Datasets:
DATEXIS
/
aci_bench_intent_annotated

Dataset card Data Studio Files
xet
Community
1
text
stringlengths
14
3.73k
encounter_id
stringclasses
207 values
text_id
int64
0
69
intents
listlengths
1
9
sections
listlengths
1
4
doc_only
stringlengths
6
3.62k
__index_level_0__
int64
0
5.29k
doctor: any recent travel or contact or exposure to the coronavirus ? patient: nope .
D2N142
19
[ "Other Socials" ]
[ "Subjective" ]
any recent travel or contact or exposure to the coronavirus ?
3,600
doctor: have you received your coronavirus vaccine ? patient: yes , on february 9th .
D2N142
20
[ "Therapeutic History" ]
[ "Subjective" ]
have you received your coronavirus vaccine ?
3,601
doctor: okay , great . all right well i'm just going to look at your ankles and feet , i'm looking for any signs of swelling . patient: okay .
D2N142
21
[ "Physical Examination" ]
[ "Objective" ]
okay , great . all right well i'm just going to look at your ankles and feet , i'm looking for any signs of swelling .
3,602
doctor: all right , well everything looks good . you can go ahead and sit up miss taylor . all right , so the good news is everything is looking okay . i think we both agree if you were able to stop drinking your blood pressure would cease to be an issue for you . patient: yeah i agree with that .
D2N142
22
[ "Discussion", "Other Treatments", "Reassessment" ]
[ "Assessment", "Plan" ]
all right , well everything looks good . you can go ahead and sit up miss taylor . all right , so the good news is everything is looking okay . i think we both agree if you were able to stop drinking your blood pressure would cease to be an issue for you .
3,603
doctor: so let us discuss the potential medicine to help you with that . what it does is it blocks some of the brain receptors that alcohol stimulates and it tricks the brain into thinking it does not need alcohol , thereby cutting down the urges . patient: the urge to drink or the constant thinking about it ?
D2N142
23
[ "Discussion" ]
[ "Plan" ]
so let us discuss the potential medicine to help you with that . what it does is it blocks some of the brain receptors that alcohol stimulates and it tricks the brain into thinking it does not need alcohol , thereby cutting down the urges .
3,604
doctor: it actually will help with both . patient: okay . so is it like a one-time thing ?
D2N142
24
[ "Discussion", "Medication" ]
[ "Plan" ]
it actually will help with both .
3,605
doctor: generally the shot is given about once a month , it can also be given as a daily pill , but the shot does tend to work a bit better . patient: yeah i've taken things like this in the past and if it is a pill , i know i wo n't take it . with a shot , it's not like you can un-take it .
D2N142
25
[ "Discussion", "Medication" ]
[ "Plan" ]
generally the shot is given about once a month , it can also be given as a daily pill , but the shot does tend to work a bit better .
3,606
doctor: yeah that's true . and the shot has been shown to work , it is more just a matter of getting you in to get your shot a month later with the nurse . patient: yeah , sure , sure .
D2N142
26
[ "Discussion", "Medication" ]
[ "Plan" ]
yeah that's true . and the shot has been shown to work , it is more just a matter of getting you in to get your shot a month later with the nurse .
3,607
doctor: okay , so it's called naltrexone . i think the other name might be vivitrol . like i've said , the research on it is pretty good . patient: i think i may have taken the naltrexone before .
D2N142
27
[ "Discussion", "Medication" ]
[ "Plan" ]
okay , so it's called naltrexone . i think the other name might be vivitrol . like i've said , the research on it is pretty good .
3,608
doctor: okay , yeah , maybe you have . patient: yeah , if it was available in a pill form then i'm almost certain i've tried it b- before .
D2N142
28
[ "Discussion", "Medication" ]
[ "Plan" ]
okay , yeah , maybe you have .
3,609
doctor: okay . if this sounds good though , we can go ahead get you started with the shot . i am looking and it looks like we have you coming back in on may 17th for your first shot , does that sound good ? patient: yeah , yeah , that sounds great . are there any possible side effects ?
D2N142
29
[ "Discussion", "Follow-up", "Medication" ]
[ "Plan" ]
okay . if this sounds good though , we can go ahead get you started with the shot . i am looking and it looks like we have you coming back in on may 17th for your first shot , does that sound good ?
3,610
doctor: yeah , some people will experience some nausea , headache , dizziness , anxi- anxiety , tiredness and trouble sleeping , but generally the side effects are mild and should go away within a few days . patient: okay .
D2N142
30
[ "Discussion", "Medication" ]
[ "Plan" ]
yeah , some people will experience some nausea , headache , dizziness , anxi- anxiety , tiredness and trouble sleeping , but generally the side effects are mild and should go away within a few days .
3,611
doctor: then we can schedule you for a follow-up in june to see how you are doing . patient: all right that sounds good .
D2N142
31
[ "Follow-up" ]
[ "Plan" ]
then we can schedule you for a follow-up in june to see how you are doing .
3,612
doctor: all right great . well otherwise stay with your current medicines , keep checking your blood pressure , and let's see if we can stop the alcohol for good . let us know if you have any questions or any issues come up after you receive the first dose . patient: all right , sounds good , thank you .
D2N142
32
[ "Medication", "Other Treatments", "Drug History" ]
[ "Plan" ]
all right great . well otherwise stay with your current medicines , keep checking your blood pressure , and let's see if we can stop the alcohol for good . let us know if you have any questions or any issues come up after you receive the first dose .
3,613
doctor: you are welcome , have a good rest of your day . patient: you too .
D2N142
33
[ "Chitchat" ]
[ "Null" ]
you are welcome , have a good rest of your day .
3,614
doctor: miss taylor is drinking alcohol four to five days per week to excess . no tobacco , no substance abuse , skin is moist , good trigger . on exam she is alert , pleasant , in no acute distress . she is not diabetic , there is no tremor , no cva tenderness , chest clear to percussion and auscultation , unlabored breathing , cardiac rhythm regular , no murmur , no gallop , jvp flat , with a head at 90 degrees . she does not appear anxious , agitated or depressed . my impression , alcohol use disorder . she would like to start naltrexone which we have previously discussed . she will take the injectable form and start on may 17th . we reviewed side effects and risks . the potential benefit of alcohol cessation would be highly beneficial to her for many reasons . hypertension , she is taking lisinopril 10 milligrams daily and hydrochlorothiazide 12.5 milligrams daily . quite possibly her blood pressure will improve completely with cessation of alcohol . her target bp is 130 to 140 over 70 to 80 . i will see her back week of june 14th , which is likely around the time of her second naltrexone injection . i recommend upgrading influenza vaccination and shingrix . number two , she did defer this .
D2N142
34
[ "Drug History", "Personal History", "Physical Examination", "Acute Assessment", "Reassessment", "Medication", "Follow-up", "Discussion" ]
[ "Subjective", "Objective", "Assessment", "Plan" ]
doctor: miss taylor is drinking alcohol four to five days per week to excess . no tobacco , no substance abuse , skin is moist , good trigger . on exam she is alert , pleasant , in no acute distress . she is not diabetic , there is no tremor , no cva tenderness , chest clear to percussion and auscultation , unlabored breathing , cardiac rhythm regular , no murmur , no gallop , jvp flat , with a head at 90 degrees . she does not appear anxious , agitated or depressed . my impression , alcohol use disorder . she would like to start naltrexone which we have previously discussed . she will take the injectable form and start on may 17th . we reviewed side effects and risks . the potential benefit of alcohol cessation would be highly beneficial to her for many reasons . hypertension , she is taking lisinopril 10 milligrams daily and hydrochlorothiazide 12.5 milligrams daily . quite possibly her blood pressure will improve completely with cessation of alcohol . her target bp is 130 to 140 over 70 to 80 . i will see her back week of june 14th , which is likely around the time of her second naltrexone injection . i recommend upgrading influenza vaccination and shingrix . number two , she did defer this .
3,615
doctor: next patient is grace ross . date of birth 8-23-97 . ms. ross is a new patient . she's here today for a full spectrum std testing . the patient states that she's having symptoms of discomfort , a change in discharge , and odor in her vaginal region . she says that the right side of her vagina is starting to become painful . she denies any fevers or chills . she reports , that she recently learned , her partner has been in sexual encounters with other people , and she wants to be evaluated for all stds . hello , ms. ross . i'm dr. diaz . it's good to meet you . patient: hi . yes . nice to meet you , too .
D2N143
0
[ "Personal History", "Greetings" ]
[ "Subjective" ]
next patient is grace ross . date of birth 8-23-97 . ms. ross is a new patient . she's here today for a full spectrum std testing . the patient states that she's having symptoms of discomfort , a change in discharge , and odor in her vaginal region . she says that the right side of her vagina is starting to become painful . she denies any fevers or chills . she reports , that she recently learned , her partner has been in sexual encounters with other people , and she wants to be evaluated for all stds . hello , ms. ross . i'm dr. diaz . it's good to meet you .
3,616
doctor: so , how are you doing today ? i hear that you're here for std testing . is that correct ? patient: yeah . actually , i found out earlier this week , that my boyfriend has been cheating on me , for some time . i'm really worried , that i could have caught something , you know ?
D2N143
1
[ "Acute Symptoms" ]
[ "Subjective" ]
so , how are you doing today ? i hear that you're here for std testing . is that correct ?
3,617
doctor: mm-hmm . patient: i wanted to make sure i do n't have anything .
D2N143
2
[ "Acute Symptoms" ]
[ "Subjective" ]
mm-hmm .
3,618
doctor: yeah . i'm sorry to hear that . of course , we can do that today . um . well , let's see . how do you feel ? do you have any symptoms ? patient: well , um , i started noticing some weird discharge last week .
D2N143
3
[ "Acute Symptoms" ]
[ "Subjective" ]
yeah . i'm sorry to hear that . of course , we can do that today . um . well , let's see . how do you feel ? do you have any symptoms ?
3,619
doctor: mm-hmm . patient: uh , it smells different . it's not the same color , or consistency , as usually , it is .
D2N143
4
[ "Acute Symptoms" ]
[ "Subjective" ]
mm-hmm .
3,620
doctor: right . patient: um . that part did n't even phase me , until i noticed that the right side of my vagina was hurting . just sore , you know , but that has n't gone away .
D2N143
5
[ "Acute Symptoms" ]
[ "Subjective" ]
right .
3,621
doctor: yep . nah , that does sound like a cause for concern . how long have you been with him ? patient: hmm , we've been dating for three years .
D2N143
6
[ "Acute Symptoms" ]
[ "Subjective" ]
yep . nah , that does sound like a cause for concern . how long have you been with him ?
3,622
doctor: mm-hmm . patient: as far as , i can figure , he started cheating on me , i think , about three months ago .
D2N143
7
[ "Acute Symptoms" ]
[ "Subjective" ]
mm-hmm .
3,623
doctor: uh- . um , okay . do you ... have you ever had an irregular pap smear ? patient: well , yeah , i did , but it was back whenever i was 20 or so . it has n't ... and i have n't had one since .
D2N143
8
[ "Acute Symptoms" ]
[ "Subjective" ]
uh- . um , okay . do you ... have you ever had an irregular pap smear ?
3,624
doctor: okay . and when was your last pap smear ? patient: uh , about six months ago . it came back normal , though .
D2N143
9
[ "Acute Symptoms" ]
[ "Subjective" ]
okay . and when was your last pap smear ?
3,625
doctor: okay . good , okay . well , let's see ... let's take a look at you , and then , we'll get some samples for std testing . okay ? patient: all right .
D2N143
10
[ "Physical Examination" ]
[ "Objective" ]
okay . good , okay . well , let's see ... let's take a look at you , and then , we'll get some samples for std testing . okay ?
3,626
doctor: you'll hear me talk through your exam , so that i can get it all documented . uh- ? use my general physical exam template . pelvic exam demonstrates no external lesions . normal labia majora and labia minora . normal physiological discharge , with normal color and smell . ms. ross , i'm going to touch you , now . you'll feel my fingers , and the speculum in your vagina . you'll feel some pressure , now . cervix is normal . vaginal wall is normal . no cervical motion tenderness and no adnexal tenderness or masses noted . swabs were done for std testing . okay , ms. ross . everything looks good from a visual standpoint . i'm going to send off std testing for , uh , gonorrhea , chlamydia , trichomoniasis , and i'll have you give some blood for syphilis , hiv and hepatitis c. some of these tests will take longer than others . we will call you , if we see anything , but if you have n't heard anything , you can call us in three days for results . patient: okay . sounds good . thank you , so much .
D2N143
11
[ "Physical Examination", "Discussion", "Diagnostic Testing", "Acute Assessment" ]
[ "Objective", "Assessment", "Plan" ]
you'll hear me talk through your exam , so that i can get it all documented . uh- ? use my general physical exam template . pelvic exam demonstrates no external lesions . normal labia majora and labia minora . normal physiological discharge , with normal color and smell . ms. ross , i'm going to touch you , now . you'll feel my fingers , and the speculum in your vagina . you'll feel some pressure , now . cervix is normal . vaginal wall is normal . no cervical motion tenderness and no adnexal tenderness or masses noted . swabs were done for std testing . okay , ms. ross . everything looks good from a visual standpoint . i'm going to send off std testing for , uh , gonorrhea , chlamydia , trichomoniasis , and i'll have you give some blood for syphilis , hiv and hepatitis c. some of these tests will take longer than others . we will call you , if we see anything , but if you have n't heard anything , you can call us in three days for results .
3,627
doctor: of course , my pleasure . and , if everything is normal , i'll see you again , at your next annual checkup . assessment : is screen for std . plan : discussed with patient , and please add that she is high risk due to an abnormal pap smear in the past , and the recent discovery of her sexual partner having multiple partners , for some period of time . end of recording .
D2N143
12
[ "Discussion", "Follow-up" ]
[ "Plan" ]
doctor: of course , my pleasure . and , if everything is normal , i'll see you again , at your next annual checkup . assessment : is screen for std . plan : discussed with patient , and please add that she is high risk due to an abnormal pap smear in the past , and the recent discovery of her sexual partner having multiple partners , for some period of time . end of recording .
3,628
doctor: tyler nelson , date of birth : 3 , 6 , 1949 , mrn , 385729 . he is here today for ongoing management of rheumatoid arthritis . last time he was here , he received a steroid injection in his right knee . hello mr. nelson , how are you ? patient: um , about the same as last time . my knee is still swollen .
D2N144
0
[ "Personal History", "Greetings", "Therapeutic History" ]
[ "Subjective" ]
tyler nelson , date of birth : 3 , 6 , 1949 , mrn , 385729 . he is here today for ongoing management of rheumatoid arthritis . last time he was here , he received a steroid injection in his right knee . hello mr. nelson , how are you ?
3,629
doctor: that was your right knee , correct ? i take it the injection did n't help ? patient: it did , maybe for a couple of weeks .
D2N144
1
[ "Personal History", "Therapeutic History" ]
[ "Subjective" ]
that was your right knee , correct ? i take it the injection did n't help ?
3,630
doctor: that's it ? and is it still painful ? patient: yeah , it's pretty painful , and now the whole leg is getting swollen .
D2N144
2
[ "Acute Symptoms" ]
[ "Subjective" ]
that's it ? and is it still painful ?
3,631
doctor: okay , what would you say your pain level is ? patient: i mean , right now it's about a 3 or so , but , typically on a normal day it's around 6 .
D2N144
3
[ "Acute Symptoms" ]
[ "Subjective" ]
okay , what would you say your pain level is ?
3,632
doctor: okay , and its been swollen like that for how long now ? patient: since i was last here a couple weeks after that . so about , maybe two months now .
D2N144
4
[ "Personal History" ]
[ "Subjective" ]
okay , and its been swollen like that for how long now ?
3,633
doctor: okay , but before it was just the knee ? patient: yeah , the whole thing was n't swollen like this , but i tried to wear compression socks a lot of the time , but it has n't been helping .
D2N144
5
[ "Personal History" ]
[ "Subjective" ]
okay , but before it was just the knee ?
3,634
doctor: okay , okay , so that has n't been working for you ? patient: i mean , it helps to some degree , but it's still swollen , especially around the knee .
D2N144
6
[ "Therapeutic History" ]
[ "Subjective" ]
okay , okay , so that has n't been working for you ?
3,635
doctor: hmm . has it been keeping you from doing things during the day ? patient: well , i slowed down a little bit , and i found a few things too fast . but when it really hurts , is when i've been sitting for a while , and then i have to try and get up . i'm so stiff getting up i have to use a cane to get my bearings . i mean , after a little bit , it loosens up , but that first getting up is real difficult .
D2N144
7
[ "Other Socials" ]
[ "Subjective" ]
hmm . has it been keeping you from doing things during the day ?
3,636
doctor: yeah , i can see , that makes sense . have you been taking your medication regularly ? your on xeljanz right ? patient: yeah , the xr , i think its , uhm , 11 milligrams a day ? yeah , but i'm taking it everyday , and i'm also taking celebrex which i started maybe 2 months ago .
D2N144
8
[ "Therapeutic History" ]
[ "Subjective" ]
yeah , i can see , that makes sense . have you been taking your medication regularly ? your on xeljanz right ?
3,637
doctor: yes , the 200mgs daily . how's that working for you ? patient: pretty good , up until it started swelling again .
D2N144
9
[ "Therapeutic History" ]
[ "Subjective" ]
yes , the 200mgs daily . how's that working for you ?
3,638
doctor: okay , well come sit over here , and if you could take of your socks and shoes , and we'll take a look at your knee . and just to let you know , i have a service now that writes my note about the visit , so you'll hear me call things out and describe what i see fully . patient: okay , gotcha .
D2N144
10
[ "Physical Examination" ]
[ "Objective" ]
okay , well come sit over here , and if you could take of your socks and shoes , and we'll take a look at your knee . and just to let you know , i have a service now that writes my note about the visit , so you'll hear me call things out and describe what i see fully .
3,639
doctor: right , so let's check your leg . can you straighten it , and does it hurt ? patient: yeah , when i try to straighten it all the way it does .
D2N144
11
[ "Physical Examination" ]
[ "Objective" ]
right , so let's check your leg . can you straighten it , and does it hurt ?
3,640
doctor: okay , range of motion slightly diminished . i'm going to press here , okay ? and how about here , hmm , i see some pitting around the knee and ankle . normal capillary refill in the toes . does any of this area hurt ? patient: um , just kinda sore , like an old bruise ?
D2N144
12
[ "Physical Examination" ]
[ "Objective" ]
okay , range of motion slightly diminished . i'm going to press here , okay ? and how about here , hmm , i see some pitting around the knee and ankle . normal capillary refill in the toes . does any of this area hurt ?
3,641
doctor: so , i can feel that the knee is hot , and that means there's something going on , like some inflammation . so we can give you another steroid injection for that . i also want to get an x-ray of that knee , so we can see where all the swelling is coming from . patient: yeah . let's do it . sounds go to me .
D2N144
13
[ "Medication", "Diagnostic Testing", "Reassessment" ]
[ "Assessment", "Plan" ]
so , i can feel that the knee is hot , and that means there's something going on , like some inflammation . so we can give you another steroid injection for that . i also want to get an x-ray of that knee , so we can see where all the swelling is coming from .
3,642
doctor: okay , and did we set up physical therapy for you last time you were here ? patient: yeah , that was some years ago , but that was the other knee .
D2N144
14
[ "Discussion", "Referral" ]
[ "Plan" ]
okay , and did we set up physical therapy for you last time you were here ?
3,643
doctor: okay . so i think we'll set that up for you now . we'll also do an x-ray on that knee . i can send you for a physical therapy , and if nothing is helping , then we really might need to get a surgery consult to see what we can do with that knee . patient: okay , sounds like a plan .
D2N144
15
[ "Referral", "Diagnostic Testing", "Other Treatments" ]
[ "Plan" ]
okay . so i think we'll set that up for you now . we'll also do an x-ray on that knee . i can send you for a physical therapy , and if nothing is helping , then we really might need to get a surgery consult to see what we can do with that knee .
3,644
doctor: all right , so for today we'll go ahead and we'll give you the steroid shot . i'll try to see if i can get a little bit of fluid out before i do give you the injection . there might be no fluid , but i'll see if i can get anything out regardless . patient: okay . and that's a procedure you're going to do right now ?
D2N144
16
[ "Medication" ]
[ "Plan" ]
all right , so for today we'll go ahead and we'll give you the steroid shot . i'll try to see if i can get a little bit of fluid out before i do give you the injection . there might be no fluid , but i'll see if i can get anything out regardless .
3,645
doctor: yep . once we're done talking here , and as far as the edema in your legs , uh , we'll take an x-ray to look for the cause , but there is a lot you can do as well . the compression socks are a good start . um , and also , do you eat a lot of salt ? patient: i mean , um , i mean i love my salty snacks .
D2N144
17
[ "Discussion", "Medication", "Other Treatments", "Diagnostic Testing" ]
[ "Plan" ]
yep . once we're done talking here , and as far as the edema in your legs , uh , we'll take an x-ray to look for the cause , but there is a lot you can do as well . the compression socks are a good start . um , and also , do you eat a lot of salt ?
3,646
doctor: okay . well , salt does have a tendency to make your body hold on to water , reducing your salt intake could help with some of the swelling . you can also prop your feet up any time you get a chance , especially at night . and have you talked to your private care doctor about this at all ? patient: no , i figured i would just come here first .
D2N144
18
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
okay . well , salt does have a tendency to make your body hold on to water , reducing your salt intake could help with some of the swelling . you can also prop your feet up any time you get a chance , especially at night . and have you talked to your private care doctor about this at all ?
3,647
doctor: okay . so i think , try some of those things out first , and if it does n't help , definitely make an appointment with them , also , as you know , xeljanz is a high-risk medication , so we need to check your cmp levels every couple of months . so this time your levels are good , but do make sure to make an appointment for the blood work for next time . patient: all right . i can do that . thank you so much doc .
D2N144
19
[ "Discussion", "Medication", "Diagnostic Testing" ]
[ "Plan" ]
okay . so i think , try some of those things out first , and if it does n't help , definitely make an appointment with them , also , as you know , xeljanz is a high-risk medication , so we need to check your cmp levels every couple of months . so this time your levels are good , but do make sure to make an appointment for the blood work for next time .
3,648
doctor: yes , of course . well let me go ahead and get supplies and we'll get to work on your knee . fluid aspiration and steroid injection procedure . the risks , benefits , and alternatives were explained . the risks of steroid injection were explained , including , but not limited to : hypopigmentation , soft tissue atrophy , tendon ruptures , and transient hypoglycemia among others . verbal consent was attained . the right knee was , uh , um , accessed through the lateral approach with 3 milliliters of initially clear fluid , then bloo- blood tinged fluid . then the right knee was prepped in a standard-fashion . the right knee was injected with 80 milligrams of triamcinolone , and one milliliter of lidocaine . the procedure was tolerated well , with no complications . post-procedure instructions were given . patient will follow up with his pcp . thank you .
D2N144
20
[ "Discussion", "Follow-up", "Medication" ]
[ "Plan" ]
doctor: yes , of course . well let me go ahead and get supplies and we'll get to work on your knee . fluid aspiration and steroid injection procedure . the risks , benefits , and alternatives were explained . the risks of steroid injection were explained , including , but not limited to : hypopigmentation , soft tissue atrophy , tendon ruptures , and transient hypoglycemia among others . verbal consent was attained . the right knee was , uh , um , accessed through the lateral approach with 3 milliliters of initially clear fluid , then bloo- blood tinged fluid . then the right knee was prepped in a standard-fashion . the right knee was injected with 80 milligrams of triamcinolone , and one milliliter of lidocaine . the procedure was tolerated well , with no complications . post-procedure instructions were given . patient will follow up with his pcp . thank you .
3,649
doctor: uh , mrn49282721 . patient's name is jacqueline miller . use last visit exam where appropriate . hi , how are you doing , jacqueline ? patient: i'm pretty . good . how are you ?
D2N145
0
[ "Greetings" ]
[ "Subjective" ]
uh , mrn49282721 . patient's name is jacqueline miller . use last visit exam where appropriate . hi , how are you doing , jacqueline ?
3,650
doctor: good as well . so it sounds like we're , um , under good control right now . patient: yes . it's doing much better .
D2N145
1
[ "Personal History" ]
[ "Subjective" ]
good as well . so it sounds like we're , um , under good control right now .
3,651
doctor: good , good . do you have any rash leftover ? patient: yeah , i have a- a small bit leftover . i started using , uh , doxycycline only one a day because i think the pharmacist said if it's getting better , to just limit it to once a day .
D2N145
2
[ "Acute Symptoms" ]
[ "Subjective" ]
good , good . do you have any rash leftover ?
3,652
doctor: okay , that sounds good . patient: but i was taking it twice a day and i did notice a lotta improvement .
D2N145
3
[ "Personal History" ]
[ "Subjective" ]
okay , that sounds good .
3,653
doctor: i see . um , are you breastfeeding at this time ? patient: no , i'm not right now .
D2N145
5
[ "Vegetative History" ]
[ "Subjective" ]
i see . um , are you breastfeeding at this time ?
3,654
doctor: okay , good . so you- you should not be breastfeeding while you're on that medication . patient: yeah , actually i stopped breastfeeding and then asked for the doxycycline at that time .
D2N145
6
[ "Vegetative History" ]
[ "Subjective" ]
okay , good . so you- you should not be breastfeeding while you're on that medication .
3,655
doctor: okay . even with the doxycycline , you can keep using the elidel . patient: okay . and i did n't take the elidel because when i read about it i got worried . so i wanted to just try the doxycycline and see .
D2N145
7
[ "Vegetative History" ]
[ "Subjective" ]
okay . even with the doxycycline , you can keep using the elidel .
3,656
doctor: okay . so we can talk about the elidel . a lot of the things you read about is not actually relevant to the cream or ointment form , but it's about the oral form that's used in really high doses , longterm , after people have a heart transplant or a kidney transplant or something like that . patient: okay . i did n't realize that .
D2N145
8
[ "Discussion", "Medication" ]
[ "Plan" ]
okay . so we can talk about the elidel . a lot of the things you read about is not actually relevant to the cream or ointment form , but it's about the oral form that's used in really high doses , longterm , after people have a heart transplant or a kidney transplant or something like that .
3,657
doctor: yeah , and when you suppress the immune system that hard for that long , it can predispose you for developing cancers like hematologic type cancers . it does n't apply to as-needed use of the medicine , a cream or an ointment , okay ? patient: okay . then i can resume taking - taking the doxycycline twice a day again ?
D2N145
9
[ "Discussion", "Medication" ]
[ "Plan" ]
yeah , and when you suppress the immune system that hard for that long , it can predispose you for developing cancers like hematologic type cancers . it does n't apply to as-needed use of the medicine , a cream or an ointment , okay ?
3,658
doctor: so let me clarify . what exactly are you using ? and then we'll look at you and figure out , okay ? so you're using the sulfacetamide wash ? uh , how frequently are you using that one ? patient: twice a day .
D2N145
10
[ "Therapeutic History" ]
[ "Subjective" ]
so let me clarify . what exactly are you using ? and then we'll look at you and figure out , okay ? so you're using the sulfacetamide wash ? uh , how frequently are you using that one ?
3,659
doctor: okay , and that's not drying you out too much ? patient: no , that's fine .
D2N145
11
[ "Therapeutic History" ]
[ "Subjective" ]
okay , and that's not drying you out too much ?
3,660
doctor: okay . and you're using the metro cream ? patient: yes .
D2N145
12
[ "Therapeutic History" ]
[ "Subjective" ]
okay . and you're using the metro cream ?
3,661
doctor: how often are you using that one ? patient: after my face wash , i immediately apply the cream .
D2N145
13
[ "Therapeutic History" ]
[ "Subjective" ]
how often are you using that one ?
3,662
doctor: okay . and then , are you using any other kind of lotions or anything ? patient: no .
D2N145
14
[ "Therapeutic History" ]
[ "Subjective" ]
okay . and then , are you using any other kind of lotions or anything ?
3,663
doctor: so you're not using the cetaphil cleanser ? patient: i'm not .
D2N145
15
[ "Therapeutic History" ]
[ "Subjective" ]
so you're not using the cetaphil cleanser ?
3,664
doctor: okay . and no neutrogena wipes ? patient: no wipes .
D2N145
16
[ "Therapeutic History" ]
[ "Subjective" ]
okay . and no neutrogena wipes ?
3,665
doctor: okay . um , and then what about , um , any lotions that you're using ? patient: i'm not using any lotion right now , just those two .
D2N145
17
[ "Therapeutic History" ]
[ "Subjective" ]
okay . um , and then what about , um , any lotions that you're using ?
3,666
doctor: no lotion , okay . so that may be something else we should add in , a lotion to just help moisturize . but we'll see . patient: okay .
D2N145
18
[ "Therapeutic History" ]
[ "Subjective" ]
no lotion , okay . so that may be something else we should add in , a lotion to just help moisturize . but we'll see .
3,667
doctor: um , and then again , when did you go down to just taking the doxycycline once a day ? patient: that was last week . so the first two weeks , i did twice a day .
D2N145
19
[ "Therapeutic History" ]
[ "Subjective" ]
um , and then again , when did you go down to just taking the doxycycline once a day ?
3,668
doctor: okay . let me take a look at your face here . i'm gon na describe for the transcriptionist what i'm seeing . you're fitzpatrick skin type iv , meaning you're not going to burn , you're going to sun tan , um , essentially , iv to v. and then on bilateral medial cheeks , there are a few really faint erythematous papules and just maybe a little bit of redness around and underneath your nostrils . so you're right , it's not totally gone . patient: yeah .
D2N145
21
[ "Physical Examination" ]
[ "Objective" ]
okay . let me take a look at your face here . i'm gon na describe for the transcriptionist what i'm seeing . you're fitzpatrick skin type iv , meaning you're not going to burn , you're going to sun tan , um , essentially , iv to v. and then on bilateral medial cheeks , there are a few really faint erythematous papules and just maybe a little bit of redness around and underneath your nostrils . so you're right , it's not totally gone .
3,669
doctor: i think i would go ahead and go back to twice a day , every day , with the doxycycline . patient: okay .
D2N145
22
[ "Discussion", "Medication" ]
[ "Plan" ]
i think i would go ahead and go back to twice a day , every day , with the doxycycline .
3,670
doctor: uh , but i would pickup the elidel too . patient: okay , i can do that .
D2N145
23
[ "Discussion", "Medication" ]
[ "Plan" ]
uh , but i would pickup the elidel too .
3,671
doctor: i mean , out of known risks associated with medications , topicals are usually safer and preferable to oral medications . with that being said , doxycycline is low risk . patient: it is ? okay .
D2N145
24
[ "Discussion", "Medication" ]
[ "Plan" ]
i mean , out of known risks associated with medications , topicals are usually safer and preferable to oral medications . with that being said , doxycycline is low risk .
3,672
doctor: um , and doxycycline can give you bad upset stomach or heartburn . um , it will make you sunburn , even if you never sunburn , so you have to protect yourself . patient: yeah , i mean , i feel sun sensitive whenever i go out , so i am taking all the precautions , with wearing a hat and all of that .
D2N145
25
[ "Medication" ]
[ "Plan" ]
um , and doxycycline can give you bad upset stomach or heartburn . um , it will make you sunburn , even if you never sunburn , so you have to protect yourself .
3,673
doctor: great . i just wanted to make sure you knew about that . patient: yes , i did . thank you .
D2N145
26
[ "Discussion", "Medication" ]
[ "Plan" ]
great . i just wanted to make sure you knew about that .
3,674
doctor: all right . but i think to help get rid of it sooner rather than later , if insurance will cover the elidel , pick it up and start using it . patient: yeah , i did check . the insurance is not covering it .
D2N145
27
[ "Discussion", "Medication" ]
[ "Plan" ]
all right . but i think to help get rid of it sooner rather than later , if insurance will cover the elidel , pick it up and start using it .
3,675
doctor: it's not ? okay . well , let's look around really quick because if you use a goodrx coupon , it will be around 30 to $ 40 or something . patient: okay .
D2N145
28
[ "Discussion", "Medication" ]
[ "Plan" ]
it's not ? okay . well , let's look around really quick because if you use a goodrx coupon , it will be around 30 to $ 40 or something .
3,676
doctor: let's see . patient: so with your coupon , it was around $ 850 or something .
D2N145
29
[ "Discussion", "Medication" ]
[ "Plan" ]
let's see .
3,677
doctor: ugh , yeah . that's way too much . patient: i agree . and- and because i also looked at the eucrisa that you recommended in my notes , and if it's still ex- if it's still expensive , i could try that instead .
D2N145
30
[ "Discussion", "Medication" ]
[ "Plan" ]
ugh , yeah . that's way too much .
3,678
doctor: yeah , so it ... actually ... it is actually more expensive . i think the prices fluctuate . patient: okay .
D2N145
31
[ "Discussion", "Medication" ]
[ "Plan" ]
yeah , so it ... actually ... it is actually more expensive . i think the prices fluctuate .
3,679
doctor: because now it's showing the cheapest of $ 70 , and when i looked before , it was around 30 to $ 40 . patient: yeah . if it was around $ 200 , i would've picked it up . but it was coming to around $ 850 after insurance .
D2N145
32
[ "Discussion", "Medication" ]
[ "Plan" ]
because now it's showing the cheapest of $ 70 , and when i looked before , it was around 30 to $ 40 .
3,680
doctor: okay . so i've found the cream form . we could try ointment form . patient: you mean the tacrolimus ?
D2N145
33
[ "Discussion", "Medication" ]
[ "Plan" ]
okay . so i've found the cream form . we could try ointment form .
3,681
doctor: yeah , mm-hmm . patient: okay .
D2N145
34
[ "Discussion", "Medication" ]
[ "Plan" ]
yeah , mm-hmm .
3,682
doctor: so if we send it to pick'n save or metro market ... let's see where else . patient: can you do the metro market ?
D2N145
35
[ "Discussion", "Medication" ]
[ "Plan" ]
so if we send it to pick'n save or metro market ... let's see where else .
3,683
doctor: yeah . let me put in the prescription and we'll see what we can find . patient: sure .
D2N145
36
[ "Discussion", "Medication" ]
[ "Plan" ]
yeah . let me put in the prescription and we'll see what we can find .
3,684
doctor: pharmacy is what i'm trying to say . patient: okay . but it's not a steroid , right ?
D2N145
37
[ "Discussion", "Medication" ]
[ "Plan" ]
pharmacy is what i'm trying to say .
3,685
doctor: correct , it's not a steroid . patient: okay , good .
D2N145
38
[ "Discussion", "Medication" ]
[ "Plan" ]
correct , it's not a steroid .
3,686
doctor: it's called a calcineurin inhibitor . it's kinda like a steroid in that it calms inflammation . patient: okay .
D2N145
39
[ "Discussion", "Medication" ]
[ "Plan" ]
it's called a calcineurin inhibitor . it's kinda like a steroid in that it calms inflammation .
3,687
doctor: but it's not a steroid , so do n't use steroids on your face , for sure , as they'll make this kind of rash worse . but also , steroids carry the risk of causing thinning of the skin . patient: all right .
D2N145
40
[ "Discussion", "Medication" ]
[ "Plan" ]
but it's not a steroid , so do n't use steroids on your face , for sure , as they'll make this kind of rash worse . but also , steroids carry the risk of causing thinning of the skin .
3,688
doctor: these medications do n't cause thinning of the skin and they're not going to cause some other kind of rash . um , the thing to know is that sometimes five to 10 minutes after you put it on , it can cause this weird kind of tingly or needle-like sensation or make it redder or flush . but it should only last a few seconds and then go away . it's not an allergy or anything bad . patient: okay . got it .
D2N145
41
[ "Discussion", "Medication" ]
[ "Plan" ]
these medications do n't cause thinning of the skin and they're not going to cause some other kind of rash . um , the thing to know is that sometimes five to 10 minutes after you put it on , it can cause this weird kind of tingly or needle-like sensation or make it redder or flush . but it should only last a few seconds and then go away . it's not an allergy or anything bad .
3,689
doctor: so it only lasts a couple seconds . it does n't mean it's going to happen again . it's nothing bad . it will still work , so keep using it as long as you know you can stand it , okay ? patient: okay , thank you for explaining .
D2N145
42
[ "Discussion", "Medication" ]
[ "Plan" ]
so it only lasts a couple seconds . it does n't mean it's going to happen again . it's nothing bad . it will still work , so keep using it as long as you know you can stand it , okay ?
3,690
doctor: so i will say , " apply to rash on face twice daily , until resolved . " patient: okay . so only apply to the rash area ?
D2N145
43
[ "Discussion", "Medication" ]
[ "Plan" ]
so i will say , " apply to rash on face twice daily , until resolved . "
3,691
doctor: yes , and keep using the face wash. patient: okay .
D2N145
44
[ "Discussion", "Medication" ]
[ "Plan" ]
yes , and keep using the face wash.
3,692
doctor: i think you could just do it once a day . i do n't think you need to do it twice a day , just because i do n't wan na dry your sky out too much , okay ? patient: i never noticed that my face is dry or got thin . i feel so good after using it .
D2N145
45
[ "Discussion", "Medication" ]
[ "Plan" ]
i think you could just do it once a day . i do n't think you need to do it twice a day , just because i do n't wan na dry your sky out too much , okay ?
3,693
doctor: i understand , but it could get dry and i do n't wan na create other problems for you . patient: all right . i'll just wash once a day with it . but it was feeling very good , like there's this little bit of moisture getting back in . with the other wash , when i would use it twice a day , i was drying out . but not with this one .
D2N145
46
[ "Discussion", "Medication" ]
[ "Plan" ]
i understand , but it could get dry and i do n't wan na create other problems for you .
3,694
doctor: i see . okay . well then do what feels good . if you do notice that you're starting to get dry , then reduce to once per day . patient: that sounds good .
D2N145
47
[ "Discussion", "Medication" ]
[ "Plan" ]
i see . okay . well then do what feels good . if you do notice that you're starting to get dry , then reduce to once per day .
3,695
doctor: so to review , um , continue using the same face wash , continue with metro cream , and increase the use of doxycycline to twice a day . patient: okay .
D2N145
48
[ "Medication" ]
[ "Plan" ]
so to review , um , continue using the same face wash , continue with metro cream , and increase the use of doxycycline to twice a day .
3,696
doctor: and then just do it until it's gone , and then do it for once a day for another week before stopping . patient: okay , sounds good .
D2N145
49
[ "Medication" ]
[ "Plan" ]
and then just do it until it's gone , and then do it for once a day for another week before stopping .
3,697
doctor: all right . and i'll rewrite your instructions here . patient: thank you so much .
D2N145
50
[ "Chitchat" ]
[ "Null" ]
all right . and i'll rewrite your instructions here .
3,698
doctor: if there are any other questions or you're getting different instructions , feel free to reach out to me and we'll clarify , okay ? patient: okay .
D2N145
51
[ "Discussion", "Follow-up" ]
[ "Plan" ]
if there are any other questions or you're getting different instructions , feel free to reach out to me and we'll clarify , okay ?
3,699