Doctor–Patient Conversations in English │ 50-Minute Listening Marathon

0:00 Welcome to a Medical Voices Listening Marathon. I am Nadia. Over the next hour, you'll hear seven real consultations in English. One patient's story from start to finish, then three new faces. Each conversation plays once at normal speed, then the key lines again more slowly. No vocabulary lists, no quizzes.

0:22 Just listen. And if you're preparing for OET or IELTS, our channel partner, E2 Language, gives Medical Voice's viewers 26% off with the code MDV26. Let's begin. Chapter 1. Elmwood Surgery. James Davis keeps getting headaches, and today he's seeing Dr. Bennett. Listen for how she opens. First, the chief complaint.

0:50 Then, his medical history. Good morning, Doctor. Thank you. So, what's brought you in today?

1:04 What's your chief complaint? I've been having headaches pretty much every day for the past two weeks. They start at the back of my head and spread forward.

1:16 I see. And on a scale of 1 to 10, how would you rate the pain at its worst?

1:22 Maybe a six, sometimes seven. It's not unbearable, but it's really affecting my concentration at work.

1:30 Understood. And have you noticed anything that makes the symptoms better or worse?

1:35 They're worse in the afternoon. Better after I sleep, usually.

1:39 Good to know. Let me take a look at your medical history. Any significant illnesses, surgeries, or chronic conditions I should know about?

1:48 Not really. I had my appendix out about eight years ago. Nothing else, as far as I know.

1:55 And are you taking any medications at the moment?

1:58 Just ibuprofen, over the counter. I've been managing it myself, but it's honestly not cutting it anymore.

2:07 Alright. Any known allergies, medications, foods, anything at all?

2:11 Penicillin. I had a reaction as a child, a rash. It was noted in my records at the time.

2:20 Noted. Allergy to penicillin. I'll flag that clearly. Now let me check your vitals. I'll start with your blood pressure. Your blood pressure is 122 over 78. That's very much within the normal range. Temperature and heart rate are both normal as well. Your vitals look good, Mr. Davies. That's a relief.

2:42 Is it anything serious, Doctor? Based on everything you've described and the examination, I think what you're experiencing is most likely tension type headaches. They're extremely common, and in your case, almost certainly being driven by stress and insufficient sleep, both of which you've mentioned.

3:02 So what do I do? For now, I'm not going to write a prescription. I'd rather we start with some straightforward lifestyle measures. Improving your sleep, reducing screen time in the evenings, managing the stress where you can. The ibuprofen you've been taking is appropriate for this type of headache. Try taking it earlier rather than waiting for the pain to peak.

3:26 And if it gets worse before my follow-up?

3:29 If the pain becomes severe or you develop a fever, visual disturbances, or nausea, come back straight away. But I don't expect that. I'd like to see you for a follow-up in two weeks. My receptionist will sort out the appointment for you on the way out. And if the headaches don't improve with all of that?

3:48 Then we'll reassess. Depending on what I find, I may consider a referral to a neurologist for further investigation. But let's give the lifestyle approach two weeks first.

4:00 That sounds very reasonable. Thank you, Dr. Bennett.

4:03 Of course. Take care, Mr. Davies. And do try to get some more sleep. We're going to repeat three key exchanges from that dialogue, just a little more slowly, so you can focus on the phrasing and the vocabulary.

4:20 Listen out for the clinical terms. See how naturally they come up.

4:25 So, what's brought you in today?

4:27 What's your chief complaint? I've been having headaches pretty much every day for the past two weeks.

4:36 And have you noticed anything that makes the symptoms better or worse?

4:41 They're worse in the afternoon. Better after I sleep usually.

4:46 Let me take a look at your medical history. Any significant illnesses, surgeries, or chronic conditions?

4:53 Not really. I had my appendix out about eight years ago. Nothing else. Any known allergies, medications, foods, anything at all? Penicillin. I had a reaction as a child.

5:09 Noted. Allergy to penicillin. I'll flag that clearly. For now, I'm not going to write a prescription. I'd rather we start with some lifestyle measures. And if it gets worse? I'd like to see you for a follow-up in two weeks. If things don't improve, we can look at a referral to a neurologist.

5:30 That sounds very reasonable. Thank you, Dr. Bennett.

5:36 Chapter 2. Straight from the Surgery to the Pharmacy Counter. Prescription in hand. Listen for how the pharmacist explains the dosage instructions and checks that he understands the side effects.

5:51 Good morning. How can I help you? Morning. I have a prescription. My GP, Dr. Bennett, gave it to me at my appointment earlier this week.

6:03 Of course. Let me take a look at that for you. Right, so Dr. Bennett has prescribed you a short course of amatryptyline. That is a medication used to help manage tension type headaches when they are frequent and not responding to over-the-counter options. Before I go any further, do you have any known allergies to medications?

6:25 Yes, penicillin. I mentioned it to Dr. Bennett.

6:30 Good, and I can see it is noted on the prescription. Ametriptyline is not related to penicillin, so there is no issue there. I just always like to ask directly. Now, let me go through the dosage instructions with you. Dr. Bennett has prescribed a low dose. You will take one tablet each evening about an hour before bed.

6:52 You take it at a low dose for headache prevention. It is quite different from how this medication is used at higher doses for other conditions. The course is six weeks.

7:04 One tablet in the evening for six weeks. Got it. Are there any side effects I should know about?

7:11 Yes, and it is worth knowing about these before you start. The most common side effects at this dose are drowsiness, a dry mouth, and occasionally some mild dizziness in the morning. The drowsiness is actually part of why you take it in the evening. It tends to wear off by the time you wake up. These side effects are usually mild and often settle down after the first week or two.

7:37 And if they do not settle down?

7:40 Then go back to Dr. Bennett. Do not just stop taking the medication without speaking to her first. Stopping abruptly is not advisable. She will guide you on how to reduce the dose gradually if needed.

7:55 Are you taking any other medications at the moment? Just the occasional ibuprofen over the counter for the headaches. I've been doing that for a while.

8:06 Right, that is actually something to be careful about. Taking over-the-counter pain relief too frequently can sometimes make headaches worse over time. It is called medication overuse headache. The amitriptyline is meant to help break that cycle. So while you are on this course, try to use the ibuprofen as little as possible.

8:27 If you feel a headache coming on, let the amitriptyline do its job rather than reaching for the ibuprofen straight away.

8:35 That makes sense. Is there a generic version of this, by the way? It looks quite expensive.

8:42 Good question. Yes, there is. Amitriptyline is actually already a generic medication. It has been off-patent for many years, so what you are getting is already the most cost-effective version available. The active ingredient is identical regardless of which manufacturer produces it.

9:02 Oh, I did not realize. That is good to know.

9:06 One more thing. Dr. Bennett has your follow-up scheduled in two weeks. Please do keep that appointment. It is important for her to assess whether the medication is helping, whether the side effects are manageable, and whether the dosage needs any adjustment. The prescription is for six weeks, but she may want to review things sooner depending on how you get on.

9:28 Will do. And if things are still not improving after the six weeks?

9:33 That is a conversation to have with Dr. Bennett at the follow-up. She may decide to extend the course, change the approach, or consider a referral. That is her call to make, not mine. My job is to make sure you have everything you need to get started safely. Any other questions?

9:52 No, I think I have got everything. Thank you very much.

9:56 You are welcome. Take care and good luck with it. We are going to repeat three key exchanges from that dialogue a little more slowly so you can really focus on the phrasing.

10:09 Listen out for the vocabulary terms and how they come up naturally in the conversation.

10:16 Let me go through the dosage instructions with you. You will take one tablet each evening about an hour before bed. The course is six weeks.

10:27 One tablet in the evening for six weeks. Got it. Are there any side effects I should know about?

10:36 The most common side effects at this dose are drowsiness, a dry mouth, and occasionally some mild dizziness in the morning. And if they do not settle down? Then go back to Dr. Bennett. Do not stop taking the medication without speaking to her first. Stopping abruptly is not advisable.

11:02 Is there a generic version of this, by the way?

11:06 Amatriptyline is actually already a generic medication. It has been off-patent for many years, so what you are getting is already the most cost-effective version available. That is good to know. One more thing. Please do keep your follow-up appointment with Dr. Bennett in two weeks. It is important for her to assess how the medication is working.

11:35 Chapter 3. Back at Elmwood, weeks later, and the headaches haven't gone away. Listen for how Dr. Bennett pins down the onset, uses a pain scale, and decides what happens next. Good morning, Mr. Davies. Come in, take a seat. It's good to see you again.

11:57 Good morning, Dr. Bennett. Yes. Six weeks already.

12:03 It is. So, this is your follow-up. Let's start with how you have been feeling. The headaches. What is the picture?

12:12 Better, I think. Definitely less frequent. I was getting them almost every day before. Now it is maybe two or three times a week.

12:22 That is a meaningful improvement. And the intensity, when you do get a headache, where would you put it on the pain scale?

12:30 Around a four. Maybe a five on a bad day. Before, it was a six or seven.

12:38 So, frequency down, intensity down. The amitriptylene does seem to be helping. What about the ibuprofen? Are you still using it?

12:48 Much less. A couple of times since I last saw you, I have been trying to hold off on it, like you said.

12:56 Good, that is exactly right. Now, you mentioned when you booked this appointment that there was something new, something you had not had before.

13:06 Yes, it is. I am not quite sure how to describe it. In the last couple of weeks, I have been getting these brief moments where my vision goes a bit strange. At the edge of my vision, like a flickering or a shimmer, it only lasts a few seconds. But it has happened maybe four or five times now. I see.

13:30 Let me ask you a few more questions about that. When did it first start? The onset.

13:38 About two weeks ago. The first time it happened, I thought it was just tiredness.

13:44 And does it happen at any particular time of day, or is it random?

13:49 Random, as far as I can tell. No pattern I have noticed.

13:53 Is it in both eyes or just one side?

13:57 Just the right side. The right edge of my vision. And does anything come before it? Or after it? Sometimes a headache follows within half an hour or so. Not always.

14:15 And how long does the visual disturbance itself last?

14:19 Seconds. Fifteen, twenty seconds at most. Then it is gone. Right, thank you.

14:28 That is very helpful. I want to be straightforward with you, Mr. Davis. The improvement in your headaches is genuinely good news. But this visual symptom is new, and it is something I want to take seriously. Not because I think something is seriously wrong, but because it is a new symptom, and it is not something I want to simply observe and wait on.

14:54 Should I be worried?

14:55 I would not say worried, I would say informed. What I am going to do is order a blood panel. That will let us check your general health markers and rule out anything that could be contributing to what you are experiencing. And I'm also going to refer you to a neurologist.

15:14 A neurologist? That does sound significant.

15:20 It is a specialist who looks at the nervous system, the brain, the nerves, and this is what referrals are for. Not because I am concerned about something serious, but because a neurologist is the right person to assess a visual symptom like this, and I would rather be thorough than not. It does not mean anything sinister.

15:40 It means we are doing this properly.

15:44 How long will the referral take?

15:47 That can vary. I will mark it as routine for now. If the visual disturbances become more frequent or last longer, or you experience anything else new, call us straight away and we can escalate it. In the meantime, I'm going to extend your prescription. Another six weeks of amitriptylene at the same dose, while we wait for the neurology appointment.

16:11 The headache improvement suggests it is working, so there is no reason to stop now. And the blood panel, when does that happen? The receptionist will give you a form on the way out. You can take it to the phlebotomy clinic at the hospital. No appointment needed. Any questions?

16:32 I do not think so. I mean, it is a lot to take in, but I understand.

16:39 That is perfectly normal. Mr. Davis, you came back when you said you would. You have been managing the medication sensibly and you flagged a new symptom clearly and calmly. That makes this consultation much easier than it might have been. Well done. Take care, and we will see you once the neurology appointment comes through.

17:02 Thank you, Dr.

17:03 Bennett. We are going to repeat three key exchanges from that dialogue a little more slowly so you can focus on the phrasing and the vocabulary.

17:15 Pay attention to how symptoms are described and how the doctor responds to a new and unexpected finding. You mentioned when you booked this appointment that there was something new, something you had not had before.

17:32 In the last couple of weeks, I've been getting these brief moments where my vision goes a bit strange. At the edge of my vision, like a flickering or a shimmer. It only lasts a few seconds. But it has happened maybe four or five times now.

17:50 When did it first start? The onset.

17:55 About two weeks ago. The first time it happened, I thought it was just tiredness.

18:01 Is it in both eyes or just one side?

18:06 Just the right side, the right edge of my vision. And does anything come before it? Or after it? Sometimes a headache follows, within half an hour or so, not always.

18:22 And how long does the visual disturbance itself last?

18:27 Seconds. Fifteen, twenty seconds at most. Then it is gone.

18:35 What I am going to do is order a blood panel, and I am also going to refer you to a neurologist.

18:42 A neurologist? That does sound significant.

18:49 It is a specialist who looks at the nervous system. This is what referrals are for. Not because I am concerned about something serious, but because a neurologist is the right person to assess a visual symptom like this. It means we are doing this properly. I am going to extend your prescription. Another six weeks of ametryptaline at the same dose while we wait for the neurology appointment.

19:18 Chapter 4. After a short stay in hospital, Mr. Davis is back at Elmwood for a medication review. Listen for one key difference: a drug allergy versus a drug intolerance. Come in, Mr. Davis. Good to see you. Take a seat. I'm Nadia. I'm one of the practice nurses here.

19:42 Thank you. Good to be back. I was actually quite nervous in hospital, so being back at the surgery feels a lot more normal.

19:51 Completely understandable. You've had quite a few weeks. Today is your post-discharge medication review before you see Dr. Bennett. I just want to make sure we have everything up to date on your record. Sound alright?

20:05 Yes, of course.

20:07 I'll start with your current medication. Can you tell me everything you're currently taking? That includes anything prescribed, anything you buy yourself, any supplements or vitamins.

20:19 Right, so the pain relief I was given when I left the hospital. And I take a vitamin D tablet every morning. That's it, I think.

20:29 Good. The pain relief from discharge. Do you know the name of it?

20:33 I have the box here, actually. It says neproxen?

20:39 Perfect. Neproxen, yes. That's the generic name. Good to have the box. Always helpful. Are you taking it as directed on the discharge summary?

20:49 I think so. With food, twice a day.

20:52 Good. And how has it been working? Are the headaches any better?

20:57 Yes, actually. Much less frequent. Still getting the odd one, but nothing like before.

21:04 That's encouraging. Any side effects from the neproxen you've noticed?

21:08 I've had a bit of an unsettled stomach. Not terrible, just noticeable.

21:15 That's a very common side effect with that class of medication. Taking it with food helps, which you're already doing. I'll note that in your record and flag it for Dr. Bennett. She may want to review it.

21:28 Should I be worried?

21:31 Not at all. Stomach upset is a known side effect. It's something to monitor, not to panic about. If it gets significantly worse, vomiting, stomach pain, black stools come back straight away. But what you're describing sounds like a typical settling in response. That's reassuring. Right, now. Any known drug allergies?

22:02 Not that I know of. I've never had a problem with medication before.

22:06 And that includes everything, not just prescription medication, anything over-the-counter, any reaction to antibiotics, painkillers, aspirin, anything like that?

22:18 No, nothing. Never had a problem.

22:21 And have you ever had a severe reaction to anything? Any history of anaphylaxis, difficulty breathing, throat swelling, a drop in blood pressure after taking something?

22:32 No, nothing like that. Ever.

22:36 Good. That's all very helpful, Mr. Davis. I'll record that in your notes as NKDA. No known drug allergies. That notation tells every clinician who sees your record that you reported no drug allergies at today's review.

22:57 NKDA. I've seen that on my hospital wristband and never known what it stood for.

23:05 That's exactly it. It's on wristbands, in letters, in electronic records. Every clinical setting uses it. It's one of the most important pieces of information on a patient record. Good to finally know. One more thing before I send you through to Dr. Bennett. The vitamin D. Do you know the dose? The actual number of units?

23:29 I genuinely have no idea. It just says vitamin D on the bottle.

23:35 That's fine. I'll note it as vitamin D supplement, dose unknown, patient initiated. If Dr. Bennett wants the specifics, she can ask you to bring in the bottle. It's not urgent. Right. I think that covers everything for the medication review. Let me just summarize what I've noted. Current medication. Neproxin, the generic name, twice daily with food, as per discharge summary.

24:02 Vitamin D supplement. Dose unknown, self-prescribed. Side effect noted. Mild gastrointestinal discomfort with neproxen. Allergy status. NKDA. No known drug allergies confirmed today. Any questions before I send you through?

24:21 Just one. Should I be worried about any contraindications? I read that neproxin doesn't mix well with some things.

24:30 Good question. A contraindication means a condition or factor that makes a drug inadvisable for a specific patient. The main ones with neproxen are kidney problems, certain heart conditions, and existing stomach ulcers, none of which apply to you based on your record. Dr. Bennett will have a look at the full picture when she reviews.

24:51 But nothing is flagging as a concern from what I can see. I just want to check that with Dr. Bennett before we confirm anything further. That's what she's here for.

25:00 Fair enough. Thank you.

25:03 You're all done with me. I'll send the notes through now. Dr. Bennett will be ready for you in about five minutes. Good to see you looking so much better, Mr. Davies.

25:13 Thank you. I appreciate it. Three key exchanges. A little more slowly. Listen to how the practice nurse structures her questions. Systematic, complete, but never clinical in register.

25:29 Each question has a purpose. Listen for the pattern. Do you have any known drug allergies?

25:37 Not that I know of. I've never had a problem with medication before.

25:42 And that includes everything, not just prescription medication.

25:47 Anything over the counter?

25:48 Any reaction to antibiotics, painkillers, aspirin, anything like that?

25:54 No. Nothing. Never had a problem.

25:58 And have you ever had a severe reaction to anything? Any history of anaphylaxis? Difficulty breathing? Throat swelling? A drop in blood pressure after taking something?

26:10 No. Nothing like that. Ever.

26:14 Good. I'll record that as NKDA. No known drug allergies. Any side effects from the neproxen you've noticed?

26:26 I've had a bit of an unsettled stomach. Not terrible, just noticeable.

26:33 That's a very common side effect with that class of medication. Taking it with food helps, which you're already doing. I'll note that in your record and flag it for Dr. Bennett. If it gets significantly worse, vomiting, stomach pain, black stools, come back straight away. But what you're describing sounds like a typical settling-in response.

26:57 Let me just summarize what I've noted. Current medication, neproxen, twice daily with food, as per discharge summary. Vitamin D supplement. Dose unknown, self-prescribed. Side effect noted, mild gastrointestinal discomfort. Allergy status. NKDA. No known drug allergies confirmed today. Any questions before I send you through?

27:26 Just one. Should I be worried about any contraindications?

27:32 A contraindication means a condition or factor that makes a drug inadvisable for a specific patient. The main ones with neproxen are kidney problems, certain heart conditions, and existing stomach ulcers, none of which apply to you. I just want to check that with Dr. Bennett before we confirm anything further.

27:55 That's what she's here for. Chapter 5. A New Patient. Mrs. Davis, no relation to James. Before she sees the doctor, the triage nurse checks her vital signs. Listen for how he says each reading out loud.

29:07 Good morning. Welcome to the Elmwood GP Clinic. I'm Tom. I'm the triage nurse. I'll take a few measurements before you see the doctor. Can I take your name?

29:19 Of course. It's Davis, Sarah Davis. I booked online.

29:24 Great. I can see you here, Mrs. Davis. This is your first time with us, yes?

29:30 Yes, I just moved to the area.

29:33 Perfect. I'll open your record as we go. Can I ask what brought you in today? It's probably nothing.

29:41 I've just been a bit tired lately, and I've had a few headaches. My old GP suggested I get a checkup when I registered somewhere new.

29:50 Good advice. I'll take a brief medical history first, then we'll do your vital signs. Blood pressure, heart rate, oxygen levels, temperature, and respiratory rate. All completely routine. All of those? All five, yes. It gives the doctor a full picture before they see you. It only takes a few minutes.

30:13 Any significant medical history I should know about? Past illnesses, surgery, ongoing conditions?

30:21 Nothing major. I had my tonsils out as a child. No ongoing conditions that I know of.

30:27 And current medication?

30:29 Just a vitamin D supplement. That's it. Any known allergies?

30:35 No, none that I know of. Thank you. Right. Let's get started with the vital signs. First, blood pressure. I'm going to put this cuff around your upper arm. It will inflate and squeeze a little. That's normal. Just relax your arm. Is that the blood pressure machine? That's right. A sphigmo manometer, though we just call it a BP cuff.

31:04 It measures the pressure of blood in your arteries as your heart beats and between beats. Right. Your blood pressure is 122 over 79.

31:18 Is that good?

31:20 That's completely normal. 122 is your systolic pressure, the pressure when your heart is actively pumping. 79 is your diastolic, the pressure between beats, when the heart is resting, both well within normal range. That's a relief. Next, oxygen saturation and heart rate. I'll use the pulse oximeter for this.

31:48 Just clip it onto your fingertip. Perfect. Your oxygen saturation is 98%, and your heart rate is 74 beats per minute.

32:00 What does oxygen saturation mean exactly?

32:04 It's the percentage of your red blood cells that are carrying oxygen. Measured without any needles, just light through your fingertip. 98% is excellent. Anything above 95% is normal. Yours is great. And the heart rate? 74%. Right in the middle of the normal range. 60 to 100 is what we're looking for at rest.

32:32 You're perfectly steady. Now, temperature. 36.7 degrees Celsius. That's completely normal. No fever, which in clinical terms we call afebrile. It means without fever. If your temperature were above 38 degrees, we'd say pyrexic or febrile. 36.7 is ideal. And finally, respiratory rate. I'm just going to watch your breathing for 30 seconds.

33:11 16 breaths per minute. Completely normal. The range we're looking for is 12 to 20. You're right in the middle. That's all fine then. All five vital signs normal. Let me just note everything in your file. Blood pressure 122 over 79, heart rate 74 beats per minute, oxygen saturation 98%, temperature 36.7, respiratory rate 16.

33:45 I'll hand this over to Dr. Bennett now. She'll be with you shortly. Probably in about 10 minutes.

33:53 Should I mention the tiredness and headaches to her?

33:56 Yes, I've noted them in the triage record, but always tell the doctor directly. The more she knows, the better. You're in good hands. Thank you very much. Take a seat just outside. We'll call you in.

34:14 Three key exchanges, a little more slowly. Listen for how the nurse announces results and explains them at patient level.

34:23 Pay attention to the numbers and the language around them. Your blood pressure is 122 over 79. Is that good? That's completely normal. 122 is your systolic pressure, the pressure when your heart is actively pumping. 79 is your diastolic, the pressure between beats when the heart is resting. Both well within the normal range.

34:59 Your oxygen saturation is 98%. Heart rate is 74 beats per minute.

35:07 What does oxygen saturation mean exactly?

35:11 It's the percentage of your red blood cells that are carrying oxygen. Measured without any needles, just light through your fingertip. 98% is excellent. Anything above 95 is normal. Yours is great. Blood pressure 122 over 79. Heart rate 74 beats per minute. Oxygen saturation 98%. Temperature 36.7 Respiratory rate 16.

35:47 That's all fine then. All five vital signs normal. I'll hand this over to Dr. Bennett now. She'll be with you shortly.

36:02 Chapter 6. Sarah Whitfield is a keen runner with three weeks of knee pain. Listen for Dr. Okafor's pain questions. When it started, what it feels like, and where it spreads.

36:18 Mrs. Whitfield, hello. Come in, please, take a seat. I'm Dr. Okafor. What's brought you in today?

36:26 Thank you, Doctor. It's my right knee. It's been hurting for about three weeks now, and it just doesn't seem to be getting any better on its own.

36:35 Three weeks, alright. I'd like to take a proper pain history, if that's okay, just to build a full picture. Can you tell me how it started? Was it sudden or did it come on gradually?

36:47 It was after a run, actually. I usually run two or three times a week, but I did a longer one that weekend, about 10 kilometers, instead of my usual five. The knee was fine during the run, but the next morning it was really stiff, and the pain started from there.

37:03 So the onset was gradual, the day after the run, not during it. That's useful to know. And has anything like this happened before with the knee?

37:13 No, never. I've been running for years, and I've never had any trouble with it.

37:19 Alright, now can you describe the pain for me? What does it actually feel like?

37:25 It's hard to put into words, Doctor. Some days it's just a dull ache, and other days it's quite sharp.

37:32 That's very common actually. Let me give you a few words and you tell me which ones fit. Would you say it's more of a dull ache, a sharp pain, a stabbing feeling, or a throbbing sensation?

37:48 Mostly a dull ache. But it goes sharp when I bend it, like going downstairs, or if I've been sitting for a long time and I stand up.

37:57 So a dull ache at rest and sharper with certain movements. That helps. Now I'd like to get a sense of the severity. On a scale of one to ten, with ten being the worst pain you can imagine, where would you put it?

38:12 On a bad day, I'd say five, maybe six. When I'm just sitting, it's more like a three.

38:18 So it varies. Five or six on a bad day, three at rest. That's the pain scale we use, and the range is really what matters. Mednomads, quick question for you. When a patient says five or six out of ten, what follow-up question do you ask to make that number more useful? Drop yours in the comments. Does the pain stay in the knee or does it radiate anywhere else?

38:47 Up into the thigh or down into the shin?

38:51 No, it stays right in the knee. I don't feel it anywhere else.

38:56 Good. That tells me the pain is localized to the knee itself, rather than being referred from somewhere else. Referred pain is when you feel it in one place, but the cause is actually somewhere different. In your case, it sounds like the knee is the source and the site.

39:17 Oh, I see. So that's a good thing?

39:19 It's helpful information. It narrows things down. Now, is the pain there all the time or does it come and go? It comes and goes.

39:30 It's worse after I've been active, like after walking a lot or going up and down stairs, and it's definitely worse at the end of the day than in the morning.

39:40 So intermittent, worse with activity, and worse as the day goes on. What about the other direction? Is there anything that seems to help? Rest helps.

39:51 If I stay off it for a while, it settles down, and I'd been putting ice on it at home, which takes the edge off for a bit.

39:58 So the exacerbating factors, the things that make it worse, are activity, particularly impact like running or stairs, and the relieving factors, what helps, are rest, keeping the weight off it, and ice. Does that match how you'd describe it? Yes, exactly. A couple more questions before I examine you.

40:19 Have you noticed any swelling or the knee locking or giving way?

40:25 No swelling that I've noticed, and it hasn't locked or given way, no.

40:30 Good, that's helpful. Would you mind if I have a look at the knee? I'll just ask you to roll up your trouser leg for me. Of course. I'm just going to press around the knee gently. Tell me if anything is particularly sore. There's some tenderness here, around the front of the knee, just below the kneecap.

40:53 Does that match where you normally feel the pain? Yes, that's the spot. It's right there. Okay. So, Mrs. Whitfield, let me summarize what we've covered. You've had pain in the right knee for about three weeks, starting the day after a longer run. The character of the pain is a dull ache at rest, sharper with movement.

41:17 You'd rate it around five or six on a bad day, and it's intermittent, worse with activity. It stays in the knee, it doesn't travel, and rest and ice help. No swelling, locking, or giving way. On examination, there's some tenderness around the front of the knee.

41:37 Yes, that's it exactly.

41:39 That's a helpful picture. I don't want to jump to conclusions on one visit, but nothing here is ringing alarm bells. What I'd like to do is have you back in a couple of weeks so we can see how it's tracking. And in the meantime, just listen to the knee. Don't push through pain.

41:58 So I don't need to stop running completely.

42:01 Not at all. That's not where we are. Just listen to what it's telling you day to day. And if it gets worse, or you notice swelling, locking, or the knee giving way, don't wait for that appointment. Come back sooner.

42:16 That sounds good, Doctor. Thank you.

42:19 You're welcome. Any other questions for now?

42:23 No, I think that covers it.

42:25 Thank you, Dr. Okerfall. You're welcome, Mrs. Whitfield. Take care. Now let's replay three key exchanges from that consultation. A little more slowly this time, so you can hear the phrasing clearly. Can you describe the pain for me? What does it actually feel like?

42:48 Mostly a dull ache. But it goes sharp when I bend it, like going downstairs, or if I've been sitting for a long time and I stand up.

42:59 So the exacerbating factors, the things that make it worse, are activity, particularly impact, like running or stairs, and the relieving factors, what helps, are rest, keeping the weight off it, and ice. Does that match how you'd describe it?

43:17 Yes, exactly.

43:20 That tells me the pain is localized to the knee itself, rather than being referred from somewhere else. Referred pain is when you feel it in one place, but the cause is actually somewhere different. In your case, it sounds like the knee is the source and the site.

43:45 Chapter 7. Our Last. Andrew Blake has had stomach trouble for weeks. Listen for how Dr. Kahn turns his everyday words into clinical ones. I feel sick becomes nausea. Mr. Blake? Hello, come on in and have a seat. I'm Dr. Kahn, one of the GPs here. Before we start, can I just check your date of birth?

44:13 Of course. 14th of March 1981.

44:17 Thank you. So, what can I do for you today?

44:20 Well, I've been having this pain in my stomach for a few weeks now. It's not terrible, but it keeps coming back, and my wife finally told me to get it looked at.

44:50 Lower abdomen. Is it always in the same spot or does it move around?

44:55 Usually it's just here, in one spot. But on a bad day, it's more spread out, like my whole lower belly aches.

45:05 So most of the time it's localized in one area, but sometimes it becomes more diffuse, spread across the lower abdomen. And how did it start? Did it come on suddenly or build up gradually?

45:18 Gradually, I think. I first noticed it maybe five or six weeks ago, just now and then, and it's been happening more often since. Can you describe what the pain actually feels like? It's hard to describe. It's not sharp, exactly. It's more of an ache that comes and goes. And sometimes it feels like everything in here is just cramping up.

45:45 That's really helpful. Comes and goes and cramping are exactly the kind of words I need. Let me ask you a few more questions so we can work out what's going on. Sure, fire away. A pain that tightens and then eases like that in waves is what we sometimes call colicky. Does it build up and then settle, or is it there all the time in the background?

46:08 It builds up, lasts maybe 10 or 20 minutes, then eases off. In between, there's sometimes a dull ache, but nothing much.

46:19 So a cramping colicky pain that comes in waves with a mild ache in between. Is there anything that makes it worse or anything that helps?

46:28 It's usually worse after a big meal, and lying down with a hot water bottle helps a bit.

46:35 Thank you. Now, have you been feeling sick at all, or actually being sick?

46:41 Feeling sick? Yes, sometimes. Mostly when the cramps come on. But I haven't actually been sick, no.

46:50 So some nausea but no vomiting. That's an important difference, thank you. Med nomads, a quick one for you. If you've ever taken an abdominal history in English, which question was the hardest to ask clearly? Tell us in the comments. Have you noticed any changes in your bowel habit recently? Sorry, my bowel habit?

47:12 Sorry, I mean going to the toilet. How often you open your bowels, and whether that's changed at all.

47:19 Oh, right. Yes, actually. I've been going more often than usual, three or four times a day some days, and it's looser than normal.

47:29 So more frequent and looser than usual. That's exactly what we mean by a change in bowel habit. And what's normal for you, usually?

47:37 Once a day. Pretty regular. Always has been.

47:41 And any bloating, a feeling of fullness or swelling?

47:45 Yes, quite a lot. By the evening, my trousers feel tight, and I feel full even when I've hardly eaten anything. And how about your appetite? Has that changed? I'm eating less, to be honest. I just don't fancy much at the moment.

48:03 So some appetite loss as well. I know this can feel like an awkward question, but have you noticed any change in passing wind?

48:12 Haha, yes, more than usual, I'd say. It's a bit embarrassing, actually.

48:17 Not at all. It's a completely normal thing to ask about, and it's useful. In my notes, I'll write that down as flatulence, but passing wind is perfectly fine between us.

48:29 Flatulence. That sounds much more respectable.

48:33 Thank you, Mr. Blake. Now I'd like to examine your abdomen if that's alright. Could you pop up on the couch and lie flat for me? Sure. I'm going to press gently in a few different areas. Let me know if anything's sore. If your muscles tense up when I press somewhere, we call that guarding, and it helps me understand where the tenderness is.

48:56 That's a bit sore, just there, low down.

49:00 Okay, a little tenderness there. Your tummy is nice and soft though, and there's no guarding. You can sit up now. So, Mr. Blake, let me check I've got everything right. For about five or six weeks, you've had pain in your lower abdomen. Most of the time it's in one spot, but on bad days it spreads out.

49:19 It's a cramping pain that comes in waves, worse after big meals. You've had some nausea, but no vomiting. You're going to the toilet more often, and it's looser than usual. You've also had bloating, you've been eating less, and you're passing more wind than usual. Is that right? Yes, that's it. That's all of it.

49:40 Thank you. That's a really clear picture. I'm not going to guess at the cause today. What I'd like to do is arrange some blood tests to find out what's going on, and depending on the results, I may refer you on for further tests. Does that sound okay? Yes, that's fine.

49:57 Is it anything to worry about?

49:59 It's too early to say, and that's exactly why we're doing the tests. In the meantime, if the pain gets much worse, or you notice anything new that worries you, please don't wait for the results. Contact us or get seen sooner.

50:13 Thanks, Doctor. I'd been putting this off for a while, to be honest.

50:18 Well, I'm glad you didn't put it off any longer. The receptionist will book your blood test on your way out.

50:24 Thanks, Dr. Khan. Right. Let's go back over three key exchanges from that consultation. A touch more slowly this time. Well, I've been having this pain in my stomach for a few weeks now. It's not terrible, but it keeps coming back, and my wife finally told me to get it looked at.

50:48 I'm glad you came in. So you've been having some abdominal pain for a few weeks. When you say stomach, can you show me where you feel it? Thank you. Now, have you been feeling sick at all, or actually being sick?

51:04 Feeling sick? Yes, sometimes. Mostly when the cramps come on. But I haven't actually been sick, no.

51:14 So some nausea but no vomiting. That's an important difference, thank you.

51:20 Oh, right. Yes, actually. I've been going more often than usual. Three or four times a day some days, and it's looser than normal.

51:31 So more frequent and looser than usual. That's exactly what we mean by a change in bowel habit. And what's normal for you usually?

51:41 Once a day, pretty regular, always has been.

51:48 That's all seven. If one of these conversations was useful, watch its full episode. The links are on screen and in the description, with the vocabulary, the breakdown, and the quiz. Free transcripts are on medicalvoices.health. Our next marathon is next month an hour of hospital English. Stay tuned.