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Doctor - Patient Dialogue: Stomachache

This dialogue was written by Dr. Hernán Posada and Ana Ramírez. The voices are from two Kenyon students, Elizabeth Hieronymus as the doctor and Andrew Shannon as the patient. To listen the dialogue, click on each blue sentence,

P:Good Afternoon, doctor.

D:Good afternoon. What is your problem?

P:I have a stomachache.

D:What do you feel?

P:I have a strong pain and heartburn.

D:How long have you had this pain and acidity?

P:For 2 months now. It does not go way! I eat and after every meal my stomach hurts. Even at night the pain persists.

D:Tell me, in the last 2 months, have you eaten any kind of heavy food, or something different?

P:No.

D:How strong is the pain. Lets say in a 1 to 10 scale, how would you describe the intensity of the pain?

P:Between 4-5

D:Is the pain continuous or does it come and go?

P:It come and goes.

D:Does the pain come after meals?

P:That's possible because it hurts everytime after eating.

D:Is there a kind of food that affects you more?

P:Greasy food.

D:Greasy food affects you?

P:Yes. At home we eat a lot of greasy food.

D:Where in the abdomen does it hurt? Point please! Does the pain travel to your chest, shoulder, back or across your abdomen?

P:It hurts in the middle. Sometimes, the pain travels across my abdomen.

D:Besides the pain, you said you have heartburn?

P:Yes, after a burp, I feel a kind of sour taste.

D:Do you feel like this more during the day or in the evenings?

P:Both. I feel the acidity during the day and at night.

D:Is it worse when lying down?

P:Yes, I taste the acid in my mouth?

D:Besides greasy food, is there any other kind of food that irritates your stomach? Like spicy food?

P:No, at home we don't eat spicy food.

D:And tell me, how often do you regularly have a bowel movement? Has that changed since you have been having these problems?

P:It is regular. It hasn't changed since the problem.

D:Have you noticed any change in the consistency of the bowel movement?

P:Yes. It is a bit softer.

D:Have you noticed any change in color?

P:Yes, it is greener.

D:Greener, not darker? Any blood in your bowel movement or black coloring to bowel movement?

P:No, not darker. I do not see any blood in my bowel movement, either.

Begin examination of the patient

D:Ok. What we can do first is check your abdomen to see where the pain comes from. You said the pain comes from the middle-part of your abdomen?

P:Correct.

D:And does the pain move somewhere else, or does it stay there?

P:It usually stays there.

D:But with the pain, do you always feel acidity?

P:Correct.

D:Do you have nausea or vomiting?

P:No, not now.

D:Tell me, what did you eat today?

P:I ate meat with tomato sauce.

D:Do tomatoes give you any trouble?

P:No, I have always eaten tomato sauce.

D:What about orange juice, does it affect your stomach?

P:Sometimes.

D:What do you feel?

P:It gives me a strange metallic taste.

D:But it does not you any acidity?

P:No, it doesn't.

D:And what do you do when you have stomachaches?

P:Sometimes I take Alkaselzer. It helps a bit.

D:Yes, it helps. Do you take any Tums, Mylanta, Maalox?

P:No.

D:Are you taking or have you been taking now or before this problem any medication on a consistant basis, like aspirin, Advil, Motrin, etc.

P:No, usually Tylenol.

D:And if you take aspirin, or any other kind of anti-inflammatory medicine, do you think it could affect your stomach?

P:No, I can't really tell you.

D:Ok. As I was telling you before, I am going to examine you. I want to examine your feces to check if you have any kind of parasite. Do you come from the tropics, or have you traveled anywhere recently such as the tropics, or overseas?

P:Yes.

D:Here in the United States, as well as in any other part of the world, one can find parasites. These can affect your stomach. Besides this, I want to look for any occult blood. You said you have not really seen any changes in your feces. It is only greener, but not darker. The digested blood, in case you have something in your stomach and you could have a haemorrhage, could produce a chemical reaction so that you can have occult blood in your feces. Many times we don't see the red color of blood or the black color of the digested blood; therefore an examination is necessary. I would also like to examine your upper gastrointestinal system through X-rays and contrast. It is a very simple thing and it does not hurt. You will drink a thick substance. The radiologist will see how you digest the substance and will see the movements of your stomach. We will have this type of examination because your pain could not come from the stomach but from the gall-bladder. After the examination, we will decide what to do first, the X-rays of an ultrasonic study of the gall-bladder. For now, do not eat greasy food. Do not eat close to your sleep time because it could cause you more acidity. Eat plain food, nothing spicy. As soon as I get the results from the medical test, I will talk to you. Do you have any questions?

P:With so many medical tests, I was wondering if I have an ulcer.

D:We need to think of that too. That is why I want that test. I need to explain to you that an X-ray of the upper intestine sometimes cannot detect an ulcer or other irritations. If the pain persists after some antibiotics you will need an endoscopy. An endoscopy is a medical examination in which the doctor inserts a tube through your mouth or nose.Then, the specialist will observe your stomach, from the small intestine to the large one, and your gullet. Any other question?

P:No doctor, thank you.

D:Good. We will see each other next week. Good bye.