患者互动：讨论胸口咳嗽

因此，以下剪辑向我展示了与一名大约胸部咳嗽的患者进行咨询。您好，詹金斯夫人。有座位。谢谢。你好。你好吗？好吧，不太好。我想我可能患有胸部感染。哦亲爱的。是的。 [coughs] Tell me more about that. Well, I’ve had a cough for quite a while now. And it just seems to be going onto my chest. I’m finding it– I’m having trouble sleeping. It’s so bad. Oh dear. Yeah. So you say for a while now. How long has it been? Oh, probably about 10 days. OK.

只是 - 它只是从正常的感冒开始，然后是某种程度上 - 咳嗽还不错，但是情况变得更糟。好的。好的。因此，您已经咳嗽了大约10天。是的。似乎越来越糟。是的。你在咳嗽吗？好吧，我的鼻子有点束缚。是的，我正在咳嗽一点痰。 OK. Yeah. Any difficulty breathing at all? [coughs] When I– yeah, when I have a coughing bout, yes. OK. So if you’re coughing a lot, you kind of lose your breath a bit? Yeah. [coughs] What about at other times when you’re not coughing, when you’re exercising or things? No. No? No, no, not really.

好的。胸部有痛苦吗？不，不。不？否。您是否完全有温度，高温？[咳嗽]我不知道。我不这么认为。好的。不，不。好吧，我们会检查一下。 I don’t think so. And I see from your records that you’re generally healthy, no sort of normal lung problems or anything like that. No, I’m normally fine. Yeah. OK. OK. [coughs] Well look, I’ll have a good look at you in a second. Before I do, can you just tell me, what is it that you’re most worried about? What are your main concerns about this? Well, no real concerns really. I just want to get rid of this cough. It’s just the cough. Yeah. OK.

因此，您有点希望得到一些[咳嗽]，以帮助您快速摆脱它。确实。是的。如果有什么东西可以给我 - 还可以。您是否担心这是更严重的事情？再次，不是真的。我只是讨厌咳嗽，我只想能够带走一些东西来摆脱它。是的。我丈夫要我吃抗生素。因此，如果他们要提供帮助，那么我一定会试一试。 Yes, yeah. OK. So you’re keen to take them if they’re going to help. Yeah, definitely, ‘cause nothing’s helping, really. Yes.[coughs] OK. OK. Yeah. Fine. OK. So let’s have a look at you now, then. And after, we’ll have a chat about that. OK?

好的。谢谢。谢谢。因此，该剪辑中的患者只是想要一些东西使她的咳嗽更快地消失。但是有时询问问题可能会引起特定的问题，例如担心更严重的事情正在发生，或者特定于上下文的问题，例如希望在婚礼或假期前变得更好。询问抗生素会使问题脱颖而出，并开始讨论。如果患者对想要抗生素有很强的看法，我通常不会与他们争论。相反，我尝试引导备份或延迟处方的方向。