SPEAKING - sẽ ổn thôi

Nếu SPEAKING đang làm bạn bấn loạn thì có lẽ topic này sẽ xoa dịu được nỗi lo đó



Yêu cầu của phần thi:

--- Có đủ 5 phần: taking history, examining a patient, indicating investigations, making diagnosis, suggesting treatments

--- Đóng kịch trọn vẹn: BS có áo blouse và ống nghe, búa phản xạ (1 lớp hùn lại mua 1 cái là đc rồi), khám thật (cho BN đứng lên, đi lại, nằm lên giường, co chân,…), giấy + viết (giả vờ ghi những gì BN nói và kê toa),…

--- Dùng những mẫu câu đã học trong SGK

--- Bệnh nhân nên có feedback lại với BS

--- Phần thi từ 5 đến 8 phút




Cũng không nhiều lắm, Bảo nghĩ là với những yêu cầu đơn giản trên thì mỗi chúng ta đều có những mẹo vặt riêng để phòng bị. Sau đây là những gì Bảo “tự rút kinh” được qua vài lần tác chiến với bản thân trong gương:

--- Taking history: cứ theo đúng trình tự mà làm (đề có yêu cầu gì thêm thì nhá vào), tốt nhất các bạn nên thuộc sẵn luôn những câu mình thích dùng (nên chọn những câu dùng được trong nhiều trường hợp khác nhau)
++++++++++ Bảo sẽ dùng: What seems to be the problem? -- How long have they been bothering you? -- Where does it hurt? -- Can you describe the pain? -- Does anything make it better/worse? -- Phần còn lại là thêm tùy tình huống đề cho.

--- Examining a patient: các bạn nên coi kỹ lại Chapter 3 để lấy từ vựng, và cô bên nhóm 1 dặn coi kỹ các tư thế đứng (tr.28) và cách thử TK tọa (Tr.31)

--- Indicating investigations: chỉ giải thích về kết quả của 1 xét nghiệm (thường là về hình ảnh như X-Quang) hoặc là giải thích tại sao cần phải làm xét nghiệm đó (phần này Bảo sẽ hướng dẫn các bạn sau)

--- Making diagnosis: chỉ là dùng cannot, unlikely, can, may, might, likely, must,… nhưng tốt hơn nên đưa ra 1 phán quyết không hoàn toàn “You may have but we’ll need more examinations to assure this consideration and to make further decisions for your problem”

--- Suggesting treatments: dễ nhất là “You should…” và có một số câu thông dụng như “For now, you should rest at home in a few days and follow the prescription I gave you”, “After two weeks, if the situation does not get any better, you will have to come back here and see me” hoặc là “Here is the phone number of the professional, you should call and make an appointment with him for further assessment”

--- Feedback của BN: thường dùng
++++++++++ những câu hỏi để hiểu rõ vấn đề “How bad is my situation?”, “Can you please explain that to me?”, “Why do you need to discuss with my family members?”…
Hoặc
++++++++++ những câu hỏi đối kháng lại yêu cầu của BS “You told me to rest, but can I at least do exercises? I love jogging/aerobics/tennis so much”, “You told me to eat less spicy food, but I am a chef in a Chinese restaurant, how can that be possible? I don’t want to get fired”,…
Hoặc
++++++++++ những lời than phiền để giải thích tình trạng của mình là không muốn bệnh cũng không được “I am living next to a very impolite neighbor and he turns his music so loud every night, I can’t sleep until 12 o’clock”, “I cannot do as you said doctor, I’m feeding two kids and my wife has run away with a gangster, I’m now under so much pressure and depression that I cannot relax”,…

Topic: The patient is suffering from a duodenal ulcer. The doctor asks the patient about the symptoms and recent medical intake. Then, they discuss the family history, medical history, lifestyle, and job.



D: Next, please
P: Good morning, doctor
D: Good morning. Please, have a seat
P: Thank you
D: What’s your name?
P: Boris
D: How old are you?
P: 21
D: What’s your job?
P: I’m now a student
D: What’s brought you along today?
P: I have a pain in my tummy
D: How long has it been bothering you?
P: About 2 weeks
D: Where does it hurt exactly?
P: Right here, at the upper left of my tummy
D: Can you describe the pain?
P: It is a sharp pain. It appears suddenly and is really sore
D: Does anything make it better?
P: I just tried my best to rest, and it eased the pain a little but didn’t solve my problem completely
D: What seems to bring it on?
P: I think that the pain increases after my meals
D: Did you take anything for it?
P: Some aspirins but they didn’t help
D: Apart from the pain in your tummy, is there any other problem?
P: I don’t think so
D: Alright, I now need to check your tummy. Can you get onto the couch and lie on your back?
P: Ok
D: Now I’ll press your tummy and if there’s any pain, please tell me
P: Alright
D: Firstly, I’m touching you softly to see if the problem comes from the wall of your tummy. Is it sore?
P: No, not at all
D: Secondly, I’ll press deeply to check the organs inside
P: Ow, that hurts, right there
D: Fine, you can get up now
P: So, what is my problem, doctor?
D: It hurt you when I pressed the upper left of your tummy and that’s the place of your stomach. For now I’m thinking of an ulcer. However, to make sure my diagnosis is correct, I need you to do some investigations for me. Here’s the list and if you have any question, the nurse can answer you
P: Ok, I’ll be back with the result
(One hour later)
P: Here are my test results
D: Thank you for bringing this back to me
P: Can you explain them to me?
D: You see, this is the endoscopy which is like taking photographs inside your stomach. And, here is an abnormal redness, surely it’s an ulcer
P: How bad is my situation?
D: Not really bad
P: So, you have a way to treat it properly and all the pain will disappear, right?
D: You can say that
P: That’s a relief
D: Now I need to ask you, is there anyone in your family suffering from the same trouble?
P: No, why do you ask?
D: Because if you take this trouble after your mom or dad, it can be bigger deal. Have you been taking anything in the recent six months?
P: Not really
D: You see, there are some drugs able to bring this pain on. Do you have your meals on time?
P: Yes, I have meals with my parents so it’s supposed to be on time
D: And you said that you’re a student. Are you under any pressure now, is any test coming?
P: Yes the final one, my goodness, in a week. I did study my butt off and I think I have already gathered everything but still I’m nervous. I think of it a lot because this exam is important and I need a high grade to get into a good class… Well, I’m afraid of failing obviously
D: Calm down. Now I see the reason clearly
P: Reason for what? Are you talking about my pain?
D: Yes, I am. Stressful condition can make you stomach work improperly
P: I see, so, what should I do?
D: I’ll give you medications and you need to have them on time, should be two hours after you meals, and try your best to relax. You must know that your health is more important than any particular exam
P: I understand
D: After a week, if you don’t get any better, please come back and see me. Now, goodbye
P: Thank you, goodbye


Phần phía trên cho chúng ta thấy:
----- Phần hỏi bệnh sử thì Cả BS và BN cùng chém
----- Phần khám thì BS nói hơi nhiều
----- Phần cho và giải thích CLS thì BS là chủ yếu
----- Phần chẩn đoán cần có 1 câu à (It should be.../ I think of...) cho nên không tính
----- Phần treatments thì tự động BN phải giải thích hoàn cảnh của mình và nên tự tạo tình huống đối kháng lại lời khuyên BS thì xem như là có thể chém lại một cách áp đảo
==> BS và BN thì số lượng nhát chém tương đương nhau cho nên đừng lo thiệt hơn gì chuyện làm BS hay BN, cái quan trọng là bản thân mình thôi

Về CLS cũng không có gì khó, các bạn nếu được cứ làm theo mẫu sau đây (quảng cáo hết từ đầu tới chân):



CT-Scan dùng khi bị đau đầu
P: What does CT-Scan mean?
D: CT-Scan is the best way for me to see what’s inside your head
P: What does it show you?
D: Well, normally, there is no round thing like this on the photo and that should be a mass
P: So, what is my problem?
Ở đây phải chia thành 2 trường hợp:
1- Có đụng đầu thì nghĩ tới máu
D: You told me that you’ve hit your head. That’s why I’m thinking of blood
2- Không có đụng thì nghĩ là u
D: You didn’t hit your head to anything. That’s why I’m thinking of tumor


X-ray tốt nhất nên dùng khi thấy BN khó thở hoặc đau tay chân
P: What does X-ray mean?
D: X-ray is the best way for me to see your lung/ bones
P: What does it show you?
D: Well, usually, your lung’s supposed to be black, but in this case it’s a little white. That’s why I’m thinking of an inflammation
Hoặc xương thì D: Well, it tells me that the surface of your bone is not smooth. That’s why I’m thinking of cracks


ECG thì cứ thấy đau tim là móc ra xài
P: What does ECG mean?
D: ECG is the best way for me to see how your heart is working
P: What does it show you?
D: Well, these lines tell me that your heart is fast and lack of oxygen. That’s why I’m thinking of angina


Endoscopy quăng cho những người bị Ruột Lòi Tới Háng
P: What does Endoscopy mean?
D: Endoscopy is the best way for me to see your throat and stomach from the inside
P: What does it show you?
D: Well, in general, there is no redness like this. That’s why I’m thinking of an inflammation


Myelogram mần cho người đau “nưng”
P: What does Myelogram mean?
D: Myelogram is the best way for me to see your spine
P: What does it show you?
D: Well, you can clearly see the fluid that we have injected into your spinal cord before and it is trapped here. That’s why I’m thinking of some damage around this area


Urinalysis dành cho ai tè hổng ra (nỗi đau thấu trời mây)
P: What does Urinalysis mean?
D: Urinalysis is the best way for me to see what’s in your urine
P: What does it show you?
D: Well, normally, there is no white blood cell in urine like this. That’s why I’m thinking of inflammation