TÀI LIỆU TRẮC NGHIỆM, BÀI GIẢNG PPT CÁC MÔN CHUYÊN NGÀNH Y DƯỢC HAY NHẤT CÓ TẠI “TÀI LIỆU NGÀNH Y DƯỢC HAY NHẤT” ;https:123doc.netusershomeuser_home.php?use_id=7046916. TÀI LIỆU surgical english. DÀNH CHO SINH VIÊN CÁC TRƯỜNG ĐẠI HỌC Y DƯỢC VÀ CÁC TRƯỜNG KHÁC, GIÚP SINH VIÊN HỆ THỐNG, ÔN TẬP VÀ HỌC TỐT KHI HỌC TÀI LIỆU surgical english
Surgical English Ramón Ribes · Pedro J Aranda John Giba Ramón Ribes · Pedro J Aranda John Giba Surgical English 123 Ramón Ribes Reina Sofia University Hospital Serv Radiología 14005 Córdoba Spain John Giba C/ Mossèn Cinto Verdaguer 19, 2-7 08181 Sentmenat Spain Pedro J Aranda MD, PhD, ED Cardiovascular Surgery Department Hospital Regional Universitario Carlos Haya Málaga Spain ISBN: 978-3-642-02964-6 e-ISBN: 978-3-642-02965-3 DOI: 10.1007/978-3-642-02965-3 Springer Heidelberg Dordrecht London New York Library of Congress Control Number: 2009933125 © Springer-Verlag Berlin Heidelberg 2010 This work is subject to copyright All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer Violations are liable to prosecution under the German Copyright Law The use of general descriptive names, registered names, trademarks, etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book In every individual case the user must check such information by consulting the relevant literature Cover design: eStudio Calamar Figueres/Berlin Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) To my youngest sister, Mara Ribes Bautista, for her enduring support Ramón Ribes To Irene and Pamela, my beloved experts in communication Pedro J Aranda For the surgical teams that saved my life and for Nuria and Julia, who make it worth living John Giba Foreword Over years ago, when Dr Ribes invited me to work on this book I thought it was a great idea However, I was convinced that I would not be able to collaborate on this project for two reasons: first, I did not feel proficient enough to take on this task, and second, I thought that I would never be able to find the time to it Later, he gave me copies of two excellent books that he wrote in collaboration with others, Medical English and Radiological English, with a handwritten dedication saying, “You are the right person to write Surgical English.” This made me reconsider undertaking the project It has taken me more than years to finish my part of the book.… I thank Dr Ribes for his patience I have my father and mother to thank for “forcing” me to learn English when I was at school and for actually pushing me to be an exchange student in the USA as a teenager As a kidney specialist, my father knows that without a minimum level of English it is difficult to progress beyond the boundaries of your language or get involved in international projects Later, I had the privilege of spending short periods in different hospitals in Europe and in the USA, when I was a medical student, a resident, and as a fully trained surgeon This experience included stays at hospitals in English-speaking countries, like Hammersmith in London or Stanford Hospitals and Clinics in California, as well as at hospitals in non-English-speaking countries, like the Berlin Heart Center, Leiden University Medical Center, and the Cologne City Hospital, among others This has been one of the most enriching experiences in my life and has opened many doors, both personally and professionally Like other specialists, surgeons have to study hard to keep our knowledge up to date However, unlike some other specialists, we also need to see other surgeons working and to acquire the skills that will enable us to master their surgical techniques Proficiency in English is of paramount importance for understanding the scientific literature (needless to say, 90% of medical publications are written in English), for understanding colleagues at international congresses, and for communicating when participating actively Perhaps everybody knows that English is the language of science But it is only when you travel to a different country that you really become aware of the need to speak English First, you need a minimum level of English to introduce yourself and request permission to visit a hospital or apply for a job abroad Then you will need the skills to survive in the operating theatre: for example, vii viii Foreword you need to know the names of the instruments, and how to establish personal and professional relationships with the staff Regardless of whether you go to an English-speaking country or to another country where you not know the local language, English will be your most important instrument abroad There is a real need for a book like this one We sincerely believe it will provide you with the basic skills to survive in the international surgical arena of the new millennium Málaga, Spain Pedro J Aranda Preface Writing a book on such a broad topic as “Surgical English” is probably as bold as talking about “the history of the Roman Empire.” However, the broad scope of this book is offset by its simple approach and realistic goals While it would be practically impossible to cover all the terminology used in the different surgical specialties, numerous topics and ways of doing things are relevant to all surgical specialties, and many instruments are common to most of them Furthermore, surgeons all over the world face similar situations like writing a surgical protocol, visiting patients in the ward, or asking for informed consent In this book, we will also provide advice about giving oral presentations at international congresses, writing articles, and moving around the operating room (or OR as it is invariably referred to in American hospitals) Given the importance of the English language in medical science, surgeons all over the world should benefit from this book; it will be invaluable to those who wish to practice in a different country, a fellowship in a different hospital, or simply spend a few weeks in a hospital with a language other than their own Even if you travel to a country where English is not one of the main languages spoken on the street, it will enable you to communicate with the people around you in hospitals in most countries While much of this book is dedicated to helping you master the basics, it will also be useful if you already have an excellent command of the English language Professional life in a foreign country brings up countless challenges to even the most proficient speakers It will always be helpful to have a pocket book to remind you of some specific words or to help you deal with specific situations You can read this book straight through or jump from chapter to chapter, as each chapter covers an independent topic We hope that you enjoy this book and that you find it helpful in your life and career Ramón Ribes Pedro J Aranda John Giba ix Contents Unit I Methodological Approach to Surgical English Getting Started Unit II Surgical Grammar Tenses Talking About the Present Talking About the Future Talking About the Past Modal Verbs Expressing Ability Expressing Necessity Expressing the Absence of Necessity Expressing Possibility Expressing Certainty Expressing Permission Expressing Moral Obligation or Giving Advice Conditionals Main Types of Conditional Sentences In Case Unless As Long As, Provided (That), Providing (That) Passive Voice Passive Forms of Present and Past Tenses Have/Get Something Done Supposed To Reported Speech Reporting in the Present 9 12 14 20 21 22 22 23 24 24 25 26 26 28 29 29 29 30 32 32 32 33 xi xii Contents Reporting in the Past Reporting Questions Reporting Orders and Requests Reporting Suggestions and Advice Questions Tag Questions Verb Patterns The Gerund (Verb + -ing) Verb + Infinitive Verb + Preposition + -ing Countable and Uncountable Nouns Countable Nouns Uncountable Nouns Articles: A /An and The Word Order Relative Clauses Defining Clauses Non-defining Clauses Relative Pronouns Prepositions in Relative Clauses Relative Clauses Without a Pronoun (Special Cases) Adjectives Adjective Order Regular Comparison of Adjectives The Superlative Irregular Forms of Adjectives Comparatives with the As Like and As So and Such Prepositions At/On/In Time For, During, and While By and Until In/At/On for Places 33 34 35 35 36 37 37 37 38 40 41 41 41 42 44 45 45 45 45 46 47 48 48 49 50 51 51 52 52 53 54 54 55 55 55 Unit III Scientific Literature: Writing an Article Common Mistakes: An Example from the Real World Preliminary Work Article Header 63 64 65 Contents Title Abstract Keywords Main Text Introduction Materials and Methods Statistics Results Discussion Acknowledgments References Articles in Journals Books and Other Monographs Other Published Material Unpublished Material Electronic Material Additional Material Tables Figures Final Tips 65 65 68 68 68 68 70 71 72 73 73 74 77 78 78 79 79 79 79 80 Unit IV Letters to Editors of Surgical Journals Submission Letters Re-submission Letters Re-configuration Letters Letters of Thanks for an Invitation to Publish an Article in a Journal Asking About the Status of a Paper Other Letters Applying for a Post Asking for Permission to Use Someone’s Name as a Referee Postponing the Commencement of Duties In Summary 85 87 88 91 92 93 93 94 95 96 Unit V Attending an International Surgical Course Introduction 99 Travel and Hotel Arrangements 100 xiii Contents Cars At the Gas/Petrol Station At the Garage At the Parking Lot or Garage (UK Car Park) Renting a Car How Can I Get To …? Having a Drink (or Two) On the Phone Emergency Situations In the Bank At the Police Station Unit XXII A Few Words About Effective Communication 361 361 361 362 362 362 363 363 364 364 365 369 xix Contributors Juan Francisco Martinez Canca Neurosurgeon, Hospital Carlos Haya, Málaga, Spain Esteban Sarria García Resident in Cardiovascular Surgery, Hospital Carlos Haya, Málaga, Spain Irene Palomo Gomez Forensic Doctor, Instituto de Medicina Legal, Málaga, Spain Maria Teresa Gonzalez González Resident in Cardiovascular Surgery, Hospital Carlos Haya, Málaga, Spain Lorena Rubio Lobato Resident in Cardiovascular Surgery, Hospital Carlos Haya, Málaga, Spain xxi Unit I Methodological Approach to Surgical English Getting Started A sound knowledge of English grammar is fundamental for building your surgical English consistently Surgeons need to be fluent in English terminology about anatomy; anatomy is crucial to understanding the different surgical approaches as well as the radiological findings Anatomy is so linked to Latin and Greek that you will never be able to speak and write about anatomy or surgery in English properly unless you are familiar with Latin and Greek terminology Additionally, surgeons must be aware that the technical aspects of their subspecialties are not widely understood by the uninitiated: surgeons need to be able to explain complex matters to referring physicians, residents, nurses, and technicians in ways that they can understand Communicating with patients and their families is also of the utmost importance Surgeons need to understand patients when they talk about their conditions and to be able inform them and their families in language that is intelligible to the layman, both before and after and the operation Finally, it is becoming increasingly common to operate on patients who are awake, and this situation requires fluent communication to ensure safety and comfort Let’s a simple exercise Read this sentence: Furthermore, partial resection of the suprarenal tumor could result in seeding of the operating field and hemostasis would be cumbersome without the use of BioGlue or the harmonic scalpel We are sure you understand the sentence and that you are able to translate it into your own language almost instantly; unfortunately, translation is not only useless but also deleterious to the fluency of your surgical English This is a key point: understanding is not the same as translating If you try to read the paragraph in English out loud, your first difficulties will appear If a conversation on the sentence starts and the audience is waiting for your opinion, you may begin to sweat Check the words you are not able to pronounce easily and look them up in the dictionary Ask an English-speaking colleague to read it aloud while you try to write it down; you will probably find some difficulty in writing certain words R Ribes et al., Surgical English, DOI:10.1007/978-3-642-02965-3_1, © Springer Verlag Berlin Heidelberg 2010 Unit I Methodological Approach to Surgical English Check the words you are not able to write properly and look them up in the dictionary Finally, try to have a conversation on the topic Notice how many problems have been raised by just one sentence in surgical English Our advice is that once you have diagnosed your actual surgical English level: Do not get depressed if it is below your expectations Keep doing these exercises, using progressively longer paragraphs It is a good idea to begin with material from your own subspecialty Arrange surgical English sessions at your institution Normally residents are more open to this sort of proposal, so a weekly resident session might be a good starting point A weekly surgical session in English will help you and your colleagues to keep up your English You will notice that you feel much more confident when talking to colleagues with a lower level than yours than when talking to your native English teacher; similarly, it will be easier for you to talk to nonnative English-speaking surgeons than to native English-speaking colleagues In these sessions, you can also rehearse talks and lectures so that when you give a presentation at an international meeting it will not be the first time you are delivering it You can use this exercise to evaluate your level of surgical English: Are the following five sentences correct? The carotid artery must be dissected from the jugular vein – INCORRECT In this case “dissected” refers to two different structures; therefore, it is necessary to say … dissected free from … ● The carotid artery must be dissected free from the jugular vein The flexor digitorum long tendon is rarely involved – INCORRECT The correct sentence is: ● The flexor digitorum longus tendon is rarely involved Always double-check the spelling of Latin/Greek terminology A 57-years-old patient with severe abdominal pain – INCORRECT The correct sentence is: ● A 57-year-old patient with severe abdominal pain In this case, the expression “57-year-old” serves as an adjective, and adjectives preceding nouns cannot be written in the plural There was not biopsy of the lesion – INCORRECT Getting Started The correct sentence is: ● There was no biopsy of the lesion Although it is technically not incorrect to say “there was not a biopsy of the lesion” or “there were not any biopsies of the lesion,” these phrases are awkward and no native speakers would say them Other correct alternatives include “a biopsy was not taken” and “the lesion was not biopsied.” An 87-year-old patient with arrithmya – INCORRECT “Arrhythmia” is one of the most commonly misspelled words in medical English You can avoid this recurrent mistake by checking that the word “rhythm” (provided it is spelled correctly!) is embedded in “arrhythmia.” What does “heart burn” mean? Colloquially, it refers to the symptoms of gastroesophageal reflux What would you understand if a scrub nurse said to you: “Dance with me”? He or she is asking you to tie his or her gown Are “Harvard students” and “Harvard alumni” synonymous? NO The former term refers to current students and the latter to former students How would you ask a patient to perform a Valsalva maneuver? Bear down as if you were having a bowel movement 10 Are “home calls” and “in-house calls” synonymous? NO They express opposite concepts In “home calls” you will hopefully sleep at home, whereas in “in-house calls” you must stay in the hospital for the entire period This set of questions is intended for those who think that surgical English does not deserve a second thought On the one hand, most surgeons who have never worked in English-speaking hospitals tend to underestimate the difficulty of surgical English; they think that provided you speak English you will not encounter any problems in surgical environments On the other hand, those who have been through embarrassing situations themselves when working abroad would never dare to say that either English or surgical English is easy Unit II Surgical Grammar The first chapters of a book are probably the least read by most readers in general and surgeons in particular, and in our opinion it is precisely in the first chapters that the most important information of a book is displayed It is in its first chapters that the foundations of a book are laid, and many readers not optimize the reading of a manual because they skip its fundamentals This is a vital unit, because unless you have a sound knowledge of English grammar, you will be absolutely unable to speak English as is expected of a welltrained surgeon It is definitely not enough just to be able to make yourself understood; you must speak fluently and your command of the English language must allow you to communicate with your colleagues regardless of their nationality As you will see immediately, this grammar section uses examples that are directly relevant to a surgeon’s everyday needs for English, so while you review, for example, the passive voice, you can also review the vocabulary and expressions you need to communicate in English, like “the CT scan had already been performed when the surgeon arrived at the CT unit.” We could summarize this approach as replacing the classic sentence of English manuals “my tailor is rich” by expressions such as “the first-year surgery resident is on call today.” Just as a certain knowledge of anatomy is necessary to create a good operating field, a certain grammatical background is necessary to speak and write correctly The tendency to skip both grammar and anatomy, considered by many as simple preliminary issues, has deleterious effects on English and surgery Tenses Talking About the Present Present Continuous We use the present continuous to talk about an action that is in progress at or around the moment of speaking This tense is formed by the present simple of the verb to be (am/are/is) + the gerund of the verb (infinitive (without to)+ ing) R Ribes et al., Surgical English, DOI:10.1007/978-3-642-02965-3_2, © Springer Verlag Berlin Heidelberg 2010 10 Unit II Surgical Grammar The negative is formed by adding not between the verb to be and the gerund: Example: She is not working today = She’s not working today = She isn’t working today Study this example: It is 7:30 in the morning Dr Hudson is in his new car on his way to the Gynecology Department So: He is driving to the gynecology department He is driving to the gynecology department means that he is driving now, at the time of speaking ● USES To talk about: ● Something that is happening at the time of speaking (i.e., now): – Dr Hudson is walking to the operating room – Dr Smith and his colleagues are performing an enteroclysis ● Something that is happening around or close to the time of speaking, but not necessarily exactly at the time of speaking: – Jim and John, general surgery residents, are having a sandwich in the cafeteria John says: “I am writing an interesting article on chordomas I’ll let you have a look at it when I’m finished.” As you can see, John is not writing the article at the time of speaking He means that he has begun to write the article but has not finished it yet He is in the middle of writing it ● Something that is happening for a limited time around the present (e.g., today, this week, this season, this year, …): – Our junior neurosurgery residents are working hard this term ● Changing situations: – Clinically speaking, the patient’s condition is getting better ● Temporary situations: – I am living with other residents until I can buy my own apartment – I am doing a rotation in the cardiology division until the end of May Special use: Present continuous with a future meaning In the following examples, the speaker has already arranged to these things ● To talk about what you have arranged to in the future (personal arrangements) – We are stenting a renal artery on Monday – I am having dinner with a cardiothoracic surgeon from the United States tomorrow We can also use the form going to in these sentences, but it is less natural when you talk about arrangements We not use the simple present or will for personal arrangements Tenses Simple Present The simple present shows an action that happens again and again (repeated action) in the present time, but not necessarily at the time of speaking FORM The simple present has the following forms: Affirmative: the same as the infinitive (without to) (remember to add -s or -es to the third person singular) ● ● Negative – I/we/you/they not (don’t) + infinitive (without to) – He/she/it doesn’t + infinitive (without to) ● Interrogative – Do I/we/you/they + infinitive (without to)… ? – Does he/she/it … ? Study this example: ● Dr Allan is the chairman of the Traumatology Department He is at an international course in Greece at this moment So: He is not running the Traumatology Department now (because he is in Greece), but he runs the Traumatology Department USES ● To talk about something that happens all the time or repeatedly or something that is true in general Here it is not important whether the action is happening at the time of speaking: – I pediatric surgery – Nurses take care of patients after the implantation of the pacemaker – For colon surgery, pre-intervention preparation serves to cleanse the bowel ● To say how often we things: – I begin to see patients at 8.30 every morning – Dr Taylor does laparoscopic surgery two evenings a week – How often you go to an international surgical course? Once a year ● The simple present is often used with adverbs of frequency such as always, often, sometimes, rarely, never, every week, and twice a year: – The heart surgery chairman always works very hard – We have a pathology conference every week ● For a permanent situation (a situation that stays the same for a long time): – I work as consultant in the breast cancer program of our hospital I have been working there for 10 years 11 12 Unit II Surgical Grammar USES ● Some verbs are used only in simple tenses These verbs are verbs of thinking or mental activity, feeling, possession, perception, and reporting verbs We often use can instead of the present tense with verbs of perception: – Now I can understand why the X-ray machine is in such a bad condition – Now I can see the solution to the diagnostic problem ● Simple present with a future meaning We use it to talk about timetables, schedules …: – What time does the laparoscopic knee surgery conference start? It starts at 9.30 Talking About the Future Am/ is/ are + going to+ infinitive USES ● To say what we have already decided to or what we intend to in the future (do not use will in this situation): – I am going to attend the 20th International Congress of Angiology and Vascular Surgery next month – There is a hands-on minimally invasive course in Boston next fall Are you going to attend it? ● To say what someone has arranged to (personal arrangements), but remember that we prefer to use the present continuous because it sounds more natural: – What time are you going to meet the vice chairman? – What time are you going to begin the ooferectomy? ● To say what we think will happen (making predictions), especially when there is strong evidence for the prediction: – The patient is agitated I think we are not going to be able to the operation under local anesthesia alone – “Oh, the patient’s chest X-ray looks terrible I think he is going to die soon,” the radiologist said ● If we want to say what someone intended to in the past but did not do, we use was/were going to: – He was going to a radical resection of the tumor but finally changed his mind and did a more limited one ● To talk about past predictions we use was/were going to: – The resident had the feeling that the patient was going to suffer a reaction to the antibiotic Tenses Simple Future (Will) FORM Will + infinitive (without to), but shall can also be used with I or we (will is more common than shall, but only shall is used in questions to make offers and suggestions): ● Shall we go to the thoracoscopy symposium next week? You/he/she/it/they will (‘ll) + infinitive (without to) Negative: shall not = shan’t, will not= won’t USES ● We use will when we decide to something at the time of speaking (remember that in this situation, you cannot use the simple present): – Have you finished the report? – No, I haven’t had time to it – OK, don’t worry, I will it ● When offering, agreeing, refusing, and promising to something, or when asking someone to something: – That case looks difficult for you Do not worry, I will help you out – Can I have the book about brain tumors that I lent you? Of course I will give it back to you tomorrow – Don’t ask to perform the appendectomy by yourself The consultant won’t allow you to – I promise I will send you a copy of the latest article on intraoperative ultrasound as soon as I get it – Will you help me out with this amputation, please? You not use will to say what someone has already decided to or arranged to (remember that in this situation we use going to or the present continuous) ● To predict a future happening or a future situation: – The specialty of General Surgery will be very different in a hundred years’ time – Twenty years from now, heart surgeons won’t need to perform thoracotomy Remember that if there is something in the present situation that shows us what will happen in the future (near future) we use going to instead of will ● With expressions such as: probably, I am sure, I bet, I think, I suppose, I guess: – I will probably attend the European Congress – You should listen to Dr Helms’s conference I am sure you will love it – I bet the patient will recover satisfactorily after the bypass – I guess I will see you at the next annual meeting 13 14 Unit II Surgical Grammar Future Continuous FORM Will be + gerund of the verb USES ● To say that we will be in the middle of something at a certain time in the future: – This time tomorrow morning I will be performing a CABG ● To talk about things that are already planned or decided (similar to the present continuous with a future meaning): – We can’t meet this evening I will be stenting the aneurysm in the patient we talked about ● To ask about people’s plans (interrogative form): – Will you be attending the congress this year? Future Perfect FORM Will have + past participle of the verb To say that something will already have happened before a certain time in the future: – I think the resident will have arrived by the time we begin the osteosynthesis – Next spring I will have been working in the Oral and Maxillofacial Department of this institution for 25 years ● Talking About the Past Simple Past FORM The simple past has the following forms: ● Affirmative: – The past of regular verbs is formed by adding -ed or -d to the infinitive – The past of each irregular verb has its own form ● Negative: – Did not= Didn’t + the infinitive (without to) ● Questions: – Did I/you/ … + the infinitive (without to) Tenses USES ● To talk about actions or situations in the past (they have already finished): – I really enjoyed the trauma residents’ party very much – When I worked as a visiting resident in Madrid, I performed one hundred vasectomies ● To say that one thing happened after another: – Yesterday we had a terrible duty We did three embolectomies and then we performed an emergency mitral valve repair ● To ask or say when or what time something happened: – When were you last on call? – I arrived ago ● To tell a story and to talk about happenings and actions that are not connected with the present (historical events): – Christian Barnard performed the first human-to-human heart transplantation Past Continuous FORM Was/were + gerund of the verb USES ● ● ● To say that someone was in the middle of doing something at a certain time The action or situation had already started before this time but hadn’t finished: This time last year I was writing the case report that I plan to publish next year in the World Journal of Surgery To describe a scene: – A lot of patients were waiting in the corridor to have their chest X-ray done Present Perfect FORM Have/has + past participle of the verb 15 16 Unit II Surgical Grammar USES ● ● ● To talk about experience To talk about the present result of a past action To talk about a recent happening In the last situation you can use the present perfect with the following particles: ● Just: to say something has happened a short time ago: – Dr Ho has just arrived at the hospital He is our new pediatric surgeon ● Already: to say something has happened sooner than expected: – The second-year resident has already finished her presentation Remember that we can also use the simple past to talk about a recent happening: ● To talk about a period of time that continues up to the present (an unfinished period of time): – We use the expressions: today, this morning, this evening, this week, … – We often use ever and never ● To talk about something that we are expecting In this situation we use yet to show that the speaker is expecting something to happen, but only in questions and negative sentences: – Dr Helms has not arrived yet ● To talk about something you have never done or something you have not done during a period of time that continues up to the present: – I have not performed a mastectomy since I was a resident ● To talk about how much we have done, how many things we have done, or how many times we have done something: – I have reported that intervention twice because the first report was lost – Dr Yimou has performed twenty vertebroplasties this week ● To talk about situations that have existed for a long time, especially if we say always In this case the situation still exists now: – We have always had an excellent internal medicine department – Dr Olmedo has always been a very talented urologist We also use the present perfect with these expressions: ● Superlative: It is the most …: – This is the most interesting otorhinolaryngology case that I have ever seen ● The first (second, third …) time …: – This is the first time that I have seen a CT of an inferior vena cava leiomyosarcoma Tenses Present Perfect Continuous Shows an action that began in the past and has gone on up to the present time FORM Have/has been + gerund USES ● To talk about an action that began in the past and has recently stopped or just stopped: – You look tired Have you been working all night? – No, I have been writing an article on breast implants ● To ask or say how long something has been happening In this case the action or situation began in the past and is still happening or has just stopped – Dr Sancho and Dr Martos have been working together on the project from the beginning We use the following particles: ● How long …? (to ask about the duration of an action): – How long have you been working as personal assistant to Dr Miller? ● For, since (to say how long): – I have been working for 10 years – I have been working very hard since I got this grant ● For (to say how long as a period of time): – I have been doing flap corrections for years Do not use for in expressions with all: “I have been working as a plastic surgeon all my career” (not “for all my career”) ● Since (to say the beginning of a period): – I have been teaching laparoscopy since 1991 In the present perfect continuous, the emphasis is on the action itself and its duration The action can be finished (just finished) or not (still happening) In the present perfect, emphasis is on the result of the action rather than the action itself Past Perfect Shows an action that happened in the past before another past action It is the past of the present perfect 17 18 Unit II Surgical Grammar FORM Had + past participle of the verb USES ● To say that something had already happened before something else happened: – When I arrived at the operating room, the traumatologist had already begun the external fixation of the shoulder Past Perfect Continuous Shows an action that began in the past and went on up to a point in time in the past It is the past of the present perfect continuous FORM Had been + gerund of the verb USES ● To say how long something had been happening before something else happened: – She had been working as a urologist for 40 years before she was awarded the Foley Prize Subjunctive Imagine this situation: ● ● The surgeon says to the radiologist, “Why don’t you a CT scan on the patient with acute abdominal pain?” The surgeon proposes (that) the radiologist a CT scan on the patient with acute abdominal pain The subjunctive is always formed with the base form of the verb (the infinitive without to): ● ● ● ● I suggest (that) you work harder She recommended (that) he give up smoking while dictating He insisted (that) she perform an ultrasound examination on the patient as soon as possible He demanded (that) the nurse treat him more politely Note that the subjunctive of the verb to be is usually passive: ● He insisted (that) the surgical report be dictated immediately ... Methodological Approach to Surgical English Getting Started A sound knowledge of English grammar is fundamental for building your surgical English consistently Surgeons need to be fluent in English terminology... that surgical English does not deserve a second thought On the one hand, most surgeons who have never worked in English- speaking hospitals tend to underestimate the difficulty of surgical English; ... many problems have been raised by just one sentence in surgical English Our advice is that once you have diagnosed your actual surgical English level: Do not get depressed if it is below your