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Note 2: Click on the line name to close/ hide the box.
2. Click on 'Compare Answer'
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The video is taken from UK Clinical Communication Council video bank.
121 DR: Ok just a few other routine questions ((picks up notes)) that we need to ask. We need to ask you, about a few other symptoms that we just use as a screening tool to make sure there’s nothing else going on- so I’m going to rattle through a few other things with you if that’s alright?
122 PT: Fine doctor
123 DR: Have you had any cough or any cold recently? (1.0)
124 PT: No
125 DR: No? and you’ve not coughed any blood up?
126 PT: No
127 DR: No? (.) Any tummy pain? (1.50)
128 PT: No
129 DR: No? (0.84)
130 PT: apart from sometimes when I get of indigestion,
[I get that anyway, it’s normal,
[nothing serious
131 DR: [that’s alright. [ok You haven’t noticed a change in your appetite or your weight? (1.34)
132 PT: Well funny you should say that- I usu::ally::: put weight on over the wintertime, about 4 or 5 pounds on
133 DR:[Right
134 PT: [.hhhhhh And then loose it, but this year, I haven’t put any weight on at all.
135 DR: Right, any change in your bowl habits, for instance maybe do you have diarrhoea or developed constipation?
136 PT: No
137 DR: Not noticing any blood in your stool?
138 PT: No
139 DR: And what about going to the toilet to pass water? (1.21)
140 PT: That’s been sort of fine (0.81)
141 DR: No frequency? Not been going more frequently than you would normally? Or having to get up at night
142 PT: No
143 DR: No. And no blood or stinging when you have a wee?
144 PT: No no
145 DR: No ok, and finally, no headaches, no difficulty with your vision?
146 PT: no
147 DR: And you haven’t noticed any weakness anywhere?
148 PT: No
149 DR: Ok I’d quite like to have a look at you if I may and examine you
150 PT: Yes of course.
The Dr shifts to the screening frame, using a structure of ‘signposting+explanation’. This is commonly seen with this Dr.
Questioning is generally a face threatening act. Therefore the Dr asks for Pt’s permission.
Note how the Dr treats what counts as the completion of a topic from T111-120. In T112 the Pt answered the Q with a ‘no’ followed by ‘apart from’ which opens up the topic again. Then the Dr picks it up and investigated further, which continues to elicit either ‘no’ answers or uncertainties. Until T111 the Dr confirms the ‘apart from’ (T113) is only about Pt’s general feelings, which doesn’t suggest other clinical or emotional concerns that require her attention. Therefore she safely concludes this topic in T121.
Recollection of symptoms prompted by a series of questions can be mentally challenging. Pts may not remember all of them. However, drawing on the clinical knowledge, Dr may speculate that the Pt is likely to have a symptom which they couldn’t remember. Here in T121 by looking at the notes the Dr may suspected that the Pt was likely to have tummy pain, but instead of denying the Pt’s answer blatantly she seeks a confirmation ‘no?’ (T129), which allows the Pt to either confirm or repair their own false recollection. In so doing the Dr avoids a face threatening event by denying the Pt’s answer (ie breaching the agreement maxim).
Note the many relatively long pauses used between questions and answers. These facilitate Pt’s recollection of symptoms.
Again the Dr shifts to the examination frame, using the common politeness tact maxim.