Questioning skills in OET Speaking and Reflecting listening

Use signposting language

• To begin with, I am going to ask you some questions about your lifestyle to get a better understanding of your
condition, and then we will discuss some ways to manage your condition. Is that okay?
• Before I take you through the treatment options, I’d like to ask you some questions about your condition. Would
that be okay with you?
• Before proceeding further, I would like to ask you some questions about your symptoms. May I proceed?
• Before proceeding further, I need to ask more questions regarding your………….. May I do that?

Questioning skills

Questions can be open-ended, closed or focused. Consultations often require a mix of questions. Find out what the
patient believes to be their problems and how these affect their life.

Open questions

Open questions allow greater exploration of an issue, for example: ‘Tell me more about the headache’, The patient perspe
ctive can be ascertained by asking them about their concerns. Prompts are helpful for encouraging the patient to expand
these concerns. Open-ended questions take up more time in the consultation as the patient elaborates on his Condition
or concern, especially if talkative, but allow a deeper understanding of the patient’s concerns.

Closed questions

Closed questions will usually result in a simple ‘Yes/No’ answer and offers lit-
tle information, unless the patient is particularly vocal. For example: ‘Do you take your inhaler every day?’ is a closed que
stion, while: ‘When did you last use your inhaler?’ allows the patient to elaborate. Closed questions can be useful to elicit
details, for example: ‘Do you bleed between your periods?’.

If the answer is ‘yes’, this can be explored further. Allow the patient time to answer. Closed questions can be useful when
time is limited.

Focused questions

Focused questions allow the nurse to gain specific information by narrowing the line of questioning.
Nurse: ‘What can I do for you today?’ (open question)

Patient: ‘I’ve tried to diet but need some help.’

Nurse: ‘Tell me what you’ve tried in the past.’ (focused question to help elaborate)

Patient: ‘I’ve tried all the slimming clubs, I lose weight but then put it back on.’

Nurse: ‘Would you like me to weigh you today, and then we can plan what support I can offer you?’ (closed question to
gain a ‘yes/no’ answer)

Patient: ‘Yes please.’

Unhelpful question types

Leading questions and compound questions are unhelpful question types that are better avoided. Leading questions
suggest the desired answer and are difficult for the patient to disagree with.

For example: ‘You don’t cough at night, do you?’ is likely to elicit a ‘no’ response, whereas: ‘When
did you last have a night cough?’ allows the patient to elaborate. Compound or multiple questions confuse both patient
and nurse, as the patient cannot answer all questions at the same time, and the nurse is unsure which
question has been answered. For example: ‘Do you have any pain, discharge or bleeding after intercourse?’. If the woman s
ays ‘yes’ the nurse will have to break down the list to clarify the symptom. Backtracking extends the consultation,
therefore ask each question individually and allow the patient time to answer.

The tone of voice can convey a wealth of information, ranging from enthusiasm to disinterest. Use the tone of voice to
emphasise ideas. Express enthusiasm using an animated tone of voice. The nurse who appears disinterested is unlikely to
gain the necessary rapport for an effective consultation.

What is backtracking?

Backtracking or paraphrasing can be used at any part of the consultation. In OET Speaking, use it:

• to clarify the meaning of something you don’t understand

When you say, “under the weather”, do you mean unwell? OR Could you please explain what you mean by,” ……..”?

• to recap the patient’s responses in history talking

so, from what I have understood so far, you have been ……… Is that right?

So, what you are saying is ………Is that correct?

So, in summary, it seems that…..Have I covered everything?

• the end of the roleplay as a final summary of what has been agreed so far.

So, just to backtrack, ...

So, just to recap what we have discussed,

To reiterate what we discussed today, …..

Back channelling
Backchanelling is a technique to show interest what the patient has to say, through active listening prompts like uh-huh,
alright, I see, Go on etc. These indicate that the health professional has heard what the patient says and is interested in
hearing the full story.

Reflecting skills

Reflecting skills enable the nurse to let the patient know they are listening and have understood their perspective.
Paraphrasing is the repetition of words in a slightly different format to check the information has been correctly
interpreted. Go over what the patient has said from time to time to check you understand what the patient means.

Empathy is another powerful communication skill—when the patient feels the nurse acknowledges the emotional
content. Summarising from the patient’s point of view can be a way of expressing empathy.

Patient: ‘I know I should stop smoking, what with my asthma and the kids getting at me, and I can’t afford it. I’ve tried to
give up before, but started again when the wife was ill. I really need to stop.’

Nurse: ‘It sounds like you would like to give up smoking with some help.’ (paraphrasing)

Patient: ‘I do want to stop, but it’s hard… with the worry about job losses.’

Nurse: ‘I can understand that you are worried about your job.’ (empathy)

Patient: ‘My breathing’s been bad for the last two weeks, my inhaler doesn’t help much. I’ve got to do something.’

Nurse: ‘It is hard to stop smoking, but it would help your breathing and we can offer you help with this.’ (Summarising,
Persuading)

Next step:

Communication strategies used in history taking: repetition and clarification

Thank you for answering my questions Mr Tom. Let me see if I have got this right: you’ve been having trouble breathing,
especially when lifting or climbing stairs. You’ve been coughing up yellowish phlegm and you have had a couple of bouts of
bronchitis in the past. You’re concerned because you feel should be helping your wife more with the care of your
grandchildren, but you don’t always feel able to do so. (Repetition) Is that can accurate summary? (Clarification)

Questions to investigate the reason for presentation

• What brings you along here today?

• What brings you here today?
• What seems to be problem /trouble?
• How may I assist you today?
• What seems to be bothering you today?
• Can you please tell me why you have come here today?
• Can you tell me what you are concerned about?
• Can you tell me what you are worried about?
• Can you tell me what you have difficulty with?
• Can you tell me what you have problems with?
• So, what brings you in (to the clinic / hospital) today?
• Can you tell me about the problems you’re having? (asking for more details)
 Direct or Indirect Language

Choosing appropriate language for the patient you are speaking to is an important part of the OET speaking test. When
your patient is sensitive or embarrassed about the condition, it is better to use indirect language. Indirect language is
unnecessary for conditions which are routine or which the patient feels comfortable about.

Read the example statements and questions and decide if they are direct or indirect.

Would you mind if I asked you some questions to get a better understanding of your condition?
In your own time, could you describe your symptoms for me?
How would you rate the pain?
I’m afraid I need to ask you a personal question. Have you had unprotected sex in the last month?
Is this something you’ve experienced before?
Would you say the symptoms are getting worse?
I want you to start doing some kind of exercise for at least 20 minutes every day.
Have you thought about trying to cut down on some of the foods in your diet that are not particularly healthy?
I understand you dislike the idea of taking medication to manage your symptoms but I’m afraid there isn’t another
option.
In cases like these, the first thing to try is changing your lifestyle.
It’s really important that you monitor your blood sugar levels regularly.
If you don’t mind me saying, I notice you’ve put on some weight since I last saw you.
This might not be what you were hoping to hear but the best way to improve your sleep is to avoid any kind of sleep
medication.
The next time you experience the symptoms, I want you to write down how long they last and any triggers you think
caused them.

Direct or Indirect language – Answers

Would you mind if I asked you some questions to get a better understanding of your condition?
Indirect
In your own time, could you describe your symptoms for me? Indirect
How would you rate the pain? Direct
I’m afraid I need to ask you a personal question. Have you had unprotected sex in the
last month? Indirect
Is this something you’ve experienced before? Direct
Would you say the symptoms are getting worse? Direct
I want you to start doing some kinds of exercise for at least 20 minutes every day. Direct
Have you thought about trying to cut down on some of the foods in your diet that are not particularly healthy?
Indirect
I understand you dislike the idea of taking medication to manage your symptoms but I’m afraid there isn’t another
option. Indirect
In cases like these, the first thing to try is changing your lifestyle. Direct
It’s really important that you monitor your blood sugar levels regularly. Direct
If you don’t mind me saying, I notice you’ve put on some weight since I last saw you. Indirect
This might not be what you were hoping to hear but the best way to improve your sleep is to avoid any kind of sleep
medication. Indirect
The next time you experience the symptoms, I want you to write down how long they last and any triggers you think
caused them. Direct

AIM: To practise forming indirect questions.

Tell me about how much you drink or Tell me how much you drink.
instead of How much do you drink?

Notice that the grammar changes. Using about is optional here.

Alternatively, you could pause and keep the direct question form:
Tell me, how much do you drink? (It is not possible to insert about here.)

Elsewhere in the interview, you could use a pause in this way:

Let me ask you, do you feel the need to drink at the start of the day?
Here the pause (indicated by the comma) means that the grammar doesn't change - the question remains a direct
question.

Without the pause, the sentence would be:

Let me ask you if (OR whether) you feel the need to drink at the start of the day.

Asking questions indirectly can seem less intrusive and perhaps more polite. There are several possible starting phrases:

Tell me ...,
Can I ask ...,
Would you mind telling me ...?
I wondered ...,
I wonder if you could tell me ...
Let’s talk about your diet. Could you tell me……
The longer phrases tend to sound more polite.
Can you tell me…..

Indirect Questions
How old ... symptoms like these before?
Do you ... found out about this condition?

Are you on ... drinking before the illness?

I call you?
Are you still ...
been feeling like this?
Did you notice any change ...
when you started the tablets?
How much were you ... to help you with the shopping?
How long have you ... have any children?
Is your son going ... me tomorrow?
What can ... feeling dizzy?
Will you phone ... are you?
any medications at the moment?
What have you ...
Have you had ...

Starting phrase Question prompt

(Can you tell me if you are on any

Can you tell me ... medications at the moment)

(Would you mind telling me how old you

Would you mind telling me ...? are)

(Tell me, how long you’ve been feeling like

Tell me ... this)

I wonder if you have any support at home

OR I wonder if you can incorporate some
I wondered ... physical activity in your routine

Can I ask if you smoke?

Can I ask ... Can I ask if you drink?

Would you be able to tell me something

Would you be able to tell me ...? about your eating habits?

May I ask how old you are? May I ask if you

May I ask ... exercise?

Please tell me if you have experience similar

Please tell me ... symptoms in the past.

I wonder if you could tell me whether you

I wonder if you could tell me ... have had similar symptoms in the past.

Let me ask you ... Let me ask you something about your diet.
Could you describe for me your typical diet
 over a 24-hour day.

Can I ask if you are on any medications at

Can I ask ... the moment?

Can you tell me if you have any ongoing

Can you tell me ... medical conditions?

Some YES-NO questions a nurse may ask patients:

About medical/family history:

• Are there any members of the family with hypertension/heart disease/diabetes?
• Are you allergic to anything?
• Have you experienced having difficulty with breathing before?
• Did you hurt your back before?

About present condition:

Have you eaten anything today?
Do you feel pain in this part?
Can you walk properly?
Have you got a temperature?
Do you have a cold/headache?

Some info-questions nurses may ask their patients:

What did you eat today? Why did you not eat anything?
When did the pain in your leg start?
How did you get the cut on your arm?
Since when have you had this cough?
Which antibiotic drug did you take?
What do you think is the reason for your headache?

Asking about location of the problem:

• Where is the sensation/pain?
• Can you tell me where it hurts?
• Where do you feel sore?
• Where does it feel sore?
• Which part of the body/your body is affected?
• Can you please tell me where the pain is?
• Are you in any pain at the moment?
• Can you show me where it hurts?
 • Is it in your hand/wrist/lower or upper arm or leg/shoulder/neck/ankle/elbow, abdomen, genital area,
stomach?

Asking about the duration:

• When did it start?

• How long have you had the pain for?
• How long have you been feeling like this?
• How often has this been occurring?
• How long have you been suffering from this problem?
• When did the problem start?
• How long have you had it? How long has it been bothering you?

Asking about the severity of the pain?

• Could you please rate your pain on a scale of 1-10 with 1 being the least and 10 is the maximum pain
you have ever experienced.
• Is the pain continuous or intermittent?
• Are there any factors that alleviate/relieves your pain?
• Are their factors that exacerbate/aggravate your pain? Or is the pain brought on by anything in
particular? Do you have any idea what may be causing the problem? Do you know what might have
caused the problem?
• Can you describe the pain for me?
• Is the pain dull or sharp? Is it a throbbing pain?
• Does the pain radiate to other parts of the body?
• Have you taken any medication for pain-relief?
• Has the pain-relief been effective?
• Have you taken any medication in the last 24 hours?

Getting information regarding social history, medical history, employment, blood type, medication, allergies, exercise,
alcohol, smoking, diet etc.

Employment
• What do you do? What is the nature of your work?
• How many days do you work in a week? How long are your shifts?
• How long have you been unemployed?
• Is your job stressful?

Past Medical History

• Are you suffering from any illnesses at present?
 • Do you have any known allergies?
• Are you taking any medication at present?
• Are you suffering from any medical conditions at present?
• Do you have any family history of this …………..? Has anyone in your family ever suffered from this
condition? Do you have any inherited medical conditions?
• Have you ever had any surgery?
• Have you had similar problems in the past?
• Do you or any of your family suffer from high blood pressure, heart disease or diabetes?

Social History
• Are you married?
• How many children do you have?

Weight
• Has your weight changed recently?
• Do you have trouble maintaining your weight?
Alcohol
• Do you drink alcohol?
• How many standard drinks do you consume per week?
• Have you thought about cutting down (reducing your intake)?
•
Smoking
• Do you smoke?
• How many cigarettes do you smoke in a day?
• Have you tried to give up smoking?
• Have you thought about cutting down (reducing your intake)?

Breathing
• Is it hard to breathe?
• When do you have difficulty in breathing?
• Could you please hold breath for a minute while we take the X ray?

Rash
• How long have you had the rash for?
• Has the rash been itchy or irritating or painful?
• Do you know what might have caused the rash, perhaps an allergic reaction to something
you ate?
• Have you ever had a rash like this before?
• Where on your body is the rash?

Injury (sprain/burn/fracture)
• Can you tell me how did you injure yourself?
 • What caused the fracture?
• How did you sprain your ankle?

Headaches
• How long have you had it?
• Where is it exactly? At the back / front / sides of the head (temples)

Asking about Central Nervous system

• Have you ever had a blackout?
• What bout fits?
• Have you had any dizziness?
• Do you get ringing in the ears/
• Have you ever experienced any numbness or tingling in your hands or feet?

Chest Pain
• Do you have any chest pain at all?
• Do you have any difficulty breathing?
Taking Observations
• I’m just going to take a look / have a listen to your chest.
• I’ll just need to check your / his / her temperature/pulse/heart rate.
• I’ll need to take some basic/routine observations.
DIET & Exercise
o How is your diet? Are you eating well? Are you eating enough fruit/vegetables?
o How is your fat and sugar intake? Are you happy with your weight?
o Have you tried to lose weight?
o Does your weight prevent you from enjoying any activities?
o Do you exercise regularly / Are you getting enough exercise? Do you walk, run, play sport? How
often? How far? How is your overall level of fitness?
• How often do you exercise?
• What is your favourite form of exercise?
• Do you get regular exercise?
• What do you usually have for breakfast?
• Do you have plenty of fibre in your diet?
• Do you have healthy eating habits?
• What are your food preferences? What type of foods do you prefer to eat?
• Do you have any food allergies?

Emotional
• How are feeling in yourself?
• Are you sleeping well?
• Are you eating normally?
• Are you under any particular stress at the moment?
• How’s work going? How are things at home?
• You seem a bit anxious at the moment. Is there anything else bothering you?
• Are you on anti-depressants?
 • Have you ever taken ant-depressants?

Gastric
• Have you had any nausea or vomiting?
• Have you eaten anything unusual?
• Has your stomach been upset at all?
• Have you been vomiting?
• Have you had any diarrhoea?
• Can you keep anything down? (e.g. solids or fluids)
• Have you noticed any changes in bowel habits / motions / movements?
Allergies
• Do you have any allergies?
• Are you allergic to penicillin or any other medications?

Family / Social
• Are you in a relationship at the moment? Have you spoken to your partner about it?
• Do you have any children?
• Do you have any extended family in the area?
• Do you have friends that you can talk to / confide in? Are they good listeners?

Patient History
• Have you ever had a major illness?
• Have you ever had surgery?
• Are you HIV positive? Have you ever been tested for HIV? What was the result ? Was it positive or negative?

Family History
• Do you have a family history of heart disease?
• Does it run in the family?

Showing them through into casualty / the surgery

• Come on through.
• We’ll get the doctor to have a look at you.
• We’re flat out (very busy) at the moment.
• There’s a wait of about four hours to see the doctor.
• Take a seat. We’ll call you when we’re ready to see you.

Tests
• We may need to do a couple of tests – just to rule out anything serious.
• We’ll take an MRI scan to have a closer look.
• We’ll send you down for an x-ray – to make sure nothing is broken.
• We’re going to do an EEG, just to have a closer look.

Giving Injections / Taking blood

• Can you roll up your sleeve please?
• We need to take some blood / do a blood-test.
• (You’ll need to) keep it still. Don’t move. That’s it.
• You might feel a (bit of a) pinch.
• It’s not much. It won’t hurt much at all.
• (Afterwards) that wasn’t so bad now, was it?

Admission / Discharge
• The doctor wants to keep you in overnight for observation.
• We’re going to admit you for observation.
• Everything is fine. We’re going to let you go / send you home / you’ll be discharge in the morning.

ON THE WARD
• Can you help me turn / move this patient?
• Can you help me sit her/him up?
• Can you help me change the sheets?
• Can you help me adjust the pillow?
• Can you give her/him a shower / full body wash?
• She needs to be fed/washed/changed.
• Can you bring the bedpan please.
• ‘I need to do a wee / poo.’ (go to the toilet)
• Can you draw the curtains / blinds.
• It’s too bright. Can you possibly switch off/dim the lights?
• We need to wheel him/her down to X-ray. (Bring the patient down in their bed)
• Can you do a full set of ‘Obs’. (‘Obs’ = observations (casual) take his/her pulse, temperature.)
• Can you administer her/his medication?
• Can you put an IV in / insert an IV?
• Can you give him/her a suppository?
Food
• Are you hungry?
• How was your meal?
• You didn’t eat much. Are you not hungry?
• You’re off your food.
• You’ve lost your appetite. You’ve got your appetite back.
• Would you like a drink / something to eat/drink?
• Is there anything else we can get you?
• Let me know when you’re ready.
Asking a patient how they feel
• Did you sleep well?
• How has your day been?
• Is there anything I can do for you?
• If you don’t feel like talking right now, I’ll come back later.
Mental State Examination
• Can you describe your mood at the moment?
• How long have you been feeling like this?
• Do you take pleasure in anything?
• How are your energy levels?
• What’s your appetite like?
 • What do you feel the future hold for you?
• Can you keep your mind on things?

Patient Ideas, Concerns and Expectations -ICE

It is important during the consultation to give patients the chance to express their own ideas and concerns about their
problem and to determine what their expectations are. The letters ICE (Ideas, Concerns and Expectations) are a way of
remembering this.
IDEAS
• What do you know about this problem/condition/illness?
• Do you have any ideas about this?
• How do you think you got this problem?

Expectations
• What do you think will happen?
• What were you hoping we could do for you?
Concerns
• What are your worries about this?
• Do you have any concerns?
• How might this affect the rest of the family?

TIP: Phrasal Verbs that can be used in History Taking

Phrasal Verb Example Meaning
Bring on Is there anything special that brings on the pain? Cause , induce
Bring up When you cough, do you bring up any phlegm? Expectorate, vomit
Carry on Carry on taking the painkillers for another week Continue
Come on When does the pain come on? Commence
Give up My advice is to give up smoking Stop
Put on Have you put on weight recently? Gain weight
Turn out She had all the tests and it turned out to be cancer Happen in the end
Turn up The rash just turned up out of nowhere Appear unexpectedly

Asking how the patient is feeling

• How do you feel right now?
• What’s on your mind?
• How are you feeling at the moment?
Asking why patient is withdrawn
• Can I ask what you are thinking?
• You seem very far away /distant- why is that?
Encouraging the patient who is trying to express him/her
• I can see that you want to say something…
• You were going to say something?
• What’s on your mind?
• You look as if you were about to say something…
Responding to strong Physical signs
• I can see that you are trembling – are you anxious?
• You look as if you are about to cry- are you very upset?