Giving the patient bad news

Unfortunately I can't give you this medicine , . .

I
~'m<bfSaid? there are some side effects.
-I '- -f ,.<> ;1 1. <:>,.ymf
ion . . .
y~&~~[@@~@t~hawwamperaf

you might have to reduce your working hours for a while

your father will need to go into hospital . .

:,.7~,,".
,..tr, ,-. 4m8 .
f,~~?y~;dd~~:f61EK&
+, . A +.,> .
operations. ..
taking anti-biotics . .
realize

understand
that many people don't like

that you've had this medicine before . . ,

I
~ ~ : ~ o Q ~ ~ i I ~ f : B ~ .~. t [ : W , ~ & t t .
&at it; upsetting
' I disappointing 1 distressing.

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mL6@fIv:5F
.. .mt:,jt:s;reurur, ,,.,.,,,, -:,\. >,

way.
....but really it's the only >,y;$?;'~f:.(q&f?;;+;;?
::.+ :y
tbfig:; i:,.<:, .,>,:,-, ,,.. .,. ,, , - .
.. , . +

I'm sorry to tell but your dog will need to be put down.
YOU
that rabbit have put to
sleep.
 3iiHF Dealing with a non-compliant or resistant patient
r

If a patient is non-compliant or resistant you need to do the following things:-

A. Indicate to the patient that the responsibility rests with hidher,

It's time for ;you to think about$ yourself

your health
your eyes
your future

You reality need to think about your health

B, Empathise with the patient.

X realize it's difficuf t but.. ...
a busy time

I know it's
/ j
difficult
noreasy
for you but.. ....

C. Make the patient understand that the condition/situation is serious by

giving a clear explanation and/or using an " if '' sentence.

- & ~ ~ ~ ~ Q ~ : L W W E # Q Ugoggles
E you mighBdamage your eye permanently .
If you don't stop smoking you won't' gif%etter

D. Re-enforce the seriousness.

rr;,qht '?:
If you don't ...... yowm~tbe~isk!oE:gettingan infection
a serious disease
seriously ill
muchl.warsa

1
Unfortunately ir:s+:thaanly,thingto,don
X-!rn.afMd, there's no other way.
,

Yes, you'll need to wear safety goggles.

No, you won't be abIe to go to work

E. Make a suggestion and /or inform the patient of hisher rights.

You' ll need to try to reorganise your working hours/ childcare arrangements1 working day
You might. need to talk to yaur husb~~ossJsupervisor

*You can say these in any order.

 4. Explaining the risks

There is a vr -
,htrisk .,. but it's &id. I

/ It & possible our we're loohng at a very sIi~htrisk.

About lin a 100/500/1,000babies react tl ....I

. .
. -reactinths way
. develop a fever

......but it can usually be eased with Panadol.

usually cle by itself in a few days.

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3ii HP
Dealing with a non-comp1iantfresistant patient

Speaking Fluency and pronunciation practice of first conditional

Exercise 1. Practice saying these if sentences quickly and with the correct intonation.

If you take; I%%"'ffiibts

these pills
this medicine
.fg=;
F6d ;d&j$ff .wXdvicq~
a rest
a holiday

smoking-
drinking
worhng so hard
eating so much fatty food
playing tennis
doing so much exercise

exercising
losing weight
cutting down on cigarettes
.~uttirrgdowmon~d~ohd

\\/
Ex.2 Use these prompts to warn a patient of the consequences of their actions. Use the first conditional,

I . If you take too many pills

2. If you go back to work too soon ..........
3. If you forget to take the pill at the usual time ...........
4. If you wear a long sleeved shirt. ........
5+ If you use these eye drops.. .....
6. If you take these iron tablets.. ....
7. If you don't drink enough .......
8. Xf you eat before the operation.. .....
9. If you don't follow the instructions on the packet.. ..
1 0. If you don't have the tooth taken out ,..
11.If you don't get psychiatric help ..............
1 2. If you don 't put your father in a nursing home.. ......
 Giving reassurance

When the patient is worried and the condition is not serious there are a number of things
you need to do.

1. Calm the patient and deflect intemptions so that you can take a history.

2. Acknowledge the patient's concerns and show hidher that you understand.

3. Reassure the patient by telling h i d her not to worry using a variety of phrases and
explain why they shouldn't worry.

4. Explain the risk if there is one

5 . Give advice.

1. CaIming the patient

Try to reIax
Try to stay calm

2. Acknowledging the problem

I can see that you're anxious

worried
concerned

... so it's good that you came to see me.

...so you did the right thing in coming to see me

3. Reassuring

Don't worry
Try not to worry
Try not to get too

There's really no need to worry

...it's a common complaint

conhtion

...it's not as serious as it seems

you might think.
1'11 explain what the probIem is.
Dr Fransiska Hutahaean
87 George Town Road
NEWNHAM, TAS 7248
24 September 2007
Dr B Aritonang
Accident & Emergency Department
Launceston General Hospital
Launceston TAS 7250
Dear Dr Aritonang,
Re : Jason Gurning
DOB : 24 April 2007
This five-month-old baby came to me yesterday with the major complaint of being
unwell with a cold. The investigation showed nothing abnormal except mildly hyperemic
tympanic membranes.
I kept him in my surgery for a while for monitoring. Finally, I sent him home after he was
fed a little by breast milk and looked better. My diagnosis at that time was unspecified
viral infection.
He came back this morning with restlessness through the night and he looked a little
irritable. He refused to feed through the night.
On examination today I found a rise in temperature from 37,1°C yesterday to 37,3°C
today. There was no photophobia or stiffness in the neck.
I am referring him to your department because for an immediate lumbar puncture. I
would appreciate your assessment and management.
Yours sincerely,
Dr Fransiska Hutahaean
Probable grade: B
Correction by Kay.
http://adrive.com/public/51840de2ac91a7edd10dda5628a7097984beba4d829c6e23571ed
18f4529b216.html
April 15, 2008 | Permalink | Comments (0)

Emma Jhonson
Dr Fransiska Hutahaean
87 George Town Road
NEWNHAM, TAS 7248
03-11-1995
Dr B Townsend
Emergency Department Royal Children’s Hospital
HOBART, TAS
Dear Dr Townsend,
I am referring Emma Johnson, 11 years old. She presented first on 24-07-1995 with viral upper respiratory
infection and the possibility of asthma for which she was treated with analgesic and more fluid intake.
Three weeks later she presented again with the major complaint of persistent nocturnal cough. On
examination there was basal wheeze on chest auscultation and her PEFR was 230 l/m. I assessed her as
having probable asthma and prescribed Ventolin puffer 2 puffs three times daily.
A 2 - month review of her condition revealed well-controlled asthma after I commenced her on Becotide
200 mg 2 puffs three times daily and continued Ventolin as required. She has a family history of asthma
and no allergies. Today she presented with a 48-hour history of worsening shortness of breath, wheezing,
runny nose, fever and loss of appetite. Further investigations have shown there was obvious difficulty in
breathing which confirmed by using of accessory muscles. Chest auscultation revealed widespread wheeze
and PEFR resulted in 140 l/m. I diagnosed severe asthma triggered by viral upper respiratory infection.
I would appreciate your further assessment and management of this patient’s condition.
Yours sincerely,
Dr Fransiska Hutahaean
http://adrive.com/public/70705c0d5b483a7cbaf4bd64e32e1f59660ffd9e34d7adefda83a7acfe77df47.html
General Practitioner
Correction by Kay
April 14, 2008 | Permalink | Comments (0)

Dr Fransiska Hutahaean
32 Mephan Street
Maylands, WA 6052
03-10-2007
Mr Peter Murdoch
Orthopedic Surgeon
St.Margaret’s hospital
NEDLANDS, WA 6031
Dear Mr Murdoch,
I am referring Mrs. Judy O’Connor, 80 years old, who has been complaining of pain in
her right hip caused by osteoarthritis. She has been suffering from osteoarthritis of her
right hip for 10 years. This month, her condition has worsened because the pain is no
longer responding to simple painkillers such as Panadol, Brufen or Voltaren Forte. She
could not sleep nor walk for long distance. She could only walk less than 100 m by using
a cane. It has become very difficult for her to take care of herself.
She is overweight ( her weight is 92 kg and her height is 1,60 m ). She has a long history
of type II diabetes mellitus which has been controlled by Insulin and a special diet.
I would appreciate your opinion regarding her future management and would be
interested to know if she would be a suitable candidate for hip replacement.
Yours sincerely,
Dr Fransiska Hutahaean
General Practitioner
Probable grade: B
Correction by Kay, the corrections are in the bold.

Speaking
Introduction
Good morning, Mr/Mrs. X! I am Dr Hutahaean.
- What brings you along here today?
- What’s brought you along today?
- What can I do for you today?
- How can I help you today?
- What seems to be the problem?
 - What seems to be the trouble?
- What seems to be bothering you?
- It’s alright, I am here to help you.
Duration
- When did it start?
- Can you tell me exactly when it started?
- When did it first start?
- When did it happen?
- How long have you had it?
- How long have you been suffering from this problem?
- How long have you been feeling like this?
- How long has it been bothering you?
- How long has she/he been like this?
- When did she/he start complaining about these symptoms?
- When did she/he start showing these symptoms?
- When were you first diagnosed with hypertension?
- When do you get it?
- How long have you had the cough?
- How long have you had the pain?
- How long have you been suffering from Diabetes?
Details on what happened
- Can you describe it to me?
- Can you describe how she fell?
- How did it happen?
- Tell me what happened?
- Can you describe what happened?
Location
- Where does it hurt?
- Can you tell me where the pain is?
- Can you tell me where it hurts?
- Where do you feel sore?
- Where does it feel sore?
- Tell me where the pain is?
- Show me where the pain is!
- Which part of your body is affected?
- Can you show me where the pain occurs?
- Is it painful for you?
The quality
- Is the pain dull or sharp?
- What is the pain like?
- What kind of pain is it?
- Can you describe the pain to me?
- How severe is the pain?
- Is it continuous or does it come and go?
- Does it occur all the time or just now and again?
- Does it feel numb at night?
 - Does it wake you at night?
- Does it affect your work?
- Did it come on suddenly or gradually?
- Does anything special bring it on?
- What seems to bring it on?
- Does anything make it better / worse?
- Is there anything that makes it better/worse?
- Does anything relieve it?
- Does it come on at any particular time?
- Does it spread to anywhere else in your body?
- Apart from what you’ve told me, do you have any other symptoms?
Other Symptoms
- Do you have any other symptoms?
- Apart from your ( headaches ), are there any other symptoms?
- How about ( a cough, a runny nose, vomiting, swelling, pain ,etc)?
- Do you have ( a cough, a fever , etc )?
- Do you also suffer from (a runny nose, etc )?
- Has he developed ( a cough, a fever , etc )?
- Are there any signs of ( a fever, etc)?
Medication
- Have you done anything about this?
- Have you taken anything for it?
- What have you done about this problem?
- Did you take any painkillers?
- Did you put (a cold pack) on it?
- Did you give him Panadol for his fever?
- How often do you give him Paracetamol?
- How often have you been giving him Paracetamol?
- Did it help?
- How often do you take the tablets?
Habit/Lifestyle
- Do you smoke?
- Do you smoke much ( a lot )?
- When did you start smoking?
- How many cigarettes do you smoke everyday?
- Have you ever considered stopping smoking?
- Have you ever considered giving up cigarettes?
- Have you ever thought about quitting?
- Have you ever tried to quit?
- Do you drink alcohol?
- How often do you drink alcohol?
- Do you exercise regularly?
- How often do you exercise?
- Do you get much exercise?
- How much exercise do you do?
- What kind of exercise do you do?
 - Do you live alone?
- Are you under any stress at work?
- Are you stressed at work?
- What is your height? And your weight?
Medical History
- Can you tell me about your medical history?
( including : surgery, allergies, medication, other particular diseases)
- How have you been keeping up to now?
- Are you on any medication?
- What tablets do you take for your ( blood pressure, Diabetes, etc)?
- How often do you take the medication ( the tablets )?
- Is his/her immunization up to date?
- Are her immunizations up to date?
- Is she up to date with her immunizations?
- Do you have any other particular problems that I should know about?
- Do you have any other problems that I should know about?
- Have you had an operation before?
- Have you had an accident recently?
- Have you ever been admitted to hospital?
- Has there been any change in your health since your last visit?
- Have you ever experienced ( had ) anything like this
( headaches, sore throat, etc ) before?
- Have you ever checked up on your general health?
Family’s Medical History
Can we talk for a minute about your family?
- Has anyone in your family suffered from any particular diseases?
- Does anyone in your family suffer from the same problem?
- Are your parents alive and healthy?
- How old are they?
- How about your siblings?
- What did he/she die of?
Examinations
- I”ll need ( I’m just going )to examine you, will you come over the bed ( the couch ) ,
please?
- I”ll need to examine him/her, will you put him/her on the bed ( the couch ), please?
- I’m just going to ( test your reflexes ).
- I’d just like to examine ( your mouth, his eyes, etc).
- Now, I’m going to ( tap your arm ).
- I’ll just check your ( blood pressure, pulse rate, etc ).
- Would you strip to the waist, please?
- Can you put your hands on your hips?
- Could you ( bend down and touch your toes )?
- Now, I just want to see you ( walking, etc ).
- Lift it up as far as you can go, will you?
- Let me see you (standing)!
- Will you hop up on the bed, please?
 - Can you look at the ceiling, please? I need to examine at your conjunctiva!
- I’ll have a look at you, will you hop up on the bed, please?
- Take your top off and slip your trousers down, please!
Other Examinations
- I need to order some blood tests to confirm my diagnosis and exclude other possible
diagnoses. How does it sound to you?
- I need to order blood tests to check on your general health.
- I need to send you to the radiology department to have an x-ray done. Is that alright with
you?
Explanation of the findings
- Your temperature (your pulse rate) is within the normal range.
- Your blood pressure is ….. over ……
- Your lungs (your heart sounds) sound normal.
- From the physical examination findings and from your description, I’d say you have (a cold,
conjunctivitis, bilateral cataracts, etc).
- After examining him and from your description, I’d say he has (diarrhea, croup, greenstick
fracture, etc).
- You have diarrhea and you are a little bit dehydrated.
- I think you are anemic.
- I found a wheezing sound in your lungs.
Explain the disease/the condition
- ( Diarrhea, Influenza, etc ) is a common disease in ( children, people, men, etc ).
- It is a common condition in newborn.
- It is an infection caused by ( a virus, a bacteria, a parasite, etc ).
- …. It causes your symptoms
- Most children suffer from this mild reaction.
- That’s why you can not (see clearly, breath well, etc).
- The good news is it is a self limiting disease so it does not need any special treatment.
- I have to put him/her on a course of antibiotics.
- I will prescribe medication but first of all I want to talk to you about some lifestyle changes
that you should make.
- I will prescribe antibiotics to clear up the infection.
- I will write ( give ) you a prescription for antibiotics and symptomatic drugs
- You do not need to worry, it will resolve itself in (two, three, etc) days.
- Don’t worry, It won’t develop into ( epilepsy, cancer, glaucoma, etc ).
- You won’t become blind.
- You won’t become addicted to it.
- Unfortunately, there is chance that your weight will balloon again.
- You just won’t be able to breathe easily.
- You are more susceptible to other diseases.
- You are prone to other disease.
- I am afraid that ( the operation has not been successful ).
- I am sorry to have to tell you that ( your son has bone cancer, your father has little chance of
recovery ).
- I won’t give you any medication for that because it will resolve ( clear up ) itself.
- If the temperature rises quickly, ….
 - This condition is irreversible but we can stop the progression by smoking cessation.
- Look on the bright side.
- You have to go cold turkey.
Giving advice
- I recommend that you (take your tablets regularly, eat more nutritious food, quit smoking,
etc).
- It will be better for you if you go back to doing some exercise.
- I strongly suggest that you start exercising regularly.
- I strongly suggest you start a diet.
- Let me make a suggestion. Why don’t you try to (stop smoking, cut down your fatty foods,
etc).
- You really need to try to change your eating habits.
- Avoid ( smoking situations, substituting alcohol for cigarettes, etc ).
- I think it will be helpful if you ( stay at his bed side, etc ).
- It would be best if he rests.
- I advise you continue breastfeeding him.
- Try to (give him/her sips of fluid, etc).
- Try to keep your leg elevated.
- Give him/her (soft food after 24 hours, etc).
- It’s better to (give him/her plenty of fluid, etc).
- Make sure you (you give him/her the full course of antibiotics, etc).
- You should/must (give him/her Gastrolyte whenever he passes a stool, etc ).
- We will do it ( take )one step at a time.
- If you bandage/ dress it properly, there shouldn’t be any problem.
- You won’t become addicted.
- It will not affect your vision.
- I don’t recommend you do that.
- You will have to cut down on fatty foods.
- Well, I see your point but…..
- Yes, but you must start to….
- I ‘m trying to suggest what is best for you.
- I’m sure that you do not need to worry about that.
- If you don’t follow this advice, you’ll end up far worse and you’ll have to be admitted to
hospital.
- I have to refer you to the…..specialist.
- I will write a referral letter to the…..specialist.
- If he does not settle in 3 days, please come and see me again.
- If you are not improving in 5 days, please come and see me.
- If it doesn’t clear up, please come and see me again.
- If he has difficulty in breathing, seek help.
- If there is no improvement in 3 days, you can come and see me again.
- Do you have any questions to ask me?
- Do you have anything to ask me?
- Any question at all?
- We can consider getting rid of ( removing ) the tonsils if……
- It will depend on what the findings of the orthopedic surgeon are.
 - This is your prescription, your referral, your pathology slip and your radiology slip. Please
make an appointment to see me in 2 days so I can review your condition and your results.
- I will give you a certificate to stay home for 3 days.
- It was nice meeting you. Bye.
- If you have private medical insurance you will probably have the operation within 12
months or you can go to a public hospital and be put on the waiting list.
- If you take out private medical insurance, you will be able to have the operation in 12
months time, but if you get put on the public hospital waiting list , it could be 2 years or more
, before you finally have the operation.
- Elevate your leg on another chair.
- Don’t put any weight on your leg.
- You have to refrain from sporting activities 3 weeks after you recover.
- I’ll get the ball rolling.
- It’s probably better if you take ( have ) a holiday so you can contemplate what you might
like to do in your future.
- You will need to have strong motivation to do that.
- I could refer you to weight watchers where you can support and encourage one another to
lose weight.
Reassuring
- Mm, I can understand how you feel …………
- Yes, you must be very worried ………..
- I can understand your concern ……….
- Yes, that’s understandable …..
- It’s quite natural to be worried about that ………..
- Yes, people often get anxious about that ……….
BUT
- I’m sure we can sort this problem out.
- Please try not to worry about that.
- He’s in good hands.
- He needs your support.
- Let’s try to work together to solve this problem.
- I’m sure we’ll soon see an improvement.
Dealing with patients who are upset/ angry
- I understand that you are upset but please try to remain calm.
- This must be a very difficult time for you.
- I can see that you are upset. Why don’t you tell me what’s troubling you?
- Please tell me what’s wrong and I ‘ll see what I can do to help.
- I’m sorry you feel that way, but there is really nothing more I can do.
- It’s perfectly natural for you to feel angry about this, but….
- Rephrase the patient’s statement e.q. :
Patient : “ I insist you let me see my child immediately.”
Health professional : “ So, you would like to see your daughter as soon as possible.”
Cardio + HT
- Do you ever have palpitations?
- Do you ever have any chest pain?
- Are you aware of your heart beating fast?
 - When do you get your chest pain?
- Does the chest pain occur more commonly when you are sitting in a chair or when you are
walking?
- Have you noticed that it is accompanied by anything else?
- What do you do when you get your chest pain?
- Does position make any difference to your chest pain?
- Do you ever get chest pain at night?
- If you take a tablet how quickly does this help relieve the chest pain?
- Does it spread anywhere else in your body?
- Do you ever become dizzy?
- Have you ever fainted?
- Before you actually faint, are you aware that you are about to faint?
- Do you actually fall to the ground?
- When you feel faint, are you able to steady yourself against the wall or an object?
- Do you sometimes feel faint when you get up from a chair or out of a hot bath?
- If you have palpitations, how would you first become aware of them?
- Does it come on gradually or in some either way?
- Are there any other symptoms that you notice when you have palpitations?
- When your heart is beating fast, can you tell me whether it is beating regularly or
irregularly?
- How long have your ankles been swollen?
- Are they swollen first thing in the morning?
- How far can you walk?
- Can you walk as far as you could five years ago?
- How many flights of stairs can you climb?
- If you have a fainting episode, can you describe the sequences of the events leading up to it?
- How long have you been suffering from hypertension?
- When were you first diagnosed with hypertension?
- What do you take for your hypertension?
- How often do you take the tablets?
- What was your latest blood pressure?
- What was your highest blood pressure?
- Do you have headaches in the morning?
- Do you suffer from shortness of breath?
- When do you usually get it?
- Didn’t you know that you have hypertension?
Cough
- Do you have a cough?
- Do you suffer from a cough?
- Have you a cough?
- How long have you had a cough?
- What kind of cough is it?
- Can you describe the cough to me?
- Do you bring anything up?
- Do you bring up any phlegm?
- Can you describe the phlegm to me?
 - Is it frothy, watery or….?
- What color is the phlegm?
- Have you noticed any blood in your phlegm?
- Is there a lot of blood or just streaky with blood?
- Is it like a dog barking or like a whooping cough?
- How much do you bring up?
- Does anything special bring it on?
- When do you usually get it?
- Does any position make it worse?
- Do you get a pain in your chest when you cough?
- Are you wheezing?
- Have you been wheezing?
Skin
- Do you have any problems with your skin?
- Have you ever had a skin rash?
- Any itching of the skin?
- Are you using anything on your skin?
- Do you feel itchy?
- What medication are you using?
- Do you use sunscreen, sunglasses, long sleeves, hat,, if you go out in the sun?
- Can you describe the lump to me?
- Have you noticed any change in the color, the shape, the size, the surface of the lump or the
mole?
- Does it itch or bleed?
Fever
- Do you have a fever?
- Have you a fever?
- Have you developed a fever?
- Did you measure the temperature?
- How did you do that?
- What was your last temp?
- What was his temp?
- Did you sponge him/her?
- Did you give him/her Paracetamol?
- Did you sponge him?
- Does he sweat, chill or convulse?
- When did the fit start?
- How many times did he have the fit?
- Can you describe the convulsion to me?
- Has he ever had convulsions before?
- Has he ever convulsed before?
- What did you do when he convulsed?
How long did he convulse?
- Can you describe how he/she convulsed?
- Do you lose consciousness when you convulse?
- Have you noticed any urine loss when he is convulsing?
Diarrhea
- Do you suffer from diarrhea?
- How long have you had it?
- How long have you been suffering from diarrhea?
- Can you describe the stools to me?
- How many times have you been to the toilet?
- How often do you have bowel motions in a day?
- How many times a day do you have a bowel motion?
- How often do you change his/her nappy in a day?
- Have you noticed any mucus or any blood in the stools?
- Is it mushy and greasy?
- Do you have a problem with flatulence?
- What did you have to eat before you have diarrhea?
- What seems to bring it on?
- Can you think of anything special brings it on?
- Are you always thirsty?
- Do you pass urine frequently?
Vomit
- Do you vomit?
- Do you throw up?
- How often do you vomit in a day?
- How many times have you vomited?
- Can he/she eat or swallow anything?
- Can you keep the food down?
- How about nausea, flatulence or bloating?
- Have you been vomiting?
Vision
- Do you suffer from blurred vision?
- How long have you been suffering from blurred vision?
- Do you have any problems with reading, watching TV, driving at night?
- Do bright lights bother you?
- Have you noticed any discharge from your eyes?
- Is it a pus or bloody discharge?
- Is the discharge pus or blood?
- Do your eyes feel gritty?
- Do your eyes feel itchy at all?
- Have you ever injured your eyes?
- Have you had an operation on your eyes before?
- Have you had an eye operation before?
- Have you noticed any floaters?
Passing Water
- Do you have problems in passing water?
- Have you any trouble with passing water?
- Do you feel pain when you pass water?
- Is there a burning sensation?
- Is it burning in the beginning, middle or the end of urination?
 - Is the difficulty when you start passing water, throughout or afterwards?
- Do you feel relief after you pass water?
- Is it a normal flow when you pass water?
- Have you a weak stream?
- Have you noticed any blood or stones in your urine?
- Do you wake up at night and feel the urgent need to urinate but then only pass a small
amount of urine?
Pregnancy
- Is this your first pregnancy?
- How many children do you have?
- How old are you?
- How long did your pregnancy last?
- Have you delivered your baby early ( at full term )?
- How far into the pregnancy were you?
- What weeks are you in?
- How far along are you?
- Have you tested with pregnancy kit?
- Did you have any trouble during your pregnancy such as raised blood pressure?
- Was labor induced or did it start by itself?
- How long were you in labor?
- Did you have a normal delivery /forceps or caesarian operation?
- Have you had any miscarriages?
- Have you had any abortions?
- At what stage of pregnancy were they?
- Did the obstretician tell you the reason why you have miscarriages?
- Have you had your blood checked for TORCH ( Toxoplasmosis, Rubella, Cytomegalovirus
and Herpes ) ?
Hearing
- Does he have an earache?
- Do you suffer from earache?
- Does he/she have a pain in his/her ears?
- Have you noticed any loss of hearing?
- Does she/he respond to sound?
- Does she/he pull at her/his ear?
- Have you had an infection/ an injury/ an operation in your ears before?
- Have you noticed any fluid ( blood, pus ) drain from his/her ears?
Diet
- Typically, what sort of meals do you eat?
- Describe your eating pattern!
- What would you usually eat during a day?
- Tell me what you had to eat yesterday!
- Do you feel that you have an excessive appetite?
- Have you noticed anything special brings it on?
- Have you noticed any loss of appetite?
- How often do you usually eat?
- Do you eat regularly?
 - How about snacks, soft drinks, cakes?
- Tell me about your diet!
- What have you done to try to lose weight?
- How many kilograms have you gained recently?
- Do you know what your weight now?
- How about your height?
- How are things in your relationship with your spouse?
- Do you feel your weight causes difficulty in your sexual life?
Depression
- Are you feeling lethargic?
- Have you been feeling dizzy, tired or depressed?
- How long have you been feeling like this?
- What do you think the matter is?
- Can you think of any reason why you feel depressed?
- Can you tell me about your social life?
- Where would you rate yourself on a scale between 1 to 10?
- What are your energy levels like?
- What is your appetite like?
- Can you sleep easily?
- Do you feel guilty about anything?
- Do you feel that life is worthwhile?
- Do you feel that you are coping well?
- Do you take recreational drugs?
- Do you drink alcohol? Tell me about it!
- Has anything changed in your life?
- Have you ever felt / been depressed before?
- Has anyone in your family suffered from depression?
- Have you ever thought of ending your life?
- Have you ever tried to end your life?
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April 12, 2008 | Permalink | Comments (0)