22 unit 2 Check up iia score what each person’s job im What do you hance tanSibcb isto 2. What do you thinkis the most stressful aspect of ‘medical work? What isthe most rewarding? Vocabulary Medical jobs 1 Match these jobs to the pictures on page 12. 1 practice manager 2 receptionist 3. general practitioner 4 midwife 5 district murse 6 health visitor 7 practice nurse 2 Add the job titles ofthe people in Yon page 12to the sentences below. You can use singular or plural nouns. 1 Apractice is run by a 2 ‘work with individuals, families, and groups like the elderly and new-born babies in the community. need very good interpersonal skills because they are the first contact people have with the practice. 4 Ninety-seven percent of the UK population is. registered witha 5 Theduties ofa__include“traditional nursing skills and running specialist clinics for immunization, diabetes,and so on. 6 Animportant link between hospitals, GPs, and other ‘health professionals involved in antenatal care is the. Ht visit those who are houseboundor those recently discharged from hospital and /or dress wounds 3 AGP’s place of work is called a surgery. Surgery also refers to the time GPs see patients. Do doctors work ‘outside hospitals in your country? Ifso, where? Working in general practice 13 An this unit ‘© Past Simple and Present Perfect ‘© asking questions in the family history © using non-technical language © asking questions in the general history © wiiting.a referral letter Pronunciation 1 Main stress 1. @® Listenand mark the main stressin the words and phrases. 1 20000 2 Allofthe people in the pictures in Check up work as part of GP practice team. In groups, discuss how each person supports the GPin his /her work. Which person in your opinion is the most important besides the GF? 3 Discuss who does the work ofthe people above in your country. Listening AGP'sjob 1 @ Listentoa GP talking about her workin an inner city area, Decide whether these statements about her work are true (T) or false (F). 1 The GP works in the centre of London. 2. High crime rates do not affect the people working at the GP practice. 3 The workload s lighter than in rural areas 4 Patients move from one GP practice to another. ___ 5. GPs receive no extra payment for working in. deprived areas. 2. Workin pairs Compareand contrast working nity urban and rural areas in your home country.14 Unit2 « Language spot Present Perfect and Past Simple «© We use the Present Perfect for actions which happen in the past at any time up to now. The exact time is not known or not defined. by ay Now abst i ‘© We use the Past Simple for specific times in the past. ‘The exact time is known or defined, but sometimes the time is not mentioned. o Last year / Two days ago/ Yesterday, ete. ‘Now Lis J + When you take a history, pay attention to the patient's use ofthe Past Simple and the Present Perfect. Look at this statement from Listening I: ‘nrecent years many developments, both technological and social, have occurred. The time of the occurrence of each event specifi. Look at diagram A above. {started workas a GP in this area over 20 years ago. not The tense isthe Past Simple. The time is specific. Lookat diagram Babove. + Now look at the relationship in a case history between the Present Perfect and Past Simple. pocror: Have you ever had a headache like this before? (Present Perfect) patient: Yes.1had a similar headache three months ‘ago. (Past Simple) 1. Use these words to make sentences. 1 coughing start five days ago be so bad it wake me up every night. ‘when attacks first come on? anything make it worse since start? henever take any medication in his life what happen when you be near animals as a child? my father die over 20 years ago, you get these problems every day when you liven Africa? 8 everhave coughing attacks like this before ? 9 your family ever have illness like this as far asyou aware? daunun 2 Workin pairs. Ask each other questions using these phrases travel abroad bea patient bein hospital asa patient read a novel in English usetheinternettostudy ride a motorcycle BEGIN Have you / Has anyone in your family ever When /Where did you..? Did you / How often did you....? Did you...? 3 Workin pairs. Decide the questions you would ask patients about themselves or their family in the past to find out about * pain. ¢ cough food poisoning, similar illness ¢ headache. 4 Role-play a patient and a doctor. Ask each other questions about the symptoms in 3. Speaking 1 Work in pairs. Look at the extract from a talk about general practice in the NHS. Student A, go to page 14 Student B, goto page 116. Ask each other questions to complete the missing information in your text 2 Work with partner and discuss these topics 1 The recent history of the heath care system in your home country 2 ‘The most important feature of the health care systems where you come fromgovernment lke a teacher or doctor. «contributory (ad helping to cause Jocum GP (a) GP who stands in for Working in general practice 15 | ivi servant (0) an employee of the precipitant (ad) factors which cause something ‘productive (ad) producing a substance (ike sputurn) “sblings(n) brothers and sisters ‘another dector who is temporarly away ‘on holiday oof sick Listening 2 Acase history 1. Before you listen to the conversation between Mr Bloomfield, a 28 y/o civil servant, and a locum GR, DrDickson, look at the notes below. With a partner, discuss why the past medical history famaily history, personal and social history, and drugs and allergy history are important. 2 G Listen and complete the notes below. emai ‘Mother /sifter: __» 3. Work in small groups. Discuss these questions. 1. What isthe differential diagnosis? 2. What investigations would you do? 3. What treatment do you think should be given? 4 Thedoctor does not take a detailed family history or social and personal history because most of this is. recorded on the patient’s notes. Ifa doctor is seeing a patient for the frst time, what questions should he / she ask in the family history about: 1 siblings? 2 children? 3. close relatives? 4 parents? 5 family illness? Vocabulary Signs and symptoms Decide whether these are signs or symptoms. Some may be both. Conditiona 1 blockednose 2 raised temperature 3 tender oversinuses 4 headache worse on bending 5 runny nose Condition 1 breathlessness 2 tachypnoea 3 tight chest 4 nightand morning coughing 5. prolonged expiration 6 wheeze Condition raised pulse 1 2 recent vorniting / diarrhoea 3. dehydration 4 abdominal tenderness 5. crampy abdominal pain Work in pairs. Discuss which conditions the signs and symptoms in Tight relate to, ‘On your own, makea list of the signs and symptoms you ‘would expect to see ina patient with a) diverticular disease and b) pneumonia, Compare your answers for both patients witha partner, Speaking Work in pairs. Take turns role-playing the conversation between Dr Dickson and Mr Bloomfield. Use the notes from the exercise to guide you. Discuss what questions you would ask about conditions a,b and c above. ‘What investigations could you do, if any. to confirm the diagnosis in each case?16 Unit 2 ‘4 requirement for primary care team 2. Match the symbols or abbreviations inthe text. ‘tothese words. 1 years servicesand the 4 use of out-of-hours and A&E services amongst deprived communities. ‘Other factors which have an effect are homelessness, sleeping rough, loyment and unemployment, dlivoree, and immigration status. The adverse effects of living in temporary accommodation are well documented. For example, adults havea 4 incidence cof depression than people of similar social standing in their own homes. ‘Children are less likely to receive their immunizations, more likely to have childhood accidents, and have higher incidence of minor and diarrhoeal diseases. Among those sleeping rough, poor diet, poor accommodation, and Jack of access to medical services are universal problems. study done in 1986 in London found one third are psychotic, a quarter have severe physical problems, and two-thirds have ‘no contact whatsoever with medical Writing services, Evidence shows that if services are provided, homeless people will use them. The effects of work have been ‘compared to effects of vitamins - we need a certain amount to be healthy: then there isa plateau, where extra doesnt ‘work, and too much is harmful Areferral letter 3 lessthan 2 increased /increasing 4 leadingto/resultingin 1 ‘Work in pairs, Look at the referral letter on page 19 writ byaGPtoa specialist at a hospital for one of her patient 3 Workin pairs. Answer these questions. 1. What main social factors are given? 2 Canyyou give your own reasons why those {n social classes land I! were more likely to smoke 80 years ago? 3. What reasons could you give for the increased incidence of depression in those living in temporary accommodation? 4 Why is poor diet a problem among those sleeping rough? 4 Insmall groups, discuss why the following may be ‘higher among the unemployed or those under the threat of being unemployed in the UK: coronary vascular disease, cancers, violence, accidents 5 Discuss what the situation slike in your own country indeprived areas Tick ¢) the features of/ points covered by the leter 1 ( dearcommunication 2 DO date of referral 3) dateofbirth ofthe patient 4 O hospital number 5 () NHSnumber 6 C1 patient's name and adress 7 C0 investigat 8 C1 treatments tried with outcomes 9] relevant past medical history and family history performed with results 10 C) reason for referral 11 () presenting condition 12 C1 socialeircumstances 13 C) clearsignature(OTC (adi) over the counter = available ina shop Piriton (proper n) an ‘over-the-counter medication to treat allergies volunteer (n) a person who ‘works without payment NHS Number 6684335792 Hospital Number 1017786F 22 August 2007 Dear Or Ahmed, Re David Hunt 17 May 1985(M) 18 Greencross Street, London SES 2PD ‘This patient has complained of a rash which has erupted on a number of occasions in different parts of his body on and off for more than three years. Recently, he has also complained of bilateral intermittent nasal blockage, itchy nose and eyes, watery nasal discharge. The rashes have also increased in frequency and duration, treated on occasion with antibiotics and OTC medication. This does not appear to be related to allergy to pets, nor work or other common factors. The rash has responded to Piriton. The patient has had allergy sensitivity testing with no ‘conclusive result. The patient spent several years in West Africa working as a volunteer in his early 20s. The Africa connection may have some bearing and | would appreciate your opinion, Yours sincerely, dw Re 2 2 Student A look at the letter above. Student B look at theletter on ‘page 117 only. Ask each other questions to find nine differences in the letter WEE 3. Underline all the main verbs in the letter, What tense iseach verb? 4 Work in pairs. Discuss what you would include in a referral letter tothe gastroenterologist at the hospital, Dr Mason, about a patient you suspect of having diverticular disease, 5 Usethe checklist at the bottom of page 18 to write the letter. Project 1 Findtthese on the internet Look for information about UK GPs! training, work, and codes of eonduet 1 the British Medical Association (BMA): wwwebmaorg.uk 2 the General Medical Council (MC) www gme-uk om 3. the Royal College of General Practitioners: wwwrcgp org.uk 4. Oxford University Press: wwrw.oup com/uk/medicine/ handbooks 2. Discuss the work of aGPin the UK compared with similar doctors inyour own country Working in general practice 19 Checklist ‘Assess your progressin this unt Tick (4) the statements which are true, ican use the Past Simple and Present Perfect. lean ask questions inthe family history. can ask questions in the genera history. ‘can understand and use non-technical language. Ican write referral letter. Key words Jobs district nurse general practitioner health visitor midwife practice manager practice nurse. receptionist Nouns practice referral letter sign symptom Adjectives prone runny (nose) tender Non-technical verbs admit avoid book come and go stick to Useful reference Oxford Handbook of Genera Practice 2nd edition, Simon et al, ISBN 978.0-19.856581-9