English For the Health Professions

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For the
Student Workbook
Based on CLB 2000
Welcome to the English for the Health
Professions Student Workbook
Congratulations! You are now participating in an advanced integrated English and Communication
Program for the Health Professions.
This program was designed to address the English language needs of internationally educated
healthcare professionals for successful workplace integration into the Canadian healthcare system. It is
an inter-professional language training course that focuses on language skills and workplace culture
within the healthcare sector.
This workbook had been developed as a resource and contains the handouts that you will need to
participate in the English for the Health Professions Course. They are designed to be taught in a
classroom environment.
This program and this workbook were designed with your needs in mind. We hope it helps you in
achieving your professional goals. Good Luck!
Module A – Everyday English
Module A – Everyday English
Module A
HO – A1 Effective Listening
A1 Effective Listening
Listening is a skill that most people take for granted; if you can hear, you can listen.
However, listening is really a conscious decision and a skill that needs to be learned
and practiced. It requires concentration and patience.
There are many barriers to listening well and becoming a good listener takes time and
effort. In today’s busy world, life is constantly happening around us and it can
sometimes interfere with our listening skills. Demands on our time, energy, and talents
all affect our ability to be effective listeners. Have you ever been in a meeting and
realized you haven’t heard a word because you were thinking about dinner? Focusing
on listening can help, as well as recognizing barriers to listening so we are ready for
them when they happen.
A good listener also gives the speaker feedback which encourages the speaker to keep
talking. Have you ever experienced a conversation with someone who doesn’t nod, say
uh-huh, or give any indication that he/she is listening? Did you think that the person
was listening to you? This lack of a response makes you want to end the conversation
and leaves you with a bad impression of the listener. Verbal and non-verbal cues are
an essential part of any conversation and are key to its success.
Write some barriers to listening.
1. ___________________________________________________________________
2. ___________________________________________________________________
3. ___________________________________________________________________
Write some keys to effective listening.
1. ___________________________________________________________________
2. ___________________________________________________________________
3. ___________________________________________________________________
Module A – Everyday English 1
Module A – Everyday English
Module A
Discuss the following questions.
Do you look at the person when he/ she is talking?
Do you ask questions to clarify your understanding of what is being said?
Do you give positive verbal feedback like, “yes,” uh-huh,” hmmm”?
Do you get easily distracted by other things during conversations?
Do you fidget while someone is talking?
Do you think about what you are going to say next?
Do you often interrupt the speaker?
What are five qualities of an effective listener?
Practice effective listening.
Now that you’ve discussed how to be an effective listener, you will have the opportunity
to practice! You will listen to your classmates tell you a story and you will have to
summarize what they said…and to summarize accurately, you must listen carefully.
Work in groups of three: take turns doing this activity so everyone has a chance to
speak, listen and observe.
The speaker: Tell your classmates why you chose a career in healthcare. Speak
for 2– 3 minutes
The listener: Listen well, and after the speaker has finished, summarize what
he/she said.
The observer: Observe the listener and fill in this evaluation checklist.
Afterwards, tell the listener how his/her skills were.
Listening Evaluation Checklist
Did the listener keep eye contact with the speaker?
Did the listener ask any clarifying questions?
Did the listener look attentive and interested?
Did the listener make any listening sounds?
Did the listener ask the speaker to repeat anything?
Module A – Everyday English 2
Module A – Everyday English
Module A
Module A – Everyday English
HO – A2 Reduced Speech
Native English speakers use reduced forms in daily speech. It is important to
understand them and know how to pronounce them. Remember, these are never used
in written English. In this exercise you will listen to some reduced forms and try to
identify the language you hear. The following pages will give you more opportunity to
identify and use this language.
Listen to some sentences and write down what you hear.
1. __________________________________________________________
2. __________________________________________________________
3. __________________________________________________________
4. __________________________________________________________
5. __________________________________________________________
6. __________________________________________________________
7. __________________________________________________________
8. __________________________________________________________
9. __________________________________________________________
10. __________________________________________________________
Module A – Everyday English 3
Module A – Everyday English
Standard English
bet you
could have + consonant
could have + vowel
did you
Don’t you
Get you
Give me
Going to + verb
Got you
Has to
Have to
How are you + verb
I don’t know
Kind of + consonant
Kind of + vowel
Let me
Lot of + consonant
Lot of + vowel
Lots of + consonant
Might have + consonant
Might have + vowel
Should not have +
Should not have + vowel
Want to
What are you + gerund
What do you + verb
Would have + consonant
Would have + vowel
Kinds of + consonant
Kinds of + vowel
Must have + consonant
Must have + vowel
Should have + consonant
Should have + vowel
Module A
I dunno
I don’t wanna go kuz it sounds hard.
I betcha she’ll be late tomorrow.
You kuda gone with me.
I kudav helped you out.
Didja learn anything new?
Doncha know?
I’ll getcha something to eat.
Can you gimme your SIN number?
I’m gonna do that report now.
I gotcha those supplies you asked for.
She hasta be here on time tomorrow.
I hafta check on that patient now.
Hwarya doin?
I dunno what to think about that.
I’m kinda worried about that test.
This article is kindav interesting.
Lemme help you with that!
I’ve got a lotta respect for Dr. Kowalski.
There were a lottav English people there.
There were lottsa people at the meeting.
I mighta gone with him if he’d told me.
She mightav agreed to come an hour ago.
She shouldn’s taken that long.
She shouldn’av ignored you like that.
I wanna learn that procedure
Whatcha doin?
Whaddaya wanna do today?
I woulda done the report if you’d asked.
I wouldav asked you to do it if Id’ known.
What kindsa supplies do they sell?
They have all kindsav optical lenses.
I musta walked past her without noticing.
She mustav offered him a pay raise.
I really shoulda studied harder for the exam.
He really shouldav operated on her.
Module A – Everyday English 4
Module A – Everyday English
Module A
Practice the following conversation with a partner with reduced speech.
How are you doing? __________________________________________
I’m kind of tired today? _______________________________________
Really? Did you stay up late last night? ___________________________
Yeah, I worked a double and I had lots of patients to take care of. I could have
finished earlier, but I want to take Friday off. ________________________
What are you doing to do? ________________________________
We’re going to take a trip to Cape Breton and drive the Cabot Trail.
That sounds like it’ll be a lot of fun. The weather ought to be nice.
I hope so. I’ll let you know how it goes_________________________
Write and practice a dialogue with a partner.
Module A – Everyday English 5
Module A – Everyday English
Module A
Module A – Everyday English
HO – A3 Register
“You have to give me tomorrow morning off. I have a doctor’s appointment.”
If you were a supervisor and one of your employees said this to you, how would you
take it? What would be your response? Probably you would take offense to this type of
demand. What would have been a better way for the employee to ask for the time off?
The above example illustrates an improper use of register. Register means our
communication style is different depending on who we are talking to. Think about the
language you use with your boss, your friends, your co-workers, your patients, and
Read the following statements and determine the relationship between the two
1. If you have any questions about the database, don’t hesitate to ask. _______
2. Good morning Mrs. Palmer. How are you feeling today? _____________
3. Can you see the TV up there? That’s a picture of your tummy. ___________
4. I can’t believe I have to work Saturday night, again! _______________
5. Can I get your opinion on some lab results, John? ______________
6. How much longer are we going to have to wait? _____________
7. May I help you? _____________
8. I expect you to be at work by 9:00. _______________
Module A – Everyday English 6
Module A – Everyday English
Module A
Module A – Everyday English
HO – A4 Body Language
With a partner, role-play the following situations.
1. Several days ago you gave an important report to a co-worker and asked him/her
to look it over and make comments. Today you see the co-worker in the hall and
ask him/her for the report. They tell you that they put it on your desk, but your
desk was bare when you came in this morning. What do you say?
2. You have had a chipped tooth for several days and you have finally been able to
make an appointment with your dentist for Friday morning. You assume that
there will be no problem taking the time off because a number of employees
have done the same in the past. On Tuesday your boss announces that there
will be a staff meeting Friday morning to discuss various problems that have
come up during the week. You know that if you cancel your appointment with the
dentist, it might take two weeks or more to get another appointment. You don’t
want to upset your boss, but you would like to keep your appointment. How
would you approach your boss?
3. There is a young man that has been admitted to your floor who has consistently
used foul language when interacting with the staff that is providing his care. You
are the supervisor and have received many complaints from your staff about the
patient’s behavior. Confront the patient and explain to him that his behavior is
not acceptable.
Module A –
You can communicate a great deal to the people around you without saying a word.
Body language has the power to make people feel attractive and interesting or
unimportant and dull.
Module A – Everyday English 7
Module A – Everyday English
Module A
Practice the following body language with your classmates and identify them
as positive (P) or negative (N). The first two have been done for you.
direct eye contact
16. _____ fully facing the other person
glancing down and away
17. _____ no eye contact
3. _____ nodding
18. _____ tight smile or no smile
4. _____ dropped gazes
19. _____ warm smile
5. _____ head tilted
20. _____ hunched shoulders
6. _____ legs crossed
21. _____ weak handshake
7. _____ upright but relaxed
22. _____ chin into chest
8. _____ stiff posture
23. _____ leaning forward
9. _____ double handshake
24. _____ arms crossed
10. _____ fidgeting
25. _____ chin up
11. _____ glancing at the ceiling
26. _____ body sagging
12. _____ scanning bellow the neck
27. _____ staring
13. _____ sitting forward
28. _____ winking
14. _____ flashing or raising eyebrow(s)
29. _____ smirking
15. _____ legs outstretched
30. _____ looking past someone
Module A – Everyday English
Module A – Everyday English
Module A
Module A – Everyday English
HO – A5 Gestures
Identify how to make each of the following gestures.
1. Call me OR I’ll call you.
2. He/she’s crazy OR that’s cuckoo!
3. Hmmmm…..let me think about it.
4. I’ve had it up to here and I’m very angry.
5. It’s over my head and I don’t understand.
6. Mmmmmm….this is delicious. Yummy.
7. Money, money, money….
8. My lips are sealed. I won’t tell anyone.
9. Shhhhh!! Be quiet!
10. So-so. It’s okay. Not too bad.
11. Thumbs up! Good work!
12. Time out. Take a break.
13. Too spicy. Too hot.
14. What a relief! Thank goodness that’s over
Module A – Everyday English 9
Module A – Everyday English
Module A
Module A – Everyday English
HO – A6 Common Language Functions for Everyday English
Read the expressions and label them according to the common language
functions listed below.
a – when you don’t understand
e – making a suggestion
b – requests
f – expressing disagreement
c – offers
g – expressing dissatisfaction
d – asking for clarification
h – showing sympathy
1. _______ Could you give me a hand lifting him?
2. _______ Why don’t we have the meeting today?
3. _______ I’m sorry to hear about your father’s illness.
4. _______ I’m afraid that time isn’t good for me.
5. _______ I could use 5 more, please.
6. _______ I don’t think that is quite right.
7. _______ I’m sorry, did you say 50 or 15?
8. _______ I’m a bit confused.
9. _______ I can do that for you.
10. _______ How many times did you say?
11. _______ I’m disappointed with the results.
12. _______ That was bed three, right?
13. _______ I’m afraid that’s not what is written here..
14. _______ Would I be able to help?
15. _______ I don’t get it.
16. _______ That’s ridiculous!
17. _______ Is it possible to use your office?
Module A – Everyday English 10
Module A – Everyday English
Module A
Read the dialogue and underline/circle any common language functions.
Excuse me, Janet. Do you have a minute?
Supervisor: Sure, Fatima. What’s up?
Well, I was wondering if I could talk to you about next month’s schedule.
Supervisor: Is there a problem?
Well maybe. My husband is returning to school and it would be helpful if I
could work evening shifts as opposed to day ones. His classes are during
the day and I would need to stay home with my son.
Supervisor: Hmm. How soon do you need to make the change?
His classes start in three weeks, but I could start as soon as it is possible.
Supervisor: Well, the first two weeks can’t be changed, but let’s see what we can do
after that.
That’s great, thank you.
Supervisor: I’ll bring this up at the next team meeting to let everyone know.
Thanks Janet. I really appreciate it.
Discuss the following questions.
1. What common language functions are used in this dialogue?
2. How does the employee introduce the topic she wishes to discuss?
3. How does the employee ask for what she needs?
4. How does the supervisor ask for more details?
5. How does the supervisor offer to help?
6. Describe the language used by the employee and the language used by the
7. Would you be able to distinguish their roles if you didn’t know who was who?
Practice reading the dialogue with reduced speech.
Module A – Everyday English 11
Module A – Everyday English
Module A
Role-play the following situations with a partner.
1. You are late for a meeting. Apologize as you go in.
2. You are served your food, but it isn’t what you ordered.
3. Offer help to a patient who is struggling to get out of bed.
4. At a conference you meet someone you think you have met before.
5. You need to speak to you supervisor immediately.
6. Introduce a patient to another health care worker.
7. Re-phrase the following: “We can’t do that.”
8. A patient has been waiting a long time to see you. Apologize.
9. Re-phrase the following: “You have given me too much work.”
10. You are looking for unit 7. Ask for help.
11. A patient is trying to tell you his/her name, but you don’t understand.
12. A co-worker has just been laid off, what do you say to them?
13. Confide in a colleague about having too much work.
14. Inquire about the abbreviations on your pay stub.
15. Re-phrase the following: “That won’t work.”
16. You are trying to take a phone message but it is too noisy in the office.
17. Suggest a time for an appointment.
18. Re-phrase the following: “What?”
19. You are in a car with a colleague and he/she ask you if you min him/her
20. Re-phrase the following: “Huh?”
21. A patient looks confused when you give directions to the appropriate
department. Everyday English
Module A – Everyday English 12
Module A – Everyday English
Module A
Module A – Everyday English
HO – A7 Making Apologies
All relationships, whether personal or professional, can reach a point where an apology
is necessary. Apologies that are simple, tactful, and honest can do a lot to mend
fences. However, making and receiving apologies are not always easy. Factors such
as, gender, personalities, upbringing, age religious or spiritual beliefs and culture can all
influence a person’s ability to say “I’m sorry.”
Read the following and think about how you apologize. What do you already do?
What is new for you? Do you like these new ideas? Discuss in a group.
Ask for permission before you apologize. The other party still may need some time to
think about the situation/argument. Asking for permission allows them to prepare for
what they are going to hear.
“I’d like to apologize for yesterday; can I come over in an hour?”
State what you did wrong as a matter of fact, without any excuses. It is always
appropriate for you to acknowledge your role in the disagreement.
“I promised to help you study for your exam and I completely forgot.”
Take responsibility for your actions and admit that you made a mistake. Do not blame
anyone else, especially not the person to whom you are apologizing.
“I know that you were counting on me for my help; I should have called you as
soon as I remembered. That was wrong.”
Recognize how your actions may have affected the other person.
“Forgetting to meet you must have added to your stress about writing the exam.”
Apologize for any pain or damage you may have caused.
“I am sorry for the stress I caused and for letting you down. You must have been
disappointed and upset.”
Module A – Everyday English 13
Module A – Everyday English
Module A
Fix the damage and state what you plan to do in the future. Include what you will do to
correct the situation and state your intention not to do it again.
“I want to make it up to you by making a weekly schedule for us to study
together. This way, our meetings will be part of my weekly routine and I won’t
Don’t expect anything in return for your apology.
“Thanks for hearing me out and I hope we can work through this.”
Match the following with the appropriate apology. More than one answer is appropriate for
1. ______ Can you call me this evening
a. I’m afraid that won’t work for me.
2. ______ Could I speak to Dr. Roberts, Please?
b. Sorry, I will be on vacation.
3. ______ Did you remember to send me that report?
c. Unfortunately, I’ll be getting home late.
4. ______ Will you be able to finish the rounds alone?
d. I’m sorry, but that is impossible.
5. ______ I want a prescription for Prozac.
e. Unfortunately she’s with a patient
at the moment.
6. ______ Would out be able to switch shifts Friday?
f. I completely forgot. I’m sorry.
7. ______ Do you want me to order the tests?
g. I’m sorry I can’t give that to you.
8. ______ Can I come in to see you next week?
h. Sorry, I forgot to mention that I
already did that.
Module A – Everyday English 14
Module A – Everyday English
Module A
Practice making these apologies with a partner.
1. It’s 2:30 pm and you just realized you completely forgot about your lunch
2. You see someone you want to talk to at a conference, but you are already
engaged in a conversation with someone else.
3. You sent a patient’s file to the wrong hospital and your boss is looking for
4. You can’t discuss a report with a colleague right now.
5. You borrowed a friend’s jacket and left it on the bus.
6. You won’t be able to cover your co-worker’s shift tomorrow night.
7. You misplace a patient’s glasses.
In English we have many ways to ask for repetition without asking a question. English
speaker are more likely to use intonation and body language to make a request.
Look at the examples below and fill in the rest of the chart. Practice the different
methods with a partner.
The meetings
at 3:30.
It says twice a
My birthday is
May 15, 1975.
3:30, is that
okay for you?
Yes twice.
May 15th?
Yes, the 15th.
Sorry, What
I’m sorry. How
many times?
Did you say the
The meeting’s
at ……
It says…..
Module A – Everyday English 15
Module A – Everyday English
Module A
Module A – Everyday English
HO – A8 Asking for Repetition
My doctor is Dr.
Hi name is
I’ve had a
cough for 7
The last time
she ate was
two days ago.
My physio
appointment is
next Tuesday.
I’m on
Side effects
might be
dizziness and
blurry vision.
I haven’t
printed the
Asking for Permission
When asking for permission at work there are a few things to keep in mind. You must
first consider your overall work situation and how your request will affect co-workers.
For example, a supervisor will want to know why you need time off and it is customary
to give a reason for you request. You do not need to go into detail, but give enough
information to justify your request. If the request is for a very personal reason, it is
usually fair to say that a personal situation has come up or that there is a family
emergency, without needing to give the specifics of the situation. If you are granted
your request, keep a low profile. Don’t advertise it to your colleagues and don’t
complain if your request is denied.
Module A – Everyday English 16
Module A – Everyday English
Module A
Role-play the following situations with a partner.
1. Ask for permission to come in to work late tomorrow because of a dental
2. You want to leave early today to pick up a friend at the airport. Ask for
3. You need to switch a shift because you want to go to your son’s play. Ask for
permission from your supervisor.
4. Ask for permission to sit in on a meeting on a topic that interests you.
A simply yes or no can sound harsh and rude when used. Instead, we use different
ways of saying yes and no that come across more politely in work situations.
Module A – Everyday English 17
Module A – Everyday English
Module A
Module A – Everyday English
HO – A09 Saying Yes and No
Saying Yes – Match these remarks with their responses.
1. Will the result be back by noon?
Yes, of course.
2. Could I have a different gown?
Yes, that’s right.
3. Is it okay to use this phone?
As far as I know.
4. Would you like me to help you?
That would be great.
5. Can I listen to your heart beat?
Of course, help yourself.
6. Is this the way to recovery?
Sure, that’s not a problem.
What are some other ways that you can say yes, naturally and politely?
Saying No – Match these remarks with their responses.
1. Did your supervisor agree?
That would be a problem.
2. Would you like a coffee?
Not right now, thanks.
3. Is the patient transfer confirmed?
I’m afraid not.
4. Is it okay if I’m a bit late?
No, I already have plans.
5. Can you witch shifts with me tomorrow? e.
I haven’t heard.
6. Is there time to go to the store?
I have no idea.
Write down some other ways to say no, naturally and politely.
Module A – Everyday English 18
Module A – Everyday English
Module A
Write polite negative responses to these questions then ask and answer them
with a partner.
1. Will you be finished by 3:00? _________________________________________
2. Are they still in a meeting? ___________________________________________
3. Do we need any more face masks?____________________________________
4. Has he seen the doctor yet?__________________________________________
5. Have they arrived yet?______________________________________________
6. May I have your telephone number?___________________________________
7. Does he know where we are?________________________________________
8. Shall I get the chart for you?_________________________________________
9. Have they eaten yet?______________________________________________
10. Would you like to join us after work?__________________________________
Write 6 typical questions you might ask or answer in your job. Ask a partner
these questions. He/she can answer either yes or no in a polite manner.
1. ___________________________________________________________
2. ___________________________________________________________
3. ___________________________________________________________
4. ___________________________________________________________
5. ___________________________________________________________
Module A – Everyday English 19
Module A – Everyday English
Module A
Module A – Everyday English
HO – A10 Saying Yes and No
When you are faced with a question that you don’t want to – or can’t – answer,
what is an appropriate response? Here are some possible responses to those
difficult questions.
Find someone who can answer the question, i.e..:
“I’m not sure. I’ll transfer you to someone in phlebotomy who can answer your
Respond with a question of your own, i.e.:
Other person:
“Where are you going?”
“I’m sorry. Why do you need to know?
Change the subject, i.e.:
Other person:
“Are you and Dr. Yoshihara dating?”
“Um…excuse me while I answer the phone.”
Provide a non-answer or a vague generalization, i.e.:
Other person:
“How much money do you make?”
“It’s never enough.”
End the discussion, i.e.:
Other person:
“What happened during the meeting?”
“I can’t talk right now, sorry.”
Answer with a defensive comment, i.e.:
“Everyone knows that don’t they?”
Answer the questions with a response that is so long-winded that the original question is
Module A – Everyday English 20
Module A – Everyday English
Module A
Module A – Everyday English
HO – A11 Paraphrasing
Brainstorm possible responses to deflect these questions with a partner.
Why didn’t you become a doctor instead of a nurse?
Can you tell me what’s wrong with the guy next to me?
Why did my daughter come to see you last week? (the daughter is over 18)
Why did you want to leave your country?
I understand that marriages are arranged in your country. How could you let
your parents do that to you?
6. Don’t you think Dave in the physio department is hot?
One of the best methods to ensure comprehension, as well as improve your speaking
skills, is to paraphrase what the other speaker has said during a conversation. This is a
skill that teachers often use to ensure student understanding and not only in the ESL
classroom. Instead of answering a simple yes or no when someone asks if you
understand, repeat back to them in your own words what you understood them to be
saying. Here is an example:
I need you to do something for me if you don’t mind. I’m going to a conference
next week and I had to reschedule all of my patients. I’ve tried calling them, but I can’t
get a hold of two of them. I left them a message, but just in case they don’t get it, can
you field my calls next week and explain the situation to them. You don’t have to make
any calls, just answer any questions or concerns anyone might have. Is that okay with
Okay, let me see if I understand correctly. You’re away next week and two of
your patients may or may not call. If they do, I should tell them you are out of the office
and try to answer their questions. Is that right?
Module A – Everyday English 21
Module A – Everyday English
Module A
Brainstorm some phrases to use when paraphrasing. Here are some examples.
In other words….
So, what you mean is…
Are you saying….?
Work in groups of three. Listen to one person tell a story and paraphrase it for
the other person. Switch roles until everyone has had an opportunity to try each
The speaker: Tell your classmates and interesting story from your career.
The listener: Listen well and paraphrase what he/she said.
The observer: Confirm if the listener got all the details of the story correct.
What is the common practice of giving and accepting compliments in our home
country? How do you show someone you are grateful?
Module A – Everyday English 22
Module A – Everyday English
Module A
Module A – Everyday English
HO – A12 Giving and Accepting Compliments
When giving a compliment, a sincere tone is the most important thing to ensure the
credibility of your words. Also, monitor the use of your compliments: you don’t want to
sound insincere because you use them too often.
Complete the compliments below and practice giving and receiving them with a
You look…
What a lovely…
You speak English…
I like your new…
Where did you get that…
I admire your…
Well done, your work…
Congratulations on your…
Keep up the good work…
Great job on…
Note for the reader…
Even though most people are sincere when they give someone a compliment, there are
instances when the individual giving the compliment has ulterior motives. Compliments
make people feel good, happy valued.
However, individuals who constantly give praise or compliments are perceived as
insincere and dishonest. It is important to be aware of this, but not to assume that
manipulation is everyone’s intention if they give compliment. If you suspect that you are
on the receiving end of this type of negative compliment, it is not necessary to confront
the person; just take their comments with a grain of salt.
Module A – Everyday English 23
Module B – Medical Administration
Module B
Module B – Medical Administration
HO – B1 Identifying the Components of a Business Letter
Read the letter.
Happy Mouth Dental Clinic
154 University Avenue
Charlottetown, PEI C1A 1R0
www.happymouth.com 11
Richard Brown, Sales Manager 2
ACE Medical Supplies
234 Yong Street
Halifax, NS R3U 1D5
April 1, 2007, 3
Re: Surgical gloves 4
Dear Mr. Brown, 5
As we have worked closely with your company for over three years and consider ourselves a 6
valued customer, we were very disappointed to see the poor quality of surgical cloves you provided in
our last order.
As per our written agreement we expected the gloves to be extra strength. Instead, we found the
gloves to be quite flimsy and they ripped easily. I think you will agree that a communication problem
We would like you to send out a new order of the highest quality gloves you carry or provide us with a
full refund.
Sincerely, 7
Lynn R. Smith
Dr. Lynn R Smith
Head Dentist 9
Enc. (2) 10
C: John Doe, President, ACE Medical Supplies 11
LRS/ cd 12
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Answer the questions.
1. What kind of letter is this?
2. Who wrote it?
3. Who is it written to?
4. What is she requesting?
5. Identify the twelve components of the letter:
1. _______________________________________
2. _______________________________________
3. _______________________________________
4. _______________________________________
5. _______________________________________
6. _______________________________________
7. _______________________________________
8. _______________________________________
9. _______________________________________
10. _______________________________________
11. _______________________________________
12. _______________________________________
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Read the following.
Letterhead/Return Address: your contact information is at the top of the letter in the
return address or company letterhead. It should include:
Phone #/Fax#/ email address
If your letter is more than one page, only print the first page on letterhead, with the
following pages on blank paper. Do not number the first page. The heading on following
pages should look like this.
Ms. Lucy Nagano, pg 2
May 23, 2007
2. Inside Address: The inside address contains your reader‟s full address. This includes:
Their name, position/job title
Their organization
Their complete mailing address
Use Mr. or Ms., unless the reader favors Miss or Mrs. Use courtesy titles, like professor
or Doctor, when appropriate. These should look the same on the envelope.
Dr. R.V. Camping, Professor
New Brunswick Medical College
435 Main Street
Moncton, NB E4B 1K5
If you do not know the name of a particular person, then use an attention line with the
position of the person you are looking for:
Attention: Registrar
3. Date: The date should be written out and not in a numeral format. It can be above or
below the inside address.
September 10, 2007
The 15th of November, 2008
4. Subject Line: You can use a key word or a brief phrase to describe the subject of the
letter. This can be prefaced with subject: sub: reference: or re:
Subject: Admission Requirements
5. Salutation: A business letter must always include a salutation. If you do not know who
to address the letter to, you should call the organization to find a contact name. If you
know the person well you can use his/her first name, if not you should use Dear plus
their surname. Put the salutation two lines under the inside address. A colon or a
comma must follow this (a colon is considered more formal).
Dear Dr. MacDonald:
To Whom It May Concern: (all words are capitalized)
Dear Jason,
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6. Body: The body of a business letter is usually single-spaced with three paragraphs:
Introductory paragraph
Body paragraph(s)
Concluding paragraph
A business letter introduces one main idea and then supports this idea. While writing,
you must think about how your letter looks. If you have a lot of information written in text
format, you should use lists or bullets to make it clearer and more concise. At the end of
the letter, always include a way for your readers to contact you.
7. Closings: Business letters should end with a courtesy closing. Capitalize only the first
word and follow all phrases with a comma.
Yours truly,
Best regards,
8. Signature: Your signature should be between the closing and the signature block.
9. Signature Block: Your name and title should be typed under your signature. The first
line is your name and the second line is your title. If you have a title or degree, you can
put it after your name. The signature block should be 3 – 4 lines under the closing.
Sally Straiescu, R.N., B.N.
10. Enclosures: sometimes you include documents inside the envelope. You must identify
these: Enclosure or Enc.
Enclosure (2) (which means 2 documents)
11. Copy Line: If other people will receive a copy of the letter, use the following symbols, cc:
or c: for copy or bc: for blind copy. Follow the symbol with the names of the other
recipients, listed either alphabetically or according to organizational rank.
Cc: Jane Doe, Vice-President Operations
12. End Notations: If an administrative assistant types your letters, the reference line
identifies this person with their initials. The writer‟s capitalized initials come first, followed
by a slash and the typist‟s small letter initials. I.e., if Karen Ritter wrote a letter that
Mabel Andrews typed, it would appear like this:
Adapted from English for Work and Business copyright Halifax Immigrant Leaning Centre
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Discuss the following questions with a small group.
1. What information does the return address include?
2. What is a courtesy title? When should you use one?
3. When should you use an attention line?
4. Do you have to include a subject line? Why would you use one?
5. Circle the date (s) that are acceptable:
a. 31/03/07
b. January 6, 2008
c. Mar. 14 „07
6. If you do not know a person‟s name, how should you address them in the salutation?
7. How can you address a group of people?
8. What are the 3 paragraphs in the body of a business letter?
9. If you have a lot of information, should you present it in a paragraph of text or should you
list it?
10. What are some common closings?
11. What does bcc mean?
12. Your name is Samuel Jones and your administrative assistant‟s name is Fred Smith.
What will your end notation look like?
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HO – B2 Common Language Functions for Business Letters
Read the following commonly used expressions and add two more to the list. Discuss
your answers with a partner.
The salutation
To Whom It May Concern:
Ladies and Gentlemen,
The reference
With reference to your advertisement in the Guardian
In regards to your letter of March 5, 2007
The purpose
I am writing to enquire about…
I would like to know….
Making requests
I would be grateful if you could…
Would it be possible for you…?
Agreeing to requests
I would be delighted to….
It would be my pleasure…
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Giving bad news
I am afraid that…
Enclosing documents
I am enclosing…
Please find enclosed…
Closing remarks
Please contact us again if we can help in any way.
Thank you for your assistance.
Reference to the future
I look forward to hearing from you soon.
I would be pleased to meet with you in the following week.
The closing
Best wishes,
Yours Truly
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HO – B3 Abbreviation, Acronyms and Symbols
What do these abbreviations, acronyms and symbols mean?
1. Cc
2. PhD
3. Incl.
4. MEng ____________________________________________________________
5. Dr.
6. Jr.
7. Rev.
8. X
9. No.
10. PS
11. #
12. Co.
13. Inc.
14. Re.
15. Enc.
16. MD
17. c/o
18. ASAP ____________________________________________________________
19. Attn.
20. MA
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HO – B4 Letter Correction
21. Dept. ____________________________________________________________
22. CEO
23. Subj. ____________________________________________________________
24. Fr:
25. COD
26. Assn. ____________________________________________________________
27. Attn.
28. BA
29. Cc
30. DDS
31. Dir.
32. ED
33. Et al. ____________________________________________________________
34. Etc.
35. Hon.
36. i.e.
37. No.
38. P.s.
39. Prof.
40. Sr.
41. Ob-Gyn____________________________________________________________
42. @
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Read the letter and circle the mistakes. There are approximately thirteen errors.
UPEI School of Nursing
Jenny Walters
550 University Avenue
Charlottetown, PE
C1a 4P3
Bob Jones
123 Smith Avenue
C1A 2V4
(902 -52.
Sub Application Form
55. Rewrite the letter with the corrections.
Hi Bob,
you for your letter of application. We are missing the following information. A copy
of your undergrad transcripts, your SIN number, and the application fee.
63. process your application without these items.
We can‟t
65.send them as soon as possible so that you don‟t miss the deadline.
Jenny Walters, Registrar
UPEI School of Nursing
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Rewrite the letter with the corrections.
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HO – B5 Inclusive Language
In Canada, you will often hear people talking about politically correct language. Language
reflects how our society views people, and to help rectify some negative language, words
change to become more inclusive. However, as language and beliefs are always changing,
these „rules‟ may change with the times. The main concept behind inclusive language is that it
does not exclude or discriminate against people because of gender, religion, race, age, or
Follow the guidelines bellow to check for biases in your communications.
Give someone‟s ethnic background or age only if it is relevant information.
Refer to a group by a term they prefer.
Avoid adjectives that suggest competent people are unusual – i.e. “She is an intelligent
black woman.” This suggests this is an odd characteristic for a black woman. It is better
to say “She is very intelligent.”
Follow these guidelines when you discuss people with disabilities or diseases.
Use people-first language to focus on the person, not the condition. This type of
language names the person first, and then adds the condition. Use it instead of
traditional adjectives which imply that the condition defines the person.
Negative terms such as afflicted, suffering from… and struck with also suggest an
outdated view of illness as a sign of divine punishment.
Complete the following exercise
Instead of:
1. Indian
2. Old person
3. Mentally retarded
4. Cancer Patients
5. Crippled
6. Confined to a wheelchair
7. AIDS victim
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HO – B6 Non Sexist Language
Read this paragraph and highlight the language that is NOT inclusive.
Mrs. Smith is an oncologist. She works at the local clinic. Each of the doctors there has
his own practice. Most of them work approximately 50 man-hours a week, which makes
for a long week. I know Mrs. Smith because I am Chairman of the Board for the clinic.
Nonsexist language treats both sexes equally. It does not assume a particular gender for a job.
Likewise, it does not assume that men are superior to women.
Read the following.
Expressions: Some expressions are still sexist, use the following language instead.
Instead of:
Staff hours
Titles: Unless specifically requested to otherwise, North Americans use Ms. for women and Mr.
for men. If the person has courtesy title, such as doctor, then use this regardless of the gender.
All these titles are followed by the family name, not the first name. For example, if the person‟s
name is Pat Byczeko, then you would never call them Mr. Pat or Ms. Pat (Pat can be short for
Patrick or Patricia). Hi/her title would be as follows.
Mr. Byczeko
Ms. Byczeko
Dr. Byczeko
Job Titles: Some job titles are still sexist; make sure you use the gender-neutral equivalent.
Instead of:
Executive, business owner, businessperson
Chair, chairperson, moderator
Worker, employee, or specific job title i.e. bricklayer
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Pronouns were traditionally male when talking about a person whose gender is unknown. For
example, each dentist must complete his shift. Nowadays, this language is considered sexist
and should be rewritten to reflect both men and women. Here are some effective ways to
remove sexist pronouns.
Use one article:
Each dentist must complete the shift.
Use one:
One must complete one‟s shift.
Use plural nouns/pronouns: Dentists must complete their shifts,
Use pronoun pairs:
Each dentist must complete his or her shift
Use you:
You must complete your shift.
Rewrite the sentence:
All shifts must be completed by dentists.
Rewrite the following using non-sexist language.
1. How many man-hours a week do your workmen put in?
2. Each candidate should return to his station to receive his next instruction.
3. Who is manning the position while Jerry is away?
4. Who is the chairman of the board?
5. We would like to invite all supervisors and their wives to the hospital picnic.
6. Miss. Drew is manning the floor.
7. Each chiropractor should file his report at the end of the month.
8. We need a lot more manpower to run this lab successfully.
9. I think Mrs. Fong will be supervising our clinical next year.
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HO – B7 Creating Inclusive Non-Sexist Correspondence
Read the following letter and correct any mistakes. You are looking for sexist, racist,
ageist or discriminatory language.
123 University Avenue
Charlottetown, PE
C1A 2R5
Phone: 902-894-1234
Email: [email protected]
August 12, 2007
Tracey F. Harris
Personnel Department Manager
Chemical Compound Ltd.
7229 Mt. Edward Road
Charlottetown, PE
C1A 4E3
Dear Mrs. Harris:
Thank you again for the opportunity to interview for the medical lab technician position.
I appreciated your hospitality and enjoyed meeting you, the Chairman, and members of
your staff.
The interview convinced me of how compatible my background, interests and skills are
with the goals of your facility. As I mentioned during our conversation, my experiences
as a counselor for deformed individuals and their families has prepared me well in my
desire to help fight these abnormal diseases. With my background as an Indian, I am
aware of the plight of marginalized victims and I am confident that my work for you will
result in increased productivity in your research.
For more information on my success as a counselor, please call Dave Garrett at 902555-0132. I look forward to seeing you again.
Yours Sincerely,
John Doe
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HO – B8 Letters of Apology
Read this example of a formal letter of apology.
Optimal Vision Clinic
4545 University Avenue
Charlottetown, PE C1A 3F5
902-345-1236 www.optimal.com
Dr. S Bawdry
Canadian Optometrists Society
42 Swan Drive
Ottawa, ON H5R 3E3
July 3, 2006
Dear Dr. Bawdry,
With reference to your letter of April 15, 2005, in which you inquired about my availability
to speak at the annual Optometrists convention, I have to send my regrets and decline
your generous invitation.
I would like to apologize for any inconvenience this may cause the convention‟s
organization committee. I am not sure if you are aware, but the North American
Optometrists Convention coincides with the dates for the Canadian Convention and I will
be attending this year‟s conference in Virginia. I would appreciate a copy of the
conference report however, and I hope that the conference is a great success as always.
Thank you for the opportunity and know that I would be interested in participating in the
2006 conference.
Dr. Rae Park
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Use the sample letter as a guide to write a formal letter of apology.
Apologize to a mental healthcare service provider because your organization can no longer
provide free outpatient services to them due to financial constraints.
H e a r t C a r e H ea lt h C a r e Se r v ic es
345 Water Street, Charlottetown, PE C1A 4G3 ph: (902) 845-4567 www.hchcs.pe.ca
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HO – B9 Peer Editing Review
When you are reading your peer’s writing, consider the following factors. Make notes on
their letter with a pencil. Be sure to write positive notes as well.
1. Responding:
a. Read the first paragraph and then stop. Does this paragraph make you want to read
further? Why or why not? List any words or phrases you don‟t understand.
Read the next two paragraphs. What is the purpose of the letter? What is the main
2. Editing: go back to the beginning of the letter and read it very carefully, circling the
following errors:
a. Misspelled words
b. Errors in capitalization
c. Errors in punctuation
d. Sentence errors: fragments & run-ons
e. Subject and verb agreement
Pronoun agreement
g. Verb tense
3. Style: comment in the margins on each of these categories
a. The writer uses clear language
b. The writer is to-the-point
c. The writer uses the active voice (not the passive)
4. Describe what is good about the letter.
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HO – B10 Memo, Letter, or Email?
Discuss whether you should send a letter, email or memo in the following situations.
There is sometimes more than one correct answer.
1. You want to inform all staff about a new position at your clinic.
2. You want to inform your boss that you are quitting your job.
3. You want to find out the prices of hotels in Toronto for an upcoming conference.
4. You were interviewed for a job and you want to say thank you to the interviewer.
5. You want to let a co-worker know about a meeting next Friday morning.
6. You need to tell your staff that the water will be shut off for two hours tomorrow.
7. You need to invite all staff to the company picnic.
8. You would like more information on a program being offered at UPEI.
9. You are trying to find new clients for your dental clinic.
10. You want a co-worker to find a book for you.
11. You are hosting a conference and want to invite the Minister of Health to make a
12. You would like to remind your staff to come to work on time.
Review your answers with a small group and discuss the following questions.
1. What are the major differences between letters, memos, and emails?
2. What information must be included in a memo?
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HO – B11 Memo Analysis
Look at this memo and discuss these questions:
1. What is wrong with this memo?
2. What are the main points of this memo?
3. If you were going to rewrite this memo how would you change it?
To: Staff
From: Hospital Administration
Date: September 03, 2007
Subject: Supplies
Due to the fact that the hospital must comply with financial constraints in adhering
to the annual budget, we must take into consideration how important it is to follow
hospital policies, so because of this I would like to inform you that we will be
conducting weekly supply inventories in order to unsure that waste and misuse is
kept to a minimum. Thusly, in order to comply with these requests floor
supervisors will be required to provide a monthly report outlining the consumption
of all medical supplies. The complete list will be distributed directly to each
supervisor in a checklist format and it will be required by the 29th of each calendar
month; 4 in total for each month. These checklists will be reviewed by the
accounting department and a monthly meeting for all supervisors will be necessary
in order to ensure that the proper procedures are being followed and until we all
become familiar with this new requirement. A supervisor may delegate the task of
taking inventory to individual staff members on a rotation basis. The administration
is leaving this up to each department to work out a schedule based on the needs
and input from the prospective staff on each floor. Any questions should be
directed to the administration through the floor supervisor and responses will
delivered as such. Thank you for your co-operation.
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Rewrite the previous memo clearly and legibly.
Hospital Administration
September 03, 2007
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HO – B12 Memo Format and Writing
Read the following memo:
All staff
April 21, 2007
Staff room
Memos are usually for
internal communication
They must include these
Please note that there have been some complaints about the noise
level coming from the staff room.
Please be aware of others who are working while you are on a
break, arriving at, or leaving work. Keep your conversations to a
should be
short and
normal level and please refrain from using obscenities.
We pride ourselves on having a welcoming and inclusive work
environment. Let’s work together to keep it that way.
Thanks everyone!
Memos can end with the writer’s
initials, signature or nothing.
The points should
be arranged in
logical order and it
is common to use
numbers or bullets
the points
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Write the following memos.
You are the supervisor in a small pharmacy. Write a memo to your staff informing them of an
upcoming holiday staff party.
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HO – B13 Email Etiquette
Read the following.
In the last few years, email has become one of the most common forms of business and
personal communication. In many cases, an email now replaces a memo, fax, or business
letter. Unfortunately, as email has evolved so quickly, the „rules‟ for proper written
communication have been slow to follow. An email can be casual or semi-formal. However, if
you would like to write something formally, a business letter is still the preferred form of
The general guidelines for using email in business are the same for writing a business letter:
clear, direct, polite, and respectful. There are some changes in the format, such as the address
block falling under the signature block in an email. As well, the use of icons and abbreviations,
a.k.a. „emoticons‟, is not appropriate.
Good Email Etiquette:
 Reply only to the appropriate person – hitting „reply all‟ could send the message
to many different people.
 Be polite. If you are short-worded it can be misinterpreted as being abrupt.
 Delete anything that is unnecessary or inconsequential.
 Find out what your organization‟s email policy is, are there rules about who or
what you can write and send.
 If you forward a message to somebody else to deal with, cc your correspondent
so he or she will know who will be responding.
 Include a signature block on your email messages. The signature block includes
your name, title, company, address and phone number.
 Do not send people junk mail or spam.
 Use an appropriate subject line.
 Tell people the format of any attachments you send if they are anything other
than basic Microsoft Word files.
 Emphasize important information by highlighting or underlining it.
 Check with the receiver before you send large attachments.
 Clean your inbox regularly. Save important messages to designated email files.
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Bad Email Etiquette:
 Don‟t use abbreviations like “lol” (laughing out loud), “b4” (before).
 Don‟t send multiple messages to people who have not requested information.
This is called “spamming” and can lead to serious trouble with your Internet
Service Provider (ISP) or IT department.
 Don‟t type in all CAPITALS as this is SHOUTING via email. THIS IS
 Don‟t use an intricate signature on your email message – keep it looking
 Don‟t mark something urgent unless it really is urgent.
 Do not reply to an email message when you are angry, as you may regret it later.
Once the message has been sent, you cannot retrieve it.
 Never send chain letters or any other kind of spam. If you get odd messages on
your email account, do not open them – check with your IT department about
 Never send unprofessional emails or attachments, especially anything of a sexual
nature, as they may be offensive or found by a third party later.
 Smileys and emoticons are not appropriate for business email.
Circle True or False
It is acceptable to use emoticons in a business email to express
Spamming is an acceptable form of business communication.
Abrupt means your language is terse and might be considered rude.
If you forward a message to someone else to deal with, you should
inform the original sender.
Typing in capitals is a good way of stressing or highlighting a word.
You should check with the recipient before you send a large
If you want to reply to an email, it is okay to hit „reply all‟.
This would be an acceptable signature block for an email.
Beverly Crulea, MBA
Health Consultant
12 Water St.
Charlottetown, PE C1A 8X2
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HO – B14 Writing Emails
Review the following example emails.
Informal (casual) emails are usually used with colleagues within your company or people you
know very well. The greeting is often hello or hi, the tone is causal, and there is no signature
New Message
[email protected]
[email protected], [email protected], [email protected]
Staff meeting information
Hi Carol,
I was wondering if I could have a few minutes tomorrow at the staff meeting to let everyone
know about the upcoming patient seminars. There‟s lots of interesting stuff coming up!
Semiformal emails are similar to business letter. The content and style are almost the same,
although they can be shorter and less formal. They often end with a closing like Best Wishes,
though Yours Truly or Sincerely are appropriate as well. Your address and phone number
actually fall under your “signature” block.
New Message
[email protected]
Meeting in Halifax
Dear Nancy,
I hope you remember me; we met at the Annual Radiology Conference last month. We had
a fairly long discussion about the new 4D ultrasound machines and your interest in
purchasing one for the IWK hospital.
We are looking at purchasing one here at the local hospital and I was hoping we could get
together to discuss how your project has been developing. Please let me know if you are
free on either October 6 or 7. I look forward to hearing from you.
Best wishes,
Jane Xiu, Director of Radiology
Prince County Hospital
902-345-7845, [email protected]
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1. Write an informal email to your supervisor reminding her you will not be in the
office as you are at a seminar all day tomorrow.
New Message
2. Write a semi-formal email to a colleague in Australia asking him/her if there are
any upcoming conferences that may be of interest to you, as you will be in
Australia on a work-related trip next month and would like to make the most of
your trip professionally. Ask if he/she is available to meet for lunch or dinner.
You will be there from May 1 to May 22. You are a healthcare professional
working in a hospital in Charlottetown.
New Message
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HO – B15 Reports Overview
Reports come in all shapes and sizes. Some are written to present the findings of research,
some report on the results of meetings and discussions, and some communicate information
given in lectures or presentations. All types of reports should be clear and accurate summaries
of information that can be evaluated.
In a group, brainstorm a list of situations when a report would be required.
A report is similar to a summary in that it doesn‟t need to include every detail. Some of the
consistent elements of reports are as follows:
All reports begin by stating their purpose, central idea, or conclusions
Supporting information is next, either chronologically or in categories (only main ideas
are required, exclude explanations, examples, unnecessary details)
A report should remain objective, but can include a section for recommendations
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HO – B16 Injury Reports
An injury report is a summary of the circumstances described by the patient. When applicable,
include the following:
1. Name of the injured party
2. Time and date of injury
3. Description of what happened
4. What happened after the incident
5. Details of the injury
Listen to the following patient statements and write two injury reports.
1. ____________________________________________________________________
2. ____________________________________________________________________
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HO – B18 Medical Abbreviations and Acronyms
Abbreviations and acronyms abound in the medical world. They are used in reports, charts,
prescriptions and discussions. The following are some common medical abbreviations.
However, there are many more that can be researched independently.
Translate the following information using the chart on the following pages.
Rash is on chest and abd.
WBC normal
Keflex 250 mg QID, is allergic to PN
Lung CA
BP 120/80
ENT specialist
LMP was November 12
FBS was over 300
Had a massive MI
Check ABC, APGAR, and FHR
Check BP and perform UA
Had GI complications
A CBC was ordered
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arterial blood gas
appearance, pulse, grimace, activity, respirations
Bowel movement/feces
Barium Enema
Body mass index
Blood pressure
Cerebrovascular accident or stroke
Chest X-ray
Dilation and curettage
D/C or DC
Discontinue (do not use the abbreviation D/C when ordering
a discontinuation of drugs. Spell out the word discontinue)
Do not resuscitate
airway, breathing, circulation
Activities of daily living
Around the clock (administration of medicine)
Complete blood count
Cubic centimeter
Date of birth
Emergency medical service
Fetal heart rate
Fellow of the Royal College of Physicians
Ear, nose and throat
Fasting blood sugar
Gravid, parity, miscarriages, abortions
Hb or Hgb
Genitourinary, gastric ulcer
Human papilloma virus
Intensive Care Unit
Infectious disease/identification
Heart rate/ rhythm
Hormone replacement therapy
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Incision and drainage
Intrauterine device
Lower left quadrant
Last menstrual period
Level/loss of consciousness
Lumbar pucture/pressure
Licensed practical nurse
Myocardial infarction
Measles, mums, rubella vaccine
Multiple sclerosis/musculoskeletal/mental status
n/g tube
Motor vehicle accident
Nasogastric tube
Neonatal intensive care unit
Nothing by mouth (nil per os)
Normal saline
Occupational therapy/ oral temperature
Past/previous medical history
Premenstrual syndrome
Every 2 hours
Every 3 hours
Every morning (quaque ante meridiem)
qAM or q.a.m.
Operating room/ outpatient rehabilitation
Every day(quaque die)
Every hour (quaque hora)
Every other night
Four times a day (quarter in die)
Red blood cell
Range of motion
Respiratory rate/ recovery room
Shortness of breath
Sexually transmitted disease
Tempormandibular joint
Urine analysis
Venereal disease
Voice/verbal order
White blood cell
UA or U/A
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HO – B20
B19 Filling
in Forms
Information from Formatted Text
Role-play these situations in pairs. One student is the patient and the other is the
healthcare practitioner filling in the WCB Physician’s Report form. Use the WCB form
from the handout.
1. A dentist has been stuck with a needle.
2. An orderly slipped on a wet floor in the staff washroom and twisted his/her ankle.
3. A patient bit a registered nurse.
4. A nurse‟s aide injured his/her back while lifting a patient.
5. A doctor got his/her hand caught in a bed mechanism.
6. A surgeon was cut with a scalpel.
7. A paramedic was punched by a patient.
8. A LPN tripped on the staff room carpet and injured his/her knee.
9. A pharmacist was hit on the head by a falling object in the storage room.
10. A lab technologist was cut with a broken glass slide in the laboratory.
1. Please read the following report and describe the major report findings in the
paragraph to follow:
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of the lowest census-to-census
Canada registered a population growth rate of 4% between 1996 and
2001, an increase of about 1.16 million people, according to the first
data from the 2001 Census of Population. There have been only two
other periods in which the population grew this slowly: during the
Depression of the 1930s and the period between 1981 and 1986.
Between 1981 and 1986, the population increased by only 966,150
as a result of exceptionally low levels of immigration. Fewer than
half a million immigrants settled in Canada during that period.
During the baby boom years, the census recorded five-year growth
rates of 14.6% in 1956 and 13.4% in 1961. By the mid-1960s,
however, the growth rate was declining as fertility rates dropped.
There was a brief reversal of the downward trend in growth between
1986 and 1996 when a large number of immigrants arrived and a
small increase in fertility occurred.
The five years leading up to the 2001 Census were marked by a
decline of about one-third in natural increase compared to the 1991
to 1996 period. The number of deaths rose primarily because
Canada's population is aging. Also, the number of births declined,
for two reasons. First, the already low fertility rates dropped even
further in the late 1990s. Second, the generation of parents who
were born in the second half of the 1960s and early 1970s belonged
to the smaller "baby bust" generations that followed the baby boom.
With natural increase declining, immigration accounted for more
than one-half of Canada's population growth between 1996 and
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Canada compared to the world
Canada's 4% growth rate is well
above that of many other developed
countries. The population of the
less developed nations increased at
a rate of 8.4%, while more
developed countries grew at a far
slower rate of 1.5%. The population
of the world rose 7% between 1995
and 2000, according to the United
For the first time in 100 years, the demographic growth rate in
Canada was lower than in the United States. This is due to the
American fertility rate, which is exceptionally high for a developed
country. The annual average number of births for each woman has
remained above 2.0 in the United States for the last 10 years.
The population of Mexico, the other member of the North American
Free Trade Agreement (NAFTA), increased 8.5% between 1995 and
2000, about double that of Canada.
Census Report taken from: http://geodepot.statcan.ca/Diss/Highlights/Page2/Page2_e.cfm
What are the major report findings?
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2. Review the following chart and make 3 generalizations.
2002 to
Number of deaths % change
223,603 226,169 1.2
Newfoundland and
Prince Edward Island
Nova Scotia
New Brunswick
Canada: “The Daily”. Wednesday,
December 21,
a. ___________________________________________________________
b. ___________________________________________________________
c. ___________________________________________________________
d. ___________________________________________________________
3. Review the data below and derive data that could be reported on.
Percentage who smoke daily or occasionally, household population aged 15 or older, Canada
excluding territories, 2000 to 2006
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Note: The estimate for 2006 is based only on data collected during the first half of the year.
Source: 2000 to 2006 Canadian Tobacco Use Monitoring Survey.
a. ___________________________________________________________
b. ___________________________________________________________
c. ___________________________________________________________
d. ___________________________________________________________
4. Review the information on heart disease and identify information that could be
used in a presentation.
a. _____________________________________________________________
b. _____________________________________________________________
c. _____________________________________________________________
d. _____________________________________________________________
e. _____________________________________________________________
Now share your findings with a small group
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HO – B21 Telephone Etiquette
Read the following tips on telephone etiquette.
1. Residential telephones are answered with a simple “hello”.
2. Business phones are answered with the name of the company, business or organization
ie “PEI Association for Newcomers to Canada. How can I help you?”
3. When calling, ask for the person you wish to speak to or state the reason for your call, ie
“May I speak to Ms. Mills, please?”
4. Do not demand, “Who is this?” when you call a home or business, especially if you have
not identified yourself.
5. If you call the wrong number, apologize and hang up, ie “I‟m sorry, I must have called the
wrong number.”
6. Do not ask, “what number is this?” what you can say is, “I‟m trying to reach Keiko
Yoshihara at 387-1245. Have I got the correct number?”
7. Do not identify yourself to an unknown caller.
8. Never give personal information over the phone, as sometimes people will be looking to
steal your credit card number or other similar information. If someone says they are a
credit card company, politely tell them you will call them back. Hang up and call the
credit card company phone number listed on the back of your card or in the phone book.
9. When calling for information, state the nature of the call and ask for the right person
before going into detail, i.e. “I would like more information about your nursing school.
Could you put me through to the registrar?”
10. If someone is providing information or explaining something, be sure to acknowledge
you are listening. Do this during the speaker‟s pauses, i.e. “uh-uh” is a negative
response and “uh-huh” is a positive response.
11. If you are silent too long, the speaker will be nervous and may ask, “Are you still there?”
12. 911 is used for emergencies only.
13. If you need information, call 411. However, remember you will be charged for
information that is already in the phone book. It is only free if it is a new listing.
14. If an answering machine takes you call, speak clearly, slowly and remember to leave
your name, number and the reason you are calling.
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Read the common language functions for the telephone and ad two more of your own.
Answering the phone.
Good morning. Janet speaking.
1. ____________________________________________________
2. ____________________________________________________
Asking for someone
I’d like to speak to Dr. Carmen
1. ____________________________________________________
2. ____________________________________________________
Responding that someone is unavailable
He’s not at his station right now.
1. _____________________________________________________
2. _____________________________________________________
Asking someone to call back
Would you like to call back?
1. ______________________________________________________
2. ______________________________________________________
Taking a message.
Can I take a message?
1. ______________________________________________________
2. ______________________________________________________
Ending the call
Have a nice day.
1. _______________________________________________________
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Role-play the situations with a partner. Sit facing away from each other so it is more like
talking on the telephone.
1. You are a doctor at a teaching hospital. You would like some up-to-date information on
laser eye surgery to give your students. Cal Dr. Henley and ask if he/she has any current
information on this subject.
2. You are a sales representative from ING pharmaceuticals. Call a local health clinic to
arrange an appointment with whoever purchases medications to discuss some new
3. You are a dentist at a private office. You are in the process of hiring a new receptionist. An
excellent candidate, Geoffrey Lee, has been tentatively chosen. All you need to do is check
his references. Call his previous employer and ask a few pertinent questions to ensure he
will be a good choice for your clinic.
4. You have a meeting scheduled for 2:00 with your supervisor. Unfortunately, you are caught
in traffic and will be late. Call your supervisor and tell him/her.
5. You need the patient files from Sandy Suhan from her family doctor. Call the clinic and
request the files from the time period of January 2001 to the present.
6. You have just opened up a bed in your ward. Call the emergency room and tell them that a
bed is free in a semi-private room in the in-patient ward. Ask for pertinent information about
the patient they are sending.
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Leaving a Message on a Machine:
If no one answers the phone, then you will need to leave a message on their answering
machine. When you leave a message it is important to make sure you speak slowly and clearly,
so the person taking the message can understand you. In addition, there is some information
you must include in your message.
Take a look at this message and analyze what is wrong with it…
Thank you for calling Harriet‟s Physiotherapy Clinic. There‟s no one here to take
your call right now. Please leave a message after the beep and we‟ll get back to
you as soon as possible. Thank you and have a nice day.
Hi, this is Don. Give me a call back when you get a chance. Thanks.
What information is missing from this message? Ty to think of five things Don should have
included in this message. Remember that it is not a personal call, it is a professional business
1. ___________________________________________________
2. ___________________________________________________
3. ___________________________________________________
4. ___________________________________________________
5. ___________________________________________________
The most important information that you should include in a message is:
1. Your first and last name
Hi. This is Karen Johnraj from Prince County.
2. Who you are calling.
I‟m looking for Mark MacDonald.
3. When you are calling.
It is 10:00 on Monday morning.
4. Your telephone number.
Can you please call me back at 555-3875.
5. Your message.
I‟d like to set up a meeting to discuss our new health database.
In fact, to be even clearer, you can restate your name and number. If you think that people will have difficulty
understanding your name, then you can spell it out for them. This will make it much easier for the person
picking up the message.
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HO – B22 Public Speaking Tips
Read the following tips on how to speak in public effectively.
1. Know your audience – make sure you are speaking to the right people at the right time
at the right level about the right topic.
2. Be organized – know what you are going to talk about and know how long it will take.
Plan your presentation in an A-B-A format:
Tell them what you‟re going to tell them – the introduction
Tell them about it – the body
Tell them what you‟ve told them – the conclusion
3. Speak directly to your audience in your own words – DO NOT read from notes or the
4. Limit your speech to NO MORE than six points, ideally only three.
5. Maintain eye contact with your audience; this is vital for a good presentation and don‟t
forget about the people in your peripheral vision. Movement and gestures also enhance
a presentation as long as they do not detract from the presentation itself.
6. Write your title on the board, or use visual aids such as PowerPoint.
7. Don‟t speak too quickly. Speaking slowly and clearly is the key to being understood.
Talk as though you are having a conversation with your audience, this more informal
format is becoming more and more popular than the standard lecture style.
8. Don‟t use jargon, slang or big words your audience won‟t know. If no one understands
your presentation, it won‟t be effective.
9. Think of your presentation as a discussion with your audience. Encourage people to ask
questions at the end.
10. If someone asks a question, repeat it back to them to ensure you understand it and that
everyone else heard it.
11. Pay attention to non-verbal signals: if everyone is looking at the floor or falling asleep,
then you‟ve probably lost them. Either they don‟t understand or they are bored.
12. Ask a friend if you are fidgeting, have distracting body language or have any distracting
habits before giving your presentation in front of a larger group.
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Read the following information on how to write an introduction.
The introduction to your presentation is vital to capturing the audience‟s attention and keeping
them interested. In the introduction, you should introduce your topic and give a preview of the
main points. However, you should do this in an interesting manner.
“Hello, my name is Dr. Jessica Nguen. Today I am going to talk about professional
conduct in a clinic. I will tell you what you should and should not do.”
This is not a very interesting introduction. You need to pick it up a little bit, perhaps with an
anecdote or a statistic. Be creative. Try to develop a rapport with your audience that you can
maintain throughout the rest of your presentation.
1. Read a catchy quote.
“The good physician treats the disease; the great physician treats the patient who has
the disease” ~ William Osler
“Always laugh when you can. It is cheap medicine.” ~ Lord Byron
2. Make a joke (Never tell a joke that refers to race, religion, gender, disability or politics)
”Doctor, are you sure I’m suffering from pneumonia? I heard once about a doctor
treating someone with pneumonia and finally he died of typhus.” The doctor replied
“Don’t worry that won’t happen to me. If I treat someone with pneumonia, they will die of
A man goes to the eye doctor. The receptionist asks him why he is there. The man
complains, “I keep seeing spots in front of my eyes.” The receptionist asks, “Have you
ever seen a doctor?” “No” the man replies, “Just spots.”
3. As a thought provoking question.
“Why is obesity amongst North American children skyrocketing?”
“Did you know that Nurses are recorded as taking the largest number of sick days, why
is that?”
4. Surprise them with statistics.
“Women from Okinawa, Japan, have the longest life expectancy in the world, averaging
85 years.”
“250, 346 immigrants came to Canada in 2001; only 300 came to PEI.”
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The Body of the Presentation:
Read the following:
The body of your presentation usually includes three main parts: an introduction, a body and a
conclusion. However, beyond this, there are many styles that you can choose from. Some of
the more common ones are topical, chronological, spatial, journalistic, problem solving, and
A topical speech is one that is divided into separate topics. For example, if you were
giving a presentation on volunteering in Canada, your outline could be split into topics
like this:
Intro – overview of nursing in Canada
History of nursing
Purposes of the profession of nursing
Where and when nurses work
Scope of Practice issues in nursing
Conclusion – summary of nursing in Canada
A chronological speech is one that narrates the history of an event or process from
beginning to end. Whenever you tell a story to your friends which starts at the beginning
and builds up to a climax, you are using the format of a chronological presentation. For
example, why you entered the field of medicine might be a good example of this type of
This type of speech often has a cause-and-effect relationship. It is commonly used to
present the history of something, while examining the cause and affect of those events.
A spatial presentation is one that relies heavily on visuals as you examine the
relationship between subjects. For example, this would be a great style for making a
presentation on how to do a specific procedure or operation. You could use diagrams,
photographs and/or video to adequately illustrate your points.
Reporters make presentations all the time and they usually follow the format of asking
questions they will then answer. The most common questions are the “wh” questions:
who, what, where, when, why and how. For example, if a reporter were to look at the
issue of immigration, their outline might look like this:
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What is Canada‟s immigration policy?
When did the current policy begin?
Who is immigrating to Canada?
Where do immigrants go in Canada?
Why do they come to Canada?
How do they fare after they arrive?
Problem Solving
A problem-solving speech could be used in a variety of situations. A doctor may need to
analyze a disease to prevent it or to find possible cures, or an engineer might need to
explore a structural problem in a building before offering alternative consequences.
Problem solving has three components:
 An analysis of the problem (what is it and how serious is it?)
 An explanation of the causes
 Possible solutions
The purpose for a persuasive speech is to convince people to do something or to believe
what you believe. Think about the United Way trying to raise money for the
underprivileged or even more compelling
Facts, such as statistics and irrefutable evidence
An authority who is an objective expert in that area
Examples that clearly related to and support your line of reasoning
A logical and realistic prediction of the consequences
Knowing how your opposition will respond and being able to refute their
Discuss these questions.
1. When and where would you make a topical presentation?
2. When and where would you make a chronological presentation?
3. What is often an element of a chronological presentation?
4. When and where would you make a spatial presentation?
5. When and where would you make a journalistic presentation?
6. What kinds of questions would a reporter ask?
7. When and where would you make a problem solving presentation?
8. What are the three components of problem solving?
9. When and where would you make a persuasive presentation?
10. What are five techniques that can be used to support your argument?
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Read the following information on Presentation Conclusions.
It is very important to conclude your speech well. Often people are so relieved to have
finished the main part of the presentation that they rush “off-stage” without giving an ending, or
if they do a very short and hurried one.
You must remember to end well: a good conclusion should summarize the main points and
remind the audience why you are giving this presentation in the first place. It is also vital to
give your speech closure so the audience knows that you are finishing. Many of the strategies
you can use to end a presentation are the same as you would use to introduce it.
A quote
A joke or humour
A personal reference
An anecdote
A question
While the conclusion may be similar to the introduction, it should not be the same. It should
highlight some of the conclusions you came to while reiterating the main idea. And most
importantly, it should give the audience something of value to take home. While this may be
food for thought, it may also be an action they can take, or the incentive to do some research
on their own time.
Write a short outline to a presentation you are planning to give. Use one (or more) of
these strategies.
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HO – B23 Public Speaking Feedback – Peer Evaluation
Give your classmate feedback on his/her presentation using this form:
Know your audience
Board work/visuals
Confidence/body language
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Discuss the following questions.
1. How do you think your presentation went?
2. What were the best points of your presentation?
3. What can you do to improve your presentation?
4. What were the best points of your classmate‟s presentations?
5. How can they improve their presentation?
6. Did you think about the following points when you were preparing your presentation:
a. Did you plan your presentation for your audience‟s level and interest?
b. Did you organize your presentation in an A-B-A format?
c. Did you prepare cue cards to help you organize and remember information?
d. Did you limit your presentation to main points?
e. Did you practice at home?
Did you check the time?
7. Did you think about the following points when you were giving your presentation:
a. Did you give an introduction, a body and a conclusion?
b. Did you speak directly to your audience (without reading)?
c. Did you maintain eye contact with your audience?
d. Did you write the title on the board?
e. Did you use visual aids?
Did you speak slowly and clearly?
g. Did you take questions at the end of your presentation?
h. Were you aware of any distracting body language?
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People are often uncomfortable evaluating someone else, especially a peer. After all, no one
likes to give or receive criticism! However, evaluation is critical to a public speaker so he or she
knows what they can improve on. It is important not to think of evaluation as a criticism; rather
think of it as an opportunity to help someone improve their speaking skills.
There are two myths about evaluation that need to be addressed.
The first is that the speaker is more advanced than you are, so you cannot possibly evaluate
him/her. There is a belief that a speaker is the expert, and no one wants to correct the expert.
After all, they are an authority! Nevertheless, just because someone has expert knowledge in a
subject, it does not make him or her a great speaker, nor does it mean her or she knows
everything about the subject. Think of evaluation as feedback about the effectiveness of the
speech. You, as part of the audience, are in a unique position to provide feedback from your own
perspective. Remember, the speaker wants to be useful and give you something, so he or she
should appreciate constructive feedback.
The second myth is that your job as an evaluator is to tell the speaker what he or she did wrong.
Your role is actually to the presenter what when went well and what can be improved! You are
not judging him or her; you are offering suggestions and ideas on enhancing public speaking
Now that you know more about evaluating your peer, think about the specifics of how you are
going to do that.
Answer these questions then discuss the issues with a small group.
1. Why did you choose this subject?
2. What value will your presentation give your audience?
3. How many main points do you have? What are they?
4. How are you going to introduce your presentation?
5. How will you conclude it?
6. Explain how you organized your presentation and why?
7. What information will you give in the body of your presentation?
8. How do you know it will be the right length?
9. Do you have any visuals? What are they? Why did you choose them?
10. What information will you put on the whiteboard? How will you organize it?
11. What questions might your audience ask you at the end of the presentation? Have you
thought about your answers?
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C –Patients
Communicating with Patients
Communicating with
HO – C1 Doctor -Patient Communication
Bedside manner is a term describing how a doctor handles a patient. A good bedside manner is
typically one that reassures and comforts the patient. Attitude, vocal tones, body language,
openness, and presence may all affect bedside manner. Poor bedside manner leaves the
patient feeling unsatisfied, worried, alone, or frightened. Bedside manner becomes difficult when
a doctor explains to his patient the true diagnosis, while keeping him from being alarmed.
Read article
Family Physician
Doctor-Patient Communication: Getting Started
During the past 15 years, one of the authors of this series (M-T.L.) has observed thousands of family physicians in training
conduct interviews. She has found that, early in their career, physicians tend to follow the same order in their consultations
as they do filling out their patients‟ charts. Guidelines useful for completing patient charts, however, should not dictate how
physicians arrange the elements of interviews. In consultations, they should instead take their cues from patients‟
Medical charts and interviews, after all, serve different purposes. Charts generally focus on clinical data and are used
mainly as a reminder for attending physicians and a resource for exchanging information with colleagues. A standardized
method of recording information clearly has many advantages.
Medical interviews, on the other hand, have three functions: to gather information to help physicians understand patients
and the problems they present, to help physicians develop relationships with patients and respond appropriately to patients‟
state of mind, and to educate patients by, among other things, sharing information with them.
Observation of physicians in training and the results of patient-physician communication studies tell us that, in general
during interviews, the information-gathering function takes precedence over other functions. Physicians correctly see their
main task as arriving at diagnoses. Traditionally, however, they have not been overly concerned with the process of
collecting necessary data, yet the quality of information they garner can well be affected by the way it is gathered.
Medical interviews have many dimensions. To start exploring them, we present a comparative analysis of two
conversations at the beginning of a medical consultation. While most published work on the subject deals in detail with
initial interviews, our scenarios involve follow-up consultations, which, we believe, constitute the bulk of visits conducted by
experienced physicians. Both conversations involve the same characters, but for the purpose of the exercise, they behave
very differently.
A 30-minute wait for an appointment is not unusual. Even though it might be unintentional, however, the wait helps define
the patient-physician relationship as “asymmetric”: patients have a subordinate, more passive role. Patients can interpret a
long wait as an indication that their physicians do not think they are important. In the first scenario, the first words Dr. Rush
exchanges with Mr. Tense contain very little information, but reinforce the asymmetry. Dr. Rush‟s businesslike approach
leaves Mr. Tense with little choice but to follow suit.
In the second scenario, Dr. Rush greets his patient cordially, acknowledges that he has kept him waiting, and apologizes.
This is more than mere courtesy; it starts to define the nature of the patient-physician relationship and indicates that the
physician wants to establish mutual respect. The different approaches also affect the beginning of the interviews.
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Communicating with Patients
Communicating with
Doctor-Patient Communication
Greeting a patient
Dr. Rush enters the reception area and absently takes the
file on top of the pile. It is Mr. Tense‟s file. He goes into
the waiting room where Mr. Tense has already been
waiting for more than 30 minutes. “Mr. Tense?” “Yes”
Dr. Rush enters the reception area. He makes sure he
has no urgent messages and that no one will interrupt him
during his next consultation. He takes Mr. Tense‟s file
from the top of the pile and reviews it quickly. Mr. Tense is
attending for his hypertension follow up. All the laboratory
tests Dr. Rush ordered are in the file. He thinks he will be
able to make up for some lost time. He heads confidently
to the waiting room where Mr. Tense has already been
waiting for more than 30 minutes. “Mr. Tense?” “Yes”
Dr. Rush gives him a half-smile and says, “Follow me,
please.” “Hello!”
Dr. Rush gives him a half-smile, holds his hand out to him
and says, “Hello, Mr. Tense. Follow me please.” “Hello Dr.
Rush. How are you doing?” “Fine, thank you.”
Dr. Rush already has his back to Mr. Tense. He leads him
at a brisk pace down the hallway to his office. Mr. Tense
follows in silence.
Dr. Rush walks briskly down the hall leading to his office.
Mr. Tense follows, asking, “Still busy?” Dr. Rush smiles,
“Always. Sorry to have made you wait.” That‟s OK.”
Beginning an interview
When he gets to his office, Dr.Rush opens the door, walks
in, sits down behind his desk, and opens the file. Mr.
Tense enters, closes the door behind him and steps
forward. Dr. Rush motions him to take a seat.
As he approaches his office door, Dr. Rush ushers Mr.
Tense in and, motioning him to a chair, invites him to sit
down. He closes the door behind him, waits until Mr.
Tense is seated and then sits down with the file opened in
front of him.
Quickly consulting his most recent notes, Dr. Rush sees
he has asked Mr. Tense to come back for his
hypertension follow up. He thinks he might be able to
make up some lost time. Still feeling rushed and still
looking over the papers in the file, he addresses Mr.
Tense, “So, Mr. Tense, you‟re here today so we can
check your blood pressure?” “Yes. You told me to come
back in 3 months and…
“Even though he feels rushed, he looks Mr. Tense in
the eye and says, “So, Mr. Tense, how have you
been since your last visit to the clinic?” “Well, OK
I‟ve been feeling pretty good.” “And your family.”
“Great, thank you.” “If I remember correctly, you‟re
here today to check your blood pressure?” “Yes.
You told me to come back in 3 months.”
Physicians have a responsibility to ensure their patients feel welcome because patients who do not are less
likely to cooperate. Since patients must reveal intimate and often unpleasant information, physicians should
make it easier for them to speak by assuring them confidentiality and by giving them their full attention. It
helps if, for example, physicians ask their secretaries to keep interruptions to a minimum, eliminate noise, and
check to make sure patients are comfortable and ready to start.
Finally, by reviewing the medical chart beforehand, Dr. Rush avoids making Mr. Tense spend more time
waiting in the office and giving him more cause for annoyance. Physicians can also prepare comments or
questions based on the information in the file to show patients they “matter” to them. Depending on test
results, they can also prepare to deliver good or bad news.
Bottom Line
Physicians demonstrate respect for their patients not by their intentions but by attention to detail. Patients
who feel respected are more likely to reciprocate, to show respect for physicians‟ work, and to adhere to
physicians‟ recommendations. Reprinted with permission © 1996-2005 The College of Family Physician s of Canada
Dr. Lussier is a family physician, and Mr. Richard is a psychologist, in Montreal, Que.
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Communicating with Patients
Communicating with
Please answer the following questions.
1. What is bedside manner?
2. What order do doctors use in consultations?
3. Is this the best approach to consultations?
4. What are the three functions of medical interviews?
1. ____________________________________________________________
2. ____________________________________________________________
3. ____________________________________________________________
5. What can affect the quality of information doctors gather?
6. What is this article exploring?
7. How do conversations differ?
8. What do physicians have a responsibility to do?
9. How can physicians demonstrate respect for their patients?
Module C Communicating with Patients- 75 -
Communicating with Patients
Communicating with
In the healthcare field, you will often be asked for your opinion. It is important to give this in as
respectful and professional manner as possible. When you are giving your opinion, keep these
points in mind:
when stating your opinion, be polite but assertive
back up your opinion with logic and facts
listen to other opinions carefully and thoughtfully
make comments about the idea, not the person
try to reach solutions that everyone can support, AKA compromise
Read these examples and add two more of your own.
Giving an opinion
In my opinion
Personally, I believe…
Personally, I feel…
1. __________________________________________________________________
2. __________________________________________________________________
Did you say…?
Let me repeat what I said.
I didn‟t say…what I said was…
4. ____________________________________________________________________
Asking for an opinion
What do you think?
What does everyone else think?
5. ____________________________________________________________________
6. ____________________________________________________________________
Before you move on, I‟d like to say…
I‟m sorry, but can I say something?
7. ____________________________________________________________________
8. ____________________________________________________________________
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Communicating with Patients
Communicating with
That‟s for sure.
You can say that again!
9. ___________________________________________________________________
10. ___________________________________________________________________
I‟ve never heard that before.
On the other hand...
11. __________________________________________________________________
12. __________________________________________________________________
Adding items
Not to mention the fact that…
Oh, one more thing is…
13. ________________________________________________________________
14. _____________________________________________________________
Showing interest
Go on.
Tell me more…
15. ___________________________________________________________________
Have you considered…?
You should think about…
17. ___________________________________________________________________
18. ___________________________________________________________________
I‟ll think about that.
We‟ll have to agree to disagree…
19. __________________________________________________________________
20. __________________________________________________________________
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C – Patients
Communicating with Patients
Communicating with
HO – C3 Talking to Patients - Scenarios
Discuss each of these situations with a small .
1. A mother has brought her eight-year old son to the clinic for a
vaccination. He is terrified of needles and already crying. He looks like he is on
the edge of hysteria. What do you do?
2. A father has brought his five-year old in for her annual dental check-up. She refuses to
open her mouth for you. What do you do?
3. A fifteen-year old has come to your clinic complaining of stomach cramps and nausea.
After doing a routine physical, you suspect she is pregnant. When you ask her if she is
sexually active, she bursts into tears and says, “No, of course not. My mother would kill
me.” What do you do?
4. A man has come into the pharmacy complaining of sinus headaches and a stuffy nose.
What do you do?
5. A young man insists he is alright after receiving a severe blow to the head. He really
wants to go home to get ready for a party tonight. His friend, however, says that he is
acting strangely. You suspect he has a concussion. What do you do?
6. A woman has come into the clinic with a black eye and a bruised arm. She says she fell
down the stairs. You are concerned that it may be spousal abuse. What do you do?
7. A forty-five year-old woman is complaining of chest pains. She has emphysema and you
know she is a heavy smoker. What do you do?
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C –Patients
Communicating with Patients
Module C – Communicating with Patients
Communicating with
HO – C2 Giving Opinions
HO – C4 Talking to Patients – Role-Plays
During your career as a health care professional, you will encounter a wide variety of people.
Each patient you meet is different and unique for a number of reasons. Their age, sex, spiritual
beliefs, level of education, and past health experiences are some of the factors that influence
how patients communicate with their health care professionals. For example, consider the
language you would use to talk to a child in comparison with the language you would use to talk
to a university professor; not only would the vocabulary be drastically different but your tone of
voice and body language would be different as well.
Discuss the following situations. How would you describe the following if you were the
patient? How would you react if you were the health care provider?
1. A young child with the stomach flu.
2. A female teenager with a yeast infection.
3. An elderly man with erectile deficiency.
4. A middle aged man who wants to lose some weight.
5. A new mother suffering from hemorrhoids.
6. A teenage male with an STD.
7. An elderly woman with corns and bunions.
Module C Communicating with Patients- 79 -
Communicating with Patients
Communicating with
Module C – Communicating with Patients
HO – C5 Introduction to Patient Consultations
A consultation is the interview where the healthcare provider and the patient discuss the present
health concern and make an assessment of the situation.
The common format is:
1. Initial greeting- the health professional introduces himself/herself
2. Identify why the patient is visiting the health facility
3. Further questions to identify the symptoms and their duration
4. Questions about the patient’s history- social and personal background
5. A physical examination
6. An assessment of the patient‟s problems and possibly the prescription of medication,
further tests, referral to hospital, or some other course of action
7. An opportunity for the patient to ask questions before the close of the consultation
Brainstorm some possible questions and statements to begin the consultation and to
inquire about the reason for the patient’s visit.
Good morning, I‟m ____________________. What can I do for you?
Module C Communicating with Patients- 80 -
Communicating with Patients
Communicating with
Brainstorm what topics need to be covered within the following categories and write
some sample questions.
a. General information
b. History of Present Illness
c. Family History (the present tense if often used – Do you have…? Is
your…? Are your…?)
d. Past Medical History and Current Health Status (the present perfect is
often used – Have you…?)
e. Social History
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Communicating with Patients
Communicating with
Module C – Communicating with Patients
HO – C7 Open Ended Questions for the Patient History
Once the consultation is underway and the patient has given an indication for the reason for
his/her visit, the health professional must find out more details about the symptoms and the
duration of the complaint. Open ended questions are the most useful because they result in
more details and information.
Brainstorm some open ended questions you could use in your consultation.
What questions:
1. What is the level of pain you are experiencing?
How about questions?
3. How about your bowels? Have you ever had any problems?
4. _______________________________________________________________
Where questions?
5. Where do you feel the pain?
6. _______________________________________________________________
When questions?
7. When did you first notice?
8. _______________________________________________________________
Do you ever questions?
9. Do you ever have?
10. ______________________________________________________________
Have you ever questions?
11. Have you ever had pain?
12. ______________________________________________________________
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Communicating with Patients
Communicating with
How much questions?
13. How much do you smoke/ drink in a normal day?
14. ______________________________________________________________
How bad questions?
15. How bad does it feel when I do this?
16. ______________________________________________________________
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Communicating with Patients
Module C – Communicating with Patients
Communicating with
HO – C8
– C7 Open
Ended Questions
for the Patient History
Once the health professional has all of the information he/she needs, they can proceed with a
physical evaluation of the patient.
Often a series of polite instructions for the patient using Could you…? Would you…? and Can
you…? are used. Remember that adding please and just a second soften the command.
Brainstorm a list of possible expressions to politely instruct the patient during
the examination.
a. Would you bend your knee please?
b. Can you take a deep breath and hold it?
c. _____________________________________________________________
d. _____________________________________________________________
e. _____________________________________________________________
g. _____________________________________________________________
h. _____________________________________________________________
Module C Communicating with Patients- 84 -
Communicating with Patients
Module C – Communicating with Patients
Communicating with
HO – C9 Physical Examination Question Corrections
The following questions and statements have some common errors.
Correct the mistakes in these sentences.
1. Would you mind wait for a few moments?
2. How about your relations to your husband?
3. How long have you had problem?
4. Do you open your mouth wide?
5. Can you make a deep breath and hold it?
6. Let‟s have a looking at you.
7. Try hard staying as still as possible.
8. Now I will press just a little but hard.
9. Do you ever get shot of breath?
10. Is he activity like other children?
11. Have you ever been operated?
12. Could you to give me your arm?
13. What‟s bringing you here?
14. Where is the pain particularly?
15. Now, to walk slowly across the room.
16. Does she has good appetite?
17. You can putting your things back on now.
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Communicating with Patients
Module C – Communicating with Patients
Communicating with
HO – C10 Giving Instructions in a Physical Examination
Giving instructions as commands can sometimes seem impolite. When phrasing instructions it
is better to format them as requests using can or could. Adding just and/or please also reduces
the impact.
Fill in the blanks with these verbs.
take off
Can you __________ the chart?
Just __________.
Can you __________ over for me?
Could you __________ your mouth?
__________ ahhh, please.
Why don‟t you__________ down on the table?
Could you __________ me your arm?
Can you __________ a deep breath and hold it?
Now __________ the air out and hold it.
Can you __________ your finger?
Could you __________ your shirt for a moment?
If you‟d just like to __________ her pants?
Just __________ out your arm for a minute.
Please __________ straight ahead.
Just __________ your knee for me.
Can you __________ your toes?
__________ here for a moment
Take a __________ to the other side of the room, please.
You can __________ your leg down now.
Could you__________ me your name?
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Communicating with Patients
Module C – Communicating with Patients
Communicating with
HO – C11 Idioms in the Examining Room
Read the sentences and identify the idiom. An idiom is a phrase whose meaning cannot be
made sense of from the literal definition, but refers instead to a figurative meaning that is known
only through common use. Then read it again and guess the meaning.
She was in the hospital for an aneurism. It was a close call.
I think her recovery is coming along just fine.
I need to insert this needle, so please don‟t move a muscle.
He may have to go under the knife if his diverticulosis returns.
Immigration requires you to have a physical before coming to Canada.
Oh dear, he‟s in a bad way. I hope it isn‟t terminal.
You should lay off the cigarettes and beer.
They‟re making headway in their search for the cure for cancer.
Sam‟s not out of the woods yet. He still has radiation treatment.
She‟s running a fever of 103. That‟s way too high.
Module C Communicating with Patients- 87 -
Communicating with Patients
Communicating with
You‟ll have to let your cold run its course. There is no cure.
We‟ll run some tests before admitting you to the hospital.
Tina took a turn for the worse. I hope she‟ll be okay.
Her surgery was touch and go. She almost didn‟t survive.
How far along are you? Oh, almost sixteen weeks!
B. Match each idiom with its meaning.
_____ close call
stay still; don‟t move
_____ coming along
have surgery
_____ don‟t move a muscle
do some tests
_____ go under the knife
routine physical examination
_____ have a physical
have a fever higher than normal
_____ in a bad way
abstain; avoid
_____ lay off
continue naturally until finished
_____ making headway
making progress
_____ out of the woods
length of pregnancy
_____ run a temperature/fever
uncertain; dangerous
_____ run its course
achieved by a narrow margin
_____ run some tests
out of danger: recovering nicely
_____ take a turn for the worst
illness returns or gets serious
in very bad health
_____ touch and go
making progress
_____ how far along
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Communicating with Patients
Module C – Communicating with Patients
Communicating with
HO – C12 Verbs for Administering Drugs
Fill in the blanks with verbs used to describe drug administration.
1. _____________________________ one of these tablets three times a day.
2. ___________________________ some lotion to the affected area.
3. Ask someone to ________________________ a drop into each ear three times a day.
4. ________________________ one puff in each nostril when congestion occurs.
5. Put a hot shower on and __________________________ the steam.
6. Don‟t _______________________ these tablets. Swallow them whole.
7. It‟s best to ___________________________ the bandage on the area.
8. You should ______________________________ this EpiPen with you at all times.
9. Just _________________________ the lozenge under your tongue and allow it to
__________________________ slowly.
10. ______________________________ some of this cream on the rash before bed.
11. ______________________________ one dose into the vagina before bed.
12. _____________________________ with the medication until it is all finished.
13. Dissolve the contents of the package in hot water and _________________________ it
14. __________________________ the wound with warm water and leave it open to the air
to dry.
15. __________________________ the end of the strip into the urine and wait one minute
to see the results.
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Communicating with Patients
Module C – Communicating with Patients
Communicating with
HO – C13 Patient Assessment Conclusions
After the physical examination is complete, the health professional gives their assessment of the
patient‟s condition. This may include further treatment, a prescription, or a referral to another
health professional.
Throughout the examination, patients should be able to ask questions or express concerns.
However, if they do not, it is good practice for health professionals to ask if they have any
questions or concerns that they wish to talk about. This is a very crucial step and it will make
patients feel as though their individual health concerns are being acknowledged.
Brainstorm some statements for a variety of assessment situations.
1. Well, I can‟t see anything wrong here.
2. I‟ll ask Dr. Jones at the QEH to have a look at you.
3. We‟ll send these samples off and I‟ll call you in two days with the results.
4. _________________________________________________________________
5. _________________________________________________________________
6. _________________________________________________________________
7. _________________________________________________________________
8. _________________________________________________________________
9. _________________________________________________________________
10. _________________________________________________________________
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Communicating with Patients
Module C – Communicating with Patients
Communicating with
HO – C15 Describing Common Complaints
Fill in the blanks with the correct vocabulary word/phrase from the list.
Bunged up
Get it up
Pins and needles
To sleep
1. I have a ______________________ headache.
2. I feel ______________________ when I stand up.
3. My sinuses are _____________________.
4. I keep getting a _______________________ in my throat.
5. My voice is _______________________.
6. I have a _______________________ in my neck.
7. I‟ve _______________________ my back in.
8. I have _______________________.
9. My heart keeps _______________________ a beat.
10. I keep _______________________ whenever I smell food.
11. I keep having _______________________.
12. I‟m _______________________.
13. I _______________________ too early.
14. I can‟t _______________________.
15. My foot keeps going _______________________.
16. I get _______________________ in my thigh.
17. I can‟t _______________________.
18. I‟m very _______________________ tempered.
19. I don‟t _______________________ like myself.
20. I‟m always on _______________________.
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Communicating with Patients
Module C – Communicating with Patients
Communicating with
HO – C16 Medical Expressions and Idioms
Match the vocabulary on the left with its meaning on the right.
1. _________ hamstring
1. A psychoanalyst
2. _________ scab
2. A psychiatrist
3. _________ collarbone
3. A person who pretends to be a doctor
4. _________ quack
4. Short form for doctor
5. _________ jawbone
6. _________ skin and bones
5. Public notice of the opening of a doctor‟s
6. Very, very thin
7. _________ hangnail
7. The spinal column
8. _________ knee cap
8. The sternum
9. _________ hang out one‟s shingle
9. The clavicle
10. _________ breastbone
10. The mandible
11. _________ funny bone
11. The tendons at the back of the knee
12. _________ backbone
12. The elbow
13. _________ doc
13. The patella
14. _________ couch doctor
14. A mole or birthmark, often on the face
15. _________ beauty mark
15. A pimple
16. _________ head shrink
16. Small piece of dead skin on the cuticle
17. _________ a zit
17. Crust covering a healing wound.
Write a dialogue using some of these expressions and idioms.
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C –Patients
Communicating with Patients
Communicating with
HO – C17 Ailment and Disease Names
Match the medical name for ailments and diseases with their colloquial equivalent
Medical name
Common name
a. _____ arteriosclerosis
a. German measles
b. _____ bursitis
b. blood clot
c. _____ candida
c. thrush
d. _____ infectious mononucleosis
d. skin tags
e. _____ rubella
e. warts
_____ atherosclerosis
heart attack
g. _____ dyspepsia
g. heat spits/nettle rash
h. _____ mucous colitis
h. cold sore
_____ halitosis
_____ cerebral infarction/bleeding
kissing disease
k. _____ herpes simplex
k. belching
_____ pyrosis
plaque in arteries
m. _____ verrucae
m. heartburn
n. _____ thrombus
n. baldness
o. _____ flatulence
o. chickenpox
p. _____ papillomas
p. hardening of the arteries
q. _____ alopecia
q. measles
_____ myocardial infraction
irritable bowel syndrome
s. _____ edema
s. food poisoning
_____ rubeola; morbilli
bad breath
u. _____ tendonitis
u. indigestion
v. _____ salmonella poisoning
v. housemaid‟s knee
w. _____ hemorrhoids
w. piles
x. _____ urticaria
x. tennis elbow
y. _____ eructation
y. stroke
z. _____ varicella
z. wind/gas
Discuss these ailments/diseases with a small group. Consider the possible
causes, symptoms and cures.
Module C Communicating with Patients- 93 -
Communicating with Patients
Module C – Communicating with Patients
Communicating with
HO – C18 Ailment and Disease Expressions and Idioms
Match the vocabulary on the left with its meaning on the right.
1. _____ a dicky ticker
11. to be disabled
2. _____ a gammy leg
12. spinal damage
3. _____ farmers lung
13. painful area near cuticle
4. _____ ingrown toenail
14. diarrhea
5. _____ miner‟s lung/black lung
15. bad heart
6. _____ Montezuma‟s revenge
16. pulmonary fibrosis. lung disease
7. _____ slipped disk
17. have cancer everywhere
8. _____ the runs
18. upset stomach and diarrhea when traveling
9. _____ the trots
19. diarrhea
10. _____ riddled with cancer
20. emphysema, lung disease
Write a sentence using some of the vocabulary
 __________________________________
 __________________________________
 __________________________________
 __________________________________
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Communicating with Patients
Module C – Communicating with Patients
Communicating with
HO – C19 Describing the Symptoms
What do the following adjectives describe? Complete the sentences below using
these adjectives. Some are used more than once.
1. His cough
2. My head
3. My vision is…_________________________________________________________
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4. My arm/foot/leg/shoulder is… ____________________________________________
5. I feel…______________________________________________________________
6. His breathing is…_____________________________________________________
7. The discharge smells…_________________________________________________
8. My chest is…_________________________________________________________
9. The discharge is…_____________________________________________________
10. My speech is…______________________________________________________
11 My nose is…_________________________________________________________
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C –Patients
Communicating with Patients
Communicating with
HO – C20 Describing Symptoms Expressions and idioms
Match the vocabulary on the left with its meaning on the right.
Write a dialogue using some of these expressions and idioms.
Module C Communicating with Patients- 97 _______________________________________________________________________
Communicating with Patients
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Module C – Communicating with Patients
HO – C21 Describing Symptoms Idioms 2
Match each idiom with its meaning
1. _________ bad nerves
a. bubbles near the mouth
2. _________ black out
b. salivate
3. _________ can‟t catch my breath
c. feel nauseous
4. _________ feel blue
d. in poor health
5. _________ feel like death warmed over
e. have lots of energy
6. _________ feel off colour
f. become unconcious
7. _________ feel out of it
g. feel sad or depressed
8. _________ foam at the mouth
h. feel slightly ill
9. _________ full of beans
i. feel like you need to cough
10. _________ go off the deep end
j. feel very ill
11. _________ have a frog in my throat
k. slightly ill
12. _________ in bad shape
l. have difficulty breathing
13. _________ makes my mouth water
m. feel disoriented
14. _________ makes my stomach turn
n. very nervous, hypersensitive
15. _________ take a dump
o. defecate
16. _________ throw up
p. vomit
17. _________ under the weather
q. behave erratically, violently
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Communicating with Patients
Module C – Communicating with Patients
Communicating with
HO – C22 Using Prepositions when Describing Symptoms
Fill in the blanks with a preposition. Some are used more than once.
1. Chicken pox is spread through direct contact _________ the patient.
2. Some intestinal illnesses are caused by the consumption of water contaminated
___________ sewage.
3. Lyme disease is transmitted _________ the bite of a tick.
4. A fever is probably due _________ an infection in the body.
5. The patient‟s recovery time depends _________ the body, the severity of the symptoms
will subside.
6. Bacterial infections can be treated _________ appropriate antibiotics.
7. Bacterial infections can be treated _________ appropriate antibiotics.
8. At my house, we are all suffering _________ the flu.
9. Expectant mothers must be warned _________ the dangers of drinking excessive
amounts of alcohol during pregnancy.
10. Did the rash first appear _________ the face and then spread _________ the rest of the
11. The symptoms consist _________ a fever, nausea, and diarrhea.
12. Children should be vaccinated _________ the chicken pox if they haven‟t had it.
13. The symptoms are consistent _________ those of appendicitis.
14. During the Middle Ages many Europeans died_________ the Bubonic Plague.
15. I have been immunized _________ Japanese Encephalitis.
16. His insomnia might be caused _________ stress.
17. Washing your hands is good prevention against the spread _________ infection.
18. Mothers are not often concerned _________ a slight cough.
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Module C – Communicating with Patients
HO – C23 A Caring Environment
Read the article
Communication Gets to Core of Complaints – By Stuart Foxman
What‟s the one skill that no doctor can do without? You won‟t find pages on it in a medical text. In fact, this area of
expertise really has nothing to do with a diagnosis or treatment – except that, to a patient, it often has everything to do
with both of those.
“Communication is probably the most important skill a physician has,” says Dr. Dale Mercer, Department Head of Surgery
at Queen‟s University and co-chair of the Complaints Committee for the College of Physician and Surgeons of Ontario. “If
we can‟t communicate in a language that patients will understand, they won‟t get the care they need.”
Considering how vital effective communication is to a doctor‟s competency, the subject often gets short shift. This is why
we want to tackle some key communication issues facing physicians in Doc Talk, a new column for Dialogue.
In future columns, we‟ll explore a wide range of topics, form how to break bad news, to dealing with confrontational
patients. To kick things off, we spoke to Dr. Mercer and to Mr. John Martel, a public member of Council and co-chair of
the CPSO‟s Complaints Committee, about the types of communication breakdowns that are reported most often to the
They agree that in the vast majority of cases, communications between physicians and patients are somewhere between
good and excellent. Yet when complaints do come to the College, “the most common reason is communication issues,”
says Dr. Mercer. “Either the absence of communication, or communications that have been misinterpreted, or done in a
poor fashion.”
Consider how communication is at the core of these two actual cases.
Case 1
A 70-year old woman was a longtime patient of Dr. A, a family physician. After she experienced paranoid and delusional
symptoms, Dr. A prescribed thioridazine, which worked. Two years later, Dr. A saw the symptoms recur. He discontinued
the thioridazine, prescribed risperidone without discussion, and asked the pharmacist to withhold a side effect information
sheet. Dr A felt that his patient wouldn‟t take the medication if she knew the side effects.
After taking the risperidone a few days, the patent became dizzy. When she went to a different pharmacist to ask about
the medication, she was shocked to learn it was an anti-psychotic, and stopped taking it.
As the Complaints Committee said, the principle of informed consent depends on physicians being open ad honest. Dr. A
should have explained to the patient why he was changing the medication, and he had an obligation to discuss the
potential side effects.
Module C Communicating with Patients- 100 -
Communicating with Patients
Communicating with
Case 2
Discuss these questions in a small group.
After she cut her finger at work, a 30-year-old grocery store worker saw a physician, Dr. B, at a walk-in clinic.
1. What is the most important communication skill a health care provider has? Why is it
Dr. B gave her a note to take back to her supervisor, specifying that while she could return to work, she shouldn‟t handle
fresh food. The grocery store supervisor got the note, but wanted to know how long the employee would need to be on
modified work. 2. What are some common communication issues?
The patient returned to the clinic to seek clarification. Dr. B became annoyed, and hurriedly scribbled on the note to the
supervisor. “Hey, idiot, she can work, just not in fresh foods. Get a little IQ” The Complaints committee noted that Dr. B
showed a lack of professionalism, and should have been clearer in the original information that he provided to the
Two different doctor-patient relationships, two different encounters, on root cause – a failure to communicate.
Why do such failures occur? One problem is the volume of conversations that doctors have with patients. Each can
become “routine” (to the doctor, but never to the patient), just one of 30 over the course of the day. Poor communications
can result when the doctor, in actual language and body language (arms crossed, perhaps a glance at a watch), appears
to be rushed or distracted.
“The worst thing,” says Mr. Martel, “is when patients feel that the physician isn‟t paying attention, then just writes a
prescription at the end. It‟s demeaning.”
Patients can also feel put off when they feel that their physician isn‟t listening. A professor of medicine at the University of
Rochester once found that, on average, patients were interrupted 18 seconds into explaining their problems. Less than
2% of patients got to finish their explanations.
As Mr. Martel notes, physicians are encouraged to probe. “By probing,” he says, “you interrupt.” But it adds to the
perception that the doctor doesn‟t seem to care, and is brushing off the patient.
Frequently, complaints centre around consent. “Perhaps because of a lack of time, some doctors don‟t fully disclose the
risks of a procedure,” says Dr. Mercer. “Or the doctor delegates the communications, having someone else describe the
risks and benefits of an operation that they themselves have never seen and never done.”
“On the flip side,” adds Mr. Martel, “we see a number of instances where the physician was clear in laying out a
procedure, and because of a negative outcome, the patient says, „I wasn‟t told.‟ The problem becomes one of
Discuss these questions in a small group
The use of medical
is another
to clear
can become
confused, and
1. What
is the
most important
a physician
(and all other
find it tough to grasp
Why is it so important?
informed consent when he gave a patient a sheet with technical language about a procedure instead of talking it over with
2. What are some common communication issues?
Given the thousands
and patients
every dayand
in Ontario,
the frequency
3. InofCase
1, what
was the
how could
it have been
complaints to the College is very low, notes Mr. Martel.
“In the past four years, we‟ve also found it unusual to get complaints about communications for physicians who‟ve been in
4. In Case 2, what was the communication breakdown and how could it have been
practice less than five years,” Mr. Martel says. “Medical schools are doing a much better job at emphasizing
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Communicating with
What can physicians do to improve their communication skills?
1. Encourage discussion of patient concerns
2. Educated and share decisions and plans with patients
3. Obtain fully informed consent for patient decisions
4. Listen well, and avoid interrupting
5. Avoid medical jargon
6. Avoid assertive, dominating or sarcastic language
7. Control your temper in negative/difficult situations.
8. Acknowledge your limitations (e.g. “I don’t know, but I’ll find out”)
Dr. Dale Mercer says patients need to insist that their questions be answered. “But, frequently, because of
the power differential between patients and doctors, patients won‟t persist” Dr. Mercer says. “Doctors may
think that their communication is fine because they talked and the patient didn‟t ask questions. But maybe
the doctor didn‟t let them ask any questions. Doctors not only need to have concern for their patients, they
need to be seen to have concern,” he said.
Reprinted with permission – The College of Physicians and Surgeons of Ontario - Nov/Dec 2005
Discuss these questions in a small group
1. What is the most important skill a physician (and all other healthcare professionals) has?
Why is it so important?
2. What are some common communication issues?
3. In Case 1, what was the communication breakdown and how could it have been
4. In Case 2, what was the communication breakdown and how could it have been
5. Why do communication failures occur?
6. How important is listening in patient communication?
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7. Why do complaints frequently occur around consent?
8. Why are there fewer complaints with physicians who have been practicing for less than
five years?
9. How can health care providers improve their communication skills?
10. How does patient communication differ in Canada from you country of origin?
11. Are you comfortable with the kind of open patient communication required in Canada?
Why or why not?
12. Can you think of any other factors that could improve communication between
healthcare professionals and patients?
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HO – C24 Comforting and Reassuring
Health care professionals often have to offer comfort and reassurance. Situations range from a
child fearing an injection to a person dealing with the end of life.
Discuss how you would comfort and reassure the patients in the following situations.
Think not only of words and phrases, but body language and gestures as well.
1. A young woman is going to have her first pap test and she is scared that it will hurt.
2. A pregnant woman is going to have an ultrasound and she is worried that there will be
something wrong with the child.
3. A man is going to have an MRI and he gets claustrophobic easily.
4. A boy needs to have an x-ray, but he wants his father to stay with him because he‟s
5. A young girl is going to have her tonsils removed and she is crying because does not
want to get a needle.
6. A man is having an ECG and he is nervous because heart disease runs in the family.
How are Canadian ways of comforting and reassuring different from your culture?
Choose one situation and write a dialogue with a partner to role play for the rest of the
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HO – C25 Common Language Functions for Sympathy
Empathy and sympathy are two words that are often synonymous in the English
language, but there is a slight difference. Do you know what it is? See if you can tell
from the following statements which is empathy and which one is sympathy.
“I understand why you would be so upset.”
”I‟m sorry that you are so upset. I really feel for you.”
Being empathetic means putting yourself in the other person‟s shoes so you can feel what
he/she is feeling. Being sympathetic means that you feel badly that the other person is sad,
angry, upset, hurting, etc., but you have not experienced a similar situation and cannot truly
understand how he/she feels.
Brainstorm a list of expressions that communicate empathy and a list that communicates
sympathy. The first on has been done for you.
1. I‟m sorry for you loss.
2. ______________________________________________________________________
3. ______________________________________________________________________
4. ______________________________________________________________________
5. ______________________________________________________________________
1. I feel your pain
2. ______________________________________________________________________
3. ______________________________________________________________________
4. ______________________________________________________________________
5. ______________________________________________________________________
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HO – C26 Sympathy and Empathy Role Plays
Discuss how you would feel and respond, using sympathy or empathy, in the following
1. A patient has just found out that his mother has cancer.
2. A patient is angry because the procedure you prescribed was quite painful.
3. A co-worker has just been laid off.
4. A young woman is in the ER with symptoms of a miscarriage.
5. A friend‟s father has passed away.
6. A co-worker did not get the promotion she was hoping for.
7. A patient has a clean bill of health after a breast cancer scare.
8. A couple has a clean bill of health after some fertility testing.
9. A friend has a new baby.
10. A patient gains mobility after a stroke.
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HO – C27 Breaking Bad News
Read the article
Breaking Bad News ~ by Cortney Davis, MA, RNC, APRN
I pick up the first chart. I‟m about to flip it open to find out why this patient is here today when I see a note stuck on the front
of the folder. “Positive for Chlamydia” is scribbled in the secretary‟s handwriting. “Here for treatment.”
I‟m tempted to put the chart back and let one of the residents deal with this patient, but its high risk-pregnancy day and we‟re
already backed up. Anyway, I‟ve been a nurse practitioner in the women‟s clinic for more than 11 years and before that, a
nurse in intensive care and on a cancer ward. Giving bad news is part of my job.
Reviewing the chart, I read that the patient, Ellen, is in the 14 week of her first pregnancy. Three days ago, she‟d
experienced burning with urination and vague pelvic pain. She‟d come to the clinic, terrified that something was wrong with
her pregnancy. The resident who saw her collected a urine culture to make sure Ellen didn‟t have an infection and did a
pelvic exam, checking for simple infections, like yeast, and culturing for more serious infections. Yesterday, the nurse called
and left a message on Ellen‟s phone: “Come into the clinic tomorrow. We have your test results.” Looking at the chart I find
that everything came back negative except the cervical culture. Ellen has Chlamydia, a sexually transmitted disease; now
I‟m the one who must tell her.
Giving bad news to patients is a special talent, something no amount of education can teach. When I was in nursing school
and, later, in nurse practitioner training, there were no courses called “how to tell a patient she has cancer,” “How to tell a
father his child has died,” or “how to tell a pregnant woman she has a sexually transmitted disease.” Breaking bad news is
an on-the-job skill learned only in the doing, in the holding of patients‟ hands and in the simple comforting acts that suddenly
erase the distance between patient and caregiver: the hug that keeps someone on her feet; the way we sometimes let
patients see tears in our own eyes.
On the cancer ward, I perfected the arts of acknowledging the approach of death and staying with patients until death arrived.
In intensive care, I learned to deliver bits of stunning information as if they were updates from some distant, unfamiliar city.
Calling a newly admitted child‟s parent, I‟d say, “Your son‟s been admitted to ICU.” Then, I‟d wait a few seconds for the
implication in my voice to travel the phone wires. Or I‟d grip a woman by the shoulders, look into her face. “I was with him
when he went,” I‟d say. “He didn‟t go alone.”
When I came to the women‟s clinic, I thought joy would outweigh tragedy. Mostly, that‟s true. But bad news here is
particularly difficult to deliver; it often involves new life, and it can pierce the soul. I‟ve told mothers that their pregnancies
won‟t survive. I‟ve announced that my fingers have palpated the solitary, fixed breast nodule that could be cancer. More and
more often I have to tell young women that their bodies are infected with diseases they get only from making love. How, I
wonder, will Ellen react to the news that she has Chlamydia.
Some women nod and smile, unable to comprehend how they, who are faithful to their partners, could have a sexually
transmitted disease. They look at me with such innocent bewilderment that I‟m afraid for them. Then, when they finally
understand, they weep or become so angry that even the bland, beige clinic walls seem unable to contain their fury.
Other women blush and lower their eyes. These are the patients who have secrets to tell and, sometimes they tell me. The
brief affair. The man who, they thought loved them more than their husbands. These women are dazed; they thought they
were only following their hearts. When I say, “You‟ll have to notify all your partners,” these women see themselves
abandoned and alone. “How can I tell my husband? They ask. I never have the right answer.
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Most often, patients receiving bad news crumble before me. Their skin blanches. They lose their breath, as if punched
in the stomach. It‟s difficult to watch their suffering. I‟ve found it‟s best to give bad news over time, bit by bit, like you‟d
give a child small bites of food that are easier to swallow. Patients can only take in what they‟re ready to accept. Of
course, bad news must be followed by a list of options, as if those might be the sips of water that help soothe the lump
in the throat. I few can offer patients new tests, specialists to see, the possibility of cure, then we can also give them
hope. After so many years in healthcare, I‟ve learned that all we can really give our patients is what we would want for
ourselves. We can listen without judging; we can accept that we are, after all, like our patients: stripped, raw and
I take the chart and go into room four, Ellen sits on the exam table. A man – I assume it‟s her partner – waits beside
her on a chair. “Oh,” I say to myself. This will be twice as hard.
“Hi Ellen. I‟m Cortney, a Nurse Practitioner here in the clinic.” I extend my hand to her, then face the man. “Hi,” I say
“And you are….?”
“Max,” he answers.
“I got a message about test results,” Ellen explains. “Is everything OK?” She rests one hand on her belly.
This react moment – the uncertainty and possibility contained in the brief pause before I answer is one of the things I
dislike most about delivering bad news. Perhaps this is because I never plan what to say ahead of time, but wait until I
can evaluate a patient‟s emotional reserve and then intuit how to proceed. Straight forward? With a maternal hug?
Offhand and casual.
During this pause, I also feel guilty, as if I‟m not simply a messenger but also somehow responsible for a patient‟s soonto-be-visible anguish. I‟ve learned that words are like stones. Tossed into the vast expanse of a patient‟s life their
impact causes shock waves. In ever-widening circles, everyone is affected. What was to be a patient‟s future is
wrenched into a different shape and becomes, eventually, the past we‟d like to forget. Sometimes, patients forever
associate caregivers with the information we‟ve delivered. I don‟t want to cause pain. Like any nurse or doctor, I want
patients to like me. A physician once told me that he “soft-pedals” the news, making a dire situation sound not so awful.
He wants to spare patients pain, but I think evasiveness leads to confusion. I can‟t skirt the issues to avoid hurting a
patient‟s feelings. At the same time, I want to be gentle. I know what it‟s like to have everything changed by a single
test result or one damning word. Ellen, even before I speak, looks hollow, as if the smallest blow could shatter her. Max
looks anxious. I picture them raising their individual shields against anything that might alter their world.
“Ellen, I have your cervical culture results. Do you want Max to be here when we discuss them?”
I sit down by the exam table so I‟m close to Ellen. After all, she is my patient. Part of me wants to say, “Tell him to
leave. You might want to hear this alone.” But there‟s another side of me, one I don‟t like, that wants to say, “Let him
stay. Let him be devastated too.”
“Yes, I‟d like him to stay,” she says.
I‟ve never met Ellen before, not an uncommon occurrence in the clinic or in this era of managed care. In some ways,
I‟m glad. Being the messenger can be more difficult when I have long-term relationship with a patient I‟ve come to care
about. In other ways, sometimes it‟s easier when I‟ve treated a patient over time. Then when I arrive with disastrous
results in hand, she knows I‟ll support her, that her misfortune will become our common grief.
“Ellen, your culture came back positive for an infection called Chlamydia.”
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“Oh God, Is that something that could hurt the baby?”
“Not if it‟s treated, and we‟ve caught it in time. I‟ll give you an antibiotic to take right after we talk. Your baby‟s going to be
fine. And Max?” I turn to him. “You‟ll have to see your doctor and get treated too. It‟s important that you refrain from
intercourse until you‟ve both taken medication.”
Max opens and closes his hands. I notice he‟s not wearing a wedding ring.
“I don‟t understand,” Ellen says. “How did I get this?”
“Chlamydia is a sexually transmitted disease. You get it from having sex with someone who has it.”
“But I only have sex with my husband.”
“You get this infection when you have intercourse with someone who is already infected.”
If I have to, I‟ll say this over and over. Bad news has to be given in short, strong sentences. Otherwise, it‟s impossible to
hear. Even when it involves the simplest absolutes – he‟s dead; she has cancer – bad news takes time to understand. I see
Ellen struggling; if she only has sex with Max, she caught this infection from him. If she has sex with other men, this could
have come from any one of them. Once a man or woman has this infection, they can spread it to every partner they have.
The room is uncomfortably quiet. My pulse quickens. I want to make everything better. I could say, “It‟s very common –
more than four million cases of Chlamydia occur annually in the US,” but that would be soft-pedaling, turning the attention
away from Ellen‟s individual dilemma.
“I only have sex with Max.” She looks at me as if I might shelter her from the image that, like a sudden eclipse, has
darkened her imagination.
“Sexual intercourse is the only route of transmission.” I place my hand on Ellen‟s knee. Tears fill her eyes and she purses
her lips. When she goes to wipe her cheeks, she begins to sob. I stand and put one arm around her, mindful of the
newness of our relationship and the ambiguity of my role. I bring both the poison and the cure.
Max stands too. “I don‟t have any symptoms. I couldn‟t have given her anything.”
“This infection might not cause any symptoms. That‟s why it‟s so difficult to detect.”
“This means Max got it from someone else and gave it to me?” Ellen‟s face is blotchy.
“I don‟t know, Ellen. Chlamydia can be dormant in the body for months.”
She speaks first. “We‟ve been together three years,” she says.
“Married for one,” Max adds.
“Does that mean you‟ve only been faithful to me for one?”
I don‟t interrupt.
“Tests can be wrong,” Max says. He paces beside Ellen, who now holds both hands on her not-yet-enlarged belly, as if to
cradle her fetus.
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I say, “The type test we use is rarely inaccurate.” I‟m accustomed to this back and forth rapid firing of questions. Such a
debate always occurs as patients sort and assimilate the facts that accompany bad news. How did it happen? When did it
happen? Are you sure? The last question patients ask, the one that I can never, ever answer, is why. Why did this happen?
Patients think bad news might be easier to accept if only it came with some reason, some lesson, or someone to blame.
“We‟re having a baby,” she says, half to me and half to Max. “How could you do this?”
“I didn‟t do anything,” he says. “I could never do anything like that, and you know it. You know me.”
I try to read his anger, then hers. Defensive? Honest? If I could ignore her embarrassment and his indignation, I might
suppose they were the perfect couple. I never know which patients will someday become the recipients of bad news. You
can‟t tell just by looking.
“I recently spoke to another couple with the same problem,” I say. “They decided to trust each other – they both said they had
no other partners – so they took the antibiotics and moved on. We have to treat this infection. But I know it‟s not easy to heal
the emotional affects.”
In the grand list of bad news, some items are worse than others. I feel better when I can convince myself that bad news might
also be the beginning of recovery, as I hope it will be for Ellen and Max. But in the end, grief is grief. It doesn‟t come neatly
measured, and we can‟t compare one pain to another. There‟s nothing to be gained by telling a patient, “It could be worse.”
For Ellen and Max right now, this is grief enough.
I give Ellen four antibiotic tablets and watch as she takes them. I hand her a pamphlet about Chlamydia. Max says, “Can‟t you
treat me too?” and I tell him that this is a women‟s clinic. We don‟t treat men. He accepts this explanation but tips his head as
if he hears something behind my words. Later, I‟ll replay our conversation. After all, I‟m still trying to learn this technique, the
best way to give bad news. Do I take sides? Even when I try not to, do I sometimes point a silent finger? Later, I‟ll wish I had a
neat formula to follow. Then I‟ll think, …No. Only we humans give and receive bad news. It must remain, therefore, a messy
and perfect skill.
In this case, I‟ll never know if the Chlamydia test was falsely positive, if Ellen had another partner, or if it was Max who had a
fling. One thing I know about bad news is that it often comes out of nowhere. Once it arrives, it never really goes away.
I shake their hands and say I hope I‟ll see them again. I ask Ellen to call me if she wants to talk or has any questions. When
they walk out of the exam room and down the hall, Max takes Ellen‟s arm. She doesn‟t draw away.
We caregivers sometimes have allies when we give bad news – patients find information on the internet, and there are
support groups for every ailment. Nevertheless, the initial announcement of bad news is always a solitary event, shared by
patient and caregiver. When I‟m the caregiver, all I can do is try to bring kindness, as well as truth, to the encounter: a hand‟s
brief pressure, a silent standing by – anything that might help steady the heart.
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HO – C28 Tips for Giving Bad News
The following is some advice for giving bad news. As you read it, think about whether you
should take this advice before, during, or after talking to the patient.
Put a B in front of the advice for before, a D in front of the advice for during and an A in
front of the advice for after.
1. ______ plan when and where you will give the news.
2. ______ ask the patient if they would like anyone else to join him/her.
3. ______ make the patient as comfortable as possible.
4. ______ don‟t sit behind a desk.
5. ______ don‟t use medical jargon/terminology.
6. ______ make sure you have all the options for the patient.
7. ______ watch his/her body language to ensure comprehension.
8. ______ don‟t read from a chart or file.
9. ______ look directly at the patient
10. ______ prepare the patient for what you are about to say.
11. ______ speak clearly and directly to the patient.
12. ______ ask the patent if they want to know the full prognosis.
13. ______ regularly ask if he/she has any questions.
14. ______ be calm and professional at all times.
15. ______ don‟t end the meeting abruptly.
16. ______ ask for more questions/
17. ______ offer additional sources of information and support.
18. ______ schedule your next appointment.
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HO – C29 Common Language Functions for Giving Bad News
Put a B in front of the statements you would say in the beginning an M in front of the
statements you would say in the middle, and an E in front of the statements you would
say at the end of a meeting where you had to deliver bad news to your patient.
1. _____ Am I making sense?
2. _____ Do you follow what I‟m saying?
3. _____ Do you know what I mean?
4. _____ Does this seem logical to you?
5. _____ Have you been very worried about this?
6. _____ How does that news leave you feeling?
7. _____ I examined your test results and as we suspected…
8. _____ I have some bad news; the biopsy came back positive for cancer.
9. _____ I‟m sorry that was difficult for you.
10. _____ If your condition is serious, how much would you like to know about it?
11. _____I‟m afraid I have some bad news (pause for a moment). The biopsy didn‟t turn out
as we had hoped. It revealed cancer.
12. _____ I‟m afraid it looks more serious than we had hoped…
13. _____ I‟m sorry there is something wrong with the baby…
14. _____ Is there someone you‟d like me to talk to?
15. _____ Is there someone we can call for you?
16. _____ Tell me what your most concerned about?
17. _____ This must be overwhelming you.
18. _____ This must be very stressful for you. Let‟s go through your options again.
19. _____ What do you make of the illness so far?
20. _____ What do you think about this…
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21. _____ What is your understanding of what has happened?
22. _____ Who would you like to be with you?
23. _____ Why don‟t you write down any questions you have for our next meeting?
24. _____ Would you like me to arrange some physio for you?
25. _____ Would you like more information now or should we talk later?
26. _____ Would you like to know exactly what is going on or would you just prefer to hear
the overview?
27. _____ Would you like to run through what you are going to tell your wife?
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HO – C30 Breaking Bad News Role-Play
Role-play these situations with a partner.
1. A young woman has been diagnosed with leukemia.
2. A 55-year old man has had a massive heart attack. He will need to have bypass
surgery. He has a 50/50 chance of full recovery.
3. A middle-aged man has liver failure and will need to use a dialysis for the rest of his life.
4. A young man was in a car accident and is now paralyzed from the waist down.
5. A couple‟s two year old daughter has just been diagnosed with a moderate mental
6. A 60-year old woman has been diagnosed with breast cancer. She will require a full
mastectomy. Plus radiation chemotherapy. Her prognosis is uncertain at this time.
7. A young man has just been diagnosed with syphilis. He is in the examining room with
his girlfriend and requests that she stay by his side when he is told.
8. A woman in her thirties has had three miscarriages and has just been diagnosed with
celiac disease. She may be unable to carry a baby to full term.
9. A teenage boy has a large un-operable tumor on his brain.
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HO – C1 Doctor -Patient Communication
Read the article.
Speak Up: New Education Campaign Offer Patients Tips for
continuing Recovery after Leaving Hospital
~ Oakbrrok Terrace, Ill. ~ August 17, 2005
The Joint Commission on Accreditation of Healthcare Organizations today launched a new initiative to help
patients continue their recovery after leaving the hospital. The new patient education effort is the latest focus of
the Joint Commission‟s award-winning Speak Up program, which urges individuals to take an active role in their
health care.
The centerpiece of this initiative is a new brochure, “Planning Your Recovery” which provides tips to help people
get the information they need and become actively involved in their recovery. Patients who understand and
follow directions about follow-up care are more likely to heal faster and less likely to require re-hospitalization.
“A patient‟s recovery is not complete just because he or she leaves the hospital. Recovery is dependent upon
continuing to get the care you need to get better, “says Dennis S. O‟Leary, M.D., involved in helping patients
plan for follow-up care, there are many things that patients and their families can do that will make a real
difference. Full recovery is dependent upon continuing to get needed support and services.”
“We know that when patients assert a more active role in the discharge process, they experience better health
outcomes in terms of symptom control and functional status and they are also less likely to need to return to the
hospital,” says Eric A. Coleman, M.D., associate professor, University of Colorado Health Sciences Centre. “So
if you want to get better quicker, speak up!”
Specifically, the Joint Commission advises patients to:
Find out about your condition – This includes knowing how soon you should feel better; setting reasonable
expectations as to when you can resume everyday activities such as walking or preparing meals; knowing
warning signs and symptoms to watch for; and enlisting the help of a family member or friend in your discharge
from the hospital, as well as to look in on you once you leave the hospital.
Find out about new medicines – It is important to request written directions about new medicines and how to
take them. You should ask any questions you have before leaving the hospital. It is also important to find out
what other medicines, vitamins and herbs that you are already taking could interfere with the new drugs and
whether there are specific foods or drinks that you should avoid.
Find out about follow-up care- It is also important to ask for written directions about taking care of your
wounds, using special equipment, or doing any required exercises; to ask about any further tests that you will
need after you leave the hospital and who you should follow up with to get the transportation arrangements for
these visits; to review your insurance to find out whether the medicine and equipment needed for recovery will
be covered; and to determine whether home care services will be necessary to support your recovery.
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The information on recovery planning is provided through the basic framework of the “Speak Up”
campaign, which urges patients to:
Speak up if you have questions or concerns, and if you don‟t understand, ask again. It‟s your body and you
have a right to know.
Pay attention to the care you are receiving. Make sure you‟re getting the right treatments and medications by
the right health care professionals. Don‟t assume anything.
Educate yourself about your diagnosis, the medical tests you are undergoing, and your treatment plan.
Ask a trusted family member or friend to be your advocate.
Know what medications you take and why you take them. Medication errors are the most common health care
Use a hospital, clinic, surgery centre or other type of health care organization that has undergone a rigorous onsite evaluation against established state of the art quality and safety standards, such as that provided by the
Joint Commission.
Participate in all decisions about your treatment. You are the centre of the health care team.
Consumers can download the brochure that provides specific guidance to individuals planning for their recovery
after leaving the hospital by visiting the Joint Commission website. Speak Up brochures are also available on
preventing medication mistake, preventing infections, preparing to become a living organ donor, avoiding wrong
site surgery, and preventing errors in care.
Reprinted with permission © Copyright 2005, Joint Commission on Accreditation of Healthcare Organizations
Answer these questions.
1. Why are patients urged to take an active role in their recovery?
2. How can we as healthcare providers help with this?
3. What is full recovery dependent on?
4. What three things should a patient find out about? What impact should that have on patient –
healthcare provider communication?
5. What does the acronym SPEAK UP stand for?
6. What other brochures do SPEAK UP offer patients?
7. How can this sort of information add a new dimension to communication in healthcare?
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HO – C32 Espressions and Idioms for Recovery
Match the vocabulary on the left with its meaning on the right.
Fill in the blanks with these expressions and idioms.
1. The doctor gave her a _____________________________.
2. I think I‟m _________________________. I feel much better now.
3. She‟ll be ________________________ for at least two weeks.
4. It was really serious, but thankfully he _________________________.
5. Jin has to _____________________________ for a few days – no heavy lifting!
6. You‟ll be _____________________ and back to work soon.
7. ___________________________. The doctor will see you soon.
8. Since her surgery, she‟s been _____________________. She‟s so energetic!
9. It took them an hour to ____________________ John _____________ after his seizure.
10. I hope you ______________________ your cold soon so we can go out and have fun!
11. The formal term for recuperate is ___________________________________.
C Communicating
117 12. Don is definitely ____________________.
He should
be as good aswith
newPatientsin a few weeks.
Communicating with Patients
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HO – C33 Patient Role-Plays
Role-play the following situations. Make sure you follow through with the whole
patient consultation process, from beginning to end.
1. Your patient is a middle aged female/male with complaints of chest pains.
2. Your patient is a married father/mother of three who has had insomnia for the past two
3. Your patient is a teenage girl complaining of severe cramping and bleeding during her
menstrual periods.
4. Your patient is a sixty-year old male/female who has blurred vision in one eye.
5. Your patient is a thirty –year old male/female complaining of abdominal pain on the right
6. Your patient is a child who has had a sore throat and a fever for two days.
7. Your patient is a child who fell from a jungle gym and hit his/her head.
8. Your patient is an elderly woman who cannot speak English and has been having shortness
of breath.
9. Your patient has sciatic nerve pain and needs to see a physiotherapist.
10. Your patient‟s right ear seems to be blocked.
11. Your patient is a young female who wants birth control.
12. Your patient is an elderly man who fell down and is complaining of a sore arm.
13. Your patient is a child who has developed a cough.
14. Your patient has had knee replacement surgery and is visiting the physiotherapist for the
first time.
15. Your patient is a child with whooping cough.
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PEI ANC Mission Statement
The PEI ANC values the contribution newcomers make to Canada. We support newcomers' integration
by providing services, in partnership with the community.
IEHP Atlantic Connection
This course was made possible through funding and collaboration with the IEHP Atlantic Connection and
its project partners.
The majority of the material contained within this course workbook was adapted from a course
developed by HILC & MISA in Halifax. Their course developers Katherine Macnaughton and Carol Derby
have done a fantastic job setting the groundwork for a solid course. A warm thank you to everyone at
HILC & MISA for the generous way that they have shared this material with us.
Adapted by: Michelle Hood at the PEI Association for Newcomers to Canada
For more information contact:
PEI Association for Newcomers to Canada
25 University Avenue
Suite 400, Holman Building
(4th floor) Confederation Court Mall
PO Box 2846 Charlottetown, PE C1A 8C4
Ph: 902-628-6009
Fax: 902-894-4928

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