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doctor: okay alright so it's been running a little bit high i know we checked your hemoglobin a1c last time and it was about seven . seven . i think and we had talked about you know improving your diet and improving some exercise but is this blood sugar been high and low or high and normal when you're especially in the last three weeks or has it been going on for longer than that patient: i would say about a month
|
D2N149
| 15
|
[
"Personal History"
] |
[
"Subjective"
] |
okay alright so it's been running a little bit high i know we checked your hemoglobin a1c last time and it was about seven . seven . i think and we had talked about you know improving your diet and improving some exercise but is this blood sugar been high and low or high and normal when you're especially in the last three weeks or has it been going on for longer than that
| 3,800
|
doctor: okay alright and how is your blood pressure been at home since you've been taking since these episodes that you've been sick are you taking norvasc patient: yes i am but i keep them on some days because my blood pressure has been running somewhat on the low side
|
D2N149
| 16
|
[
"Personal History",
"Therapeutic History"
] |
[
"Subjective"
] |
okay alright and how is your blood pressure been at home since you've been taking since these episodes that you've been sick are you taking norvasc
| 3,801
|
doctor: okay alright and right now it's about a hundred and twenty over seventy what how low does it go in the more when you check it patient: well there are sometimes in the lower nineties
|
D2N149
| 17
|
[
"Personal History"
] |
[
"Subjective"
] |
okay alright and right now it's about a hundred and twenty over seventy what how low does it go in the more when you check it
| 3,802
|
doctor: okay alright well let me let me examine you here in a second and we'll think about you know what we need to do especially with your coughing and your shortness of breath okay so nita i'm i'm examining you now let's pretend i did my exam i'm just gon na verbalize some of my findings so i can put it into my chart okay and i'll explain what those things mean so on my exam you've got no jvd there is no swelling in your neck no carotid bruits your lung exam you've got some rails and some rhonchi on on more on the right side i do n't hear any wheezing right now there is some diminished breath sounds in the right side as well on your heart exam you've got two over successolic ejection murmur you've had that in the past that's unchanged from before the rest regular rate and rhythm otherwise your belly exam is nice and soft on your extremity exam you've got one plus nonpitting edema on both of your lower extremities on your on your ankles no calf tenderness no negative homan sign so what does all this mean so basically you've got you know you've got some sort of infection or something going on in your lungs that i can hear right now the rest of your exam is pretty much stable it's unchanged from before so let's talk about what we what we should do about this so for the for the first problem with the shortness of breath the first thing i wan na do is go ahead and get a chest x-ray for you okay you've been coughing up blood i also wan na send you to the emergency department to get some blood testing done i'm worried about a blood clot or something else going on so i wan na get a cat scan of your chest as well so i'm gon na go ahead and refer you to the emergency department i'll call them and and have you head over that way they can get a chest x-ray and a cat scan and some blood work as well and then we'll evaluate why you're having the shortness of breath and why you're coughing up this blood okay and then depending on what they find you may need you know it could be as simple as a pneumonia or it could be something a little bit more serious we may have to get you know start you know depending on what you find we will get the right treatment started any questions about that or can you drive to the emergency department from here or is that okay patient: yeah i can bike no problem i have no question
|
D2N149
| 18
|
[
"Physical Examination",
"Discussion",
"Diagnostic Testing",
"Reassessment",
"Acute Assessment"
] |
[
"Objective",
"Assessment",
"Plan"
] |
okay alright well let me let me examine you here in a second and we'll think about you know what we need to do especially with your coughing and your shortness of breath okay so nita i'm i'm examining you now let's pretend i did my exam i'm just gon na verbalize some of my findings so i can put it into my chart okay and i'll explain what those things mean so on my exam you've got no jvd there is no swelling in your neck no carotid bruits your lung exam you've got some rails and some rhonchi on on more on the right side i do n't hear any wheezing right now there is some diminished breath sounds in the right side as well on your heart exam you've got two over successolic ejection murmur you've had that in the past that's unchanged from before the rest regular rate and rhythm otherwise your belly exam is nice and soft on your extremity exam you've got one plus nonpitting edema on both of your lower extremities on your on your ankles no calf tenderness no negative homan sign so what does all this mean so basically you've got you know you've got some sort of infection or something going on in your lungs that i can hear right now the rest of your exam is pretty much stable it's unchanged from before so let's talk about what we what we should do about this so for the for the first problem with the shortness of breath the first thing i wan na do is go ahead and get a chest x-ray for you okay you've been coughing up blood i also wan na send you to the emergency department to get some blood testing done i'm worried about a blood clot or something else going on so i wan na get a cat scan of your chest as well so i'm gon na go ahead and refer you to the emergency department i'll call them and and have you head over that way they can get a chest x-ray and a cat scan and some blood work as well and then we'll evaluate why you're having the shortness of breath and why you're coughing up this blood okay and then depending on what they find you may need you know it could be as simple as a pneumonia or it could be something a little bit more serious we may have to get you know start you know depending on what you find we will get the right treatment started any questions about that or can you drive to the emergency department from here or is that okay
| 3,803
|
doctor: alright for the second problem for the diabetes since your blood sugar is running a little bit high once you get over this i'm blood sugars running a little bit high once we get you over this hump of the shortness of breath and get this diagnosed i'm gon na go ahead and order another hemoglobin a1c today we will probably increase your dose of metformin from five hundred twice a day to seven fifty twice a day so why do n't we do that and then why do n't we have we'+C20:C23ll have the hemoglobin a1c back and then we can once you get over this illness that you're undergoing we'll we'll we'll discuss that more i'll have you come back in about three weeks to just discuss your diabetes and what our treatment plan will be for that okay patient: okay
|
D2N149
| 19
|
[
"Discussion",
"Follow-up",
"Medication",
"Diagnostic Testing",
"Reassessment"
] |
[
"Assessment",
"Plan"
] |
alright for the second problem for the diabetes since your blood sugar is running a little bit high once you get over this i'm blood sugars running a little bit high once we get you over this hump of the shortness of breath and get this diagnosed i'm gon na go ahead and order another hemoglobin a1c today we will probably increase your dose of metformin from five hundred twice a day to seven fifty twice a day so why do n't we do that and then why do n't we have we'+C20:C23ll have the hemoglobin a1c back and then we can once you get over this illness that you're undergoing we'll we'll we'll discuss that more i'll have you come back in about three weeks to just discuss your diabetes and what our treatment plan will be for that okay
| 3,804
|
doctor: for the high blood pressure definitely hold off on the norvasc for right now let's figure out what's going what's causing this episode of shortness of breath i want some blood testing done and and once we have that under better control we can reassess your blood pressure so right now hold the norvasc and then we'll have you come back once everything is done okay patient: no
|
D2N149
| 20
|
[
"Follow-up",
"Medication",
"Diagnostic Testing",
"Reassessment"
] |
[
"Assessment",
"Plan"
] |
for the high blood pressure definitely hold off on the norvasc for right now let's figure out what's going what's causing this episode of shortness of breath i want some blood testing done and and once we have that under better control we can reassess your blood pressure so right now hold the norvasc and then we'll have you come back once everything is done okay
| 3,805
|
doctor: any other questions or anything we know if we need to talk about today patient: no i'm good
|
D2N149
| 21
|
[
"Discussion"
] |
[
"Plan"
] |
any other questions or anything we know if we need to talk about today
| 3,806
|
doctor: sounds good we'll get you signed out here in a second
|
D2N149
| 22
|
[
"Chitchat"
] |
[
"Null"
] |
doctor: sounds good we'll get you signed out here in a second
| 3,807
|
doctor: alright scott so so i understand that you you had some right knee injury can you tell me a little bit about what happened patient: yeah i was trying to go out and play some pickup soccer games over the weekend and went to go plank kick the ball and and just felt a pop in my right knee
|
D2N150
| 0
|
[
"Acute Symptoms",
"Greetings"
] |
[
"Subjective"
] |
alright scott so so i understand that you you had some right knee injury can you tell me a little bit about what happened
| 3,808
|
doctor: okay and and how long ago did that happen patient: about three days ago
|
D2N150
| 1
|
[
"Acute Symptoms"
] |
[
"Subjective"
] |
okay and and how long ago did that happen
| 3,809
|
doctor: three days okay and when did you notice any swelling anything like that patient: it it's swollen some some of that swelling has gone down
|
D2N150
| 2
|
[
"Vegetative History"
] |
[
"Subjective"
] |
three days okay and when did you notice any swelling anything like that
| 3,810
|
doctor: okay alright and then so how's the pain with your knee on a scale of one to ten one being the least pain ten being the worst pain how's how's it been ranging patient: it's somewhere between six and seven right now it's about four or five with some of the swelling going down
|
D2N150
| 4
|
[
"Acute Symptoms"
] |
[
"Subjective"
] |
okay alright and then so how's the pain with your knee on a scale of one to ten one being the least pain ten being the worst pain how's how's it been ranging
| 3,811
|
doctor: okay alright and did you take anything at all to relieve the pain patient: anti-inflammatories
|
D2N150
| 5
|
[
"Acute Symptoms",
"Therapeutic History"
] |
[
"Subjective"
] |
okay alright and did you take anything at all to relieve the pain
| 3,812
|
doctor: okay alrighty and did that help patient: yeah the ibuprofen helped a little bit but i'm on it pretty on a pretty regular basis right now
|
D2N150
| 6
|
[
"Acute Symptoms",
"Therapeutic History"
] |
[
"Subjective"
] |
okay alrighty and did that help
| 3,813
|
doctor: gotcha okay now tell me are you able to bend or straighten your leg ever since then patient: i can bend it but it hurts towards the end of the motion and i can straighten it but it does n't it feels like i have to help get it straightened
|
D2N150
| 7
|
[
"Acute Symptoms"
] |
[
"Subjective"
] |
gotcha okay now tell me are you able to bend or straighten your leg ever since then
| 3,814
|
doctor: okay alright and then how about you able to bear any weight on it or walk on it at all patient: i can still bear weight on it but it feels just really loose it it does n't feel normal
|
D2N150
| 8
|
[
"Acute Symptoms"
] |
[
"Subjective"
] |
okay alright and then how about you able to bear any weight on it or walk on it at all
| 3,815
|
doctor: gotcha okay alright well let's go ahead and take a look at your knee here real quick before i take a look at your knee here i'm gon na do a physical exam and in terms of your gait here i did notice that you do have a marked limp on your looks like it's your right leg upon ambulation so let me go ahead and take a look at that right knee real quick i do appreciate some significant effusion in the right knee just a slight bit of ecchymosis let me just feel around here scott how does that feel does that hurt when i kinda press on that there patient: a little bit of pain there not not really bad it's it feels like it's just more on the inside of my knee
|
D2N150
| 9
|
[
"Physical Examination"
] |
[
"Objective"
] |
gotcha okay alright well let's go ahead and take a look at your knee here real quick before i take a look at your knee here i'm gon na do a physical exam and in terms of your gait here i did notice that you do have a marked limp on your looks like it's your right leg upon ambulation so let me go ahead and take a look at that right knee real quick i do appreciate some significant effusion in the right knee just a slight bit of ecchymosis let me just feel around here scott how does that feel does that hurt when i kinda press on that there
| 3,816
|
doctor: yep okay so you definitely feeling some a little bit of pain to palpation at the medial joint line now i'm gon na have you lie on your back and also i'm gon na do some maneuvering here of your leg i'm gon na do a real quick test on you here okay alright how does that feel patient: just feels just feels loose it hurts when you pull it at the very end
|
D2N150
| 10
|
[
"Physical Examination"
] |
[
"Objective"
] |
yep okay so you definitely feeling some a little bit of pain to palpation at the medial joint line now i'm gon na have you lie on your back and also i'm gon na do some maneuvering here of your leg i'm gon na do a real quick test on you here okay alright how does that feel
| 3,817
|
doctor: okay sorry about that alright so you're definitely having some difficulty with some passive range of motion here and you're lacking a few degrees of terminal extension to about a hundred and fifteen degrees as well as lacking about maybe twenty to thirty degrees of terminal flexion on the secondary secondary to the pain here and you do have a positive lachman exam so one more thing i wan na take a look at real quick i'm gon na take a look at your toes here real quick very good so neurovascularly your bilateral lower extremities are intact and it looks like you have a muscle strength of a five out of five so scott you know based on my examination here your right knee injury is really suggestive of anterior cruciate ligament tear and you've heard of it probably even heard as acl tear sometimes especially when a lot of people do sports and they injure their knee that that can happen so my plan for you though is i wan na i wan na go ahead and order an mri because i wan na evaluate the integrity of that acl now you may need surgery but we'll we'll first take a look at that mri result and reevaluate and reevaluate that first but in the meantime i wan na go ahead and order some anti-inflammatory medication meloxicam fifty milligrams a day it's gon na help reduce that swelling and the pain and then i want you to go ahead and ice the knee if you need to if you're still seeing some swelling and some pain you can go ahead and use ice as well but i definitely would like for you to moderate your activities so i would like for you to wear a knee immobilizer and then also use crutches when you walk around just to help you a little bit so not to put too much stress and strain on that knee does that sound like a plan patient: it it does now well i need to limit my work activities i i typically sit behind a desk but it's not been very comfortable sitting here lately
|
D2N150
| 11
|
[
"Physical Examination",
"Discussion",
"Medication",
"Other Treatments",
"Diagnostic Testing",
"Acute Assessment"
] |
[
"Objective",
"Assessment",
"Plan"
] |
okay sorry about that alright so you're definitely having some difficulty with some passive range of motion here and you're lacking a few degrees of terminal extension to about a hundred and fifteen degrees as well as lacking about maybe twenty to thirty degrees of terminal flexion on the secondary secondary to the pain here and you do have a positive lachman exam so one more thing i wan na take a look at real quick i'm gon na take a look at your toes here real quick very good so neurovascularly your bilateral lower extremities are intact and it looks like you have a muscle strength of a five out of five so scott you know based on my examination here your right knee injury is really suggestive of anterior cruciate ligament tear and you've heard of it probably even heard as acl tear sometimes especially when a lot of people do sports and they injure their knee that that can happen so my plan for you though is i wan na i wan na go ahead and order an mri because i wan na evaluate the integrity of that acl now you may need surgery but we'll we'll first take a look at that mri result and reevaluate and reevaluate that first but in the meantime i wan na go ahead and order some anti-inflammatory medication meloxicam fifty milligrams a day it's gon na help reduce that swelling and the pain and then i want you to go ahead and ice the knee if you need to if you're still seeing some swelling and some pain you can go ahead and use ice as well but i definitely would like for you to moderate your activities so i would like for you to wear a knee immobilizer and then also use crutches when you walk around just to help you a little bit so not to put too much stress and strain on that knee does that sound like a plan
| 3,818
|
doctor: yeah definitely so yeah so you you can limit the activities for sure in terms of your work activities i know if you sit too long sometimes it can be painful because you do need to move that leg a little bit so it does n't lock up so i i would like for you to you know do do some slight activities not enough to stress your legs but definitely move move them a little bit every now and then so it does n't lock up on you okay patient: okay
|
D2N150
| 12
|
[
"Discussion",
"Referral"
] |
[
"Plan"
] |
yeah definitely so yeah so you you can limit the activities for sure in terms of your work activities i know if you sit too long sometimes it can be painful because you do need to move that leg a little bit so it does n't lock up so i i would like for you to you know do do some slight activities not enough to stress your legs but definitely move move them a little bit every now and then so it does n't lock up on you okay
| 3,819
|
doctor: alright i do want you to i know you are i know you actually jog often so i want you to just slow that down for a bit no jogging for a while until we get you know results of your mri till we figure out what we what we are gon na be doing okay patient: okay
|
D2N150
| 13
|
[
"Discussion"
] |
[
"Plan"
] |
alright i do want you to i know you are i know you actually jog often so i want you to just slow that down for a bit no jogging for a while until we get you know results of your mri till we figure out what we what we are gon na be doing okay
| 3,820
|
doctor: alright and how's your dog you has it been jogging with you before this incident patient: how's just how's my dog or how is my job
|
D2N150
| 14
|
[
"Chitchat"
] |
[
"Null"
] |
alright and how's your dog you has it been jogging with you before this incident
| 3,821
|
doctor: your your dog patient: my my my dog is okay
|
D2N150
| 15
|
[
"Chitchat"
] |
[
"Null"
] |
your your dog
| 3,822
|
doctor: very good alright well i'm gon na go ahead and have the nurse take you to the scheduler to get your mri and i'll get back with you as soon as we get the results of that patient: okay sounds good thank you
|
D2N150
| 17
|
[
"Chitchat"
] |
[
"Null"
] |
very good alright well i'm gon na go ahead and have the nurse take you to the scheduler to get your mri and i'll get back with you as soon as we get the results of that
| 3,823
|
doctor: thank you
|
D2N150
| 18
|
[
"Chitchat"
] |
[
"Null"
] |
doctor: thank you
| 3,824
|
doctor: alright teresa i see here in your chart that you seem to be experiencing some elbow pain could you tell me where it hurts patient: yeah so it's hurting on the inside of my elbow
|
D2N151
| 0
|
[
"Acute Symptoms",
"Greetings"
] |
[
"Subjective"
] |
alright teresa i see here in your chart that you seem to be experiencing some elbow pain could you tell me where it hurts
| 3,825
|
doctor: mm-hmm patient: and when i i i've been doing some pottery i've been creating you know i have a pottery wheel and i've been i love my pottery and for my son's birthday i've been making a a ceramic bowl and i'm gon na paint it and i have to do some real full decorations but i've really been working on it a lot and my gosh this is hurting and i ca n't work on it right now because it's hurting so much
|
D2N151
| 1
|
[
"Acute Symptoms"
] |
[
"Subjective"
] |
mm-hmm
| 3,826
|
doctor: i am so sorry so i mean that's really cool that you do parttery it's something that i've wanted to pick up you know but i do n't know that i have those skills yet does the pain radiate down your arm or up your shoulder or anything patient: yeah it does down my arm and along that inside of my arm
|
D2N151
| 2
|
[
"Acute Symptoms"
] |
[
"Subjective"
] |
i am so sorry so i mean that's really cool that you do parttery it's something that i've wanted to pick up you know but i do n't know that i have those skills yet does the pain radiate down your arm or up your shoulder or anything
| 3,827
|
doctor: okay so the medial aspect okay have you did you hit it on anything patient: no not that i recall
|
D2N151
| 3
|
[
"Acute Symptoms"
] |
[
"Subjective"
] |
okay so the medial aspect okay have you did you hit it on anything
| 3,828
|
doctor: okay and have you ever injured your elbow before patient: no i have n't
|
D2N151
| 4
|
[
"Personal History"
] |
[
"Subjective"
] |
okay and have you ever injured your elbow before
| 3,829
|
doctor: okay alright so on a on a scale of one to ten with ten being your arm is actively being sought off by a chainsaw how bad is the pain patient: well i'd say it's about a seven
|
D2N151
| 5
|
[
"Acute Symptoms"
] |
[
"Subjective"
] |
okay alright so on a on a scale of one to ten with ten being your arm is actively being sought off by a chainsaw how bad is the pain
| 3,830
|
doctor: wow that's pretty bad does it keep you up at night patient: yes it really does it's you know if i roll over and it it it just wakes me up
|
D2N151
| 6
|
[
"Acute Symptoms"
] |
[
"Subjective"
] |
wow that's pretty bad does it keep you up at night
| 3,831
|
doctor: okay have you done anything to relieve the pain patient: well i have been taking some ibuprofen but that is n't really helping
|
D2N151
| 7
|
[
"Acute Symptoms",
"Therapeutic History"
] |
[
"Subjective"
] |
okay have you done anything to relieve the pain
| 3,832
|
doctor: okay and have you tried anything like ice or heat or anything else patient: i tried a little bit of ice at first
|
D2N151
| 8
|
[
"Acute Symptoms",
"Therapeutic History"
] |
[
"Subjective"
] |
okay and have you tried anything like ice or heat or anything else
| 3,833
|
doctor: mm-hmm patient: but and it's just it's been hurting for about four days now
|
D2N151
| 9
|
[
"Acute Symptoms",
"Therapeutic History"
] |
[
"Subjective"
] |
mm-hmm
| 3,834
|
doctor: okay okay so it's probably it do you think it's getting worse patient: well it's just not getting better
|
D2N151
| 11
|
[
"Acute Symptoms"
] |
[
"Subjective"
] |
okay okay so it's probably it do you think it's getting worse
| 3,835
|
doctor: okay no i understand okay so i know that you also have like a history of hypertension and that we have you on ten milligrams of lisinopril have you been checking your blood pressures regularly patient: yeah you know what i remember too i mean they they have been pretty good one teens to one thirties
|
D2N151
| 12
|
[
"Personal History",
"Therapeutic History"
] |
[
"Subjective"
] |
okay no i understand okay so i know that you also have like a history of hypertension and that we have you on ten milligrams of lisinopril have you been checking your blood pressures regularly
| 3,836
|
doctor: okay alright and okay do you think that you've been good about taking your medications do you usually take them everyday patient: yeah pretty much i i i you know set an alarm for that lisinopril
|
D2N151
| 13
|
[
"Therapeutic History"
] |
[
"Subjective"
] |
okay alright and okay do you think that you've been good about taking your medications do you usually take them everyday
| 3,837
|
doctor: awesome that's great alright and so i see that you also we are treating you for diabetes as well and that we have you on five hundred milligrams of metformin twice a day how about that have you been taking that regularly patient: well sometimes i forget i mean having a medication twice a day you know sometimes i'm out doing stuff and i just forget to take it
|
D2N151
| 14
|
[
"Personal History",
"Therapeutic History"
] |
[
"Subjective"
] |
awesome that's great alright and so i see that you also we are treating you for diabetes as well and that we have you on five hundred milligrams of metformin twice a day how about that have you been taking that regularly
| 3,838
|
doctor: okay alright so when you say a sweet tooth what are we talking about there patient: i love to bak also besides my ceramics i'm really big and baking and i like to make cakes and and take them to you know parties and get togethers you know family get togethers and i like to make senna rules too i've been doing that since i was very young so i kinda noticed that
|
D2N151
| 16
|
[
"Vegetative History"
] |
[
"Subjective"
] |
okay alright so when you say a sweet tooth what are we talking about there
| 3,839
|
doctor: okay cinnamon rolls can be kind of hard like do you for your cakes do you do you use fondant you know to like do any of the decorations patient: no i i mine are just pretty basic they're not overly fancy
|
D2N151
| 17
|
[
"Vegetative History"
] |
[
"Subjective"
] |
okay cinnamon rolls can be kind of hard like do you for your cakes do you do you use fondant you know to like do any of the decorations
| 3,840
|
doctor: so you know it's good patient: yeah
|
D2N151
| 20
|
[
"Vegetative History"
] |
[
"Subjective"
] |
so you know it's good
| 3,841
|
doctor: alright well so i totally understand like baking and like the excitement of being able to give those to your family but we maybe wan na start cutting down on eating and taste testing ourselves is do you think that's something we could manage patient: yeah i know i need to get better on it i probably could use maybe a refresher on just managing what i should and should n't eat how like if i need to combine a protein you know if i do eat something a little bit sweet maybe pling a protein or something with it
|
D2N151
| 21
|
[
"Discussion",
"Other Treatments"
] |
[
"Plan"
] |
alright well so i totally understand like baking and like the excitement of being able to give those to your family but we maybe wan na start cutting down on eating and taste testing ourselves is do you think that's something we could manage
| 3,842
|
doctor: mm-hmm yeah that sounds like a patient: had some friends tell me something about that
|
D2N151
| 22
|
[
"Discussion",
"Other Treatments"
] |
[
"Plan"
] |
mm-hmm yeah that sounds like a
| 3,843
|
doctor: yeah that sounds like a great idea and i think if that's something that we can maybe discuss to get you in contact with someone who can offer you someone with a degree that can offer you some really good advice you know i do n't wan na as much as it's really helpful to have friends i do wan na be able to give you like a source of truth right patient: yeah i i had a diabetic consult a long time ago but yeah it it would be nice to see a dietitian again and go over those and maybe there is some new stuff too
|
D2N151
| 23
|
[
"Discussion",
"Other Treatments"
] |
[
"Plan"
] |
yeah that sounds like a great idea and i think if that's something that we can maybe discuss to get you in contact with someone who can offer you someone with a degree that can offer you some really good advice you know i do n't wan na as much as it's really helpful to have friends i do wan na be able to give you like a source of truth right
| 3,844
|
doctor: a hundred percent yeah you know like i one of the things that i struggle with is like are eggs good for you or bad for you you know like with cholesterol i feel like it changes every other year or something like that so you're right there may be some pieces of information that we do need to update and and you know over a fresh of course would n't hurt but if you do n't mind i'm gon na go ahead and start my physical exam i'm gon na call out my findings and just go let me know if you have any questions or if anything sounds anything that you you want me to expand on further but this is just for the recording sake so we can get everything documented okay patient: yeah and can i ask you what word what were my vital signs can you show me what my vital signs were
|
D2N151
| 24
|
[
"Discussion",
"Physical Examination",
"Other Treatments"
] |
[
"Objective",
"Plan"
] |
a hundred percent yeah you know like i one of the things that i struggle with is like are eggs good for you or bad for you you know like with cholesterol i feel like it changes every other year or something like that so you're right there may be some pieces of information that we do need to update and and you know over a fresh of course would n't hurt but if you do n't mind i'm gon na go ahead and start my physical exam i'm gon na call out my findings and just go let me know if you have any questions or if anything sounds anything that you you want me to expand on further but this is just for the recording sake so we can get everything documented okay
| 3,845
|
doctor: yeah that's uh uh that's a really good question so our big and favorite one is gon na be your blood pressure right so you're right like we are seeing some some definite improvement today it was one twenty over seventy and honestly that's a great place to be so that tells me that your medication is working and that maybe we can start to evaluate a bit more your respiratory rate is completely normal so i see it here as eighteen that's wonderful you are not running a fever so ninety seven . nine and you're honestly that's within like a good enough range for me you're satting pretty well your oxygen saturation is a hundred percent again so that means that you're not experiencing any kind of difficulty getting in that oxygen to the rest of your body i do wan na say that you know pain is one of the vitals that we worry about and you're saying that at it's worst your the pain in your elbow is a seven out of ten so that's something that i'm gon na evaluate and then your pulse rate seems to be appropriate as well so those are all great do you have any questions about that so far patient: no that sounds good yeah i was just curious
|
D2N151
| 25
|
[
"Physical Examination"
] |
[
"Objective"
] |
yeah that's uh uh that's a really good question so our big and favorite one is gon na be your blood pressure right so you're right like we are seeing some some definite improvement today it was one twenty over seventy and honestly that's a great place to be so that tells me that your medication is working and that maybe we can start to evaluate a bit more your respiratory rate is completely normal so i see it here as eighteen that's wonderful you are not running a fever so ninety seven . nine and you're honestly that's within like a good enough range for me you're satting pretty well your oxygen saturation is a hundred percent again so that means that you're not experiencing any kind of difficulty getting in that oxygen to the rest of your body i do wan na say that you know pain is one of the vitals that we worry about and you're saying that at it's worst your the pain in your elbow is a seven out of ten so that's something that i'm gon na evaluate and then your pulse rate seems to be appropriate as well so those are all great do you have any questions about that so far
| 3,846
|
doctor: mm-hmm i do wan na say that like looking at your the weight we do see like maybe a five pound increase from the last time that you were here but that's completely normal right to be able like to fluctuate you know give or take five pounds so i'm not i'm not i'm not like seriously worried about it but if we do come back and notice an additional five pounds then we might have to start talking about like actually you know what let's do that right now what kind of exercise regimen are you on patient: well i do go for some walks in the evening i try to get one in on the morning too
|
D2N151
| 27
|
[
"Physical Examination",
"Other Socials"
] |
[
"Subjective",
"Objective"
] |
mm-hmm i do wan na say that like looking at your the weight we do see like maybe a five pound increase from the last time that you were here but that's completely normal right to be able like to fluctuate you know give or take five pounds so i'm not i'm not i'm not like seriously worried about it but if we do come back and notice an additional five pounds then we might have to start talking about like actually you know what let's do that right now what kind of exercise regimen are you on
| 3,847
|
doctor: mm-hmm patient: so not a whole lot other than that because i'm busy with my pottery or baking so but i do try to get out and walk daily
|
D2N151
| 28
|
[
"Physical Examination",
"Other Socials"
] |
[
"Subjective",
"Objective"
] |
mm-hmm
| 3,848
|
doctor: okay that's awesome so like how about about how long are your walks patient: well i just walk around the neighborhood there is you know the sidewalks and there is kind of a little bit more of a nature type area that goes across the bridge and so it's probably you know maybe one to two miles a day
|
D2N151
| 29
|
[
"Other Socials"
] |
[
"Subjective"
] |
okay that's awesome so like how about about how long are your walks
| 3,849
|
doctor: wow that's intense i was not expecting that number that's awesome okay alright so maybe this five pounds is muscle we're gon na go for it okay but thank you but that's some really important information but i'm gon na start your physical exam now okay patient: okay
|
D2N151
| 30
|
[
"Physical Examination"
] |
[
"Objective"
] |
wow that's intense i was not expecting that number that's awesome okay alright so maybe this five pounds is muscle we're gon na go for it okay but thank you but that's some really important information but i'm gon na start your physical exam now okay
| 3,850
|
doctor: alright so i know that you said that you are experiencing elbow pain could you tell me is it your left or your right elbow patient: it's my right
|
D2N151
| 31
|
[
"Physical Examination"
] |
[
"Objective"
] |
alright so i know that you said that you are experiencing elbow pain could you tell me is it your left or your right elbow
| 3,851
|
doctor: okay alright right elbow when i touch it does it hurt on the inside patient: yes it does
|
D2N151
| 32
|
[
"Physical Examination"
] |
[
"Objective"
] |
okay alright right elbow when i touch it does it hurt on the inside
| 3,852
|
doctor: okay so moderate tenderness at the medial epicondyle when you turn like when you turn your wrist is if you're trying to open a door knob do you experience pain patient: no not really
|
D2N151
| 33
|
[
"Physical Examination"
] |
[
"Objective"
] |
okay so moderate tenderness at the medial epicondyle when you turn like when you turn your wrist is if you're trying to open a door knob do you experience pain
| 3,853
|
doctor: alright so turning out no pain but when you turn your wrist inwards do you have any pain patient: yeah
|
D2N151
| 34
|
[
"Physical Examination"
] |
[
"Objective"
] |
alright so turning out no pain but when you turn your wrist inwards do you have any pain
| 3,854
|
doctor: okay so pain with resisted pronation of right forearm when you rest your arm on a table with the palm side up alright i want you to raise your hand by bending the wrist do you experiencing any pain patient: yeah that hurts
|
D2N151
| 35
|
[
"Physical Examination"
] |
[
"Objective"
] |
okay so pain with resisted pronation of right forearm when you rest your arm on a table with the palm side up alright i want you to raise your hand by bending the wrist do you experiencing any pain
| 3,855
|
doctor: alright alright so when you are when i'm pressing here and like flexing your wrist are you experiencing any pain patient: yes
|
D2N151
| 36
|
[
"Physical Examination"
] |
[
"Objective"
] |
alright alright so when you are when i'm pressing here and like flexing your wrist are you experiencing any pain
| 3,856
|
doctor: alright pain with flexion and when bending the wrist alright when i listen to you you know i'm just gon na check your heart and lungs everything sounds sounds good no murmur no rub no gallop your lungs are clear bilaterally to bilaterally to auscultation i'm not noticing any rash for your at your elbow i do n't notice any bruising any swelling we do wan na note that tenderness but otherwise there is no discoloration no lesions so that's good your pulses and are equal bilaterally and i think i think we have an idea of what we are dealing with here okay so i'm gon na go ahead and give you my impression and plan for your your first problem like your primary problem that you are here for is right elbow pain it's consistent with medial epicondylitis and that it just means it's pain caused from overuse and damage to the tendons in your arm what we are gon na do is rest it i'm gon na order a sling for your right arm and you can wear this while you're awake well i want you to apply ice to your elbow for twenty minutes three times a day i'm going to i'm gon na ask you to take six hundred milligrams of ibuprofen that's three pills every six hours with food and you can take that for one week i know it's really important that you said that you have something that a gift that you wan na make for your son but we're gon na hold off on pottery for the next couple of weeks just to give your arm a chance to heal you know like it's awesome that you wan na be able to do these things for your family but sometimes you know your body is not where your where your where your heart is like where your heart and your head are right and then so patient: i'll i'll just let him know that that i maybe i'll take a picture of what i have so far
|
D2N151
| 37
|
[
"Physical Examination",
"Medication",
"Other Treatments",
"Acute Assessment"
] |
[
"Objective",
"Assessment",
"Plan"
] |
alright pain with flexion and when bending the wrist alright when i listen to you you know i'm just gon na check your heart and lungs everything sounds sounds good no murmur no rub no gallop your lungs are clear bilaterally to bilaterally to auscultation i'm not noticing any rash for your at your elbow i do n't notice any bruising any swelling we do wan na note that tenderness but otherwise there is no discoloration no lesions so that's good your pulses and are equal bilaterally and i think i think we have an idea of what we are dealing with here okay so i'm gon na go ahead and give you my impression and plan for your your first problem like your primary problem that you are here for is right elbow pain it's consistent with medial epicondylitis and that it just means it's pain caused from overuse and damage to the tendons in your arm what we are gon na do is rest it i'm gon na order a sling for your right arm and you can wear this while you're awake well i want you to apply ice to your elbow for twenty minutes three times a day i'm going to i'm gon na ask you to take six hundred milligrams of ibuprofen that's three pills every six hours with food and you can take that for one week i know it's really important that you said that you have something that a gift that you wan na make for your son but we're gon na hold off on pottery for the next couple of weeks just to give your arm a chance to heal you know like it's awesome that you wan na be able to do these things for your family but sometimes you know your body is not where your where your where your heart is like where your heart and your head are right and then so
| 3,857
|
doctor: absolutely that's awesome and so it'll be like a a movie like coming soon to a shelf near you that's great for your second problem right we have this longstanding diabetes i want to increase your metformin to a thousand milligrams twice a day i know that you're saying you're having a hard time keeping up with that so i want you to do a good job of like checking and recording your blood sugars every day i do need you to follow up with me in a couple weeks i also wan na order something called an a1c since you are having a hard time with like the blood like the blood sugars everyday an a1c will give me a more accurate picture of like a longer period of time and then we might need to evaluate like what are what other options that we have if your sugars if we ca n't get them a bit more under control i do want you to follow up with me in a couple of weeks about the about your diabetes and for your third problem of hypertension we're just gon na continue you on your lisinopril at ten milligrams that's it seems to be doing it's job i'm really i'm really glad about that and it's probably due to the walking that you're doing i forgot to mention for your diabetes we are gon na i'm gon na recommend a a referral to diabetic counseling that way you can get like a bit more information on like the steps that you can take to help you with that patient: i was gon na ask you how about my x-ray the x-ray of my elbow how did that look
|
D2N151
| 38
|
[
"Follow-up",
"Referral",
"Medication",
"Diagnostic Testing",
"Reassessment"
] |
[
"Assessment",
"Plan"
] |
absolutely that's awesome and so it'll be like a a movie like coming soon to a shelf near you that's great for your second problem right we have this longstanding diabetes i want to increase your metformin to a thousand milligrams twice a day i know that you're saying you're having a hard time keeping up with that so i want you to do a good job of like checking and recording your blood sugars every day i do need you to follow up with me in a couple weeks i also wan na order something called an a1c since you are having a hard time with like the blood like the blood sugars everyday an a1c will give me a more accurate picture of like a longer period of time and then we might need to evaluate like what are what other options that we have if your sugars if we ca n't get them a bit more under control i do want you to follow up with me in a couple of weeks about the about your diabetes and for your third problem of hypertension we're just gon na continue you on your lisinopril at ten milligrams that's it seems to be doing it's job i'm really i'm really glad about that and it's probably due to the walking that you're doing i forgot to mention for your diabetes we are gon na i'm gon na recommend a a referral to diabetic counseling that way you can get like a bit more information on like the steps that you can take to help you with that
| 3,858
|
doctor: your x-ray honestly looks great in that i do n't see any kind of fracture or bony abnormality so that's what makes me think that this is like a tendon related thing right so in reviewing your x-ray like it it does support the the the assessment and plan that i have given you i patient: okay
|
D2N151
| 39
|
[
"Discussion",
"Radiology Examination"
] |
[
"Objective",
"Plan"
] |
your x-ray honestly looks great in that i do n't see any kind of fracture or bony abnormality so that's what makes me think that this is like a tendon related thing right so in reviewing your x-ray like it it does support the the the assessment and plan that i have given you i
| 3,859
|
doctor: yeah absolutely i do think for your your primary problem the elbow that we might wan na get put you in some physical rehab if the problem is taking a little longer to heal but we'll discuss that at your next visit here okay patient: okay
|
D2N151
| 41
|
[
"Discussion",
"Referral"
] |
[
"Plan"
] |
yeah absolutely i do think for your your primary problem the elbow that we might wan na get put you in some physical rehab if the problem is taking a little longer to heal but we'll discuss that at your next visit here okay
| 3,860
|
doctor: alright no problem any other questions patient: nope
|
D2N151
| 42
|
[
"Discussion"
] |
[
"Plan"
] |
alright no problem any other questions
| 3,861
|
doctor: alright thank you for keeping me accountable
|
D2N151
| 43
|
[
"Chitchat"
] |
[
"Null"
] |
doctor: alright thank you for keeping me accountable
| 3,862
|
doctor: good morning noah tell me a little bit about why you are here today patient: hi document i'm i'm just had you know the back pain you know and i've i've had it for you know about a week and
|
D2N152
| 0
|
[
"Acute Symptoms",
"Greetings"
] |
[
"Subjective"
] |
good morning noah tell me a little bit about why you are here today
| 3,863
|
doctor: okay can you tell me a little bit more about it how did it start or how did it do you remember injuring yourself patient: no not really i mean i was just like you know i guess i one day i mean i just twisted you know on my left and maybe i mean i might have picked something up
|
D2N152
| 2
|
[
"Personal History"
] |
[
"Subjective"
] |
okay can you tell me a little bit more about it how did it start or how did it do you remember injuring yourself
| 3,864
|
doctor: okay and is it anywhere in specific is it in the middle of the back across the whole low back or on one side or the other patient: i think it's more towards you know right in the middle maybe on the lower side and nothing on the you know i mean it sometimes it goes back you know maybe having troubles with the left eye i suppose but i mean it's aggravated you know when i you know when i do some you know maybe i'm a sudden movement to the left
|
D2N152
| 5
|
[
"Personal History"
] |
[
"Subjective"
] |
okay and is it anywhere in specific is it in the middle of the back across the whole low back or on one side or the other
| 3,865
|
doctor: okay and that's when you get the pain more patient: maybe located in the center but it goes across to the little back and i on the left side
|
D2N152
| 6
|
[
"Personal History"
] |
[
"Subjective"
] |
okay and that's when you get the pain more
| 3,866
|
doctor: i also heard you say you know if you twist suddenly that makes it worse is that correct patient: it makes it worse it makes it worse i mean yeah
|
D2N152
| 7
|
[
"Personal History"
] |
[
"Subjective"
] |
i also heard you say you know if you twist suddenly that makes it worse is that correct
| 3,867
|
doctor: now you know i was looking at your records and i know you have that history of diabetes and i have n't seen you a while for a follow-up for that how you've been feeling patient: i mean been okay i mean i take my meds
|
D2N152
| 8
|
[
"Personal History"
] |
[
"Subjective"
] |
now you know i was looking at your records and i know you have that history of diabetes and i have n't seen you a while for a follow-up for that how you've been feeling
| 3,868
|
doctor: okay so you're on patient: mm-hmm
|
D2N152
| 10
|
[
"Therapeutic History"
] |
[
"Subjective"
] |
okay so you're on
| 3,869
|
doctor: yeah i think i think you're on that metformin twice a day patient: yeah
|
D2N152
| 11
|
[
"Therapeutic History"
] |
[
"Subjective"
] |
yeah i think i think you're on that metformin twice a day
| 3,870
|
doctor: yeah okay patient: yes
|
D2N152
| 12
|
[
"Chitchat"
] |
[
"Null"
] |
yeah okay
| 3,871
|
doctor: do you test your blood sugar at home in the mornings patient: yeah i mean i try to
|
D2N152
| 13
|
[
"Personal History"
] |
[
"Subjective"
] |
do you test your blood sugar at home in the mornings
| 3,872
|
doctor: and how have those numbers been patient: they bumped towards i mean bit towards the higher side i mean i must have been
|
D2N152
| 15
|
[
"Personal History"
] |
[
"Subjective"
] |
and how have those numbers been
| 3,873
|
doctor: well if patient: yeah
|
D2N152
| 17
|
[
"Chitchat"
] |
[
"Null"
] |
well if
| 3,874
|
doctor: yeah if i remember right your family do n't they own that that bakery down on the corner of main street and did n't they own that patient: yeah thank you
|
D2N152
| 18
|
[
"Chitchat"
] |
[
"Null"
] |
yeah if i remember right your family do n't they own that that bakery down on the corner of main street and did n't they own that
| 3,875
|
doctor: and how do you do you stay away from those i i got ta be honest i love i love the cakes and donuts they make those are delicious patient: yeah i try to
|
D2N152
| 19
|
[
"Chitchat"
] |
[
"Null"
] |
and how do you do you stay away from those i i got ta be honest i love i love the cakes and donuts they make those are delicious
| 3,876
|
doctor: well let me so we're gon na have to watch that and i'll come back and we'll talk a little bit about the diabetes but let's go ahead and do that i do n't wan na do a a a quick physical exam on you i'm gon na look in your eyes here and so let me quickly look in your ears patient: i see
|
D2N152
| 22
|
[
"Physical Examination"
] |
[
"Objective"
] |
well let me so we're gon na have to watch that and i'll come back and we'll talk a little bit about the diabetes but let's go ahead and do that i do n't wan na do a a a quick physical exam on you i'm gon na look in your eyes here and so let me quickly look in your ears
| 3,877
|
doctor: okay that looks good and any let me let me listen to your lungs okay your lungs are clear and your heart it's a regular rate and rhythm that's all good as we go through that now i want you to sit up here i'm gon na press down your back starting at the top and any pain up top no patient: no
|
D2N152
| 23
|
[
"Physical Examination"
] |
[
"Objective"
] |
okay that looks good and any let me let me listen to your lungs okay your lungs are clear and your heart it's a regular rate and rhythm that's all good as we go through that now i want you to sit up here i'm gon na press down your back starting at the top and any pain up top no
| 3,878
|
doctor: okay and then once i get down here and around that low back i wan na press in the center first does that cause you a lot of pain patient: yeah
|
D2N152
| 24
|
[
"Physical Examination"
] |
[
"Objective"
] |
okay and then once i get down here and around that low back i wan na press in the center first does that cause you a lot of pain
| 3,879
|
doctor: yeah okay patient: yeah that that's the spot
|
D2N152
| 25
|
[
"Chitchat"
] |
[
"Null"
] |
yeah okay
| 3,880
|
doctor: okay and if i come over here to the right no patient: not that much you know
|
D2N152
| 26
|
[
"Physical Examination"
] |
[
"Objective"
] |
okay and if i come over here to the right no
| 3,881
|
doctor: okay so and then on the left hand side if i push down here kind of into your butt patient: yeah
|
D2N152
| 27
|
[
"Physical Examination"
] |
[
"Objective"
] |
okay so and then on the left hand side if i push down here kind of into your butt
| 3,882
|
doctor: yeah okay patient: yeah
|
D2N152
| 28
|
[
"Chitchat"
] |
[
"Null"
] |
yeah okay
| 3,883
|
doctor: lay back on the stretcher for me for a second i'm gon na go ahead and and lift your legs for me or i'm gon na go ahead and lift your legs for you just relax i'm gon na start here on the right side when i lift that right leg up does that cause you significant pain or any pain at all patient: a little a little bit
|
D2N152
| 29
|
[
"Physical Examination"
] |
[
"Objective"
] |
lay back on the stretcher for me for a second i'm gon na go ahead and and lift your legs for me or i'm gon na go ahead and lift your legs for you just relax i'm gon na start here on the right side when i lift that right leg up does that cause you significant pain or any pain at all
| 3,884
|
doctor: okay let me come around let me lift up the left side if i lift that up does that cause patient: yeah yeah yeah that's that's
|
D2N152
| 30
|
[
"Physical Examination"
] |
[
"Objective"
] |
okay let me come around let me lift up the left side if i lift that up does that cause
| 3,885
|
doctor: i can see that gritts on your face so okay that's good and you know as i look at your lower extremities there is no pain or numbness or tingling in your feet or anything like that patient: hmmm no
|
D2N152
| 32
|
[
"Acute Symptoms",
"Physical Examination"
] |
[
"Subjective",
"Objective"
] |
i can see that gritts on your face so okay that's good and you know as i look at your lower extremities there is no pain or numbness or tingling in your feet or anything like that
| 3,886
|
doctor: okay okay so lem me talk a little bit about my impression and plan so for that low back pain i believe you have a musculoskeletal low back strain i'm going to order a low back x-ray so we'll order that and get that done as an outpatient i do n't expect to see anything significant but it's gon na tell me how those joint spaces look and if you know if we're dealing with any disk issue but that will be the start of it and i'm also gon na order some physical therapy two for two reasons to help with a little bit with the pain but also strengthen some of the muscles there in the back so those are the two things that we are gon na do now i want you to take take four hundred milligrams of ibuprofen you can take that occasionally with some tylenol when the pain gets more severe up to about three times a day i'm gon na also give you a prescription for some flexeril that's a muscle relaxant and i want you to take one of those once a day every evening but be careful if you're doing any strenuous or hazardous activities such as driving after you take those now for your diabetes my impression is that your diabetes is is under control i noticed that we do n't have n't had a a1c for almost five months so i'm also gon na order an a1c so we can find out where we are with that continue with your diet and exercise we know that's really important and then continue with your metformin i'm not gon na make any changes today but we'll go ahead and look at that once i get that results of that a1c do you have any questions for me patient: yeah can i still go to the bakery
|
D2N152
| 33
|
[
"Reassessment",
"Discussion",
"Diagnostic Testing",
"Acute Assessment",
"Other Treatments",
"Referral",
"Medication"
] |
[
"Assessment",
"Plan"
] |
okay okay so lem me talk a little bit about my impression and plan so for that low back pain i believe you have a musculoskeletal low back strain i'm going to order a low back x-ray so we'll order that and get that done as an outpatient i do n't expect to see anything significant but it's gon na tell me how those joint spaces look and if you know if we're dealing with any disk issue but that will be the start of it and i'm also gon na order some physical therapy two for two reasons to help with a little bit with the pain but also strengthen some of the muscles there in the back so those are the two things that we are gon na do now i want you to take take four hundred milligrams of ibuprofen you can take that occasionally with some tylenol when the pain gets more severe up to about three times a day i'm gon na also give you a prescription for some flexeril that's a muscle relaxant and i want you to take one of those once a day every evening but be careful if you're doing any strenuous or hazardous activities such as driving after you take those now for your diabetes my impression is that your diabetes is is under control i noticed that we do n't have n't had a a1c for almost five months so i'm also gon na order an a1c so we can find out where we are with that continue with your diet and exercise we know that's really important and then continue with your metformin i'm not gon na make any changes today but we'll go ahead and look at that once i get that results of that a1c do you have any questions for me
| 3,887
|
doctor: i would yes it's nice for you to go to the bakery but you ca n't have any donuts i'm no i you just really need to watch that intake of of anything that you might get at the at the bakery so just just be careful with those carbohydrates those sweets that you're taking as we go through your day it's occasional occasional one perfectly fine but on a routine basis we need to watch that patient: right and how soon should i you know check my blood sugars i mean what's a good you know
|
D2N152
| 34
|
[
"Discussion",
"Other Treatments"
] |
[
"Plan"
] |
i would yes it's nice for you to go to the bakery but you ca n't have any donuts i'm no i you just really need to watch that intake of of anything that you might get at the at the bakery so just just be careful with those carbohydrates those sweets that you're taking as we go through your day it's occasional occasional one perfectly fine but on a routine basis we need to watch that
| 3,888
|
doctor: yeah i that's a great question i'm really glad you asked that i would prefer that you're taking your blood pressure every morning the first thing you get up when you get up in the morning that's gon na give me a good idea and so if you can do that the first thing in the morning and keep a record of it you know i know your glucometer keeps a record of it but if you can write them down and once we get that a1c that's gon na give me a little more guidance on how to deal with your blood your diabetes patient: right do you think would i need to see you know a pain doctor or you know
|
D2N152
| 35
|
[
"Discussion",
"Diagnostic Testing"
] |
[
"Plan"
] |
yeah i that's a great question i'm really glad you asked that i would prefer that you're taking your blood pressure every morning the first thing you get up when you get up in the morning that's gon na give me a good idea and so if you can do that the first thing in the morning and keep a record of it you know i know your glucometer keeps a record of it but if you can write them down and once we get that a1c that's gon na give me a little more guidance on how to deal with your blood your diabetes
| 3,889
|
doctor: not yet let's let's get the that's a great question i may end up referring you to a a pain doctor for that low back pain but i really would like to start with some of the diagnostics first let's get an x-ray and if there is you know any question of that x-ray and the pain continues i'm gon na go ahead and maybe order a cat scan and then at that point in time we can refer you to a pain doctor if we're still having significant pain patient: sounds good
|
D2N152
| 36
|
[
"Discussion",
"Diagnostic Testing",
"Referral"
] |
[
"Plan"
] |
not yet let's let's get the that's a great question i may end up referring you to a a pain doctor for that low back pain but i really would like to start with some of the diagnostics first let's get an x-ray and if there is you know any question of that x-ray and the pain continues i'm gon na go ahead and maybe order a cat scan and then at that point in time we can refer you to a pain doctor if we're still having significant pain
| 3,890
|
doctor: okay thank you i'm gon na send my nursing to see you and we'll get you out the door patient: thank you
|
D2N152
| 37
|
[
"Chitchat"
] |
[
"Null"
] |
okay thank you i'm gon na send my nursing to see you and we'll get you out the door
| 3,891
|
doctor: take care patient: that one is a follow-up mm-hmm
|
D2N152
| 38
|
[
"Chitchat"
] |
[
"Null"
] |
take care
| 3,892
|
doctor: hi gregory how are you i the medical assistant told me that you injured your knee patient: yeah yeah i heard it stepping off a curb
|
D2N153
| 0
|
[
"Acute Symptoms",
"Greetings"
] |
[
"Subjective"
] |
hi gregory how are you i the medical assistant told me that you injured your knee
| 3,893
|
doctor: how long ago did that happen patient: about two and a half weeks ago
|
D2N153
| 1
|
[
"Acute Symptoms"
] |
[
"Subjective"
] |
how long ago did that happen
| 3,894
|
doctor: two and a half weeks ago and what what knee is bothering you patient: the right knee the outside of my right knee
|
D2N153
| 2
|
[
"Acute Symptoms"
] |
[
"Subjective"
] |
two and a half weeks ago and what what knee is bothering you
| 3,895
|
doctor: the outside of your right knee patient: yeah
|
D2N153
| 3
|
[
"Acute Symptoms"
] |
[
"Subjective"
] |
the outside of your right knee
| 3,896
|
doctor: okay and did you actually fall down when this happened or patient: no i just sorta turned over my ankle
|
D2N153
| 4
|
[
"Acute Symptoms"
] |
[
"Subjective"
] |
okay and did you actually fall down when this happened or
| 3,897
|
doctor: and no okay so now it clicks when you walk okay does it hurt when you walk patient: no unless i stand on one foot for an extended period of time like leaning my foot up against the wall
|
D2N153
| 6
|
[
"Acute Symptoms"
] |
[
"Subjective"
] |
and no okay so now it clicks when you walk okay does it hurt when you walk
| 3,898
|
doctor: okay and what have you taken for the pain patient: really nothing
|
D2N153
| 8
|
[
"Acute Symptoms",
"Therapeutic History"
] |
[
"Subjective"
] |
okay and what have you taken for the pain
| 3,899
|
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