TAKING HISTORY

Flu Also called: Grippe, Influenza

Flu is a respiratory infection caused by a number of viruses. The viruses pass through the air and enter your body through your nose or mouth. Between 5% and 20% of people in the U.S. get the flu each year. The flu can be serious or even deadly for elderly people, newborn babies and people with certain chronic illnesses. Symptoms of the flu come on suddenly and are worse than those of the common cold. They may include : Body or muscle aches Chills Cough Fever Headache Sore throat Is it a cold or the flu? Colds rarely cause a fever or headaches. Flu almost never causes an upset stomach. And "stomach flu" isn't really flu at all, but gastroenteritis. The main way to keep from getting the flu is to get a yearly flu vaccine. If you get the flu, your health care provider may prescribe medicine to help your body fight the infection and lessen symptoms. National Institute of Allergy and Infectious Diseases

QUESTIONS
1. 2. 3. 4. 5. What is flu? What is other name of flu? How do the viruses work? Who are the victims? What are the symptoms of the flu?

TRANSLATION
Translate the passage above

USEFUL EXPRESSIONS
To ask the chief complaint: What brings you in today? Tell me what has been going on! What seems to be the problem? What are your complaints? To ask present illness: What is wrong? Where is it wrong? When did it start going wrong? How did it go wrong?

Practice these following Questions! Close-ended Questions Do you have diarrhea everyday? Do you have any allergies? Do you drink alcohol? Does it stay in one place or does radiate anywhere else? Does it affect your sleep? Are your bowels movements regular? Is the pain continues or does it come and go? Have you noticed any blood in your stool? Have you taken any medicine for the pain?

Open-ended Questions
WH-questions What seems to be the problem? What makes it better? What makes it worse? Where does it hurt? When did you feel the pain? Why do you scratch it? Which part of your chest/abdomen/head is affected? How many loose stools do you have a day? How much sleep do you get? How is your appetite?

INTERVIEW
There are some elements of the comprehensive History: The Opening It is important to begin each medical interview with a patient-centered approach. The Chief Complaint History of Present Illness Past Medical History

PART 1: The Opening (Identifying the data)

Nurse : Good morning, Mr. Gunawan. Patient :Good morning, nurse. Nurse :Im Nurse Halida and I would like to have an interview with you. Patient :Yes. Be my guest. Nurse : Well, Sir. What is your full name? Patient : My full name is Anggodo Gunawan Nurse :Alright. How do you spell your first name? Patient : A-N-G-G-O-D-O. Nurse :How old are you? Patient :Im 40 years old. Nurse :Are you married? Patient :Yes, I am. Nurse :What is your occupation? Patient :Im a businessman.

PART 2 Asking for the Chief complaint

Nurse :Well, sir. Tell me whats wrong with you? Patient :I got a terrible pain in my stomach last night. I couldnt get back to sleep nor walk around. Nurse :And was it just last night? Patient :Yes, it was.

PART 3 History of the Present Illness

Nurse :And could you explain a little bit about the pain? Patient :Its getting bad and went away and went back Nurse :And when did it happen last light? Patient :It was around 8 or 9 pm Nurse :And could you point to me where the pain is? Patient :Its just here, under the rib cage. Nurse :Did you take any medicine? Patient :I took an aspirin at two oclock but it did not work and panadol at five oclock but it didnt work either. Nurse :Did you have other symptoms that it got along with the pain? Patient :I had a little bit nausea.

PART 4 History of the Past Illness

Nurse :And about your past medical history, did you have any ongoing issues, diabetes, any issues with your lung, heart? Patient :No. I didnt Nurse :Had you had any surgery in the past? Patient :Yes, I had a fracture ankle surgery because of playing football. I had asthma when I was in elementary school but I havent got it so far unless the wheezy cough. Nurse :Are you carrying on medication, herbal medicine? Patient :No, I am not.

Pair work Work on pair, find a situation and make a simple dialog about history taking.
Note: You can take the case from the reading part above.

After doing the interview with your friend in a dialog practice, write some simple sentences about the case as a brief conclusion.