Diálogo: en el médico

A trip to the médico de cabecera (your assigned GP in the Spanish public-health system) is one of the most rule-bound conversations you can have in Spanish. The patient describes symptoms with a few fixed templates — me duele…, tengo fiebre, desde hace dos días — and the doctor answers in usted imperatives that sound clipped and authoritative without being rude. This page walks through a full GP consultation in Madrid and annotates the grammar piece by piece.

The vocabulary is everyday but the patterns are precise: the wrong preposition or a missing definite article will mark you out instantly. Get these right and you will sound like a patient who has done this many times before.

The text

Recepción. —Buenos días. ¿Tiene cita? Paciente. —Sí, a las diez y cuarto, con la doctora Ramírez. —Pase a la sala de espera, por favor. La avisarán.

(En la consulta)

Doctora. —Buenos días, siéntese. ¿Qué le pasa? Paciente. —Pues, doctora, llevo unos días fatal. Me duele mucho la cabeza y la garganta, y tengo fiebre desde hace dos días. Doctora. —¿Cuánto le ha subido la fiebre? Paciente. —Esta mañana tenía treinta y nueve y medio. También tengo tos y me siento muy cansado. Doctora. —¿Ha vomitado? ¿Está mareado? Paciente. —He vomitado dos veces esta noche. Estoy un poco mareado, sí. Doctora. —Voy a auscultarle. Respire hondo… otra vez… Abra la boca y diga «aaah». Bien. Tiene la garganta muy roja. Probablemente sea una gripe, pero le voy a hacer una prueba rápida para descartar la gripe A. Súbase la manga, por favor. Paciente. —¿Tendré que tomar antibióticos? Doctora. —De momento no. Los antibióticos no sirven contra los virus. Voy a recetarle un antipirético para la fiebre. Tome estas pastillas cada ocho horas durante una semana y beba mucha agua. Necesita reposo. Si en tres días no ha mejorado, vuelva a verme. Paciente. —Muy bien, doctora. Muchas gracias. Doctora. —Que se mejore. Aquí tiene la receta — puede recogerla en cualquier farmacia.

Annotations

¿Tiene cita? — usted from the first word

The receptionist's opening question conjugates tener as tiene — third-person singular, the form Spanish uses for usted. There is no separate pronoun in sight; the verb ending is the only marker. In peninsular Spain, usted is the default with anyone you have not been introduced to socially, and it is obligatory in medical, legal, banking, and most public-service settings. A learner who says ¿Tienes cita? to a receptionist will sound either rude or like a tourist trying out a phrase from the wrong page of a textbook.

The subject pronoun usted is often dropped, just like yo or tú; but unlike with tú, you can also keep it in to add formality, especially when calling someone's attention: Disculpe, usted — ¿es el siguiente? (Excuse me, are you next?).

¿Qué le pasa? — the le of involvement

The doctor's opening is not ¿qué pasa? (what's happening?) but ¿qué le pasa? (what's happening to you?, lit. what is happening to you-usted?). The clitic le is the indirect-object pronoun for usted — the same le that appears in le voy a recetar, le he traído un papel, le duele la cabeza. With pasar meaning to be the matter, the le is obligatory: the experiencer is the indirect object, not the subject. This is the same logic that runs through every gustar-type verb in Spanish.

Me duele la cabeza — doler as a gustar-type verb

This is the single most important grammar point on the page. English says my head hurts. Spanish does not. Spanish says me duele la cabeza — literally to-me hurts the head. The body part is the grammatical subject; the person experiencing the pain is the indirect object. The verb agrees with the body part, not with the patient. This is the same syntactic mould as gustar: me gusta el café / me duele la cabeza; me gustan los gatos / me duelen los pies.

Two related traps for English speakers:

1. The body part takes the definite article, not the possessive. Spanish says la cabeza, la garganta, el estómago, los pies. Not ❌mi cabeza, ❌mi garganta. The indirect-object clitic (me, te, le) already tells you whose head it is — adding mi is redundant and ungrammatical.
2. The verb agrees with the body part. Me duele el pie (singular). Me duelen los pies (plural). Forgetting to switch produces ❌me duele los pies, an instantly noticeable error.

Tengo fiebre desde hace dos días — tener for physical states

Spanish uses tener (to have) for a long list of bodily and emotional states that English packages as to be + adjective. Tengo fiebre — I am feverish. Tengo frío — I am cold. Tengo hambre — I am hungry. Tengo sueño — I am sleepy. Tengo sed — I am thirsty. Tengo miedo — I am afraid. These take no article: never ❌tengo una fiebre, never ❌tengo el hambre. The noun is bare and is treated almost like part of a fixed verbal expression.

The intensifier is mucho/mucha, agreeing with the noun, not muy: tengo mucha fiebre, not ❌tengo muy fiebre. Muy modifies adjectives and adverbs; mucho modifies nouns and verbs.

Desde hace dos días — duration up to now

The phrase desde hace + time means for + time, starting in the past and continuing now. It is the standard answer to ¿desde cuándo…? (since when…?). Crucially, Spanish uses the present tense for the verb that goes with it, because the situation is ongoing. English wants to say I have had a fever for two days (present perfect); Spanish says tengo fiebre desde hace dos días (simple present).

If the situation is over, Spanish uses hace + time + que with a preterite or imperfect: hace dos días que tuve fiebre (it's been two days since I had a fever). But for the ongoing case — the one you almost always need at the doctor's office — desde hace + present is your formula.

¿Ha vomitado? Estoy mareado. — ser / estar in medical Spanish

Note how estar dominates: estoy mareado, estoy cansado, estoy resfriado, estoy mejor. These are temporary conditions, and estar is the verb for temporary states. Ser mareado would mean to be a dizzy person by nature — an inherent trait, not a symptom. The contrast is grammatical but feels deeply semantic.

Voy a auscultarle. Respire hondo. Abra la boca. — usted imperatives

Doctors give instructions with the usted imperative, which is identical in form to the third-person singular of the present subjunctive: tomar → tome, respirar → respire, abrir → abra, volver → vuelva, subir → suba. Clitic pronouns attach to the end of an affirmative imperative: súbase la manga, siéntese, quítese la chaqueta. These commands sound brisk but not rude — they are the expected register in clinical Spanish, the way please take a deep breath sounds in an English clinic.

In peninsular Spanish, the usted imperative is not softened with por favor every time — the imperative itself is the polite form. Adding por favor every sentence sounds anxious. The doctor in our dialogue uses it sparingly.

Voy a recetarle un antibiótico — periphrastic future + clitic position

Voy a recetarle is ir a + infinitive, the workhorse future of conversational Spanish — far more common in medical talk than the recetaré future. The clitic le (the indirect object referring to the patient) attaches to the end of the infinitive: recetar + le = recetarle. You could equally say Le voy a recetar un antibiótico, with the clitic in front of the conjugated verb. Both are correct and equally common; the first is slightly more formal.

Hay que / necesita + infinitive — impersonal medical advice

Doctors love hay que and necesita + infinitive for telling you what to do without bossing: hay que beber mucha agua, necesita reposo. Hay que is fully impersonal — one must, no specific subject — while necesita + noun or infinitive directly addresses usted but reframes the command as a need rather than an order.

Si en tres días no ha mejorado — si with present perfect

In Spain the present perfect (ha mejorado) is the natural tense for the recent past relevant to now. A doctor in Mexico might say si en tres días no mejoró; a doctor in Madrid will say si en tres días no ha mejorado. The difference is one of the clearest dialect markers between peninsular and Latin American Spanish, and it is especially pronounced in medical, legal, and journalistic Spanish. See the dedicated page on preterite vs present perfect in Spain for the full picture.

Que se mejore — the formulaic farewell

The doctor's parting words que se mejore (get well soon) is a third-person present subjunctive functioning as an indirect command — literally (I hope) that you get better. Spanish has dozens of these que + subjunctive wishes: que tengas un buen día, que descanses, que aproveche (enjoy your meal), que te vaya bien. They are bits of social glue, not full sentences, and you should learn them as fixed expressions.

Cultural note

In Spain, the public Sanidad (the national health service) assigns each registered resident a médico de cabecera — your GP, the first point of contact for almost any medical concern. Appointments are usually free at the point of use; la receta (prescription) is partially subsidised, with patients paying a percentage at the farmacia depending on income and pension status. Emergency care goes through urgencias (the ER) and the unified emergency number is 112 (see the emergency dialogue). Private healthcare exists alongside, but the conversational defaults — usted, the symptom templates, the Que se mejore farewell — are identical in either setting.

Common transfer errors

Key takeaways