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doctor: all right , new patient , jordan roberts . date of birth : 3/2/1972 . he's a 49 year old , uh hm , with hypertension and palpitations . please copy forward his thyroid profile from march 1st , 2021 . hello mr. roberts , how are you doing today ? patient: i'm fine , thank you . | D2N139 | 0 | [
"Acute Symptoms",
"Personal History",
"Greetings"
] | [
"Subjective"
] | all right , new patient , jordan roberts . date of birth : 3/2/1972 . he's a 49 year old , uh hm , with hypertension and palpitations . please copy forward his thyroid profile from march 1st , 2021 . hello mr. roberts , how are you doing today ? | 3,500 |
doctor: good . good . so , i saw you were recently in the emergency room with high blood pressure and some palpitations . patient: yeah . that was back in march i think , but my girlfriend and i , we talked about it , and on that day i had a few cups of coffee , and no breakfast . so , i think it was probably more of a... | D2N139 | 1 | [
"Personal History"
] | [
"Subjective"
] | good . good . so , i saw you were recently in the emergency room with high blood pressure and some palpitations . | 3,501 |
doctor: yeah . have you , uh , have you felt it again since ? patient: uh , no . | D2N139 | 2 | [
"Personal History"
] | [
"Subjective"
] | yeah . have you , uh , have you felt it again since ? | 3,502 |
doctor: okay . uh , so tell me about the blood pressure then . patient: well , i've had issues with my blood pressure since i was young . | D2N139 | 3 | [
"Personal History"
] | [
"Subjective"
] | okay . uh , so tell me about the blood pressure then . | 3,503 |
doctor: do you have a family history of this ? patient: yeah . a lot of my family does have high blood pressure . | D2N139 | 4 | [
"Family History"
] | [
"Subjective"
] | do you have a family history of this ? | 3,504 |
doctor: uh , can you tell me which medications you're taking ? patient: my new med is , uh , a combo med , something 40-25 . | D2N139 | 6 | [
"Therapeutic History"
] | [
"Subjective"
] | uh , can you tell me which medications you're taking ? | 3,505 |
doctor: okay . um . yes , i see that in your chart . the benicar hct . it has hydrochlorothiazide in it . patient: yeah , that's it . my water pill i call it . | D2N139 | 7 | [
"Therapeutic History"
] | [
"Subjective"
] | okay . um . yes , i see that in your chart . the benicar hct . it has hydrochlorothiazide in it . | 3,506 |
doctor: okay . are you still taking the amlodipine , 10 milligrams daily ? patient: uh , yes i am . | D2N139 | 8 | [
"Therapeutic History"
] | [
"Subjective"
] | okay . are you still taking the amlodipine , 10 milligrams daily ? | 3,507 |
doctor: that's- that's a good start on a regimen . are you checking your blood pressure at home , and if yes , what numbers are you seeing ? patient: um , every day . | D2N139 | 9 | [
"Personal History"
] | [
"Subjective"
] | that's- that's a good start on a regimen . are you checking your blood pressure at home , and if yes , what numbers are you seeing ? | 3,508 |
doctor: awesome . patient: yeah . every morning , i take it when i get up , and it's been running at about , uh , 146 to 155 lately . | D2N139 | 10 | [
"Personal History"
] | [
"Subjective"
] | awesome . | 3,509 |
doctor: so you're not down in the 120s yet ? patient: no , not yet . well , we're trying to get there though . | D2N139 | 11 | [
"Personal History"
] | [
"Subjective"
] | so you're not down in the 120s yet ? | 3,510 |
doctor: okay . uh , how are you doing with your salt intake ? patient: i'm trying to back off of it . i think i'm doing good with it , not eating too much . | D2N139 | 12 | [
"Vegetative History"
] | [
"Subjective"
] | okay . uh , how are you doing with your salt intake ? | 3,511 |
doctor: good , uh , it plays a huge part in lowering your pressure and , uh , staying away from salt is important . um , i'll give you some information on the dash eating plan , which is the only eating plan that has been shown to lower blood pressure . patient: sounds good . | D2N139 | 13 | [
"Vegetative History"
] | [
"Subjective"
] | good , uh , it plays a huge part in lowering your pressure and , uh , staying away from salt is important . um , i'll give you some information on the dash eating plan , which is the only eating plan that has been shown to lower blood pressure . | 3,512 |
doctor: are you doing any exercise ? patient: i do try to walk on the treadmill when i can . | D2N139 | 14 | [
"Other Socials"
] | [
"Subjective"
] | are you doing any exercise ? | 3,513 |
doctor: okay , great . um , all right . so , let's take a look . patient: all right . | D2N139 | 15 | [
"Physical Examination"
] | [
"Objective"
] | okay , great . um , all right . so , let's take a look . | 3,514 |
doctor: uh , you're gon na hear me talk throughout your exam , just so i can make sure i get everything documented . patient: okay . | D2N139 | 16 | [
"Chitchat"
] | [
"Null"
] | uh , you're gon na hear me talk throughout your exam , just so i can make sure i get everything documented . | 3,515 |
doctor: so , use my general physical exam template . let me take a listen to you and make sure everything sounds good . patient: all right . | D2N139 | 17 | [
"Chitchat"
] | [
"Null"
] | so , use my general physical exam template . let me take a listen to you and make sure everything sounds good . | 3,516 |
doctor: your heart and lungs sound good , so that's great . patient: good to hear . | D2N139 | 18 | [
"Physical Examination"
] | [
"Objective"
] | your heart and lungs sound good , so that's great . | 3,517 |
doctor: all right . go ahead and lie down . uh , and let me know if anywhere i press hurts . patient: nope . nowhere . | D2N139 | 19 | [
"Physical Examination"
] | [
"Objective"
] | all right . go ahead and lie down . uh , and let me know if anywhere i press hurts . | 3,518 |
doctor: all right . so , i'm gon na take a look at your ankles and feet . i'm just gon na look for some swelling . patient: all right . | D2N139 | 20 | [
"Physical Examination"
] | [
"Objective"
] | all right . so , i'm gon na take a look at your ankles and feet . i'm just gon na look for some swelling . | 3,519 |
doctor: all right . it all looks good . go ahead and sit up . so , in terms of getting that pressure down , you're on three meds that are maxed out and your blood pressure is still not down . and , the question is what do we need to do to get your- to get it down . uh , your potassium one week ago was 4.0 . uh , has it... | D2N139 | 21 | [
"Physical Examination"
] | [
"Objective"
] | all right . it all looks good . go ahead and sit up . so , in terms of getting that pressure down , you're on three meds that are maxed out and your blood pressure is still not down . and , the question is what do we need to do to get your- to get it down . uh , your potassium one week ago was 4.0 . uh , has it been re... | 3,520 |
doctor: okay . uh , four is good for your potassium level , some people have what is called resistant hypertension that is driven by something else in their body , uh , often it is a form , uh , hormonal response . if i were to take 10 people under the age of 50 who have high blood pressure who developed it at a young ... | D2N139 | 22 | [
"Discussion",
"Reassessment"
] | [
"Assessment",
"Plan"
] | okay . uh , four is good for your potassium level , some people have what is called resistant hypertension that is driven by something else in their body , uh , often it is a form , uh , hormonal response . if i were to take 10 people under the age of 50 who have high blood pressure who developed it at a young age , ei... | 3,521 |
doctor: um , in these cases , there's medicine called , uh , spironolactone , that is very effective at dropping the ald- aldosterone level , and your blood pressure , and i think we should give that a try . patient: all right . i mean , i'm willing to give it a try . | D2N139 | 23 | [
"Discussion",
"Medication"
] | [
"Plan"
] | um , in these cases , there's medicine called , uh , spironolactone , that is very effective at dropping the ald- aldosterone level , and your blood pressure , and i think we should give that a try . | 3,522 |
doctor: okay . so , let's discuss the piss- the possible risk of , uh , being on hydrochlorothiazide , which is the fluid med that you're now on . and , the spironolactone . one issue is that they can affect your electrolyte balance . um , they can also cause dehydration . so , when ... so , you got ta make sure that y... | D2N139 | 24 | [
"Discussion",
"Medication",
"Other Treatments"
] | [
"Plan"
] | okay . so , let's discuss the piss- the possible risk of , uh , being on hydrochlorothiazide , which is the fluid med that you're now on . and , the spironolactone . one issue is that they can affect your electrolyte balance . um , they can also cause dehydration . so , when ... so , you got ta make sure that you hydra... | 3,523 |
doctor: yeah . and then the third thing is that spironolactone combined with hydrocholorozide- chlorothiazide can cause your sodium levels to go down . now , this does not mean- mean that you need to be eating more salt , okay ? but , it does mean that you will need to do blood tests in two weeks to make sure that it's... | D2N139 | 25 | [
"Medication",
"Diagnostic Testing"
] | [
"Plan"
] | yeah . and then the third thing is that spironolactone combined with hydrocholorozide- chlorothiazide can cause your sodium levels to go down . now , this does not mean- mean that you need to be eating more salt , okay ? but , it does mean that you will need to do blood tests in two weeks to make sure that it's okay . | 3,524 |
doctor: uh , dizziness possibly , as well as , uh , one in 100 guys might develop tenderness in their chest , swollen breasts , or enlarged breasts . this is a rare side effect , um , called gynecomastia , and if it happens , you just cut the medication and you let me know , but it is very uncommon . patient: i'll defi... | D2N139 | 26 | [
"Discussion",
"Medication"
] | [
"Plan"
] | uh , dizziness possibly , as well as , uh , one in 100 guys might develop tenderness in their chest , swollen breasts , or enlarged breasts . this is a rare side effect , um , called gynecomastia , and if it happens , you just cut the medication and you let me know , but it is very uncommon . | 3,525 |
doctor: okay . uh , we'll keep working at it until your blood pressure gets better . um , it can be tricky when your blood pressure starts to go up at a young age though , it is important to get it under control because it can lead to your heart getting bigger or enlarged . um , same thing that happens when you lift we... | D2N139 | 27 | [
"Discussion"
] | [
"Plan"
] | okay . uh , we'll keep working at it until your blood pressure gets better . um , it can be tricky when your blood pressure starts to go up at a young age though , it is important to get it under control because it can lead to your heart getting bigger or enlarged . um , same thing that happens when you lift weights an... | 3,526 |
doctor: yeah , so getting that under control is really important to help prevent kidney failure , strokes , and- and things like that- that you're at high risk for with high blood pressure . patient: okay . | D2N139 | 28 | [
"Discussion"
] | [
"Plan"
] | yeah , so getting that under control is really important to help prevent kidney failure , strokes , and- and things like that- that you're at high risk for with high blood pressure . | 3,527 |
doctor: um , the american heart association has a website called heart.org , it has a lot of really good information about blood pressure to teach- to teach you about it and how to control your diet with exercise . um , if you do your treadmill routinely for 30 minutes or so most days , that could be seven to 10 points... | D2N139 | 29 | [
"Discussion",
"Other Treatments"
] | [
"Plan"
] | um , the american heart association has a website called heart.org , it has a lot of really good information about blood pressure to teach- to teach you about it and how to control your diet with exercise . um , if you do your treadmill routinely for 30 minutes or so most days , that could be seven to 10 points off you... | 3,528 |
doctor: yeah , yeah . it's very important to be active , lower your salt , and increase your potassium . um , the goal is to keep your salt under 2000 milligrams a day , the actual recommendation is- is 1500 milligrams per day , but most people have a hard time with that . um , so just take a look at the website and th... | D2N139 | 30 | [
"Discussion",
"Other Treatments"
] | [
"Plan"
] | yeah , yeah . it's very important to be active , lower your salt , and increase your potassium . um , the goal is to keep your salt under 2000 milligrams a day , the actual recommendation is- is 1500 milligrams per day , but most people have a hard time with that . um , so just take a look at the website and the dash d... | 3,529 |
doctor: all right . so , we'll try the spironolactone and schedule a followup in two weeks to check your blood pressure and electrolytes . uh , if the new med does n't work , the next up is going to be the resistant hypertension clinic . patient: all right . | D2N139 | 31 | [
"Discussion",
"Follow-up",
"Referral",
"Medication"
] | [
"Plan"
] | all right . so , we'll try the spironolactone and schedule a followup in two weeks to check your blood pressure and electrolytes . uh , if the new med does n't work , the next up is going to be the resistant hypertension clinic . | 3,530 |
doctor: all right . so , there they will look into secondary causes of your hypertension . they have access to newer procedure based technologies that can lower your blood pressure without medication , uh , for example , there is something called a renal , uh , denervation , uh , where they go inside the artery that fe... | D2N139 | 32 | [
"Discussion"
] | [
"Plan"
] | all right . so , there they will look into secondary causes of your hypertension . they have access to newer procedure based technologies that can lower your blood pressure without medication , uh , for example , there is something called a renal , uh , denervation , uh , where they go inside the artery that feeds your... | 3,531 |
doctor: yeah . so , that procedure has been shown to lower blood pressure by 10 points . um , there are of course some risks , so not everyone is a candidate . uh , but we'll cross that road , uh , when we need to , and let's just- let's just see how you do with the addition of the medication . patient: sounds good to ... | D2N139 | 33 | [
"Discussion"
] | [
"Plan"
] | yeah . so , that procedure has been shown to lower blood pressure by 10 points . um , there are of course some risks , so not everyone is a candidate . uh , but we'll cross that road , uh , when we need to , and let's just- let's just see how you do with the addition of the medication . | 3,532 |
doctor: all right . so , we will see you in two weeks then . patient: sounds good . thanks doc . | D2N139 | 34 | [
"Follow-up"
] | [
"Plan"
] | all right . so , we will see you in two weeks then . | 3,533 |
doctor: yeah , you're welcome . let me know if you have any questions . patient: will do . | D2N139 | 35 | [
"Discussion"
] | [
"Plan"
] | yeah , you're welcome . let me know if you have any questions . | 3,534 |
doctor: all right . have a great day mr. roberts . patient: you too . | D2N139 | 36 | [
"Chitchat"
] | [
"Null"
] | all right . have a great day mr. roberts . | 3,535 |
doctor: mr. roberts presents with resistant hypertension . he's on three meds and maximum dose . i have added spironolactone to his regiment . we will need to monitor his potassium and sodium . he will have a metabolic panel and blood pressure check in two weeks . uh , next medication would be carvedilol , uh , which i... | D2N139 | 37 | [
"Acute Assessment",
"Medication",
"Diagnostic Testing",
"Follow-up",
"Discussion"
] | [
"Assessment",
"Plan"
] | doctor: mr. roberts presents with resistant hypertension . he's on three meds and maximum dose . i have added spironolactone to his regiment . we will need to monitor his potassium and sodium . he will have a metabolic panel and blood pressure check in two weeks . uh , next medication would be carvedilol , uh , which i... | 3,536 |
doctor: brittany edwards , 07 , 1898 . she is a return visit for ibs with functional abdominal pain , nausea , vomiting . ms. edwards is a pleasant , 32-year-old female who was last seen in august of 2019 with flares of abdominal pain , who was diagnosed with irritable bowl that was treated with bentyl . she had a prev... | D2N140 | 0 | [
"Personal History",
"Greetings"
] | [
"Subjective"
] | brittany edwards , 07 , 1898 . she is a return visit for ibs with functional abdominal pain , nausea , vomiting . ms. edwards is a pleasant , 32-year-old female who was last seen in august of 2019 with flares of abdominal pain , who was diagnosed with irritable bowl that was treated with bentyl . she had a previous pre... | 3,537 |
doctor: good . how have you been feeling ? patient: not so good . | D2N140 | 1 | [
"Acute Symptoms"
] | [
"Subjective"
] | good . how have you been feeling ? | 3,538 |
doctor: yeah , so my nurse told me you have been going out to eat some on friday nights and saturday nights and that you have had some spicy foods or spicy shrimp . patient: yeah , i have . | D2N140 | 2 | [
"Acute Symptoms"
] | [
"Subjective"
] | yeah , so my nurse told me you have been going out to eat some on friday nights and saturday nights and that you have had some spicy foods or spicy shrimp . | 3,539 |
doctor: okay . well , your gut probably does not always appreciate that . patient: no , it does n't like it at all . | D2N140 | 3 | [
"Acute Symptoms"
] | [
"Subjective"
] | okay . well , your gut probably does not always appreciate that . | 3,540 |
doctor: yeah , so ibs is one of those things where you are very sensitive to certain things such as spicy foods or fatty foods and alcohol . and this can cause lower belly stuff like cramps , or you can get upper belly stuff such as nausea . patient: i've been getting both . | D2N140 | 4 | [
"Acute Symptoms",
"Drug History"
] | [
"Subjective"
] | yeah , so ibs is one of those things where you are very sensitive to certain things such as spicy foods or fatty foods and alcohol . and this can cause lower belly stuff like cramps , or you can get upper belly stuff such as nausea . | 3,541 |
doctor: okay . um , so how frequently have you been getting or having a bowel movement on normal days ? patient: i'm starting to notice it's between two and three times a day . | D2N140 | 5 | [
"Acute Symptoms"
] | [
"Subjective"
] | okay . um , so how frequently have you been getting or having a bowel movement on normal days ? | 3,542 |
doctor: okay . and are they soft stools or formed stools ? patient: um , they're formed . | D2N140 | 6 | [
"Acute Symptoms"
] | [
"Subjective"
] | okay . and are they soft stools or formed stools ? | 3,543 |
doctor: okay . and after you have gone out either drinking with your friends , do you tend to have more diarrhea ? patient: yeah , i do . | D2N140 | 7 | [
"Acute Symptoms"
] | [
"Subjective"
] | okay . and after you have gone out either drinking with your friends , do you tend to have more diarrhea ? | 3,544 |
doctor: okay . do you feel it's the food or the alcohol or both ? patient: uh , well usually we go to friday's restaurant . i always eat pasta , the chicken alfredo . | D2N140 | 8 | [
"Acute Symptoms",
"Drug History"
] | [
"Subjective"
] | okay . do you feel it's the food or the alcohol or both ? | 3,545 |
doctor: okay . i can s- i can bet it's the alfredo sauce . patient: but it normally does n't bother me . | D2N140 | 9 | [
"Acute Symptoms"
] | [
"Subjective"
] | okay . i can s- i can bet it's the alfredo sauce . | 3,546 |
doctor: okay . well , pasta can make you bloated , uh , but it does n't usually cause diarrhea . grilled chi- uh , grilled chicken is usually all right . alfredo , though , is higher in fat , and it does contain dairy . but you're saying it usually does n't bother you ? patient: no . | D2N140 | 10 | [
"Acute Symptoms"
] | [
"Subjective"
] | okay . well , pasta can make you bloated , uh , but it does n't usually cause diarrhea . grilled chi- uh , grilled chicken is usually all right . alfredo , though , is higher in fat , and it does contain dairy . but you're saying it usually does n't bother you ? | 3,547 |
doctor: okay . what type of alcohol drink do you drink when you are there ? is it a sweet drink ? patient: most of the time it's either tequila or dark liquor . i prefer patron , but if i get brown liquor , i only get two . um , every now and again , i'll drink a martini .sometimes it's the mixer they tend to put in th... | D2N140 | 11 | [
"Drug History"
] | [
"Subjective"
] | okay . what type of alcohol drink do you drink when you are there ? is it a sweet drink ? | 3,548 |
doctor: um , so when you're not eating out or drinking , what we do on a daily basis does help keep us regular , so when it does flare up , it c- it might not be as bad . um , have you had any luck using the fiber like citrucel regularly ? patient: um , no . i guess i need to find a new drink . | D2N140 | 12 | [
"Acute Symptoms"
] | [
"Subjective"
] | um , so when you're not eating out or drinking , what we do on a daily basis does help keep us regular , so when it does flare up , it c- it might not be as bad . um , have you had any luck using the fiber like citrucel regularly ? | 3,549 |
doctor: okay . and how is it during the week ? patient: like what i eat ? | D2N140 | 13 | [
"Acute Symptoms"
] | [
"Subjective"
] | okay . and how is it during the week ? | 3,550 |
doctor: yeah , and with the diarrhea and abdomal- um , abdominal pain . patient: right now , i'm still having the cramping and sharp pains , so i've been avoiding heavy foods . i did have some fried chicken today , though . | D2N140 | 14 | [
"Acute Symptoms"
] | [
"Subjective"
] | yeah , and with the diarrhea and abdomal- um , abdominal pain . | 3,551 |
doctor: and was everything all right after that ? patient: yeah , for the most part . | D2N140 | 15 | [
"Acute Symptoms"
] | [
"Subjective"
] | and was everything all right after that ? | 3,552 |
doctor: okay . remember , it's also the portion sizes . so i mean , if you eat a little and you feel fine , then that's okay . you have to just really watch the portions . patient: okay , good . i ca n't go out- go without some fried chicken at least once in a while . | D2N140 | 16 | [
"Acute Symptoms"
] | [
"Subjective"
] | okay . remember , it's also the portion sizes . so i mean , if you eat a little and you feel fine , then that's okay . you have to just really watch the portions . | 3,553 |
doctor: sounds good . all right , well let's take a look at you today , and we'll do a brief physical exam . you will hear me call out some findings . i will answer any questions , and we will discuss once we have finished the exam . patient: sounds good . | D2N140 | 17 | [
"Physical Examination"
] | [
"Objective"
] | sounds good . all right , well let's take a look at you today , and we'll do a brief physical exam . you will hear me call out some findings . i will answer any questions , and we will discuss once we have finished the exam . | 3,554 |
doctor: all right . so the patient is alert and cooperative , appears stated age . all right . i'm going to listen to your heart and lungs . and lungs are clear to auscultation bilaterally . heart regular rate and rhythm . all right , so if you could just lay back for me , and i'll examine your abdomen . patient: okay ... | D2N140 | 18 | [
"Physical Examination"
] | [
"Objective"
] | all right . so the patient is alert and cooperative , appears stated age . all right . i'm going to listen to your heart and lungs . and lungs are clear to auscultation bilaterally . heart regular rate and rhythm . all right , so if you could just lay back for me , and i'll examine your abdomen . | 3,555 |
doctor: all right . do you have any tenderness ? patient: no , not really . | D2N140 | 19 | [
"Physical Examination"
] | [
"Objective"
] | all right . do you have any tenderness ? | 3,556 |
doctor: okay . so the abdomen is soft , non-tender . no masses or organomegaly . and let me take a listen . normal active bowel sounds . all right . you can go ahead and sit up now . thank you . all right , so first i want you to try citrucel . it does come in a tablet . you should use it twice daily for regularity . t... | D2N140 | 20 | [
"Discussion",
"Acute Assessment",
"Medication"
] | [
"Assessment",
"Plan"
] | okay . so the abdomen is soft , non-tender . no masses or organomegaly . and let me take a listen . normal active bowel sounds . all right . you can go ahead and sit up now . thank you . all right , so first i want you to try citrucel . it does come in a tablet . you should use it twice daily for regularity . then i wo... | 3,557 |
doctor: okay . and so your bentyl , that's the anti-spasm medication , and i would take the higher dose . patient: can i get a refill of that ? | D2N140 | 21 | [
"Discussion",
"Medication"
] | [
"Plan"
] | okay . and so your bentyl , that's the anti-spasm medication , and i would take the higher dose . | 3,558 |
doctor: yes , absolutely . uh , so take one tablet about 30 to 45 minutes before leaving the house and then the second tablet at the restaurant . then with the nausea , um , i think we should try and see if you can recognize a pattern with what you are eating and drinking , um , um , about , like , what makes it worse ... | D2N140 | 22 | [
"Discussion",
"Other Treatments",
"Medication"
] | [
"Plan"
] | yes , absolutely . uh , so take one tablet about 30 to 45 minutes before leaving the house and then the second tablet at the restaurant . then with the nausea , um , i think we should try and see if you can recognize a pattern with what you are eating and drinking , um , um , about , like , what makes it worse . | 3,559 |
doctor: okay , good . and then for your zofran , i would n't take that ahead of time . just plan on drinking plenty of water . patient: okay . | D2N140 | 23 | [
"Discussion",
"Other Treatments",
"Medication"
] | [
"Plan"
] | okay , good . and then for your zofran , i would n't take that ahead of time . just plan on drinking plenty of water . | 3,560 |
doctor: okay , and you can take it , but before you do , we want to try to reduce the triggers . uh , so watch out for greasy or fatty foods and sugary drinks . patient: okay , i can do that . | D2N140 | 24 | [
"Discussion",
"Other Treatments",
"Medication"
] | [
"Plan"
] | okay , and you can take it , but before you do , we want to try to reduce the triggers . uh , so watch out for greasy or fatty foods and sugary drinks . | 3,561 |
doctor: okay . and so , however , if it is not just these isolated inci- incidents and the symptoms are happening all the time , we could put you on a long term medication that would take ... that you would take every night . and so then you do n't have to use so much bentyl or the zofran . how do you feel about that ?... | D2N140 | 25 | [
"Discussion",
"Medication"
] | [
"Plan"
] | okay . and so , however , if it is not just these isolated inci- incidents and the symptoms are happening all the time , we could put you on a long term medication that would take ... that you would take every night . and so then you do n't have to use so much bentyl or the zofran . how do you feel about that ? | 3,562 |
doctor: yeah , there is . and it actually works on the chemicals in your brain that are causing your gut to be overly sensitive . one is called elavil , but the only drawback is that it can make you a little sleepy . how does that sound ? patient: that sounds like a much better plan . | D2N140 | 26 | [
"Discussion",
"Medication"
] | [
"Plan"
] | yeah , there is . and it actually works on the chemicals in your brain that are causing your gut to be overly sensitive . one is called elavil , but the only drawback is that it can make you a little sleepy . how does that sound ? | 3,563 |
doctor: okay , great . we can definitely do that . uh , just take it every night before bedtime . patient: okay , that sounds good . thank you so much . | D2N140 | 27 | [
"Discussion"
] | [
"Plan"
] | okay , great . we can definitely do that . uh , just take it every night before bedtime . | 3,564 |
doctor: you're welcome . and so i have gone ahead and sent your prescriptions to your pharmacy . just give us a call if you have any questions or need us for anything else . and then let's plan on touching base through mychart email in about a month to just check in to see how you're doing with symptoms . okay ? patien... | D2N140 | 28 | [
"Discussion",
"Follow-up"
] | [
"Plan"
] | you're welcome . and so i have gone ahead and sent your prescriptions to your pharmacy . just give us a call if you have any questions or need us for anything else . and then let's plan on touching base through mychart email in about a month to just check in to see how you're doing with symptoms . okay ? | 3,565 |
doctor: you're welcome , and have a good rest of your day . so review of symptoms is positive for diarrhea , nausea , and abdominal pain . assessment and plan . brittany edwards is a pleasant female with ibs and functional abdominal pain , aggravated by high stress , poor eating habits , and poor sleeping habits . i've... | D2N140 | 29 | [
"Vegetative History",
"Personal History",
"Medication",
"Other Treatments",
"Reassessment",
"Follow-up"
] | [
"Subjective",
"Assessment",
"Plan"
] | doctor: you're welcome , and have a good rest of your day . so review of symptoms is positive for diarrhea , nausea , and abdominal pain . assessment and plan . brittany edwards is a pleasant female with ibs and functional abdominal pain , aggravated by high stress , poor eating habits , and poor sleeping habits . i've... | 3,566 |
doctor: okay , so our next patient is christopher watson . date of birth 04/12/1934 . mr . watson is- is an 86-year-old male who returns in follow-up for adult hydrocephalus . this is his first visit since undergoing sh- shunt surgery , excuse me , on august 1st , 2020 . i have followed mr . watson since may of 2020 wh... | D2N141 | 0 | [
"Personal History",
"Greetings"
] | [
"Subjective"
] | okay , so our next patient is christopher watson . date of birth 04/12/1934 . mr . watson is- is an 86-year-old male who returns in follow-up for adult hydrocephalus . this is his first visit since undergoing sh- shunt surgery , excuse me , on august 1st , 2020 . i have followed mr . watson since may of 2020 when he fi... | 3,567 |
doctor: mr . watson , have you been sick or been hosp -- hospitalized since your shu- shunt surgery three months ago . patient: uh , not that i recall . patient_guest: no , he has n't . he has been doing much better . | D2N141 | 1 | [
"Acute Symptoms"
] | [
"Subjective"
] | mr . watson , have you been sick or been hosp -- hospitalized since your shu- shunt surgery three months ago . | 3,568 |
doctor: good , i'm glad to hear that . before surgery , you were having some progressive problems that affected your walking , thinking , and bladder control . are these symptoms better , worse , or unchanged ? patient_guest: his walking has improved . he's now able to walk to the dining room just fine . but he could n... | D2N141 | 2 | [
"Acute Symptoms"
] | [
"Subjective"
] | good , i'm glad to hear that . before surgery , you were having some progressive problems that affected your walking , thinking , and bladder control . are these symptoms better , worse , or unchanged ? | 3,569 |
doctor: that's impressive , mr . watson . patient: yeah , i guess . patient_guest: now his bladder control did improve some after surgery , but now seems to have leveled out . so he is wearing diapers . | D2N141 | 3 | [
"Acute Symptoms"
] | [
"Subjective"
] | that's impressive , mr . watson . | 3,570 |
doctor: no issues with sores from wearing the diaper ? and any decreased or painful urination ? patient_guest: no , not at all . | D2N141 | 4 | [
"Personal History",
"Vegetative History"
] | [
"Subjective"
] | no issues with sores from wearing the diaper ? and any decreased or painful urination ? | 3,571 |
doctor: and how about cognition ? patient: i think i'm better . i do n't feel lost when talking to someone anymore . patient_guest: dad and i both think my sister , hannah , summarized it best . she said " i feel like i can have a normal conversation with him again , " | D2N141 | 5 | [
"Personal History"
] | [
"Subjective"
] | and how about cognition ? | 3,572 |
doctor: that's so wonderful ! now have you had any headaches or pain where the shunt is ? patient: no . has n't bothered me one bit . | D2N141 | 6 | [
"Personal History"
] | [
"Subjective"
] | that's so wonderful ! now have you had any headaches or pain where the shunt is ? | 3,573 |
doctor: okay . and any pain in your belly at all ? patient: ca n't say that i have . | D2N141 | 7 | [
"Personal History"
] | [
"Subjective"
] | okay . and any pain in your belly at all ? | 3,574 |
doctor: okay , sounds like you have been improving . alrighty , mr . watson , i'm going to step out of the room while my resident comes in to do a few tests for me . is that all right ? patient: sounds good . | D2N141 | 8 | [
"Personal History"
] | [
"Subjective"
] | okay , sounds like you have been improving . alrighty , mr . watson , i'm going to step out of the room while my resident comes in to do a few tests for me . is that all right ? | 3,575 |
doctor: okay , i'm going to go out and review the ct scan you had last month , and then we'll chat about it when i come in . all righty , mr . watson , so you definitely have made some improvements since the shunt surgery . now on ct scan though i do believe i see a tiny bit of blood fluid collection in the right parie... | D2N141 | 9 | [
"Radiology Examination"
] | [
"Objective"
] | okay , i'm going to go out and review the ct scan you had last month , and then we'll chat about it when i come in . all righty , mr . watson , so you definitely have made some improvements since the shunt surgery . now on ct scan though i do believe i see a tiny bit of blood fluid collection in the right parietal regi... | 3,576 |
doctor: just that i would like to leave the shunt set for another two to three months before we go in changing it . like i said , if you're not having any headaches or pain and you have improved so that's all good for me . so really there's , there's nothing to worry about . patient: all right so i'll come back in thre... | D2N141 | 10 | [
"Discussion"
] | [
"Plan"
] | just that i would like to leave the shunt set for another two to three months before we go in changing it . like i said , if you're not having any headaches or pain and you have improved so that's all good for me . so really there's , there's nothing to worry about . | 3,577 |
doctor: yep , that's right . patient: i do have a question for you though . | D2N141 | 11 | [
"Discussion"
] | [
"Plan"
] | yep , that's right . | 3,578 |
doctor: yeah , of course . patient: do you think i will be able to drive again ? | D2N141 | 12 | [
"Discussion"
] | [
"Plan"
] | yeah , of course . | 3,579 |
doctor: ah man , mr . watson , i knew you were gon na ask me that one . i think at this point it's unlikely that your movement speed will improve to the level that would be needed for you to pass the driver safety evaluation . now , i will say that i do occasionally have patients who surprise me by improving over a nin... | D2N141 | 13 | [
"Discussion"
] | [
"Plan"
] | ah man , mr . watson , i knew you were gon na ask me that one . i think at this point it's unlikely that your movement speed will improve to the level that would be needed for you to pass the driver safety evaluation . now , i will say that i do occasionally have patients who surprise me by improving over a nine to 12 ... | 3,580 |
doctor: yeah , your safety is our number one priority and , ya know , i'm sure your daughters do n't mind as much , right , they want to keep you here and have you safe . but , i overall am very pleased with how much you have improved . and so , i'm sure when we talk again in three months , we'll continue to be on that... | D2N141 | 14 | [
"Discussion",
"Follow-up"
] | [
"Plan"
] | yeah , your safety is our number one priority and , ya know , i'm sure your daughters do n't mind as much , right , they want to keep you here and have you safe . but , i overall am very pleased with how much you have improved . and so , i'm sure when we talk again in three months , we'll continue to be on that upward ... | 3,581 |
doctor: yeah , that would be great . the girls up front will take care of you and get you settled for three months from now , and you both take care , all right ? patient: thanks patient_guest: thank you . | D2N141 | 15 | [
"Chitchat"
] | [
"Null"
] | yeah , that would be great . the girls up front will take care of you and get you settled for three months from now , and you both take care , all right ? | 3,582 |
doctor: all righty , so ros is constitutional significant for impaired ability to carry out daily functions . negative for fever or unintentional weight loss . gu is significant for urinary incontinence and wearing a diaper . negative for genital sores , decreased or painful output . neurological significant for contin... | D2N141 | 16 | [
"Personal History",
"Vegetative History",
"Physical Examination",
"Radiology Examination",
"Reassessment",
"Lab Examination"
] | [
"Subjective",
"Objective",
"Assessment"
] | doctor: all righty , so ros is constitutional significant for impaired ability to carry out daily functions . negative for fever or unintentional weight loss . gu is significant for urinary incontinence and wearing a diaper . negative for genital sores , decreased or painful output . neurological significant for contin... | 3,583 |
doctor: amanda taylor , birth date october 31st 1949 . patient is a 72 year old woman who comes for followup for hypertension . her history includes significant alcohol use disorder and mi- mild hypercholesterolemia . at last visit on april 16th her blood pressure was 130 over 90 . after presenting at 150 over 100 she ... | D2N142 | 0 | [
"Greetings",
"Therapeutic History",
"Drug History"
] | [
"Subjective"
] | amanda taylor , birth date october 31st 1949 . patient is a 72 year old woman who comes for followup for hypertension . her history includes significant alcohol use disorder and mi- mild hypercholesterolemia . at last visit on april 16th her blood pressure was 130 over 90 . after presenting at 150 over 100 she was pres... | 3,584 |
doctor: thanks for coming in today . patient: yeah , no problem . | D2N142 | 1 | [
"Chitchat"
] | [
"Null"
] | thanks for coming in today . | 3,585 |
doctor: so how have things been going for you ? patient: uh , they've been all right . i'm struggling with not drinking . i wanted to discuss that , uh , shot that you had mentioned last time , but we did n't get to discuss it too much . | D2N142 | 2 | [
"Acute Symptoms"
] | [
"Subjective"
] | so how have things been going for you ? | 3,586 |
doctor: okay , well i'll be happy to provide you with more information . so tell me when did you last have a drink ? patient: on monday . | D2N142 | 3 | [
"Vegetative History"
] | [
"Subjective"
] | okay , well i'll be happy to provide you with more information . so tell me when did you last have a drink ? | 3,587 |
doctor: okay , so you've gone a couple days without it ? patient: yeah , yeah i have . | D2N142 | 4 | [
"Vegetative History"
] | [
"Subjective"
] | okay , so you've gone a couple days without it ? | 3,588 |
doctor: yeah , and had you been drinking for a while ? patient: yep . | D2N142 | 5 | [
"Vegetative History"
] | [
"Subjective"
] | yeah , and had you been drinking for a while ? | 3,589 |
doctor: how much had- how much had you been drinking ? patient: um , four or five times a week hard alcohol , so , you know . | D2N142 | 6 | [
"Drug History"
] | [
"Subjective"
] | how much had- how much had you been drinking ? | 3,590 |
doctor: okay . well it will certainly help your blood pressure if you're able to stop drinking . patient: yeah , yeah i- i- i agree with you . | D2N142 | 7 | [
"Vegetative History"
] | [
"Subjective"
] | okay . well it will certainly help your blood pressure if you're able to stop drinking . | 3,591 |
doctor: okay . are you taking your blood pressure medications ? patient: yeah , but i'm only taking half of the lisinopril . | D2N142 | 8 | [
"Therapeutic History"
] | [
"Subjective"
] | okay . are you taking your blood pressure medications ? | 3,592 |
doctor: and are you also taking the full dose of the hydrochlorothiazide ? do you have any , um , chest tightness or pressure or any shortness of breath ? patient: yeah i'm taking the full dose of that medicine too , and no none of those symptoms . | D2N142 | 10 | [
"Therapeutic History",
"Vegetative History"
] | [
"Subjective"
] | and are you also taking the full dose of the hydrochlorothiazide ? do you have any , um , chest tightness or pressure or any shortness of breath ? | 3,593 |
doctor: okay . anything else i should be aware of or that we should be checking ? patient: mm , no . | D2N142 | 11 | [
"Acute Symptoms"
] | [
"Subjective"
] | okay . anything else i should be aware of or that we should be checking ? | 3,594 |
doctor: okay , good . are you doing the blood pressure checks at home ? patient: yes . yes i am . | D2N142 | 12 | [
"Personal History"
] | [
"Subjective"
] | okay , good . are you doing the blood pressure checks at home ? | 3,595 |
doctor: okay good . what kind of numbers are you seeing ? patient: well , in the morning i'm seeing lower numbers than in the evening , um , where i run anywhere from like 130 to 145 or 150 over 95 to 100 on the bottom . | D2N142 | 13 | [
"Personal History"
] | [
"Subjective"
] | okay good . what kind of numbers are you seeing ? | 3,596 |
doctor: yeah , so it sounds like we are not too far out of where we wan na be . patient: right , mm-hmm . | D2N142 | 16 | [
"Personal History"
] | [
"Subjective"
] | yeah , so it sounds like we are not too far out of where we wan na be . | 3,597 |
doctor: okay . well let me get a listen to your heart , go ahead and hop up here . patient: okay . | D2N142 | 17 | [
"Physical Examination"
] | [
"Objective"
] | okay . well let me get a listen to your heart , go ahead and hop up here . | 3,598 |
doctor: use my general exam template . all right , go ahead and take some deep breaths . okay , good . any fever , cough , shortness of breath or sore throat ? patient: no . | D2N142 | 18 | [
"Physical Examination",
"Vegetative History"
] | [
"Subjective",
"Objective"
] | use my general exam template . all right , go ahead and take some deep breaths . okay , good . any fever , cough , shortness of breath or sore throat ? | 3,599 |
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