DATEXIS/aci_bench_intent_annotated · Datasets at Hugging Face

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doctor: it's with ibuprofen okay what's your pain level without then patient: i would say probably a six	D2N042	9	[ "Acute Symptoms" ]	[ "Subjective" ]	it's with ibuprofen okay what's your pain level without then	1,200
doctor: okay alright that that sounds good have you ever injured that foot and ankle before patient: you know i've had a lot of injuries to my ankle but i've never hurt this ankle before i just realized an error	D2N042	11	[ "Personal History" ]	[ "Subjective" ]	okay alright that that sounds good have you ever injured that foot and ankle before	1,201
doctor: okay you know and i see here that you have a history of playing sports looks like you played soccer in college and then played a little bit of a inner marrow soccer now patient: yeah	D2N042	12	[ "Other Socials" ]	[ "Subjective" ]	okay you know and i see here that you have a history of playing sports looks like you played soccer in college and then played a little bit of a inner marrow soccer now	1,202
doctor: i'm i'm guessing you probably have n't been able to do that since you hurt your ankle patient: no i have not been	D2N042	13	[ "Other Socials" ]	[ "Subjective" ]	i'm i'm guessing you probably have n't been able to do that since you hurt your ankle	1,203
doctor: so did you hear about the new major league soccer stadium and team that's coming to town they opened in the this year actually they built the stadium have you been down there yet patient: no i have to get there	D2N042	14	[ "Chitchat" ]	[ "Null" ]	so did you hear about the new major league soccer stadium and team that's coming to town they opened in the this year actually they built the stadium have you been down there yet	1,204
doctor: yeah we are all excited it's going to be a good time well have you experienced any numbness or tingling in that right foot patient: no	D2N042	15	[ "Acute Symptoms" ]	[ "Subjective" ]	yeah we are all excited it's going to be a good time well have you experienced any numbness or tingling in that right foot	1,205
doctor: okay so if it's okay with you i would like to do a quick physical exam your vitals look good and everything there looks okay now i'm gon na do a focused exam on your right ankle i do appreciate some ecchymosis or bruising over the lateral malleolus malleolus associated with some edema or swelling of that area you are positive for tenderness to palpation of the anterior lateral soft tissue and now i do n't appreciate any laxity on anterior drawer and inversion stress there is no bony tenderness on palpation to that foot or ankle area now on neurovascular exam of your right foot you have brisk capillary refill of less than three seconds strong dorsalis pedis pulse and your sensation is intact to light touch and all of that is consistent with what's present on your left side as well so i did review the results of your of your x-ray the x-ray of your right ankle showed no fracture which is a good thing so now let me talk to you a little bit about my assessment and plan so for the first problem of right ankle pain your symptoms are consistent with a right ankle sprain or i'm sorry right ankle sprain of your lateral ligament complex more specifically your anterior talofibular ligament now this ligament's on the outside of your ankle ankle which got stretched when you fell the best treatment at this time for your sprain is to keep your leg elevated when you're seated and let's continue to ice okay you're gon na be given an air cast which is gon na help stabilize that ankle and i'm also going to prescribe some crutches because i want you to stay off that leg and start walking on it stay off your leg for now and then in a couple of days start walking on it as tolerated do you have any questions or concerns for me patient: so how long do you think it'll take to heal	D2N042	16	[ "Physical Examination", "Other Treatments", "Radiology Examination", "Acute Assessment" ]	[ "Objective", "Assessment", "Plan" ]	okay so if it's okay with you i would like to do a quick physical exam your vitals look good and everything there looks okay now i'm gon na do a focused exam on your right ankle i do appreciate some ecchymosis or bruising over the lateral malleolus malleolus associated with some edema or swelling of that area you are positive for tenderness to palpation of the anterior lateral soft tissue and now i do n't appreciate any laxity on anterior drawer and inversion stress there is no bony tenderness on palpation to that foot or ankle area now on neurovascular exam of your right foot you have brisk capillary refill of less than three seconds strong dorsalis pedis pulse and your sensation is intact to light touch and all of that is consistent with what's present on your left side as well so i did review the results of your of your x-ray the x-ray of your right ankle showed no fracture which is a good thing so now let me talk to you a little bit about my assessment and plan so for the first problem of right ankle pain your symptoms are consistent with a right ankle sprain or i'm sorry right ankle sprain of your lateral ligament complex more specifically your anterior talofibular ligament now this ligament's on the outside of your ankle ankle which got stretched when you fell the best treatment at this time for your sprain is to keep your leg elevated when you're seated and let's continue to ice okay you're gon na be given an air cast which is gon na help stabilize that ankle and i'm also going to prescribe some crutches because i want you to stay off that leg and start walking on it stay off your leg for now and then in a couple of days start walking on it as tolerated do you have any questions or concerns for me	1,206
doctor: so your symptoms should significantly improve over a few weeks but i'd like to follow up with you and see how you're doing let's say i'll see you again in fourteen days now i do want you to go ahead and continue to take nsaids or ibuprofen as needed to help with any pain and that's also gon na help reduce that inflammation and swelling okay patient: okay	D2N042	17	[ "Follow-up", "Medication" ]	[ "Plan" ]	so your symptoms should significantly improve over a few weeks but i'd like to follow up with you and see how you're doing let's say i'll see you again in fourteen days now i do want you to go ahead and continue to take nsaids or ibuprofen as needed to help with any pain and that's also gon na help reduce that inflammation and swelling okay	1,207
doctor: alright i will see you again in two weeks carolyn patient: great thank you	D2N042	18	[ "Follow-up" ]	[ "Plan" ]	alright i will see you again in two weeks carolyn	1,208
doctor: you're welcome	D2N042	19	[ "Chitchat" ]	[ "Null" ]	doctor: you're welcome	1,209
doctor: how are you doing patient: i'm doing i'm good i'm i'm doing really good i'm here i'm just ready to quit smoking and but i've been having quite a hard time with it	D2N043	0	[ "Greetings" ]	[ "Subjective" ]	how are you doing	1,210
doctor: well i'm glad that you're taking the first steps to quit smoking would you tell me a little bit more about your history of smoking patient: yeah so i've been smoking for some time now i started in high school and was just you know just experimenting and smoking here and there with friends or at parties and then it just started getting more regular and regular and i do n't even know how i'm 44 now and i'm smoking everyday so yes now i'm up to a pack and a half a day	D2N043	1	[ "Drug History" ]	[ "Subjective" ]	well i'm glad that you're taking the first steps to quit smoking would you tell me a little bit more about your history of smoking	1,211
doctor: okay do you use any other type of tobacco products patient: no smoking is enough	D2N043	2	[ "Drug History" ]	[ "Subjective" ]	okay do you use any other type of tobacco products	1,212
doctor: okay and i understand that so when you wake up in the morning how soon after waking up do you smoke your first cigarette patient: i would say probably within an hour of waking up i'll have my first cigarette	D2N043	3	[ "Vegetative History" ]	[ "Subjective" ]	okay and i understand that so when you wake up in the morning how soon after waking up do you smoke your first cigarette	1,213
doctor: okay so i'm really excited that you wan na quit and i know that you probably heard this multiple times before but this really is one of the best things that you can do to help your health especially since you have the history of gout and type two diabetes this is really gon na be a great step in you having better long term health outcomes patient: yeah i know and you know i'm really motivated now because i am about to be a father any day now and i just really wan na be there for my daughter growing up	D2N043	4	[ "Personal History" ]	[ "Subjective" ]	okay so i'm really excited that you wan na quit and i know that you probably heard this multiple times before but this really is one of the best things that you can do to help your health especially since you have the history of gout and type two diabetes this is really gon na be a great step in you having better long term health outcomes	1,214
doctor: hey that's great and that's great to hear congratulations i'm so excited to hear about the new baby patient: yeah	D2N043	5	[ "Chitchat" ]	[ "Null" ]	hey that's great and that's great to hear congratulations i'm so excited to hear about the new baby	1,215
doctor: i i have a daughter myself have have you picked out any names patient: we're you know we're deciding between a few names but we're kinda just waiting to see her to see which name fits	D2N043	6	[ "Chitchat" ]	[ "Null" ]	i i have a daughter myself have have you picked out any names	1,216
doctor: okay alright that sounds good well congratulations again i'm very excited for you and your and and your wife that that's this is great patient: thank you	D2N043	7	[ "Chitchat" ]	[ "Null" ]	okay alright that sounds good well congratulations again i'm very excited for you and your and and your wife that that's this is great	1,217
doctor: so you mentioned you tried to quit before can you tell me a little bit about the methods that you used or or what you tried patient: yeah actually i just went cold turkey one day i woke up and i said you know i've had enough and i know that smoking is not good for me so i woke up and stopped and i actually did really well and i was able to quit smoking for almost a year and then things just started getting really stressful at work they started laying people off and i'm happy i still have a job but that also meant that i was responsible for more things so things just got stressful and i and just started picking it up again	D2N043	8	[ "Drug History" ]	[ "Subjective" ]	so you mentioned you tried to quit before can you tell me a little bit about the methods that you used or or what you tried	1,218
doctor: well you are absolutely correct you know stress can often be a trigger for things like smoking and drinking have you thought what you would do this time when you encountered the stressful situations patient: yeah i i did n't think about that a lot actually and one thing is i have started learning and trying to do more meditation and then i also just recently joined the gym so i'm really looking forward to working out again	D2N043	9	[ "Drug History" ]	[ "Subjective" ]	well you are absolutely correct you know stress can often be a trigger for things like smoking and drinking have you thought what you would do this time when you encountered the stressful situations	1,219
doctor: okay well that's great to hear that you're getting back in the gym that will be good for your long term health too you know helping to maintain that type two diabetes you know those are really great strategies talking about gym for stress relief and and you know we have other products as well that you can use for an additional aid to help you stop smoking have you given any thought to using some type of smoking cessation aid at this time or or what do you think about that patient: you know i've had you know because i've been trying to do cold turkey and it's not working and some of my friends actually have mentioned using a patch and they they've had some success with that so i think i would i would probably wan na start with that	D2N043	10	[ "Discussion", "Medication", "Drug History" ]	[ "Plan" ]	okay well that's great to hear that you're getting back in the gym that will be good for your long term health too you know helping to maintain that type two diabetes you know those are really great strategies talking about gym for stress relief and and you know we have other products as well that you can use for an additional aid to help you stop smoking have you given any thought to using some type of smoking cessation aid at this time or or what do you think about that	1,220
doctor: okay alright that that sounds good it's good that you've you've picked out one of those aids and have you thought of a quit date i mean we we really wan na talk about when you're gon na say this is the day patient: yeah you know next monday is actually my birthday so i think that's a good day	D2N043	11	[ "Discussion" ]	[ "Plan" ]	okay alright that that sounds good it's good that you've you've picked out one of those aids and have you thought of a quit date i mean we we really wan na talk about when you're gon na say this is the day	1,221
doctor: that's a fantastic day and happy birthday coming up on monday patient: thank you	D2N043	12	[ "Chitchat" ]	[ "Null" ]	that's a fantastic day and happy birthday coming up on monday	1,222
doctor: so let's talk a little bit about your exam here okay i'm gon na go ahead and do a quick physical exam and i reviewed your vitals and everything looks good including your oxygen saturation blood pressure for today was one twenty eight over eighty eight heart rate was sixty eight respirations were sixteen and your pulse ox was ninety eight percent on room air so those were all really good now on your heart exam you do have a nice regular and your your rate is of regular rate and rhythm or i'm sorry your heart exam for your heart exam notice that your heart is regular in rate and rhythm i do however still appreciate that two over six systolic murmur that we talked about in the past now that's okay we'll just continue to monitor that now for your lung exam i'm gon na go ahead and listen to your lungs your lungs are clear and equal bilateral with no expiratory wheezes and no rales or rhonchi are appreciated on your neck exam i do n't appreciate any lymphadenopathy when i listen i do n't hear any extra noises so i do n't hear any hearing any carotid bruit which is a good thing now for my impression and plan let's talk a little bit about my assessment and plan for you so for your first problem of nicotine dependence first of all i just want to apply you on making this first step to stop smoking and i want you to know with absolute one hundred percent certainty that i'm gon na be with you every step of the way i think it's fantastic that you're very welcome i i i think it's fantastic you've chosen next monday as a quit date and on that day i'm gon na start you with a twenty one milligram nicotine patch and the goal will be to decrease that over time okay now we will work together to decrease that so there is no necessarily hard dates in mind okay be sure to change the patch location each day and that's going to help reduce or avoid that skin irritation that can occur if you use the same location over and over again i would like to see you again in two weeks just to see how things are going and we will reevaluate at that time the dosage for your nicotine patch now we also see further need to discuss any handouts you received today for those common smoking triggers i really want you to keep an eye on and monitor your stress level not only about work but also the fact that you are experiencing are going to be be a new father and we really want to watch any stress you will be experiencing around the birth of your new child so please keep an eye on that and let me know how that goes now for now until we meet in two weeks go ahead and keep up your exercise routine i think that's a great plan and just try to monitor your stress and and maybe think about some things like meditation or adding in some yoga and that type of thing to help further work with your your stress levels so do you have any questions for me patient: no not at this time	D2N043	13	[ "Physical Examination", "Discussion", "Follow-up", "Medication", "Acute Assessment", "Drug History" ]	[ "Objective", "Assessment", "Plan" ]	so let's talk a little bit about your exam here okay i'm gon na go ahead and do a quick physical exam and i reviewed your vitals and everything looks good including your oxygen saturation blood pressure for today was one twenty eight over eighty eight heart rate was sixty eight respirations were sixteen and your pulse ox was ninety eight percent on room air so those were all really good now on your heart exam you do have a nice regular and your your rate is of regular rate and rhythm or i'm sorry your heart exam for your heart exam notice that your heart is regular in rate and rhythm i do however still appreciate that two over six systolic murmur that we talked about in the past now that's okay we'll just continue to monitor that now for your lung exam i'm gon na go ahead and listen to your lungs your lungs are clear and equal bilateral with no expiratory wheezes and no rales or rhonchi are appreciated on your neck exam i do n't appreciate any lymphadenopathy when i listen i do n't hear any extra noises so i do n't hear any hearing any carotid bruit which is a good thing now for my impression and plan let's talk a little bit about my assessment and plan for you so for your first problem of nicotine dependence first of all i just want to apply you on making this first step to stop smoking and i want you to know with absolute one hundred percent certainty that i'm gon na be with you every step of the way i think it's fantastic that you're very welcome i i i think it's fantastic you've chosen next monday as a quit date and on that day i'm gon na start you with a twenty one milligram nicotine patch and the goal will be to decrease that over time okay now we will work together to decrease that so there is no necessarily hard dates in mind okay be sure to change the patch location each day and that's going to help reduce or avoid that skin irritation that can occur if you use the same location over and over again i would like to see you again in two weeks just to see how things are going and we will reevaluate at that time the dosage for your nicotine patch now we also see further need to discuss any handouts you received today for those common smoking triggers i really want you to keep an eye on and monitor your stress level not only about work but also the fact that you are experiencing are going to be be a new father and we really want to watch any stress you will be experiencing around the birth of your new child so please keep an eye on that and let me know how that goes now for now until we meet in two weeks go ahead and keep up your exercise routine i think that's a great plan and just try to monitor your stress and and maybe think about some things like meditation or adding in some yoga and that type of thing to help further work with your your stress levels so do you have any questions for me	1,223
doctor: okay so for your other conditions that we talked about briefly your second condition of type two diabetes we'll let's go ahead and continue to maintain that with diet and exercise and we'll just monitor your type two diabetes i am gon na go ahead and order a hemoglobin a1c for your next blood draw since i'll see you in two weeks go ahead and have that done and we will talk about that when you come back in now for your third problem of your history of gout let's go ahead and continue you on your allopurinol and just you know continue to watch those foods that will exacerbate your uric acid levels any other questions about those patient: no i think that's it thanks so much	D2N043	14	[ "Follow-up", "Medication", "Reassessment" ]	[ "Assessment", "Plan" ]	okay so for your other conditions that we talked about briefly your second condition of type two diabetes we'll let's go ahead and continue to maintain that with diet and exercise and we'll just monitor your type two diabetes i am gon na go ahead and order a hemoglobin a1c for your next blood draw since i'll see you in two weeks go ahead and have that done and we will talk about that when you come back in now for your third problem of your history of gout let's go ahead and continue you on your allopurinol and just you know continue to watch those foods that will exacerbate your uric acid levels any other questions about those	1,224
doctor: alright sounds good i'll see you in two weeks congratulations on the baby and and we're excited about next monday that's your quit date patient: alrighty thank you	D2N043	15	[ "Follow-up" ]	[ "Plan" ]	alright sounds good i'll see you in two weeks congratulations on the baby and and we're excited about next monday that's your quit date	1,225
doctor: you're welcome i'll see you in two weeks thanks bye-bye patient: alright bye	D2N043	16	[ "Chitchat" ]	[ "Null" ]	you're welcome i'll see you in two weeks thanks bye-bye	1,226
doctor: good morning julie how are you doing this morning patient: i've been better my primary care doctor wanted me to see you because of this this knee pain that i've been having for about six months now	D2N044	0	[ "Greetings" ]	[ "Subjective" ]	good morning julie how are you doing this morning	1,227
doctor: okay and do you remember what caused the pain initially patient: honestly i do n't i ca n't think of anytime if i fell or like i i've really been trying to think and i ca n't really think of any specific event	D2N044	1	[ "Acute Symptoms" ]	[ "Subjective" ]	okay and do you remember what caused the pain initially	1,228
doctor: okay now it it says here that it's in both knees is that correct patient: yes both my knees	D2N044	2	[ "Acute Symptoms" ]	[ "Subjective" ]	okay now it it says here that it's in both knees is that correct	1,229
doctor: okay it kinda try let's let's try describing the pain for me please patient: yeah it's kind of feels like it's like right behind my kneecaps	D2N044	3	[ "Acute Symptoms" ]	[ "Subjective" ]	okay it kinda try let's let's try describing the pain for me please	1,230
doctor: a deep achy pain okay what kind of activities makes the pain feel worse patient: let's see so anytime so if i'm sitting at my desk and i get up i have a lot of pain so anytime from like standing up from sitting for a while or even going up and down the stairs	D2N044	5	[ "Acute Symptoms" ]	[ "Subjective" ]	a deep achy pain okay what kind of activities makes the pain feel worse	1,231
doctor: okay so you work from home patient: i do	D2N044	6	[ "Other Socials" ]	[ "Subjective" ]	okay so you work from home	1,232
doctor: okay okay so there is a lot of desk setting at home is your office upstairs or is it i mean do you have to go up or downstairs to get to it patient: no well first thing in the morning but otherwise it's downstairs	D2N044	7	[ "Other Socials" ]	[ "Subjective" ]	okay okay so there is a lot of desk setting at home is your office upstairs or is it i mean do you have to go up or downstairs to get to it	1,233
doctor: okay okay how do you like working from home patient: you know it has it's plus and minuses	D2N044	8	[ "Other Socials" ]	[ "Subjective" ]	okay okay how do you like working from home	1,234
doctor: and the parking i'm sure the parking is patient: and the parking is great	D2N044	11	[ "Chitchat" ]	[ "Null" ]	and the parking i'm sure the parking is	1,235
doctor: yeah i you know if i could do telehealth visits all day long i would be totally happy with that yeah and just set it home and do those so you mentioned is there anything that makes that pain feel better patient: usually after like if i feel that pain and then i just it does get better	D2N044	12	[ "Acute Symptoms" ]	[ "Subjective" ]	yeah i you know if i could do telehealth visits all day long i would be totally happy with that yeah and just set it home and do those so you mentioned is there anything that makes that pain feel better	1,236
doctor: okay now you mentioned earlier that you tried some things in the past what have what are they and did they work at all patient: yeah i've done some ibuprofen or aleve sometimes some tylenol and that does help	D2N044	13	[ "Therapeutic History" ]	[ "Subjective" ]	okay now you mentioned earlier that you tried some things in the past what have what are they and did they work at all	1,237
doctor: okay but you're never really pain free is that what i hear you saying patient: not really unless i'm like really just resting which i hate to do but otherwise any type of movement especially from sitting it causes pain	D2N044	15	[ "Acute Symptoms" ]	[ "Subjective" ]	okay but you're never really pain free is that what i hear you saying	1,238
doctor: okay so are you active other than going up and down the steps to your office patient: very i'm a big runner i love to run i run about five to six miles a day but with this knee with with these knee pain that i've been having it's i barely can even do half a mile	D2N044	16	[ "Personal History" ]	[ "Subjective" ]	okay so are you active other than going up and down the steps to your office	1,239
doctor: yeah you know what that's that's i am a biker and i know that once you get that into your you know you have loved doing that activity it's so frustrating when you ca n't it's almost like a it's almost like a dry it almost becomes a drug when you get up patient: exactly	D2N044	17	[ "Chitchat" ]	[ "Null" ]	yeah you know what that's that's i am a biker and i know that once you get that into your you know you have loved doing that activity it's so frustrating when you ca n't it's almost like a it's almost like a dry it almost becomes a drug when you get up	1,240
doctor: okay so have you noticed any redness or swelling in your knees patient: no	D2N044	19	[ "Acute Symptoms" ]	[ "Subjective" ]	okay so have you noticed any redness or swelling in your knees	1,241
doctor: okay and have you ever injured your knees before patient: you know despite how active i am i you know i've never	D2N044	20	[ "Personal History" ]	[ "Subjective" ]	okay and have you ever injured your knees before	1,242
doctor: okay great so let's go ahead and do a i just wan na take a look here i reviewed your vitals and overall they look good your blood pressure is one twenty over seventy your your heart rate is sixty and your respiratory rate is fourteen those are all phenomenal numbers as i listened to your heart it is at a regular and a slower rate but i do n't hear any extra sounds so there is no murmurs as we go through that now on musculoskeletal exam you have a normal gait i watched you you know kinda walk in here this morning your strength i just wan na check it when i go ahead and i want you to move your leg okay your muscle strength is is good you do have a three out of five for abduction of your legs bilaterally and that's you know kinda bringing your legs in the remainder of your muscle strength for your lower extremities is a five out of five now let me focus specifically on your knee examination i do n't see any redness or ecchymosis or warmth of the skin and those are big words you know i do n't see any bruising or or that redness there is no effusion that's just like a fluid underneath the knee i do n't appreciate that any at all you do seem to have some tenderness when i palpate and you do have a positive patellar grind test when you stood up i could feel that as we went through there you did say you had that knee pain with squatting but your lachman your anterior and posterior drawer and mcmurray test are all negative bilaterally neurologically and your your your lower extremities your patella and your achilles reflex are symmetrical and that's good so i did review the x-rays of both your knees which shows no fractures or osteoarthritis so based on what you told me and reviewing the mri that you had done before you came in your symptoms are consistent with patellofemoral pain syndrome and this is a really common condition that we see that causes knee knee pain especially in really active young people that's probably why i do n't get it when i'm riding my bike forever and ever now this condition has to do with the way your kneecap moves across along the groove of your thigh bone your femur so for pain i want you to continue to take the ibuprofen or any other anti-inflammatories you know aleve or any of those as you need it to help with the pain now i am going to recommend physical therapy well they will show you a number of lower extremity exercises this is probably one of the best things that you can do and this will help increase your lower extremity strength your mobility and correct any incorrect running mechanics that you might have do you have any questions for me patient: so will i be able to run again	D2N044	22	[ "Physical Examination", "Discussion", "Medication", "Referral", "Acute Assessment" ]	[ "Objective", "Assessment", "Plan" ]	okay great so let's go ahead and do a i just wan na take a look here i reviewed your vitals and overall they look good your blood pressure is one twenty over seventy your your heart rate is sixty and your respiratory rate is fourteen those are all phenomenal numbers as i listened to your heart it is at a regular and a slower rate but i do n't hear any extra sounds so there is no murmurs as we go through that now on musculoskeletal exam you have a normal gait i watched you you know kinda walk in here this morning your strength i just wan na check it when i go ahead and i want you to move your leg okay your muscle strength is is good you do have a three out of five for abduction of your legs bilaterally and that's you know kinda bringing your legs in the remainder of your muscle strength for your lower extremities is a five out of five now let me focus specifically on your knee examination i do n't see any redness or ecchymosis or warmth of the skin and those are big words you know i do n't see any bruising or or that redness there is no effusion that's just like a fluid underneath the knee i do n't appreciate that any at all you do seem to have some tenderness when i palpate and you do have a positive patellar grind test when you stood up i could feel that as we went through there you did say you had that knee pain with squatting but your lachman your anterior and posterior drawer and mcmurray test are all negative bilaterally neurologically and your your your lower extremities your patella and your achilles reflex are symmetrical and that's good so i did review the x-rays of both your knees which shows no fractures or osteoarthritis so based on what you told me and reviewing the mri that you had done before you came in your symptoms are consistent with patellofemoral pain syndrome and this is a really common condition that we see that causes knee knee pain especially in really active young people that's probably why i do n't get it when i'm riding my bike forever and ever now this condition has to do with the way your kneecap moves across along the groove of your thigh bone your femur so for pain i want you to continue to take the ibuprofen or any other anti-inflammatories you know aleve or any of those as you need it to help with the pain now i am going to recommend physical therapy well they will show you a number of lower extremity exercises this is probably one of the best things that you can do and this will help increase your lower extremity strength your mobility and correct any incorrect running mechanics that you might have do you have any questions for me	1,243
doctor: absolutely my goal is to get you out there and maybe we can cross pads on the the bike trail some day you are gon na have to take it a little bit easy for now but we are gon na get you back and once we do that i think you will be really pleased is there anything else patient: no i think that's it	D2N044	23	[ "Chitchat" ]	[ "Null" ]	absolutely my goal is to get you out there and maybe we can cross pads on the the bike trail some day you are gon na have to take it a little bit easy for now but we are gon na get you back and once we do that i think you will be really pleased is there anything else	1,244
doctor: okay have a great day patient: okay you too	D2N044	24	[ "Chitchat" ]	[ "Null" ]	okay have a great day	1,245
doctor: thank you patient: bye	D2N044	25	[ "Chitchat" ]	[ "Null" ]	thank you	1,246
doctor: hi abigail how are you today patient: hello hi nice to meet you i'm i'm doing okay	D2N045	0	[ "Greetings" ]	[ "Subjective" ]	hi abigail how are you today	1,247
doctor: good i'm doctor sanchez and i'm gon na go ahead and take a look i saw with your notes that you've been having some knee pain yes that's that's true you know it's been going on for a while i like to run i do jogs i sign up for the 5k tack you know sometimes the marathon and i have n't been doing longer distances because patient: when i'm running i my right knee here it just starts to ache and it's it's just to the point where i need your opinion	D2N045	1	[ "Acute Symptoms" ]	[ "Subjective" ]	good i'm doctor sanchez and i'm gon na go ahead and take a look i saw with your notes that you've been having some knee pain yes that's that's true you know it's been going on for a while i like to run i do jogs i sign up for the 5k tack you know sometimes the marathon and i have n't been doing longer distances because	1,248
doctor: okay okay what have you done for it so far what makes it better what makes it worse patient: well it used to be that when i run it ache and then i put ice on it and then it would be okay so i do ice and ibuprofen	D2N045	2	[ "Acute Symptoms", "Therapeutic History" ]	[ "Subjective" ]	okay okay what have you done for it so far what makes it better what makes it worse	1,249
doctor: okay okay and did you see anybody for this before coming into the office here patient: yeah i doctor wood is my primary care provider and i talked to him about it actually over the years and this last visit he said he referred me to you	D2N045	3	[ "Personal History" ]	[ "Subjective" ]	okay okay and did you see anybody for this before coming into the office here	1,250
doctor: okay okay good so ice and rest makes it feel better running and and activity makes it hurt a little bit more is that correct patient: yeah that's right	D2N045	4	[ "Acute Symptoms" ]	[ "Subjective" ]	okay okay good so ice and rest makes it feel better running and and activity makes it hurt a little bit more is that correct	1,251
doctor: okay do you have any family history of arthritis or any of those type of immune diseases patient: i'm trying to think no i do n't think so no	D2N045	5	[ "Family History" ]	[ "Subjective" ]	okay do you have any family history of arthritis or any of those type of immune diseases	1,252
doctor: okay and do you get is it is this primarily worse in the morning or does it is it just there all the time when it comes on patient: it actually is worse towards the end of the day	D2N045	6	[ "Acute Symptoms" ]	[ "Subjective" ]	okay and do you get is it is this primarily worse in the morning or does it is it just there all the time when it comes on	1,253
doctor: okay so let's go ahead and i want to do a quick examination here your blood pressure and was one twenty over sixty that's phenomenal your heart rate was fifty eight and you can tell that you're a runner with that that level of a heart rate and your respirations were fourteen so all of that looked very good there was no fever when you came in when i'm gon na just quickly listen to your heart and lungs okay those those sound good but let me get let's focus here on your lower extremities i'm i'm gon na look at your your left knee first when i move your left knee do you get any type of pain or is it just feel like normal and it's always your pain's always isolated to the right patient: that feels that feels normal	D2N045	8	[ "Physical Examination" ]	[ "Objective" ]	okay so let's go ahead and i want to do a quick examination here your blood pressure and was one twenty over sixty that's phenomenal your heart rate was fifty eight and you can tell that you're a runner with that that level of a heart rate and your respirations were fourteen so all of that looked very good there was no fever when you came in when i'm gon na just quickly listen to your heart and lungs okay those those sound good but let me get let's focus here on your lower extremities i'm i'm gon na look at your your left knee first when i move your left knee do you get any type of pain or is it just feel like normal and it's always your pain's always isolated to the right	1,254
doctor: okay okay so let me i just want you to back up here in the stretcher a little bit more and i'm just gon na do some movement of your knee any okay so i want you to push your leg out against my hand does that hurt patient: no	D2N045	9	[ "Physical Examination" ]	[ "Objective" ]	okay okay so let me i just want you to back up here in the stretcher a little bit more and i'm just gon na do some movement of your knee any okay so i want you to push your leg out against my hand does that hurt	1,255
doctor: okay and if you pull back does that hurt a little bit patient: no	D2N045	10	[ "Physical Examination" ]	[ "Objective" ]	okay and if you pull back does that hurt a little bit	1,256
doctor: okay and i'm gon na move it around so when i look at the knee there is no redness there's no swelling i can appreciate a a small amount of effusion and that means that there's a little bit of fluid under the knee or in that knee's joint space and there is there is several reasons that could be now when i push on your knee does it hurt more on the inside or does it hurt more on the outside here patient: the the right knee here hurts on the outside	D2N045	11	[ "Physical Examination" ]	[ "Objective" ]	okay and i'm gon na move it around so when i look at the knee there is no redness there's no swelling i can appreciate a a small amount of effusion and that means that there's a little bit of fluid under the knee or in that knee's joint space and there is there is several reasons that could be now when i push on your knee does it hurt more on the inside or does it hurt more on the outside here	1,257
doctor: okay okay and you've got a good pedal pulse so you know you can feel that and when i touch your feet you do n't have any numbness or tingling or anything like that patient: no uh uh	D2N045	12	[ "Physical Examination" ]	[ "Objective" ]	okay okay and you've got a good pedal pulse so you know you can feel that and when i touch your feet you do n't have any numbness or tingling or anything like that	1,258
doctor: okay well so what i want to tell you is that i think you have a knee sprain from overuse and we see that sometimes in runners now unfortunately you're gon na have to take some a little bit of time off of of active running but i do n't think it will be that long until we can get you up and running again now i reviewed the x-rays that we did when you first came into the office here this morning and the joint spaces of that right knee are are well maintained i do n't see any evidence of any fracture and when compared to the left knee everything looks good so i do n't even see any signs of any arthritis that i would've been suspecting i would like you to stay on two tylenol five hundred milligrams and two ibuprofen two hundred milligram tablets and i want you to take that three times a day and that's gon na help with both the pain and the inflammation i'm also gon na order some physical therapy for your your right knee and that physical therapy will help strengthen the lower extremities and make it give you a little bit of a balance and some they'll be able to recommend good running exercises for you i do wan na follow up with you in two weeks and see if we're getting better so let's no running for two weeks and if we're we're improving then we'll move on and probably start adding some additional activity does that sound like a plan patient: yeah that does i i was curious so i will lay off the running for now can i you know lift weights and do like my squats and and those type of exercises at the gym	D2N045	13	[ "Discussion", "Follow-up", "Medication", "Radiology Examination", "Referral", "Acute Assessment" ]	[ "Objective", "Assessment", "Plan" ]	okay well so what i want to tell you is that i think you have a knee sprain from overuse and we see that sometimes in runners now unfortunately you're gon na have to take some a little bit of time off of of active running but i do n't think it will be that long until we can get you up and running again now i reviewed the x-rays that we did when you first came into the office here this morning and the joint spaces of that right knee are are well maintained i do n't see any evidence of any fracture and when compared to the left knee everything looks good so i do n't even see any signs of any arthritis that i would've been suspecting i would like you to stay on two tylenol five hundred milligrams and two ibuprofen two hundred milligram tablets and i want you to take that three times a day and that's gon na help with both the pain and the inflammation i'm also gon na order some physical therapy for your your right knee and that physical therapy will help strengthen the lower extremities and make it give you a little bit of a balance and some they'll be able to recommend good running exercises for you i do wan na follow up with you in two weeks and see if we're getting better so let's no running for two weeks and if we're we're improving then we'll move on and probably start adding some additional activity does that sound like a plan	1,259
doctor: yeah absolutely and and those are good exercises but i'd like you to get that first physical therapy appointment in and they'll be able to talk with you on what the best exercises are for you to do patient: okay got it	D2N045	14	[ "Discussion", "Referral" ]	[ "Plan" ]	yeah absolutely and and those are good exercises but i'd like you to get that first physical therapy appointment in and they'll be able to talk with you on what the best exercises are for you to do	1,260
doctor: any questions patient: hmmm no i do n't think so	D2N045	15	[ "Discussion" ]	[ "Plan" ]	any questions	1,261
doctor: okay thank you abigail and i'd like i said stop out at the desk and we'll make an appointment for two weeks patient: okay thanks doctor	D2N045	16	[ "Follow-up" ]	[ "Plan" ]	okay thank you abigail and i'd like i said stop out at the desk and we'll make an appointment for two weeks	1,262
doctor: thank you	D2N045	17	[ "Chitchat" ]	[ "Null" ]	doctor: thank you	1,263
doctor: okay so we are recording okay so okay so i understand you've so you've got a past medical history of type two diabetes and you're coming in and for evaluation of a newly diagnosed ovarian cancer so how are you doing today patient: i do n't hear the question but i'm assuming that you when you say batcher so when i start talking about my dog and my three cats and all that those sort of things are not going to be included in the in the note	D2N046	0	[ "Personal History", "Greetings" ]	[ "Subjective" ]	okay so we are recording okay so okay so i understand you've so you've got a past medical history of type two diabetes and you're coming in and for evaluation of a newly diagnosed ovarian cancer so how are you doing today	1,264
doctor: right i want you you can talk about those things yes patient: okay	D2N046	1	[ "Chitchat" ]	[ "Null" ]	right i want you you can talk about those things yes	1,265
doctor: okay so with your newly diagnosed ovarian cancer so how are you feeling today how are you doing patient: i'm doing pretty good depressed	D2N046	2	[ "Acute Symptoms", "Personal History" ]	[ "Subjective" ]	okay so with your newly diagnosed ovarian cancer so how are you feeling today how are you doing	1,266
doctor: little depressed i can understand it's a lot to take on is n't it patient: yes	D2N046	3	[ "Acute Symptoms" ]	[ "Subjective" ]	little depressed i can understand it's a lot to take on is n't it	1,267
doctor: okay okay so lem me ask you some questions so what kind of symptoms were you having that prompted you your doctor to do the tests patient: i was having severe pain and bleeding	D2N046	4	[ "Personal History" ]	[ "Subjective" ]	okay okay so lem me ask you some questions so what kind of symptoms were you having that prompted you your doctor to do the tests	1,268
doctor: okay now do you have other symptoms such as weight loss constipation vomiting or issues with urination patient: no vomiting but constipation and weight loss	D2N046	5	[ "Vegetative History" ]	[ "Subjective" ]	okay now do you have other symptoms such as weight loss constipation vomiting or issues with urination	1,269
doctor: okay yeah that's understandable so do you have any children or have you ever been pregnant patient: i'm sorry i did n't hear that part	D2N046	6	[ "Other Socials" ]	[ "Subjective" ]	okay yeah that's understandable so do you have any children or have you ever been pregnant	1,270
doctor: do you have any children or have you ever been pregnant patient: no to either one of those	D2N046	7	[ "Other Socials" ]	[ "Subjective" ]	do you have any children or have you ever been pregnant	1,271
doctor: okay so and do you know at what age you got your period and when you started menopause patient: thirteen for my period and twenty eighth for menopause	D2N046	8	[ "Vegetative History" ]	[ "Subjective" ]	okay so and do you know at what age you got your period and when you started menopause	1,272
doctor: okay do you take any oral hormone replacement therapy patient: no	D2N046	9	[ "Therapeutic History" ]	[ "Subjective" ]	okay do you take any oral hormone replacement therapy	1,273
doctor: okay any history of endometriosis patient: any history of what	D2N046	10	[ "Personal History" ]	[ "Subjective" ]	okay any history of endometriosis	1,274
doctor: endometriosis patient: no	D2N046	11	[ "Personal History" ]	[ "Subjective" ]	endometriosis	1,275
doctor: okay how about any family history of any gynecological cancers patient: i was adopted	D2N046	12	[ "Family History" ]	[ "Subjective" ]	okay how about any family history of any gynecological cancers	1,276
doctor: okay okay so i'm just gon na do a quick exam of your abdomen and then perform a vaginal exam okay patient: okay	D2N046	13	[ "Physical Examination" ]	[ "Objective" ]	okay okay so i'm just gon na do a quick exam of your abdomen and then perform a vaginal exam okay	1,277
doctor: alright okay so i do feel the mass on the where to go here okay patient: i did n't know you're gon na play a doctor today	D2N046	14	[ "Physical Examination" ]	[ "Objective" ]	alright okay so i do feel the mass on the where to go here okay	1,278
doctor: i did okay okay so i do feel the mass on the left side but everything else looks good and on abdominal exam there is slight tenderness to palpation of the left lower quadrant no rebounding or guarding on vaginal exam there are no external lesions on the labia the vaginal vault is within normal limits the cervix is pink without lesions and on bimanual exam i appreciate a left adnexal mass and there is no masses on the right okay so now i reviewed the results of your abdominal ct which show a three centimeter left ovarian mass with an associated local localized lymph node involvement there is no evidence of gross peritoneal or metastatic disease so lem me tell you a little bit about my assessment and plan so for the first problem so i do think this is most likely ovarian cancer looking at your ct scan it looks like stage three a disease based on the lymph node involvement i want to start by sending off some blood tests like a ca-125 and hcg and afp and ldh these are just tests that help me to determine what type of tumor i'm dealing with and then i want you to undergo genetic counseling and testing to see if you have a genetic predisposition for developing ovarian cancer so this stage of ovarian cancer is treated by performing surgery followed by adjunct chemotherapy so this means we'll start chemotherapy after you've recovered from surgery okay so for the surgery i would perform a hysterectomy remove both ovaries and perform a lymph node dissection to remove the involved and involve lymph nodes as well as any other ones i see and i'll also send a sample of any tissue if there anything that looks suspicious at all and we'll be able to tell exactly what stage this is based on the pathology reports i then recommend chemotherapy with cisplatin and taxol and based on how the surgery goes i may want you to receive intraperitoneal intraperitoneal chemo which is done inserting a small tube into your belly for the chemo to go directly into your peritoneum now i know that was a lot sick in do you have any questions or patient: am i gon na die	D2N046	15	[ "Physical Examination", "Discussion", "Medication", "Radiology Examination", "Diagnostic Testing", "Acute Assessment", "Other Treatments" ]	[ "Objective", "Assessment", "Plan" ]	i did okay okay so i do feel the mass on the left side but everything else looks good and on abdominal exam there is slight tenderness to palpation of the left lower quadrant no rebounding or guarding on vaginal exam there are no external lesions on the labia the vaginal vault is within normal limits the cervix is pink without lesions and on bimanual exam i appreciate a left adnexal mass and there is no masses on the right okay so now i reviewed the results of your abdominal ct which show a three centimeter left ovarian mass with an associated local localized lymph node involvement there is no evidence of gross peritoneal or metastatic disease so lem me tell you a little bit about my assessment and plan so for the first problem so i do think this is most likely ovarian cancer looking at your ct scan it looks like stage three a disease based on the lymph node involvement i want to start by sending off some blood tests like a ca-125 and hcg and afp and ldh these are just tests that help me to determine what type of tumor i'm dealing with and then i want you to undergo genetic counseling and testing to see if you have a genetic predisposition for developing ovarian cancer so this stage of ovarian cancer is treated by performing surgery followed by adjunct chemotherapy so this means we'll start chemotherapy after you've recovered from surgery okay so for the surgery i would perform a hysterectomy remove both ovaries and perform a lymph node dissection to remove the involved and involve lymph nodes as well as any other ones i see and i'll also send a sample of any tissue if there anything that looks suspicious at all and we'll be able to tell exactly what stage this is based on the pathology reports i then recommend chemotherapy with cisplatin and taxol and based on how the surgery goes i may want you to receive intraperitoneal intraperitoneal chemo which is done inserting a small tube into your belly for the chemo to go directly into your peritoneum now i know that was a lot sick in do you have any questions or	1,279
doctor: well that's a good question so based on what i see at this time i will we believe you have a favorable diagnosis prognosis and you're also still young and healthy which makes your prognosis even better and we do need to see a final pathology report to give you a definitive answer though okay patient: alright alright	D2N046	16	[ "Discussion" ]	[ "Plan" ]	well that's a good question so based on what i see at this time i will we believe you have a favorable diagnosis prognosis and you're also still young and healthy which makes your prognosis even better and we do need to see a final pathology report to give you a definitive answer though okay	1,280
doctor: hi billy how are you what's been going on the medical assistant told me that you're having some difficulty urinating patient: yeah yeah i i did n't really wan na come in to talk about it's kinda weird but i think probably over the last six months i'm just not peeing right it just does n't seem to be normal	D2N047	0	[ "Acute Symptoms", "Greetings" ]	[ "Subjective" ]	hi billy how are you what's been going on the medical assistant told me that you're having some difficulty urinating	1,281
doctor: okay so let's talk a little bit about that now is your is your stream is your urination stream weak patient: yeah i'd probably say so	D2N047	1	[ "Acute Symptoms", "Vegetative History" ]	[ "Subjective" ]	okay so let's talk a little bit about that now is your is your stream is your urination stream weak	1,282
doctor: okay and do you feel like you're emptying your bladder fully or do you feel like you still have some urine left in there when you when you finish patient: most of the times i'm okay but sometimes if i stand there long enough i i can kinda go a little bit more so it's taking a while actually to just go to the bathroom	D2N047	2	[ "Acute Symptoms", "Vegetative History" ]	[ "Subjective" ]	okay and do you feel like you're emptying your bladder fully or do you feel like you still have some urine left in there when you when you finish	1,283
doctor: okay and are you waking up at night to go to the bathroom does it impact your sleep patient: yeah i try to empty my bladder now right before i go to bed and and not drink anything but i'm still probably getting up three or four times a night to go to the bed	D2N047	3	[ "Vegetative History" ]	[ "Subjective" ]	okay and are you waking up at night to go to the bathroom does it impact your sleep	1,284
doctor: okay so you're getting up about three or four times a night and and how long has this been going on you said for about six months patient: yeah six months to like this and it's probably been a little bit worse over the last six months and maybe it's been longer i just did n't want to bring it up	D2N047	4	[ "Personal History", "Vegetative History" ]	[ "Subjective" ]	okay so you're getting up about three or four times a night and and how long has this been going on you said for about six months	1,285
doctor: okay so you think it's been going on longer okay alright now how about have you had any burning when you urinate at all patient: no it i do n't think it burns	D2N047	5	[ "Vegetative History" ]	[ "Subjective" ]	okay so you think it's been going on longer okay alright now how about have you had any burning when you urinate at all	1,286
doctor: no burning when you urinate okay and and any other any other issues any problems with your bowels any constipation issues patient: hmmm no i i i had diarrhea last week but i think i ate something bad	D2N047	6	[ "Acute Symptoms", "Vegetative History" ]	[ "Subjective" ]	no burning when you urinate okay and and any other any other issues any problems with your bowels any constipation issues	1,287
doctor: okay and ever have you ever had any issues where you had what we call urinary retention where you could n't pee and you needed to have like a catheter inserted patient: my gosh no	D2N047	7	[ "Personal History" ]	[ "Subjective" ]	okay and ever have you ever had any issues where you had what we call urinary retention where you could n't pee and you needed to have like a catheter inserted	1,288
doctor: alright and have you ever seen a urologist i do n't think so you've been my patient for a while i do n't remember ever sending you but have you ever seen one patient: i do n't think so	D2N047	9	[ "Personal History" ]	[ "Subjective" ]	alright and have you ever seen a urologist i do n't think so you've been my patient for a while i do n't remember ever sending you but have you ever seen one	1,289
doctor: okay now tell me how are you doing with your with your heart when was the last time you saw doctor moore the cardiologist i know that you had the the stent placed in your right coronary artery about what was that twenty eighteen patient: yeah sounds about right i think i just saw him in november he said everything was okay	D2N047	10	[ "Personal History" ]	[ "Subjective" ]	okay now tell me how are you doing with your with your heart when was the last time you saw doctor moore the cardiologist i know that you had the the stent placed in your right coronary artery about what was that twenty eighteen	1,290
doctor: he said everything was okay alright and so you have n't had any chest pain or shortness of breath you're still walking around doing your activities of daily living are you exercising patient: kind of	D2N047	11	[ "Acute Symptoms" ]	[ "Subjective" ]	he said everything was okay alright and so you have n't had any chest pain or shortness of breath you're still walking around doing your activities of daily living are you exercising	1,291
doctor: kind of okay now from what i remember i remember you being a big college football fan are you as excited as i am that georgia beat alabama in the national championships patient: yeah yeah i'm super excited	D2N047	12	[ "Chitchat" ]	[ "Null" ]	kind of okay now from what i remember i remember you being a big college football fan are you as excited as i am that georgia beat alabama in the national championships	1,292
doctor: you do n't really seem that excited patient: get the problem fixed because i have to be able to sit there and watch the whole game	D2N047	13	[ "Chitchat" ]	[ "Null" ]	you do n't really seem that excited	1,293
doctor: yeah i i really do n't like nick saving i'm so i'm super happy that that the dogs pulled it out patient: i do n't know if we can do friends anymore	D2N047	14	[ "Chitchat" ]	[ "Null" ]	yeah i i really do n't like nick saving i'm so i'm super happy that that the dogs pulled it out	1,294
doctor: are you in alabama fan patient: maybe i'm actually originally not from georgia so	D2N047	15	[ "Chitchat" ]	[ "Null" ]	are you in alabama fan	1,295
doctor: okay alright well i mean i i'm i'm a long horns fan but anyway well i digress let's talk a little bit about your diabetes how are how are you doing with your sugars are you watching your diet patient: i'm trying to yeah i think they are okay	D2N047	16	[ "Personal History" ]	[ "Subjective" ]	okay alright well i mean i i'm i'm a long horns fan but anyway well i digress let's talk a little bit about your diabetes how are how are you doing with your sugars are you watching your diet	1,296
doctor: okay and are you still taking the metformin patient: yep	D2N047	17	[ "Therapeutic History" ]	[ "Subjective" ]	okay and are you still taking the metformin	1,297
doctor: you are okay alright now i wan na go ahead and just move on to a quick physical exam okay i'm gon na be calling out some of my exam findings and i'm gon na let you know what that means when i'm done okay alright i do have to do a rectal exam i apologize i'm just gon na be calling it out what what i what i appreciate okay so on your heart exam i do appreciate a slight three out of six systolic ejection murmur hurt at the left base on your lung exam your lungs are clear to auscultation bilaterally on your abdominal exam your abdomen is nontender and nondistended i do n't appreciate any masses or any rebound or guarding on your prostate exam i do appreciate an enlarged prostate i do n't appreciate any masses on physical exam so what what does that mean billy so that ultimately means that you know everything looks good you know you have that little heart murmur which i believe you you've had in the past but we're gon na go ahead and look into that you know your prostate seems a little bit enlarged to me on physical exam so let's talk about how we can go about and and remedy that okay so for your first problem of this you know difficulty urinating i wan na go ahead and just order some routine labs i wan na get a a psa that kind of that ultimately kinda looks for prostate cancer issues which i do n't think you have because we did n't really appreciate that on physical exam i wan na go ahead and we can try to start you on what we call flomax zero point four milligrams once a day you should take it at night because it can cause people to get a little bit dizzy if they take it in the morning so i would take it at night and i wan na go ahead and refer you to a urologist just to look into this more so we can go ahead and and get this problem solved for you okay i'm also gon na go ahead and just order some routine blood tests just to make sure that we are not missing anything do you have any questions about that and i wan na go ahead and order a urinalysis and a urine culture patient: yeah so sounds good have you seen that commercial for that super batter prostate stuff does that work	D2N047	18	[ "Physical Examination", "Discussion", "Medication", "Diagnostic Testing", "Acute Assessment" ]	[ "Objective", "Assessment", "Plan" ]	you are okay alright now i wan na go ahead and just move on to a quick physical exam okay i'm gon na be calling out some of my exam findings and i'm gon na let you know what that means when i'm done okay alright i do have to do a rectal exam i apologize i'm just gon na be calling it out what what i what i appreciate okay so on your heart exam i do appreciate a slight three out of six systolic ejection murmur hurt at the left base on your lung exam your lungs are clear to auscultation bilaterally on your abdominal exam your abdomen is nontender and nondistended i do n't appreciate any masses or any rebound or guarding on your prostate exam i do appreciate an enlarged prostate i do n't appreciate any masses on physical exam so what what does that mean billy so that ultimately means that you know everything looks good you know you have that little heart murmur which i believe you you've had in the past but we're gon na go ahead and look into that you know your prostate seems a little bit enlarged to me on physical exam so let's talk about how we can go about and and remedy that okay so for your first problem of this you know difficulty urinating i wan na go ahead and just order some routine labs i wan na get a a psa that kind of that ultimately kinda looks for prostate cancer issues which i do n't think you have because we did n't really appreciate that on physical exam i wan na go ahead and we can try to start you on what we call flomax zero point four milligrams once a day you should take it at night because it can cause people to get a little bit dizzy if they take it in the morning so i would take it at night and i wan na go ahead and refer you to a urologist just to look into this more so we can go ahead and and get this problem solved for you okay i'm also gon na go ahead and just order some routine blood tests just to make sure that we are not missing anything do you have any questions about that and i wan na go ahead and order a urinalysis and a urine culture	1,298
doctor: well i think the data it's it's i'm not really sure if it works or not i'm not that familiar with it let's just go ahead and stick with flomax and that's why we are gon na refer you to the urologist so that they can go ahead and talk to you about you know the most current treatment options for you okay patient: alright	D2N047	19	[ "Discussion", "Medication" ]	[ "Plan" ]	well i think the data it's it's i'm not really sure if it works or not i'm not that familiar with it let's just go ahead and stick with flomax and that's why we are gon na refer you to the urologist so that they can go ahead and talk to you about you know the most current treatment options for you okay	1,299

doctor: it's with ibuprofen okay what's your pain level without then patient: i would say probably a six

D2N042

9

[ "Acute Symptoms" ]

[ "Subjective" ]

it's with ibuprofen okay what's your pain level without then

1,200

doctor: okay alright that that sounds good have you ever injured that foot and ankle before patient: you know i've had a lot of injuries to my ankle but i've never hurt this ankle before i just realized an error

D2N042

11

[ "Personal History" ]

[ "Subjective" ]

okay alright that that sounds good have you ever injured that foot and ankle before

1,201

doctor: okay you know and i see here that you have a history of playing sports looks like you played soccer in college and then played a little bit of a inner marrow soccer now patient: yeah

D2N042

12

[ "Other Socials" ]

[ "Subjective" ]

okay you know and i see here that you have a history of playing sports looks like you played soccer in college and then played a little bit of a inner marrow soccer now

1,202

doctor: i'm i'm guessing you probably have n't been able to do that since you hurt your ankle patient: no i have not been

D2N042

13

[ "Other Socials" ]

[ "Subjective" ]

i'm i'm guessing you probably have n't been able to do that since you hurt your ankle

1,203

doctor: so did you hear about the new major league soccer stadium and team that's coming to town they opened in the this year actually they built the stadium have you been down there yet patient: no i have to get there

D2N042

14

[ "Chitchat" ]

[ "Null" ]

so did you hear about the new major league soccer stadium and team that's coming to town they opened in the this year actually they built the stadium have you been down there yet

1,204

doctor: yeah we are all excited it's going to be a good time well have you experienced any numbness or tingling in that right foot patient: no

D2N042

15

[ "Acute Symptoms" ]

[ "Subjective" ]

yeah we are all excited it's going to be a good time well have you experienced any numbness or tingling in that right foot

1,205

doctor: okay so if it's okay with you i would like to do a quick physical exam your vitals look good and everything there looks okay now i'm gon na do a focused exam on your right ankle i do appreciate some ecchymosis or bruising over the lateral malleolus malleolus associated with some edema or swelling of that area you are positive for tenderness to palpation of the anterior lateral soft tissue and now i do n't appreciate any laxity on anterior drawer and inversion stress there is no bony tenderness on palpation to that foot or ankle area now on neurovascular exam of your right foot you have brisk capillary refill of less than three seconds strong dorsalis pedis pulse and your sensation is intact to light touch and all of that is consistent with what's present on your left side as well so i did review the results of your of your x-ray the x-ray of your right ankle showed no fracture which is a good thing so now let me talk to you a little bit about my assessment and plan so for the first problem of right ankle pain your symptoms are consistent with a right ankle sprain or i'm sorry right ankle sprain of your lateral ligament complex more specifically your anterior talofibular ligament now this ligament's on the outside of your ankle ankle which got stretched when you fell the best treatment at this time for your sprain is to keep your leg elevated when you're seated and let's continue to ice okay you're gon na be given an air cast which is gon na help stabilize that ankle and i'm also going to prescribe some crutches because i want you to stay off that leg and start walking on it stay off your leg for now and then in a couple of days start walking on it as tolerated do you have any questions or concerns for me patient: so how long do you think it'll take to heal

D2N042

16

[ "Physical Examination", "Other Treatments", "Radiology Examination", "Acute Assessment" ]

[ "Objective", "Assessment", "Plan" ]

okay so if it's okay with you i would like to do a quick physical exam your vitals look good and everything there looks okay now i'm gon na do a focused exam on your right ankle i do appreciate some ecchymosis or bruising over the lateral malleolus malleolus associated with some edema or swelling of that area you are positive for tenderness to palpation of the anterior lateral soft tissue and now i do n't appreciate any laxity on anterior drawer and inversion stress there is no bony tenderness on palpation to that foot or ankle area now on neurovascular exam of your right foot you have brisk capillary refill of less than three seconds strong dorsalis pedis pulse and your sensation is intact to light touch and all of that is consistent with what's present on your left side as well so i did review the results of your of your x-ray the x-ray of your right ankle showed no fracture which is a good thing so now let me talk to you a little bit about my assessment and plan so for the first problem of right ankle pain your symptoms are consistent with a right ankle sprain or i'm sorry right ankle sprain of your lateral ligament complex more specifically your anterior talofibular ligament now this ligament's on the outside of your ankle ankle which got stretched when you fell the best treatment at this time for your sprain is to keep your leg elevated when you're seated and let's continue to ice okay you're gon na be given an air cast which is gon na help stabilize that ankle and i'm also going to prescribe some crutches because i want you to stay off that leg and start walking on it stay off your leg for now and then in a couple of days start walking on it as tolerated do you have any questions or concerns for me

1,206

doctor: so your symptoms should significantly improve over a few weeks but i'd like to follow up with you and see how you're doing let's say i'll see you again in fourteen days now i do want you to go ahead and continue to take nsaids or ibuprofen as needed to help with any pain and that's also gon na help reduce that inflammation and swelling okay patient: okay

D2N042

17

[ "Follow-up", "Medication" ]

[ "Plan" ]

so your symptoms should significantly improve over a few weeks but i'd like to follow up with you and see how you're doing let's say i'll see you again in fourteen days now i do want you to go ahead and continue to take nsaids or ibuprofen as needed to help with any pain and that's also gon na help reduce that inflammation and swelling okay

1,207

doctor: alright i will see you again in two weeks carolyn patient: great thank you

D2N042

18

[ "Follow-up" ]

[ "Plan" ]

alright i will see you again in two weeks carolyn

1,208

doctor: you're welcome

D2N042

19

[ "Chitchat" ]

[ "Null" ]

doctor: you're welcome

1,209

doctor: how are you doing patient: i'm doing i'm good i'm i'm doing really good i'm here i'm just ready to quit smoking and but i've been having quite a hard time with it

D2N043

0

[ "Greetings" ]

[ "Subjective" ]

how are you doing

1,210

doctor: well i'm glad that you're taking the first steps to quit smoking would you tell me a little bit more about your history of smoking patient: yeah so i've been smoking for some time now i started in high school and was just you know just experimenting and smoking here and there with friends or at parties and then it just started getting more regular and regular and i do n't even know how i'm 44 now and i'm smoking everyday so yes now i'm up to a pack and a half a day

D2N043

1

[ "Drug History" ]

[ "Subjective" ]

well i'm glad that you're taking the first steps to quit smoking would you tell me a little bit more about your history of smoking

1,211

doctor: okay do you use any other type of tobacco products patient: no smoking is enough

D2N043

2

[ "Drug History" ]

[ "Subjective" ]

okay do you use any other type of tobacco products

1,212

doctor: okay and i understand that so when you wake up in the morning how soon after waking up do you smoke your first cigarette patient: i would say probably within an hour of waking up i'll have my first cigarette

D2N043

3

[ "Vegetative History" ]

[ "Subjective" ]

okay and i understand that so when you wake up in the morning how soon after waking up do you smoke your first cigarette

1,213

doctor: okay so i'm really excited that you wan na quit and i know that you probably heard this multiple times before but this really is one of the best things that you can do to help your health especially since you have the history of gout and type two diabetes this is really gon na be a great step in you having better long term health outcomes patient: yeah i know and you know i'm really motivated now because i am about to be a father any day now and i just really wan na be there for my daughter growing up

D2N043

4

[ "Personal History" ]

[ "Subjective" ]

okay so i'm really excited that you wan na quit and i know that you probably heard this multiple times before but this really is one of the best things that you can do to help your health especially since you have the history of gout and type two diabetes this is really gon na be a great step in you having better long term health outcomes

1,214

doctor: hey that's great and that's great to hear congratulations i'm so excited to hear about the new baby patient: yeah

D2N043

5

[ "Chitchat" ]

[ "Null" ]

hey that's great and that's great to hear congratulations i'm so excited to hear about the new baby

1,215

doctor: i i have a daughter myself have have you picked out any names patient: we're you know we're deciding between a few names but we're kinda just waiting to see her to see which name fits

D2N043

6

[ "Chitchat" ]

[ "Null" ]

i i have a daughter myself have have you picked out any names

1,216

doctor: okay alright that sounds good well congratulations again i'm very excited for you and your and and your wife that that's this is great patient: thank you

D2N043

7

[ "Chitchat" ]

[ "Null" ]

okay alright that sounds good well congratulations again i'm very excited for you and your and and your wife that that's this is great

1,217

doctor: so you mentioned you tried to quit before can you tell me a little bit about the methods that you used or or what you tried patient: yeah actually i just went cold turkey one day i woke up and i said you know i've had enough and i know that smoking is not good for me so i woke up and stopped and i actually did really well and i was able to quit smoking for almost a year and then things just started getting really stressful at work they started laying people off and i'm happy i still have a job but that also meant that i was responsible for more things so things just got stressful and i and just started picking it up again

D2N043

8

[ "Drug History" ]

[ "Subjective" ]

so you mentioned you tried to quit before can you tell me a little bit about the methods that you used or or what you tried

1,218

doctor: well you are absolutely correct you know stress can often be a trigger for things like smoking and drinking have you thought what you would do this time when you encountered the stressful situations patient: yeah i i did n't think about that a lot actually and one thing is i have started learning and trying to do more meditation and then i also just recently joined the gym so i'm really looking forward to working out again

D2N043

9

[ "Drug History" ]

[ "Subjective" ]

well you are absolutely correct you know stress can often be a trigger for things like smoking and drinking have you thought what you would do this time when you encountered the stressful situations

1,219

doctor: okay well that's great to hear that you're getting back in the gym that will be good for your long term health too you know helping to maintain that type two diabetes you know those are really great strategies talking about gym for stress relief and and you know we have other products as well that you can use for an additional aid to help you stop smoking have you given any thought to using some type of smoking cessation aid at this time or or what do you think about that patient: you know i've had you know because i've been trying to do cold turkey and it's not working and some of my friends actually have mentioned using a patch and they they've had some success with that so i think i would i would probably wan na start with that

D2N043

10

[ "Discussion", "Medication", "Drug History" ]

[ "Plan" ]

okay well that's great to hear that you're getting back in the gym that will be good for your long term health too you know helping to maintain that type two diabetes you know those are really great strategies talking about gym for stress relief and and you know we have other products as well that you can use for an additional aid to help you stop smoking have you given any thought to using some type of smoking cessation aid at this time or or what do you think about that

1,220

doctor: okay alright that that sounds good it's good that you've you've picked out one of those aids and have you thought of a quit date i mean we we really wan na talk about when you're gon na say this is the day patient: yeah you know next monday is actually my birthday so i think that's a good day

D2N043

11

[ "Discussion" ]

[ "Plan" ]

okay alright that that sounds good it's good that you've you've picked out one of those aids and have you thought of a quit date i mean we we really wan na talk about when you're gon na say this is the day

1,221

doctor: that's a fantastic day and happy birthday coming up on monday patient: thank you

D2N043

12

[ "Chitchat" ]

[ "Null" ]

that's a fantastic day and happy birthday coming up on monday

1,222

doctor: so let's talk a little bit about your exam here okay i'm gon na go ahead and do a quick physical exam and i reviewed your vitals and everything looks good including your oxygen saturation blood pressure for today was one twenty eight over eighty eight heart rate was sixty eight respirations were sixteen and your pulse ox was ninety eight percent on room air so those were all really good now on your heart exam you do have a nice regular and your your rate is of regular rate and rhythm or i'm sorry your heart exam for your heart exam notice that your heart is regular in rate and rhythm i do however still appreciate that two over six systolic murmur that we talked about in the past now that's okay we'll just continue to monitor that now for your lung exam i'm gon na go ahead and listen to your lungs your lungs are clear and equal bilateral with no expiratory wheezes and no rales or rhonchi are appreciated on your neck exam i do n't appreciate any lymphadenopathy when i listen i do n't hear any extra noises so i do n't hear any hearing any carotid bruit which is a good thing now for my impression and plan let's talk a little bit about my assessment and plan for you so for your first problem of nicotine dependence first of all i just want to apply you on making this first step to stop smoking and i want you to know with absolute one hundred percent certainty that i'm gon na be with you every step of the way i think it's fantastic that you're very welcome i i i think it's fantastic you've chosen next monday as a quit date and on that day i'm gon na start you with a twenty one milligram nicotine patch and the goal will be to decrease that over time okay now we will work together to decrease that so there is no necessarily hard dates in mind okay be sure to change the patch location each day and that's going to help reduce or avoid that skin irritation that can occur if you use the same location over and over again i would like to see you again in two weeks just to see how things are going and we will reevaluate at that time the dosage for your nicotine patch now we also see further need to discuss any handouts you received today for those common smoking triggers i really want you to keep an eye on and monitor your stress level not only about work but also the fact that you are experiencing are going to be be a new father and we really want to watch any stress you will be experiencing around the birth of your new child so please keep an eye on that and let me know how that goes now for now until we meet in two weeks go ahead and keep up your exercise routine i think that's a great plan and just try to monitor your stress and and maybe think about some things like meditation or adding in some yoga and that type of thing to help further work with your your stress levels so do you have any questions for me patient: no not at this time

D2N043

13

[ "Physical Examination", "Discussion", "Follow-up", "Medication", "Acute Assessment", "Drug History" ]

[ "Objective", "Assessment", "Plan" ]

so let's talk a little bit about your exam here okay i'm gon na go ahead and do a quick physical exam and i reviewed your vitals and everything looks good including your oxygen saturation blood pressure for today was one twenty eight over eighty eight heart rate was sixty eight respirations were sixteen and your pulse ox was ninety eight percent on room air so those were all really good now on your heart exam you do have a nice regular and your your rate is of regular rate and rhythm or i'm sorry your heart exam for your heart exam notice that your heart is regular in rate and rhythm i do however still appreciate that two over six systolic murmur that we talked about in the past now that's okay we'll just continue to monitor that now for your lung exam i'm gon na go ahead and listen to your lungs your lungs are clear and equal bilateral with no expiratory wheezes and no rales or rhonchi are appreciated on your neck exam i do n't appreciate any lymphadenopathy when i listen i do n't hear any extra noises so i do n't hear any hearing any carotid bruit which is a good thing now for my impression and plan let's talk a little bit about my assessment and plan for you so for your first problem of nicotine dependence first of all i just want to apply you on making this first step to stop smoking and i want you to know with absolute one hundred percent certainty that i'm gon na be with you every step of the way i think it's fantastic that you're very welcome i i i think it's fantastic you've chosen next monday as a quit date and on that day i'm gon na start you with a twenty one milligram nicotine patch and the goal will be to decrease that over time okay now we will work together to decrease that so there is no necessarily hard dates in mind okay be sure to change the patch location each day and that's going to help reduce or avoid that skin irritation that can occur if you use the same location over and over again i would like to see you again in two weeks just to see how things are going and we will reevaluate at that time the dosage for your nicotine patch now we also see further need to discuss any handouts you received today for those common smoking triggers i really want you to keep an eye on and monitor your stress level not only about work but also the fact that you are experiencing are going to be be a new father and we really want to watch any stress you will be experiencing around the birth of your new child so please keep an eye on that and let me know how that goes now for now until we meet in two weeks go ahead and keep up your exercise routine i think that's a great plan and just try to monitor your stress and and maybe think about some things like meditation or adding in some yoga and that type of thing to help further work with your your stress levels so do you have any questions for me

1,223

doctor: okay so for your other conditions that we talked about briefly your second condition of type two diabetes we'll let's go ahead and continue to maintain that with diet and exercise and we'll just monitor your type two diabetes i am gon na go ahead and order a hemoglobin a1c for your next blood draw since i'll see you in two weeks go ahead and have that done and we will talk about that when you come back in now for your third problem of your history of gout let's go ahead and continue you on your allopurinol and just you know continue to watch those foods that will exacerbate your uric acid levels any other questions about those patient: no i think that's it thanks so much

D2N043

14

[ "Follow-up", "Medication", "Reassessment" ]

[ "Assessment", "Plan" ]

okay so for your other conditions that we talked about briefly your second condition of type two diabetes we'll let's go ahead and continue to maintain that with diet and exercise and we'll just monitor your type two diabetes i am gon na go ahead and order a hemoglobin a1c for your next blood draw since i'll see you in two weeks go ahead and have that done and we will talk about that when you come back in now for your third problem of your history of gout let's go ahead and continue you on your allopurinol and just you know continue to watch those foods that will exacerbate your uric acid levels any other questions about those

1,224

doctor: alright sounds good i'll see you in two weeks congratulations on the baby and and we're excited about next monday that's your quit date patient: alrighty thank you

D2N043

15

[ "Follow-up" ]

[ "Plan" ]

alright sounds good i'll see you in two weeks congratulations on the baby and and we're excited about next monday that's your quit date

1,225

doctor: you're welcome i'll see you in two weeks thanks bye-bye patient: alright bye

D2N043

16

[ "Chitchat" ]

[ "Null" ]

you're welcome i'll see you in two weeks thanks bye-bye

1,226

doctor: good morning julie how are you doing this morning patient: i've been better my primary care doctor wanted me to see you because of this this knee pain that i've been having for about six months now

D2N044

0

[ "Greetings" ]

[ "Subjective" ]

good morning julie how are you doing this morning

1,227

doctor: okay and do you remember what caused the pain initially patient: honestly i do n't i ca n't think of anytime if i fell or like i i've really been trying to think and i ca n't really think of any specific event

D2N044

1

[ "Acute Symptoms" ]

[ "Subjective" ]

okay and do you remember what caused the pain initially

1,228

doctor: okay now it it says here that it's in both knees is that correct patient: yes both my knees

D2N044

2

[ "Acute Symptoms" ]

[ "Subjective" ]

okay now it it says here that it's in both knees is that correct

1,229

doctor: okay it kinda try let's let's try describing the pain for me please patient: yeah it's kind of feels like it's like right behind my kneecaps

D2N044

3

[ "Acute Symptoms" ]

[ "Subjective" ]

okay it kinda try let's let's try describing the pain for me please

1,230

doctor: a deep achy pain okay what kind of activities makes the pain feel worse patient: let's see so anytime so if i'm sitting at my desk and i get up i have a lot of pain so anytime from like standing up from sitting for a while or even going up and down the stairs

D2N044

5

[ "Acute Symptoms" ]

[ "Subjective" ]

a deep achy pain okay what kind of activities makes the pain feel worse

1,231

doctor: okay so you work from home patient: i do

D2N044

6

[ "Other Socials" ]

[ "Subjective" ]

okay so you work from home

1,232

doctor: okay okay so there is a lot of desk setting at home is your office upstairs or is it i mean do you have to go up or downstairs to get to it patient: no well first thing in the morning but otherwise it's downstairs

D2N044

7

[ "Other Socials" ]

[ "Subjective" ]

okay okay so there is a lot of desk setting at home is your office upstairs or is it i mean do you have to go up or downstairs to get to it

1,233

doctor: okay okay how do you like working from home patient: you know it has it's plus and minuses

D2N044

8

[ "Other Socials" ]

[ "Subjective" ]

okay okay how do you like working from home

1,234

doctor: and the parking i'm sure the parking is patient: and the parking is great

D2N044

11

[ "Chitchat" ]

[ "Null" ]

and the parking i'm sure the parking is

1,235

doctor: yeah i you know if i could do telehealth visits all day long i would be totally happy with that yeah and just set it home and do those so you mentioned is there anything that makes that pain feel better patient: usually after like if i feel that pain and then i just it does get better

D2N044

12

[ "Acute Symptoms" ]

[ "Subjective" ]

yeah i you know if i could do telehealth visits all day long i would be totally happy with that yeah and just set it home and do those so you mentioned is there anything that makes that pain feel better

1,236

doctor: okay now you mentioned earlier that you tried some things in the past what have what are they and did they work at all patient: yeah i've done some ibuprofen or aleve sometimes some tylenol and that does help

D2N044

13

[ "Therapeutic History" ]

[ "Subjective" ]

okay now you mentioned earlier that you tried some things in the past what have what are they and did they work at all

1,237

doctor: okay but you're never really pain free is that what i hear you saying patient: not really unless i'm like really just resting which i hate to do but otherwise any type of movement especially from sitting it causes pain

D2N044

15

[ "Acute Symptoms" ]

[ "Subjective" ]

okay but you're never really pain free is that what i hear you saying

1,238

doctor: okay so are you active other than going up and down the steps to your office patient: very i'm a big runner i love to run i run about five to six miles a day but with this knee with with these knee pain that i've been having it's i barely can even do half a mile

D2N044

16

[ "Personal History" ]

[ "Subjective" ]

okay so are you active other than going up and down the steps to your office

1,239

doctor: yeah you know what that's that's i am a biker and i know that once you get that into your you know you have loved doing that activity it's so frustrating when you ca n't it's almost like a it's almost like a dry it almost becomes a drug when you get up patient: exactly

D2N044

17

[ "Chitchat" ]

[ "Null" ]

yeah you know what that's that's i am a biker and i know that once you get that into your you know you have loved doing that activity it's so frustrating when you ca n't it's almost like a it's almost like a dry it almost becomes a drug when you get up

1,240

doctor: okay so have you noticed any redness or swelling in your knees patient: no

D2N044

19

[ "Acute Symptoms" ]

[ "Subjective" ]

okay so have you noticed any redness or swelling in your knees

1,241

doctor: okay and have you ever injured your knees before patient: you know despite how active i am i you know i've never

D2N044

20

[ "Personal History" ]

[ "Subjective" ]

okay and have you ever injured your knees before

1,242

doctor: okay great so let's go ahead and do a i just wan na take a look here i reviewed your vitals and overall they look good your blood pressure is one twenty over seventy your your heart rate is sixty and your respiratory rate is fourteen those are all phenomenal numbers as i listened to your heart it is at a regular and a slower rate but i do n't hear any extra sounds so there is no murmurs as we go through that now on musculoskeletal exam you have a normal gait i watched you you know kinda walk in here this morning your strength i just wan na check it when i go ahead and i want you to move your leg okay your muscle strength is is good you do have a three out of five for abduction of your legs bilaterally and that's you know kinda bringing your legs in the remainder of your muscle strength for your lower extremities is a five out of five now let me focus specifically on your knee examination i do n't see any redness or ecchymosis or warmth of the skin and those are big words you know i do n't see any bruising or or that redness there is no effusion that's just like a fluid underneath the knee i do n't appreciate that any at all you do seem to have some tenderness when i palpate and you do have a positive patellar grind test when you stood up i could feel that as we went through there you did say you had that knee pain with squatting but your lachman your anterior and posterior drawer and mcmurray test are all negative bilaterally neurologically and your your your lower extremities your patella and your achilles reflex are symmetrical and that's good so i did review the x-rays of both your knees which shows no fractures or osteoarthritis so based on what you told me and reviewing the mri that you had done before you came in your symptoms are consistent with patellofemoral pain syndrome and this is a really common condition that we see that causes knee knee pain especially in really active young people that's probably why i do n't get it when i'm riding my bike forever and ever now this condition has to do with the way your kneecap moves across along the groove of your thigh bone your femur so for pain i want you to continue to take the ibuprofen or any other anti-inflammatories you know aleve or any of those as you need it to help with the pain now i am going to recommend physical therapy well they will show you a number of lower extremity exercises this is probably one of the best things that you can do and this will help increase your lower extremity strength your mobility and correct any incorrect running mechanics that you might have do you have any questions for me patient: so will i be able to run again

D2N044

22

[ "Physical Examination", "Discussion", "Medication", "Referral", "Acute Assessment" ]

[ "Objective", "Assessment", "Plan" ]

okay great so let's go ahead and do a i just wan na take a look here i reviewed your vitals and overall they look good your blood pressure is one twenty over seventy your your heart rate is sixty and your respiratory rate is fourteen those are all phenomenal numbers as i listened to your heart it is at a regular and a slower rate but i do n't hear any extra sounds so there is no murmurs as we go through that now on musculoskeletal exam you have a normal gait i watched you you know kinda walk in here this morning your strength i just wan na check it when i go ahead and i want you to move your leg okay your muscle strength is is good you do have a three out of five for abduction of your legs bilaterally and that's you know kinda bringing your legs in the remainder of your muscle strength for your lower extremities is a five out of five now let me focus specifically on your knee examination i do n't see any redness or ecchymosis or warmth of the skin and those are big words you know i do n't see any bruising or or that redness there is no effusion that's just like a fluid underneath the knee i do n't appreciate that any at all you do seem to have some tenderness when i palpate and you do have a positive patellar grind test when you stood up i could feel that as we went through there you did say you had that knee pain with squatting but your lachman your anterior and posterior drawer and mcmurray test are all negative bilaterally neurologically and your your your lower extremities your patella and your achilles reflex are symmetrical and that's good so i did review the x-rays of both your knees which shows no fractures or osteoarthritis so based on what you told me and reviewing the mri that you had done before you came in your symptoms are consistent with patellofemoral pain syndrome and this is a really common condition that we see that causes knee knee pain especially in really active young people that's probably why i do n't get it when i'm riding my bike forever and ever now this condition has to do with the way your kneecap moves across along the groove of your thigh bone your femur so for pain i want you to continue to take the ibuprofen or any other anti-inflammatories you know aleve or any of those as you need it to help with the pain now i am going to recommend physical therapy well they will show you a number of lower extremity exercises this is probably one of the best things that you can do and this will help increase your lower extremity strength your mobility and correct any incorrect running mechanics that you might have do you have any questions for me

1,243

doctor: absolutely my goal is to get you out there and maybe we can cross pads on the the bike trail some day you are gon na have to take it a little bit easy for now but we are gon na get you back and once we do that i think you will be really pleased is there anything else patient: no i think that's it

D2N044

23

[ "Chitchat" ]

[ "Null" ]

absolutely my goal is to get you out there and maybe we can cross pads on the the bike trail some day you are gon na have to take it a little bit easy for now but we are gon na get you back and once we do that i think you will be really pleased is there anything else

1,244

doctor: okay have a great day patient: okay you too

D2N044

24

[ "Chitchat" ]

[ "Null" ]

okay have a great day

1,245

doctor: thank you patient: bye

D2N044

25

[ "Chitchat" ]

[ "Null" ]

thank you

1,246

doctor: hi abigail how are you today patient: hello hi nice to meet you i'm i'm doing okay

D2N045

0

[ "Greetings" ]

[ "Subjective" ]

hi abigail how are you today

1,247

doctor: good i'm doctor sanchez and i'm gon na go ahead and take a look i saw with your notes that you've been having some knee pain yes that's that's true you know it's been going on for a while i like to run i do jogs i sign up for the 5k tack you know sometimes the marathon and i have n't been doing longer distances because patient: when i'm running i my right knee here it just starts to ache and it's it's just to the point where i need your opinion

D2N045

1

[ "Acute Symptoms" ]

[ "Subjective" ]

good i'm doctor sanchez and i'm gon na go ahead and take a look i saw with your notes that you've been having some knee pain yes that's that's true you know it's been going on for a while i like to run i do jogs i sign up for the 5k tack you know sometimes the marathon and i have n't been doing longer distances because

1,248

doctor: okay okay what have you done for it so far what makes it better what makes it worse patient: well it used to be that when i run it ache and then i put ice on it and then it would be okay so i do ice and ibuprofen

D2N045

2

[ "Acute Symptoms", "Therapeutic History" ]

[ "Subjective" ]

okay okay what have you done for it so far what makes it better what makes it worse

1,249

doctor: okay okay and did you see anybody for this before coming into the office here patient: yeah i doctor wood is my primary care provider and i talked to him about it actually over the years and this last visit he said he referred me to you

D2N045

3

[ "Personal History" ]

[ "Subjective" ]

okay okay and did you see anybody for this before coming into the office here

1,250

doctor: okay okay good so ice and rest makes it feel better running and and activity makes it hurt a little bit more is that correct patient: yeah that's right

D2N045

4

[ "Acute Symptoms" ]

[ "Subjective" ]

okay okay good so ice and rest makes it feel better running and and activity makes it hurt a little bit more is that correct

1,251

doctor: okay do you have any family history of arthritis or any of those type of immune diseases patient: i'm trying to think no i do n't think so no

D2N045

5

[ "Family History" ]

[ "Subjective" ]

okay do you have any family history of arthritis or any of those type of immune diseases

1,252

doctor: okay and do you get is it is this primarily worse in the morning or does it is it just there all the time when it comes on patient: it actually is worse towards the end of the day

D2N045

6

[ "Acute Symptoms" ]

[ "Subjective" ]

okay and do you get is it is this primarily worse in the morning or does it is it just there all the time when it comes on

1,253

doctor: okay so let's go ahead and i want to do a quick examination here your blood pressure and was one twenty over sixty that's phenomenal your heart rate was fifty eight and you can tell that you're a runner with that that level of a heart rate and your respirations were fourteen so all of that looked very good there was no fever when you came in when i'm gon na just quickly listen to your heart and lungs okay those those sound good but let me get let's focus here on your lower extremities i'm i'm gon na look at your your left knee first when i move your left knee do you get any type of pain or is it just feel like normal and it's always your pain's always isolated to the right patient: that feels that feels normal

D2N045

8

[ "Physical Examination" ]

[ "Objective" ]

okay so let's go ahead and i want to do a quick examination here your blood pressure and was one twenty over sixty that's phenomenal your heart rate was fifty eight and you can tell that you're a runner with that that level of a heart rate and your respirations were fourteen so all of that looked very good there was no fever when you came in when i'm gon na just quickly listen to your heart and lungs okay those those sound good but let me get let's focus here on your lower extremities i'm i'm gon na look at your your left knee first when i move your left knee do you get any type of pain or is it just feel like normal and it's always your pain's always isolated to the right

1,254

doctor: okay okay so let me i just want you to back up here in the stretcher a little bit more and i'm just gon na do some movement of your knee any okay so i want you to push your leg out against my hand does that hurt patient: no

D2N045

9

[ "Physical Examination" ]

[ "Objective" ]

okay okay so let me i just want you to back up here in the stretcher a little bit more and i'm just gon na do some movement of your knee any okay so i want you to push your leg out against my hand does that hurt

1,255

doctor: okay and if you pull back does that hurt a little bit patient: no

D2N045

10

[ "Physical Examination" ]

[ "Objective" ]

okay and if you pull back does that hurt a little bit

1,256

doctor: okay and i'm gon na move it around so when i look at the knee there is no redness there's no swelling i can appreciate a a small amount of effusion and that means that there's a little bit of fluid under the knee or in that knee's joint space and there is there is several reasons that could be now when i push on your knee does it hurt more on the inside or does it hurt more on the outside here patient: the the right knee here hurts on the outside

D2N045

11

[ "Physical Examination" ]

[ "Objective" ]

okay and i'm gon na move it around so when i look at the knee there is no redness there's no swelling i can appreciate a a small amount of effusion and that means that there's a little bit of fluid under the knee or in that knee's joint space and there is there is several reasons that could be now when i push on your knee does it hurt more on the inside or does it hurt more on the outside here

1,257

doctor: okay okay and you've got a good pedal pulse so you know you can feel that and when i touch your feet you do n't have any numbness or tingling or anything like that patient: no uh uh

D2N045

12

[ "Physical Examination" ]

[ "Objective" ]

okay okay and you've got a good pedal pulse so you know you can feel that and when i touch your feet you do n't have any numbness or tingling or anything like that

1,258

doctor: okay well so what i want to tell you is that i think you have a knee sprain from overuse and we see that sometimes in runners now unfortunately you're gon na have to take some a little bit of time off of of active running but i do n't think it will be that long until we can get you up and running again now i reviewed the x-rays that we did when you first came into the office here this morning and the joint spaces of that right knee are are well maintained i do n't see any evidence of any fracture and when compared to the left knee everything looks good so i do n't even see any signs of any arthritis that i would've been suspecting i would like you to stay on two tylenol five hundred milligrams and two ibuprofen two hundred milligram tablets and i want you to take that three times a day and that's gon na help with both the pain and the inflammation i'm also gon na order some physical therapy for your your right knee and that physical therapy will help strengthen the lower extremities and make it give you a little bit of a balance and some they'll be able to recommend good running exercises for you i do wan na follow up with you in two weeks and see if we're getting better so let's no running for two weeks and if we're we're improving then we'll move on and probably start adding some additional activity does that sound like a plan patient: yeah that does i i was curious so i will lay off the running for now can i you know lift weights and do like my squats and and those type of exercises at the gym

D2N045

13

[ "Discussion", "Follow-up", "Medication", "Radiology Examination", "Referral", "Acute Assessment" ]

[ "Objective", "Assessment", "Plan" ]

okay well so what i want to tell you is that i think you have a knee sprain from overuse and we see that sometimes in runners now unfortunately you're gon na have to take some a little bit of time off of of active running but i do n't think it will be that long until we can get you up and running again now i reviewed the x-rays that we did when you first came into the office here this morning and the joint spaces of that right knee are are well maintained i do n't see any evidence of any fracture and when compared to the left knee everything looks good so i do n't even see any signs of any arthritis that i would've been suspecting i would like you to stay on two tylenol five hundred milligrams and two ibuprofen two hundred milligram tablets and i want you to take that three times a day and that's gon na help with both the pain and the inflammation i'm also gon na order some physical therapy for your your right knee and that physical therapy will help strengthen the lower extremities and make it give you a little bit of a balance and some they'll be able to recommend good running exercises for you i do wan na follow up with you in two weeks and see if we're getting better so let's no running for two weeks and if we're we're improving then we'll move on and probably start adding some additional activity does that sound like a plan

1,259

doctor: yeah absolutely and and those are good exercises but i'd like you to get that first physical therapy appointment in and they'll be able to talk with you on what the best exercises are for you to do patient: okay got it

D2N045

14

[ "Discussion", "Referral" ]

[ "Plan" ]

yeah absolutely and and those are good exercises but i'd like you to get that first physical therapy appointment in and they'll be able to talk with you on what the best exercises are for you to do

1,260

doctor: any questions patient: hmmm no i do n't think so

D2N045

15

[ "Discussion" ]

[ "Plan" ]

any questions

1,261

doctor: okay thank you abigail and i'd like i said stop out at the desk and we'll make an appointment for two weeks patient: okay thanks doctor

D2N045

16

[ "Follow-up" ]

[ "Plan" ]

okay thank you abigail and i'd like i said stop out at the desk and we'll make an appointment for two weeks

1,262

doctor: thank you

D2N045

17

[ "Chitchat" ]

[ "Null" ]

doctor: thank you

1,263

doctor: okay so we are recording okay so okay so i understand you've so you've got a past medical history of type two diabetes and you're coming in and for evaluation of a newly diagnosed ovarian cancer so how are you doing today patient: i do n't hear the question but i'm assuming that you when you say batcher so when i start talking about my dog and my three cats and all that those sort of things are not going to be included in the in the note

D2N046

0

[ "Personal History", "Greetings" ]

[ "Subjective" ]

okay so we are recording okay so okay so i understand you've so you've got a past medical history of type two diabetes and you're coming in and for evaluation of a newly diagnosed ovarian cancer so how are you doing today

1,264

doctor: right i want you you can talk about those things yes patient: okay

D2N046

1

[ "Chitchat" ]

[ "Null" ]

right i want you you can talk about those things yes

1,265

doctor: okay so with your newly diagnosed ovarian cancer so how are you feeling today how are you doing patient: i'm doing pretty good depressed

D2N046

2

[ "Acute Symptoms", "Personal History" ]

[ "Subjective" ]

okay so with your newly diagnosed ovarian cancer so how are you feeling today how are you doing

1,266

doctor: little depressed i can understand it's a lot to take on is n't it patient: yes

D2N046

3

[ "Acute Symptoms" ]

[ "Subjective" ]

little depressed i can understand it's a lot to take on is n't it

1,267

doctor: okay okay so lem me ask you some questions so what kind of symptoms were you having that prompted you your doctor to do the tests patient: i was having severe pain and bleeding

D2N046

4

[ "Personal History" ]

[ "Subjective" ]

okay okay so lem me ask you some questions so what kind of symptoms were you having that prompted you your doctor to do the tests

1,268

doctor: okay now do you have other symptoms such as weight loss constipation vomiting or issues with urination patient: no vomiting but constipation and weight loss

D2N046

5

[ "Vegetative History" ]

[ "Subjective" ]

okay now do you have other symptoms such as weight loss constipation vomiting or issues with urination

1,269

doctor: okay yeah that's understandable so do you have any children or have you ever been pregnant patient: i'm sorry i did n't hear that part

D2N046

6

[ "Other Socials" ]

[ "Subjective" ]

okay yeah that's understandable so do you have any children or have you ever been pregnant

1,270

doctor: do you have any children or have you ever been pregnant patient: no to either one of those

D2N046

7

[ "Other Socials" ]

[ "Subjective" ]

do you have any children or have you ever been pregnant

1,271

doctor: okay so and do you know at what age you got your period and when you started menopause patient: thirteen for my period and twenty eighth for menopause

D2N046

8

[ "Vegetative History" ]

[ "Subjective" ]

okay so and do you know at what age you got your period and when you started menopause

1,272

doctor: okay do you take any oral hormone replacement therapy patient: no

D2N046

9

[ "Therapeutic History" ]

[ "Subjective" ]

okay do you take any oral hormone replacement therapy

1,273

doctor: okay any history of endometriosis patient: any history of what

D2N046

10

[ "Personal History" ]

[ "Subjective" ]

okay any history of endometriosis

1,274

doctor: endometriosis patient: no

D2N046

11

[ "Personal History" ]

[ "Subjective" ]

endometriosis

1,275

doctor: okay how about any family history of any gynecological cancers patient: i was adopted

D2N046

12

[ "Family History" ]

[ "Subjective" ]

okay how about any family history of any gynecological cancers

1,276

doctor: okay okay so i'm just gon na do a quick exam of your abdomen and then perform a vaginal exam okay patient: okay

D2N046

13

[ "Physical Examination" ]

[ "Objective" ]

okay okay so i'm just gon na do a quick exam of your abdomen and then perform a vaginal exam okay

1,277

doctor: alright okay so i do feel the mass on the where to go here okay patient: i did n't know you're gon na play a doctor today

D2N046

14

[ "Physical Examination" ]

[ "Objective" ]

alright okay so i do feel the mass on the where to go here okay

1,278

doctor: i did okay okay so i do feel the mass on the left side but everything else looks good and on abdominal exam there is slight tenderness to palpation of the left lower quadrant no rebounding or guarding on vaginal exam there are no external lesions on the labia the vaginal vault is within normal limits the cervix is pink without lesions and on bimanual exam i appreciate a left adnexal mass and there is no masses on the right okay so now i reviewed the results of your abdominal ct which show a three centimeter left ovarian mass with an associated local localized lymph node involvement there is no evidence of gross peritoneal or metastatic disease so lem me tell you a little bit about my assessment and plan so for the first problem so i do think this is most likely ovarian cancer looking at your ct scan it looks like stage three a disease based on the lymph node involvement i want to start by sending off some blood tests like a ca-125 and hcg and afp and ldh these are just tests that help me to determine what type of tumor i'm dealing with and then i want you to undergo genetic counseling and testing to see if you have a genetic predisposition for developing ovarian cancer so this stage of ovarian cancer is treated by performing surgery followed by adjunct chemotherapy so this means we'll start chemotherapy after you've recovered from surgery okay so for the surgery i would perform a hysterectomy remove both ovaries and perform a lymph node dissection to remove the involved and involve lymph nodes as well as any other ones i see and i'll also send a sample of any tissue if there anything that looks suspicious at all and we'll be able to tell exactly what stage this is based on the pathology reports i then recommend chemotherapy with cisplatin and taxol and based on how the surgery goes i may want you to receive intraperitoneal intraperitoneal chemo which is done inserting a small tube into your belly for the chemo to go directly into your peritoneum now i know that was a lot sick in do you have any questions or patient: am i gon na die

D2N046

15

[ "Physical Examination", "Discussion", "Medication", "Radiology Examination", "Diagnostic Testing", "Acute Assessment", "Other Treatments" ]

[ "Objective", "Assessment", "Plan" ]

i did okay okay so i do feel the mass on the left side but everything else looks good and on abdominal exam there is slight tenderness to palpation of the left lower quadrant no rebounding or guarding on vaginal exam there are no external lesions on the labia the vaginal vault is within normal limits the cervix is pink without lesions and on bimanual exam i appreciate a left adnexal mass and there is no masses on the right okay so now i reviewed the results of your abdominal ct which show a three centimeter left ovarian mass with an associated local localized lymph node involvement there is no evidence of gross peritoneal or metastatic disease so lem me tell you a little bit about my assessment and plan so for the first problem so i do think this is most likely ovarian cancer looking at your ct scan it looks like stage three a disease based on the lymph node involvement i want to start by sending off some blood tests like a ca-125 and hcg and afp and ldh these are just tests that help me to determine what type of tumor i'm dealing with and then i want you to undergo genetic counseling and testing to see if you have a genetic predisposition for developing ovarian cancer so this stage of ovarian cancer is treated by performing surgery followed by adjunct chemotherapy so this means we'll start chemotherapy after you've recovered from surgery okay so for the surgery i would perform a hysterectomy remove both ovaries and perform a lymph node dissection to remove the involved and involve lymph nodes as well as any other ones i see and i'll also send a sample of any tissue if there anything that looks suspicious at all and we'll be able to tell exactly what stage this is based on the pathology reports i then recommend chemotherapy with cisplatin and taxol and based on how the surgery goes i may want you to receive intraperitoneal intraperitoneal chemo which is done inserting a small tube into your belly for the chemo to go directly into your peritoneum now i know that was a lot sick in do you have any questions or

1,279

doctor: well that's a good question so based on what i see at this time i will we believe you have a favorable diagnosis prognosis and you're also still young and healthy which makes your prognosis even better and we do need to see a final pathology report to give you a definitive answer though okay patient: alright alright

D2N046

16

[ "Discussion" ]

[ "Plan" ]

well that's a good question so based on what i see at this time i will we believe you have a favorable diagnosis prognosis and you're also still young and healthy which makes your prognosis even better and we do need to see a final pathology report to give you a definitive answer though okay

1,280

doctor: hi billy how are you what's been going on the medical assistant told me that you're having some difficulty urinating patient: yeah yeah i i did n't really wan na come in to talk about it's kinda weird but i think probably over the last six months i'm just not peeing right it just does n't seem to be normal

D2N047

0

[ "Acute Symptoms", "Greetings" ]

[ "Subjective" ]

hi billy how are you what's been going on the medical assistant told me that you're having some difficulty urinating

1,281

doctor: okay so let's talk a little bit about that now is your is your stream is your urination stream weak patient: yeah i'd probably say so

D2N047

1

[ "Acute Symptoms", "Vegetative History" ]

[ "Subjective" ]

okay so let's talk a little bit about that now is your is your stream is your urination stream weak

1,282

doctor: okay and do you feel like you're emptying your bladder fully or do you feel like you still have some urine left in there when you when you finish patient: most of the times i'm okay but sometimes if i stand there long enough i i can kinda go a little bit more so it's taking a while actually to just go to the bathroom

D2N047

2

[ "Acute Symptoms", "Vegetative History" ]

[ "Subjective" ]

okay and do you feel like you're emptying your bladder fully or do you feel like you still have some urine left in there when you when you finish

1,283

doctor: okay and are you waking up at night to go to the bathroom does it impact your sleep patient: yeah i try to empty my bladder now right before i go to bed and and not drink anything but i'm still probably getting up three or four times a night to go to the bed

D2N047

3

[ "Vegetative History" ]

[ "Subjective" ]

okay and are you waking up at night to go to the bathroom does it impact your sleep

1,284

doctor: okay so you're getting up about three or four times a night and and how long has this been going on you said for about six months patient: yeah six months to like this and it's probably been a little bit worse over the last six months and maybe it's been longer i just did n't want to bring it up

D2N047

4

[ "Personal History", "Vegetative History" ]

[ "Subjective" ]

okay so you're getting up about three or four times a night and and how long has this been going on you said for about six months

1,285

doctor: okay so you think it's been going on longer okay alright now how about have you had any burning when you urinate at all patient: no it i do n't think it burns

D2N047

5

[ "Vegetative History" ]

[ "Subjective" ]

okay so you think it's been going on longer okay alright now how about have you had any burning when you urinate at all

1,286

doctor: no burning when you urinate okay and and any other any other issues any problems with your bowels any constipation issues patient: hmmm no i i i had diarrhea last week but i think i ate something bad

D2N047

6

[ "Acute Symptoms", "Vegetative History" ]

[ "Subjective" ]

no burning when you urinate okay and and any other any other issues any problems with your bowels any constipation issues

1,287

doctor: okay and ever have you ever had any issues where you had what we call urinary retention where you could n't pee and you needed to have like a catheter inserted patient: my gosh no

D2N047

7

[ "Personal History" ]

[ "Subjective" ]

okay and ever have you ever had any issues where you had what we call urinary retention where you could n't pee and you needed to have like a catheter inserted

1,288

doctor: alright and have you ever seen a urologist i do n't think so you've been my patient for a while i do n't remember ever sending you but have you ever seen one patient: i do n't think so

D2N047

9

[ "Personal History" ]

[ "Subjective" ]

alright and have you ever seen a urologist i do n't think so you've been my patient for a while i do n't remember ever sending you but have you ever seen one

1,289

doctor: okay now tell me how are you doing with your with your heart when was the last time you saw doctor moore the cardiologist i know that you had the the stent placed in your right coronary artery about what was that twenty eighteen patient: yeah sounds about right i think i just saw him in november he said everything was okay

D2N047

10

[ "Personal History" ]

[ "Subjective" ]

okay now tell me how are you doing with your with your heart when was the last time you saw doctor moore the cardiologist i know that you had the the stent placed in your right coronary artery about what was that twenty eighteen

1,290

doctor: he said everything was okay alright and so you have n't had any chest pain or shortness of breath you're still walking around doing your activities of daily living are you exercising patient: kind of

D2N047

11

[ "Acute Symptoms" ]

[ "Subjective" ]

he said everything was okay alright and so you have n't had any chest pain or shortness of breath you're still walking around doing your activities of daily living are you exercising

1,291

doctor: kind of okay now from what i remember i remember you being a big college football fan are you as excited as i am that georgia beat alabama in the national championships patient: yeah yeah i'm super excited

D2N047

12

[ "Chitchat" ]

[ "Null" ]

kind of okay now from what i remember i remember you being a big college football fan are you as excited as i am that georgia beat alabama in the national championships

1,292

doctor: you do n't really seem that excited patient: get the problem fixed because i have to be able to sit there and watch the whole game

D2N047

13

[ "Chitchat" ]

[ "Null" ]

you do n't really seem that excited

1,293

doctor: yeah i i really do n't like nick saving i'm so i'm super happy that that the dogs pulled it out patient: i do n't know if we can do friends anymore

D2N047

14

[ "Chitchat" ]

[ "Null" ]

yeah i i really do n't like nick saving i'm so i'm super happy that that the dogs pulled it out

1,294

doctor: are you in alabama fan patient: maybe i'm actually originally not from georgia so

D2N047

15

[ "Chitchat" ]

[ "Null" ]

are you in alabama fan

1,295

doctor: okay alright well i mean i i'm i'm a long horns fan but anyway well i digress let's talk a little bit about your diabetes how are how are you doing with your sugars are you watching your diet patient: i'm trying to yeah i think they are okay

D2N047

16

[ "Personal History" ]

[ "Subjective" ]

okay alright well i mean i i'm i'm a long horns fan but anyway well i digress let's talk a little bit about your diabetes how are how are you doing with your sugars are you watching your diet

1,296

doctor: okay and are you still taking the metformin patient: yep

D2N047

17

[ "Therapeutic History" ]

[ "Subjective" ]

okay and are you still taking the metformin

1,297

doctor: you are okay alright now i wan na go ahead and just move on to a quick physical exam okay i'm gon na be calling out some of my exam findings and i'm gon na let you know what that means when i'm done okay alright i do have to do a rectal exam i apologize i'm just gon na be calling it out what what i what i appreciate okay so on your heart exam i do appreciate a slight three out of six systolic ejection murmur hurt at the left base on your lung exam your lungs are clear to auscultation bilaterally on your abdominal exam your abdomen is nontender and nondistended i do n't appreciate any masses or any rebound or guarding on your prostate exam i do appreciate an enlarged prostate i do n't appreciate any masses on physical exam so what what does that mean billy so that ultimately means that you know everything looks good you know you have that little heart murmur which i believe you you've had in the past but we're gon na go ahead and look into that you know your prostate seems a little bit enlarged to me on physical exam so let's talk about how we can go about and and remedy that okay so for your first problem of this you know difficulty urinating i wan na go ahead and just order some routine labs i wan na get a a psa that kind of that ultimately kinda looks for prostate cancer issues which i do n't think you have because we did n't really appreciate that on physical exam i wan na go ahead and we can try to start you on what we call flomax zero point four milligrams once a day you should take it at night because it can cause people to get a little bit dizzy if they take it in the morning so i would take it at night and i wan na go ahead and refer you to a urologist just to look into this more so we can go ahead and and get this problem solved for you okay i'm also gon na go ahead and just order some routine blood tests just to make sure that we are not missing anything do you have any questions about that and i wan na go ahead and order a urinalysis and a urine culture patient: yeah so sounds good have you seen that commercial for that super batter prostate stuff does that work

D2N047

18

[ "Physical Examination", "Discussion", "Medication", "Diagnostic Testing", "Acute Assessment" ]

[ "Objective", "Assessment", "Plan" ]

you are okay alright now i wan na go ahead and just move on to a quick physical exam okay i'm gon na be calling out some of my exam findings and i'm gon na let you know what that means when i'm done okay alright i do have to do a rectal exam i apologize i'm just gon na be calling it out what what i what i appreciate okay so on your heart exam i do appreciate a slight three out of six systolic ejection murmur hurt at the left base on your lung exam your lungs are clear to auscultation bilaterally on your abdominal exam your abdomen is nontender and nondistended i do n't appreciate any masses or any rebound or guarding on your prostate exam i do appreciate an enlarged prostate i do n't appreciate any masses on physical exam so what what does that mean billy so that ultimately means that you know everything looks good you know you have that little heart murmur which i believe you you've had in the past but we're gon na go ahead and look into that you know your prostate seems a little bit enlarged to me on physical exam so let's talk about how we can go about and and remedy that okay so for your first problem of this you know difficulty urinating i wan na go ahead and just order some routine labs i wan na get a a psa that kind of that ultimately kinda looks for prostate cancer issues which i do n't think you have because we did n't really appreciate that on physical exam i wan na go ahead and we can try to start you on what we call flomax zero point four milligrams once a day you should take it at night because it can cause people to get a little bit dizzy if they take it in the morning so i would take it at night and i wan na go ahead and refer you to a urologist just to look into this more so we can go ahead and and get this problem solved for you okay i'm also gon na go ahead and just order some routine blood tests just to make sure that we are not missing anything do you have any questions about that and i wan na go ahead and order a urinalysis and a urine culture

1,298

doctor: well i think the data it's it's i'm not really sure if it works or not i'm not that familiar with it let's just go ahead and stick with flomax and that's why we are gon na refer you to the urologist so that they can go ahead and talk to you about you know the most current treatment options for you okay patient: alright

D2N047

19

[ "Discussion", "Medication" ]

[ "Plan" ]

well i think the data it's it's i'm not really sure if it works or not i'm not that familiar with it let's just go ahead and stick with flomax and that's why we are gon na refer you to the urologist so that they can go ahead and talk to you about you know the most current treatment options for you okay

1,299