5: Learn to Analyse Demo

1  DR: Morning Mr Mead

2  PT: Hello Doctor

((Cleanses hands with anti-bacterial gel and shakes his hand))

3  DR: I’m Dr Robinson...sorry you’ve had to come to hospital and I gather you’ve had to wait a little bit as well

((She turns her face away to quickly skim through his medical records))

4  PT: That’s all right, it’s not very efficient I must say

5  DR: Yeah, how can we help you today?

6  PT: Well me palpitations, that’s what I call them anyway, er they haven’t stopped yet, they’ve been going on for at least about 4 hours now. And my wife said to me, look I'm going to get you in the car she said, and I’m gonna get you off to hospital, so a doctor can actually see them while they are actually happening are actually happening to me=

7  DR: =humm, (.) she’s worried about you

8  PT: Yes, yes she [is

9  DR:                     [humm (.) .hh so you’ve had some palpitations, going on for 4 hours today, anything else? (1.6)

10  PT: Well I ve::: I sort of e:: you know they have been sort of a problem you know

11  DR: In terms of::::, do you mean in [terms of time?

12  PT:                                                  [Well they’re fast you see ((Thumps on his chest to demonstrate))

13  DR: [They’re going very fast?

14  PT:  [They are sort of fast.     And I do feel a bit funny I have to say

15  DR: Wha- what do you mean by funny?

16  PT: erm hhh. well hhh. sort of like a strain, tense. It’s most unlike me you know I’m usually sort of horizontal

17  DR: So they make you feel anxious?

18  PT: Yes

19  DR: Right, ok so you’ve had this fast, fluttering of your heart or fast heart rate for about 4 hours, you feel anxious or a bit odd with it, anything else at all? Have you noticed any other symptoms you would normally::: em be experiencing?

20  PT: Well I must say I’ve had this sort of tightness around me here in my chest, not a pain, more of a tightness is my chest here ((points to chest))

21  DR: Right ((nods)) anything else?

22  PT: erm:: hhh. (0.9) No not really no

23  DR: No?

24  PT: No just annoying

25  DR: And have you felt any shortness of breath with it

26  PT: Yes I have been a bit short of breath

27  DR: Have you been able to do what you normally like to do? Or have you had to rest?

28  PT: well the shortness of breath has really been you know for the past 4 or 5 hours

29  DR: Right

30  PT: Before that I was quite all right

31  DR: You were fine, ok. And what were you doing 4 hours ago when all this started?

32  PT: Well my wife and I don’t get a lot of time together you know, because we’re in business together you see, and it’s the only time we get to relax you see, so we had an early lunch and put the tele on, and then it just suddenly on!

33  DR: So you were sitting down having lunch and it just suddenly came on out of the blue

34  PT: Yes

35  DR: Ok what I’d like to do now, is perhaps go over the story a little more, perhaps find out if you’ve had anything similar before, and then ask you some specific questions about some other things that sometimes patients feel along with the palpitationsand the chest pain if that’s                  [alright.        [OK?

36  PT:      [Ok              [yes yes

37  DR: So you’ve had this for 4 hours have you ever had this feeling in your chest before, of the fast heart rate?

38  PT:   OH  yes

39  DR: When was the first time you experienced it?

40  PT: god I suppose it was about (1.06) a year ago? (2.32)

41  DR: And how often since then? How frequent?

42  PT: About every month or so they come on

43  DR: Ok and how long do they normally last for?

44  PT: About 10 minutes, 15 minutes tops, no-no- not like this

45  DR: So it was the fact that they weren’t going away for 4 hours that was REAlly:: concerning you and your wife particularly?

46  PT: Mo::re my wife really frankly

47  DR: Right (.) Ok What she worried about is there anything that’s::: (1.28) particularly worrying her about this?

48  PT:  Well the whole thing really she doesn’t really know what’s going on, you know

49  DR: Right       

50  PT: So I suppose it is a bit worrying [it is, it is.

51  DR:                                                  [humm↓ ok .hhh (0.49) so you’ve had it for 4 hours, is it still there?

52  PT: Yes

53  DR: It’s certainly going along at quite a rate on ou::::r monitors

54  PT: is it?

55  DR: And your heart rate is irregular (1.29) so it’s not as regular as we would like to see::: your (.) your normal heart rate↑(0.57) ok? .hhh the ches:: we are going back to this chest pain, did it come on with the palpitations, or did it come on after a few hours?

56  PT: I cannot:: a little while after  a little
             [while, not at the begin[ning.

57  DR: [right.                          [Ok,    .hhh and it’s a tightness and not a chest pain (.) is that [right?

58  PT:                                                     [No    it’s it’s not a pain no no, it’s just like a:: tightness, it’s a feeling of discomfort

59  DR: Right, does it go anywhere?

60  PT:   No no it just stays across here ((points to centre of chest))

61  DR: Does it go into the neck or down the arm, or through to the back?

62  PT: No:::

63  DR: No.    And the shortness of breath what does that stop you from doing?

64  PT: Well as I said, it’s only been this last, you know probably this last hour or two that I’ve been feeling like this.

65  DR: em:: (0.70) and how are you::: how are you generally? (0.60) Are you normally fit and well?

66  PT: Yes, I’m as fit as a fiddle [absolutely yes

67  DR:                                       [ yeah?               Have you had any medical problems at all that may have suggested that this was going to happen?

68  PT: Not that suggested this was going to happen though, apart from the fact that I’ve had these palpitations        [that I had before

69  DR:              [Right

70  PT: But:: No I’m fit and well

71  DR: OK↑

72  PT: apart from falling off a few ladders and things I’ve been quite healthy