Oxford English for Careers : Medicine 2 : Students Book ( PDFDrive )

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4 'r: - prolln\\ Descrrhethctrrncnr' \"' \"' trsr\",d\" ' . 'i' \"' ,..'n in thc nhntns Whir:h ol tl.,tse-sr-.:r r ::'-ilcDliate for urban or built- u p a r e a s ?F o r r u r a j r r a , r : ' a '- '. ':r e : . s o n sa n d e x a m p le s. WhLclrtVpe.[re 1 : -. : .: :.l]tyoutcountry? f)ncqtnlnrktnorIr,r, I \"t -,t ( rrF)nnF:ltorrnrr) Listeningfor detail 't ,i ,'il /r-[\\l p Lr ;l^>+L^c'r^r +L^U d^ L^^v'l^r v- -E^l-)^d^ti on betweerr .r doctor and a i;''5l5*s*,, * - patient.Write down asmany detarlsr. voll Lanabout what you hear.Compareyour answe15\\\\'lth a partner. t - n m n l c t c r r n n v n f t h e f o r m ,,-.,ot.n\"t1..n. r o c I l \\ ( i l i l L l S t e nt O t n e C O n V e 1 5--r;^- a L t od-^r-Bi- a - l ld,-r,.]l L lrLl.^r^l c r l-L, O m p a l e notes aga1n. Checkyour details with the rest of the class

E mergencmy edicine5 Inthisunit o rapi dtensechange o adverbsof manner r thi rd partyi ntervi ew i ng a comparison c conti nui ngprofessi onadlevel opment Vocabulary Adverbsd: escribinghow thingshappened 1 Adverbscanhelp to describehowthings happened and help to make a diagnosis.Lookat thesestatements fromlistenin4 l and underline the adverbs. ...ut{.ttt4ndlttq Barbara, *oft, j,^*t ffutd. wetnkJ tojet h,^e/ru,prighta/4d slu ttalted. h,,itchlft! qtw\\evbl,ent{y. Underlinethe most appropriateadverbinthese P a t i e n tc a r e sentences. I Decidewhethertheseitemsaretechnicalor non- 1 Thefainting? It just happenedabruptly/ gradually/ technlcal.Thenmatch them with correspondingwords s/owly.The next thing I knew shewas lying and phrasesin Vocabulary2. completely fl at on the pavement. post-icta1 2 Thepatient suddenlybecamepale and startedto b fit sweat,but notprofusely/ rapidly/ enormously. c to belncontinent of stool d syncope 3 After the attack,Mr Jonescameto rapidly/ slowly/ e d-,.,v^v--dir-r^-i^L-rtLE )rBrr leisurely,whichquestionswhether it was a seizure. f to beincontinentofwater o suprne 4 Embarrassingl/yGradually/ Clearly,sl oiiedmyself h to gointospasmb, ut notreallyjerking andwet myself.It wasn't very pleasant. 1 to tellthedifference(between) 5 Shewas lying flat,but bystanderswere trying to Ideally,when speakingto a patient,you shoulduse keepher upright, soshewas twit chingslowly/ non-technicalwords.Sometimesy, ou canmakethe convulsively/ suddenly. mistakeof using technicalwords.Work in pairs and practisegiving lay terms or your own explanationsfor 6 As he couldn't seegood/ clearly/ visual/y,he got the technicalwords above. quite frightened. 7 In a selzuret,here is typically/ rarely/ seldomno prodrome,but this is not alwaysthe case. 8 After collapsing,he didn't get betler spontaneously/ slowly/ gradually.Thepatient was a bit drowsy for quite awhile afterwards. 9 He recoveredcompletely/ partially / poorlyfrom the accident.Nowhe's perfectlyOK. 10 Faintingandvomiting don'treliably / partially / clearly discriminate seizuresfrom faints. Work in pairs.Decidewhether the statementsin 2 are Iikelyto besaidby apatient or amedicalprofessional. EXAMPLE I'm sorry,butwhat'sa prodrome? W h a t d o e ss u p i n em e a n ? p A r I EN r : It' sa...Itmeans...It' sw here,.. DocroR:

6 Unit1 comecve r(v)sud de nl yf eel 999 (n )then umb erd ialledf or emer ge nccya llsin the U K Speaking 2 Placesentences1.2.8.9.and15on the timeline. Work in pairs.Studythe information in the form you a-b-c 1 d-e- completedfor Listeningl. Taketurns role-playinga doctoraskingquestionsto elicit the information from J'JJJI the patient who fainted inthe street. Now Completethe sentencesusing the verbsin bracketsin the correctpasttense. 1We (walk)alongthe streetwhen she (passo) utsuddenly. >ne (havenever)the pain before till now,but she (expenencejsome bleedingthe flrst time. 3 Afterhe (admit),he o languagespot (become)suddenlyworse,but he'sstarted R a p i dt e n s ec h a n g e respondingto treatment. Understandingthe sequenceof eventsand hencethe 4He (neversuffer) a fit before,but he tensesis important for correctdiagnosis.What arethe (feel)unwell sincethis morning. tensesofthe highlightedphrases? 5He (yawn) repeatedly,which he :Wewere shopping in Cambridge Streetin town, when suddenlyBarbara,my wife,2justfainted. 3Wetried (not do)before,and then hejust to get her upright and ashestarted twitching quite violently.sltwas quite scary.6Shecameround very (faint). rapidly.But 7wedialled 999 and a paramedicappeared 6 Afterhe ( f a i l ) ,h e almostinstantly andthen the ambulancealmost rmmediately afterwards.8Shehad beencomplaining (start)twitching violently when we of feeling a bit unwell, and ehadalmost fainted and ::shefelt a bit woozy. tlShewas a bit dizzy and 12she (try)togethim up. r,,zsyawning repeatedly andthen all of a sudden, '=ere shewas,Iying on the ground. When I cometo 7 When she (lie)on the ground,she -,--- i :::: :-he passedout oncebefore about a month (not shake)at all.Then shejust stood agr Sftrchasn't beenfeeling well on and off over the ..---:: .Llhthought it was the heat. up. 8 Whatactually (happen)when she (fall)? 9He (bite)his tongue and he (mess)himself and he (feel)a bit groggysince ::; l:- Cor.t) - t:.L

b u t t o nb a t t e r y( n )a s m a l lr o u n o€ ; : battery Useeachofthe tensesin bracketsonceonly asyou Speaking expandthesenotesinto sentences. W orki n groues).::-::' .' ,-..a:i ..-ci l c' rerhemai n signs 1 Weeat in a restaurant.I suddenlyfeel woozy.I faint. and symptornsvc: 'i,-:;.c expeCrn a case Thisneverhappenbefore.(SESPP, CP, resPerfl 1 where an othen,,':sie: 30-year-oldman presents 2 Ahmed neverbeill beforebut feel unwell yesterday. with pneurr,or:aai A&Eor He abruptly crledand then passout. (PastPerf,SPS, P) 2 wherea n-.othepr resentsat A&E with a childwho 3 Wetravel by train to the city.He not eat sincethe hasswallor.veda button battery. morning. He vomit and we comestraight here.(Sf; PastPerf,SP,PC) Youaregoing to role-playthe history.Decidewhich two of theseitemsyou want to focuson in the assessment 4 Mary havefainting fits for the pastfew days.Shedo of the role-playG. ivereasonsfor your choice. a lot of running aroundwhen it happen secondtime. Sheneverhavethem before.And none of us have t]'e qpnrrpnrp nfthe tgngg5 them, either.(PCP, resPerfCont,PresPerf, SPP, resPerfl the grammatical accuracyof the tenses 5 Sheget out bedwhen shecomeoverall giddy,but the accuracyofthe descriptionelicitedby the doctor shehave it before,sowe think nothing of it. (Sf;5l the useof non-technicallanguage PastPerf,PC) fluency Work in pairsand describeyour day sofar,pointing out Work with a partner from another group.Eachchoose one of the two scenariosin L Agreeon the two items '. whatyouhave donesofartoday you want to be assessedon.Takea history from your + things you haven'tdoneyet patient.Thepatient shouldmakeafew notesaboutthe t' things youwere doingwhile doing somethingelse doctor'sperformance.When you havefinished,give '\" andthings you had donebeforeyou did something. feedbackto your partner about your own performance andthen invite commentsfrom your partner. 6 Role-playthesesituations. Rememberto begin wlth positivecommentsand use constructivecriticism. 1 StudentA, goto page114S. tudentB,take a history from StudentA.Write notesasyou listen and decide what the patient'scomplaint is. 2 StudentB,goto page116S. tudentA,take a history from StudentB. ) Girto GrammarreferenceI ll8

8 Unit1 t r a f f i< - b u s t i n g( a d j )a b l e to get throughroad congestion {raa ,,n , rc =:<r It'smyjob ',\\:.at do you think the work of a cycleparamedic 4 Is the bikethe most effrcientrapid responsemeans ::.r,'olves?What do you think are the advantages or isthis not mentioned? :: a cycleparamediccomparedto a conventional ambulance? 5 Doesthe cycleparamedlcresponsetime in the West Endexceedor equalthe governmentbenchmark? Work in pairs.Skimthe text and the questionsin 3 4 Workin groups.lstheemergencysystemsimilaiin quickly and decidewhat the text is about. your own country?Giveexamples.How do you think the systemdescribedbelow couldoperatein urban / Answerthe questions. rural areasin your country? 1 Do cycleparamedicsin London'sWestEnd arriveat the sceneasrapidly asor more rapidly than conventionalambulances? Isthe paramedic'sbike equippedwith only a basic FirstAid Kit or more sophisticatedequipment? In seriouscasesa, rethe conventionalambulance andthe cycleparamedicssent simuitaneouslyor are the latter sentfirst? JohnRhys touristswhovisittheareaeachyearU. singthebike givesusanopportunittyo savepotentiallvyital My nameisJohnRhysa, nd l'm oneof a team of four secondisn startingtreatmenet,specialilnythenarrow cycleparamedicosf the LondonAmbulanceService's streetws hichwecannegotiatme orequicklyand traffic-busting bicycleambulanceserviceW. e attend e a s i ltyh a na m b u l a n c eFso.re x a m p l em,yc o l l e a g u e s 999emergencycallsin the Cityof London- the i n t h e W e s tE n dC y c l eR e s p o n sUen i tr e g u l a r lrye a c h fi nanc iacl ent r ec a l l e dth e Sq u a reM i l e .T h eb i k ei ts el f 1 0 0p e rc e n to f t h e m o s ts e r i o u s , ' C a t e gAolr9y9 9c a l l s isthe sameasthoseusedbythe successfuclycleunits w i t h i ne i g h tm i n u t e s . T hr iess p o n si sem u c hq u i c k e r operatingin London'Ws estEnd,which regularlyreach thanthegovernmenst andarfdorthiscategoroyf oatientsfasterthan conventionIaambulances. c a l lo f 7 5p e rc e n t . Theteam'sbikesarefitted with bluelightsandsirens, catrya rangeof equipmenti,ncludinga heart-starting defibrillatoro,xygenp, ain-relievinggas,andevena maternitypackfor deliveringbabies. Wherethe patientis believedto be in a life- th r eat eningc ondi ti o nw, e a res e n ta t th e s a meti m e asa regularambulancecrewsothat we canstart treatmentbeforethey arriveW. herethe patientis understoodto besufferingfrom a moreminorinjury o r illnes sw, e ar ein i ti a l l ys e n to n o u ro w n a n dth e n areableto requesfturtherassistanc-efreeingup ambulancetso attendother,morepotentiallylife- th r eat ening, 99c9a l l se l s e w h e rien th e C i ty . llore than 300,000peoplework in the Cityof London a\"d their numbersareswelledbvthe severaml illion

:- a';a' :t C u i d e l i n epsu b l i s h e db yt h e A m e r i c a nl i e a - :! . , : : , -. .' statethat for everyminuteof delayin gettir:a1: . : .- .- - i n c a r d i a ca r r e s t . t h ec h a n c eos f s u c c e s s f urle s u s : , : : - d e c r e a s be y 1 0 p e rc e n t . o Languagespot 4 Work in pairs.Compareyour life now asa student / worker with the past.Usetheseadjectives/ adverbs: C o m p a r a t i v ea n d s u p e r l a t i v ea d j e c t i v e s hard / easy;stimulating / dull; relaxing/ stressful; andadverbs complicated/ simple.Givereasonsand examples. Lookat /t's myjob. Canyou find examples of )) Coto Grammar referencep 1lB comparativeand superlativeadjectivesand adverbs? Listening2 EXAMPLE Descriptionof an emergencyincident ...reachpatientsfu;lstthan conventionalambulances Lookat the picture Completethe sentenceswith a word from the list. and describethe Add any necessarywords to indicate comparativeor equipment.What do superlativeand make any necessarychangesto the you think isthe benefit adjectiveor adverb. of suchequipment on cycleambulances? drowsy frequent lively long bad serious shallow violent wet f) risten to a case study about an I Thistime Jessicatook to improve incident at Heathrow Airport. Write down as than before. much detail asyou can, Comparenoteswith a Shedidn't twitch as asthe lasttime. partner. 3 Its I have everhad.It was agony. f) tisten again and write down the verb only in each missing step. 4 Isthis attack than the lasttime. or 1 GaryEdwardshad beenrelaxing. 2 He developeda severepain in his chestand arms. not asbad? J 5 He's than hewas aboutten minutes 4 His respirationceased. ago.He'scoming to gradually q 6 Natalia appearsa bit than the last 6 timewe sawher.She'srunning around. 7 A cycleparamedicarrivedfasterthan the ambuiance. 8 He continuedresuscitation. 7 How haveyou beencopingwith the weather?It's 9 10 Paramedicsd, ispatchedin an ambulance,turned up much than lastyear. afew minutes later. HErbreathing is than before. 11 9 Peopleseemto be coming in with this Work in pairsand completethe restof the missing details. than lastyear. In groups,discusswhetherthis type of rapid response Expandthe part ofthe sentencesin italics adding would work in your country. Givereasonsand a comparativeor superlativein eachcase.Insome examples. sentencesb, oth more and lessmay be used. 1 He is much big the lasttime you brought him to seeus. 2 Thisis byfar goodhospitalI haveeverbeenin. 3 How doesthis compareto severepain you've had? 4 lt's easyto walk now itwas beforethe operation. 5 He was sweatingprofuselybefore. 6 His heart is beating irregularlybefore.It's almost backto normal. 7 I'm pleasedJ. ohnis stressedhe was last year. 8 He needsexerciseto getthe full movement back.

lO Unit1 ( v )s t ar t 'j-ir'la::- 3 Correctthesestatementsaboutthetextbychanging or removingwords. '- --'- )\\'-)r)trvtokeenrrntodatewithcurrent : - ' . . conm ent si n m e d i c i n e ?H o w ? 1 All doctorskeepa written log of their CPD. 2 TheCollegeof EmergencyMedicineinstigatedthe - -srt important to continuestudying throughout V o u rm e d i c a lc a r e e r ?W h y ? nroressofannrarsal . 3 TheGMCdocument GoodMedicalPractice(2001\\ 3 Lookat the title. What do you think Continuing ProfessionaDl evelopmentinvolves? contributedconsiderablyto the revisionofthe Collegeguidelineson CPD. Findwords in the text which havethe samemeaning 4 CPDis a processthat repiacesformal educationand a st h e s ew o r d s . training. 5 Theresponsibilityfor keepingup to datelieswith 1 experienced,gonethrough the Colleseof Medicine. 2 put together,drafted,compiled,composed 3 altered,changed,modified 4 setup, introduced,started 5 lying behind,underpinning 6 pertinent,applicable 7 requirementsw, hat you require (iu i d e l i n e so n C o n ti n u i n g P ro i e ssiona[l) er .elopnr ent Thevastmajorityof EmergencMyedicine Thisrevisioonf theCollegeguidelineosn CPDisanobligatorryequiremenfot rall (EMd) octorspractisceontinuing professionadlevelopmen(tCPD)h;owever, C P Di sb a s e do n : p r a c t i s i nEgm e r g e n cMy e d i c i n ep h y s i c i a n s notalldoctorskeepa recordC. PDhas undergonaedramatiec volutionandwas . A frameworkforContinuingProfessional andit isup to eachdoctor[you]to keepup i n i t i a l l fyo r m a l i z ebdy a n a g r e e m e ni nt 1993bythe Conferencoef MedicaRl oyal Developme-nI theAcademoyf Medical to date. CollegesandFaclutiesT. hefirstguidancefor continuingmedicael ducation(CMEf)orthe RoyaCl ollege(sFebruar2y002) TheGMCsetout in paragrap1h0of Good Collegeof EmergencMyedicinwe asdrawn up in Novembe1r995.Sincethentherehave , GuidelineosnCPDFacultyofAccidenat nd MedicaPl ractic(eSeptembe2r001) EmergencMyedlcrneH- enryGulyp, ast ' Y o um u s tk e e py o u rk n o w l e d g ae n ds k i l l s Directoor f CPD(2003) upto datethroughouytourworkinglife.ln . TheGMCguidelineosnCPD(April2004) particulayro, ushouldtakepartregularly . TheGMCdocumentcoodMedicalPractice in educationalctivitiewshichmaintain ( 2 0 0 )1 a n df u r t h e rd e v e l o py o u rc o m p e t e n caen d beenmanychangedsueto the introduction performanceJ of appraisalndrecommendatiobnysthe Pr inc ipleus n d e r l y i n gC o n t i n u i n g HoweverC, PDmustbe relevanto you GMC(GeneraMl edicaCl ouncila),ndthe ProfessionaDl evelopment andmeetyourneedsto allowmaintenance g u i d e l i n ewse r ea m e n d e di n J a n u a r y1 9 9 9 ContinuinPg rofessionDael velopment of a highqualityof patienct areC. ontinuing andJanuar2y000.Thme ostrecenet dition (CPDi)sa continuinglearningprocestshat professiondael velopmensthouldbe :'the guidelinewsaswrittenin September complementfsormaul ndergraduaatend r e f l e c t i v el i ,f e l o n gl e a r n i n ga l l o w i n gy o ut o :: i3. postgraduaeteducatioanndtrainingC. PD developwithinthespecialtoyf emergency 5 nceappraisahlasbeeninstituteadnd requireysouto maintainandimproveyour medicinea,ndshouldalsosupporyt ouin developinogutsideor subspecialitnyterests. ' = .:iida tionisine vita bldees pit et hedelayin standardascrosas llareasof yourpractice. :-= -plementationt,hedocumentatioonf CPDshouldalsoencouragaendsupport : ' : :' :f CPDh asb ecom em or er elev ant . s p e c i f icch a n g e isn y o u rp r a c t i c ae n dc a r e e r ICPDGuidanceGMCApril2004] development.

Project Checklirt Workin groupsA. rejobsin A&E departments/ Emergency Assesysourprogressin this unit. departmentspopular in your country?Why / Why not? Tick(/) the statementswhicharetrue. What methodsarecommon in your country for obtaining jobs,e.g.recruitment by job advert,curriculum vitae (CV) Icanchangetensesrapi dl y followedby an interview? I canunderstanaddverbsof manner I cando thi rd partyi ntervi ew i ng What do you understandby ajob specif.cation/ job spec? I canunderstancdomoari son Icanunderstancdonti nui ngprofessional Writing development Ajob application Keywords Lookat this extractfrom ajob applicationform for a post in the Adverbs emergencydepartment of a largecity hospital. abruptly embarrassi ngl y J o ba p p l i c a t i o n sp o n t an e o u s l y S t a t ew h yy o ut h i n ky o us h o u l db ec o n s i d e r ef od r t h i sp o s tB i v i n g Nouns . s uit ab i l i tfyo rth ep o s t apprai saI . relevanet xperience b y s t an d e r . training Contni uing ProfessionI aDevelopment o qualities job specification paramedic Wrlte a descriptionof your suitabilityfor the postor a postin rapi dresponse your speciality.Rememberthe information must be individual to S e t uz r e you and contain genuinedetails. w arni ngsi gn Adjectives giddy groggy woozy Verbs d isp a t c h faint soil twitch wet 5p*ck$r:g Ureful refer*ffi(m In an interview,rememberthat what you sayneedsto match OxfordHandbookof EmergencyMedicine accuratelywhat you havewritten in your job application.Work 3rdedi ti on,W yatet t al , in pairs.Giveyour descriptlonfrom your job applicationin l s B N9 7 8 - 0 - r _ 9- 9 2 0 6 0 7- 0 Writing Eto a partner Taketurns askingeachother aboutthe detailsyou wrote.Checkthe descriptionfor accuracy. Make surethat what you aresayingdoesnot soundasif you have learnt it by heart.Avold repeatingexactlywhat you havewritten. USXFUL XXPRESSIONS WhenI wasin ... Aff pr I fini<hprl 'a-- 'J\"\"-'--\"\" What makesmesuitableforthepost is... TherelevantexperienceI haveis... I'vefollowed varioustraining courseslike... As regardsmy qualities,...

12 Unit2 C h e c ku p 1 Describethe pictures. Vocabmffmry Fractures 1 Match the descriptions1-8with the types of fracture a-h. 1 simple which occurswhen certain 2 avulsion bonesarelikely to breakfrom 3 spiral repeatedminor injuries 4 comminuted 5 crush where the endsof aboneare 6 stress driven into eachother 7 impacted a complexfracturewhich resultsin more than two bone fre om pntc 8 hairline where the volume of boneis reducedbecauseit hasbeen cnm nrcq qed where thereis a singlefracture of the bonewith only two main flI-4^ Sr^r*rtrltL^)-+- f where a bit of boneis pulled off with aligament or muscle What type(s)of injuries do you think canoccurin g whichis notveryclearand e a c hc a s e ? there is no cleardlsplacement Are theseaccidentspreventable?Why / Why not? h which is seenin lonq bonesasa resultof twisting iniuries Work in pairs.Describea fracture to your partner,who then givesthe name.

A ccident s13 lF thi{ {,rfi{t o know l edgeaboutfractures a descri bi nfgracturesandacci dents $ P resenSt i mpl eP, resenCt onti nuousP,resenPt er f ect 6 gi vi ngi nstructi onws i th the i mperati veandneed o languagespot Talkingaboutthe present f,) Vouaregoing to hearthree statementsby either a - ' E doctoror a patient.Listenanddecidewho is speaklng andwhat they aretalking about. (|} tisten againandwrite down the orderin which the t e n s e sa r eu s e d . 1 PresentContinuous- PresentSimple- PresentPerfect- 2 PresentContinuous- PresentSimple- PresentPerfect- 3 PresentContinuous- PresentSimple- PresentPerfect- In your own words explain why eachtenseis being usedin the three statements. l\"isteningE Readthe statementsmadeby patients and doctors. Onetenseln eachitem is wrong.Which oneis it? U n d e r s t a n d i nvge t bt e n s e s i Ijust slamthe dooron my finger and it'sbleedinga f) fisten and match eachconversationwith a picture lot.It'sreallypainful in Checkup. 2 TheX-rayis coming backand it showsyou havea 1_ hairline fracture here and here.Is it hurting you at 2_ the moment? 3_ Yest,he doctor'sgiven me a telephonenumber and written instructionsin caseanything is happening f) tisten again and write down the tenses(a-c)of the with the plastercast.But honestly,I'm fine.I'm not verbsasthey occurin eachconversation. getting pins and needlesor anything like that. YesI,'ve seenthe doctorand he'sgivenme some e Preqeni Simnlp painkillers.1'vejust waited for the nurseto come back.When shecomesback,I cangohome. b PresentContinuous It mendsrather nicely,consideringyou havehad a c PresentPerfect rather nasty fall. But avulsionfracturesheal qulte well. 1 2 l Are you wearing your neckbraceall the time? Yes? hurt hurt And do you beginto regainmovement? break cry I immobilize his arm with a backslabPOPand the Brvc look fracture X-rayshavebeendone.They demonstratethe whole lengthsof the radiusandthe ulna.I think he's happen feeling comfortable. }} urilJ?)rtr,rr t \" {\". rr\"tr f

14 Unit2 A b r a h a mC o l l e s1,7 7 3 - 1 8 4 3 , Professoorf SurgeryD, ublin Vocabulary Speaking Causesof injury 1 Lookat the X-rays.Identify the type of fracture for patientsa andb. I Completethe sentencesusing the verbsbelow. banged dislocated fell landed pulled slipped smash squashed stubbed stumbled tripped twisted twisted went over 1 I on a loosepaving stoneasI was walkins down the streetand flat on myface. 2I andlostmy footing and myankle. 3I my toe on a chair.I may have fracturedit, but I hopeI haven't. 4I my kneeon the metal table.I am surprisedI didn't my kneecapto preces. Work i.npairs.Choosean X-rayand createa history for the patient.Includethesedetails:name,sex,age, 5i mv ankle when I went over and the presentingcomplaint (what the problem is,how / where / when it happened,etc.),needof analgesia,and now I canbarelywalk.I don't think it'sbrokenor any other detailsyou wish to add. anything.It'smorellkelyto bea sprain. Work with a partner from another pair with a different scenarioand take the history up to the point ofsending 6I on the wet floor andwent overand the patient for an X-ray. on my bottom. 4 Explainthe X-rayto the patient. Themotorbike onmyankle and It'smyjob crushedmy leg Work in pairs.What do you think the job of a radiologist involves?How hasthe radiologist'swork changedin I think I've my shoulderand I can the lasthalf century? barelymoveit. Readthe text and answerthe questions. 9I my finger in the doorand it's 1 WheredidMatthewJenkins originallyfindthat radiologyappealedto him? throbbine llke mad 2 How doeshe describethe RoyaiCollege'sbooklet? 10 I this nick out of the sideof mv 3 What is the main purposeof radiology? 4 What doesthe radiologistseeashis role? fingernail andnow it'sinfected. 5 Why is it important to includethe detailsmentioned Work in pairs.Haveyou evertreated someonewho has on the requestform? injured themselvesasin 1above?Describethe case. 6 Why is the radiologist'sday busy?

A cci d ent s15 I am gladto saythat in th iscountrythereisno needto carryout testsasa formof insurance.lt isnot in th iscountrydesirable,or indeednecessray,that overprotectivaend overexaminationworkshould bedonemerelyand purelyasI sayto protectoneselaf gainst pos s ibllei t i g a t i o n . -Judge Fallon,quotedby OscarCraig,ChairmanCasesCommitteeM, edicalProtectionSociety. - OxfordHandbookof EmergencyMedicine flilatthewfenkins Work in groups.Do you think the radiologist'sjob will becomelessor more complexin the future? Give M y nam eisM at t h e wJ e n k i n sa n dI a m a ra d i o l o gi satt a reasonsand examples. h os pit ailn M anch e s teIrd. e c i d e dto ta k eu p ra d i o l ogay s a specialtyafterworkingin variousotherdepartments * Describea situation where a radlologlsthelpedyou in first.lt was in the A&Edepartment hat my interestwas vourwork. first arousedI.wasat a lossinitiallyasa youngdoctor out of m edic atlr a i n i n ga sto h o wto m a k ea re q u est Writing to the radiologydepartmentevenfor somethingas basicasan X-rayB. ut I soonfound my feet.A veryuseful Describinga fracture guidefor doctorsisthe RoyaCl ollegeof Radiologists' booklet,Makingthe BestLtseof a Departmentof Clinical' Completethe list of the information which is neededto Radiology(5, thedition,London2003).Thisisa must- describea fracture. havefor doctorsdealingwith radiologydepartments 1 the ageof the patient andhow the fractureoccurred andis highlyr ec o m m e n d e d . 2 if it is simpleor compound 3 namethe bone Theprimaryaim of radiologyisto provideinformation 4 describethe position of the fracture (proximal, i n or dert o alt erth e ma n a g e me not f th e p a ti e n t andt he out c omeo f th e d i s e a s eS.omyfu n c ti o na s supracondylar) a r adiologisitst o h e l pc o n fi rma d i a g n o s i se,x c l u de 5 s om et hingim po rta n td, e fi n eth e e x te n ta, n d mo ni tor 6 the progressof a diseaseM. ostof the requestsfor X-rays 7 that we receivein the departmentnow comethough 8 electronicallryatherthan face-to-facwe ith a clinician. It ist her ef or eim p o rta n t h a t a l l re l e v a nct l i n i c a l I i nf or m at ioninc lu d i n gth e me c h a n i s mo f th e i n j ury 2 Match the different elementsto this description. with the sideinvolvedb. loodtests.recent radiologicafilndingsa, nd suspected 2 9 -y e,a,r-oW vndnt vnotor\"cy d,t *t w ftIv w Typ a c l i n i c adl i a g n o s iissg i v e no n the I co'ynpou d/ fra\"ctl^.red/1p,fr hlovneru.y. It & requesftorm.Withoutthe benefitof vni'vnrn6ll'y diaple&A, oL'vd,i,ywolu e*Llvz b e i n ga b l eto e x a mi n eth e p ati ent, hu.'vnq\"aL thaft w(71vvw vtB,+t tw a&<^^lnr a l lo f th i sd e ta i li sc ru c i a l . co'n1Dot fii,,e/... F o rm ss h o u l da l s os ta teh o wthe Write descriptionsfor the X -raysin Speakingon page investigationwill helpresolvethe 14.In eachcasethe patient is a 4O-year-oldfemale c l i n i c apl ro b l e mfa c i n gth e doctor policeofflcer. a n d s t a t ea n y i n v e s t i g a t i o nosn the requestform ifthe doctor th i n k sth e yw i l l ta k ep l a c e . E a c hd a ym y s c h e d u l ei sfu l l a sI try to b a l a n c eth e n e e d sa n d \" prioritiesof different d e p ar t m e n t s .

16 Unit2 Speaking Reading 1 Workin groupsW. hichoftheseX-raysshowsan avulsionfracture?Whatdothe otherX-ravsshow? +lnpeuB ur ernpe4 dpq p Beforeyou readthe text, answerthe questions. Moqls pallnd r 1 Where do you think the majority of accidentsoccur: 3l{uE eq}Joarn}JErJuorsFuv q the home,work, or in the street? plrqJ e ur mrue; eqllo arnperg alaldruoJul e 2 Which groupsof societyaremore proneto sraMsuv accidents? Checkyouranswers.Preparea short presentationofno 3 Are accidentsat work generally preventable? more than five minutes explaining one or more of the following: Skimthe text and match the headingswith the * the X-ray appropriate paragraph A-D. e the likely causes c the symptoms 1 Accidentsinthe home r the treatment. 2 Accidentsinthe workplace 3 Accidentsand children Chooseoneor more studentsfrom your group to 4 Accidentsandthe elderly presentthe X-rayto the rest of the classM. ake the presentationand invite commentsatthe end of the Find words and phrasesin the text which havethe presentation. samemeaning asthese.Items 1-7arenot in the order they occurin the text. 4 Giveconstructive feedbackfor eachpresentation, 1 stated 5 asamatterofcourse choosingtwo of thesecriteria:organization,relevance, 2 deaths 6 weakness Jluenry,clinicalaccuracyg, rammatical accuracy. 3 amongthe poor 7 attending 4 encouraging

A c c i d e n t s1 7 p r e s s u r seo r e( n )d e c u b i t u su l c e r m u l t i f a c t o r i a(la d j )i n v o l v i n gm a n y featuresor elements c h i pp a nf i r e s( n )f i r e sc r e a t e df r o m cookingchippepdotatoesin hotfat 4 Answer the questionsabout the text. 1 Among children,which group had the greatest mortality rate? 2 Among which group areaccidentsmore frequent? 3 What kind of help shouldbe offeredto the elderly who are susceptibleto falls? 4 What arethe main sourcesof accidentalfiresin homes? 5 What are doctorsresponsiblefor averting? Accidents A In2004t,herewere230child NICEguidelinews ereissued During2005/ 2006therewere fatalitiesdueto accidents in 2004on the assessmeannt d 148,713occupationainl juries in EnglandandWalest,he preventionof fallsin older reportedo, f which212werefatal. highesnt um b e rsb e i n gi n peopleT. heystatethat older All placesof work arepotentially f ive-to fourteen-year-oldTsh. e p e o p l es h o u l db e a s k e dr o u t i n e l y dangerouws hetheran oil rig,a commonesctauseof accidental if they havefall.e-inn the past coalmine,a factory,an office,or injuryin childrenpresenting yearT. hosewho havefallen,or a kitchenT. heHealthandSafety to UKhospitalsisfalls.Others thoseconsidereadt riskof falling, E x e c u t i vhea ss t i p u l a t e dr u l e s i n c l u d es u f f o c a t i n ga n dc h o k i n g , shouldhavea multifactorial aboutsafetyin the workplace. b u r n sa n ds c a l d sa, n d p o i s o n i n g . fallsriskassessmeannt dshould It alsohasthe necessarpyowers A recentreport bythe Audit beconsiderefdor interventions to inspecat ndenforcethem. Commissioanndthe Healthcare includingthoseto improvetheir S a f e t ye q u i p m e n tm u s tb e w o r n . Commissiosntatesthat eachyear s t r e n g t ha n d b a l a n c ea n d r e m o v e RisksmustbeappreciatedE. very therearetwo millionattendances a n yh o m eh a z a r d s . workplaceshouldhavea safety to accidenat ndemergency C In EnglandandWalesin 2004, officerwho isresponsiblfeor d e p a r t m e n t sb y c h i l d r e na sa t h e r ew e r e 3 , 8 9 2a c c i d e n t adl e a t h s i d e n t i f y i n gd a n g e ra n da d v o c a t i n g r€sultof accidenttshat mighthave in andaroundthe home.Those action.Asdoctors,we havea beenpreventedA. ccidentas re mostat riskof seriousor fatal duty to be awareof measuretso morecommonin the lowersocio- injuryin the homeareyoung preventinfectionand needle-stick e c o n o m i cg r o u p s . c h i l d renandthe el derl yF. al l s injury. F r a i l t ya n d h e a l t hp r o b l e m sm a k e arethe mostcommontype of the elderlyp. articularltyhoseover accident. the ageof 75,at increaserdiskof accidentsu,suallyoccurringin the In2004,fire brigadesattended home.Fallsarethe mostcommon 442,700firesin the UK.Therewere causeI.nabilityto get up after 508fire-relatedeathsand 14,600 fallingputsthe personat riskof non-fatacl asualtieAs.large hypothermia ndpressurseores. proportionof firesin homeswere Hipfracturesafterfallsarea major accidentatlh, e maincausebseing causeof morbidityandmortality. misuseof equipmen/t appliances a n dchi ppanfi res.

18 Unit2 s,rfety* et (n)a re mindetro t he patient hat theycancomeback if th erearea nych an gesor if anythin gh ap pe ns ilistem$mffgi Note:avoidusingyou haveto ...andyou must...(on its own without r/). Accidentpreventionmeasures Underlinethe alternatlvesin italicswhich arecorrect. f) Listento the extractfrom a taik on accident In somecasesm, orethan onemay be correct. preventionmeasuresand tick (/) the items which are mentioned. 1 If the arm swellsin the plaster cast,comeback/ you needto comeback/ you'II comebackandseeus. 1 - Adviceabout preventing accidentsis more the responsibilityof the government. 2 Don't hesitateto / Youaregoingto / you needn't contactus if it getsworsein any way. 2 - Whenweusethewordaccident,this somehow signiflesthat something cannot 3 If your fingersbecomediscoloured,raise/ you need be avoided. to raise/ you'regoing to raiseyour hand and try to keepit up. 3 - Simplesafetymeasuresand thinking about the future canreduceaccidents. 4 If the plastercastbecomestight ,you needto come back/ comeback/ try to comebackimmediately. 4 - Patientscanbealertedtoanvriskv situations. 5 Ifyourhandbecomesparalysedd, on't wait,just comein / you needto comein / you needn'tcomein. 5 - Peopleneedtobemoreawareof accidentscausedby Ieisurethan by home 6 If you get any pain ln your arm,don't leaveit / you improvements. needn'tto leaveit / you don't needto leaveit - come straight in. 6 - Hails and stairwaysneedto havegood lighting. 7 If you get any circulationproblemslike pins and needles,youneedto get/ getyourself/ don't hesitate 7 - Looserugsandflooringaredangerousfor to getyoursef backhereimmediately. oldpeople. 8 If the castbecomesdamagedor loose,replace/ we're What other precautionsneedto betaken at home? going to needto replace/ we needto replaceit. Think ofthe kitchen andheatins. i I Grarnm:rrleference, j. l, o languagespot Sayingwhat'snecessarpyolitelybut firmly =,In certain situationswhen you aregiving patients information, there is not really any negotiation- on discharginga patient or where there is no alternative,for example.In any situation,you need to providea'safetynet'in casesomethinghappens. Youneed... ...to comebackand see Don'thesitate... usif anything unusual nappens. If anything ...comebackand seeus unusual immediately. happens,... ...you don't needto ring - justcomein. Youneedto... ...restyour legfor awhile. You'regoing to haveto ...

A cci dent s19 .$w*mk*mg flftpwqfuff$s.. 'l Thesesixpicturesshowcommonminor injuriesyou might seein Assesysourprogressin this unit. an A&E department.Describethe injury shownin eachpicture. Tick(/) the statementswhicharetrue. E I cantal kaboutfractures I candescri beacci dents t\\&-r I canusethe P resenSt i mpl eP, resent C onti nuousa,nd P resenPt erfect T-$- I cangi vei nstructi onws i th the i mperat ive \\ andneed Workin groups.Createa historyfor a nineteen-year-olpdatient, ffi*par w*rr€+ Gerhard/ GabrieleSchneiderw, ho presentswith oneor moreof the aboveminor injuries.lnclude Adjectives hairline det ailsabou th o w th e i n j u ry h a p p e n e d impacted when andwhereit happened prone treatment simple instructionsyou would giveby way of 'safetynetting'. spi raI Nouns avul si on f r a c t ur e POP safetynet Verbs b an g dislocate I an d sl i p(over) smash s qu a s n stub stumbl e tri p (over/ up) twist #sw wxffffi #wvffitrssffi OxfordHandbookof EmergencMy edicine 3rdeditionW, yattet al, l S B N9 7 8 - 0 - 1-99 2 0 6 0 7- 0 Finda partnerfrom anothergroupandindicatethe lnjuriesyou haveaccordingto the history you havecreated.Taketurns taklng the historyfrom eachother.Usethe grid to givefeedbackabout the languageusedby the doctor. Doctor1 Doctor2 U s e st e n s e s Usesthe tensesfluently U s e sn o n - t e c h n i c aIla n g u a g e Usessafetynetting

2 O U n i t3 Checkup 1 Describtehepictures. Matchthelay statementswith the picturesin l. listeningI 1 I'rn coveredin cutsandbruises. Spotthe difference 2 I think I'vepulledamusclein my leg. 3 I'vegotcrampall downthis leg. Q tisten. write down details of what the patient said. 4 I'm dyingofthirst. Compareyour noteswith a partner. Whatotherinjuriesarethe sportspeoplein the pictures Q tistento anotherversionof the sameconversation. proneto?Giveexamplesfrom yourexperience. Which details are different? In groupsd, iscussthe questions. What is the difference in the questionsthat the doctor Areyouinterestedin sportsmedicine?Why / V1/hnyot? usesin eachconversation? Whatarethe advantagesof followingacareerin sports medicine?.A,trheereanydisadvantages? Which technique is better for the patient? Which approach do you find easierto use?

S portsmedi ci ne2l Inthisunit a usingdifferenttypesof questions a usi ngcol l oqui allanguage a gi vi ngw arni ngsandusi ngpersuasi on a usi ngw eak/ unstressesdyl l abl eisn speech Vorabulary ':...-::-----' \" Verbsof movement E In conversationl inlistening lthe doctorwasjust about to givethe patient someinstructions.What instructionsdoyou think shemight givethe patient to checkthe wrist? Workin groupsandmatch the instructionsto the pictures. E Work in pairs.Youaregoing to checka patient who has a shoulderinjury from the gym. Decidewhat instructionsyou would usefor the drawingsbelow. Thentaketurns giving instructionsto the patient. USEFUL EXPRESSIONS oK. I'd(just)likeyouto ... Fine. Could/ canyoujust...forme? Thankyou. I needyouto... 1 Bring your kneetowardsyour chest. -q 2 Straightenthelegatthe knee. 3 Putyourchinonyour chest. 1 4 Lookovereachshoulder. 5 Standup straight without support. 6 Crossyour legsover. 7 Leanyour headsidewaysplacingyour ear on your shoulder. 8 Pointyour toesatyour head. Y Fanout your toesasfar aspossible. 10 Bendthe knee asfar asyou can. 11 Curlyour toesandthen straightenyour toes. 7 2 Keepyour kneestogether and spreadthe anklesas far aspossible.

22 Unit3 No classof questionsistorrect'.Sometimes you needto askonetypeofquestion; sometimesanother.Getgoodat shifting from onekindto anotherandyouwill soonlearnto judgethe mostimportant questionsfor the patientin front ofyou. - OxfordHandbookof ClinicolMedicine Signsand symptomj 3 tvtatchthe medicaltermswith wordsandphrasesin 2. PatientYocabulary (adhesive)capsulitis bullae torticollis I Lookatthepicture. furuncle hyperkeratosis paraesthesia \\Alhat does it show andwhat isthe o language3pot colloquial term for these? Typesof questions 2 Completethe I Usethecuestomakequestions. sentenceus sing the wordsbelow l Havefallover? Youwilluseone 2 Cantell ifyoutrip inthe street? bodypartmore 3 youhurt? thanonce.What 4 What thinkthe problem? dothe sentences 5 Who aroundwhenpainsetin? mean? 6 Could describewhat happen me? 7 How long you havechestpain? (Lookingat the armpit back feet foot hand patient holding his chest) hands leg neck shoulder arm 8 there any other things you like talk about? 9 What elseyou concern about? I'vegotfrozen I can'tgetmy armup 10 the phlegm bronm, yellow or green? veryfar. 2 Identify the type of question in I by using the descriptions.More than one may be possiblefor each I'vegotwry I canbarely move my answer. head. a aclosedquestion b anopenquestion I'vegotwhat I think isaboilin my c a leading question d apatient-centredquestion can'tput anydeodoranton. e a family- / work-related question f a prejudicial question or question suggestingthe I think I've pulled a muscle in my answer can onlyhobble along. In pairs,work outthe questionsfor theseanswersI.n I've got theseblisters all over the palm of my somecasesa prompthasbeengiven.Theremay be morethan oneanswerin eachcase. 6 I'm not surebut I think I'vetorn aligamentin my It'sswollenandI can'tgetmy shoe 1 It hurtsjust here. 2 Well,I don'tknowwhereto startreally.I supposeit on. 7 I'vegotalot of callusesontheballsof both happenedjustafterI hadbeento... 3 It'sgonecompletelyblack. Theknuckleson both have allflared 4 No,not that I amawareof.(trauma:knock/ bang) 5 Sittingat my deskat work.(whenit'sworst) up.Ican'tgetmy ringoff 6 Foraweeknow. 7 No.Ican'tthinkof anything. 9 I'vegotapainrighthereinthe smallof my 10 I'vegottingling allthewaydownmy Ieft and

S oortsmedi cine23 standin for (v)replace temporarilyb,ea locum 4 Useyour own words to completethe doctor'squestions Work in groups.Isthe conversationpatient centred? in the conversation. What type of questionsdoesthe doctorask?Couldyou lmprovethe conversation? DocroR Goodmorning,my nameis Dr Nesbitt.i'm standing in for Dr Ratanawhile he'son 6 Write out the conversationkeepingthe samepatient holiday.You'reMr Finn? information, but changingthe doctor'squestions PATIXNT Yes. where youwould like to. DOCTOR oK.1 D f-iotr: Grammar referencep 1.10 PATITNT Well,mmm, I'm not feeling too good. Speaking DOCTOR 2 Work ln pairs.Role-playDr Nesbitt (StudentA) and take PATIENT Mmm.I havethis pain in myback. the history from the patient (StudentB)inLanguage spot4 opposite.Rememberto be patient centredand DOCTOR 3 askopenquestions. PATIENT Acouple of weeksnow. StudentA,go to page114S. tudentB,take a history from StudentA.Write notesasyou listen and decidewhat DOCTOR 4 the patient'scomplaint is. PATIXNT Yes.Off and on for a year or so.But neverlike StudentB,goto page116S. tudentA,take a history from StudentB. thls. DOCTOR 5 PATIENT Well, I could barely move at first. And now it's like a dull ache.I just haveto be careful getting up and it's not easyat all getting in andout ofthe careither. DOCTOR 6? PATIENT Mmm, just herein the small of my back. DOCTOR '7) PATIENT No.It staysjust here DOCTOR 8 PATIENT Nothing really,but I can't stayin the one positionfor long.And walking andlylng down hurts too and,weli, I suppose...I usuallygoto the gym quite alot. DOCTOR 9 PATIENT Not sincethis started. DOCTOR 10 PATIXNT Mmm.Well,I still drive,but getting down into the caris not that easy. DOCTOR Is it a sportscar,then? PATIENT Yes.

24 Unit 3 ffiead**g ? Find adjectivesand nouns with similar meaning that areusedto describenounsin the text. 1 relatedtocarryingheavyobjects 2 coveredmanypeople 3 carriedout overa periodof time 4 relatedto contests 5 relatedto exploring and studying 6 worth noting 7 relatedto questionsabout physicalactivity P h y s i c af itt n e s s m u s c l emassandi mproveBdMDi nthe A numbeor fpaperas ddrestshe a n dh e a t t h femorarlegionforal[andsuggestthat moregeneral i ssuoeftherel ati onship A seriesofresearcfhindingsillustrates if BMDisincreaseadtskeletalmaturity, betweensportsparticipatioanndhealth t h ep o s i t i v er e l a t i o n s h i pbse t w e e n p hy s ic aalc t iv itayn db o n em i n e ra I reductionms ightbeachieveidnfracture behavi ouirnsyoungpeopl eM. i l teer t density(BMDi)n avarietyofsub- p opulat ionIsn.t o n g i tu d i n a ts tu d i e s riskin lateryearsS. upportintghis al(zooo)usedatafroma large-scale u s ingv ar ioussam p l es i z e sK, e m p e r etaIandPuntilteatal illustrattehat c o n c l u s i oNnevi tleetal demonstratthee surveyofschoopt upitsto illustrattehat r e g ul a r( w e i g h t - b e agr i)np h y s i c a t activityissignificantrtyelatedto BMDat i mp o rtancoefsportsi nvol vi nhgi ghpeak athleticparticipatiohnasbothpositive thelum basr pinea n dfe m o ranl e c kl.n relat iotnot ot albo d ya n dl u mb asr p i n e strainfordetermininpgeakbonestatus, andnegativiemplicationfsoradolescent BMDv, anLangendonectkaIillustrate t h a tt h et y p eo f s p o r t sp a r t i c i p a t i oi ns e s p e c i a tilnyyoungmenandpossi btfyor healthandrecommenwdaysto use a significanfat ctorw, ithhighimpact s p o r t s( g r o u n df o r c e sh i g h e trh a nf o u r youngwomen(whoarelesslikelytotake sportforhealthpromotionP. astoer tal timesbodyweightm) osteffectivaend remaininbgeneficiafol rtheskeletat partin suchsports)G. reendaleeta1, usesurveydataonfifteent-o eighteen- h e a l t ho f m a l e sa g e d4 o .R y a ne ta l reporot ntheeffectsofsixmonths' in a studyof4z-to 5z-year-owldomen, year-oldtso conctudtehatthehighetrhe wholebodyresistivterainingin both explorefourdomainos fphysicalactivityl evel sofsportsparti ci pati otnh,ehigher y oungandolderme na n dw o m e nT. h e y r e p o rt h a tt h e p r o g r a m mi en c r e a s e d (sporth, omew, ork,activeliving)T. hey theperceivefditnessandconsequently illustrattehatbothsportandweight- enhancepderceivehdealthw, ithlower bearingworkinthehomewerethebest, levelsofsmokingandalcohoul sealso andequa[p, redictorosfgreateBr MD enhancinhgealthperceptionHs.owever, a tl u mb asr oi neandfemoranlecksi tes. therelationshipasreonlyweakto T h ew o rkofC hengetalrai setsheone moderateP.yleeta['ssurveydataon negativneoteinthisliteraturefi,nding highschoost tudentisltustrattehat,for thathighlevelsof physicaalctivity m a l e sa n df e m a l e sc,o m p e t i t i vsep o r t s (runningtwentyormoremilesperweek) participatiownasassociatewditha wereassociatewdithosteoarthritis lowerfrequencoyfmentailtt-heatth, (k n e ea n dhi pi oi ntsa) mongmenl ess eati nganddi etarpy robl emsa,ndtot al t h a n5 oy e a r so f a g e( a l t h o u g nh o risks(althougthherewasa higher f r e q u e n coyf s p o r t s - r e l a t ei ndi u r i e s ) . r e l a t i o n s h iwpa ss u g g e s t eadm o n g w o me no rol dermen). In the text a number of researcherse, .g.Kemperet al, $ Workin groupsA. nswerthe questions. and the focusof their researcharementioned.Match eachdescriptionto a researcher. ,\"' How canpeoplebe encouragedto participatein sport?Think,for example,of clubs,education,and 1 lookedonly at women advertising. 2 exploredinformation on olderteenagersonly 3 mentionedfindings relatingto men and running e Isit difficult to dissuadepeoplefrom over-exercising 4 madesuggestiontso improvehealth or exercisingwhen they areinjured?What strategies 5 researchedboth gendersovera wide agerange canyou use?Canyou orderor persuadethe patient? Givean example of what you would say.

S portsmedicine25 I nt h e s i c kr o o m , t e nc e n t s 'w o r t ho f h u m a nu n d e r s t a n d i n g e q u a l st e n d o l l a r s 'w o r t ho f m e d i c asl c i e n c e . - Martin H.Fischer l i s t e n i n gE F a t F e m€t* v e Patientattitude Lookat the following patient'sreasonsfor not following the doctor'sinstructions after a minor head Lookat the picture.How injury.Howwould you respondtothem? would you describethe patient'sattitude? 1 But I'dliketo goafriend'sbirthday party. 2 But can'ti just go andring if I feelbad? Q Listentothe 3 But I needto go and pick up my child from school. conversationbetween 4 I'm sorry,but I haveno oneto be with me forthat Dr JohnstonandMr AlexanderMunro. Map Iength of time. the patient'sattitude 5 If I don't turn up,I'm goingto bein troublewith my asthe conversation progressebsy numbering boss. 6 If I stayin hospital,I'm going to miss an important ihe rdieriirrcq job intervi.ew a ecstatic tr 7 A ndl ' l l mi ssthe pl ane.l havetocatchafl i ghtt oa h evecncrrtcd tl football match in Germany. 8 And I can't get to sleepwithout sleepingtablets. r rlpqnprefp n Matchthe repliesto the patient'sexcuses. rl ennmrprl n a I'm afraid,unlessyou havesomeoneto be with, we d e uncooperative E needyou to ... f irreqnnncihle n b Youneedto avoidthem; otherwiseyou can't be roused. g friendly I c And what if you feeldizzyor vomit all of a sudden h recenfirre n and...? fi tisten again and do the samefor the doctor. d But can't we arrangefor your wife or a friend to meet her? a exasperatedtr d netieni T e But lf you go to the party,you won't restand you b cooperative ! e persuaslve tr may betempted... c calm I f I'm afraidif you goto a gameand you don't restfor the next 24hours,... 4 () rlstentotheconversationagain.Whichwordas re g But canyou not just phone and rearrange...? usedby the doctor? h Youneedto restfor the next 24hours rather than 'I hr rt rrnr r mr rcf T exertingyourselfworking; otherwlse,you couldbe T off ... ? rara naorl rrnr r tn l Work in pairs.Taketurns readingthe patient'sexcuses 3 i'm afraidyou do need... and replyingin your own way. 4 Youmayfeeiwell,but.... Tx 5 I'm sorrybut you must ... 6 Yesb, ut other things couldhappen like ... tr 7 Youmay get a.. ! 5 Q fisten to the conversationagain.Which words are usedby the patient? 1 Youmean I haveto stay... nn 2 but I c an' t . lh a v e tog o to ... 3 Oh,thankyou.That'skind ofyou.. T 4 ButlfeelOK... T \\ Tnnnrprirtc thiq tr tr 6 W ell,I c ant ak e ... 7 OK,butIcan... !

26 Unit3 Pronunciation An exampleof headinjurywarning instructions Main stress Adults Ensuraeresponsibpleersonisavailablteo keepaneye 1 Beforeyou listen,underline the word that you think on youfor the next24hoursandshowthemthiscard. hasthe main stressin the part of the sentencein italics Resftorthenext24 hours. Dotakepainkillesrsuchasparacetamtool relievepain 1 Canyoutell me a Iittle bit more abouthowit all andheadache. happened? DONOTDRINKalcohoflorthenext24 hours. DOtakenormaml edicatiobnut DONOTtakesleeping 2 But iJyour child'smoodchangesin any way,make t a b l e t so r t r a n q u i l l i z ewr si t h o u tc o n s u l t i nygo u rd o c t o r sureyou contactus immediately. first. lf anyof thefollowingsymptomosccurt,henyoushould 3 But I can't.l haveto goto my bestfriend'sparty this returnor bebroughtbackin or thehospitaslhouldbe evenlng. telephoneidmmediatelTye. l'********(*24hours): . Headachneotrelievebdv painkillesrsuchas 4 But I'm afraidyou do needtobecareful. 5 I'm not surebut I think I've torn a ligament in my oaracetamol o Vomiting foot.II's swollen and I can't get my shoeon. o Disturbancoefvision 6 I've had it sincethe week beforeIasl,hereon the heel o Problemwsithbalance o Fits of myhand. . Patienbt ecomeusnrousable 7 Andyou needto havesomeoneto go homewithyou Taketurns role-playingthe conversationbetween Dr and staywith you for the next 24hours aswell. Johnstonand AiexanderMunro fromListening 2.The third student usesthe speakingcheckliston page117 Q tisten and mark with a'O'the syllablein 1that has for the patient and the doctorto givefeedback.Use the main stressin eachclause. thesecriteria for assessingthe doctor:ableto negotiate, persuasivewithout beingbossyc, alm,showingempathy. Work in pairs.Practisesayingthe statementsto each Rememberto include'safetynetting'at the end. other and checkeachother'spronunciation. 3 Nowwork in groupsand studythis scenario. 4 Make sevenquestionsof your own to take a history M r sN e w m a an ,Z 5 - y e a r - oml do t h ebr ,r i n ghs e rs e v e n - from a patient who hasfallen off a bicycle and hurt his year-orldhildintoA&ET, hechildbumpehdisheadduring knee.Usethe rangeofqueslionsinLanguage spoton a P h y s i c aEld u c a t i o(nP Ec) l a s sa t s c h o oTl .h em o t h e r page22. wascalledandshebroughtthechildin,Afterathorough examinatioynouaresatisfietdhattheinjuryisnotserious, Changepartnersand takethe history.Try not to Explaitno themothewr ha'pt recautionssheneedstotake, focuson the pronunciation.Giveeachother feedback Notethatthemothewr antsto takethechildto apartylater specificallyaboutthe pronunciation.Youmay want to i nt h ed a y , practisetaking the history severaltimes. Which statementin t hasproportionatelyfewer weak stressesW? hy doeslay languagegenerallyhavea largerproportion of weak stresses? Speaking Work in groupsof three.Lookat the following example of the headinjury warning cardfor adults.Identify which points the doctoralreadycoveredinListening2 on page25.

S portsmedi cine27 Adapting the advicefor adults,make a list of the'warnings'you ffi$xwskE$wR givethe parent.Rememberto include'safetynetting'at the end. Assesysourprogressin this unit. Again work in groupsof three,role-playingthe scenarioin $. Tick(/) the statementswhicharetrue. Followthe sameprocedureasin * above.Notethat the attitude of the parent is caring and cooperativeb, ut initially shewants to I canusedifferent ypesof questions takethe child to the party. l can usecol l oqui allanguage I canw arnandpersuadepati entsw i thout swtrB€Effim upsetti ngthem H e a di n j u r yw a l n i n gi n s t r u c t i o n s I canunderstanadnd usew eak/ unstr essed syl l abl eisn speech ffiwpwwrds Nouns bal l blister frozenshoul der heel persuasi on smal lof the back tingling warning wryneck Adjectives exasperateo I rnannnFr2ti\\/P Verbs DUmp c ur l fan out fl areup hobble negotiate s t r ai g h t e n Abbreviation et al '$ Lookat the'head injury warning card'for adultsin Ein &Sse$wtr$ffi#ffitr#wE## Speaking.lJsingthis asan example,write 'headinjury warning OxfordHandbookof Sportand Exercise instructions'fora sportscentret,o be givento teachersand MedicineD, omhallMacAuley(ed), rS B N978-0-19-856839-1 parentsof chiidrenwho havehad a minor headinjury while using the sportsfacilities.Lookat theseadditlonal points to watch out for: ' child'smood ,' resl o r' behaviourf:lts,. r tiredness ', cannotrouse qnfptrr neftin Write the instructionsin groupsand shareyour exampleswith the class. Roie-playthe scenarioinSpeaking$ again.Checkfor improvementsin the light of the instructionsyou havewritten

28 Unit4 C h e c ku p I Work in pairs.What do you think is happening in each picture? Gtl\\ Theincidenceof Caesareansectionin the UK was 23per centof laboursin 2002.Nine per centarepre- labour.How do thesestatisticsfor Caesareansectionin the UK comparewith your country? fl Which is more common in your country - natural or managedlabour?Do you think there is too much intervention in labour? Iistening Takingdetails Readthis extractfrom a conversationbetween Mrs Canterburyand Dr Abboud.What arethey taiking about? ,lI I'-G\" DocroR So,what canwe do for you? pArIENr M m m , w e l l , d o c t o r , i t ' sn o t r e a l l y t r o u b l e , l Ia; think...lthink l DOCTOR I see,and areyou happy about that? PATIENT O h y e s ,2 DOCTOR OK.Well,Iet'stake somedetails.Canyou rememberwhen your lastperiodwas? PATIENT Mmm, not exactly,but probably about six weeksago. DOCTOR Soyou think you've missedone? PATIENT Yes.3 DOCTOR Any other changesyou've notlced? PATIENT I do feela bit sickmost mornings,and my breastsfeel a bit tender. DocroR Right,if I giveyou a littie bowl, canyou just a the toilet and bring backa samplefor me? What cluesarethere in the conversationto help you understandwhat is happening?

O b s t e t r i c s2 9 Inthisunit s tal ki ngaboutpregnanc/ygi vi ngbi rth t usi ngsmal ltal k * speaki ngsmoothl yandfl uentl y * understandi nlgayl anguagei n obstetri cs * usi ngmodalverbsfor negoti ati on Completethe conversationusing one of thesephrases Signsand iymptsm$ for eachgap 1-4in the conversationin I. lay wordsandmedicatlerms I'm asregularasclockwork 1 What doesthe patient mean?Work in pairs.Translate _J '_m. ' pnncr^tin o the lay words into medicalterms. --_r---\"'o 1 I haven'thad aperiodfor three months now. I'm likeaclock 2 I'vebeenfeeling sickin the morning. I keep I'm wai.tlngfor something throwing up, especiallyin the morning, and it's worryingme. makeavisit to 3 I haven'tbeenfor two davsand it'sthe secondtime popro it'c hennene.l We'vebeenpractislngfor ages 4 I think I'vegot piies. I'vecomeout in this rashon my tummy and arms. We'vebeentrying for ages My mum saysit will go when the baby'sborn,but I don't know. 4 Q tisten and checkyouranswers. I'vebeenbringing up this horribletastefrom my stomach. 3 Q WtLodo you think saysthe phrases?Listento the 7 I keepgoing to the toilet and passingwater. restof the conversationW. hat dothe phrasesmean? 8 My back'skilling me,especiallyat night. 9 I don't know what this brown patchls on my face. 1 You'reprobablyabout four weeksgone. 10 I'vegot this tingiing in the thumb andthesetwo 2 We canusually get a clearpicture. 3 I takeit... fingers. 4 I do skip mealssometimeswhen I'm rushed. 5 Therearecertainthings you needto steerclearof. Match eachmedial term with one of the patient's 6 I haven'tbeenon a bingefor ages. statements. 6 Checkyour answerswith your partner. a haemorrhoids b amenhorroea 7 Work in groups.Isthe doctorvery patient centred c refluxoesophagitisandheartburn or very abrupt / businesslike?Ifnecessary,how d morningsickness would you evaluatethe doctor'smanner and what e constipation improvementswould you make? f prurigoofpregnancy(PEP) g urinaryfrequency h paraesthesia i chloasma j lumbago How would you reassurethe patient in eachcase? Work in pairs.Taketurns sayingthe statementsand r e a s s u r i n ge a c ho t h e r . USEFUI EXPRESSIONS It happensat thisstage,but it'il ...when the babyis born. It'sa goodsignas it isassociatedwithfewerfoetal losses.

30 Unit4 a c k n o w l e d g (ev )r e c o g n i z/es h o w Speaking Establishingrapport with patientsis essentialif you want them to cooperatewith you. If you go straight into the medical aspectof the consultationwithout first acknowledgingthat the patient in front of you is a person,it can affectthe history taking. I In Iistening,the doctor startsthe conversationwith the safesubjectof weather during which there are several very simpleexchangesF. orthe'safes' ubjectsinthese pictures,decidehow you would begin the consultation. What would you say? Which topicsof conversationarebetter to avoidif you Matchtheseresponseas -h to 1-8in l. don'tknowthe patient? a lt'swonderful.I... Youmay start the smalltalk or it may be startedby b YesI.'m soakedthrough! the patient.How do you think the statementscouldbe c Yesb, ut we mustn't complain.We might not haveit developed? for long. L patlrur It'sstill raining very hard out there. d She'smuchbetter.Thankyouforasking.lt'sreally 2 parrr lgt Theweather'sstill awfully hot. 3 oocron Hi. Youlook asif you arein a hurrytoday. kind ofyou. 4 oocron Howhasyourworkbeenrecently/sincel e Yes,I've beendoing lots of different things this Iastsawyou? morning. 5 oocron Hi.Howareyou?Fine?Good.lsawyour f Yes,I'm mad about football. g It'sbeenhectic,but fun. Thanksfor asking. husbandwith the childrenthe other dav. h He'scoming on very well. He'snot looking forward Hewas lookingwell afterthe op. 6 pocron How'syour mother sinceyou brought her to goingbackto work. to seeme lastweek? 7 oocron [Tochildwithmother]lseeyou're How long shouldthe small taik last?How canyou a football supporter.Haveyou been bring the smalltaik to an end? following the football on TV? 8 oocron You'reatuniversitv now. How'sit all Work in pairs.Taketurns role-playingthe beginning of going? a history from a patient and addingthe phrasesin 4. Developit in your own way.

Obste t r ics31 b a l l o t( v )p u s hd o w na si n p u s h i ngd o w n a n a p p l ei n t ow a t e r piacenta(n)the afterbirth n u r l e u s( n )m a i ns t r e s si n t h e s e nte n ce Vocabulary Work in pairs.Chooseone of the medicaltopics1-8 in 1.Preparebrief notesusing your own knowledge Technicalterms and experienceabout the topic.Then swappairs and useyour notesto givea mini-presentationof two or 1 Work in pairs.Completethe sentencesby using one threeminutes aboutthe topic to your partner. word from eachlist in eachsentence. A antepartum blrth contractions dilation Working withthe samepartner,choosea subjectfor tie mother obstetric placenta your partnerto talk aboutwithout preparation. B associated cervix defined descends Pronunciation foetal lifting longitudinal cnnnienenr relrr Sentencenucleus C dilated fundus gestation haemorrhage Find at leastoneword in Vocabularvforeachstress nelvis retained traction ultrasound pattern. 1 Thefirst stageof labour is the time from the onset r Oor 4 .4.r. 2 .4. s .cC.e ofregular - until the tully 3 ..Oo 2 Afterfull the headflexesfurther and further into the Identify the main stressor nucleusin the text in italics. 3 A not deliveredin 30 minutes will 1 At vaginal hysterectomy,the uterusisbroughtdown through thevagina. probablynot beexpelled Thedanger What happensisthe womb is broughtdown through thevagina. witha placentais haemorrhage. Pre-eclampsia ispr eg nancy-induced hyperten sion with proteinuria + oedema. Ine usuallvreoortsabsent It's a condition wherethe bloodpressureis raised with protein in the urine and possiblyswelling. movements.Thereis no foetal Normal labour is often heraldedby a show. movement (e.g.heartbeat)on 6 Whenan induction is beingplanned,the stateof the cervixwill beassessed. 5 Abreechpresentationiswherethe Ankleswellingisverycommonwhen you're preSnanr. on palpation is no headisfelt in the 8 It tendsto worsenat night?Well,if you usea firm pelvis,and inthe there is a smooth mattressand wear flat shoesi,t will help. round mass.which canbe balloted. haemorrhagehasbeen asbleedingat >24weeks' by ofthe posteriorshoulderis aided f) Listenand mark the nucleusand secondary maintaining the headupwardswhilst stressesin the text in italics above.Checkyour answers Most with a partner. severe shockis with 4 Work in pairs.Tohelp you feel the rhythm of the sentencesr,eadoniythe words with secondarystress and the nucleus.Then readthe full sentenceC. heck eachother'sresponses. Which of the sentenceshasmore secondarvstresses? Whv isthis so?

32 Unlt4 N cT( n)t heNat ional C h i l d b i rth T r u s ta, U Kc h ar i t ys u p p o r t i n g parents It's rnyjob 3 Antenatal classesareonly held in hospitals. 4 Theadvicegivenis restrictedto the pregnancyitself Answerthese questionsbeforeyou read. andthe time immedlately after pregnancy. 1 What happensin antenatal classes? 5 Painrelief is left to more specialistprogrammesrun 2 Are they a gooduseof resourcesin your opinion? 3 Who doyouthink shouldrun suchclasses? bymidwives Now readthe text. Are thesestatementstrue or false? 3 Work in groups.Are antenatalclassesheld in your 1 Theantenatalcourseis restrictedto pregnant country?If not,would they beuseful?Givereasons. Who organizes/ would organizethe classes? women. 2 It is essentialfor trainersteaching in the name of the NCTto havethe propercertification. IUlaryKnox I am MaryKnox,an NCTteacherof an o l ooki ngafterthe mother' sheal thduri ngpregnancy a nt enat acl our s ew, h i c hw a ss e tu pto h e l p f l o o r e x e r c i s e sa)n d preparemothersfor labourt,helr baby's b ir t h,andear lyp a re n th o o d .T htirsa i n i n g afterthe birth isopento pregnantwomen,their partners, o the mother' sfeel i ngsabout andtheir birth supportersI.haveundergone a three-yeatrrainingprogrammew, hich is pregnancyb,irth,andthe period u niquein t he wo rl do f c h i l d b i rthe d u c a ti o n , afterthe birth. l eadingt o a diplo mai n H i g h e rEd u c a ti o nl n. orderto facilitateclassesin the nameof the T h ec l a s sa l s oo r o v i d e sa n NCTt,eachersmust holda currentlicenceto opportunityto learnabout practise. andexoerimenwt ith different bi rthposi ti onas ndgi ves Theant enat apl ro g ra mmeI ru n i s h e l di n mothersthe chanceto l earn the eveningfor pregnantwomenandtheir a b o u t r e l a x a t i o nt e c hn i q u e s partners(whichmaybethe baby'sfatheror (i ncl udi ngmassageski l l sand a not hers uppor t i n gp e rs o ns,u c ha sa mo th e r, breathi ngtechni quesfo, r sisterf,riend,or femalepartner)S. omecourses, e x am p l e ) .l t ' s r e a l l yg r a t i f y i n g howeverm, aybe heldin a homeor in a public gi vi ngpregnanwt omenan v enueandus ual l ys ta rta t 3 0w e e k sa l th o u g h opportunityto discussthe s om et im es ' earbl yi rd 'c l a s s easrea v a i l a b l e i nformati onavai l abl ei n order earlieron in pregnancyM. y presentclasscovers to makechoi cetshat areri ght o what happen sd u ri n gl a b o u ra n d b i rth for them.And it isn'tjust I c opingwit h la b o u r(i n c l u d i n gi n fo rma ti o n antenatasl upportw e g i v e .N C Tc l a s s e cs r e a t ea aboutpainr e l i e f) s u p p o r tn e t w o r kb e c a u s e o preparingfor lifewith a new baby p e o p l em a k ef r i e n d s o exercisetso keepthe motherfit during with otherswho areat a si mi l arol acei n l i fe. pr egnancayn d h e l ph e rd u ri n gl a b o u r o how to carefor a newbornbaby

Obstetr ics33 t h c p i {l( n )t h e c o n t r a c e p t i vpei l l o languagespot $p*akimg G i v i n ga d v i c ea n dt a l k i n ga b o u t Workln groupsand discussthesescenarios. exPectation , A 25-year-olpdatientwho is epileptich, asa I Underlinethe correctmodalverbin thesesenrences. poordiet,andistaking the pill wants to become pregnant. 1 Are you sayingthat giving up smoking shouldI can/ A 25-year-olfdemalewhosepartnersmokesand musfimproveour chancesof havinga baby? drinks wants to havea baby.Both havea poor diet. 2 May / Must / Canthe epilepticdrugsI'm taking Makea list ofthe points you want to makeandthe questionsyou want to ask. rffcrf th e h: hrr if Tocf nrpon r nf) Chooseoneofthe scenariosandtaketurns talkingto 3 AretherethingsI canI oughtto / maybecareful the patient.Thepatient shouldtry to usethe questions aboutduring the first few weeksof pregnancy? in exerciseSinLanguagespot. 4 Can't/ Mustn't / Shouldn'tthebabybe lying the USEFUL EXPRESSIONS FOR THE DOCTOR otherway round? Ifyouwantto... 5 Do we haveto / ought to / needto giveup smoking you can... and drinking then if we want to try for ababy? you needto / it should... you aregoingto haveto ... 6 Can't/ Must / Shouldlseea specialist?Isn'tit [smoking]affects[eggproduction/ sperm] possible? 7 DoI must/ needto/ shouldhavemybabyin hospital?Can'tI haveit at home? 8 Thedoctorsayslcan/ must/ shouldrestfor a couple of days.Thereis no alternative. 9 Youthinkitmust / needstobetodowithmvblood pressure? 70 Can't/ Shouldn't/ Mustn'tI justhaveoneor two drinksduring the pregnancy? I Work in pairs and categorlzethe statementsin t as:conclusion,p ersuasion,expectation,p ossibility, necessitoy,bligationp, ermissionT. heremay be more than oneanswerln eachcasea, swhen we speakw, e conveyseveraml essagesat onetime. 3 Work in pairsand choosea questionin trto askyour partner.Developthe conversationin your own way. Beforeyou begin,look al Grammarreferenceon p a g e1 2 1 . 4 Changepartnersand askeachotheranotherquestion. 5 Imaginethat you area pregnantwoman at an antenatalclassT. hink of cuestionsto askthe antenatal teacher. USEFUL EXPRESSIONS Areyou sayingI / we...? DoI / wehaveto ...? D oy ou t hinkI s h o u l d...? Shouldn'tl/we...? Can'tI (just)...? D oy ou t hink it m u s t...? CanI...? )) .'- r,'*ramruarveference

34 Unit4 T hepa inisre allyyo ur f r ienidn labourI.nt hes ebigt r ans it io nisn l i f e the pain iscomingto help you.Andthat issucha differenct oncept of pain;that painisyour friendinsteadof your enemyl.t'sthe same asin bige motio napl ro blem s . Thpeainac t uallyhelps y ouwh e n you'reg rieving ... - Well-knownDutchmidwife,BeotrijsSmulders Reading Beforeyou start to read,useyour own knowledgeand Although, for convenience,health professionalsdivide make a list of the main points you would expectto see labour lnto three stages,it is more useful to seelabour as one in an information leaflet for women about the third contlnuous processwlth each preceding phase affecting what stageoflabour. follows.The thlrd stage of labour is the phasefrom the time when your baby ful1yemergesuntil the placenta is delivered. Underlineand numberthe words in the text that mean: It is alsothe time when your baby adapts to life outside the womb. 1 through 2 holdtightly There aretwo ways in which your placenta can be 3 acceierate delivered.These are either a natural (physiological)third stage 4 triggered or a managedthird stage. 5 previous 6 probability A natural third stage meansthat no drugs areused to 7 throbbing dehverthe placenta.Instead it relieson the natural contraction ofthe uterus, stimulated by the surge of the hormone oxytocin Usewords from the passageto completethese at birth. This is the hormonethat causesyour uterus to sentencesI.n eachcaseyou will haveto changethe contract and expelyour placenta.A natural third stage does form of the word. not lncreasethe likelihood of severebleeding if the labour has been normal and without epidural analgesiauntil then. 1 Thethird stageof labour endswiththe After your baby is born, the umbllical cord will be left of the umbilical cord. intact. It is long enough sothat you can hold your baby comfortablyand begin the processof getting to know each z lne ofbleeding doesnot necessarily other.As your baby adapts to life outside the womb the flow of blood from the placentato your baby via the umbilical cord risein anatural third stage. wrll decrease,as the role it has had during pregnancy comes to completion. The cord will only be cut and clamped when it 3 Toquicken delivery a drug canbe hasstopped pulsating. After a while you will begin to feelyour uterus contract. At some stage you will feelyour placenta in into the patient'sthigh. your vagina and push it out with a few small contractions.This stage can take anything from ten minutes to over an hour. 4 When the placentahas itstask,the A managed third stage meansthat a drug (usually bloodflow declines. syntometdn or syntocinon) is given to speedup the delivery ofthe placenta.Thesedrugs can causenauseaand vomiting 5 The of the placentain a managed and may rarsethe blood pressurein some women. They are given by injectlon into your thigh usually asyour baby is being born or if requested,immediately afterwards.The main effect of this drug is an extra sfiong contraction. Your midwife wrll immediately clamp and cut your baby's cord so asto stop him receiving an abnormalsurge of blood ftom the squeezedplacenta. This strong contraction wrll have the effect of causing your placentato peel away from the wall of your uterus. Other longer-lastingcontractions wi-llclosethe cervix, soyour placenta will need to be deliveredwithin about 7-8 minutes. third stageis causedby drug inducedcontraction.

O b s t e t r i c s3 5 ; .:i.:'plan(n)a system aT (heckllrt cf careagreedwith thepatient *,}} Assessyouprrogressin this unit. Tick(/) the statementswhichare ,f\", true. -{':-* I cantal kaboutpregnanc/y gi vi ngbi rth $peaking l can usesmal l tal k I canspeaksmoothl yandfl ue nt ly Work in groupsof three.Chooseoneof the topics.Imagine you are a patient l can understandl ayl anguag ein and using your own experiencem, ake notesabout what you want to know obstetrics I canusemodalverbsfor from your doctoraboutthe topic. negotiation 1 pre-eclampsia 4 stillbirth Keywords 2 anaemiain pregnancy 5 urinary frequency Nouns afterbirth 3 wheretodeliver 6 hyperemesisgravidarum breech conclusion Shareyour information with the restof the class.Make somequestionsyou expectation thinkthe patientmight ask. lie membranes Divide into two groupsof doctorsand patients.Patientsconcernedwith morni ngsi ckness one of the topics1-6 sit ln a semicircleasper the diagram above.Onedoctor patch sits oppositeeachpatient.Thedoctorshaveflve minutes to speakto each period patient andoneminute for feedback. pre-eclma psi a r ap p o r r At the end of the five minutes,the doctorsmove clockwise.After two or smalltalk threepatientst,he doctorsandpatientsswitchrolesand repeatthe process. the Pill Writing Verbs beexpecting S u p p o r t i n go p i n i o n s r up t u r e rry Work in groups.Useyour own experienceto list the checksby weeksthat a pregnantwoman might needduring pregnancy. Adjectives an t e na t aI Work in pairs and imagine you arethe patient.Listthe questionsand gone concernsyou would askthe doctorin this scenario. l ongi tudi nIa A young couple,Mr and Mrs Minton, arebookingthe antenatal Urefulre$€ren€* carewith your GPsurgery.Mrs Minton is six weekspregnant.Sheis primiparus and is in goodhealth.Theywould preferto havea home OxfordHandbookof Clinical delivery.Answer their questionsand addresstheir concernsand then Specialtie8sth edition,Collierand agreethe careplan. LOnSmOre, rsBN978-0-19-922888-1 5 Taketurns role-playingthe scenario. 4 Workin groupsW. hat type of essayareyou beingaskedto write? Descriptiveor argumentative? Deliveryshouldoniy take placein a safehospital environment. Howfar doyou agree? Brainstormideasfor hospital and other types of delivery.Select hree or four main ideas.Write a reason(becausea),n example(like/ for example), an explanation (If),additionalinformation for each(Moreover)a, result (Andso/ As a consequenc/eAs a result)T. henwrite about250-300words in answerto the questionin 4.

35 Unit5 C h e c ku p S i g n sa n d r y m p t o m s t Work in groups.Canyou name thesepeople? Psychiatriscymptoms eoluowuAIrrEW p I Work in pairs.Canyou identify the psychiatric de.nrrSunuag+seurg J symptomsbelow? ]e{JaglanurEs q 1 Theemotionalstateprevaiiing in a patient at a urnqdapldarpnv e particular moment and in responseto a particular All of the abovesufferedfrom a depressiveillness. eventor situation. Canfamous peoplelike thesehelp removethe stigma of mental illness?How?Or do they confirm people's 2 Thelossofthe ability to understandabstract beliefs? conceptsand metaphoricalideasleadingto a strictly Are there any psychiatricillnessesin your country literal form of speechand inabllity to comprehend which arestigmatized?Are pubiic attitudes changing aliusivelanguage. or havethey beenthe samefor a long time? 3 A normal and adaptiveresponseto dangerwhich is pathologicalifprolonged, severeo, r out ofkeeping with the realthreat of the externalsltuation.There aretwo types:psychicand somatic. 4 Deliberatelyfalsifyingthe symptoms of illnessfor a secondarygain (e.g.compensation,to avoidmilitary service,to obtain an opiateprescription). 5 A sustainedand unwarranted cheerfuiness. It is associatedwith manic statesand organic impairment. 6 Therepetition of phrasesor sentencesspokenby the examiner.It occursin schizophreniaand learning disability. 7 A severeandprolongedelevationofmood.Itisa featureof manic illnesses. 8 A form of mood disorderinitially characterizedby elevatedmood,insomnia,Iossof appetite,increased libido,and grandiosity.More severeforms develop elation and grandiosedelusions. 9 Thesubjectiveemotional stateovera period of time. 2 Matchthesetermswith 1-9in l. a affect d euphoria g mood b anxlety e mania h elation c concretethinking f malingering i echolalia Write your own definition for oneor more of these terms and comparethem with other classmembers: depressedmood,ataxia,clangassociationb, ulimia, delusionalmood,panic attack,somatlzation. In pairs,take turns giving definitions of the terms in 1-3.YoucanusetCanyou defne ...forme?

P s y c h i a t r3y7 Inthisunit a understandi nbgasi cdefi ni ti onsi n psychi atry o talkingaboutaffectand mood o understandi nagnd usi ngl ayterms o usi ngphrasavl erbs o understandi nagnd pronounci npgreposi ti onwsi th ver bs 5 In pairs,decidehow to explain oneor two of the terms PatientGare in 3to a patient.Thentake it in turns role-playingthe patient and doctor. I Completethesepatients'statementsusing a suitable word of your own. PATIENT I feel asif I'm on ofthe world. Y o uc a nu s e :E x c u s em e , b u t w h a t d o e s. . .m e a n ?C h o o s e terms from the Iist that you havenot preparedtogether I'm alwayson -, doctor,for no to help prepareyou for dealingwith the unexpected. real reason.I'm a bundle of DOCTOR I just feel asif I'm weighed Useyour own knowledgeand experienceto answerthe by everything and everyonearound me. patient'squestions. attackswhenI try to ListeningI get on busesor trains.I get pins and needles.I get out of breath and reallytenseasif somethingis Mentalstateexamination goingto happen. I'M out of mywits of leaving the flat.I don't know how I eot here. I do things Iike cleaningthe house,again and again.I sometimesthink I'm mymind. I'm feelingreally atthe moment. I'vebeendoing alot of painting andI think I'm asgoodasPicassoi,fnot better. I f) fistentoadoctor,DrVine,talkingaboutthe I don't think I needmuch sleep.It seemssucha appearanceb, ehaviour,and speechof one of the new of time. I haven'tbeento bedfor patientsaspart of the mental stateexamination.Take notesunder the three headingsappearanceb, ehaviour, two daysnow andyou seeI'm OK. andspeech. Food?Oh.I haveno - for preparing 2 f) compareyouranswerswithapartner.Thenlisten againand checkthe details. anything to eator doing shopping. What other detailswould you want to know aboutfor Work in pairs.Categorizethe statementsaccordingto the examination under theseheadings:mood,risk, whether you would associatethem with anxiety or anxiety,perception,thought,cognition,fnsight?Use elation. your own knowledgeand experience. Work in groups.List and discussother signsand 4 What doyouthinkthe patient might sayto indicate symptoms you would expectin classicpresentationsof patientswith anxiety or elation. their mood,anxiety,or insight?

38 Unit5 o Languagespot 2 a Sometimesworkandtheweathergetme P h r a s a l v e r b-ss e p a r a b l ae n d i n s e p a r a b l e b Canyou try and get somefood you today? 3a My fathergot hisdepressioqnuite quickly. b Hegottheprocedure to the patient. 4 a Iget aviolent temper quite easily thesedavsat work and I know I shouldn't. 6*,-u b His depressiongot me abadmood too. 5 a Ithelpstotrytotalkaboutitsoyoucangetit uws#?r yourchest. Wfr0Nveffrw b Ifindit verydifficulttoget to sleepmost nights. 6 a Everybody'sgetting my nerves at the moment. b He gets with everybodylnthe psychiatricward. 7 a I'vetried getting Dr Jarvind but his bleeperappearsto be faulty. b I'vetried getting the importanceof this message An understandingof phrasalverbsis another feature him,but he'sveryresistant. of colloquial English that will help you interpret and understandthe patient. 8 a He'll get onhisfeetveryquickly, sotry notto worry. EXAMPLES b Whendoyouthink I'l1beableto get Inseparablephrasalverb:I got into washingmy hands towork? againand again. Separablephrasalverb:I couldn'tfix it, whichgot me 2 Usethesewords to rewrite the relevantsentencesin 1 intoarage. where possible. 1 Work in pairs.Add the appropriateparticleto eachpair annoying (xz) convincing(someone)of contacting of sentences. mastered denressme eatsomefood leturn at back down into explained releaselt off on over through to 3 Write at leasttwo sentenceswith the separableand I a Ifeelasifeveryoneisgetting inseparable phrasal verbs aboveabout a patient you allthetime. havetreated.Work in pairs and describethe behaviour of the patient.Rememberto maintain confidentiality. b With solittle information it's difficult to get the diagnosisin this case. D Goto Grammar referencep 121

P sychiat r3y 9 ..::ji:..rrr, ,,.1(n)a nar r angem enwt her e t he au die ncfeo r a ro le- plasyur r ounds the performersotheycanseeboth particip an tisn the ro le- play Spwm€e$*g Workin groups.Preparequestionsyou would aska patientpresentingeither with anxietyor with elevatedmood.Usethe categoriesin the tablebelow. Anxiety Elevatedmood Nature:Wouldyou sayyou werean anxiousperson? Mood:How hasyour mood beenlately?Doyoufind your Severity: moodischangeablaet the moment? Thoughts: Prceinif: nfq. Gifts/ talents: Impacton patient'slife: Sleep: Situations/ activitiesavoided: Appetite: Time spenton obsessionasl ymptoms: Concentration: Workwith a partnerfrom anothergroup.Do a role- play.Taketurns taking a hlstory from eachother.The patientandthe doctorshouldtry to usethe phrasal v e r b s i n L a n g u a g es p o t . sruDENrA (earrnNr): Do not tell the partnerwhat your condition1sD. ecide o n a nam e,age,a n ds e xfo r th e p a ti e n t. sruDENr B (oocron): Takea historyfrom StudentA.Bearin mind the Mental Stateexamination above. When you havefinished,discussany speciflcmedical o r languagedet a i l sth a t c a u s e dp ro b l e ms . Now two volunteersperform the role-playagain ln 'the goldfishbowl'.Beforethe performance,turn to the speakingcheckliston page117and,asa classc, hoose a criterioneachto assessthe performanceT. aketurns role-playingand givingfeedbackT. hefeedbackshould be constructive.

4O Unit5 steepe din (v)immers edin Reading 4 assumptions(affectivedisorders) 5 subjectivesymptoms (focus) I Below arethe answersto questionsabout the reading 6 variable (neuroticor reactivedepression) text. Readthe text then work in groups.Make questions beginning withWhat, usingthe words in brackets. Work asa whole class.Compareyour questionswith other groupsand decidewhich group hasthe best 1'vapours','hypochondria'o, r'neuroses('depressive questionin eachcase. disorder) Work asa whole class.Explainthe answersusing the 2 reducedfunctioning (othermedicaldisciplines) information in the text. 3 physiological(change/ depression) Thechangingfaceof depression t h ef o c u so f c l i n i c adle s c r i p t i o fnrso m objectivbeehavioursaigl nstosubjective symptoms. O v etrh ei n t e r v e n i nyge a r st,h e r e h a sb e e nm u c hd e b a t ea st o w h e t h ear 'biologicadle' pressioenxists eparate froma'neurotitcy' peT. erminotogy h a sf l u c t u a t eadr o u n d ' e n d o g e n o u s ' , 'vitat','autonomous','endomorphic', and' mel anchodlei cp' ressi ocnh,ara c- t e r i z e db yd i s t i n c t i vsey m p t o masn d si gnsa,genetibcasi sa,ndrunni nagn f'lUR currenidt easofwhatconstitutes T h ec o n c e pwt a se n l a r g eadn d i n d e p e n d ecnot u r s ue n r e t a t et odp s y c h o - sociaflactorsln. contras'tn,eurotic'or V depressiodnatefromthemid-eight- tegitimizebdyKraepel(inr9erw) ho e e n t hc e n t u r yB.e f o rteh a tt i m e t, h eo l d u s e dt h et e r m' d e p r e s s i vs et a t e si n' 'reactivdee' Dressicoonuldmanifesint notionofmelancholsiate, epeidnclassical hisdescriptioonftheunitarcyoncept multiplfeormss, howecdlearesponsive- humorathl eorie(smelanchodliearived of'manic-depressililvneesse',ncom- nesstotheenvironmeannt,drana more fromtheGreekmelaiannadkole'black passinmg elanchosliiampleaxnd v a r i a b lceo u r s eB. o t hI C D - raon dD S M bile')r,eftecteindtensityoidf eaS. adness graviss,tuporf,antasticmalelancholia, -lV'fudge'thiessuesomewhabtyusing orlowmoodwerenotprimarsyymptoms. d e l i ri o umsetancholai an.di nvol uti onal severitsypecifie(ris.e.mitdm, oderate, The'melancholsicy'mptomwseregard m e l a n c h olAi an.umbeorfassumpti ons severea)swellas'symptomsp' ecifiers t o d a ya sp a r to fa d e p r e s s i vdei s o r d e r surroundethdeaffectivdeisorderastthat (i.es. omatiscymptompss, ychotic wouldhavebeencalled'vapours','hypo-timet:heyinvolvepdrimarpyathologoyf symptoms). ch ondr iao'r,' neur o s e s ' .' D e p re sas i o n ' ,affecth, adstablepsychopathotohgayd, T h ea d v e not fa n t i d e p r e s s a n t s termusedtomean'reducfeudnctioning' brainpathotogwy,ereperiodiicnnature, introduceadfurthecromplicatioinntothe i not hemr edic ald i s c i p l icnaems ,etob e hadagenetibcasiso, ccurreidnpersons mixA. tthougEhlectroconvulTsihveerapy associatewdithmentadlepressiolnt . withcertaipnersonalittryaitsa, ndwere (ECTw)aswidelyaccepteadsatreatment wasadoptebdecausiet imptiead'physi- 'endogenou(nso' trelatetdoprecipitants).for'vitald' epressiotnh,eideaofa o l o g i c a l ' c h a n ga en ,dw a sd e f i n e ad s ' a Inr9 r7F, reupdubti shed' Mourni ng drugtreatmenfot r'reactivdeepressive conditiocnharacterizbeydasinkingofthe andMelancholiian'f,luencinmgorethan disorderrsa' ncountetor thereceived spiritsl,ackofcouragoerinitiativea,nd a generatioinnemphasizicnoggnitive wisdomofthepsychotogibcalsisto atendenctoy gloomtyhoughts(.J' astrow andintra-psychfaicctorisntheaetiology theseconditionasndtheneedforpsycho- rgor). ofdepressivdeisorderasn, dshifting l o g i c a l t r e a t m eI n t . 4 Dlscustshecontributionmadeto psychiatryby oneor USEIUL EXPRESSIONS moreofthepeoplein thephotosW. hichwasthemost importantdevelopmen?t Themost important is (probably)... ...hascontributedthe most/ leastto .. If ...had not ... Had henot ...

P s y c h i a t r y4 1 BabybluesU: p to l/aof newmotherswill experiencea short-livepderio do f tea r f ulnesasndem ot ionalabilit y startingtwo or threedaysafterbirthand lastingoneto tw o da ys.Th iissco mmonenought o ber ec ogniz abbley m i d w i f e r ys t a f f a n d[ m a y ]r e q u i r eo n l yr e a s s u r a n caen d observatiotnowardsresoul tion. - OxfordHandbookof Psychiatry Vocabulary 1 I sometimesfeelI can't adequately Verbswith prepositions the baby asI am on my own with no support. 2 Inever myselfunnecessarily things that gowrong. 3 Thebaby me for everything and sometimesit all getson top of me, but I look forward to everv dav. I get down at times and sometimesfeel a bit panicky and I don't know where it Myfriend saidyou could- me - somethingto stopmy moodfluctuations. 6 No,I can safely sayI haven't harming myselforthe baby at all. 7 Iam somanythings to doon my own that I don't know which way to turn attimes. 8I the babya lot, especiallyabout her health,but I wouldn't hurt her. 9 Wouldl s e e r n ga counsellor,do you think? Eachtime you comeacrossa verb,note the preposition Which sentencescanyou rewrite using thesewords? that is usedwith it. Are the prepositionsthe samein eachcase? EXAMPLE deal fret get something/ anything out of He wasadmitted to thepsychiatricward. rely reproach stem/ derive 1 Lookback at the readingpassageand find the Proiect prepositionswhich areusedwith theseverbs. 1 date 5 fluctuate Searchthe web for the EdinburghPostnatalDepression 2 steep 6 manifest Scale(EPDSo)r look in the OxfordHandbookof 3 derive 7 introduce Psychiatry. 4 associate Work in groups.Add a word from eachlist below to Work in groups.Discussthe significanceof eachof the completesentences1-8.Youmay haveto changethe ten items on the scale. form ofthe verb. USEFUl EXPRESSIONS A benefit blame come anha dcncnrl associatewith blamefor carefor fece distinguish nrescrihe think worry datefrom discusswith insiston stemfrom B about for from from of from / between hintat think of on with with with reactto relate to sufferfrom suspectof

42 Unit5 t#:i'!:'!,i,{ii:r\":;::,':,'^\"'\"M F r o n u mi aet l o m l\"istening* Sayingprepositions Askingaboutabnormapl erceptions k il Llsrenano completethe sentencebs elow 'l (-) flstentoadoctoraskinga 30-year-oldpatient about abnormal perception.Completethe sentences. 1I TI L^^4-rL lt^A,U,^Sl-r. L DocroR Now I want to askyou about some 2 It'sdifficult to distinguish oneday experienceswhich sometimespeoplehave 3 Ofcourse,lcare but find it difficult to talk about. 4 I'm not trying to hint 5 Sheinsisted Isthat OK? 6 I sometimesblame mvself pnrtEsr Yeah. 7 Thechild depends DocroR Haveyou everhadthe sensation (6j) Work in pairs.Checkyour answers.When you are surethe statementsarecorrect,Iisten again. 2 What happensto the pronunciation of the preposition in eachcase?Canyou copythepronunciation?Practise or that the world had becomeunreal? repeatingthe sentenceswith your partner. pArrENr It'slike...I don't know howto expiainit. It's Speaking ...I supposeit's Ilkebelng in a play somehow. That maybesoundsasif I'm going mad. DocroR Haveyou everhadthe experienceof hearing noisesor voiceswhen 3 PATIENT Yess, ometimes. Doa role-play. DOCTOR IsitOKa PATIENT Yeah,if youwant. 1 StudentA,goto page114S. tudentB,take a history DOCTOR Whendid it happen? from StudentA.Write notesasyou listen and decide PATIENT Thelasttime was a coupleof daysago. whether the patient is at risk or not. DOCTOR Weres PATIENT Yeah,it was during the day. 2 StudentB,go to page116S. tudentA,take a history DOCTOR How often hasit happened? from StudentB.Write notesasyou listen and decide PATIENT Recentlyonly onceor twice. whether the patient is at risk or not. DOCTOR Andwheredid 6 PATIENT I don't know.From someonein the room. E Workin groups.Discussthe two casesG. iveexamples from your own or colleagues'experiencbee,aring in mind confidentiality.Tryto usethe verbsand prepositionsin VocabularyandProject. z Work in groups.Checkyour answers. What other questionscouldthe doctor askabout voices?What other questionscanthe doctoraskabout tasteor smell? Do a role-playofthe scenarioabove.Taketurns taking a history. Now perform the role-playin front ofthe class.Before doing so,turn to the speakingcheckliston page117 and.asa classc. hoosea criterioneachto assestshe performance.Taketurns role-playingand giving constructivefeedback.

P s y c h i a t r y4 3 Wtiting (heeklist Describinga chart Assesysourprogressin this unit. Tick(/) the statementswhicharetrue. I Work in groups.Describethe chart below.What is your reaction to the chart?Do you identify with the opinions of the medical I canunderstandbasi cdefi ni ti onsi n groups? p s y c hi a t r y I canaskaboutaffectandmood IiJ A:J + \\rrrr:rld ia Jlaien i ircleref(!e'.!pl ol I canunderstandand usesomenew l av jJot(!lc!! O !riorCa'!riNI tJcrrt: Ierms t I canusesomenew phrasavl erbs (,fir'till'€ !fl A lledaaaidiPr is 1. I canunderstandandpronounce )\\,!ti: I ijf:frJ !rattt:!te1 preposi ti onwsi th verbs ofr Pcinte tlr oT r Keywords tmchy!emi al Nouns M e J re s o+ tl abnormapl ercepti on ll dbeten5a liils affect iiuil3ie salercsr5 o+r anxiety \\'1u!a!laarisro0ir! Trr babybl ues i .r+ I elation F o e ! n c r3 mania a rras i oitl': Irel AO 'l m e n t a ls t a t ee x am i n a t i o n mooo r!inl; &+\"' ot 'lie0cN'!; Verbs ,aO $ I benefitfrom A i r c i s lt r c o p ew i t h !3i:!!l + a .ar d e p e n do n r*I get at atr,ll't tlr!mbaiJ ,aro I get down Hllr l.rid ctx(Lle geton I ger over \\il l:lflf.13 g e t t h r o u g ht o ilterlll! al +to r I worryabout iale f! .lJrij +. 4 o *Ja1\".' . . . + a I Adjectives baI ilJ.ti I oneoSe Flyieiar on top of the world +aa al I rrl.'dr'r.tr 1.. o.+ Urefulr€fer€n(e ialIs!;or +' o la +'o OxfordHandbookof Psychiatry2nd edition, I ii i'Jarrjrrll ljr o+&r S empl eet al ,l S B N978-O-19-92f946-7 La,ilt:i5,u f! o+ TOf, ar 'lll!n rldrairilalJttrl,r! rI )a,r ir o+r^ ..aT ra Flf!aYfi fr.:rtrrer.hi ;l + ,', l', au, , ' Percenotafrgeesp0nd(elanstsiticnognditai0rdnisease I make a Iist of the most striking featuresof the chart and prepare a surnmary sentenceor overview of all the data. 3 Describethe information in the chart in your own words.Write about 100-150words.Then compareyour descriptionwith a partner. USETUL EXPRESSIONS Whilearound85per centof generapl ractitionersthink ...o, nly about45per centof ... Whereas... Whilst... a smallerproportionof / fewersecondarsychoosl tudentsconsider Moregenerapl ractitionersthan medicalacademics (approximately90per centand 75respectively)though.t.. believe/ state/ considetrhat Thepercentageof...exceeded/ surpassed/ wasgreaterthan ... a greaterproportion of generalpractitioners(approximately60%) th an. .o. r . .s. t at et h a t

44 Unit6 C h e c ku p I Describethe picturesbelow l i s t e n i n gt Pickingup the threadof what is beingsaid It canbedifficult to pickup the thread of conversations when peoplearespeakingfast and when you come into them from outsideoncethey havestarted. Q tisten to the four conversationextractsand decide what eachconversationis about. f) tisten again,and when you think you haveenough information to identify the topic of eachconversation, askfor the conversationto be stopped. 11 4 What heipedyou work out the topic of the conversation? 2 Work in groups.Discussthe questions. 4 What stoppedyou getting into the conversation immediately? 1 What is the beneflt of the young personwearing the training suit? E not knowing the topic immediately Ll the words 2 Why is it goodto encourageelderlypeopleto remain E colloquialisms active? LJ the speed Ll the voicesthemselves 3 Which picture reflectscarein a home and which I the shortwords communitv care? E listening to everyword What is the proportion of elderlypeoplein the UK and Work in groups.Poolyour answers.Then discusswhat in your own country? made it difficuit or easyfor you to understandthe conversationsand what strategiesyou used. What is the differencebetween handicapand impairment?Findthe answerin the WHO 6 Q Listento the conversationsagain.Do you classification. understandthem more?

C eri atri cs45 ln thisunit a understandi nsgi gnsandsymptoms a supporti ngadvi cew i th purposeandreason o would, usedto,get usedto, be usedto o tal ki ngaboutrehabi l i tati on o w ri ti ngan essayw i th reasons S i g n sa n d s y m p t o m s Which sentencesin 2 relateto Parkinson'sdiseaseand which to A,lzheimer'sdisease? Parkinson'asndAlzheimer's 4 Work in pairs.Taketurns eliciting a history from a 1 Lookat the pictures.Decidewhich relatesto Parkinson'sdiseaseand which to Alzheimer'sdisease woman whosehusbandpresentswith earlysignsof Parkinson'ds isease. tu Explainto a son/ daughterof a patient that their tr.eE parent hasParkinson'sdiseaseP. ointout the signsand symptoms of the diseaseR. eferthem to the Parkinson's I Work in pairs.What technicalterms arebeing DiseaseSocietyand Age Concern.[Websitesw' ww. described?If you needhelp,checkthe list below. parkinsons.org.ukand www.ageconcern.org.uk] 1 He takesshuffling stepsand he leansforward asif USEFUI EXPRXSSIONS he is trying to keepup with his feet. What he'sgot is... 2 Hehaslostinterestin everything. It'sa conditionwhere... 3 His armslook asif he is carryingsomethingheavy a mask-Iiheexpression- expressionlesfasce repetitiveactionsliketyping when he stretchesthem out. dfficulty doingfine movementslikepickingthingsup 4 He haslost all his senseof shameand keepsdoing dfficulty swallowing/ dribbles cog-wheeling-tremors imposedon rigidity embarrassingthings. pill-rolling hands- worseat rest 5 When he'srelaxing,his hand shakesasif he'srolling morning stiffness hesitatesin starting movements pills between his fi.ngerandthumb. 6 It startedoff by his missing appointmentswhen he 6 Work in pairs.Usingthe technicalterms in 2 and your own experienced, escribethe signsand symptoms of a usedto be reallypunctual and getting the wrong classicpresentationof Parkinson'sdisease. endofthe stickin conversations. 7 Hejust wandersoff on his own and doesn'tknow Project wherehe is. 8 Hetakeshis time starting off doing something. Checkthe following sourcesfor information on Alzheimer'sdisease. = wvwv.patient.co.uk a the websitefor the Alzheimer'sDiseaseSocietv q the websitefor AgeConcern -\" the OxfordHandbookof GeriatricMedicine '= respitefor the carer:wvwv.carers.org a n oh s- o g n^-i o s^ l a apatny disinhibition ^ ^-^^ rigidity marcheaupetit pas/ festinant galt bradykinesia disoiientation tremor

46 Unit6 D r . J a m ePsa r k i n s o n t755-t824 care:(n)some onwe h o look s aftera familymemberor friend on a lo ng -termb asis respite(n)relieffora carer o Languageipot Speaking would, usedto,get usedto, be usedto Work in groups.Collate the information that When we talk about repeatedactionsin the pastwhich you coliectedabout no longer existwe canuse usedto or would,They are Alzheimer'sdiseasefor generallyinterchangeableexceptusedto canrelateto Project.Makea list of continuousstateslike jobs which would cannot (unless threeto sevenpoints it meansa repeatedactionsayon a particularday):1 that ahusbandorwife usedto work at StMary'shospitalon Thursdays/ I would would beworrled about work at StMary's hospitalonThursdays. regardingtheir spouse who maybe suffering Getusedto means'becomeaccustomedto' and beused from the condition. to means'beaccustomedto'. Disrrrqq the nnccihle Underlinethe correctalternativein eachcasebelow.In somecasesboth answersmay be correct. managementof the case. 1 It'sdifficultbeing / getting usedto the new regime Work in groupsof three of looking after my husbandall day. with partnersfrom another group.Taketurns 2 I am used/ am getting usedto doing everything for taking the history from myself,soit's very distressinghaving someonelike a eachother aboutthis carerdo lt. scenario: 3 Hewould/ got usedtotakeit intohis headjustto Mr Deaconpresentswith his wife, who has wander off for no reasonwhatsoever. beensufferingmood swings,forgetting things, 4 He usedto / wouldworkinthe samehospitalasme. 5 We would spend/ got usedto spendingalot of time andwandering off on her own.Hecompares in the iibrary when we wereundergraduates. what sheusedto be like and what they would 6 I can'Iget / beusedto this night shift. On the dotogether.He is distressedby the experience. geriatricward,it's alwaysbusy. 7 He used/ 'susedto being turned everynight in his Takethe history,explainthe condition (after bed,but he'sgetting too heavyfor me to move. r^r* - +L ^t r >-L+> /-, \\d-r'L.U, L-U^U.l. r s e jt h e h u s b a n d . 8 I didn't useto / wouldn'tspendmuchtime doing uullrB exercisebut now I wish I had. Thedoctorshould explain what the diagnoslsis Work in pairs.Eachchooseonething you would do in after running sometestsand offer a leafletfrom the the past,onething you usedto do,onething you're Alzheimer'sDiseaseSocietyE. ncourageMr Deacon getting usedto now, and onething you areusedto. to think aboutrespitefor carersR. ememberto be Explainto eachother. reassuring,sympathetic,and empathetic. USEFUL EXPRESSIONS Thiscan't beeasyfor you (atall). Thismust bereallydfficult for you, but ... It's not easycomingto termswith this,but ... It'sdfficult to cometo termswith all this,but ... Nowand again,you'Ilneedsometime toyourself. Weare hereto helpyou.

C eri atr ics47 T hepo sitivefe atu reso f dem ent ia( Aunt ieKat hleens' sy ndr o m ei)n c l u d ew a n d e r i n g , aggressionfl,ightof ideasa, ndlogorrhoea: ' N otfo rhe ralistless,d ull- ey edwor dles s dec line; wit hh e r irtui ssahl,lg a b b l e , c e l e r i t y . 5heha dalwa ysb ee na talk erb, ut nowwit h herdem ent iaunl e ash e st o r r e n t so f s p e e c h. . . onetrain ofthought switchingto anotherwithout signaI or pause,rattlingacrosspoints andth rou ghj unction sa t a r at eno lis t enecr an f ollow. . .Follo w i ntgh e s e n s ei sl i k et r y i n g to tracka particular ripplein a peltingtorrenlof talk.'-AlanBennettU, ntoldStories. Reading Findwords or phraseswith the samemeaning asthe following. 1 attacksor traumas 6 involving the whole body 2 like or similar to 3 identlfyordescribe 7 nerin:fcfir A nal alva^^ : TTVL JLlVILS 5 constantor reliable Rehabilitation d e fi n etsh e i rsneri ;lvr ;rd i tcan t e d [ lc. d r ]^e^-n, S,\"u^ r+tekn^,e, yd- r ec o n S r S I e n I c e rta i n lbyeore oi the\" nosrt ew ardi ng i nthei rapproach. R ehabilit at iiosan pr o c e sosfc a re o a .tso rIh ei ohThebl acLboxoi . functionolly-basetrdeatmente, .g. re h a b i l i taticoonntai nassel ecti oonf a i m edat r es t or inogr ma x i mi z i n g thehaemogl obirneveol nryrnatrer s ^' I^r^J | - e^.V,i;^U^-e^rl L e Au-d.^S: e u ,L-^o- i l r m o n 5 e n 5 e p hy s ic aml,ent ala,n ds o c i a l i fi t i smakngthepati enbt ' eathl e ss i n te rv e n t i oncos mpri si ng: frrnrt onino | t .!ui ^ he rr s pdf or ac ut e . positiveattitude.Good w hi l ew al ki ngto thetoi l et. \"' Y'! . individualizedholisticoutcome r e h a bIiit a t l o n Iai s t sa r eo p t ir ni s t s . rev er s ibilnes ult se,.gs. e p s i sa;c u ten o n rev er s iboler par tall yre v e rs i bilnes u l ts , goolsT. heseincorporatseocial e , 9 , d r i l l J U,+i-d+Li^,^( J rr^,/vl l rd,-^n; u L- n r o n l c o r This .s n.rrtlv hp-:r rqtrthev hplipvp :(na.t< rvrv rrl hl ! l IiurlhL rro nftpn n aqn9 r q t L ! -oU-, t o r l vlLLlI p r ogr es s icvoendit i o nes.,gP. a rk i n s o n ' s a l ls h o u l dbeg ver a chanceand uJPl!LJ I I heteamconceni rateosn handi cap d i s e a s el t.i n v o l v ebs o t hr e s t o r a t i oonf p^ - \"d+ 1r, ,L r yAu^ e- - L d J' . ^5 ertLn^',e y f,-. v es e e nv e r y ' atl -etrhani rnpai rment. S neci ,r,i zreed^ah:l i ta' i ownardSare 'rd (r,,u^-r+Lt^^t o n d^^l-lt u d--lo-^d+-fpi^t- d . t o r r iL o ' e o L l c e o fr:il ;nel,-li<2hlp.l ^,l.-lp-r, p e o p r eo o nottheonl ypl aceforrehabl.fthe frrnrt or denp.rd:nn nn how much w e l lA n osi ti vaerri rr.dei ' om the rev er s ibilritryer eisi nth ep a th o l o g y , ma i nte amandotherrehabi l i tati on aboveconsi derati oanrsei npl ace R e h a b i l i t a t i oi sna na c t i v ep r o c e s s ^^+i^^+ - r t ) d-rr-)^u :r^'I.p^r-u^v. c) ^- *he tnr:-r.i,o- ntc, .- thensuccessfruel habilitatlocnantake PdLrur L- donebythepatientn, otto him/ her. tr\\ ne.' il in^( Rpr:hiliration wards pl acei n:acutew ardss,peci al iwstards (e.9s.trokeuni tso, rrhopaedwi cards ) , It ishardworkforthepatien(t akin s h o u l dharbouar nenabl i ncgul ture to t r ainingf ora m ar a th o n- )i t i sn o t w h e rethew hol eteamencourages communi tyhospi taldsa, yhospi tals, co nv ales c en(caek i nto a h o l i d aiynth e inarananrianra. ^1ri6^rS d reSSed in nrrrcinn :nr-1 rocir-lonti,:l. - , h, ,nJ m e S , sun). th e i ro w ncl othesw,i thnocatheter andthe patient'oswn home.The Rehabilitatioisnthesecrewt eaponof h:n< nn chnrlr :nd A)t nn mp)lc 2l ) alternativseitesoftenemploya roving thegeriatriciapno, orlyunderstood, tahle w th oTher natient5. rehabi l i tatitoenamw hi chmaybe-sed i n hospi taolrthecommuni ty. a n dlit t ler es pec t ebdyo th e rc l i n i c i a n s . multidisciplinarycoordinated Ma nyger iat r ic iafnese li t i sw h a t teamworkingB.ysharing oalsthe Work in groups.In your own words explain the meaning of Workin groups.Describethe rehabilitation thesephrasesfrom the text and comparethem with the rest servicesthat you havehad experienceof ofthe class. or are awareof.If none areavailable,what doyou thlnk couldbedoneto help improve l- restorationof function and adaptationto reducedfunction the quality of carefor elderlypatientsin 2 Rehabilitationis an activeprocessdoneby the patient,not hospitalsand at home? to him / her. 3 Rehabilitationis the secretweapon of the geriatrician 4 Rehabilitationwards shouldharbour an enabling culture 5 Theteam concentrateson handicaprather than impairment.

48 Unit6 OneintenpersonisovertheageofsixtyB. yzo5o, t h i sp r o p o r t i owni l lh a v ed o u b l etdo o n ei nf i v e . - KofAi nnan,formeUr NSecretarGyeneral listening2 o Languageipot Activelistening Purposeand leason Q tisten to the recording of part of a conversation between Dr Gonzalezand Mrs Day and decidewhat it Duringthe conversation between is about generally. Dr Gonzalezand Mrs Day,thedoctortries Map the consultation between the doctor and the to encouragethe patient. Number the items 1-6 asthey are mentioned patient to do exercise bythe patient. byexplainingthe purpose for doing it: a -Medication ...to help improveyour strengthandbuild up b -Painputs her off exercise your musclese, xercise Iikeswimming really c -Workmates upsether helps. d -Sleeplessnights Supporting adviceby giving reasonsand the purpose of rehabilitation treatment can help increase e -Handicap concordanceand henceindependencein patients. f -Lackofphysiotherapy 1 eU of the phrasesbelow contain purposes.Work in groups.Decidewhich sentenceendingsmatch each Work in pairs.Answer the questions. beginning. 1 Why doesn't the patient take the painkillers? a We encouragepeopleto havephysiotherapy... 2 Whyisthe concordancelow? b Wewillvisityourhome... 3 What handicap doesthe patient mention? c We aregoing to sendyou to rehabilitation... 4 What disability doesthe patient mention? d We aregoingto arrangeacarertocomeinonce a 5 How doesthe doctorseekto persuadethe patient day... aboutthe exercise? 1 to get you readyfor living on your own. Q tisten again and note two examples of active 2 tohelpwiththepain. listening by the doctor.What is the effect of this on the 3 to seehow you get on with doing things on your patient? own. 4 in order to assesshow you can copewith cooking for Taketurns role-playing the consultation between Dr Gonzalezand Mrs Day.Decidehow severethe pain is yourself. and how cooperativethe patient is.Rememberto show 5 topreventfalls. that you are listening actively at least twice during the 6 in orderto rehearsethe skillsyou needat home. consultation. 7 to seeif your home environment is suitable to return to. 8 to ensurethat it is feasible for you to leavehospital and that all possibleproblems and dangershave beenminimized. 9 to monitor how you are ableto get around on your own with the walking frame. 10 to help with washing in the morning. 1L to improvecoordination.

C eri atri cs49 Work in pairs.Rewriteat leastthree of the sentences 2 Work in pairs.Explainto eachother the benefit of each using the following constructions:sof hat (we/ you) of the items a-k. Youmay usethe following setsof andbecause. words to help you. EXAMPLE 1 get peoplebedto chair and viceversa 2 dispensetabletspatient safely Weencourage.peoplteohavephysiotherapybecauseit 3 supportwalking reducesthepain. / sothat wecanhelpyou with thepain. 4 getup stairs 5 help easepain Work in pairs.Taketurns encouragingthe patient, 6 walk about house Mrs Day,to do somephysiotherapy.Mrs Day canbe 7 callhelpproblemfall ascooperativeor uncooperativeasyou wish. Support 8 help go out street what you sayby giving reasonsand stating purposes 9 pick somethingdrop using the structuresin this section. 10 opencans 11- lean / sit onwhenyou get dizzyspells Cloto Grammar referencep 122 3 Work in groups.Describewhat aids are available for Vocabulary elderly peopleinyour country. Speciael quipment 4 Write sentencesfor items 1-11using reasonsand purposes. t Workin pairsW. hataretheseitems? USEFUL XXPRESSIONS Thepurposeof the hoist isto getpeoplefromthe bedto a chairand viceversa. Youcanusethe hoist in orderto / sothat you canget peoplefromthe bedto a chairand viceversa. Thehoistisapracticaldevicebecauseyou can useit to getpeoplefrom the bedto a chairand viceversa. [It] canhelpyouto... ...handy / convenient/ useful/ helpful slaeq/vrqluv\\ aurer; Euqparr e { qrrad e t{ xoquassoc€ p rauadouer lelradse I {Jeu aq}punor€ uro/v\\rurEIEuE 8 4redleaqe uI 4Pqr E T 4cr1sEuqprvre q (asnoqaq1ro;) per 7req e I pueq Eurdlaqe a lslor{€ e

50 Unit6 r a t i o n i n g( n )l i m i t i n gr e s o u r c e s F E R T I L I RT YA T E i r r e s p e c t i v(ea d v )r e g a r d l e s s I n Eur ope2. 1c hildr enp e rw o m a ni sc o n s i d e r etdo b et h e populationreplacemenltevel.Thesaerenationaal verages: lr eland: 1. 99 Swede n1 . 7 5 C e r m a n y1: . 3 7 C r e e c el -: . 2 9 France:1.90 UK:I.74 I t a l y1: . 3 3 Nor way : 1. 81 Net her l a n d s : 1 . 7 3S p a i n : 1 . 3 2 SourceE: urosta-t 2004fiaures Speaking Proiect Lookat the scenarioand preparenoteson your own. Work in groups.Lookat the graph below taken from the ONS(Officefor National Statistics)or www.statistics. A 70-year-oldpatient,Mr / Mrs Leeh, ad been gov.uk.What arethe implications for health careof the admitted for a hip replacementoperation.The changing demographics?Are there similar projections operationwas successfual nd he / shewants to for your own country? go home.However,he / shels not ableto go home becausehe / shehasno oneto look after him / her Expectedfurther yearsoflife at age50and65, UK andhis / her home environmentis not suitable. ye4a0rs Work in groups.Comparethe information you havegathered.Discussthe attitude ofthe patient 35 paying particular attention to the patient'sfeeiings, impairment, disability,and handicap. 25 Work in groupsof three.Copythe checkliston page117.Two studentsrole-playpersuadingthe patient to stayin the hospital andthen to moveto a rehabilitation ward.Rememberto indicatethat you arelistening activelyasthe doctor,Thethird student Iistenscarefullyto the conversationand writes down asmuch information aspossible. USEFUI EXPRESSIONS g\"'$\\ \\q\"$' b \\q^+ g^qb ,^\\ ^b n$^-\\ .b 1,^ss, as\" \",s- r,s' It's betternot ...because...is not suitablebecause ...notpractical/ suitableconvenien.t..becaus.e.. Find projectionsfor fertility rateson the ONSwebsite In orderto/ Tomake...safer/ moreconvenien/t suitable... or Eurostatand / or checkEurostatfor fertilitv ratesin Sothatwe can... the developedworld. Beforewesendyou homewe needto ...because * Thethird student givesfeedbackaboutthe consultation.Discussany inaccuratedetailsand times where it was difficult to follow the conversation. Work on your own. Learningto speakimpromptu Speaking (without preparation)is a useful skill,but requiresa Iot of practice.Tohelp you start preparing,chooseone Divide into two groups:one group debatefor and one debateagainstthe statementbelow.Spendten of the following topics.Using a stopwatch,spendtwo mlnutes preparingyour argumentsandthen debate minutes making notesto preparea short talk on any the lssueasa whole class. aspectof the items below relating to the elderly. In health-carebudgetsthere shouldbe no rationing @ pressuresores + theflu ofresourcesand everyoneshouldbetreatedequally, irrespectiveofage. * funnyturns ; hypothermia Appoint a studentto makeaIist of the main arguments 6 Work in pairs.Placeyour notessothat your partner can for and againstonthe boardor on a computer. seethem. Talk about the items you havenoted for 3-5 minutes.Yourpartner shouldtime the talk and allow Chooseanother studentto summarizethe ideasat the you to speakfor no more than five minutes. end.Takea classvote on the issue. At the endyour partner givesyou feedbackon how closelyyou followed your notes.