Dictation Practice – Part A03
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- (terrible) discomfort
- 4 years / four years
- muscle relaxants
- barium enema
- real pain / physical pain
- pleasurable things
- 2- 3/2 or 3 months
Hello there. My name is Dr. Betty. I’m one of the new GPs in the practice. First of all, what would you like me to call you?
|Well, you can call me Barbara. That’ll be fine.
|Okay. That’s fine.
Okay, so Barbara, I’m seeing you today, but I think it’s usually Dr. Brown that sees you. Is that right?
|Yes. Dr. Brown’s my doctor.
|Okay. What is it that brought you to see me today?
|Well I’ve come about my tummy problem.
I’ve got terrible trouble with my stomach and Dr. Brown just doesn’t seem to be able to get to the bottom of it.
And I thought perhaps, I’d come and see you to see if you could help.
|Okay. Can you tell me a bit more about your tummy problems?
|Well, I have this terrible discomfort nearly all the time. It very often feels bloated. (I am…) I swing between being constipated and having diarrhea.
I have sort of cramping feelings sometimes and other times it stabs. It’s a real stabbing feeling.
I often have the urge to go to the toilet and I passed very smelly wind.
|So, quite a few symptoms and some of them sound quite troublesome to you.
Okay. And how long has this been going on?
|Well, I’ve traced it back to a holiday I had in Egypt about four years ago. I had a horrible bout of sickness and diarrhea. and…
|And… What sort of treatments have you tried for this before?
|Well, Dr. Brown gave me some muscle relaxants at the beginning, but I’ve been to the health shop and they’ve been really helpful. They’ve given me lots of different tablets and medicines for different things.
Imodium. I have an Imodium in my handbag all the time, just in case.
|So, these different tablets that you got from the herbal shop. How are you taking them?
What about tests? Have you had any tests for these problems?
|Yes. I had…, in the early days, I had a gas…., what are they called?
|Gastroscopy. The tube down starts at the top. Okay.
|And at the same time I had a barium enema. (Right.) That was very uncomfortable. (Okay.) But now I’ve tried. Well, yeah…
|It sounds like you’ve had these problems now for about four years.
You’ve got a lot of various symptoms in your stomach. You’ve tried a lot of tablets, some prescribed some herbal remedies and you’ve had some investigations.
But you’re not entirely happy that you’ve been investigated thoroughly enough. Is that about your story, right?
|I know you’ve been seeing Dr. Brown about this for the last few years.
What is it that he’s said that he thinks might be wrong with you?
|Well, he thinks it’s all in my head.
(He’s…) I mean it can’t all be in my head. I get too much physical pain for it to be in my head. I mean it’s real – it’s real pain.
|And, have you had any thoughts yourself about what you think might be causing it?
|Well, I mean I did think that perhaps it was an infection that hadn’t cleared up in the early stages.
But I think… I mean sometimes I think it’s IBS. A friend of mine’s got that and it sounds similar and then other times I think I wonder if it’s an ulcer.
On a really bad day, I start to think it might be cancer.
|Right. Given that we’ve tried medication for you and we’ve tried investigations and we’ve drawn a blank really with those. None of those have really helped you.
I guess I’m wondering whether now it would be a good idea to try a different approach to your problems.
|Oh, I don’t know.
|I guess what I’d be wondering is whether one of the approaches we need to be using now is thinking about what you do with your life and what you do with your day. And maybe trying to bring back some of those pleasurable things.
Even if it’s just meeting up with your female friends once a week and whether actually doing those sorts of things might generally improve your quality of life.
I’m also thinking about the tablets that you’re taking and the fact that you seem to be taking quite a lot of them, and wondering whether it’s worth sitting and looking at them.
And, maybe trying to rationalize them a little bit and really decide which are helping you, which are doing nothing and which may actually be making some of your symptoms worse, I guess.
What would you think about trying that slightly different approach for…, say, two or 3 months just to see whether or not it makes any difference?
|Well, two or three months is a long time, if there is something going on.
I mean… that’s what happened to my mother in law. You know, they left her and didn’t spot it and…
|Well, I guess if we did decide to work together like this, this new approach, I’d be seeing you regularly, we can keep an eye on your symptoms and if they change, then we can investigate as appropriate.
But if they stay the same, then we could be pretty clear that there’s nothing new happening that we’re missing.