oxford english for careers medicine 1 teacher039s resource book

Introduction 5r In the reading sections students meet a variety of r Inthe speaking sections,tryto ensure use of Englishduring activities, particularly those involving some anyfunctional

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2006 | PDF | 113 Pagesbuihuuhanh@gmail.com

fieocher's Resource Book

OXTORD

\egplstrY PREss

l J N I V E R S I T Y P R E S S

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The author and publisher are gratefultothose whohave givenpemissiontortproducethe Jol,lc^ringextracts ond adaptattotrs of coryishttnoteri^l: p20 Excerpt frompp767fromoxfordHandbookoJC:linicalMedicine 7th Edition, edited by Longmore et al(2007) Reproduced by permission ofOxford University Press; p43 Excerptsfiom pp159 from OxfordHandbookofilinicalSpelialities 7th Edition, edited byCollier et al (2006) Reproduced by permissio/ ofOxford University Press:p101 Excerpts from pp28 from OxfordHandb(okofPsychiatry, edited by Sempleet al (2005) Reproduced by permission ofO:fford University Press.

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Introduction p.+Background, teachlng noter, tlps, and addltional actlvltler

i

I

1 Presentingcomplaints p.o2 Working in general practice p.rr3 f nstructions and procedures p.LT4 Explainingand reassuring p.zl5 Dealingwith medication p.zs5 Lifestyle p.r+

7 Parents and young children p.+r8 Communication p.+a

9 Working in psychiatry p.so10 Terminal illness and dying p.oz11 Working in a team p.oa

12 Diversityatwork p.z+

Grammar terts and communicatlon actMties

Instructions for communication activities p.ao1 Presentingcomplaints p.az

2 Working in general practice p.a+3 Instructions and procedures p.s64 Explainingand reassuring p.aa5 Dealingwith medication p.so5 Lifestyle p.sz

Grammartests key p.roo r

7 Parents and young children p.sa8 Communication p.ee

9 Working in psychiatry p.e810 Terminal illness and dying p.roo11 Working in a team p.roz

12 Diversityatwork p.ro+Symbols and abbreviations p.rro

4 l n t r o d u c t i o n

lntroduction

Medicine is aimed at preparing trained and trainee

variety of medical fields and situations, developstheir communication skills, and provides them with

medicine is unlikelyto be a doctor, and information isgiven throughout to help with medical terminology

Check up

This is designed as a warm-up activity to the unit It

to get students to focus on the topic

It's myjob

These occur regularly and are all based on authentic

to the students as they stand with only minimal tasks.Students wiII read about a variety of people in differentmedical environments and gain insight into the skillsrequired

a portfolio of other'lt's my job'features For example,if students have contact with someone who is fullyqualified and works in medicine, they can write their own'lt's my job'article or interview, with photos

Patient care

Increasingly in medicine, it is not enough to havetechnical skills, qualifications, and knowledge of the field.Doctors and nurses must also be skilled communicators -

and their family and friends - often about difficult orsensitive matters They also need to be able to conveyinstructions to patients in a sympathetic but clearway,which can be extremely demanding The Patient carefeature gives students practice in these important'softskills'

Top margin

of exploitation include asking whether your students

There are also definitions for difficult words or phraseswhich are important to understand a text which appearson the same page

Vocabulary

Students meet a large amount of vocabulary during the

from the start, for example:* organizing vocabulary into word sets and word groups

rather than simple alphabetical lists* understanding the context ofvocabulary and

whether it is a key word needed for production or forcomprehension

x checking and learning the pronunciation of a word orphrase

[anguage spot

application.If your students need revision after completing theLanguage spot, direct them to the Grammar reference,which provides a handy check

There is also one photocopiable Grammar test for each

Listening, Reading, Speaking, Writing

These activities give realistic and communicative practiceof language skills needed in medicine

situations related to medicine, including

Introduction 5

r In the reading sections students meet a variety of

r Inthe speaking sections,tryto ensure use of Englishduring activities, particularly those involving some

anyfunctional language students may need The

also provide additional, freer discussion activities.r Writing practice inthe units is designed as

consolidation and extension of the topic withstructured, meaningful writing tasks

Project

This encourages students to take an active role in the

work andthe subject of medicine itself

worth spending time in class preparing students for thetask Students are usuallyrequiredto use search enginessuch as www.google.com to find information, as well as

givenbybrainstorming some standard places where theycan gather information

Checklist

This allows students to check their own progress You maywant to get students to grade or assess how well they canperform each of the'Can do' statements, e g.'easily','withdifficulty', or'not at all' They can also test each other inpairs, by giving examples from the trnit of each of the'Cando'statements.

Keywords

These are the main items of medical vocabularyintroduced inthe unit A definition of each of these wordsappears in the Glossary You should certainly checkstudents' pronunciation, including the stress, of wordsIikelyto be used orally

Usefulleference

This section provides students with useful referencesto key medical handbooks where they canfind furtherinformation on the topics discussed in the unit

Reading bank

This is in the middle of the book and gives specific skillspractice in reading The ability to read and understandtexts in English has never been more important inmedicine than it is today with the amount of writtenlnformation available on the internet, the majority ofwhich is in English The reading texts are accompanied by

self-study or homework There is also an Answer key in the

Speaking activities

This section contains one or more parts of the informationgap activities from Speaking in the main units (seeSpeaking)

Grammar reference

This can be used together with the Language spot, as ahandy check or revision It shows the form of a particulargrammar point, briefly explains its use, and providesexample sentences as well as indicating likely studenterrors

listening scripts

This is a complete transcript of all the recordings Directstudents to it for checking answers after they havecompleted a Listening task, or allow weaker students toread it as they listen to a particular recording, perhaps forafinaltime.

Glossary

This is an alphabetical list of all the Key words Each wordis followed by the pronunciation in phonetic script, thepart of speech, and a definition in English

The section begins with a phonetic chart, with anexample word from medicine to illustrate each of thesounds

Abbreviations

A list of common medical abbreviations is included at the

6 U n i t 1

Background

Patients are vulnerable when they come into contact

doctors and nurses need to learn to ask questions in a waythat instils confidence in patients and elicits accurateinformation

of asking about the PC and probably stick to one or twoofthese The tenses that are used in the recent historyrelate primarily to the present and recent past: the Present

to be able to use these tenses effectively at a simple levelas it is for doctors to be able to understand patients whenthey use them Any misunderstanding can affect thedoctor's or nurse's ability to make the correct diagnosis.You will therefore have to balance accuracy with fluency,encouraging the latter without sacrificing the former.It is said that 80 per cent of the diagnosis comes from

investigations and so on So being able to ask simple politequestions using the word Can,beingable to ask about

personal details, and questions relating to pain are thebasic tools of any doctor or nurse

In a patient-centred approach to history-taking, whichis increasinglythe focus of history-taking inthe UK and

not the doctor In this situation, taking a history is not justabout asking the questions that a doctor or nurse feelsthey have to ask, but about relating the history to eachpatient as an individual, not as a hospital number As yourstudents go through this book, they will learn the skills tobe abie to become more patient-centred

As the first step in helping your doctors and nurses tobecome more aware of the patient and of their own

language is introduced.For your own further reading about asking questionsr e ad p 4, 5, and 22 in O xf o r d H an db o ok of C lini c aIMedicine (Murray Longmore et al.,7th edition, OUP,

for you and your students.Useful reference: Oxford Handbook of Clinical Medicine,7th edition, Longmore et aL

x Tip

situations in their own countries

information could lead to giving the wrong treatment, performing the

students to give at least one reason for each answer Follow on with an open

C / o = c o m p l a i n i n g o f

P r e s e n t i n g c o m p l a i n t s 7

El ldditional activityAsk students to ask you questions usinggentle questions and / or a mixture ofgentle and shorter questions as intheconversation in Iistening 1 Make thenames / numbers simple or difficultaccording to the level ofyour students Askthem to write dovun the details and thencompare them with a partner before youcheck the answers with the whole ciass.* Tip

Look at the Listen ing script to see whichtype ofquestions the doctor asked.E x p e r i e n c e w i l l t e l l t h e s t u d e n t s h o w t omix the more gentle and short questions.A'safe' way is to start with the more gentleo uestions a nd then mix What ? a nd shortq u e s t i o n s , e n d i n g w i t h g e n t l e C a n / B u t ita l l d e p e n d s o n th e i n d i v i d u a l !

El AdditionalactivityWith the whole class, allow the studentsa chance to take a history from you Startwith a volunteer and then choose anotherstudent to follow on

* TipYour students will need to be able to use theq uestions relating to pai n freq uently a ndaccurately To hel p them remem ber, referthem to the mnemonic SOCRATES: site,onset, cha racter, radiation, associations,timing, exacerbating and alleviatingfactors, severity Ask them to work i n pairsand do the following exercise or do it withthe whole class Say the letter 5 or'site' a ndask students to give you the a ppropriatequestion as quickly as possible Try it againa s a w a r m e r in th e n e x t le s s o n a n d th e nseveral lessons later

* TipEncourage students to learn two orthreequestions initially for the presentingc o m p l a i n t ( P C ) s o t h a t t h e y d o n o t m i xthem and make mistakes

E additionalactivityYou can use a skeleton and attachthe non-technical names for the various parts ofthe body, e.g the ribs, the skuil, the elbow,etc byway of follow-up Or ask studentsto draw an outline of the body and writethe names against each part they knowin pairs and then compare with otherstudents From this, make a masterdiagram labelled with the various parts ofthe bodv

write the answers down as they wlll use them inlanguage Spot l You can

fictitious details if thev wish

3 2 p.m.4 19733045

2 correct

5 7 9 5 36 correct

7 correct8 D r J o n e s

Language spot

Asking short and gentle questions

Students do l-l in pairs Set a time limit of 10 mlnutes for f, and encourageany early finishers to do it again.

O'r I Possibleanswers

C a n y o u t e l l m e :your family name /whatyourfamily name is?your first name(s) / what your first name is?your address /whatyour address is?when you were admitted? the dateyou were admitted?your hospital number / whatyour hospital number is?your date of birth / what your date of birth is?y o u r t e l e p h o n e n u m b e r / w h a t y o u r t e l e p h o n e n u m b e r i s ?whetheryou are married or single?

your job /whatyour job islwhatyou do for a living?t h e n a m e o f y o u r C P l w h o y o u r G P i s ?

2 a Where dolou getthe pain?b Does the pain spread anywhere else?c Does itwakeyou up at night?d Con you tell me whatthe pain is like?e Can you desoibethe pain for me?f Howlong haveyou hadthe pain?g ls there anything which makes itworse / better?h When did it start?

i ls there anything which brings it on?j lsthe pain constant?

k Hoveyou hadthe pain before?t 1 f 2 h 3 c ( d / e ) 4 i s b 6 d a n d e 7 g 8 a 9 k 1 0 j

2 Can you tell mewhat seemsto be botheringyou?3 W h a t c a n w e d o f o r y o u ?

I PossibleanswersWhat seems to be troublingyou? What's troublingyou? Whatbringsyou here? What's the problem? What's the matter? Whatcan I doforyou?

5 1 e 2 i 3 9 4 k 5 d

6 a c o l l a r b o n eb gullet

d tummy, belly

gut, bowelswrist (bone)K n e e c a p

s h i n b o n eh e e l b o n ea n k l e ( b o n e )i

jk

E

fgh

x Tip

Note American pronunciation and stress ofu m bi I icu s : /,,rmbrl'arkas/

fl AdditionalactivityPut students into groups and ask eachgroup to choose one ofthe conditionsin 1 and describe how they woulddifferentiate between this condition andsomething similar Get them to discusseach chosen condition in turn Set a timeIimit, but allow the discussion to continueif it looks as if it is developing well Trynot to interfere, and use the discussion tobuild your knowledge, which wiII increaseyour confidence Give feedback on pointslike pronunciation, tenses, questionformation, and vocabulary

x Tip

Point out to st udents that, with rega rd topain, what is considered mild by one personmay be severe for a nother There a re ma nyfactors involved in assessing pain, such asage a nd cu ltu re; so mild, severe, and veryseve re ate su bjective interpretations

&w

Pronunciation

Medical terms: word stress

O ask students to complete I in pairs, then listen to check their answers.Followonwith3

Students can do 4 in pairs The missing words are from t

follow-up, do a quick check of pronunciation by pointing to parts of the body

different types of pain They can do this by asking as many pain relatedquestions as possible or by encouraging patlents to talk about the pain

else are the most obvious ways to differentiate between types Studentsremain in pairs for 3 and 4

' l M 2 V 3 V 4 5 5 V

P r e s e n t i n g c o m p l a i n t s 9

O t r 2 1

z

34 5

T h e h i g h l y t r a i n e d t e a m Their work (the triage nurses, receptionists, etc.) is vitalto the next of kin for contact (is taken) in case of emergency the potential for confusion is great unless the data that aretaken are accurate

information is checked to make sure it is correct and thatthepatients can confirm their identity.

x Tip

Set a time lim it of 15-20 m in utes for theSpeaking exercise Allow students to discussfreely without interfering and use thediscussion to build your knowledge Avoida nswering q uestions at th is stage a ndcollect items for feed back

* TipU s e d i a g r a m s 1 - 4 t o h e l p e x p l a i n t h etenses Often the tenses overlap, but the keyp o i n t is a c h a n g e o f e m p h a s i s

x Tip

Beforeyour students start, remind themof the mnemonic SOCRATES and theq u e s t i o n s r e l a t i n g t o t h e p r e s e n t i n gc o m p l a i n t E n c o u r a g e t h e m to i n t r o d u c ethemselves clearly

* TipEncourage students to form discussiongroups outside the class to discuss theexercises in the units and to do role-playss i m i l a r t o t h e s c e n a r i o s i n th e c l a s s o r a twork lf you can, provide a place in theinstitution where they study The meetingc a n e i t h e r b e in f o r m a l a n d a t a n y t i m e o rf o r m a l a t a p a r t i c u l a r t i m e e a c h w e e k T h estudents could rotate the responsibility foro r g a n i z a t i o n

Listening 3

A presenting complaint

O C"t students to do I in pairs or small groups For 2, ask them to writenotes while listening to the recording and then compare them with apartner or in groups Let them listen again to check their notes They will

Language spot

Tenses in the presentint complaint

Ask students to match the statements and diagrams in l, then complete 2with a partner

2 t h a s b e e n h a v i n g

5 is getting / has been getting worse Look at the diagroms.The

around the presenting complaint.6 a m n o t t a k i n g

l O U n i t 1

E ndditionalactivitylJter Speaking I and 4, ask students toexplain to each other what they thinkthe diagnosis is in each case and to giveevidence from the patients' answers.Then allow a whole-class discussion atthe end aboutthe diagnosis and possibleexamples of cases - but emphasize theconfidentiality of the patient Set a timeIimit, but allow the discussion to continueif necessary

* TipDo not be afraid to allow free talking hereand do not worry about not knowingt h e m e d i c a l d e t a i l C o n c e n t r a t e o n th elanguage and pick up a few relevant detailsto feed back on Never be afraid of sayingyou don't know the answer The studentswill respectyou for it

E ndditionalactivityByway of revision, ask students in pairsto role-play one ofthe scenarios fromthe unit again Ask them to concentrateon their own and the patient's bodylanguage Ifyou have access to a camera,video some of the role-plays and playthem back with and without the sound;concentrate on the body language only.You may find the students will want to dothe role-play again

E ndditionalactivityYou can turn the internet research into aproject by putting students into groupsand asking them in the class or at home tocollect information Ask for volunteers topresent the information to the class withor without visuals

E AdditionalactivityAs a quick check ofyour students'abilitytomake questions, ask them in pairs or as aclass to make a verbal list of the questionsasked, using the text in l,4/riting l

Speaking

* Ask students to work in pairs for I and 2 In 2, questions relating to painneed to be asked for both notes, as well as questions relating to general,family, and social history and to diet and drinking habits Students remainln pairs for 3 and 4

feed back at the beginning of the next lesson by way of revision

2 l t i s a n a p p r o a c h w h i c h m e a n s t h a t t h e d o c t o r n e e d s t o d e a l

Writing

A case report

Students do I and 2 alone or in pairs

On examination, he was sweaty, but no abnormalities were found inthe cardiovascular or respiratory systems His blood pressure was138 /82 and his pulse ratewas 110/ min regular Hewas given

analgesia and streptokinase intravenouslyand his beta blockers werecontinued His pain settled and aftertwodays he beganto mobilize.

pronunciation and understanding Remind students to transfer useful

U n i t 2 1 1

, 1

.rrir.l;1u t ::i,r::lii l{ll ,iti

,];ru .,iri

Background

Inthe UK, private health care provision exists,but mostpeople are treatedwithinthe National Health Service(NHS),which provides free health care Primary carewithin the NHS is provided by general practitioners (GPs)

care is provided by hospitals The general doctors who

theUK.)

increasingly rare as many now work in teams with other

nurses, and midwives

need specialist attention or tests to a hospital General

Although 80% of patients have seen their GP within theIast year, only 137" arereferred for hospital care In order to

illness itsell taking account of personality, familypatterns, and the effect ofthese on the presentation ofsymptoms

organisms as affected by their environments) of healthand illness within communities and the culturaldeterminants of health beliefs

r be able to draw on a far wider range of resources thanare taught in medical school, including intuition,knowledge of medicine, communication skills, businessskills, and human empathy

There are three commonly-used definitions of generalpractice covering many of the points in the list above:

For further information on these see p.3 of the Oxford

edition, OUB 2006) and for more general background on thework of GPs inthe UK see pp.1-98 of the same publication.Useful referencet Oxford Handbook of General Practice,2nd edition Simon et al

E additionalactivity

do?

* TipAsk students to compare proceduresbetween cou ntries they have knowledgeof For example, here they could discuss therelativefunctions of medical oersonnel inhospitals / clinics in their own cou ntries

O f , l l f 2 a 3 9 4 d 5 e 6 b 7 c2 1 practice manager 5 practice nurse

2 Healthvisitors 6 midwife3 Receptionists 7 Districtnurses4 general practitioner

1 2 U n i t 2

* TipCeneral l'd3enaral/ is often pronounced asa two-syllable word: /'dSenral/ Note alsothe difference in emphasis between districtnurse and practice nurse

E additionalactivityEncourage students to ask each otherquestions andto develop the conversationby explaining, giving reasons and

examples Time limits exercises like this,but allow some freedom for them todevelop Let students ask you questions- but you don't have to reveal the truthabout yourself

Pronunciation I

Main stress

O tn l, ask students to listen and identify the main stress

the team would not work without everybody performing their respectivetasks!

4 mlelwife (o.)

5 district nurse {' o)6 health visitor (O'r)7 gggtice nurse (o )

listening I

AGP's job

the whole class

Language spot

Present Perfect and Past Simple

Students can do I on their own and compare their answers wlth a partner orwork in pairs

andWhat etg giving as full answers as they can Then ask them to makea list of questions for 3 You could then create a master list which the wholeclass can refer to when doing the role play in 4

3 H a s a n y t h i n g m a d e it w o r s e s i n c e i t s t a r t e d ?4 H e h a s n e v e r t a k e n a n y m e d i c a t i o n i n h i s li f e 5 W h a t h a p p e n e d w h e n y o u w e r e n e a r a n i m a l s a s a c h i l d ?

you are aware?

Speaking

W o r k i n g i n g e n e r a l p r a c t i c e 1 3

1 19112 1948

Student B:4 4 2 , 0 0 0 1 2 5 0 m i l l i o n 4 1 45 10.500 2 15 5 786 quarter 3 2000 6 40

E ndditionalactivityAsks your students to researchinformation about asthma, COPD, andpulmonary oedema the day before youdo Listening 2 in class Give them thereferences for the Oxford Handbookslisted in the answer key to listening 2,exercise 3, or ask them to search on theintemet

* TipAppoint someone from each group to feedback their a nswers to the whole class

Students need to be careful when they aska b o u t s e r i o u s i l l n e s s e s l i k e m a l i g n a n c y(cancer) because the patient may thenth i nk they a re suffering from this SeeOHCM7,p.22

x Tip

Be prepared for disagreement and allowit to ha ppen Ask students to check theiranswers in a medicaltextbook if necessary,e.g one ofthe Oxford Handbooks

A case history

l Use this as an opportunity to bulld your own knowledge Then play therecording for 2 so students can complete the notes

feed back to the class

p a s t ? H a s a n y o n e i n y o u r f a m i l y h a d a n y t h i n g l i k e t h i s ?

Vocabulary

Signs and symptoms

Ask students to do I and 2 in pairs A sign is an indication of particular

and give feedback about grammar and pronunciation To help expand yourknowledge, ask the class to explain the answers to you afterwards.Students write answers for 3 on their onm, and compare in pairs

Or I Condition a: Condition b:

1 Symptom 1 Symptom2 Sign/Symptom 2 Sign3 Sign/Symptom 3 Symptom4 Symptom 4 Symptom5 Symptom 5 Sign

Condition c:1 Sign2 Symptom3 Sign4 Sign5 Symptom2 a s i n u s i t i s

6 Sign/Symptomb asthma c gastroenteritis.(See OHFP 2forfurther detoils on eoch of these conditions.)

1 4 U n i t 2

rc Tipf l a t u s = breakingwindpp = psr rectumLIF = left iliacfossasats = oxySen saturation

* Tip(weaker students)Allow students to read the Listening scriptf rom Listening 2 or practise reading it aloud.El additionalactivity

Encourage students to keep a list oftechnical words and their non-technicalequivalents You could create a master liston a computer, which the whole class addsto periodically as a revision exercise Everytime you update it, an electronic or paperversion can be given to each student.* Tip

Point out non-technical equivalents oftechnical words and purely medical wordseach timeyou come across them.* Tip

4 = increasedPSPB = peak expiratoryflow rateFBC = full blood count

U&E = urea and electrolytesCRP = C-reactive proteinABC = arterial blood gasWCC = white cell count

I a) Diverticulardisease:5ymptoms: abdominal pain cramps (usuallyleft-sided, improves with bowelopening) irregular bowel habit,flatus, bloating, PR bleeding Signs: increased temperature, increasedpu lse, + decreased BB LIF tenderness, + periton itis, d istension.(See OHFP 2for more information obout this disease.)

b) Pneumonia : Symptoms: cough, increased sputum (green), pleuriticchest pain, breathless, haemoptysis, fever, unwell, confusion Srgns;Increased temperature, increased RR, increased pulse, decreasedsats, unequal air entry, bronchial breathing, dull percussion, reducedexpansion.

I

a

7 stickto8 admitted9 booked

OF | 1 lsyourappetiteokT

2 Bowels OK?

3 Waterworks OK?4 Sleeping OK?

Speaking

Ask students to work in pairs to do the role-play in IPut students in groups for 2 and 3 Ask them to make a master list of gentleand short questions for 2 to feed back to the class Set a time limit and askone person to be responsible for ensuring the questions are written down.A different student can give feedback to the whole class.

a CT scan, but rarely necessaryb PEFR, sputum culture, FBC, U&E,CRB blood cultures, ABG analysisc ,IWCC, 4CRB stoolcultures, and possibly an abdominal X-ray

Vocabulary

Non-technical language

in pairs for 2 and 3 Listento as many pairs as you can and give feedback onquestion formation

O F l l s t a r t 2 p r e c i p i t a t e2 1 d o 4 o r o n e

2 h a s g o t 5 c o m e s a n d g o e s3 a v o i d 6 t h e r e a l l t h e t i m e

Listening 3

Short questions in the general history

6) Ask students to listen and write down the questions

E ldditionalactivityAsk students to work in pairs and take ahistoryfrom each other about pneumoniaor another condition oftheir choice.If you can, video one or more of theconversations and playthem back to thestudents If this is the first time you use avideo with your students, be positive ingiving feedback Allow students to feedback about themselves first.

E ldditionalactivityCheck at the end ofthe class thatstudents can make short questions asautomatically as possibie Ask them tolisten out for examples of short questionson TV / radio, etc Point out that they areused in all types of communication Youcan begin your subsequent checking with:Foundany?

rc TipIn some class discussions, you may want tomake the d iscussion as free as oossible andnot provide feedback at the end

* Tip

Socia I class I refers to people withprofessiona I occupations, e.g doctors,cha rtered accountants, engi neers Socia Iclass ll refers to people with manageria Ior technical occupations, e.g managers,journalists, school teachers.

Or | 1 Areyou/ Haveyou been eatingwell?

2 lsyour appetite OK/ Hasyour appetite been OK?3 Areyou/ Haveyou been sleeping OK?

4 Areyou/ Haveyou been passing water a lot?5 Areyour periods/ Haveyour periods been OK?6 H a v e y o u h a d a n y d i a r r h o e a ?

7 Haveyou lost any weight?8 Haveyou been livingthere long?9 Haveyou been keepingwellT10 Areyou/ haveyou been OK inyourself?

11 Areyou/ haveyou been lookingafteryourself?

Questions: rising and falling intonation

6) llay the recording in 2 Let students compare their answers with apartner before listening again They can stay in these pairs for 3, reading thequestions from the listening script to each other

Reading

Students do I in pairs For 2, ask them to the scan the text individually for

questions in lwith a partner

I

*

l 5 U n i t 2

4 Possible answers:Poor d iet a nd stress i ncrease the risk of corona ry vascu la r diseasesand cancers Those who are unemployed or underthe threatof unemployment may not be able to afford to eat properly or maybe suffering high levels of stress d ue to uncertainty a bout theirfuture, therefore are more likely to suffer from these diseases.Violence and accidents may occur for various reasons like frustrationand anger as a result of work loss One study showed that aftertheannouncement of a factory closure, CP consultation rates increasedby 2O%and referral ratesby 6O%.(See OHGP2, p.223)

Writing

A referral letter

Ask students to work in pairs to read the letter and complete I to 5

done in class or as homework

factors

I has complained - Present Perfect

has also complained -Present Perfecthave also increased* Present Perfect

Proiect

I can be done in class or as homework, individually, in pairs, or in groups.To help structure the activity, make sure students understand they will

to compete to see who finds the information first Then use 2 as an

Checklist, Key words

pronunciation and understanding Remind students to transfer useful

U n i t 3 1 7

Background

instructions about how to perform a wide range of

and use the imperative form of the verb Insert the needle

impolite here, as each command forms a step which is

The person receiving the instruction wiil perhaps pass on

part of revising a procedure

patient-centred environment, it is essential to take amore gentle and more indirect approach to fit in with the

important when people are feeling vulnerable and

instruction which for someone else may seem rude If adoctor keeps repeating Canyou / Couldyou without anyvariation it can end up sounding rather artificial and

another can seem strange Students need to learn that it isthe meaning that they need to translate, not the words

* Tiplfyou think it betterto concentrate on thestudents' best experiences, then encouragethis However, it is important for studentst o t a l k a b o u t d i f f i c u l t s i t u a t i o n s a n d c a s e sso that they can learn from them Theym i g h t fi n d s o m e b o d y i n t h e i r g r o u p w h of a c e d a s i m i l a r p r o b l e m l t i s a l s o i m p o r t a n tf o r p e r s o n a l d e v e l o p m e n t , a s w e l l a s in jo binterviews, to review difficult situationsthey have dealt with

2 a A n e w l y - q u a l i f i e d / j u n i o r d o c t o r i s a s k i n g a p a t i e n t t o g e t

d A n e w l y - q u a l i f i e d / j u n i o r d o c t o r i s ta l k i n g w i t h a c o n s u l t a n t

a s k e d t h e j u n i o r d o c t o r q u e s t i o n s a b o u t t h e p a t i e n t s a n d th e n

1 8 U n i t 3

E ldditionalactivityYou can ask groups to prepare a list oftips,on paper or on a computer, and then rankthem in order ofimportance Each groupcan then present the information to thewhole class and compare their rankings.Invite students to give examples fromtheir own experience

El additional activityTo encourage the inclusion ofintroductions in procedures, wheneveryou do a role-play, always ask students tointroduce themselves and give their titleand position in greetings: Good afternoon,Mrs [ ], my name is , and I'm

* Tip

CSF = cerebrosDinal fluidE additionalactivityAsk students in pairs to take turns sayingthe verbs to each other and eliciting thecomplete instructions Use this exercise tocheck vocabularv with the whole class

Preparing for the first ward round

have found useful themselves or wish they'd been given, or any they might

examples where possible.6) Students can do 3 on their own, then compare their answers with a

given

c refertothem quickly

3 All necessaryequipment needsto be present A missinginstrument in the middle of a procedure may cause problems,2 Possible answers

Explain the procedure to the patient simply and clearly.Explain why it is necessary

Explain what the proced u re will be like for the patient.Think about previous successful procedures you have done.Prepare the procedure by thinking through each step and use thisprocess to check though the equipment.

Decide whether vou need an assistant.

Vocabulary

Instructions for a procedure

listening I

b Drain d Wash

e Obtain g Preparef Sterilize h Attach2 The instructions relate to the first stages of a lumbar puncture (For

the full set of instructions, see OHCMT pp.756-7.)

E additionalactivityFor homework, ask students to choosetheir own procedure to explain step bystep If possible, they could do this inpairs or groups Ask them to presenttheir procedure to the class at thefollowing lesson Allow 5-10 minutes forpresentation and 5 minutes for feedbackand discussion.

E additionalactivityAs an alternative to asking a studenttotalk through the set of instructions, askfor volunteers to do it in front ofthe classor for a student to do it with you Invitefeedback first from the student or fromthe volunteers themselves; then ask theclass and then give your own feedback.Ifyou then have other volunteers, allowseveral to do it Always encourageconstructive feedback

* Tip

Allow about 15 minutes forthe discussion.Setting a time limit encourages studentsto focus and organize their discussion lta lso hel ps you to orga n ize and control theclassroom activities

El additionalactivity

Ask students to use the notes madefrom their discussion to write r5o wordsexplaining the notes taken This can be aclass or homework activity

Language spot

Giving instructions

Go through the introduction as a class Ask students to work in groups orpairs to do I using the imperative, and 2 using the present simple with You.Invite students to suggest other linking words: then, before, after, when

Put students in small groups for 3 They can write down the instructionstogether, or they can prepare the list verbally, then write it dornm on theirown, and compare with each other You can check students are using thecorrect language without needingto knowwhatthese steps are (The OHFPgivesfull descriptions of both IM injections and ABG.)

Speaking

explain the procedure in 2 Allow students to look at the vocabulary the

diagram only.Students could be encouraged to think about 3 for homework Put theminto groups of three orfourto discuss.Allow about 15 minutes One group

time warning after 10 minutes Make sure you vary the note-taker and thegroup members each time you do this type of activity Set a time limit forfeedback

e Massage between fingers, right palm over back of left hand, left

h Rinsethoroughly.i Dry hands thoroughly using a papertowel

Reading

Ask students to do I in pairs Then for 2 they talk briefly about how the verband noun pairs might relate to the text This will help them to predict partsofthe text and develop the general gist before reading They can then do I

Put students in groups for 4 Either follow the procedure for group

where a student volunteer writes the notes on the board When you havefinished, ask several students to volunteer to summarize the notes taken

2 0 U n i t l

O; | 1 providefeedback

2 undertake procedures3 assess competence4 identify strengths3 1 v a r i o u s

2 solely3 created4 expected

5 a d m i n i s t e r m e d i c a t i o n s6 s e e k h e l p

7 consider feelings5 very

6 may7 considered

rc TipAsk for a volunteer to type up a masterl i s t o f in s t r u c t i o n s t o s h a r e w i t h h i s / hercolleagues Choose a different student;:::J'."

r, ask for volunteers to type upE additionalactivity

Collect photographs of differentprocedures or ask students to collect themfor you Use them for group discussion /pairwork / randomtesting / class

E ldditionalactivityBefore playing the recording, studentscan use the illustrations to give their owninstructions (without referring to theListening script)

x Tip

lf you have access to a clinical dummy, askstudents to use it for role-play

El additionalactivity

patient for a lumbar puncture or primarysurvey

Speaking

partners and take turns explaining the procedure

Airwav

B r e a t h i n g

listening 2

Giving instructions

O Students can do I and 2 on their own, then form pairs to do l Elicit theanswer to 4 Then put students in pairs or groups for 5 and 6 Remind themto use polite requests.

O r l a 4 b 7 c 2 d 3 e 5 f 6 g l4 l V c a n n u l a t i o n

5 PossibleanswersCanyou sit in an upright position for me? That's fine.Can you lie down flatfor me?

Now I'd like you to roll up your right sleeve above the elbow OK,t h a n k y o u

lU li ke you to ra ise you r el bow - that's it (to a pply the tou rn iq uet)Can you liftyour arm for a second for me? (to put a paper towelunderneath to collect any blood spills)I hank you.

And just stretch out your a rm a nd relax Tha n k you.Just relax and keep nice and stillfor me, ifyou can.Can you clench and unclench your fist for me?Can you waitfor a second while I get a senior colleague? (if theconnula can't be inserted).

(See 1HCMI pp.748*9)

* TipSet a time limit of about an hou r for thewhole activity, but be flexible.6o roundh e l p i n g 5 t u d e n t s a n d g i v e a t i m e r e m i n d e revery 10 minutes to encourage them toorga nize themselves.

* TipRemind students about confidentiality anda n o n y m i t y a t a l l t i m e s w h e n ta l k i n g a b o u tparticular cases

* TipEncourage students to review theirpreparation and presentation and keep alog ofany significant points Ask studentsto review each other lfyou have a videocamera, record the presentations, play back,a n d d i s c u s s

l n s t r u c t i o n s a n d o r o c e d u r e s 2 1

language spot

Making polite requests to patients

Read through the introduction as a class Students then do I and 2 in pairs.O r I c a n d g a r e i n a p p r o p r i a t e a s t h e y a r e v e r y a b r u p t

2 Possible answers1 Canyou just pop behind the screen 2 so if you could turn ontoyour stomach (for me), (please) (Thank

you)'3 Just cough for me.4 l d l i k e y o u t o s t a n d u p f o r m e 5 Could you (just)tiltyour head 6 C a n y o u m a k e a ti g h t f i s t 7 l d l i k e y o u t o k e e p n i c e a n d s t i l l

6 the consultants' rounds7 t h e j u n i o r d o c t o r

Speaking

Ask students to work in groups for l Get a student from each group to give

presentation'.)

For 3 and 4, each student presents the case history he/she has preparedto a partner in another group, who takes notes while listening Again,

factors such as organization, clarity, and fluency

2 2 U n i t 3

tr TipFBC =full blood countepistaxis = nose bleed

Wdting

Case notes

r For t, students discuss in pairs what each note means and what thepatient's condition is Check that students understand the underlined itemsin 2 Then get themto do 3 on their own

Ward Roundroad traffic accident 1 rsad traffic collisionObservation(s)

temperatureblood pressureon examinationinternationa I normalized ratioliver function test

urea and electrolyteshome

tomorrow(O/P in 6/52) Out-patient in 6weeksO r I W R

RTA/ RTCObs

(r)

B P

olE

I N RLFTU+E(H)mane

Che*list, Key words

pronunciation and understanding Remind students to transfer useful

U n i t 4 2 3

Background

Your students may be used to listening to proceduresbeing describedto them but maynot be familiarwithdescribing procedures themselves, as they may have to dointeaching settings Theymaybe even less familiarwithexplaining procedures to patients.

The language used in explaining procedures to patients isvery different from that used when one health professionalis explaining somethingto another.The most obviousdifference that comes to mind is in vocabulary -the useof layterms instead of sub-technicalwords andtechnicalwords that are pure"medical terminology Sub-technicalwords are words like visua lize,insert,attach, etc., i.e wordsthat are technical, but which may be found in other non-medicaltechnical fields such as chemistry or engineering.Medical terminology also consists of technical words lilce

diverticulitis, g astroscope, anaesthesia, etc., which are wordsthat you would expect to find only in a medical setting.

When talking to patients, it is not just the vocabularywhich is different, but also the grammatical structuresthat are used Before a patient signs a consent form orgives verbal consent, he or she needs to understand clearlywhatis goingto be done Usingbe going toimpliesthatthe intention is to carry out the procedure, but it dependson the patient giving written or verbal consent.

Another feature of explaining procedures to patients isstructures such as What we are going to do next is to /What happens next is we These encourage students touse simple language and help to avoid using the passive.Some procedures,like colonoscopy or colposcopt involvetalking about intimate areas of the body Medical studentsshould not be embarrassed, so it is important that you arenot embarrassed either.

Useful referencet Oxford Handbook of Clinical Medicine,7th edition,longmore et al.

E additionalactivityAs a whole-class activity, ask students todiscuss the similarities and differencesin procedures such as gastroscopy intheir own countries.Is the equipmentdifferent? Who carries out the procedures?tr Tip

patient

rc Tip

r Elicit the answer to I from the class Then put students in pairs to do 2 Forquestions 1-3 of 2, encourage students to think about the patient's physicaland emotional reaction compared to their onm For question 4, encouragestudents to talk about procedures they have done Remind them that notonly is this good language practice, but also good practice for job interviews,where they need to be able to give specific examples of their own ratherthan an example from atextbook.

Put students in groups of three to discuss 5 The instruments are aproctoscope /irrokteskaup/, a colposcope /kolpeskeop/, and a bronchoscope/bro4keskeop/; checkthe pronunciation as students are talking.

aa

2 4 U n i t 4

El ldditional activityGet students in groups to list as manywords as possible withthe suffixes 1-4fromPronunciation l Write their answerson the board, and ask students to explainto you what each procedure or item is.Ask for a volunteer to type up a masterlist for the whole class Examples mightinclude appen dectomy, tonsillectomy,lump e ct omy, n e p hr e ct omy, m a st e ct o my,Iap ar ot o my, lap ar o s co py, tr a che oto my,ile e ctomy I iliektemil, ile ostomy, ile oto my,hy st e ro s c o py, hy st e r e ct o my

x Tip

Before the lesson, collect pictures ofthel a t e s t i n s t r u m e n t s a n d /orold instrumentsor ask students each to bring in a picture.Get students to discuss them and decidewhat they are / were used for

x Tip

For a wea ker class, stop the record ing aftereach piece ofadvice and allow studentsto compare notes Then play the wholerecording straight through once again.Alternatively, playthe recording and askstudents to dictate notes toyou to write onthe boa rd Avoid correcting the a nswers att h i s s t a g e A n o t h e r w a y t o d o t h i s is t o w r i t et h e a n s w e r s o n th e b o a r d , b u t a d d i n g i nsome m istakes (e.g n u m ber 1: stop anti-acidtherapyforthree weeks) and ask students tolisten and correct

tl additional activityAsk students in groups to make similarstatements about one ofthe procedurescarried out with the instruments in thepictures you brought in for Pronunciation6 Don't let them write the statementsdor,rrn: instead, ask for them to be writtenoutforhomework

E ldditionalactivityWhen students have done Ia nguage spot3-7, ask them to tell you the verbs used inorder List them vertically on the board,then ask students to make a completesentence for each verb without referringto the book

Language spot

Expf aining investigations I procedures with the PresentPassive

Go through the introduction as a class if students have not already read it

Put students in pairs for 2 They can then do 3 on their own before pairingup again for 4 and 5 Don't let them write the answers down for 4 so theyhave to think about the answers for 5

Students can do 6 onthelr own,then compare with a partner They remainin pairs for 7 They may want to add to or expand the steps in the procedure

t r a i n i n g 7 T h e v e i n i s t a p p e d ( b y t h e d o c t o r )

l n s e n t e n c e s I ,3,4,5,and 7 th e a g e n t is le f t o u t w h e n e x p l a i n i n g a

I 1 consent/obtained2 anaesthetized3 sedated4 e n d o s c o p e f a d v a n c e d4 1 Obtain informedconsent

2 Anaesthetizethe pharynx usinga spray.3 Sedatethe patientto induce drowsiness.4 Introducethe endoscope and advance itfurther down

5 a i r l b l o w n6 p a t i e n t / g i v e n7 swallow/section

E x p l a i n i n g a n d re a s s u r i n g 2 5

S ldditionalactivityGive students the lay terms for parts ofthe body, and ask them to give you themedical name Ask students to writethese medical names on pieces of paperand take turns sticking them on to askeleton Then ask them to write the layterms onto the labels (or supply themyourself if necessary) Make sure studentsdistingulsh between fingers and toes Ifyou don't have a skeleton, you could use arough outline onthe board or a large sheetof paper Ask for a volunteer to collate thelist and type it up for the whole class.* Tip

A gastroscopy is a type ofendoscopy.* Tip

Allow weaker students to readthe Listeningscnpttogether before they do l

E add:tionalactivityTake one ofthe sentences 1-8, for exampleWe're just going to take somefluidfromyour backbone Write the sentence on theboard and say it withthe main stress ondifferent words: j ust, fluid, your, b ackbone.Ask students to identifythe main stressand give you the meaning in each case.Once they are familiar with this, askthem to work in groups to vwite theirown sentences using words like simple,or other reassuring words Go roundchecking the sentences Ask them to workwith a partner from another group andsay their sentences to each other Thepartner says the word which is beingstressed and explains the meaning

Listening 2

Explaining gastroscopy (endoscopy)

O Students listen and do I and 2 For 2, the lay words may be phrasesrather than a single word You may need to play the recording again Theycan then do 3-5 in oairs

8 hardly + [31s1y

7 pleasant8 anything

I o : flexible, biopsy, sedative, visualize4 'l We're goingto do something called a gastroscopy.

2 W h a t w e a r e g o i n g t o d o i s t o h a v e a l o o k a t y o u r g u l l e t a n d y o u rstomach to see what's going on there.

3 First, we're goingto giveyou somethingto helpyou relax.4 W e a r e g o i n g t o p a s s a b e n d y t u b e , w h i c h i s n o t h i c k e r t h a n y o u r

little finger, down through your throat into your stomach.5 The tube will have a tiny camera on the end so that we can look

at you r stomach.6 We're also going to blow some air intoyour stomach to help us

see a bit better7 l f w e s e e a n y t h i n g , w h a t w e c a n d o is t a k e a t i n y t i s s u e s a m p l e

Vocabulary

Reassuring

answers in t, for example, how would each statement make the patient feel,how could it have been said differentlv?

2 1 simple *straightforward2 s o m e - a l i t t l e

3 slightlY

listening 3

Emphasis

explaining detail in such situations They remain in their pairs for 3

O.r I l simple 3 just5 ten

6 only2 just4 tiny

7 look at8 belch9 see

The doctor emphasizes the words to reassure the patient.

2 5 U n i t 4

E ldditionalactivityIn groups, ask students to write anothersentence describing a different part ofeach procedure in 2, beginningWhat This can be set as homework

E ldditionalactivityUsingtheir own knowledge, ask groupsof students to prepare a brieftalk lastingno more than five minutes on any aspectofone ofthe procedures in 2 They shouldappoint someone to lead the discussionand someone to take notes Give themabout 15 minutes to prepare Then askeach group to present their talk to theclass Allow questions and commentsaft er each presentation

* TipERCP = endoscopic retrogradecholangiopancreatography/ke,lrendSieo,pagkridtng refi /

* Tip

In role-play practice, remind students toseek consent where necessarv

Language spot

Explaining plocedures with be going to future

Read the introduction as a class before students do l, either on their own orin pairs, taking turns to say a sentence for their partner to transform Putthem in pairs to do 2.

O.r I 1 We're going to remove a tiny piece of tissue from your bowel.

2 Whatwe're goingto dothen is attach the end ofthe gutto ano p e n i n g i n y o u r t u m m y w a l l

3 We're goi ng to ta ke a ti ny piece of tissue from the neck of your wom b.4 What we're goingto do afterthat is (to) passthistubethrough

the urethra.5 What we're going to do then is (to) remove the glands i n you r a rm pit.6 What happens next is that a tiny piece ofyour lung is removed ,/

What we are goingto do next is (to) remove a tiny piece ofyour lung.7 W h a t h a p p e n s n e x t i s a t u b e i s t h e n p a s s e d d o w n / W h a t w e a r e

going to do next is to pass a tube down past the prostate intoyour bladder.

8 What happens next isthatwe/Whatwe are goingtodo next is(to) inject a dye into the pancreatic and bile ducts so that we cansee them.

9 We're goingto use a mesh to repairthe muscle.2 a 7 b 5 c 2 d 1 e 3 f 8 g h 6 i 9 -

Speaking

Students work in pairs for 3, taking turns asking questions about theconditions in 2, and answering using the explanations they have devised.They can remain in pairs to do 4 or you could do it as a whole class

it has to be removed

take a sample if necessary

E x p l a i n i n g a n d r e a s s u r i n g 2 7

6 anaesthesia: it's a procedure whereyou are given ageneral anaesthetic to putyou to sleep before an operation andthen you come round after it is over.

{ Informed consent is given afterthe patient has been made aware ofwhat is goingto happen and why lmplied consent is not explicitlystated but clear from the patient's actions, for example, if thepatient offers you their arm when you are about to take blood.Expressed verbal consent is when information about a procedure isexplained and the patient verbally agrees to have it done Expressedwritten consent is when an extensive explanation is given and thepatient and the doctor both sign a consent form Consultantconsent is given bytwo senior doctors where a patient lackscapacityto consentthemselves, for example in cases of severem e n t a l i l l n e s s

(Fo r fu rther i nform ation, see OHCMT pp.554- 5.)

x Tip

A good introduction to any reading exercisecan be to get students to predict thecontent ofthe text from titles, headings,pictu res etc.

E additionalactivityAt the end ofthis section, ask students inpairs to take turns selecting a procedureand describing the possible complicationsto a patient Ask them to describe two orthree procedures each

5 always6 sometimes

Reading

Students can do 2 on their own, then form pairs for 3 and 4 Thev should do4 with books closed

4 What doyou need afterthe operation?

6 What do some people have afterwards?

Vocabulary

Explaining complications and leassuring the patient

Students can do I and 2 in pairs

Discussing com plications

O Students can do t in pairs They listen and do 2-4 on their own PIay the

2 8 U n i t 4

* Tip

lf students need prompting for l, refer themto the last section ofthe Readi ng text onp.33

* TipW h i l e s t u d e n t s a r e t a l k i n g a b o u t m e d i c a lm a t t e r s , l i s t e n a n d u s e t h i s a s a l e a r n i n gopportu n ity to bu ild you r understa nd ing oft h e s u b i e c t

S ldditionalactivityCollect a range of pictures showingdifferent emotions to bring to the class.Put the students into groups and giveeach group two or three different pictures.Ask them to discuss the emotions beingshown and how they would deal withthem Ask the groups to present theirpictures to the ciass and describe howthey would deal with each situation Askthem to taik about visual cues in theirown cultures / countries

E ldditionalactivityYou can ask students to explain thecomplications to you in lay terms.* Tip

l f s t u d e n t s a r e re l u c t a n t t o ' a c t a o a r t ' i nrole-plays, remind them that it is bettertooractise now and make mistakes on eacho t h e r t h a n o n a r e a l p a t i e n t !

2 you mayfeel a bittired afterwards

Speaking

pairs to do 4.O r l a l b 6 c l d 2 e 5 f 4

Proiect

You can suggest students use other websites they know of and suggest

class using some of the language learnt in this unit, as if explaining the

Checklist, Key words

pronunciation and understanding Remind students to transfer useful

U n i t 5 2 9

Background

The administration of drugs requires attention on a

about the dosage (for children and adults) and the

should be given a drug and whetherthey have any

they are unfamiliar with them.Another important aspect of drug treatment is

nurse to prescribe a medicatlon, and another thing for thepatient to comply with the advice given The first factorwhich has a bearing on compliance is the way in whichthe doctor presents the benefits and side effects of anymedication to the patient

Explanations about benefits and side effects have tobe finely balanced so that the patient can make aninformed choice about whether or not they will takethe medication If patients understand the benefits tothemselves without being frightened offby the side

So it is crucial for doctors to know how to communicateeffectively in this area

whether a patient will comply with a prescription, suchas the patient's situation or ability to follow a regimen

administering medication, so any mistakes (or potential

S l d d i t i o n a l a c t i v i t yCheck the pronunciation and stress ofthemedications;

a paracetamol /pcrr si:telnol/b qyclizine /'sarklrzi:nrc salbutamol/siel'bju:tanrnl/d aspirin/'iesprrn/

e amoxiciliin /a,moksr'srlrn/f ranitidine /rr'nrtrdi:n/g chlorphenamine /kb:'fenemi:n/h diazepam/dar'ezapem/Or the categories:

1 antibiotic/,&ntibar'otrk/2 a n a l g e s i c , a e n e l ' d 3 i : z r k3 antiemetic/,anti:e'metrk/4 sedatlve /'sedatrv/, hypnotic /hrp'notrk/5 gastroin!99tinal /,grstraorn'testrnl/6 antih:igtamine /,tenti:'hrstami:n/7 cardiov4gcular /,ko:diaii'veskjala/8 respiratory/'resprrtri, res'prratri/E n d d i t i o n a l a c t i v i t y

Divide the class into two groups and turnthe discussion on generic forms of drugsinto a debate, for and against

d i s c u s s l a s a c l a s s

drug manufacturers; cost of researching drugs could lead to increased cost

detriments to poor / wealthy countries

2 a r e l i e v e p a i n

c w i d e n t h e b r o n c h i

hel p prevent heart attackse fight infection

Patient care

all the guidelines on large sheets of paper or flipcharts, or the computer

3 0 U n i t 5

S ndditionalactivity.A.sk students to give you additionalabbreviations to write on the board andthen ask them to give the meaning Try tolimit these to prescribing medication

o n e ti m e

2 O t h e r p o s s i b l e g u i d e l i n e s m i g h t in c l u d e :

medication

4-6h: every4-6 hours1-4h: every l*4 hoursl M : in t r a m u s c u l a rN E B : b y n e b u l i s e rm g : m i l l i g r a m

7 a ( o m n i m a n e )

8h: every eight hourslV: intravenous5C: subcutaneous

F8: mlcrogramm l : m i l l i l i t r e

tds (ter die sumendus): to be taken three times a dayq d s ( q u a t e r d i e s u m e n d u s ) : t o b e t a k e n f o u r t i m e s a d a y

PR (per rectum): bythe rectum INH: by inhalation

by mouth, upto a maximum of 16 milligrams

by mouth, upto a maximum of 300 milligrams

* Tip

While students a re doing the role-play,watch discreetly, but don't interfere Makenotes about language, pronunciation,body language, etc Ask students to givef e e d b a c k t o t h e i r o a r t n e r a n d r e m i n d t h e mw h y t h i s is im p o r t a n t - t o h e l p u n d e r s t a n dtheirstrengths and weaknesses, in ordertohelp them improve Students may want tod o t h e r o l e - p l a y a g a i n

Discuss the role-play with the class as awhole You cou ld invite students to do theexercise with you -this benefits you both,building upyour confidence and knowledgewhilst a llowing the students to interactwith a morefluent soeaker

rc TipMl = myocardial infarction

6 4 h1 prn8 r M9 SN Bond

yesacute and chronicindividualized careTo help improve concordanceA master's in cardiovascular medicine and training in the diagnosisand management of common medical conditions in this specialty.She provides much of the same basic, non-emergency care asphysicians.

5 r1.30

Speaking

Put students into A / B pairs You may want to put the As and Bs in groupsfirst to study the role-play cards Check that they understand the procedureand all the answers.

It's myjob

medication Ask students how they might feel if they were patients Alsopoint out the availability of drugs on the internet

able to prescribe medication

O r t ' t

234

listening 2

Benefits and side effects

O pr.t students in pairs to do L They then listen and do 2 on their own,comparing with a partner for 3.

O ror 4 and 5, students listen and check answers and compare them withthe Listening script.They can work in pairs to do 6.

Or 2 1 verygoodprogress/letyougohome

2 aboutyour medication3 f e e l f r e e t o d o s o4 by mouth once a day after a mealfrom now on5 itthinsthe blood / helpsto preventfurther attacks6 asyou may not get anyofthem

7 an upset stomach /the stools of some people dark and smelly/bleeding (e.g nose bleeds) or shortness of breath

3 2 U n i t 5

* TipSet a time limit of 2-3 m in utes for the role-play Afterwards, discuss it with the wholeclass, looking at it first from the patient'spoint of view (i.e why the patient mightbehave in a certain way), a nd then how thedoctor has to dealwith this

EI ldditionalactivityAsk students to select other drugs thatthey are familiar with and explain thebenefits and side effects

H ldditionalactivityYour students may want to discuss otherdrugs such as diuretics, vasodilators, orACE inhibitors

x Tip

lfnecessary, referthem to p.34for a reviewofadverbs offrequency (See OHCMTpp.100-110 for lists of benefits and sideeffects.)

and explain it to me?

h a p p y w i t h t a k i n g t h e m e d i c a t i o n , w h i c h w i l l in c r e a s e t h e li k e l i h o o do f c o m p l i a n c e

language spot

Phrasalverbs

(out) the ta blets (out) each day

Language spot

Explaining side effects can / may

Readthe introduction as a class before students complete I ontheir ornm.Then form pairs to do 2

3 may not4 possibility

5 c a n6 may

s*

Speaking

For 2 and l, ask two of the students in the group to take turns explaining themedication to each other while the third gives feedback

their dialogue in 2 and use it as feedback to help them improve

D e a l i n g w i t h m e d i c a t i o n 3 3

Reading

whilst always maintaining patient confidentiality

67

M e e t i n g p a t i e n t s ' i n d i v i d u a l n e e d s a n d p r i o r i t i e s

l m p r o v i n g s e l f - m a n a g e m e n t s k i l l s a n d c o m p l i a n c e i n m e d i c i n et a k i n g

* TipA microgram (pg)is1/1,0OO,000 of a gram,o r 1 / 1 , 0 0 0 o f a m i l l i g r a m T h e a b b r e v i a t i o nltgisoften used in scientific literature,but it is recommended that hospitals donot use this abbreviation in handwrittenorders due to the risk that the Creek letterpr could be mistaken for an m, resulting ina thousandfold overdose The abbreviationmcg is recommended i nstead

Proiect

in particular reiating to how incidents of drugs being prescribed wrongly

research

Writing

highiight the patient's safety and the need to be constantly vigilant For 5,

culture

w a s n o t e d b y t h e p h a r m a c i s t T h e p a t i e n t d i d n o t t a k e t h e

pronunciation and understandlng Remind students to transfer useful

3 4 U n i t 6

Background

From a lifestyle point of view,the major health issues are

way people behave is far from easy.Any attempt at modulating patients'behaviour is a

one's own opinion on the patient or ordering them to

by coaxing and encouraging patients, and presentingoptions from which the patient is likelyto make a choice

individual patient's lifestyle There is no point, for

off a bus one stop early when going to work if the patientdoes not use buses or no buses go near their work Patientsmight then begin to lose faith in the doctor's attemptsto help them So the options need to be patient-centred,taking into account the patient's way of life Anotherstrategy is to involve patients by finding out what theythink they can do and / or if what you suggest would workfor them, and if not, whether they could adapt it

Effective negotiation on the part of a doctor or nurse alsorequires sympathy (feeling for the patlent from your

distinction between these is often biurred Care needs tobe taken not to make the empathy too personal to oneself,by giving examples from one's own life which may drawattention away from the patient

2nd edition, Simon et ai

E ndditionalactivityYou can use the photographs as a resourcefor student presentations: each groupcan choose a photograph and do a mlni-presentation on people's attitudes andlifestyles

x Tip

I t c a n b e h e l p f u l t o s e t a t i m e l i m i t f o r a n yd i s c u s s i o n s u c h a s th a t i n l, a n d s e t a t a r g e tf o r t h e n u m b e r o f a n s w e r s v o u e x o e c tstudents to come uo with

e Put students in pairs to do l-5

u n hea lthy foods

c S m o k i n g a n d d r i n k i n g a l c o h o ld Eatingfattyfood

Howevel these factors vary from country to cou ntry

e n g a g i n g t h e p a t i e n t i n h e l p i n g t o d e c i d e w h a t to d o ; p r e s e n t i n g

Lifestyle 35

e n c o u r a g e c y c l i n g o r w a l k i n g

E additionalactivityIf possible, keep an eiectronic master listof questions and add to it with students'answers Give copies to the students

Family history and social history

in each case.O flay the recording again for 2 then ask students to work in pairs for3 and make full questions from their notes If necessary show them thequestions from the Iistening script

Students remain in their pairs for 4-7 In 7 they practise asking each

variations in the topics if they are appropriate, and remind students theydon't have to answer the questions truthfully for this role play They can

2 P r e s e n t S i m p l e ; P r e s e n t S i m p l e

P a s t S i m o l e

P o s s i b l e q u e s t i o n s a b o u t h o b b i e s : D o y o u h a v e a n y h o b b i e s / l e i s u r e

W h a t d o y o u d r i n k ?

P o s s i b l e q u e s t i o n s a b o u t c h a n g e s i n h a b i t s : H a v e y o u c h a n g e d

from before?

c o n c e r n s a b o u t lu n g c a n c e r i f t h e f a m i l y h i s t o r y i s n o t t a k e n i n t o

3 6 U n i t 6

El Additional activityStudents can use the grid to ask otherstudents in the class to rank habits thevfind difficult to change

E additionalactivityStudents can make questions to ask eachother using the phrases in l: Haveyoutaken up any physical activity recently? Doyou think it's important to take up someform oJ physical activity?

* TipCive feed back to the class on their role-plays, or ask students to give feedback toeach other As part ofthe feedback look atthe scenariofrom both the oatient's andthe doctor's point of view

* TipEach time they spea k, encou rage studentsto expand on what they say by givingexamples and reasons To illustrate this,give them an example of a cause or effectofstress, using only general ideas Then uset h e s a m e i d e a s a g a i n , b u t t h i s t i m e e x p a n dthem, giving specific examples and reasons.Ask the class which version is easiertou ndersta nd

Speaking

Ask students to do I on their own.If they want to, Iet them rank all of theitems Then get them to compare their answers with a partner for 2.For 3, allow students to modifu the statements and add their own answersif theywant

body language presented by patients, and oftheir own body language

doctor)to challenge

comfort

w i l l d o s o

Vocabulary

Language for exercise

Students match the verbs to the noun phrases for l, then add them to the

For 3, put students into groups to decide which are the three most important

more specific examples for each of the general ideas in 2, using th e Useful

Students work in pairs for 5, taking turns as doctor and patient The doctorshould practise advising the patient, explaining the risks and benefits of

take the doctor's advice Possible risks include: the dangers of moving from a

include better mood, improved health in general, reduced weight, greater

2 1 s e t t l e i n t o a n e w r o u t i n e2 make minor changes

I n group or class discussions, lea rn to standback a nd allow students to spea k freely a ndmake mistakes-this is part of the learningprocess Note down mistakes asyou listena nd correct them with the whole class atthe end (not identifying individuals!) asconstructive feed back

E ndditionalactivityYou can have a debate about the longhours that doctors work Divide the classinto two groups: one in favour of workinglong hours to meet demands and gainexperience, and one against Give eachgroup time to prepare,limit the debate toa fixed time, and give a free vote

* TipAs with anyactivitywhich involves studentd iscussion, use this as a way of building upyour own knowledge to use with the nextcl a ss

Ask students to work in groups to discuss the quotation in l, which comes

You could combine this with 2 and 3, and then ask groups to report back to

patients' attitudes, and the concentration required.In 4, ask students to give information about organizations they know ofwhich help doctors If there are no organizations, you could have a class

difficult Datients

Writing

Help with stress

Put students in groups for I and 2 - you could combine these two situations

both mental and physical approaches.For 3, ask students to write a reply email on their own They should include

of the situation and his difficulties; a recommendation of something thatmight help and why; an example of a similar situation they have dealt with,what strategies they used, and what the results were Write these items as achecklist on the board for students to include in their replies

Listening 2

Being sympathetic

Q nefore playing the recording in l, ask students to consider thestatements and decide what the doctor and patient are talking about Thenask students to listen and decide which are true, and compare their answerswith a partner They can then answer 2 and l

In 4, students in pairs take turns to role-play the doctor and patient, usingthe BMI chart to helpthem explain

1 T 2 T 3 T 4 T 5 F 6 F 7 F2 Sensitive

3 8 U n i t 6

E additionalactivityAsk students to make more'barrier'sentences, as in 4 Encourage them to useexamples from their own experience.E ldditionalactivity

As well as having students do 5 in pairs,you can ask for volunteers to do the role-play in front of the class, possibly withyou as patient Choose a different paireach time you do this Give constructivefeedback and always bear in mind thatat first 'performing' in front of others canaffect fluency

Try to avoid If you can You could have insteadIt's better to rather than

Or I I sympathy

4 sympathy2 1 empathetic

5 e m p a t h e t i c2 sympathetic 4

1 and 5 are very personal.

sympatheticsympathetic3 The personal statements are not appropriate The patient may not

necessarily respond to them In '1, the reason could simply be left offorthe doctor could add but we ore here to help.ln 5,the statementcould be rephrased: I know it can be hard because I have seen manypatients in the same situation.

tl i I appreciate it's difficult, but haveyou thought of the advantagesto giving up? You could, for example, tryto reduce it gradually, sayby drinking more slowly or drinking half pints / smaller glasses ofwine And then come backto see me in two weeks' timeto seehowyou are getting on How does that sound? / Doyou thinkthat will work foryou?

language spot

Encouraging patients and making suggestions

Read through the introduction as a class before students do t

they use phrases such as:

What about trying to You might like to try , Have you ever thought of Instead of

O r | 1 H a v e y o u t h o u g h t o f t r y i n g t o t a k e i t e a s y f o r a c o u p l e o f

days and having a couple ofdays off?2 lt's better to step up the exercise very gradually.3 You could spend moretime on a physicallydemandingform of exercise.4 Instead ofeating red meat, eatwhite meat orfish whereyou can.5 Try and do something which will getyou out and about.

6 You might (liketo)try havinga balanced ratherthan a crash diet.

Patient care

Ask students to do l-5 in pairs For 4, you could prompt them with some of

Haveyouthought of cutting down gradually?

It's not easy to change things, but how do you think you could do it?

own exDerience

Lifestyle 39

2 Doyou wantto give up? Doyourfamilywantyou to give up?Civing up smoking isnt easy, but haveyou thought of cuttingdown gradually? For example, ifyou have found it difficult to stopwithout any help,you can try cutting down one cigarette a dayfor a week and so on You could setyourselftargets to achieve andputthe moneyyou save into a jar.

3 Tryingto make changes like this, atfirst, seems difficult, but haveyou thought about how it might help you ? You might like to try

makingyourself stop at a specific time each day, say 5 / 6 pm, andnot take any work home Would you be able to do this? / Would thiswork foryou, doyou think? I Orwould you find this difficultto do?4 lt's not easyto changethings, but howdoyou thinkyou could

do it? The temptation to eat is all around us Whatthings doyouthink you could cut out each day? / Haveyou thought about whatthings you could cut out each day?

5 Yes lt can be difficult, butwhat abouttryingtofit it intoyourdaily routine? By climbing stairs where possible orwalking part ofthe way home? Small changes like this can make a big difference.ls there anything elseyou think you could do?

Speaking

Put students into groups ofthree for l-4 You can do 5 as a class or groupdiscussion

have used so far inthis unit, andto come to an agreement

motivation

Reading

Before students read the text, ask them to work on their own to complete

their answers for 2

4 $ 2 1 b i l l i o n i n 2 0 0 5