Ten minutes, a patient who says "it's probably nothing", and a language that isn't your first. Getting the history right is almost entirely a question of what you ask and how — and the questions that work are the same ones every time.
The Scene 🎬
You are the doctor. You have ten minutes, and the first ninety seconds decide the rest.
You trained in your own language. You know medicine perfectly well. What's hard is that a consultation in English is not a translation exercise — it's a set of very specific questions, asked in a very specific order, and the wrong phrasing gets you the wrong answer.
Marta Nowak is fifty-eight. She has come in about something she's been ignoring since roughly March, she will describe it vaguely, she will minimise it, and she will not mention the thing that actually frightens her until you make room for it. That's not unusual. That's most patients.
Your job in this ten minutes is to get an accurate history out of someone who is downplaying it — and to do that in a second language without losing the authority that makes her trust you.
In your own language, how do you get a patient to stop saying "it's fine"? Does the same approach translate?
What's the hardest part of working in English in your field — the vocabulary, or the small talk around it?
YouThe doctor. Clinically confident, working in your second language, with ten minutes and a patient who is underselling her symptoms.
MartaFifty-eight. Polite, apologetic for taking up your time, vague about dates, and frightened about something she hasn't said yet.
First: read the conversation in the next tab and count the open questions against the closed ones. The open ones come first and get the story; the closed ones come later and pin it down. Reverse that order and you get a yes, a no, and nothing useful.
The Conversation 💬
A GP surgery. She sits down, still holding her coat.
YouTake a seat. Right — what's brought you in today?
MartaWell, it's probably nothing, honestly. I feel a bit silly. It's just I get — I don't know how to describe it — a bit dizzy sometimes.
YouNot silly at all. Tell me a bit more about that.
MartaIt's just when I stand up, mostly. Or sometimes in the shop, if I've been walking round a while. It passes.
YouSorry — when you say dizzy, do you mean the room spins, or you feel faint?
MartaOh — faint. Not spinning. Like I have to hold on to something for a second.
YouThat's helpful, thank you. When did you first notice it?
MartaOh, a while. Not long. A few months, maybe?
YouCan you put a date on it — roughly? Was it before Christmas, after?
Marta…After. It was after my sister's birthday, so — March. Yes, March. Because I remember on the day I—
YouMarch. Good. And is it there all the time, or does it come and go?
MartaComes and goes. Some weeks nothing at all.
YouBear with me a second while I get this down. …Right. What makes it better? What makes it worse?
MartaSitting down makes it better. Standing up too quick makes it worse. And — this sounds daft — it's worse if I haven't eaten.
YouNot daft, that's exactly the kind of thing I need. On a scale of one to ten, where is it now — and where's the worst it's been?
MartaNow? Nothing. Zero. The worst — I don't know, six? I had to sit down on the floor in Tesco once. That was the frightening one.
YouTell me about that one.
Marta…I went right down. Not fainted, but nearly. And nobody was with me, and I thought — well. I thought about my mother, because she had a stroke at sixty-one, and I've not been able to stop thinking about it since. That's really why I'm here.
YouThank you for telling me that. That's a very reasonable thing to be worried about, and it's the most useful thing you've said. Let's take it properly.
From memory — don't scroll back up.
Marta uses one word vaguely and the doctor stops to define it. Which word — and what turned out to be the case?
She says "a few months, maybe". What question gets her to an actual month, and how does she work it out?
The real reason she came in doesn't appear until the very end. What is it, and what question finally unlocks it?
1. "Dizzy" — which can mean the room spinning (vertigo) or feeling faint (presyncope). Two different problems. She meant faint.
2. "Can you put a date on it — roughly? Was it before Christmas, after?" Offering a fixed landmark lets her anchor it: after her sister's birthday, so March.
3. Her mother had a stroke at sixty-one and she's been frightened since the episode in the shop. It comes out after "Tell me about that one" — an invitation to tell the story rather than answer a question.
Useful Phrases 🧰
Ten phrases for taking a history in English. Each does one job, and each works on any patient with any symptom — swap the noun and it still stands. Say each out loud BEFORE you reveal it.
Say it like you mean it. Slower than feels natural, and leave a gap after every question. Patients fill silences with the thing they were not going to say — the shop, the mother, the fear — and if you rush into the next question you lose it. Your pace, not your vocabulary, is what makes you sound like a doctor in any language.
🚪 Opening
Phrase 1
The job: opening so they tell you the story rather than answer a question. Which one?
A. "So you're having dizzy spells, is that right?"
B. "What's brought you in today?"
C. "How can I help you?"
B — "What's brought you in today?" A hands them your assumption and they'll simply confirm it — you've closed the history before it opened. C is fine but slightly transactional, and invites a request rather than an account. B asks about the decision to come, which is subtly different from the symptom, and it very often produces the real reason: something changed, something frightened them, someone told them to.
Take it anywhere: the standard, near-universal opener in British clinical English.
Phrase 2
The job: getting more without asking a new question — because a new question narrows, and you're not ready to narrow. Complete it:
"Tell me a bit ___ about that."
"Tell me a bit more about that." Not a question at all — an invitation, which is why it works. "A bit" keeps it low-pressure and finite, so it doesn't feel like an interrogation. Used two or three times in the first minutes it gets you the history in the patient's own words, which is where the useful detail lives.
Take it anywhere: "Tell me a bit more about ___." Works in any consultation, interview, or investigation.
🔍 Pinning down the vague
Phrase 3
The job: getting a real date out of "a few months, maybe". The trick is to offer a landmark rather than ask for a number. Put the pieces in order:
— roughly?Can you puton ita date
"Can you put a date on it — roughly?" "Roughly" is the permission that makes it answerable; without it people say "I don't know" rather than risk being wrong. Follow it with a landmark — before Christmas or after? — and almost everyone can anchor themselves to an event even when they can't produce a month. Marta gets there via her sister's birthday.
Take it anywhere: "Can you put a date on it — roughly?" plus a fixed landmark. Works on any vague timeline, clinical or not.
Phrase 4
The job: establishing the pattern — constant or intermittent. This is one question, not two. Complete it:
"Is it there all the time, or does it ___ and ___?"
"Is it there all the time, or does it come and go?" To come and go is the everyday English for intermittent — patients use it, and using it back keeps you in their register rather than sending them to look up a word. Offering two options rather than asking "how often?" gets a usable answer immediately; "how often?" gets "not that often", which tells you nothing.
Take it anywhere: "Is it ___ all the time, or does it come and go?"
Phrase 5
The job: finding what triggers and relieves it — the two questions that most often give you the diagnosis. Say them out loud, then write them.
"What makes it better? What makes it worse?" Four words each, and between them they produce the pattern almost every time. Asked as a pair, back to back, they invite comparison and patients answer far more precisely than to "what causes it?" — a question that asks them to do your job. Marta's answer here (worse standing, worse unfed, better sitting) is most of the picture.
Take them anywhere: any symptom, any patient, in that order.
Phrase 6
The job: turning a feeling into a number you can track over time — and the second half is the part most people forget. Complete it:
"On a scale of one to ten, where is it now — and where's the ___ it's been?"
"On a scale of one to ten, where is it now — and where's the worst it's been?" Asking only for "now" is nearly useless, because people attend when they're between episodes — Marta's "now" is zero. The second half gets you the peak, and more importantly it makes her describe the worst episode, which is where the frightening detail lives. One question, two pieces of information.
Take it anywhere: "Where is it now — and where's the worst it's been?"
Phrase 7
The job: getting the story behind the worst episode. Not a question — an instruction, gently given. Say it out loud, then write it.
e.g. "Tell me about that one." Four words, and in this conversation they're the ones that finally produce her mother's stroke and the real reason she's here. Once a patient names a specific episode, ask them to narrate it — the story carries the fear, the context and the detail that no direct question would have retrieved. Then stay quiet.
Take it anywhere: "Tell me about that one." Any time someone mentions a specific incident in passing.
🗣️ Working in your second language
Phrase 8
The job: pinning down a word the patient is using loosely — without appearing not to understand English. Which version keeps your authority?
A. "Sorry, my English — what is dizzy exactly?"
B. "Sorry — when you say dizzy, do you mean the room spins, or you feel faint?"
C. "Right, dizziness. Okay."
B — "Sorry — when you say dizzy, do you mean the room spins, or you feel faint?" A apologises for your English and puts the patient in charge of the vocabulary. C accepts an ambiguous word and you may follow the wrong diagnosis for ten minutes. B is what a good doctor does in any language: "dizzy" genuinely has two meanings and the patient must be made to choose. Offering the two options shows expertise rather than uncertainty — you knew there was a distinction to make.
Take it anywhere: "When you say ___, do you mean ___ or ___?" The single most useful clinical phrase for a second-language speaker.
Phrase 9
The job: buying yourself a few seconds to write, think or find a word — without an awkward silence. Complete it:
"___ with me a second while I get this down."
"Bear with me a second while I get this down." To bear with someone is to be patient with them for a moment. This is doing two jobs: it covers the pause while you write, and it covers the pause while you find your next sentence in English — and the patient cannot tell which. It reads as thoroughness, not hesitation. Learn it before anything else on this list.
Take it anywhere: "Bear with me a second while I ___." Any professional context where you need a beat.
🤍 Receiving the real reason
Phrase 10
The job: responding when a patient finally says the frightening thing — validating it without dismissing or inflating it. Which version?
A. "I'm sure it's nothing like that at all — try not to worry."
B. "That's a very reasonable thing to be worried about."
C. "Right, well, we'd need to rule that out obviously."
B — "That's a very reasonable thing to be worried about." A is a promise you can't keep and she'll hear it as not being taken seriously — patients who are reassured too fast stop volunteering things. C is clinically fine and emotionally cold; she's just told you something difficult and got a process in reply. B does the essential job: it tells her the fear is legitimate, which is what allows her to keep talking. It also commits you to nothing.
Take it anywhere: "That's a very reasonable thing to be worried about." Works whenever someone finally admits what's frightening them.
🔑 Make them yours
These frames work in any consultation, in any specialty — and most of them work outside medicine entirely. Fill them with your own work. Say each answer out loud before you type it.
"When you say ___, do you mean ___ or ___?" — which word do your patients use loosely?
"Can you put a date on it — roughly?" — what landmark would work for your patients?
"Bear with me a second while I ___." — when in your day do you most need a beat?
Quick test: run the consultation out loud using all ten, in order — what's brought you in → tell me more → define the vague word → put a date on it → all the time or comes and goes → better/worse → scale, now and worst → tell me about that one → bear with me → that's reasonable to worry about. Then check: how many were open questions, and did they come first?
Your Turn 🎭
Now you take the history. Twice — once as the doctor, once as the patient.
Round 1 — you're the doctor
Use your own specialty if you have one. The patient has just sat down and said it's probably nothing.
Open it so they tell you the story.
They use a vague word — "funny", "heavy", "off". Pin it down.
They say "a while ago". Get a date.
Establish the pattern, and what changes it.
Get the number — both halves.
They mention one bad episode in passing. Open it up, then take the fear when it comes.
Round 2 — now you're the patient
Swap. You're Marta: apologetic, vague about dates, minimising, and frightened about something you haven't said. This half teaches you what your own patients are doing — and it's harder than it looks to be usefully unhelpful.
The doctor asks what's brought you in. Underplay it.
You're asked for a date. You genuinely don't know — answer the way real patients do.
Something in the doctor's manner makes it possible to say the real thing. Say it.
⚡ The twist
Two minutes in, Marta mentions — as an aside, while talking about something else — that she's been taking her husband's blood pressure tablets, because they had some in the cupboard and she thought it might help. She says it lightly, as though it's obviously fine.
You need to know exactly what, how much and for how long, and you need her to keep being honest with you afterwards. React badly and she'll stop telling you things. What do you say?
Before you close the tab…
Can you open a consultation without handing the patient your assumption?
Can you make someone define a vague word without apologising for your English?
Can you get a real date out of "a few months ago"?
Can you buy yourself a few seconds without sounding hesitant?
Can you receive someone's fear without either dismissing it or promising anything?
The Echo 🕰️
In 1918 a flu swept the world and killed more people than the war that preceded it. Doctors had no vaccine, no antivirals and no reliable test. What they had was the ability to ask a patient questions and to listen to the answers.
So they asked. When did it start? Is it steady, or does it come in waves? What makes it worse? The histories taken in those wards became the pattern that eventually showed how the disease moved — years before anyone could see the virus itself.
You have a scanner and a laboratory behind you, and they change nothing about the first ten minutes. Those are still one person asking careful questions, and another one deciding whether to tell the truth.