１本目：【医学英語】英語で医療面接 - 胸痛 Chest Pain

台本

Doctor: Hello, my name is Dr. Tanaka, part of the healthcare team that is taking care of you. I’d like to ask you a few questions about your visit today. Before I begin, may I have your full name and date of birth please?Patient: Hello, my name is John Smith. Date of birth is February 15, 1960.
Doctor: How would you like me to address you?
Patient: You can call me Mr. Smith.
Doctor: Hi Mr. Smith, how can we help you today?
Patient: Yeah doctor… I’ve been having this chest pain.
Doctor: Since when?
Patient: Since this morning, about 10am.
Doctor: What were you doing when the pain started?
Patient: I was watching TV at home.
Doctor: Is this the first time you’re having this kind of pain?
Patient: Yes
Doctor: I see. Where is the pain?
Patient: Right here, in the middle.
Doctor: I see… Can you describe the pain for me? Is it a sharp pain? Dull pain? Crushing pain? Squeezing pain?
Patient: It’s a crushing type of pain.
Doctor: Does the pain move or spread anywhere?
Patient: It actually goes to my left arm and the back.
Doctor: Is the pain always there? Or does it come and go?
Patient: It’s always there.
Doctor: Alright. Anything that makes the pain worse? Or better?
Patient: The pain is worse when I walk.
Doctor: Is the pain worse when you take a deep breath?
Patient: Nope.
Doctor: Okay… I just want to know how painful it is; on a scale of zero to ten, with zero being no pain at all, and ten being the worst pain you can imagine, how would you rate the pain?
Patient: I would say it’s about eight.
Doctor: Alright. Do you have any breathlessness?
Patient: Yes.
Doctor: How about any palpitations? Do you feel like your heart is beating very fast?
Patient: Nope.
Doctor: Ok. Recently have you had any leg swelling?
Patient: Nope.
Doctor: How many pillows do you use when you sleep?
Patient: Just one.
Doctor: Do you suddenly wake up at night feeling breathless?
Patient: Nope.
Doctor: Any recent trauma to the chest?
Patient: Nope.
Doctor: Ok. I am going to ask you a few more questions just to make sure I haven’t missed anything. Any fever recently?
Patient: Actually, I had the flu two weeks ago.
Doctor: I see. Did you see a doctor for that?
Patient: Not really. It just went away by itself.
Doctor: I see. Any nausea or vomiting?
Patient: Nope.
Doctor: Any headaches?
Patient: Nope.
Doctor: Any tummy pain?
Patient: Nope.
Doctor: Any problems with urination or bowel movement?
Patient: Nope.
Doctor: Any recent diarrhea, or blood in your stool?
Patient: Nope.
Doctor: Any loss of appetite or weight loss recently?
Patient: Nope.
Doctor: Alright, Mr. Smith. Do you have any medical issues?
Patient: Yes, I have diabetes, high blood pressure, and high cholesterol.
Doctor: Alright. Any other issues such as heart attack or stroke?
Patient: Nope
Doctor: Have you ever been hospitalized before? Have you had any surgeries before?
Patient: Nope
Doctor: What medications are you on right now?
Patient: Here is a list of the medications that I am on.
Doctor: Ok thanks. Do you take any traditional medicine or any supplements?
Patient: No, doctor.
Doctor: Do you have any drug allergies?
Patient: I am allergic to penicillin.
Doctor: What happens when you take penicillin?
Patient: I develop this rash.
Doctor: Alright. I’ll take note of that. Any family members who had a heart attack? Or stroke?
Patient: My dad had a heart attack when he was 60.
Doctor: I see… I’m very sorry to hear that. How about your mom?
Patient: Thank you, she is fine.
Doctor: I just have a few more questions for you, Mr. Smith. Do you drink alcohol?
Patient: Yes, I do.
Doctor: I see. In a week, how many days do you drink?
Patient: Just during the weekends.
Doctor: And how much do you drink each time?
Patient: Just a few cans of beer.
Doctor: Ok. Do you smoke?
Patient: Yes, I do.
Doctor: How many sticks per day?
Patient: 20.
Doctor: For how many years?
Patient: Since I was 20.
Doctor: Alright. And what do you work as, Mr. Smith?
Patient: I’m a lawyer.
Doctor: I see. Alright Mr. Smith, based on our conversation, there could be several reasons for your chest pain. You might be having a heart attack, or it could be because of a tear in a big blood vessel called the aorta, or it could be an inflammation of your heart. It is crucial that we run some tests including an ECG which monitors your heart activity, some blood tests and an Xray. Do you have any questions for me?
Patient: No, doctor.

２本目：【解説動画】英語で医療面接 - 胸痛

解説ポイント

>> オープナー
- I’d like to ask you a few questions about your visit today.
- I’d like to ask you a few questions and discuss my impressions with you.
- I’d like to ask you a few questions and discuss my findings with my senior colleagues.
- I’d like to ask you a few questions and come up with a treatment plan for you.
>> 患者の呼び方の確認
- How would you like me to address you?
Mr/Ms/Mrsつけずに、最初フルネームで呼んで、どう呼ばれてほしいか確認する
>> 患者情報の確認
- May I have your full name and date of birth please?
- May I confirm your full name and date of birth please?
>> 主訴を聞く
- How can we help you today?
- What brings you to the hospital?
- What brings you in?
- What happened today?
>> 持続時間を聞く
- Since when?
- When did it start?
- What time did it start?
>> 初めてかどうかを聞く
- Is this the first time you’re having this kind of pain?
- Is this your first episode?
>> 痛みの場所を聞く
- Where is the pain?
- Can you point to where the pain is?
- Can you point to where it is?
- The pain is on the left.
The pain is on the right.
>> 痛みの性状
- Sharp pain: 鋭い痛み
- Dull pain: 鈍い痛み
- Crushing pain: 押しつぶされるような痛み
- Squeezing pain: 絞扼性
- Colicky pain: 疝痛
- Cramping pain: こむら返るような (menstrual cramps = 生理痛）
- Sore: ひりひりするような
- Tearing pain: 引き裂かれるような痛み
>> 放散の確認
- Does the pain move or spread anywhere?
- Does the pain travel anywhere?
- Does the pain go anywhere?
- Does the pain radiate anywhere?*
>> 持続・断続
- Is the pain always there?
- Is the pain constant?
- Or does it come and go?
- Or is it intermittent?*
>> 痛みの評価
- On a scale of zero to ten, with zero being no pain at all, and ten being the worst pain you can imagine, how would you rate the pain?
- On a scale of zero to ten, with zero being no pain at all, and ten being the worst pain imaginable, how would you rate the pain?
- How painful is it now?
- When it was most painful how would you rate the pain from zero to ten?
- Was the pain always 8? or did it get to 8?
- Is 8 the most painful?
>> 息切れの確認
- Do you have any breathlessness?
- Do you feel breathless?
- Do you feel short of breath?
>> 起座呼吸の確認
- Do you feel breathless when you lie down?
>> 既往歴の確認
- Do you have any medical issues?
- Do you have any medical conditions?
- Do you have any major medical conditions?
>> 家族歴の確認
- Do you have any family members with similar issues?
>> 同情の表現
- I’m very sorry to hear that.
- I’m very sorry for your loss. (亡くなった場合）
- That must have been very tough.
>> 職業の確認
- What do you work as?
- What is your job?
- What is your occupation?
>> サマリー
- Based on our conversation, there could be several reasons for your chest pain.
- Based on what you have told me, there could be several reasons for your chest pain.

３本目：【口頭発表・プレゼン例】英語で医療面接 - 胸痛 Chest Pain

プレゼン例

既往を最初に言うパターン
61 year old Caucasian male with history of diabetes, hypertension, hyperlipidemia and positive family history of myocardial infarction presents with first onset acute substernal chest pain that radiates to the left arm and back.
主訴を最初にいうパターン
61 year old Caucasian male presents with first onset chest pain for 3 hours duration. He has a background history of diabetes, hypertension, hyperlipidemia and positive family history of myocardial infarction. The chest pain is central and radiates to the left arm and back.
続き
The pain started 3 hours ago and is constant, crushing in quality, 8/10 in intensity, and worsens with exertion. The pain is pleuritic and is alleviated with rest. Of note, the patient has URTI symptoms 2 weeks ago which self-resolved. Otherwise, he has no other symptoms including orthopnea, PND, leg swelling, palpitations, abdominal pain, urinary and bowel symptoms. He is a heavy smoker with 40 pack year history.

解説ポイント

>> He has never experienced this type of pain → first onsetで簡潔に
>> 主訴を最初に言えば、聞き手側は重要な既往歴とそうでない既往歴をフィルターしながら聞ける。主訴の前に既往歴を言うと、最初の方の既往歴を忘れる場合がある。
>> worsens with walking → worsens with exertion（労作時に増悪）
>> 重要な事柄を述べる前に”Of note,”（ちなみに）をつけると、聞き手側も注意を払ってくれる
>> 陰性所見を述べる前に”Otherwise”とつけるといいトランジションになる
>> Precordialは前胸部；胸痛の場所を伝え場合は通常 central / left-sided / right-sided
>> Migratory painは放散というよりかは移動性（虫垂炎のバズワード）
>> 痛みの問診：SOCRATES
- Site, Onset, Character, Radiation, Association symptoms, Timing, Exacerbation/alleviation, Severity
>>痛みの性状で患者の言葉をそのまま引用する場合は “The patient describes the pain as…”
- The pain started 3 hours ago
- The pain first occurred 3 hours ago
- The pain is intermittent; each episode lasts 5 minutes, first started 3 hours ago.