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351 Topics: Ask an American - Rural doctors; let’s start versus let’s get started; continuously versus continually; chaos

Complete Transcript
You’re listening to ESL Podcast’s English Café number 351.

This is ESL Podcast’s English Café episode 351. I’m your host, Dr. Jeff McQuillan, coming to you from the Center for Educational Development in beautiful Los Angeles, California.

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On this Café, we’re going to have another one of our Ask an American segments, where we listen to other native speakers talking at a normal speed. We’ll listen to them and then explain what they’re talking about. Today we’re going to talk about a problem in some small American towns. It has to do with doctors and not having enough doctors to work in those small towns. After we do that we will, as always, answer a few of your questions. Let’s get started.

Our topic on this Café’s Ask an American segment is rural doctors. “Rural” (rural) are any areas that are away from a large town or city. So, when we talk about rural Minnesota we mean anywhere that’s not near basically the two largest cities in Minnesota, St. Paul and Minneapolis, although there are other somewhat big cities such as Rochester, Duluth, uh, Mankato, Albert Lea, I guess Austin. Those are all sort of medium-sized towns in Minnesota, but all of the land in between those big towns and cities would be called “rural” areas.

It can be difficult for these rural areas to attract doctors, to find doctors who want to live there and take care of the people who live there. Today we’re going to hear about a program in a rural part of the state of Kansas, which is trying to address or deal with this problem. Kansas is located right in the center of the United States.

We’re going to first listen to Dr. William Cathcart-Rake. He directs or leads a new program at Kansas University that is designed to provide physicians or doctors in rural areas. We’ll listen first as he explains the idea behind this program. Try to understand as much as you can as he’s talking, then we’ll go back and explain what he said. Let’s listen:


They say, you know, I really have every intention of coming back to rural Kansas but they meet a soul mate, they get married. Their soul mate happens to be from a big city and we never see them again. They get captured in the big city. Hopefully, if we train them in smaller communities, they can meet their prospective spouses here, they can network here and they have those connections which hopefully can be lifelong.

[end of recording]

The good doctor begins by explaining what happens to young men and women who come from small towns, from rural areas in places like Kansas, who then go to a big city to study medicine to become a doctor. Many of them say they want to come back and work in the small towns, but they don’t actually do that. The doctor says that these medical students say, “I really have every intention of coming back to rural Kansas.” “To have every intention” (intention) means that you really plan to do something; you absolutely want to do it and your plan is to do it, but for some reason you don’t do it, something else happens. Many people say they have every intention of losing weight, but they just can’t say no to that chocolate cookie or that piece of apple pie. For me, it would probably be a piece of pumpkin pie, very difficult for me to say no to a piece of pumpkin pie. I try, but for some reason the words just don’t get out of my mouth – probably because it’s filled with pumpkin pie!

Well, the doctor here, Cathcart-Rake, says that many of these students have every intention of returning to the small towns after they go and study in a big town – in a big city, but that doesn’t happen. Why doesn’t it happen? Well, he explains that they – these students – these medical students meet a soul mate; they get married. A “soul (soul) mate (mate)” is someone who you have a romantic relationship with who you feel is perfect for you. Your “soul” is that immaterial, that not-physical part of you that makes who you are, at least that’s the sort of general nonreligious meaning. Your “soul mate” is the person who you want to be with, who understands you. A “mate” just means a person who is your friend or person who you are with. In British English people may sometimes called each other “mates,” a man might call his friend a “mate.” But in American English, “mate” always means a person you are romantically connected with and/or married to. You can be romantically connected and not married and you can be married and not romantically connected, but I don’t have time for your marriage problems right now; we have a podcast to do!

So, the doctor said that these students, they go to the big city, and they meet someone in their medical school or on campus or somewhere in the city, and they decide to marry that person. Well, the problem is that person often is not from a small town; they’re from a big city, and they don’t want to move to a small town. “Their soul mate,” he says, “happens to be from a big city.” “Happens to be” means it just turns out that way. They don’t go looking for someone from a big city, but if you’re in a big city most of the people themselves will be from big cities – that’s why the cities are big – and therefore the person doesn’t go back to the small town – to the rural area, and that’s why Dr. Cathcart-Rake says, “we never see them again,” they never come back. He says these students get captured in the big city. Normally “to be captured” (captured) means that someone takes you, usually with some sort of violence or force, and holds you. This happens, for example, in a war. When you are beating the other side you may capture some of their soldiers – some of their fighters. That’s to capture. Well here, the doctor uses the word “capture” not in the meaning of they’re physically held by someone else against their will – that is, by force, but rather the big city, because it’s so interesting and because perhaps they can make more money there, because they can meet more interesting people there, they get “captured” by the city.

“Hopefully,” he says (he says with great hope), “if we train them in smaller communities (if we train these students in smaller communities – in smaller towns), they can meet their prospective spouses there.” “To train (someone)” means to teach them to do something, to give them opportunities to practice that something. We talk about training doctors; it’s the same as educating them. But “train” as a verb is often used when we’re dealing with some sort of specific job-related skill, in this case the skill of dealing with curing and helping people who are sick. Well, the doctor’s idea here is that if we train these students in smaller communities they will meet their prospective spouses here. “Prospective” (prospective) is an adjective used to describe something that is in the future. Your “spouse” (spouse) is the man or woman whom you marry, the person who becomes your husband or wife. So, your “prospective spouse” is the person that you may some day married or will some day marry. If you are a listener to ESL Podcast but you’re not yet a member, we could call you a “prospective member,” meaning we hope some day you will become a member, not a prospective spouse – at least not for me, I’m already married, I’m sorry. Um, you know, I just already have a wife, okay? Um, so I can’t really be looking for a prospective spouse among those of you who are listening. But, you can be a member, and I promise never to divorce you!

Dr. Cathcart-Rake explains that this program hopes that students who study in the small towns will then meet their prospective spouse in these small towns. He says the students “can network here and can have those connections which hopefully can be lifelong.” “To network” usually means to build relationships with other people, other professionals, people in your area, people in your kind of work, people who do the things that you do; in this case, perhaps other doctors or other professionals in the towns where they live. When we say something is “lifelong” (lifelong – one word) we mean that it will remain that way until you die. So, “lifelong connections” would be connections or relationships that you have for the rest of your life. That’s often difficult if you move from one place to another; it’s sometimes hard to maintain those relationships for your entire life. I’ve lived in California for 20 years. There are a lot of connections and relationships I had in Minnesota when I was growing up that I no longer have. They’re not lifelong; they didn’t continue because I’m not there anymore. Well, the good doctor here wants these medical students to study in the small towns so they never go to the big city. You see? We keep them in the small towns, they meet their spouse, they make these lifelong connections through networking, and they’ll stay there and be able to be doctors and help the people who live there.

Let’s listen to Dr. Cathcart-Rake one more time.


They say, you know, I really have every intention of coming back to rural Kansas but they meet a soul mate, they get married. Their soul mate happens to be from a big city and we never see them again. They get captured in the big city. Hopefully, if we train them in smaller communities, they can meet their prospective spouses here, they can network here and they have those connections which hopefully can be lifelong.

[end of recording]

Now we’ll listen to one of the students in this program, a young woman. She’s called Claire Hinrichsen – I think that’s her name. Anyway, she’s a medical student in this program, located in a town called Salina, in Kansas. She’s going to talk about what it’s like to take classes that are taught electronically, when the teacher isn’t actually in the same room as you are. Let’s listen.


It’s set up with interactive TV and so we have two monitors. One, we get to see the lecturer’s slides; the other monitor, we get to see a video of the lecturer.

[end of recording]

Young Claire begins by saying, “It’s set up with interactive TV.” Well, “it” is the classroom. So the classroom where the students are sitting is “set up with.” “To set up (something)” is a two-word phrasal verb meaning to organize something or to put something in a place and get it operating correctly. We often use this when talking about machines or electronic equipment, such as a new television. When you buy a new television you have to set it up, meaning you have to put it where it’s supposed to go, you have to plug it in, you have to perhaps plug in or connect some cables to it, an antenna; all this is part of setting it up. When you buy a new computer you have to set it up. You have to install or put on the programs, the software you want to use, and so forth. Well, this classroom is set up, meaning it’s arranged, with an interactive TV. When we say something is “interactive” (interactive) we mean that you’re not just watching the television like you watch your television at home, you can actually interact with or communicate with someone through the television. We talk about interactive websites, where you don’t just read them and listen to them or watch them; you can actually communicate back with someone else through the website. Well, interactive television is like that; you’re able to react to it, to respond to it.

Claire says that the classroom is set up with interactive television; they have two monitors in the room. A “monitor” (monitor) is an electronic screen, especially one connected to a computer or to some other medical device. Here, the monitor is connected to a computer, which is connected to the Internet. What happens is that in one monitor – remember they have two – she says, “we get to see lecturer’s slides. A “lecturer” (lecturer) is a person who is giving a presentation – an educational presentation, such as a professor or a teacher. We might call that person a “lecturer.” A “lecturer” is someone either in a school or perhaps in a large room who’s giving a presentation. We sometimes say “giving a talk” or “giving a lesson” or “giving a class” or “teaching a course,” all of those are possible. The lecturer is giving a lecture – a class. In this case, it’s a professor in one of the big city universities.

She mentions the lecturer’s slides. “Slides” (slides) nowadays refer to images, pictures on a large screen during a presentation. Many people use Microsoft’s PowerPoint software, or if you’re a Mac user you might use the Mac software Keynote. Well in any case, when you have one of these presentations you have different images that you put up on the screen. We called them “slides” because in the old days before computers people would give presentations like this sometimes, and they would have a small machine called a “projector” – a “slide projector,” and they would have these little pieces of transparent film that they would put into the machine that would show the picture up on a large screen. In the old days when you took pictures with a camera you could either have the pictures developed as regular “prints,” regular pictures that you can hold and see, or you could have them developed as slides, and a slide would be this sort of little picture that you have to put into a machine before you can see it. We still use that same word, “slide,” to describe the screens that you show people in a presentation through a piece of software like PowerPoint.

Anyway, Claire – young Claire – I don’t know if she’s young. She sounds young, though, doesn’t she? She sounds like she’s maybe, I don’t know, in her early 20s perhaps. In any case, dear Claire says that while one monitor shows the lecturer’s slides, the other monitor shows a video of the lecturer. So the students sitting in the classroom are looking at two different computer monitors – two different computer screens, and in one screen they see the presentation slides, the PowerPoint presentation of the professor, and in the other monitor they see the ugly professor’s face. I say “ugly” because all professors are kind of ugly – I was a professor so I know! Most professors, not all professors; there are two or three in the world perhaps who are not ugly. Anyway, let’s listen to Claire one more time. Shall we?


It’s set up with interactive TV and so we have two monitors. One, we get to see the lecturer’s slides; the other monitor, we get to see a video of the lecturer.

[end of recording]

Thanks to the good Dr. Cathcart-Rake and young Claire, and to Voice of America for those audio segments.

Now let’s answer some of the questions that you have sent to us.

Our first question comes from Patrick (Patrick). Patrick is from New Caledonia. Patrick wants to know the difference between “let’s start” and “let’s get started.” Well really, these two things basically mean the same thing. The problem isn’t really in understanding these two expressions, but using the verb “let’s” or the expression “let’s” (let us) in other cases, especially when you add the verb “get.” Let’s just start, shall we? Let’s start with “let’s start” and “let’s get started.”

Both “let’s start” and let’s get started” really mean let’s begin right now. “Let’s” (let’s) is short for “let us,” and it’s used to say we are all going to do this or I want you and I to do this. “Let’s start” means I want you and I to begin. “Let’s start the movie,” let’s start watching the movie. “Let’s get started” means, as I mentioned earlier, basically the same thing. However, when you say “let’s get started, typically you will add the preposition “on” afterwards: “Let’s get started on our project.” “Let’s get started on watching this movie.” “Let’s get started on this recipe for pumpkin pie.” “On” is a preposition and it begins what’s called a prepositional phrase, which means the word that comes after “on” has to be some sort of noun. That’s why we say “let’s get started on this project,” “project” is a noun. “Let’s get started on watching the movie.” “Watching” is what we call a gerund (gerund), which is a verb acting as a noun.

Okay, so that’s pretty clear. “Let’s get started on (something)” or “let’s start.” Both of these mean we want to begin the action right now. The problem comes in in using “let’s” with other verbs, especially when you add the verb “get.” “Let’s work” means let’s begin working right now. “Let’s play” means we’re going to start playing now. “Let’s go to the movies” means I want you and I to get in our car and drive to a movie theater and watch a movie. “Let’s clean the house” means I want you and I to start cleaning my house. When I say “you and I” it could be you and somebody else and three other people and I, whoever else is together with you or with me.

That’s the simple one, “let’s do (something).” However, when you say “get” things get a little more complicated. If you say “let’s get” and the next word is the past tense of the verb – “let’s get cleaned,” let’s get washed” – you mean that that action is going to happen to you. You and I aren’t going to do the washing or the cleaning, someone else is going to wash or clean us. That’s “let’s” plus “get” plus the past tense of the verb – except “started.” “Started” is the past tense of the verb, but that’s a different case. For other verbs it means that the action is going to happen to you. If you say “let’s get cleaning” or “let’s get washing” or “let’s get going,” then it does mean you and I are doing the action, so it’s like “let’s go,” “let’s start,” let’s get going,” “let’s get cleaning.” It’s an informal way of saying I want you and I to begin doing this action, whatever it is: cleaning, going, washing. However, remember “start” is an exception to the rule; we don’t say “let’s get starting,” no, we say “let’s get started.” But if we’re using most other verbs, and we want the idea to be that you and I are going to begin this action, then we use the “ing” form. “Let’s get running.” “Let’s get cooking.” It’s an informal way of saying let us start cooking, let us begin running, let us commence cleaning. All of these are connected with the “ing” after the “let’s get.” “Let’s get cleaning” means the same as “let’s clean.”

Finally, “let’s get” can also be used with certain adjectives: “let’s get wet.” Here, it means that I want you and I to put water on ourselves or to jump into the pool or to dive into the lake; I want the two of us to get wet. If you’re having a really bad day you might say to your friend, jokingly we hope, “Let’s get drunk,” meaning let’s go out and have 10 beers and 5 whiskeys and 3 vodkas and get completely inebriated, to drink so much alcohol that you can’t even say what your name is. “Let’s get drunk.” “Let’s get wet.” That only works for a small number of adjectives, however; you can’t use that for every adjective, so it’s best probably not to try to use the expression “let’s get” with an adjective. You can use it with a verb, remembering that there’s a difference when you say “let’s get” plus the past tense of the verb, “let’s get” plus the “ing” form of the verb, and “let’s get started on (something).”

Our next question – which I hope will be less confusing, at least the answer – comes from Ahmad (Ahmad) in Iran. The question has to do with two words – two adverbs: “continuously” and “continually.”

“Continuously” (continuously) means without stopping, uninterrupted, something that happens over and over without any pause, without any stopping. “Tim laughed continuously throughout the television show.” It was so funny he never stopped laughing.

“Continually” is something that happens often, but there are starting and stopping going on, and it happens at regular intervals – at regular pauses. There are pauses or stops in between the action. “My friend is continually sick (is continually ill).” That doesn’t mean that they’re sick all of the time every day, every week. It means that it happens often, on a regular basis: every other week. Sometimes they’re sick, sometimes they’re not, but on a regular schedule almost they get sick. If I said, “My friend is continuously sick,” then I would mean that he or she is always sick; they are never healthy, they are never well.

Finally, Talal (Talal) from Libya wants to know the meaning of the word “chaos” (chaos). “Chaos” means complete confusion, complete disorder. It’s a situation where people are perhaps being loud, are not obeying the law, are not obeying the rules, maybe there’s violence going on: people are hitting each other. It can mean a lot of different kinds of situations, but all of them are confusing and somehow not following the regular rules or the regular laws. It can mean the opposite of “peaceful.” Sometimes we have chaos when you have a natural disaster. We have an earthquake or a flood or a tornado, people might describe the situation as “chaos” afterwards, meaning there’s confusion, there’s a lot of disorder. For a while I taught high school here in the U.S. in Minnesota, and the principal – the leader of the school – would sometimes come into my classroom and say, “Jeff, why is there always chaos in your classroom?” Well, that’s because I wasn’t a very good teacher!

If you have chaos in your life, go see a psychologist! But, if you have a question about English, then email us at eslpod@eslpod.com, and we’ll do our best to answer you.

From Los Angeles, California, I’m Jeff McQuillan. Thank you for listening. Come back and listen to us again here on the English Café.

ESL Podcast’s English Café is written and produced by Dr. Jeff McQuillan and Dr. Lucy Tse, copyright 2012 by the Center for Educational Development.

intention – what one truly plans to do, but often ends up doing something else instead

* It wasn’t my intention to hurt your feelings. I’m sorry for what happened.

rural – an area that is far from a big city, generally associated with farming or areas with many trees

* Kai grew up in a rural area and it was difficult for him to adjust to life in the big city.

soul mate – the one person who we’re supposed to find in our life and then have a romantic relationship with; one special person who is a perfect match for one

* Do you believe in soul mates, or do you believe there are many people you could live happily with for the rest of your life?

to be captured – to be caught against one’s will, especially in a war; to be held or fascinated by something so that one cannot leave it or stop doing it

* All the men in the room were captured by the woman’s beauty.

to train – to teach someone something and to show him or her how to do it, offering many opportunities to practice under supervision, or while someone with more experience is watching

* Ollie is an electrician who really enjoys training young people.

prospective – describing something that may happen in the future or is likely to happen in the future

* You’ll have an opportunity to meet a lot of prospective clients at this party.

lifelong – for the rest of one’s life; lasting one’s entire life

* Many people form lifelong friendships in college.

interactive – participatory; requiring back-and-forth interactions and responses

* The workshop was very interactive. The instructor had the participants work in small groups and share their ideas with the rest of the participants.

monitor – an electronic screen, especially for a computer or for a medical device

* This monitor shows how quickly the patient’s heart is beating and how much oxygen is in his blood.

lecturer – a person giving a lecture or presentation, especially a professor

* When our professor was on vacation, we had a guest lecturer for our chemistry class.

slides – the images shown on a large screen during a presentation, especially when using Microsoft’s PowerPoint software

* The slides were really difficult to read. I wish the presenter had used brighter colors and a larger font.

continuously – without stopping; uninterrupted; something that happens over and over without pause (stopping briefly and starting again) or stopping

* Jun chatted continuously throughout the meal.

continually – occurring often and/or at regular intervals (stopping and starting at regular times), with pauses between actions

* Helen continually fails to get to work on time.

chaos – complete confusion and disorder; a situation where people are not behaving peacefully, but are being loud and not behaving according to the law

* We didn’t realize that having a birthday party with 12 four-year-olds would bring so much chaos into our home!

What Insiders Know
Loan Forgiveness Program for Rural Doctors and Nurses

In an attempt to get more doctors and “nurses” (people who help doctors in the hospital or doctor’s office) to work in rural areas of the United States, governments and organizations have programs that “repay” (pays back) part of the “loan” (money lent to someone for a specific reason) that medical and nursing students may take out to pay for medical school or nursing training. “Medical school,” a school that teaches doctors how to help “injured” (hurt) people, and “nursing programs” that train future nurses can be very expensive, depending on which university a student attends. In loan forgiveness programs, doctors or nurses who decide to work in a rural community where there aren’t enough medical professionals do not need to pay all or any of the loan back.

For example, in a typical loan forgiveness program, a doctor or nurse is able to stop repaying their loan after 120 monthly payments if they qualify for the program. To do this, he or she must have a certain type of loan and have made all of their payments on time, and they must also be “employed full-time” (in this case, working at least 30 hours per week) in a “public service job,” or a job that helps people in a government medical program, rather than become a doctor or nurse for a private medical office or hospital.

In the Nursing Education Loan Forgiveness program from the U.S. Department of Health and Human Services, for example, the goal is to get more nurses into areas that have long had a “shortage” (having a need, but not enough for those needs). If a nurse graduates nursing school and agrees to work for two years teaching nursing to other students, 60 percent of their “tuition” (money they paid to go to school) will be given back to them. To be “eligible” (able to apply for) this program, one must be a “registered nurse” (a nurse with an advanced degree) or a nursing teacher, and he or she must also be a U.S. citizen.