การตรวจคนไข้เป็นภาษาอังกฤษ ไม่จำเป็นต้องเป็นคนไข้ฝรั่งเสมอไป คนไข้ที่มาจากประเทศอื่นที่พูดภาษาไทยไม่ได้ ภาษาอังกฤษยังคงได้รับการยอมรับว่าเป็นภาษากลางที่สามารถใช้สื่อสารกันได้ ถ้าเป็นแพทย์ที่เคยทำงานในประเทศที่ใช้ภาษาอังกฤษมาก่อนไม่เป็นปัญหาแน่นอนครับ แต่สำหรับหมอที่ทำงานในเมืองไทย ในความเห็นผมนะครับ พยายามใช้ภาษาให้กระชับไม่ต้องเยิ่นเย้อแต่ได้ข้อมูลครบถ้วน ที่สำคัญการพูดด้วย accent หนาๆไม่ใช่เรื่องน่าอายแต่อย่างใด ขอให้ช้าและชัดเจน เข้าใจตรงกัน ผมว่าพอแล้ว ขอแนะนำ pattern ในทุกขั้นตอนให้อย่างละเอียดนะครับ แล้วลองเอาไปปรับใช้ดู ▒ Introduction Mr. Roman?, Hi, Good morning/afternoon, I'm Dr. Jarvis, one of the attending physician/medical resident/surgical resident/GI fellow. What made you come into the hospital today? (new case), Good to see you again (follow up) ▒ History Can you tell me more about your symptoms? (open question, and listen to them) Where does it hurt? Can you show me exactly where do you feel the pain (Site) When did it start? (Onset) Can you describe the pain? Burning/Stabbing/Pressure like ... (Character) Does the pain move or spread? (Radiation) Does anything make it better? (Alleviating factors) Does anything make it worse? (Exacerbating) How long does the pain last, and how often does it happen? (Timing) On a scale from 1 to 10, how bad is it? (Severity) Have you ever had this symptom before? Do you have shortness of breath? How many steps can you climb before getting short of breath? How far can you walk on level ground before getting short of breath? Do you ever wake up at night short of breath? Do you have to prop yourself up on pillows to sleep? Have you noticed any swelling at your legs? Dizziness? Palpitation? Tell me more about it? Have you ever had a black out? (Syncope in lay terms) when? how many times? any warning before you blacked out? Do you have any other symptoms (Associated Symptoms) Did you vomit? Did you have diarrhea? Did you cough? When did cough start? Do you bring up any phlegm? what color is the phlegm? is there any blood in the phlegm? Have you been having runny nose? Did you have sorethroat? Have you been running fever? chill? how many days? Any pain or burning during urination? Any change in the color of your urine? Any blood? How often do you have to urinate? Any difficulty urinating? Do you lose weight? how much? How about your appetite? Any problems falling asleep? Do you smoke? how many packs a day? Do you drink? how much you drink? how many times in a week? Any of your family members having (particular illnesses/diseases)? Any drug allergy? ▒ Physical Exam Mr. Roman, thanks for answering all of my questions. Now I'm going to proceed with the physical exam. Could you please lie on the bed? ปกติในการตรวจคนไข้เราควรบอกเค้าทุกครั้งนะครับว่าเราจะทำอะไร ก่อนจะวางมือหรืออุปกรณ์ลงไป ยกตัวอย่างเช่น Now, I need to look in your throat, open your mouth widely Stick out your tongue please I'm going to listen to your chest I need to put my hand on your chest to examine your heart I'm going to check your nerves. Follow my fingers with your eyes and keep your head still. ประมาณนี้ พอได้ไอเดียนะครับ ▒ Sit down and Talk (Provisional/Differential Diagnosis and Required Tests) Thank you for your cooperation. According to all information I got from you and examination, I'm considering a couple of possibilities including .... (use lay term as much as you can). In order to figure it out what's exactly the cause, we need to run some tests which are ...... Does this sound ok to you? Any question, please feel free to ask ▒ Management Mr. Roman, we need to admit you into the hospital/ICU/CCU/regular ward because you have an infection in your lungs/blockage in your coronary arteries which warrants immediate reperfusion ..... Mr. Roman, we need to put you on antibiotic for 5 days which are ..... we have to start antihypertensive medication, diuretics, beta-blocker .... and you need to follow up with me in the next 4 weeks. We're done here for now. You have to wait on the 1st floor to get all your prescribed medications. Mr. Roman, we have to refer you to the .... hospital by the ambulance immediately ▒ Counseling Mr. Roman, drugs are not the only things. Regular exercise and dietary control will play a major role in managing your hypertension. Hypertension puts you at high risk for heart disease and stroke. Now, you were put on 3 drug-eluting stents, two on the left and one on the right coronary arteries. you MUST take two antiplatelet agents for at least 6 months. You must contact a doctor, call ER or 1669 at once if you experience chest pain, weakness of any limbs, sudden severe headache or have visual problems. จะเห็นว่าการดูแลรักษาคนไข้ การสื่อสารสำคัญมาก ไม่จำเป็นต้องพูดแบบไม่มี accent มี accent ได้ครับ ไม่ใช่เรื่องน่าอายแต่อย่างใด ถ้าไม่มั่นใจพูดให้ช้าและชัดไว้ก่อนเสมอ ไม่เข้าใจอย่าเดาเด็ดขาดนะครับให้พูดว่า "I beg your pardon, please say it again" หรือ "I'm sorry, could you speak more slowly?" หรือ "I don't really understand, please say it again"
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