Transcript: OET Listening Practice Test – Extra03

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Doctor:	Hello Miss Wells. Please come in and sit down. I’m Miss Moore, the Consultant. I’ve read your GP’s referral letter which details your history of endometriosis. I wonder if I could start off by asking you a few questions. How old are you?
Miss Wells:	Twenty-two.
Doctor:	Are you married?
Miss Wells:	No, but I live with my partner.
Doctor:	Have you ever been pregnant?
Miss Wells:	No.
Doctor:	And when was your last cervical smear?
Miss Wells:	Ah…that would have been done when I went to see my GP. Probably three months ago now. It was all normal.
Doctor:	Okay, great. Now I gather you’ve had some pelvic pain recently.
Miss Wells:	Yes, that’s right. It started in February of this year as sharp pain in the left side of my stomach. It usually came on a few days before my period and then seemed to settle down at the end of my period. After February the pain got really bad and it wouldn’t go away, so I was admitted to hospital. The Consultant there performed a laparoscopy and it revealed that on my left ovary and behind my womb I had endometriosis. After that, he suggested I should take the pill without a break, but the pain didn’t get any better so he started me on progesterone tablets, which made me feel horrible. I put on weight and felt bloated all the time. I also developed acne – I hadn’t had that since I was a teenager – but the pain still didn’t get any better. So the Consultant readmitted me in May of this year and performed another laparoscopy and treated the endometriosis with a diathermy. After that, I was much better and the pain almost completely went away. That was until August, when it returned. It’s been slowly getting worse since then, and again, as in the beginning, it’s in my stomach and hurts just before my periods, only now the pain is there at all different times and it really hurts when I’m having intercourse, especially in certain positions.
Doctor:	Right, I see. And are your periods regular?
Miss Wells:	Yes, regular because I’m taking the pill again with a week’s break. The last one was about three weeks ago.
Doctor:	What about any other health concerns?
Miss Wells:	No, everything else is fine. I’ve never been a smoker, but I do like a drink at weekends. Just one or two though, nothing crazy. My family are all well too. No serious illness in either my mum or dad, or in my older sister. Nothing else I can think of really.
Doctor:	Okay. And do you have any problems passing urine or with your bowel motions?
Miss Wells:	No, that’s all good too.
Doctor:	All right Miss Wells, I think it would be sensible to have a look at you and run some tests. Then we can chat about how to take things forward. But from what you’ve told me my initial suspicions are that the endometriosis might have come back.
Miss Wells:	That’s what I was afraid of. Since I was first diagnosed I’ve been doing a lot of reading, so I was really worried when the pain returned. I’d like to be able to have children in the future and I’m worried it might be difficult with the endometriosis. I really don’t want to be one of those women who ends up having problems getting pregnant. I’m also really sick and tired of the pain. It’s beginning to feel like I’ll be stuck with it forever. I can tell it’s starting to affect my mood. Just ask my boyfriend.

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Mrs Georges:	Hello Nurse. My husband seems quite settled now. I can answer those questions if you like.
Nurse:	Yes, Mrs Georges, now’s a good time. Come in and have a seat. So how are you feeling now that Mr Georges is here with us?
Mrs Georges:	I know it was the right decision. Being the only carer for my husband has been such hard work, and we did discuss everything fully with the social workers and our doctor. But I do miss having him with me at home. It had to happen though. I’m completely worn-out.
Nurse:	Do you mind telling me more about your husband?
Mrs Georges:	I do wish you could have seen him before all of this happened. He was so alert and active – always helping people. He was in the navy when he was younger, so he’d often spend months away at a time. I got quite used to being on my own before he retired.
Nurse:	I hope you’ve got family nearby to help you out and keep you company.
Mrs Georges:	Oh, I won’t be lonely. Our son lives just around the corner, and we have a daughter who comes to visit as often as she can. She has a young family now though, so she’s quite busy. I really lost my husband when his mind started to go.
Nurse:	When did you first notice something was wrong?
Mrs Georges:	At first he knew something was wrong. He was frustrated and would fly off the handle with me and I’d snap back at him. I suppose I didn’t realise he couldn’t help it. I feel teary now just talking about it. After 40 years of marriage we knew what the other was thinking most of the time, but now we can’t understand one another at all.
Nurse:	I’m sorry Mrs Georges.
Mrs Georges:	In the beginning, when I really started to suspect something wasn’t right, one of the main things he’d do was ask me the same question again and again. I’d say to him, “Bob, you’re driving me mad,” and he’d just smile and the next minute he’d do it again. But he hardly speaks at all now.
Nurse:	How is he with everyday tasks?
Mrs Georges:	Oh, he has a lot of trouble with dressing. I have to help him. It’s as if he’s completely forgotten what it is he has to do. Getting him to have a shave is another issue. He just won’t do it and he pushes me away if I try to help. I hate to see him looking so untidy. He was always so particular about the way he looked. Maybe you’ll have better luck with him than I’ve had.
Nurse:	Perhaps.
Mrs Georges:	Oh and in the last few months he’s started to wander off during the day. That’s been a real problem. He could be out the front door and down the street before I even knew what was happening. I was sure one day he was going to get hit by a car. And then he stopped knowing the difference between day and night and would get up out of bed at all hours. That really frightened me. I used to wonder what would happen if he turned on the gas for the oven – he was always playing with the controls for it during the day. I’d lay there in bed in the dark listening to hear if he was going to get up, and when I did finally fall asleep, any little noise would wake me. That’s what finally convinced me to bring him here.

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Question 25

Dr Jones:	Dr Khan, have you got a moment? I wanted to talk to you about Polly Peptide.
Dr Khan:	Sure Dr Jones.
Dr Jones:	Polly is a 6-year-old girl with a medical history of asthma and eczema who was admitted yesterday for an asthma exacerbation. She presented with shortness of breath and cough after visiting with her grandparents, who are smokers. She responded well to albuterol and prednisolone in the emergency department, but was admitted due to persistent hypoxia in room air. She was also given a recent dose of acetaminophen because of fever. Her current temperature is 39.7 degrees Celsius.
Dr Khan:	How is she on auscultation?
Dr Jones:	There are significant audible expiratory wheezes throughout the left lung and in the right upper regions. Her breathing sounds are diminished and there is an absence of wheezes toward the right base.
Dr Khan:	Possible bacterial pneumonia?
Dr Jones:	That’s what I was thinking. I’m sending her for a full range of tests to confirm. Thanks Dr Khan.

Question 26

Dietician:	There are reasons the doctor talked to you about being on a diet low in fat.
Patient:	I know, but I like salami, cheese, fries. A meal is not a meal without bread and butter.
Dietician:	I can understand that it’s hard for you. I myself have had to eliminate nearly all the fat from my own diet, and it is difficult to give up the things we like so much.
Patient:	What foods have you had to give up?
Dietician:	Ice-cream was my favourite. I used to have a bowl of that almost every night. But there have been others – butter, sausages. No one’s saying you can’t eat fatty food occasionally, but you really do need to try and reduce your overall fat intake if you want to start to feel better. Here, let’s look at a possible meal plan to give you a better idea of what I’m talking about.

Question 27

Professor:

European wasps feed on meat and meat products, such as dog food and barbecue scraps. They also like to scavenge sweet food and drinks and steal honey from beehives. Their stings are not barbed like bee strings. This means a single wasp can sting repeatedly. The toxins in the sting will cause a powerful reaction, and in some people an allergic reaction.Because they are attracted to food, many wasp stings are in or around the mouth. These are the most dangerous places for a sting, as swelling can result. Minor reactions include painful swellings on the lips, while in severe cases there can be blockage of the trachea due to swelling and in the most severe cases this can lead to death.

Question 28

GP:	Hello, Mr. Hartley. Come and sit down. I gather you’ve been having more trouble since I last saw you?
Mr Hartley:	Yes, that’s right. I’ve kept vomiting and feeling dreadful. I can’t keep on like this.
GP:	Mmm. It looks as though the next the step will be to get you to hospital to start further treatment. I think you’re going to need peritoneal dialysis treatment.
Mr Hartley:	What’s that doctor?
GP:	It means putting a tube into the abdomen and then washing fluid in and out to keep the toxic substances in the blood down. It’s not uncomfortable and you’ll be taught to do it yourself for when you get home. With this method of dialysis you can walk about and live a reasonably normal life.
Mr Hartley:	Will I have to use this for the rest of my life?
GP:	Well, we will also take a specimen of your blood and put you in the computer for a kidney transplant. If a suitable kidney becomes available, you may be able to undergo a kidney transplant operation. So you see, there are several ways of helping you. We’ll just have to see how you get on

Question 29

Physiotherapist:	Now that we’ve established that you’re not going to be playing sport, here’s what you’re going to need to do for the next two to four weeks.
John:	Ok.
Physiotherapist:	First of all, you’re going to have to wear a neck brace. You can get one in the shop on the ground floor.
John:	Do I wear that at night, like when I’m sleeping?
Physiotherapist:	One thing that will help with the pain is using an icepack for 10 to 20 minutes, followed by a warm shower.
John:	Ok, um…I’ll still probably be working a bit…we don’t have a shower there.
Physiotherapist:	If you’re at work, you can just use a warm cloth instead. Another really good thing to do is neck and back stretches. We can go through those now if you like.
John:	Ok, great.

Question 30

Physician:	Ah, nurse, hello. I’m wondering if you can help me. I’ve just been going over the charts for Mr Chui in bed 34 and I’m wondering why I wasn’t told that his blood pressure medications were being held over the past few days
Nurse:	Hi Dr Greizman, right, I’m not sure. I didn’t even know that had happened. Let me look into it and get back to you.
Physician:	There’s no need for that. I’ve been sitting here for 20 minutes looking at the blood pressures and medications that have been given to the patient and it simply doesn’t make any sense.
Nurse:	Well, I really don’t know, Dr Greizman. I’ve literally taken care of this patient for 4 hours. I can discuss it with the nursing director though if you like
Physician:	No, that isn’t necessary. Thank you nurse.

Part C Extract 1

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Interviewer:	My guest today is Dr Naveed Pettis, associate dean of medical education at the University of Massachusetts Medical School. In light of a new report that’s recently been published on the subject, we’re talking today about saturated fat. So, Dr Pettis, can you tell us what the difference is in how many experts view fat now versus 30 years ago?
Dr Pettis:	The low-fat era is finally starting to come to an end. The 2015 UK Dietary Guidelines did, for the most part, exonerate fat and cholesterol with no restrictions on total fat or cholesterol in the diet — after 35 years of previous guidelines advising a low-fat and low-cholesterol diet. I think there is still a lot of misinformation floating around about saturated fat. Not all saturated fats are bad, and they’ve somehow been grouped together and labelled as harmful. So, we still have some work to do there.
Interviewer:	Can you talk a little more about the relationship between saturated fat and cholesterol levels?
Dr Pettis	We spent most of the last generation looking at total cholesterol and LDL as if to suggest that those two values give you an accurate reflection of what we know to be a much more complex and nuanced issue with lipids. But, when you give people fat from a quality source and lower their carbohydrates, generally you see their triglycerides come down. That’s a good thing. You see their good cholesterol, the HDL, go up. That’s a really good thing. What you see in the majority of people when you give them more saturated fat is a shift from the small dense LDL particles — these are the more risky, inflammatory, atherogenic types of LDL — to larger, more buoyant LDL particles which are less inflammatory. Many physicians still aren’t aware of this.
Interviewer:	What are your views on saturated fat and its place in the diet?
Dr Pettis:	Quality becomes paramount here. The saturated fat in a fast-food bacon cheeseburger will have an entirely different effect than saturated fat in coconut oil. I absolutely love healthy saturated fats like coconut oil and grass-fed butter, and I think they have a place in our diets. Healthy saturated fats can actually help you burn fat, they make your brain work better and faster, they make your skin glow, and they can help optimise your cholesterol profiles. It is very important that you only include saturated fat in the context of a diet that’s very low in refined carbs and sugar and includes omega-3 fats. The entire LDL-lowering hypothesis is being questioned by recent studies that have found that those who had the LDL lowered the most by vegetable oil had the greatest risk of heart attack or death.
Interviewer:	Are you saying we should embrace saturated fat and stop worrying about cholesterol?
Dr Pettis:	No, I’m actually not suggesting that. The saturated fat in your diet has very little correlation to the saturated fat in your blood, but we do know that higher saturated fats in your blood are linked to heart disease. The question is how do you get high saturated fat in your blood? Logic would dictate that it is by eating butter. But biology is not so straightforward. It is by eating sugar and refined carbs. Low-fat, high-carb diets trigger synthesis of the type of blood-saturated fats that are linked to heart disease.
Interviewer:	Why is nutritional science often so contradictory and confusing?
Dr Pettis:	There is contradictory information because the research is hard to read and, of course, if a study is being performed or funded by someone who has a strong opinion, the outcome is more likely to favour that opinion. A lot of experts are also looking at outdated research. These are studies in which people who are eating fat are eating bad fats, inflammatory fats, and junk foods. Well, of course, you would think that the fat is bad for you if you’re looking at a study like that. So, it often comes back to an individual’s understanding of the research.
Interviewer:	Why do a lot of organisations and experts still push a no-fat or low-fat message?
Dr Pettis:	I think that is such an important question. I’ve been in practice almost 30 years, and I have had very academic roots all along. And there is this incredible delay. The structures and organisations and associations that we look to for guidance and advice are not nimble at all. They bring inherent bias. These are good people, but there’s an inherent bias that these structures tend to embrace. We all know that there are researchers who will lose grant support overnight if they suddenly change from saying “fat is bad”. They’ll struggle to maintain their academic integrity based on the culture they’re in. In all of this debate over fat and saturated fat in particular, I still recommend filling your plate with at least 75 percent phytonutrient-rich, colourful, non-starchy veggies. Plant foods, by volume, should take up the majority of your plate.

Part C Extract 2

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Carly Dugan:	Hello there. My name is Carly Dugan. I’m an emergency medicine physician and researcher. I’d like to talk to you today about the importance of consumer engagement in health, an area which has been widely acknowledged in recent years as playing a crucial role in achieving the best possible health outcomes for patients.
	As health professionals, our clients or patients come to us with various levels of education or literacy, and they may prefer to speak a different language, and these issues can become barriers for them to understand health information.This, essentially, is the issue of health literacy, which is defined as the capacity to obtain, process and understand basic health information and services; make appropriate health care decisions or act on health information; and the ability to access or navigate the health care system, which we all know is extremely complicated. Any client who does not read or write well, has trouble understanding verbal or written communication about health, speaks a different language, or has trouble understanding or using numbers could have trouble with these areas.
	Studies show that patients immediately forget 40-80% of medical information provided to them by health care providers, and my own research clearly indicates that health literacy is a strong predictor of health status. Patients with low health literacy have more difficulty recalling health information, and inadequate health literacy can lead to numerous negative effects on an individual’s health and well-being, including poor self-care, increased utilisation of health services, worse outcomes, and decreased likelihood of receiving preventive care and services. Poor communication by health professionals with patients also contributes to unnecessary readmissions. In response to surveys that have indicated high rates of poor health literacy, governments and national agencies in countries as diverse as the US, China, Australia and some European nations have now gone on to develop national strategies and targets to improve health literacy in their populations.
	Health information can be confusing even for those with advanced literacy skills. It’s easy for those of us working in health care to forget that we speak our own language that patients can’t always easily understand. Most of us can recall times when we believed that we had shared information with a patient and family member or caregiver and believed they understood our instructions, only to later discover confusion or misunderstanding. Communication breakdowns in the chain of care are also a leading factor in preventable disability and death.
	I teach a session on health literacy at a local college, and share examples from my own time in practice. One example I share with my students is a study in which researchers asked patients what they knew about diuretics, better known to some of you as fluid pills. Fifty-two percent of the respondents researchers interviewed believed that fluid pills caused fluid retention instead of alleviating it. Another example I use is the story of a patient who was informed that she had Grave’s disease, and burst into tears because she thought the doctor was telling her she was about to die. This kind of confusion is understandable, but may also be avoidable if we take some extra care with our communication with patients and family caregivers.
	Regardless of a patient’s health literacy level, it is important that as health care professionals we ensure that patients understand the information they have been given. The “teach-back” method is one way of checking understanding by asking patients to state in their own words what they need to know or do about their health. It is a way to confirm that we have explained things in a manner our patients understand. A pediatrician I recently did some work with told me: “I decided to do teach-back on five patients. With one mother and her child, I concluded the visit by saying ‘so tell me what you are going to do when you get home.’ She could not tell me what instructions I had just given her. I explained the instructions again and then she was able to teach them back to me. I had no idea she did not understand the first time. I was so wrapped up in delivering the message that I did not even realise it wasn’t being received”.
	Research clearly shows that consultations that include checking patients’ recall and understanding do not take any longer than consultations that don’t, and that they help prevent future unnecessary health service use. It is therefore essential that as we continue to work on improving the safety and reliability of care, we consider deficiencies that contribute to patient harm beyond the obvious focus on acute care and ambulatory settings, to include how we communicate with patients about their treatment plans and their health. Ensuring that we are communicating clearly and delivering information at the appropriate literacy level will be an important step.

Curriculum

Transcript: OET Listening Practice Test – Extra03

Part A Extract 1

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Part A Extract 2

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Part B

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Question 25

Question 26

Question 27

Question 28

Question 29

Question 30

Part C Extract 1

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Part C Extract 2

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