Click on the highlighted texts to see a suggested analysis.
Note: Click anywhere on the screen to close the pop-up box.
The video is taken from UK Clinical Communication Council video bank.
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 palpitations and 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