Table 6

Excerpt of referral transcript—receiving party guides conversation on decision to admit

Sender:He's 73, diabetes, stomach ulcer 2 years ago, left-sided paralysis since 1967, gout and [inaudible] enlargement. Presenting with chest pain, which started today at 8 o'clock in the morning, woke the patient up from sleep, never had this pain before. He's not sure of the nature of the pain, whether it's tightness or stabbing or anything like that. 8 of 10 in severity, doesn't radiate anywhere, but he hasn't got any other symptoms. Risk factors are diabetes and a smoker for 60 years, stopped last December. He has a nurse with him and he's using a wheelchair to move around since last December. Family history is unknown. Obs are within normal and heart—ECG, there are no significant changes there.
7Sender:Right. I just sent his bloods and I've just sent to him to X-Ray—chest X-Ray.
8Receiver:OK, so what do you think is going on?
9Sender:Well, I think I can't rule out a cardiac.
10Receiver:No, not about ruling out. What do you think is going on?
12Receiver:Not what you think needs to be ruled out.
14Receiver:What do you think the cause of his symptoms is?
15Sender:I think it's cardiac.
16Receiver:So you think it's cardiac?
18Receiver:Based on what?
19Sender:Based on chest pain, which started at 8 o'clock.
20Receiver:But why? What is it about it that makes you worry that it's cardiac?
21Sender:Well, the history of smoking, the nature of the pain.
22Receiver:OK, so what in the nature of the pain makes you worried about it being cardiac?
23Sender:Well, it's left-sided chest pain. It started all of a sudden and it is continuous until now, you know.
25Sender:And with significant smoking history and he's diabetic also.
26Receiver:OK, so it's the risk factors that he's got that are worrying you?
27Sender:Yes, the risk factors. Yes, exactly yes.