中醫臨床技能實訓-天津中醫藥大學【周桂桐 等】（101講完整版） P97 - 100-101中醫國際接診能力實訓2-2

Good afternoon everyone Today we will continue our study on good practice of communication skill in English for medical practitioner And today we will learn communication skill in examining a patient At the end of this unit You are expect to be able to give effective instruction in a patient friendly manner First of all, put yourself in the patient's shoes Asking by yourself Put yourself in patient's shoes How do you feel before being examined? You just think when you first time go to hospital First time see doctor Before being examined How do you feel? Who can give us adjective? Ask by yourself Such like anxious, frightened, nervous, embarrassed Overexposed, humiliated Is right? Yes Patient are likely to be afraid a doctor who they don't know Especially even more anxious in the hospital Because of unfamiliar environment In physical examination The patient may be asked to undress if necessary They may feel overexposed, humiliated and embarrassed Is that right? Yes Then as a future doctor What communication skill can you use to reduce patient's nervous, fear and embarrassment? To achieve a patient friendly instruction That is the question we should solve today Now you have a chance Prefers as doctor I give you one case Your patient is female She suffer from bellyache You will give her physical examination Now who can give the patient an instruction? Now I will translate his instruction 把鞋脫掉 躺在牀上 把你的內衣撩起來 把你的手放在兩邊 放鬆 The doctor's instruction is filled with impressive And may be too direct And come across as commander rather than as instruction This form is a little abrupt And may not be considered polite Is that right? How do you feel? Then what should we do improve the instruction? Now let's listen to one video You should pay attention Then you can got new idea If you could stand up for me please Julie I'd like you first to try to bend your left knee Very gently Like this That's right As if you're trying to touch your bottom with your heel Fine, thank you You can put your foot down now Okay, I'd just like you to lift your left leg as high as you can That's it How does that feel? Actually, it's quite painful in that position Please, if you could take off your shoes and your tights And sit back up on the examining table Do you need any help getting up on the table? No, I think I can manage that okay Right Would you mind just lifting your skirt over your knee? Yes, yes, the left one Thank you Now I'm gonna examine your knee Just relax your leg I'm gonna press on your knee And I want you to tell me if it starts to feel uncomfortable Or if there's any pain Okay Using direct language for instruction Can you tell me what these words are? Could Just like Would you mind Want Yes They are model Then why do you think the doctor tend to use indirect language for instruction? Why? Think about it Direct language, too direct As a commander rather than an instruction Erupt and in plight Indirect language soften the instruction It comes across more as a request More plight, less anxiety and fear Now with indirect language Let's practice this again So Would you mind take off your shoes? And just like you lay back Please relax I want you tell me if it starts to feel uncomfortable Would you mind rest your arm by your side? Okay I think you can feel this time It's really much better So The first communication skill we learn today To use indirect language To make your instruction less aggressive and more plight Okay Now let's shift out attention to the second one As a doctor How can you give instruction in a patient friendly manner Actually include three aspects The first part use indirect language We already finished Second aspect We should use simple or informal language We can see here ABCDE 5 ABCDE These five words belong to medical term If as your major Is the medical As a future doctor Actually you know these five word meaning But it very confuse for your patient And give more anxiety to them Then we can during the instruction So we should As medical term change into simple term Such like Number A Circumduction Means make small circle with your arm We can show just like Like that B Adduction The simple term means rotate Turn inward 內旋 C Pernation Pernation means Turn your palm down Palm 手掌 Inhale Inhale means breath in 吸氣 Exhale means breath out This word are some medical term of movement So during the instruction During the check physical examination for the patient We should use simple or informal language You'd better to use informal or simple language Instead of formal or professional medical term in instruction Read the dialogue And underline all the instruction written a formal style The first one is done for you Replace the formal words with following less formal Inquivalent Such like Sit up Breath in Nose Breath out Present complaint is asthma Ok Miss Wang You can as doctor I'm as a patient So we can make dialogue Please Mrs. Daniel Can you sit up for me please I can see you are having difficulty today I'm just going to listen to your chest Sure Good Now I want you to breath through your nose Breath in deeply That's it Now breath out And again Breath in and breath out Good We finish the second one Now we will learn the third communication today It's softener Read aloud the following instruction Then decide what effect the word just the creative There are three groups A B C Each group have two sentences One sentence has just We use softener One sentence just the normal one Ok Miss Zhao Can you please read for us I just like you to lift your leg I like you to lift your leg One more examination left Just one more examination left It looks like a mineral fracture It just look like a mineral fracture Yes Very good The following instruction sounds a little abrupt Please soften Miss Wang Can you put some softer word like just Then to read it Ok please I just want you to lift your left leg Just relax your leg I'm just going to feel your shoulder for any fractures It just looks like a mineral fracture Ok You've done very good job We put just into sentences Make more softener And also patient feel more comfortable Here have a one very famous sentences Come from love day It is important to use softener such as just To establish and maintain good interprofessional relations In English speaking cultures An absence of softener can convey a lack of the warmth and the track That sentences we should remember During the use check patient So we have to use softener such like just We use very often Now I will see one patient Watch the example Pay attention to communication skill The doctor use physical examination This patient is foreigner She second time to come to see me First time she suffer from high fever This time maybe she still have some uncomfortable place Such like cough or stomach ache So I will ask some question Especially you should pay attention How can I examine for the patient Hi Monica Hi Nice to see you again Nice to see you Dr.Wan Have a seat please Thank you How do you feel since the last treatment Because last week you come see me again You suffer from high fever So how do you feel now Well I'm feeling better But the cough is still killing me I still feel a lot of cough Like Something like that But sometimes they also came with food So I feel like nausea And the sputum is like with food inside Sometimes I have stomach ache Stomach ache too So I'm not feeling really well So I want you to If you can give me something more OK no problem But I Would you mind I will check you again OK So yeah Would you mind I take your pulse Yes Take off your watch please OK This side is not bad OK another hand please OK When you do some exercise Do you feel short breath Yes sometimes And a lot of sweat Yes sometimes Recently I feel that Before was not like that OK Because I feel your pulse It's lung pulse It's a little weaker than another organs OK Would you mind show me your tongue please Yes OK So your cough During the cough have some phlegm Sometimes I have phlegm Yes usually I have phlegm OK after give you some medicine You take it So you feel better But just the cough left And with some phlegm And stomach ache And throw up with the food Before last week I feel much better But I still have that phlegm And nausea and stomach ache OK So would you mind I just like you to lie down on the back And I will check your tummy And also will listen your lungs OK First would you mind take your shoes please OK Before we take physical examination For the foreign patient And also of course the Chinese patient too So we should washing hand first Make our hand clean Then we get the examination Then we should cover something Cover something Use the blanket or clothes To cover the patient private part And also make patient more comfortable If in the winter time They can feel warm not feel cold If feel cold more nervous This is the second step Then now we should to do some Because this patient suffer from belly ache Stomach ache And during the cough vomiting nausea So we should ask the patient to do some things Would you mind lift up your coat please Yes Because now I feel my hand is cold If I direct to touch the patient So feel uncomfortable So that's why I should warm my hand first Or I can use the hot water to warm my hand Then I will touch or to do some examination OK How do you feel here There is OK How about here Also OK There is pain OK Here is the stomach area OK Please bend your knee Because I want to check your This side is more easy for me Compare left side and the right side Which side is more uncomfortable I think the pain is more like in the middle In the middle Because last week the main problem is cough And this week you get stomach ache And throw up with the phlegm OK Would you mind I use the stethoscope To listen to your lungs OK So because and also it's cold weather So we should warm the stethoscope first Then we can listen the lungs Please take your breath deeply OK Breath in please OK Breath out please OK The sound is not big problem OK Sit up please I will listen your back of your lungs You to do take your deep breath again please OK That's it That's all Thank you Yeah So could you take back to the table again So I will prescription some herbs to you But not don't worry not big problem Just a little infection Maybe got some virus something like that Don't worry I will give you prescription OK Thank you so much OK Through my show we can understand How to take physical examination for the foreign patient Can you understand now Yes Communication skill has three aspect The first one can you remember Indirect language The second aspect Simple or informal instruction The third aspect Softness Yes very good OK Let's now let us do role play So I will give you some case I will give different case And all class separate or divide five groups Maybe four or three students can one group And also we have a three teachers Teacher Yang Teacher Tu And if any questions you can ask us And also I will give you table of progress check The end of this class you will hang it in OK So now let's begin the role play OK 分組 OK And here I have some cases for you to choose Your practice should be based on these cases And OK It's yours OK you choose it You choose it So at the end of the role play Please evaluate their performance So if you think he or she is professional You just give a tick And if you think he or she need more work on this item Just give a cross Understand Yes OK now I give you several minutes To discuss your case with your partner And then we will begin the role play Anything Yes OK Besides the language point In the table don't forget the three things You learn from the doctor in the video Washing hands OK We count the body of the patient Right And warm the stethoscope Before you give the patient an examination Yes And during your interview Try to use some language to encourage your patient Such as great, thank you, very good, etc. OK Now are you ready Yes OK now let's begin Who is the first group OK now Mr. Wang isn't it Yes Come in and help me Why did you make me so long Thank you doctor You know I was sitting there for an hour Oh I'm so sorry So what's wrong with you today Last night I fell from the bed And I think there is something wrong on my arm All right let me see You need to have a few tests first just in case So would you please take off your coat for me OK OK Thank you Please be careful So please sit on the edge of the bed Oh yes Now I'm going to have a test of your wrist All right Oh yes Fine Now I'd like you to bend your wrist upward Just like this OK OK Like that Yes be careful Is that hurt No not yet Fine And then the reverse Please downward Fine great And then I'd like you to rotate your wrist Internally and externally OK External right Yes yes Fine it seems that wrist is strong enough And then let's come to elbow Now I'd like you to flex your elbow Yes towards yourself Please be careful OK Is that hurt No not yet Fine and then stretch it Yes Fine It seems that there's nothing wrong with your elbow So at last let's check your shoulder Now I'm going to feel your shoulder for any fractures This might be a little painful And I'd like you to tell me if it starts to feel uncomfortable Is that all right Yes Oh it's fine All right fine fine fine Now one last examination left I'd like you to lift your arm Yes try your best to lift your arm And try your best to reach the mirror Is that all right Yes OK OK OK Is that hurt Fine fine fine All right please stand up for me All right and put your arm by your side Fine We are going to have some further examinations Such as x-ray OK Just in case you know Yes All right That's all OK very good So what do you think about their performance What do you think What is your evaluation So do they use interact language Yes They used Can I ask you to do Yes Do you mind doing something You could etc. That's very good But you forget something Does she greet her patient Good morning Mr No You forget it So next group Pay attention to this You have to greet your patient To show your blindness Yes And one sentence I think it's somewhat inappropriate You ask your patients What's wrong with today right Yes Do you think it's appropriate No No OK So you'd better use what Instead of what's wrong with you You'd better use what What can I do for you And May I help you You need my help Yes It's much better OK And yes I'm afraid you forget to wash your hands Yes Right Forget to wash your hands And yes And do you soften and adjust No Forget to use soften and adjust So other students When you do the role play Pay attention to these points The soften and adjust And wash your hands Before the examination And greet your patient Any sentence May I help you What's wrong with you OK So good Very good Thank you OK Who is the next one This way OK Come in please Good morning Miss Tang Good morning doctor Sit down please Thank you doctor You're welcome Oh Sorry to have kept you Waiting such a long time Miss Tang It's OK doctor Now What can I do for you I really think I have hurt my right knee this time Oh Well Let's see I will need you to do a few examination first Just in case OK All right OK Follow me please Yes Here please Thank you You're welcome Oh Could I ask you to take off your shoes OK And If you could recline the bed And flex the right knee It will be better Softly Yes And If you don't mind I'm going to feel your knee for any moments Now It might be a little painful I'd like you to tell me If it's starting to feel uncomfortable Right Yes OK Let's begin Does it hurt No OK Do you feel any painful Yes Just a little Well Now What I want to do is to examine Whether there is any water accumulated here OK Yes Let's begin Ouch Oh Right That's fine OK And now Gently then Just bring your knee up to the chest Like that Yes Very good Softly Slowly OK That's great And now Extend your leg again Yes Slowly Yes OK That's very painful Oh where? Can you point it Here OK I got it Thank you Yes Slowly down Slowly Well It looks like There are some problems in your right knee Just in case You'd better to take an X-ray Do you need any other help I can do it It's not better That's all Yes OK Can I help you OK Very good So what do you think About their operation Better Or worse Better Yes You had your attention to the Let me see What can I do for you The sentence And The doctor Greet her patient With good morning Right And You Don't forget to wash your hands Yes Very good And But how about your intonation Oh Do you use your Writing tongue In your questioning I just forgot OK So That's the point You should remember Use writing tongue In your questioning It may sound much better Or polite Right Thank you OK Next group Yeah Good morning doctor Good morning Mr.Liu Yeah it's me Come in Yeah Thank you I'm so sorry to have you waiting for me That's OK Thank you Now may I help you Yeah I just feel hard in the room I see I just need to do some test first Just in case Before I examine your abdomen You might feel You might want to go to the toilet I need to examine you with an empty blender Toilet Yeah I have it before I came Oh right Yeah Could you just take off your shoes And lie on your shoulders And lie on the bed OK Yeah Now If you are comfortable Could you just bring your knees up And put your both feet on the bed Like this Yeah very good Now Could you please upper height Upper coat in the height OK Is that OK Yeah I'd just like you to put your arms at sides Like this Yeah Now I will press down your abdomen You might feel mildly uncomfortable I want you to tell me If you feel any uncomfortable Yeah OK Very good I'm sorry Here Yeah Now what I will do is to examine your liver And gallbladder Please breathe in and out regularly OK It's hard It's so hard I'm sorry OK I know Please sit down What's wrong with me It's hard to say But don't worry Is that very dangerous It seems that there is an infection in your gallbladder So I'd better give you a BRT just in case OK Thank you doctor You're welcome OK good So what is your evaluation to their performance Great Great OK What is your idea Come here They just use some light It's just sound softly OK So how do you translate this sentence 把衣服撩上來 剛纔你那句話說的 Please hold your clothes in high Yes It's much better 如果你感覺不舒服 你告訴我 你那句話怎麼說 Please I want you to tell me If you feel any uncomfortable Any uncomfortable Not able Able事情 這些細節 Pay attention to these details OK Anyway very good I think you have done a great job The three groups Thank you very much No problem OK now let's begin our exercise in this room So first of all We shall be divided into several groups And one student will be the doctor And another student will be the patient Who's suffering from some kind of illness So first of all I have a table for you to do If you're in here Each one will have it You should do some evaluation work Of the doctor and the patient For their performance All right You should observe their performance carefully And then you should make marks Whether they did it very professional Or it needs more work to do Do you understand Yes OK now let's divide into the groups OK Good afternoon doctor Good afternoon Mr. Cao What can I do for you Oh I just finished a knee operation And I still feel something wrong with this knee OK let me have a look Can you walk to a child like for me All right OK thank you If you could please lie back on the bed OK Oh let me have a look Do you feel painful No OK OK now bend your right knee Oh turn Oh still seems to be causing you a little discomfort Yeah I know Gently then bring your knee up to your chest Oh turn again Oh I'm sorry Now straighten your leg again Good thank you Come here and sit down please Is it still wrong Nothing still wrong The examination is just in case I will prescribe it for you OK What do you think of their performance Now would you please look at your paper And we should give some marks for their performance The first one What do you think of their indirect language use Do you think that they use some indirect languages in their dialogue Yes OK And the second one What do you think of the software just they use in their dialogue Now number three What do you think of their use in simple or informal languages And the final one What do you think of their intonation OK so give the marks for their performance Now let's do the second group And this time who's turn to be the doctor And who's turn to be the patient Good evening Good evening doctor Is Zhao a patient Yes And what can I do for you How long do you have it For two days I can see you are having difficulties today We are going to try to make things more comfortable for you Can you sit up for me please Sure I'm just going to warm it But you may still feel a little cold And now I want you to infuse your nasal passage What does that mean Breathe in through your nose Oh I see Yeah OK Breathe in please OK breathe out Breathe in please Breathe out Breathe in Breathe out Breathe in Breathe out Breathe in Breathe out Breathe in Breathe out Yeah OK You have infection in your throat So I will give you some medicine But if you still feel uncomfortable You may return as soon as possible OK thanks OK that's very good Now what do you think of their performance Now as you look please look at your paper To give the mark for their performance OK the first one Now what do you think of the language Did they use some indirect language Yes And as for what do you think of the softness Did they use it Yes Anniversary And did they use some simple or informal language In their dialogue Yes Yes of course OK since that the first time when Geling Influenced something inhale or exhale This is a very professional medical term Maybe the patient didn't understand it But I think the second time you did a good job Because you said it has a Breathe in Breathe out It's quite easy for the patient to understand it Yeah that's very good OK now the final group Good evening Mr. Moise Sorry to have kept you waiting such a long time Mr. Mo Thank you doctor You know I've been sitting there for nearly an hour Oh now may I help you I really feel discomfort in my stomach Well let's see I will just need you to do a few tests first just in case That's OK Before I examine your abdomen You might want to go to the toilet I examine you with an empty bladder OK doctor I want just before I came in Well let's get started then If you could just take off your shoes And buckle your trousers and lie on the bed That's all right Very good Now if you are comfortable Yeah Could you just bring your knees up And put both feet on the bed Like this Oh very good Now I will I just need you to keep arms at sides All right I will press on your abdomen You might feel mildly uncomfortable I want you to tell me if it starts to feel uncomfortable That's OK Is it painful No that's OK Ouch Sorry That's a lot of pain OK please sit up I will talk with you All right Sit up All right OK thank you doctor Now students what do you think of their performance Now would you please look at your paper To give the marks for their performance Did they use some indirect language Yes OK And did they use the softened gestures OK Did they use some very simple or informal language Yes OK the final one Did they use some proper intonation in their conversation OK yes Now let's do the summary lines And I think all of you really did a very good job in this part And we may get to summarize What should you do in the clinical communication The first of all please remember to greet your patient Say hello, say good morning, say good evening to your patient And the second one You should respect your patient You know I think you should respect their privacy So please remember to ask for permission For the areas that you will do You will tell the patient what you will do next For example to check your body OK to give you some medicine You should tell your patient And finally to keep the eye contact with your patient OK And I think you did a very good job Because in this room there is no water basin But you remember to wash your hands OK and I think this is very good OK and so I think all of you do a very good job