最近はpodcastやNetflixで英語の耳を鍛えている最中です。
英語が苦手で話せないので、泥臭いですが地道にコツコツやる毎日ですね。
時々Chat GPTと実際に音声入力にして、英会話しています。
何回wordって発音してもwhatになるんやけど。挫けそう
Chat GPTに医者だったり、また患者だったりと好きなだけロールプレイできるので練習にはなります。
そんな中、なぜ自分が英語で医療面接ができないのかと思うと、型を理解してないのも理由かなと思いました。
大体、日本語だと自然にできるのも、型というかパターンがある。
医療面接で必要な内容を分解すると、
- 主訴
- 現病歴や身体初見などそれを修飾する事由(いつから、どのような)
- 介入(血液検査や画像検査)
- 結果の説明
- 診断結論
- Decision making
これを聞き取る、また話せばいいはずなので、各項目を英語で深めることにした。
もちろんchat GPTに例を作ってもらう。
あくまでは私個人の学習用なので、Native的には違うとかあるかもしれませんが、chat GPTに依存していますのでご考慮ください。
主訴について：chief complaints
- I have a headache.” – 頭痛があります。
- “I’m feeling nauseous.” – 吐き気がします。
- “I have a fever.” – 熱があります。
- “I’ve been coughing a lot.” – たくさん咳が出ます。
- “I’m experiencing chest pain.” – 胸の痛みがあります。
- “I have difficulty breathing.” – 呼吸が苦しいです。
- “My stomach hurts.” – お腹が痛いです。
- “I’ve been feeling very tired lately.” – 最近、とても疲れやすいです。
- “I have a sore throat.” – 喉が痛いです。
- “I’m having trouble sleeping.” – 睡眠に問題があります。
- “I’ve lost my appetite.” – 食欲がありません。
- “I have back pain.” – 背中が痛いです。
- “I’ve noticed a rash on my skin.” – 皮膚に発疹が出ました。
- “I’m experiencing dizziness.” – めまいがします。
- “I have a runny or stuffy nose.” – 鼻水や鼻詰まりがあります
嘔吐しました。下痢があります。
子どもならいつもより不機嫌とか、そんな感じでしょうか。
痛い＋場所の組み合わせ
commonな主訴なので、この各項目の基本的な診察の流れを英語で頭に入れておけば、なんとか対応できそうな気もする。
問診から身体診察の流れ
まずは冒頭の挨拶が肝要。
What brings you in today?が個人的には使っていきたいけども、
他も
- “How can I assist you today?”
- “What concerns do you have that I can help with?”
- “What symptoms are you experiencing?”
- “Can you tell me why you’re seeking medical attention today?”
- “What’s the reason for your visit?”
- “I’d like to hear about what’s been bothering you.”
- “Could you describe what symptoms brought you in?”
- “What health issues are you currently facing?”
- “How may I help you with your health concerns today?”
- “What has prompted you to come in today?”
What concerns do you have that I can help with?”なんかも良さそうである。
Concernは結構出てくる気がする。
頭痛がある人の場合でロールプレイしてみます
DrはmorisとchatGPTに出力されたのでそのままにします。
医者:Good morning, I’m Dr. Morris. How can I assist you today?
患者: Hi, Dr. Morris. I’ve been experiencing some really bothersome headaches for the past couple of weeks.
医者: I’m sorry to hear that. Can you tell me more about these headaches? Where exactly is the pain, and how would you describe it?
患者: The pain is mostly in my forehead and temples. It feels like a constant, dull ache, but sometimes it turns into a throbbing sensation, especially in the afternoons.
医者: That must be quite uncomfortable for you. How often do these headaches occur, and how long do they usually last?
患者: They happen almost every day, and once they start, the pain can last for several hours. Nothing I’ve tried seems to help much.
医者: Have you noticed anything that triggers the headaches, like stress, certain foods, or changes in your sleep pattern?
患者: Now that you mention it, my sleep hasn’t been great lately. I’ve been under a lot of stress at work, which might be affecting my sleep and, in turn, causing these headaches.
Now that you mention it,」は英語でよく使われる表現で、直訳すると「それを言われてみれば、」または「そういえば、」という意味になります。このフレーズは、相手が何かを指摘したり、話題に上げたりしたことに対して、話者がそれまで気づかなかった視点や情報に基づいて応答する際に使用されます。
知らんかった。
医者: Stress can definitely be a contributing factor to headaches.
Let’s discuss some strategies to manage your stress and improve your sleep. Additionally, I’d like to conduct a thorough examination and possibly run some tests to rule out any other underlying causes. How does that sound?
最後のこの文章は、これからいろいろ検査しまっせ、いいですかの前振り。
患者の同意を求める：最後の「How does that sound?」は、患者に提案された計画に対する意見や同意を求める礼儀正しい方法です。これにより、患者と医師との間での対話と協力を促進します。
患者: That sounds good, Dr. Morris. I really appreciate your help. I just want to find a way to get these headaches under control.
医者: Absolutely, we’ll work together to find the best approach to manage your headaches and address the root cause. Let’s start with a detailed examination, and we can go from there.
ところで、I’m sorry to hearは医療面接で使うのか?
「I’m sorry to hear that.」というフレーズは、英語圏の医療現場において患者からの辛い話や困難な状況を共有された際に、医師が同情や共感を示すためによく使われます。
なるほど真似しよう。
次は身体診察の流れを記載します。
身体診察の流れ
頭痛があるので神経診察メインのストーリーです。
医者: Alright, let’s proceed with a physical examination to better understand what might be causing your headaches. First, I’ll check your vital signs, including your blood pressure and heart rate, as these can sometimes influence headaches.
患者: Okay, I understand.
医者: (After checking vital signs) Your blood pressure and heart rate are within normal ranges, which is good. Now, I’d like to conduct a neurological examination. This involves checking your reflexes, muscle strength, eye movements, and coordination. It’s all pretty straightforward and shouldn’t take too long.
患者: Sounds good. I’m ready for that.
医者: (Conducting neurological examination) I’m going to ask you to follow my finger with your eyes without moving your head. Now, I’ll check your reflexes with this small hammer. It might feel a bit odd, but it shouldn’t be uncomfortable.
患者: Alright, I’m okay with that.
医者: (After neurological examination) Everything seems normal with your neurological exam, which is reassuring. I’d also like to check your eyes with this ophthalmoscope to look at the back of your eyes. It helps me see if there’s any increased pressure inside your skull that could be contributing to your headaches.
患者: Got it. Do I need to do anything special?
医者: Just look straight ahead and try to keep your eyes open. I know the light might be a bit bright, but it’ll be over quickly.
医者: (After examining the eyes) Your eye examination looks normal as well. Lastly, I want to ask about your environment and daily habits. Factors like screen time, hydration, diet, and even posture can contribute to headaches.
Can you tell me about your daily routine, especially regarding these factors?
患者: Sure, I spend a lot of time in front of the computer for work, and I guess I might not be drinking enough water throughout the day. My diet is okay, but it could probably be better.
医者: It’s important to take regular breaks from the screen to reduce eye strain, and staying hydrated is crucial for preventing headaches. Let’s work on incorporating more water into your day and improving your diet. I can provide some tips and resources to help with that. Additionally, considering everything we’ve discussed and the examinations we’ve done today, I believe your headaches could be tension-related, exacerbated by stress and perhaps poor posture at your workstation. Let’s explore some treatment options and lifestyle adjustments to help alleviate your symptoms.
患者: That sounds like a plan. I’m willing to try anything to get these headaches under control. Thank you for being so thorough, Dr. Morris.
医者: You’re welcome. It’s important to address all possible factors contributing to your headaches. I’ll also recommend a follow-up appointment to see how these changes are affecting you and to decide if we need to explore further diagnostic tests or treatments. In the meantime, I’ll provide you with some information on stress management techniques and ergonomic adjustments for your workspace. Let’s aim for gradual improvements, and we’ll adjust our approach as needed.
ということで一旦様子を見ようとことになりました。
これは身体診察のみで診療を終えたパターンです。
血液検査をした、画像検査もしたパターンも考えられます。
次は、症状が治らなかったので画像をとるパターンで考えます。
画像をオーダーする流れまで
医者:I appreciate your patience and effort in following the treatment plan and making those lifestyle adjustments. However, since your headaches haven’t improved, it’s important we take the next step in our investigation. I recommend we schedule a head CT scan. This will help us get a clearer picture of what’s happening inside your head and ensure we aren’t missing anything.
患者: I understand. I’m a bit nervous about it, but if you think it’s necessary, then let’s do it.
医者: I assure you, it’s a standard procedure and will provide us with valuable information. The process is quick and painless. I’ll arrange for the CT scan as soon as possible. Once we have the results, we’ll meet again to discuss the findings.
[After the CT scan, during the follow-up consultation]
医者: Thank you for getting the CT scan done. I’ve reviewed the results, and I’d like to discuss them with you. The good news is that there are no signs of any serious conditions like tumors or significant abnormalities. However, the scan did show signs of chronic sinusitis, which can sometimes cause headaches, especially the type of pain you’ve described.
患者: Sinusitis? I wouldn’t have guessed that. What does that mean for my treatment?
医者: Chronic sinusitis is the inflammation of the sinuses that can lead to blockages, causing pressure and pain, which can manifest as headaches. Given this diagnosis, we can adjust your treatment plan to address the sinusitis directly, which should help alleviate your headaches. This might include medications to reduce the inflammation, decongestants, and possibly nasal corticosteroid sprays. Additionally, I recommend seeing an ENT specialist to further evaluate and manage your sinusitis.
患者: I’m relieved to hear it’s something treatable. How soon do you think I’ll start to see improvements?
医者: With the right treatment, you should start to notice an improvement within a few weeks. It’s important to follow the treatment plan closely and keep track of your symptoms. If you don’t see an improvement or if your symptoms worsen, please let me know immediately.
医者: Also, managing sinusitis is a key step, but continuing with the lifestyle adjustments we discussed—like staying hydrated, managing stress, and maintaining good posture—will also contribute to your overall well-being and help prevent headaches.
患者: Thank you, Dr. Morris. I feel much better knowing what’s causing my headaches and that there’s a specific plan to address it.
医者: You’re welcome. I’m here to support you through this process. Let’s schedule a follow-up appointment to monitor your progress. In the meantime, if you have any questions or concerns, don’t hesitate to reach out.
この流れでは、医者は頭痛が改善しなかった患者に対し、頭部CTを推奨し、その結果を基に診断を下しています。診断名は慢性副鼻腔炎（chronic sinusitis）で、これが患者の頭痛の原因である可能性が高いことを示唆しています。
まとめ
まずは医療面接を主訴から考えてみました。
今回は副鼻腔炎が頭痛の正体であったという症例です。
多い主訴からの問診内容のパターンをまずは暗記したら、最低限は話せそうな気がしてきました。
主訴からの問診内容+身体診察までの流れをまずは徹底的にやってみようと思います。
以上参考になれば幸いです。
下記は今回の記事の医療面接の内容を連続したものです。
これをコピペして、chat GPTで音声入力出力すれば練習できます。
医者と患者は変な音声主力になりますが・・・
医者:Good morning, I’m Dr. Morris. How can I assist you today?
患者: Hi, Dr. Morris. I’ve been experiencing some really bothersome headaches for the past couple of weeks.
医者: I’m sorry to hear that.
Can you tell me more about these headaches? Where exactly is the pain, and how would you describe it?
患者: The pain is mostly in my forehead and temples. It feels like a constant, dull ache, but sometimes it turns into a throbbing sensation, especially in the afternoons.
医者: That must be quite uncomfortable for you. How often do these headaches occur, and how long do they usually last?
患者: They happen almost every day, and once they start, the pain can last for several hours. Nothing I’ve tried seems to help much.
医者: Have you noticed anything that triggers the headaches, like stress, certain foods, or changes in your sleep pattern?
患者: Now that you mention it, my sleep hasn’t been great lately. I’ve been under a lot of stress at work, which might be affecting my sleep and, in turn, causing these headaches.
医者: Stress can definitely be a contributing factor to headaches. Let’s discuss some strategies to manage your stress and improve your sleep. Additionally, I’d like to conduct a thorough examination and possibly run some tests to rule out any other underlying causes. How does that sound?
患者: That sounds good, Dr. Morris. I really appreciate your help. I just want to find a way to get these headaches under control.
医者: Absolutely, we’ll work together to find the best approach to manage your headaches and address the root cause. Let’s start with a detailed examination, and we can go from there.
医者: Alright, let’s proceed with a physical examination to better understand what might be causing your headaches. First, I’ll check your vital signs, including your blood pressure and heart rate, as these can sometimes influence headaches.
患者: Okay, I understand.
医者: (After checking vital signs) Your blood pressure and heart rate are within normal ranges, which is good. Now, I’d like to conduct a neurological examination. This involves checking your reflexes, muscle strength, eye movements, and coordination. It’s all pretty straightforward and shouldn’t take too long.
患者: Sounds good. I’m ready for that.
医者: (Conducting neurological examination) I’m going to ask you to follow my finger with your eyes without moving your head. Now, I’ll check your reflexes with this small hammer. It might feel a bit odd, but it shouldn’t be uncomfortable.
患者: Alright, I’m okay with that.
医者: (After neurological examination) Everything seems normal with your neurological exam, which is reassuring. I’d also like to check your eyes with this ophthalmoscope to look at the back of your eyes. It helps me see if there’s any increased pressure inside your skull that could be contributing to your headaches.
患者: Got it. Do I need to do anything special?
医者: Just look straight ahead and try to keep your eyes open. I know the light might be a bit bright, but it’ll be over quickly.
医者: (After examining the eyes) Your eye examination looks normal as well. Lastly, I want to ask about your environment and daily habits. Factors like screen time, hydration, diet, and even posture can contribute to headaches.
Can you tell me about your daily routine, especially regarding these factors?
患者: Sure, I spend a lot of time in front of the computer for work, and I guess I might not be drinking enough water throughout the day. My diet is okay, but it could probably be better.
医者: It’s important to take regular breaks from the screen to reduce eye strain, and staying hydrated is crucial for preventing headaches. Let’s work on incorporating more water into your day and improving your diet. I can provide some tips and resources to help with that. Additionally, considering everything we’ve discussed and the examinations we’ve done today, I believe your headaches could be tension-related, exacerbated by stress and perhaps poor posture at your workstation. Let’s explore some treatment options and lifestyle adjustments to help alleviate your symptoms.
患者: That sounds like a plan. I’m willing to try anything to get these headaches under control. Thank you for being so thorough, Dr. Morris.
医者: You’re welcome. It’s important to address all possible factors contributing to your headaches. I’ll also recommend a follow-up appointment to see how these changes are affecting you and to decide if we need to explore further diagnostic tests or treatments. In the meantime, I’ll provide you with some information on stress management techniques and ergonomic adjustments for your workspace. Let’s aim for gradual improvements, and we’ll adjust our approach as needed.
医者:I appreciate your patience and effort in following the treatment plan and making those lifestyle adjustments. However, since your headaches haven’t improved, it’s important we take the next step in our investigation. I recommend we schedule a head CT scan. This will help us get a clearer picture of what’s happening inside your head and ensure we aren’t missing anything.
患者: I understand. I’m a bit nervous about it, but if you think it’s necessary, then let’s do it.
医者: I assure you, it’s a standard procedure and will provide us with valuable information. The process is quick and painless. I’ll arrange for the CT scan as soon as possible. Once we have the results, we’ll meet again to discuss the findings.
[After the CT scan, during the follow-up consultation]
医者: Thank you for getting the CT scan done. I’ve reviewed the results, and I’d like to discuss them with you. The good news is that there are no signs of any serious conditions like tumors or significant abnormalities. However, the scan did show signs of chronic sinusitis, which can sometimes cause headaches, especially the type of pain you’ve described.
患者: Sinusitis? I wouldn’t have guessed that. What does that mean for my treatment?
医者: Chronic sinusitis is the inflammation of the sinuses that can lead to blockages, causing pressure and pain, which can manifest as headaches. Given this diagnosis, we can adjust your treatment plan to address the sinusitis directly, which should help alleviate your headaches. This might include medications to reduce the inflammation, decongestants, and possibly nasal corticosteroid sprays. Additionally, I recommend seeing an ENT specialist to further evaluate and manage your sinusitis.
患者: I’m relieved to hear it’s something treatable. How soon do you think I’ll start to see improvements?
医者: With the right treatment, you should start to notice an improvement within a few weeks. It’s important to follow the treatment plan closely and keep track of your symptoms. If you don’t see an improvement or if your symptoms worsen, please let me know immediately.
医者: Also, managing sinusitis is a key step, but continuing with the lifestyle adjustments we discussed—like staying hydrated, managing stress, and maintaining good posture—will also contribute to your overall well-being and help prevent headaches.
患者: Thank you, Dr. Morris. I feel much better knowing what’s causing my headaches and that there’s a specific plan to address it.
医者: You’re welcome. I’m here to support you through this process. Let’s schedule a follow-up appointment to monitor your progress. In the meantime, if you have any questions or concerns, don’t hesitate to reach out.
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