医学英語 Case 2: Jaundice動画全３本まとめ

１本目：【英語で医療面接】黄疸 Jaundice

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 Sophia Rodriguez. Date of birth is January 7th, 1981.
Doctor: How would you like me to address you?
Patient: You can call me Ms. Rodriguez.
Doctor: Hi Ms. Rodriguez, how can we help you today?
Patient: I have yellow eyes and skin.
Doctor: I see. When did you first notice that your eyes and skin were yellow?
Patient: About two weeks ago.
Doctor: Alright. Has it been getting worse since then?
Patient: No, I think it is about the same.
Doctor: Do you have any pain in your stomach?
Patient: Actually, I do.
Doctor: I see. I need to ask you more about that. When did you notice the pain?
Patient: I guess it’s about three weeks ago.
Doctor: How would you characterize the pain? Is it a sharp pain, dull pain, or squeezing pain?
Patient: I’d say it's a dull pain.
Doctor: Have you ever experienced this kind of pain before?
Patient: No.
Doctor: Where is the pain?
Patient: Around here. Upper right.
Doctor: I see. Does the pain spread anywhere?
Patient: No.
Doctor: Is the pain constant, or does it come and go?
Patient: It’s constant.
Doctor: Is it getting better or worse?
Patient: It’s getting worse.
Doctor: Alright, Ms. Rodriguez, I just want to know how painful it is. On a scale of zero to ten, with 0 being no pain at all and 10 being the worst pain you can imagine, how severe is the pain?
Patient: It’s about 3.
Doctor: Has it started with 3 or got to 3?
Patient: Got to 3.
Doctor: Is the pain related to eating food?
Patient: No.
Doctor: Does anything make the pain better?
Patient: Paracetamol made it better. So I took it a couple of times three weeks ago.
Doctor: Does anything make the pain worse?
Patient: Not really.
Doctor: Any nausea or vomiting?
Patient: I feel constantly nauseated over these three weeks, and vomited once.
Doctor: I’m very sorry to hear that. When did you vomit?
Patient: Just yesterday.
Doctor: How do you describe the vomitus?
Patient: It was sour, and yellowish.
Doctor: Any blood in it?
Patient: Nope.
Doctor: Have you noticed that your urine is darker?
Patient: Hm, I actually do. But that’s maybe because I’m dehydrated.
Doctor: What color is it?
Patient: Brown color.
Doctor: How about your stools? Did you notice that your stool is more pale?
Patient: No, doctor.
Doctor: Any itchy skin?
Patient: Yes, since I noticed my yellow skin.
Doctor: Any diarrhea or constipation?
Patient: No.
Doctor: Have you had any fever?
Patient: Yes, I do.
Doctor: Alright, what was the temperature?
Patient: Yesterday, it was 37.7.
Doctor: Since when?
Patient: Since around the same time my stomach ache started.
Doctor: Do you feel fatigued recently?
Patient: Because of this, yes.
Doctor: Any change in your appetite?
Patient: Yes, I have no appetite now.
Doctor: Any change in your weight?
Patient: No.
Doctor: Any stomach bloating?
Patient: A little bit.
Doctor: Alright, Ms. Rodriguez. I’ll be asking you about your health in general. Do you have any medical issues?
Patient: I have been diagnosed with antitrypsin deficiency, but it was mild, and the doctor just told me to avoid both active and passive smoking.
Doctor: Are you on any medications for that?
Patient: No.
Doctor: Have you ever been hospitalized before? Have you had any surgeries before?
Patient: Nope.
Doctor: What medications are you on right now?
Patient: Just over the counter paracetamol.
Doctor: Do you have any drug allergies?
Patient: No, I don’t.
Doctor: Any family members with antitrypsin deficiency?
Patient: Yes, my father. He is alive, but has COPD and recently he was started on home oxygen therapy and enzyme replacement therapy.
Doctor: I see, what about your mother?
Patient: She is alive and healthy, thank you for asking, doctor.
Doctor: No problem Ms. Rodriguez. I just have a few more questions for you. Do you drink alcohol?
Patient: To be honest, yes I do.
Doctor: I see. In a week, how many days do you drink?
Patient: Almost everyday.
Doctor: And how much do you drink each time?
Patient: When I drink, I finish at least a bottle of wine.
Doctor: Have you ever felt the need to cut down on your drinking?
Patient: Yes I do. Recently I have been drinking more because I don’t feel good and sometimes I don’t even know what to do while I take medical leave from my workplace. And now I have this yellow skin and stomach pain. I’m feeling even more terrible. Only alcohol can relieve this pain and emptiness.
Doctor: Have people annoyed you by criticizing your drinking?
Patient: No, they didn’t, and these are all because of me.
Doctor: Do you feel guilty about drinking?
Patient: Yes. A lot.
Doctor: When you wake up in the morning, do you feel the need to drink alcohol as an eye-opener to calm your nerves down, or get rid of a hangover?
Patient: In fact, yes I do. When I have headaches in the morning I might take some paracetamol too.
Doctor: And how long has this drinking problem been going on for?
Patient: Since about 10 years ago.
Doctor: Alright Ms. Rodriguez, we have to take care of your symptoms to solve both your physical and alcohol problems. In order to do that, I need to ask you a bit more questions. Is that okay? Can we keep on?
Patient: Yes, please. Doctor.
Doctor: If you feel uncomfortable at any point, just let me know okay?
Patient: Thank you doctor.
Doctor: Okay, do you smoke?
Patient: No, I don’t.
Doctor: Are you vaccinated against Hepatitis B?
Patient: I’m not too sure.
Doctor: Have you traveled outside the country recently?
Patient: Yes, I went to the Philippines for a brief vacation about a month ago.
Doctor: Did you consume any contaminated food or drink there, like tap water, or raw shellfish?
Patient: I guess I ate a few shellfish in some seafood buffet in Cebu City. But I guess they were fully grilled.
Doctor: Alright. I just have a few more questions for you Ms. Rodriguez. Some of these questions may seem irrelevant but they are important for me to make the correct diagnosis. Is it okay with you?
Patient: Yes doctor.
Doctor: Do you have any tattoos anywhere on your body?
Patient: No, doctor.
Doctor: Have you received any blood transfusion before?
Patient: No, doctor.
Doctor: Alright, what do you work as, Ms. Rodriguez?
Patient: I work as a receptionist in a moving company.
Doctor: Okay, Ms. Rodrigues, I need to ask you about your gynecological history. These are the questions that I ask all the patients with similar symptoms to yours. Everything we talk today will be kept confidential. Are you okay with that?
Patient: Sure, understood.
Doctor: Are you sexually active?
Patient: Yes, with my husband.
Doctor: Do you use any protection?
Patient: Yes, we do, we use condoms.
Doctor: How many sexual partners have you had in the past?
Patient: I’m not too sure doctor… maybe 10?
Doctor: Have you ever had sexually transmitted infections before?
Patient: No, never.
Doctor: Okay. Do you use any illicit drugs?
Patient: No, never, doctor.
Doctor: I see. Alright Ms. Rodriguez, based on our conversation, there could be several reasons for your yellow skin and abdominal pain. You might be having an infection in your liver, or it could be alcohol-related, or it could be because of paracetamol, or it could be because of your antitrypsin deficiency. It is crucial that we run some tests including blood tests, checking on your liver enzyme, acé|taminophen, and antitrypsin levels. Once we identify the cause, we can proceed with an appropriate treatment plan. Until then, I recommend that you stop drinking and limit the use of paracetamol, as both might be contribúting to your possible liver damage. Any questions for me?
Patient : No, doctor.
Doctor: Alright, Ms. Rodriguez. I’ll get back to you later.
Patient: Thank you doctor.

２本目：【解説動画】黄疸 - 英語で医療面接　飲酒歴の聞き方など

MD+CALCのリンク
https://www.mdcalc.com/

解説ポイント

>> 痛みの性状
How would you characterize the pain?
How would you describe the pain?

>> 過去の類似エピソード
Is this your first time having this kind of pain?
Is this your first episode? (硬めの表現)

>> 痛みの程度
How bad is the pain? (子供にも使いやすい表現)
How would you rate the pain?
How much pain would you say you’re in?

>> CAGE
>>Cut down
Do you feel that you need to cut down on your drinking?
>>Annooyed
Do you feel annoyed when people criticize your drinking?
>>Guilt
Do you feel guilty about drinking?
>>Eye opener
When you wake up in the morning, do you feel the need to drink alcohol as an eye-opener to calm your nerves down, or get rid of a hangover?

>>相手が辛そうなときなどの気遣いの言葉
Can we keep on?
Can we continue?
Can we proceed?
→この表現に加えて
If you feel uncomfortable at any point, just let me know okay?
If you would like to stop at any point, please let me know.
If you would like to take a break at any point, please let me know.

>>何か心当たりのある(衛生的でない) ものを食べたか
Did you consume any contaminated/spoiled/unhygienic food or drink there, like tap water, or raw shellfish? (大人に向けた言葉)
Did you have any dirty food or drink? (子供)

>>単調な質問が続いたり、患者さんからするとなぜ聞くのか分かりにくいような質問(ex, タトゥー歴、輸血歴など) の前置き
I just have a few more questions for you. Some of these questions may seem irrelevant, but they are important for me to make the correct/accurate diagnosis. Is it okay with you?

>>性交歴の前置き
These are questions that I ask all my patients.
→
Everything we talk about today will be strictly kept confidential.
Everything we talk about today will stay within this room.
Everything we talk about today will stay between us.

>>性交歴
Are you sexuallly active?

>>避妊法
Do you use any protection?
What form of protection do you use?

>>違法薬物使用
Do you use any illicit drugs?
Do you use any illegal drugs?
Do you use any recreational drugs?

３本目：【口頭発表・プレゼン例】黄疸 - 英語で医療面接

解説ポイント

>>オープナーの例
40yo Asian American female with a heavy drinking history, regular use of paracetamol, and a history of antitrypsin deficiency presents with jaundice for 2 weeks duration, associated with abdominal pain and fever.

She has dull, constant upper right abdominal pain and constant fever, both of which lasting for 3 weeks.

>>陰性所見の述べ方
Otherwise she has no tattoos, transfusion history, or unprotected sex with multiple partners.
Otherwise she has no other symptoms such as diarrhea or loss of weight.

>>家族歴の述べ方
She has positive history of breast cancer in her maternal side of the family.
He has positive history of hemophilia in his paternal side of the family.