Note these expres...ions u::;ed beltveen doctors in discllssing a diagnosis.

Cerla;n Fairly cel1aifl Uflcertwn

Yes is seems might

must could
probably may
likely

No can't unlikely possibly

definitely not
exclude a possibility
rule out

The li sten in g extract in Tasks 1 and 2 provides little information on

wl'lkh to base our diagnosis. We are still uncertain . We can sa)':
- TIle patient might have cervical spo ndylosis.
- Cervical spondylosis is a possibility.
The findings on examination provide more evidence. Some diagnoses
become more likely while o ther s become less likely. We can say:
- He seems to have temporal arteritis.
- TIler<: is no 1H.."Ck stiffness. It's unlikely that he's got cervical spondylosis.
The results of the investigations providf' stronger evidence for ou r
final diagnosis. We can say:
- A mised ESR makes temporal arteritis uery likely.
- Normal MRI scali excludes a space-occupying lesion.
- He can't have a space-occupying lesion.
Finally. followin g the biopsy. we can say:
- He mustlm"e temporal arterit is.

Work in pairs. Try to make a diagnosis on the basis of th e informntioll

given on each patient. The exercise is in three stages. AI each stage you
H are given mo re information to help you make a final diagnosis. Discuss
you r diagnoses at each stage.
STAGE A

I The patient is a 26-year-old woman complaining of swelling of the a"'lkles.

2 The patient is a 5-year-old girl with a petechial rash.
3 The patient IS a 28-year-old man with headaches, sore throat and enlarged
glands in the neck
4 The patient is a 40-year-old woman complaining of nausea and episodes of
pain in the right hypochondrium.
5 The patient is a 49-year-old man exhibiting Raynaud's phenomenon and with
difficulty in swallowing.
Do not look ahead until you have considered a diagnosiS for each I>atient.
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 STAGE B
Pregnancy test is negative. Chest X-ray IS normal. Pulse is normal. The liver is
not enlarged.
2 Both ankles, the lett elbow and the right wrist are s'NOllen and painful. The
history shows no ingestion of drugs. Bone marrow IS normal.
J I he spleen is palpable and there is a maculopapular -ash all over.
4 The pain is associated with dietary indiscretion. Murp1Y'S sign is positive. There
is mild jaundice.
5 The patient e)(hibits cutaneous calcinosis and has difficulty in breathing.

Do no t look ahead until you have con sidered a diagnosis for each pat ient.
SI:AGE C

I Five day fecal fat collection is 15 mmoi/i. Jejunal blo:Jsy is normal. Lab slick
urinary protein test show s pro tein ++. Serum total protein is 40 gil.
2 The rash is on the buttocks and extensor surfaces of the arms and legs.
3 WBC shows lymphocytes ++. Monospot is positive.
4 Lab tests show alkaline phosphatase 160 units/I. USS shows a non-
functioning gall bladder.
S The patient's face is pinched.

Section 2 Explaining a diagnosis

Look back al Task I in Unit 3. p. 28. In that extract a doc tor was examin ing
a patient, M r Jameson, suffer ing from leg and bac k pain. An MRl scan of
the lumbar spi ne confi rmed t hat the patient had a prolapsed
inter vertebral disc . T hink about how you would ex plain t his diagnosis to
the patient. Wr ite down the poin ts you would include in your explanation.
List t he pOi nts in the bes t ord er. For example:
I how serious the problem is

You wi ll hear th e d octor explaining the diagnosis to the !>utient. As you

li sten , note th e points covered and the order in which t hey are dealt wit h.
Th en compare th is with you r ow n li st In Task 6.

When exp lainin g a diagnosis , a pal ient wou ld expect you 10 answer
I he following question s:
1 What's the cause of my problem?
2 How serious is it?
3 What are you going to do about it?
4 What are the chances of a full recovery?

68
In Unit 7. we will deal w ith questions 3 and 4. Here we will look at some of
the language used to answer questions I and 2.

In explanations It is important to use straightfor ward. non-speciali sl

language with only such detail as is importan t for the patient 's
understandi ng of the problem. The language of thp textbooks you may
have studied Is clearly unsui table for patient explanation . Compare this
ext ract with the recorded explan ation in Task 7.

Herniation of part of a lumbar intervertebral disc is a common

cause of combined back pain and sciatica ... Part of the
gelatinous nucleus pulposus protrudes through a rent in the
annulus fibrosus at its weakest part, which is postero-Iateral ... If
it is large, the protrusion herniates through the posterior ligament
and may impinge upon an issuing nerve to cause sciatic pain.
(J. C. Adams , Ou/line of Orrllopof'riics, 10th ed. (Edinburgh: Churl.:h llJ
livings tone, 1986). p. 21 7.)

You can make sure your explanations are easily understood by avoid ing
medical terminology where possible and defining the terms you use in a
simple way.
Note how the doctor describes a disc:

- The disc is a lillIe pad of gristle which lies between the bones in your spine.

Write simple explanations for pati ents of these terms. Compare your
explanations with those uf other students.
I the pancreas 5 arrhythmia
2 the thyroid 6 bone marrow
3 flbrOlds 7 the prostate gland
4 emphysema 8 gastro-oesophageaJ reflux

Explanations often involve describing causes and effects. Look at

these examples :

Cause Effec/
'"'"
bend the knee the tension is taken o ff the nerve m
straighten it the nerve goes taut x

We can link a cause and an effect like this:

"
- If we bend tile knee. the tension is taken off the "erne.
- If we straighten it, the nerve goes Jaul.

Nute thai both the cause and effect are in the present tense because
we are describing something whic h is generall y true. u
'"
69