This example combines a conversation between a GP and a gastroenterologist with a related referral letter, showing both spoken and written medical communication in English.
Conversation between a GP and a gastroenterologist
– Hello, could you give me some advice regarding a 64 year old woman with a history of upper quadrant pain radiating to the back.
– Have you checked her for gallstones?
– Well, yes I have, and on ultrasound no cholelithiasis was shown.
– Is it possible she has reflux, like dyspepsia?
– Well, yes, it’s possible. Since she has been on Omeprazole she does not have heartburn.
– What about her bowels?
– Bowel motions are alright. Truth betold, she has seen blood in her stools time and again.
– Has she had any endoscopies?
– She had a flexible sigmoidoscopy when she had blood loss from her back passage and only haemorrhoids were found.
– Is she anaemic at all?
– Yes, definitely. Her haemoglobin is 11.3. Her ferritin is normal but she needs to be on iron supplementation.
– Is she on Aspirin or Warfarin?
– Yes, she takes 75mg Aspirin and also anti-hypertensive medication.
– Let’s repeat the endoscopies then, what do you think?
– Well the patient is petrified at the thought of endoscopies as her husband allegedly died after having urgent OGD and her son had a complication with colonoscopy as well.
– Oh dear. What can we do then?
– Could you request a CT for her?
– Well I could, but there is always the possibility that Radiology will turn me down.
– Anyhow I would be grateful if you tried.
– Ok, but please let her know that the sensitivity of this method is far lower.
– Ok, I will. Thank you ever so much.
– Hm…
Useful abbreviations
BM is blood sugar taken from a drop of blood from the fingertip, CABG is bypass surgery, COPD is chronic obstructive pulmonary disease.
Referral letter
Dear Dr. Smyth,
I saw Debra in the clinic today. She is a very nice 75 year old elderly lady with a history of peptic ulcers and peptic ulcer surgery. She cannot quite recall what happened and there is no documentation about it, but she and her daughter thought that part of the stomach has been taken as well. She has a history of ischaemic heart disease, type II diabetes and COPD. She had a myocardial infarction and she hadCABG.
The reason for referral was reflux symptoms and diarrhoea. She may have watery stools that she was not able to hold on several occasions.
It is to be noted that her mobility is poor.
On physical examination she had epigastric tenderness. The edge of her liver was just palpable below the right costal margine. It is to be noted that she does not have diarrhoea every day, and she has never seen blood in her stools. She had a slight tremor; this maybe just an essential tremor. She frequently has abdominal pain. She is on Lansoprazole but it did not help her acid reflux symptoms. She had a colonoscopy in 2011 which was normal. Histological specimens did not show anything untoward. It is to be noted that a side effect of Lansoprazole maybe diarrhoea and that is why I gave her a prescription of Pantoprazole. She is also on Glucophage and this may be another reason for the diarrhoea. I would stop this for some days while checking her BM. I updated her blood. I was a bit worried about requesting a colonoscopy for her due to age and decreased mobility and co-morbidities. I requested an OGD and I plan to reassess her in 3 months time.
