In this lesson you are in an outpatient clinic (or GP-style appointment) and you need to get a focused history efficiently. The patient can talk a lot, and their story is not well organised. Your task is to guide the conversation so you get the key facts without sounding impatient.
You will practise starting with an open question, then narrowing down using targeted checks: onset, duration, severity, triggers and impact on daily life. You will also build short, respectful interruptions for when the patient goes off-topic, and you will practise summarising back the key points so the patient can correct you. Throughout, the focus is patient safety and clarity: making sure the timeline is accurate, avoiding assumptions, and confirming important details before you move on. You finish by signposting what happens next, so the patient knows you have listened and you are taking action.
1. Starting the clinic visit with one open question.
You’re in an outpatient clinic and you’ve got a patient who can talk a lot. Your job is to get the key facts efficiently, but without sounding impatient. In this first step, we begin exactly as you would in a real appointment: a warm greeting, then one open question that invites the patient’s story.
The tricky part is that an open question can lead to a long, messy answer. That’s not a problem; it’s useful information. But you need to listen with a clinical filter: what is the main symptom, when did it start, what changed, and what is the patient worried about? As you listen, imagine you’re already planning your next focused checks.
In the activity, you’ll listen to a realistic first answer from our patient, Luis Garcia. Don’t try to write everything. Your aim is to capture the key facts clearly so you can take control of the history in the next step.
Situation.
You are the clinician in a GP-style / outpatient appointment. Your patient, Mr Luis Garcia (39), has come in with a problem, but his story is not well organised.
Today’s “can do” focus: Start with an open question, listen actively, and pull out the key facts you need to guide the next questions.
The open question that starts a focused history.
An open question invites the patient’s story, but it also gives you information about their priorities.
Useful starters (choose one):
“What brings you in today?”
“Can you talk me through what’s been happening?”
A calm, structured tone helps. Think: warm voice, steady pace, and clear turn-taking.
What to listen for (your “first 30 seconds” filter).
When the patient gives a long answer, don’t panic. Mentally collect these pieces:
Main problem (in the patient’s own words)
Onset / timeline (when it started, how long it’s been going on)
Pattern and change (better/worse, constant/comes and goes)
Impact (sleep, work, daily activities)
Patient’s ideas/concerns/expectations (what they think is happening, what they’re worried about, what they want today)
You will not have everything yet, and that’s fine. The next blocks will help you narrow down with targeted checks.
Model micro-dialogue (what this step sounds like).
Clinician: “Hello, I’m one of the clinicians in the clinic today. What brings you in today?”
Patient: (long answer)
Clinician: “Thank you. I’m just going to ask a few focused questions to get the timeline clear.”
That final sentence is a small piece of signposting. It tells the patient you listened, and now you’re moving to structure.
Mini self-check.
After the patient’s first answer, can you say (even in your head):
“The main issue is…”,
“It started…”,
“It’s getting…”,
“It’s affecting…”,
“He’s worried about / hoping for…”?
That’s exactly what you’ll practise now.
Practice & Feedback
Listen to the patient’s first answer. Then write 5 short notes (one line each) capturing the key facts.
Keep your notes simple and patient-safe. Don’t write full sentences unless you want to. Focus on:
main symptom/problem,
when it started (timeline),
whether it is getting better or worse,
one trigger or reliever (if mentioned),
impact on daily life or the patient’s concern/expectation.
Imagine you are preparing to ask the next focused questions. If a detail is unclear in the audio, write “unclear” rather than guessing.
2. Narrowing down with timeline, severity and impact checks.
Now that you’ve heard Luis’s story, the next skill is to take control of the history without sounding abrupt. You do that by funnelling: one open question first, then a set of focused checks. The checks are not random; they follow a pathway.
In this block we’ll work on three high-yield areas: timeline, severity, and impact. These are the things that most often become vague if you don’t ask clearly, and they’re also the things that make your later summary accurate.
As you practise, notice how small wording choices change the tone. “When did it start exactly?” is direct but still polite. “On a scale of zero to ten…” is standard and helps you compare over time. And “How is this affecting your day-to-day life?” makes the consultation human, not interrogative.
You’ll read a short extract and then write your own focused follow-up questions, using the clinic-appropriate phrases from the lesson.
From open story to focused checks: a simple funnel.
You already have a general picture:lower back pain, started after lifting, worse this week, sometimes shoots down the left leg, affecting sleep and work.
Now you need precision. Precision is patient safety.
A useful funnel:
Timeline (when exactly, how long, change over time)
Severity (how bad at worst, how bad now)
Triggers and relievers (what makes it better/worse)
Impact (work, sleep, mobility, daily tasks)
Past episodes (anything like this before)
Phrases to keep the tone calm (from today’s chunk bank).
“When did it start exactly?”
“Has it been getting better or worse?”
“On a scale of 0 to 10, how bad is it at its worst?”
“What makes it better or worse?”
“How is this affecting your day-to-day life?”
“Have you had anything like this before?”
What good focused questions look like.
Focused does not mean unfriendly. It means you ask one thing at a time, and you help the patient give a clear answer.
Compare:
Less clear: “So tell me more about your back and the leg and your work and your sleep.”
More focused:
“When did it start exactly?”
“Has it been getting better or worse since it started?”
“Is the pain there all the time, or does it come and go?”
“On a scale of 0 to 10, how bad is it at its worst?”
“How is it affecting your work and sleep?”
Micro-tip: time language.
If the patient says “about ten days”, you can gently tighten it:
“When you say about ten days, do you mean last week, or the week before?”
“Was it before or after the weekend?”
You are not doubting them; you are making the record accurate.
Your job in this block.
You will create a short set of follow-up questions for Luis. Keep them natural, one idea per question, and in a logical order (timeline → severity → impact).
Practice & Feedback
Read the short extract below (it’s a written snapshot of the consultation). Then write 6 focused follow-up questions you would ask next.
Rules:
Use a calm, professional tone.
Ask one thing at a time.
Include at least: 1 timeline question, 1 better/worse question, 1 severity scale question, 1 trigger/reliever question, 1 impact question, and 1 past episode question.
Try to reuse phrases from the chunk bank (for example, “When did it start exactly?” and “How is this affecting your day-to-day life?”).
Consultation snapshot (written).
Patient (Luis): “It’s lower back pain. It started after I helped my brother move house about ten days ago. It’s worse this week. Sometimes it shoots down my left leg, especially when I sit driving. I’m not sleeping well. I tried ibuprofen and hot showers; they help a bit. I’m worried it’s something serious and I can’t afford to miss work.”
Clinician: “Thanks, Luis. I’m going to ask a few focused questions to get the timeline and the pain clear.”
3. Politely interrupting and bringing the story back.
A common challenge in clinic is that the patient’s story drifts. Luis mentioned stress, his mum, work pressures, and that can be real and relevant, but if you follow every side path, you lose the timeline and you risk missing key details.
So in this block we practise something very specific: respectful interruption. The goal is not to shut the patient down. It’s to keep the interaction safe and efficient, while still sounding human. Think of it as gently steering the conversation.
The most useful pattern is a two-step move: first, a soft interruption, then a clear check question. For example, “Sorry to interrupt, can I just check one detail?” followed by a timeline question. You can also use phrases like “Just to bring you back to the pain…” or “Before we go into that, can I clarify…”.
On the screen you’ll see a model where Luis goes off-topic, and you’ll see several possible clinician responses. Then you’ll write your own lines to bring the history back on track.
Why interruption is a patient-safety skill.
When a patient’s story becomes long or tangled, you can miss:
when it started,
how it changed,
what exactly makes it better or worse.
Interrupting politely protects the timeline and reduces assumptions. Done well, it also reassures the patient because you sound organised.
Useful interruption shapes (calm and respectful).
Here are three reliable patterns. Notice the tone: soft first, then specific.
1) Soft interruption + one detail
“Sorry to interrupt, can I just check one detail? When did it start exactly?”
2) Acknowledge + steer back
“That sounds stressful. Just to bring you back to the back pain, is it constant or does it come and go?”
3) Signpost your structure
“I will come back to that in a moment. First, I want to get the timeline clear. Has it been getting better or worse?”
What to avoid (even if you’re under pressure).
These can sound impatient:
“You’re not answering my question.”
“That’s not relevant.”
“Just tell me the pain score.”
You can be direct, but stay respectful.
Mini scene: the patient drifts.
Patient (Luis): “And then my manager keeps calling, and my brother says I shouldn’t complain, and honestly I’ve had a lot on my plate, and I don’t know if it’s stress or what, and also I had a similar thing years ago but I can’t remember…”
Clinician option A: “Sorry to interrupt, can I just check one detail? You said it started after moving boxes. Was that ten days ago exactly, or closer to two weeks?”
Clinician option B: “I understand, but we don’t have time for this.”
Option A keeps the relationship and the focus. Option B risks conflict.
Your turn.
You’re going to write a short interruption that:
sounds polite,
refocuses on one key detail (timeline, severity, trigger/reliever, impact, or past episodes).
Keep it short. One or two sentences is enough.
Practice & Feedback
Below you’ll see a short ‘rambling’ message from Luis. Write two clinician lines to bring the conversation back on track.
Line 1: a respectful interruption (use a softener like “Sorry to interrupt…” or “Just to check…”).
Line 2: a focused check question linked to the history funnel (timeline, severity, trigger/reliever, impact, or past episodes).
Aim for natural clinic English. Keep each line short (about 10–18 words). Finish with question marks where needed.
Patient (Luis).
“Also, my mum’s been unwell and I’ve been travelling to see her, and I’m sleeping badly anyway, and sometimes I feel like everything is connected, and I don’t know, maybe it’s just me getting older, and my brother said I should do yoga, and I watched a video online and it said it could be a trapped nerve…”
4. Summarising back and confirming you’ve understood.
Once you’ve asked your focused questions, there’s a moment that makes a huge difference: summarising back what you’ve understood. This is not just a nice communication skill; it’s a safety step. It gives the patient a clear chance to correct you, and it shows you have listened.
At B2 level, what we’re aiming for is a short, structured summary, not a long speech. Think of it as a mini paragraph with the key facts: the symptom, the timeline, the pattern, impact, and one or two relevant triggers or relievers. Then you add a confirmation question: “So, if I’ve understood you correctly… is that right?”
In a busy clinic, this also keeps the appointment moving. You can summarise, confirm, and then signpost what happens next: examination, tests, advice, or a plan.
In the activity, you’ll read a set of details from Luis and write a two-to-three sentence summary plus one confirmation question. Aim for calm and precise language.
The summary moment: short, structured, patient-safe.
A good summary does three jobs:
Accuracy: checks you have the facts right.
Rapport: the patient feels heard.
Structure: it creates a clean step to “what happens next”.
A reliable summary frame.
Use this pattern (from the chunk bank):
“So, if I’ve understood you correctly…”
Then include:
what the symptom is,
when it started,
how it has changed,
what makes it better/worse (if known),
impact (sleep/work/daily life).
Finish with a simple check:
“Is that right?”
“Have I got that right?”
“Does that sound accurate?”
Example summary for our case (model).
“So, if I’ve understood you correctly, you developed lower back pain about ten days ago after lifting boxes, and it’s been getting worse this week. At its worst it’s around eight out of ten, and sitting for long periods, especially driving, brings on a sharp pain down the left leg. It’s affecting your sleep and your ability to work. Have I got that right?”
Mini tip: keep certainty appropriate.
If a detail is unclear, show that:
“It started around ten days ago…”
“You said it was especially when you sit…”
This avoids over-claiming and gives the patient room to correct you.
Your goal in this block.
Write a summary that is:
2–3 sentences (not too long),
fact-based (no diagnosis),
easy for the patient to confirm or correct.
After this, you can signpost: “Thanks. Next I’d like to examine your back and check a few movements.” We’ll use that kind of signposting in the final performance task.
Practice & Feedback
Read the details below. Write:
a 2–3 sentence summary beginning with “So, if I’ve understood you correctly…”
one confirmation question at the end.
Keep it patient-friendly and factual (no diagnosis). Include timeline, change over time, one trigger/reliever, and one impact point. Imagine Luis is sitting opposite you and you want him to say, “Yes, that’s right,” or to correct you.
Key details gathered so far.
Lower back pain started after lifting boxes when moving house.
Onset: about 10 days ago.
Trend: worse this week.
Radiation: sometimes shoots down left leg.
Worse with: sitting, especially driving for work.
Better with: hot shower helps a bit; ibuprofen helps a bit.
Impact: poor sleep; worried about missing work.
Patient concern: worried it could be something serious.
5. Chat simulation: guiding a talkative patient step by step.
Now we’ll put the pieces together in a short chat-style simulation. You are the clinician, and Luis is messaging you as if this were a digital triage or a pre-clinic chat, but the communication principles are the same: open question first, then focused checks, and polite steering when the story drifts.
In a simulation like this, your main aim is control with kindness. You don’t need lots of words; you need the right words. Use one question at a time, and keep the funnel in mind: timeline, better or worse, severity, triggers, impact, and any previous episodes.
Also, don’t be afraid to interrupt in writing. In chat, you can do it with one short sentence: “Sorry to interrupt, can I just check one detail?” Then ask the detail.
In the activity, you’ll write your next clinician message. After you send it, I’ll respond as Luis, and you’ll see feedback on your English and your clinical structure. Try to sound calm, professional, and human.
How to sound structured in chat (without sounding cold).
Chat can feel abrupt because it’s short. So your wording matters.
A helpful chat rhythm:
Invite: “Can you talk me through what’s been happening?”
Narrow: “When did it start exactly?” / “Has it been getting better or worse?”
Measure: “On a scale of 0 to 10…”
Explore: “What makes it better or worse?”
Impact: “How is this affecting your day-to-day life?”
Confirm: “So, if I’ve understood you correctly…”
Mini language bank for chat.
You can reuse these safely in most clinic chats:
“Thanks, that’s helpful.”
“Sorry to interrupt, can I just check one detail?”
“Just to make sure I’ve got this right…”
“When did it start exactly?”
“Has it been getting better or worse?”
“How is this affecting your day-to-day life?”
The scenario continues.
You are mid-consultation with Luis. He has already told you the long first story (back pain after moving boxes, worse this week, shoots down leg, impacts sleep and driving). Now he sends another message that mixes relevant information with side information.
Your job:steer. Ask focused questions that move the history forward.
What “good” looks like here.
A good clinician message in chat:
is 2–5 lines,
contains 2–3 questions max,
includes a softener if you are interrupting,
follows a logical order.
You don’t need to solve the case. You need to get clear information.
Practice & Feedback
Write your next clinician message in the chat.
You are replying to Luis. Write 4–6 short chat lines (like a real messaging exchange). Include:
one soft acknowledgement (e.g., “Thanks, that’s helpful.”),
one polite steering line (e.g., “Sorry to interrupt, can I just check one detail?”),
2 or 3 focused questions in a logical order (timeline → better/worse → severity OR trigger).
Keep it calm and patient-friendly. Use question marks for your questions. Don’t give a diagnosis. Your goal is to gather precise facts and keep the conversation focused.
Chat message from Luis (patient).
“Yeah, so it’s definitely worse when I sit, but also sometimes when I’m walking it feels strange, like it might give way. And my brother keeps saying it’s because I’m stressed and I should just stretch more. I don’t know, maybe it’s been longer than ten days? Time’s a blur. Also I had a long drive last weekend and after that I was in bits. Do you think it’s something serious?”
6. Full mini performance: focused history and clear next steps.
You’ve practised the building blocks: an open question, a set of focused checks, polite interruption, and a clear summary. Now you’ll do a short end-to-end performance.
Imagine this is a real clinic appointment and you’re aiming for safe, calm efficiency. You will guide Luis from the start of the history to a clear closing where you signpost what happens next. We are not doing diagnosis. We are doing communication that protects the patient and protects your consultation time.
As you write, keep the funnel in mind. Start open, then tighten the timeline, ask about better or worse, ask severity, ask triggers and impact. If he drifts, use one respectful interruption. Then summarise back: “So, if I’ve understood you correctly…” and ask him to confirm. Finally, signpost the next step: for example, examination and a plan to discuss management.
In the activity, you’ll write a short script of the interaction. Aim for something you could genuinely say in clinic tomorrow.
Your integrated task (mini OSCE style).
You will write a short consultation script with Luis Garcia (39) about his lower back pain.
This is the full communication outcome for today:
Start with an open invitation.
Move to focused checks (timeline, severity, triggers/relievers, impact, past episodes).
Use one respectful interruption if needed.
Summarise and confirm accuracy.
Signpost next steps so the patient knows what will happen.
Suggested structure (you can follow this exactly).
Open question: “What brings you in today?”
Focused checks:
“When did it start exactly?”
“Has it been getting better or worse?”
“On a scale of 0 to 10…”
“What makes it better or worse?”
“How is this affecting your day-to-day life?”
“Have you had anything like this before?”
Polite interruption (only if he drifts): “Sorry to interrupt, can I just check one detail?”
Summary: “So, if I’ve understood you correctly…”
Next steps signposting (simple and realistic):
“Thanks. Next I’d like to examine your back and check a few movements.”
“After that, we’ll talk through the plan and what you can do at home.”
Mini rubric (check yourself).
Your script is successful if it is:
Structured: clear funnel, not random questions.
Patient-friendly: calm tone, no blaming.
Accurate: timeline and severity are clear.
Safe communication: no assumptions; you confirm key facts.
Closed well: patient knows what happens next.
Remember.
You are practising language you can reuse across many consultations, not only back pain. The same patterns work for headaches, abdominal pain, dizziness, cough, and many other problems.
Practice & Feedback
Write a short consultation script (about 12–16 lines). Label each line Clinician: or Patient:.
Use the case notes below to keep it consistent. You can make the patient’s answers short, but include at least one moment where the patient starts to drift off-topic so you can use a polite interruption.
Must include these exact elements:
one open question,
at least 5 focused check questions (timeline, better/worse, severity, trigger/reliever, impact, past episode),
one polite interruption line,
one summary starting with “So, if I’ve understood you correctly…” plus a confirmation question,
one clear signposting line about next steps.
Write it as natural British workplace English.
Case notes (use these facts).
Patient: Luis Garcia, 39.
Main issue: lower back pain.
Started after lifting boxes while helping his brother move house.
Onset: around 10 days ago (patient is slightly unsure on exact timing).
Trend: worse this week.
Sometimes sharp, shooting pain down left leg.
Worse with sitting/driving; long drive last weekend made it worse.
Slightly better with hot shower and ibuprofen.
Impact: poor sleep; worried about missing work (delivery driver).
Patient worry: “Is it something serious?”
(Do not add diagnosis; keep it communication-focused.)
