblecauseb: iliary colic I a Iiketo seesomeone I I ! fossiblecausep: ost-viralfatigue I I I I I I I I I I I r-- I I PATIENT Cz'I've beengetting the runs I andstomachpain.' I .l o diarrhoeawith bloodmucus o Iowerabdominalpain- doesn'tradiate PATIENTDz'I've got quitebad I heartburn,Doctor.' I anywhere I o skinchanges- slighterythemanodosum a heartburn I a thoughtjust virus a burningepigastricpain I o tirednessandmalaise o worsensonbending,stoopingo, r lying t a anaemic-rundown I o weightloss I O runningafever o faecalurgency/ incontinence o sometimesafterhot drinks o tenesmus/ straining o nomouthulcers o antacidshelp o no clubbing o no eyeproblems a sometimeswaterbrash- mouth fills o arthritis with saliva a no perianalfistulae/ pendulousskintags refluxof acidinto mouth- especially Possiblecause:inflammatory bowel disease lyingflat rrrr o nauseaandvomiting ---l- a sometimescoughat night (dueto aspiration of refluxedstomachcontents) a affectingsleep o makingmemiserable/ irritable Possiblecause:Gastro-oesophagearel flux disease(GORD) rrrr-r

98 Photocopiabl@e OxfordUniversityPress 9 Grammatrest I Circlethe correctform. 1 I wish I contacted/ had contactedt}:tehospital sooner. 2 If oniywe hadbrought / broughthimhere yesterday. 3 I wish I didn't haveto / hadn't had to repeatthe examination tomorrow. 4 [et's supposewe borrowed/ had borrowed more money now to finance the clinic. 5 Let'ssaywe allowed/had allowedyouto go home. How do you think we would feel if something happened? 6 I wish he were/ had beenlessanxious at the moment. 7 I wish my son were OK and didn 't needto / hadn't neededto take anti- depressantdrugs. 8 Let'ssayyou went / had gonehome and you weren't fully recovered.What wouldhappen? 9 I wish I had done/ could do things all over again now. 10 If only I/oIIowed / hadfollowe d the advicethe doctor gaveme. 2 tvtatchthe two parts of the sentences.Then put the verbs in bracketsinto the Past Simple orthe PastPerfect. Beforethe consultant went on her a she- (feel)more rounds. relaxed on the ward. 2 Thenurse ran to the clinic, b thenextshift-(turn) up. 3 The patient had been on the ward before c butthepatient-(go). The staff were ableto deal with Mr d andthenl-(move)to Wicksbecause the capital. Two days after he had been e sohe - (be)aware of discharged, whatto do. Bythe time the doctorshad f she- (finish)her clinic. finished, g the police - (section) Previously,Ihad worked in a rural himagain. hospital h they-(treat)himonce When shehad gained some before. experience Decidewhich ofthe underlinedverbsareincorrectandcorrecthem. OnceI had graduatedlandfinishedmy training,I hadfoundzajob in ahospital closeto my homevery quickly.I devoted3alot of time to that new job in psychiatryandI neglectedmy privatelife for quite awhile. Lookingback,I wish I didn't doneathat.I keepsayingto myself,if only I hadtakenup5sport,even just walking.Butit meantthat by the time I hadleft the postandmovedto my presenjtob,Ihadbeen6confidenint dealingwithawide rangeof assessments. I haddoneTmany different assessmentasndworkedwith avariety of patients with differentdisorders. All this experiencehashelpedfurther my careerO. ncethe first weekhadpassed in mypresentpost,Irealizedhow muchI learntsin my previouspost.

Photocopiabl@e OxfordUniversitvPress99 9 Communication Card1:Introductions I C a r d2 : S e a t i n g I h i ' think aboutmeetingsomeoneforthe first I avoidtraditional'consultation room' time - adoptingsocialnorms I - deskwith peopleon either side t. inappropriate introduceyourselfandaccompanying I arrangethe room - severalcomfortable nurse- namesandstatus f I chairsof the sameheight I orient the chairsat an angleto eachother ensurethatyouknownamesof any I -less confrontational, allows eyecontact peopleaccompanyingthe patientand l. where necessaryf their relationshipwith the patient I usea clipboardto take notes asyou go I along ,X askif thepatientwishedthesepeopleto I bepresent l' Card4: Documentation I donot usethe patient'sfirst nameexcept t keepawritten record- crucial attheir request I write up the accountasyou go along- I more accuraterecord l. vwitelegibly f I sign I date ,X I orderin a standardfashion I initially you may find it helpful to write I out the standardheadingson sheetsof I paperbeforehand f I I I I I Card3:Explanation I I I informthe patientofyourstatusand I t' specialityf I l. explainthepurposeofthe interview I I explainthe reasonsfor referralasyou l. I understandthem I r' explainthe informationyouhave I beentoldby thereferrer l' I indicatehow longthe interview t. I I willlast /( l. I I l. advisethemyoumaywish to obtain I I I I furtherinformationfrom othersources I II l. obtainconsento talk to anyinformants I I I accompanyingthem I I II II II II