DATEXIS/aci_bench_intent_annotated · Datasets at Hugging Face

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: okay . so on exam you've got some tenderness over your lateral epicondyle . uh , you have some swelling there and some redness . uh , you have some pain with flexion , extension of your elbow as well . uh , and you have some pain on the dorsal aspect of your- of your forearm as well . okay ? so let's look at your x-rays . hey dragon , show me the x-rays . all right . your x-ray of your elbow-it looks like , i mean , the bones are lined up properly . there's no fracture- . it , uh , there's a little bit of swelling there on the lateral elbow but i do n't see any fracture , so that's good . so , looking at the x-ray and looking at your exam , uh , my diagnosis here would be lateral epicondylitis , and this is basically inflammation of this area where this tendon in- inserts . and probably that happened when you were moving those boxes . so we'll try some motrin , uh , about 800 milligrams every six hours . uh , i'll give you a sling for comfort , just so you can use it if- if it's causing a lot of pain . patient: hmm .	D2N019	19	[ "Physical Examination", "Radiology Examination", "Acute Assessment", "Discussion", "Medication", "Other Treatments" ]	[ "Objective", "Assessment", "Plan" ]	okay . so on exam you've got some tenderness over your lateral epicondyle . uh , you have some swelling there and some redness . uh , you have some pain with flexion , extension of your elbow as well . uh , and you have some pain on the dorsal aspect of your- of your forearm as well . okay ? so let's look at your x-rays . hey dragon , show me the x-rays . all right . your x-ray of your elbow-it looks like , i mean , the bones are lined up properly . there's no fracture- . it , uh , there's a little bit of swelling there on the lateral elbow but i do n't see any fracture , so that's good . so , looking at the x-ray and looking at your exam , uh , my diagnosis here would be lateral epicondylitis , and this is basically inflammation of this area where this tendon in- inserts . and probably that happened when you were moving those boxes . so we'll try some motrin , uh , about 800 milligrams every six hours . uh , i'll give you a sling for comfort , just so you can use it if- if it's causing a lot of pain .	500
doctor: and it should get better , uh , in about , you know , in a couple of days it should be improved . and if it does n't get better , give us a call and we'll see you some time next week . okay ? so we'll give you a sling , we'll give you the motrin , i'll give you about , uh , 30 , uh , uh , 30 , uh , uh , medications for that . uh , do you have any questions ? patient: no , no . thank you .	D2N019	20	[ "Discussion", "Follow-up" ]	[ "Plan" ]	and it should get better , uh , in about , you know , in a couple of days it should be improved . and if it does n't get better , give us a call and we'll see you some time next week . okay ? so we'll give you a sling , we'll give you the motrin , i'll give you about , uh , 30 , uh , uh , 30 , uh , uh , medications for that . uh , do you have any questions ?	501
doctor: hey dragon , order the medications and the procedures . all right , why do n't you come with me and we'll get you signed out ? patient: okay , sounds good .	D2N019	21	[ "Chitchat" ]	[ "Null" ]	hey dragon , order the medications and the procedures . all right , why do n't you come with me and we'll get you signed out ?	502
doctor: hey dragon , finalize the report .	D2N019	22	[ "Chitchat" ]	[ "Null" ]	doctor: hey dragon , finalize the report .	503
doctor: hi , vincent . how are you ? patient: i'm good . how about you ?	D2N020	0	[ "Greetings" ]	[ "Subjective" ]	hi , vincent . how are you ?	504
doctor: i'm good . so le- are you ready to get started ? patient: i am .	D2N020	1	[ "Chitchat" ]	[ "Null" ]	i'm good . so le- are you ready to get started ?	505
doctor: okay . vincent is a 56-year-old male here with abnormal lab findings . so , i've heard you were in the er , vincent , and they found that you had a low hemoglobin . patient: yup .	D2N020	2	[ "Personal History" ]	[ "Subjective" ]	okay . vincent is a 56-year-old male here with abnormal lab findings . so , i've heard you were in the er , vincent , and they found that you had a low hemoglobin .	506
doctor: were you having some dizziness and some lightheadedness ? patient: i was very lightheaded . i- i do n't know . very lightheaded .	D2N020	3	[ "Personal History", "Vegetative History" ]	[ "Subjective" ]	were you having some dizziness and some lightheadedness ?	507
doctor: okay . and have you noticed bleeding from anywhere ? patient: i have not . i have n't hurt myself in quite a while . maybe a slight nick from a knife while chopping some onions , but nothing more than that .	D2N020	4	[ "Personal History" ]	[ "Subjective" ]	okay . and have you noticed bleeding from anywhere ?	508
doctor: but no blood in your stools or- patient: no .	D2N020	5	[ "Vegetative History" ]	[ "Subjective" ]	but no blood in your stools or-	509
doctor: . anything like that ? patient: no .	D2N020	6	[ "Vegetative History" ]	[ "Subjective" ]	. anything like that ?	510
doctor: okay . and any type of weight loss or decreased appetite or night sweats ? coughs ? patient: uh , s- slightly decreased appetite , but i wish i had some weight loss .	D2N020	7	[ "Vegetative History" ]	[ "Subjective" ]	okay . and any type of weight loss or decreased appetite or night sweats ? coughs ?	511
doctor: um , okay . and how about any abdominal pain ? fever , chills ? patient: uh , none of that .	D2N020	8	[ "Vegetative History" ]	[ "Subjective" ]	um , okay . and how about any abdominal pain ? fever , chills ?	512
doctor: okay . all right . um , any nausea or vomiting ? patient: not really . yeah . maybe a bit of nausea .	D2N020	9	[ "Vegetative History" ]	[ "Subjective" ]	okay . all right . um , any nausea or vomiting ?	513
doctor: okay . all right . um , well , how are you doing in terms of your knee replacement . i know you had that done last year . that's going okay ? patient: mm , it seems okay . yeah .	D2N020	11	[ "Personal History" ]	[ "Subjective" ]	okay . all right . um , well , how are you doing in terms of your knee replacement . i know you had that done last year . that's going okay ?	514
doctor: okay . you're walking around without a problem ? patient: yup , yup . just not good enough to run yet , but everything else works just fine .	D2N020	12	[ "Personal History" ]	[ "Subjective" ]	okay . you're walking around without a problem ?	515
doctor: all right .um , and i know a few years ago , you had , had that scare with the possible lung cancer , but then they did the biopsy and , and you've been fine . patient: yup , yup . all good .	D2N020	13	[ "Personal History" ]	[ "Subjective" ]	all right .um , and i know a few years ago , you had , had that scare with the possible lung cancer , but then they did the biopsy and , and you've been fine .	516
doctor: turned out to be benign . patient: yup .	D2N020	14	[ "Personal History" ]	[ "Subjective" ]	turned out to be benign .	517
doctor: okay . great . all right . well , let's go ahead and do a quick physical exam . so looking at you , you do n't appear in any distress . your heart is regular . your lungs sound nice and clear . you have some tenderness to the right lower quadrant to palpation of your abdomen . your lower extremities have no edema . um , all right . well , let's go ahead and look at your labs , okay ? patient: yup .	D2N020	15	[ "Physical Examination" ]	[ "Objective" ]	okay . great . all right . well , let's go ahead and do a quick physical exam . so looking at you , you do n't appear in any distress . your heart is regular . your lungs sound nice and clear . you have some tenderness to the right lower quadrant to palpation of your abdomen . your lower extremities have no edema . um , all right . well , let's go ahead and look at your labs , okay ?	518
doctor: hey , dragon , show me the hemoglobin . yeah , so your hemoglobin is 8.2 , which is quite low for somebody of your height and weight , so we'll have to look into that a , a little bit further . i know that they did the endoscopy in the emergency room . hey , dragon , show me the endoscope results . good . so it looks like you had some gastritis , which is just inflammation of your stomach and they also found a slight polyp , which i know that they biopsied and the results are pending at this time . um , so , you may have had some bleeding from the gastritis . it's not usual for people to have bleeding from that . um , okay , well , hey , dragon , show me the anemia panel . okay . anyway , okay . well , vincent , i think , you know , in terms of , my impression of you is that you've had this newfound anemia and for that , i think that we should go ahead and put you on protonix , 40 milligrams , once a day to help with the gastritis . does that sound okay to you ? patient: it does . you're the doctor . i do n't know what it is .	D2N020	16	[ "Reassessment", "Radiology Examination", "Lab Examination", "Medication" ]	[ "Objective", "Assessment", "Plan" ]	hey , dragon , show me the hemoglobin . yeah , so your hemoglobin is 8.2 , which is quite low for somebody of your height and weight , so we'll have to look into that a , a little bit further . i know that they did the endoscopy in the emergency room . hey , dragon , show me the endoscope results . good . so it looks like you had some gastritis , which is just inflammation of your stomach and they also found a slight polyp , which i know that they biopsied and the results are pending at this time . um , so , you may have had some bleeding from the gastritis . it's not usual for people to have bleeding from that . um , okay , well , hey , dragon , show me the anemia panel . okay . anyway , okay . well , vincent , i think , you know , in terms of , my impression of you is that you've had this newfound anemia and for that , i think that we should go ahead and put you on protonix , 40 milligrams , once a day to help with the gastritis . does that sound okay to you ?	519
doctor: so that's just , uh , what we call a proton pump inhibitor which , uh , helps decrease the amount of acid secreted within your stomach . patient: got it . makes sense .	D2N020	17	[ "Discussion" ]	[ "Plan" ]	so that's just , uh , what we call a proton pump inhibitor which , uh , helps decrease the amount of acid secreted within your stomach .	520
doctor: hey , hey , dragon , order protonix , 40 milligrams , once a day . and i'd like you to try to cut down on your caffeine 'cause that can also irritate your stomach . try not to take any ibuprofen and try to cut down on any alcohol intake , okay ? patient: yup , yup . the coffee's the hard part .	D2N020	18	[ "Other Treatments", "Medication", "Drug History" ]	[ "Plan" ]	hey , hey , dragon , order protonix , 40 milligrams , once a day . and i'd like you to try to cut down on your caffeine 'cause that can also irritate your stomach . try not to take any ibuprofen and try to cut down on any alcohol intake , okay ?	521
doctor: yeah . it always is . how about one , one , one eight-ounce cup a day ? okay ? patient: sure .	D2N020	19	[ "Discussion", "Other Treatments" ]	[ "Plan" ]	yeah . it always is . how about one , one , one eight-ounce cup a day ? okay ?	522
doctor: um , and we'll go ahead and we'll see you in a couple weeks , okay ? patient: sure thing .	D2N020	20	[ "Follow-up" ]	[ "Plan" ]	um , and we'll go ahead and we'll see you in a couple weeks , okay ?	523
doctor: i'm going through , uh , i'll also order another , uh , cbc on you . hey , dragon , order a complete blood count . all right . the nurse will be in soon . it's , you know , settle all that . i'll see you soon . patient: see you .	D2N020	21	[ "Diagnostic Testing" ]	[ "Plan" ]	i'm going through , uh , i'll also order another , uh , cbc on you . hey , dragon , order a complete blood count . all right . the nurse will be in soon . it's , you know , settle all that . i'll see you soon .	524
doctor: hey , dragon , finalize the note .	D2N020	22	[ "Chitchat" ]	[ "Null" ]	doctor: hey , dragon , finalize the note .	525
doctor: next patient is christine hernandez , uh , date of birth is january 13th , 1982 . hey , miss christine , how are you doing today ? patient: i'm good , thanks . how are you ?	D2N021	0	[ "Greetings" ]	[ "Subjective" ]	next patient is christine hernandez , uh , date of birth is january 13th , 1982 . hey , miss christine , how are you doing today ?	526
doctor: i'm pretty good . so it looks like you've completed the covid vaccine , that's great . patient: yes , i did .	D2N021	1	[ "Therapeutic History" ]	[ "Subjective" ]	i'm pretty good . so it looks like you've completed the covid vaccine , that's great .	527
doctor: anything new since your last visit ? patient: no , i did all the tests that you had recommended me to take . i have n't been able to take the thyroid medicine , the one that you prescribed , as i'm still taking my old one . um , the price was a little high on the new one .	D2N021	2	[ "Personal History" ]	[ "Subjective" ]	anything new since your last visit ?	528
doctor: okay , so did ... did you try the coupon that i gave you ? patient: i did not try the coupon , uh , there was a charge of $ 75 .	D2N021	3	[ "Therapeutic History", "Other Socials" ]	[ "Subjective" ]	okay , so did ... did you try the coupon that i gave you ?	529
doctor: okay , well , next time that ... that coupon should help , and it should only be about $ 3 . patient: okay , um ... i do n't have it , do you happen to have another one you can give me ?	D2N021	4	[ "Discussion" ]	[ "Plan" ]	okay , well , next time that ... that coupon should help , and it should only be about $ 3 .	530
doctor: yep , right here . patient: wonderful , thank you so much , and ... and then the gel , they are charging me $ 100 for it . so , i do n't know if this is because it's a ... it's wal-mart , or if i should try somewhere else , or ... maybe you know how or where i can get it cheaper .	D2N021	5	[ "Other Socials" ]	[ "Subjective" ]	yep , right here .	531
doctor: yeah , let's try something else , um ... sometimes it can be cheaper if we just prescribe you the individual ingredients of a medication , rather than the , the combined medication itself . patient: that would be great .	D2N021	6	[ "Discussion", "Medication" ]	[ "Plan" ]	yeah , let's try something else , um ... sometimes it can be cheaper if we just prescribe you the individual ingredients of a medication , rather than the , the combined medication itself .	532
doctor: so , that's clindamycin gel and benzoyl peroxide , uh , maybe by doing them separately , they could be a lot cheaper . so , that we can do . the unithroid , with the discount code , should only be about $ 9 for 90 days . patient: okay , that would be great . yeah , they were charging me $ 75 , and i just could n't pay that .	D2N021	7	[ "Discussion", "Medication" ]	[ "Plan" ]	so , that's clindamycin gel and benzoyl peroxide , uh , maybe by doing them separately , they could be a lot cheaper . so , that we can do . the unithroid , with the discount code , should only be about $ 9 for 90 days .	533
doctor: maybe we'll try different pharmacy , as well . patient: okay . so , do you think that my weight gain could have been the birth control that i was taking before that caused it ?	D2N021	8	[ "Medication", "Discussion" ]	[ "Plan" ]	maybe we'll try different pharmacy , as well .	534
doctor: maybe . i do n't really see an endocrine cause for it , at least , so i would need to see the , the hyperandrogynism or high testosterone . or , a high dhea , to cause acne , or hair growth , or any of that stuff . but , the numbers are n't showing up out of range . patient: okay .	D2N021	9	[ "Discussion", "Medication" ]	[ "Plan" ]	maybe . i do n't really see an endocrine cause for it , at least , so i would need to see the , the hyperandrogynism or high testosterone . or , a high dhea , to cause acne , or hair growth , or any of that stuff . but , the numbers are n't showing up out of range .	535
doctor: i really do n't see any endocrine cause for it , like i said . your growth hormone was fine , but we definitely want to and need to treat it . um , i do n't know if we talked about maybe a little weight loss study . patient: you mentioned the weight loss study , and you mentioned that i have some meal plans , um , that you had given me . i still have those , too .	D2N021	10	[ "Discussion", "Medication" ]	[ "Plan" ]	i really do n't see any endocrine cause for it , like i said . your growth hormone was fine , but we definitely want to and need to treat it . um , i do n't know if we talked about maybe a little weight loss study .	536
doctor: have you tried to make any changes in the diet since the last time we spoke ? patient: i've been trying to get better . i will start back at the gym in july , because of my contract , i had to put a hold on it until then .	D2N021	11	[ "Personal History" ]	[ "Subjective" ]	have you tried to make any changes in the diet since the last time we spoke ?	537
doctor: okay , good . patient: and then my cousin was telling me to ask you about cla , because it's supposed to help your metabolism . is that okay to take ?	D2N021	13	[ "Discussion", "Medication" ]	[ "Plan" ]	okay , good .	538
doctor: um , i'm not sure . what is c , cla ? patient: i'm not sure what it is , either .	D2N021	14	[ "Discussion", "Medication" ]	[ "Plan" ]	um , i'm not sure . what is c , cla ?	539
doctor: okay , well , i'm unfamiliar with it , so ... patient: okay . i also have a coworker who has a thyroid issue too , and she suggested to try chromium for weight loss .	D2N021	15	[ "Discussion" ]	[ "Subjective", "Plan" ]	okay , well , i'm unfamiliar with it , so ...	540
doctor: so , that likely will not help too much . you can try either , if you really want to , but then ... it will not accept you into the weight loss study if you try those two . patient: okay .	D2N021	16	[ "Discussion", "Medication" ]	[ "Plan" ]	so , that likely will not help too much . you can try either , if you really want to , but then ... it will not accept you into the weight loss study if you try those two .	541
doctor: chromium is just a supplement and it wo n't help that much . patient: it wo n't , okay , thank you .	D2N021	17	[ "Discussion", "Medication" ]	[ "Plan" ]	chromium is just a supplement and it wo n't help that much .	542
doctor: it wo n't hurt ... okay , i should n't say that it wo n't hurt , but , it also wo n't help that much . so , it's up to you . patient: okay . and so , my cousin also suggested amino acids , and that i might find them in certain foods , i guess , for my workout .	D2N021	18	[ "Discussion", "Medication" ]	[ "Plan" ]	it wo n't hurt ... okay , i should n't say that it wo n't hurt , but , it also wo n't help that much . so , it's up to you .	543
doctor: yeah . amino acids are fine , they wo n't , wo n't really help with weight loss either , but it might help , uh , you replenish , and just kind of , feel hydrated . patient: okay . are they proteins ? um , my cousin said she had lost some weight , and has been working out every day , but she does n't work , so ... i do n't know .	D2N021	19	[ "Discussion" ]	[ "Plan" ]	yeah . amino acids are fine , they wo n't , wo n't really help with weight loss either , but it might help , uh , you replenish , and just kind of , feel hydrated .	544
doctor: yes , amino acids are what make up the protein , which is in any food you eat , with any protein . so , meats , dairy , nuts , any of that sort of thing . patient: okay , thank you . got it .	D2N021	20	[ "Discussion" ]	[ "Plan" ]	yes , amino acids are what make up the protein , which is in any food you eat , with any protein . so , meats , dairy , nuts , any of that sort of thing .	545
doctor: all right . um , are you allergic to any medications ? patient: no , not that i know of .	D2N021	21	[ "Personal History" ]	[ "Subjective" ]	all right . um , are you allergic to any medications ?	546
doctor: okay . is your s- skin pretty sensitive ? patient: yes .	D2N021	22	[ "Personal History" ]	[ "Subjective" ]	okay . is your s- skin pretty sensitive ?	547
doctor: all right . patient: um , yeah , my size , i will start getting rashes , with different products .	D2N021	23	[ "Personal History" ]	[ "Subjective" ]	all right .	548
doctor: and have you ever tried clindamycin topical , as an antibiotic for your acne ? patient: no , i've never tried anything for it .	D2N021	24	[ "Personal History", "Therapeutic History" ]	[ "Subjective" ]	and have you ever tried clindamycin topical , as an antibiotic for your acne ?	549
doctor: okay . we might give you some of that . patient: okay . and i also want to mention that my feet do swell up a lot .	D2N021	25	[ "Medication" ]	[ "Plan" ]	okay . we might give you some of that .	550
doctor: okay . i'm ... let me take a look at that for just a moment . um , any constipation ? patient: yes , i also do have that problem .	D2N021	26	[ "Vegetative History" ]	[ "Subjective" ]	okay . i'm ... let me take a look at that for just a moment . um , any constipation ?	551
doctor: all right . mira- miralax will definitely help with that . patient: okay , yes , my doctor did also recommend that .	D2N021	27	[ "Medication" ]	[ "Plan" ]	all right . mira- miralax will definitely help with that .	552
doctor: great . all right , let's do an exam real quick . please have a seat on this table and i'll listen to your lungs and heart . patient: okay .	D2N021	28	[ "Physical Examination" ]	[ "Objective" ]	great . all right , let's do an exam real quick . please have a seat on this table and i'll listen to your lungs and heart .	553
doctor: all right , deep breath . all right , again . patient: okay .	D2N021	29	[ "Physical Examination" ]	[ "Objective" ]	all right , deep breath . all right , again .	554
doctor: all right , sounds good . patient: great .	D2N021	30	[ "Physical Examination" ]	[ "Objective" ]	all right , sounds good .	555
doctor: let me take a look at your feet and ankles . patient: okay .	D2N021	31	[ "Physical Examination" ]	[ "Objective" ]	let me take a look at your feet and ankles .	556
doctor: all right , they look okay right now , certainly let your doctor know about this if it gets any worse or reoccurs . patient: okay , i will do that .	D2N021	32	[ "Physical Examination", "Follow-up" ]	[ "Objective", "Plan" ]	all right , they look okay right now , certainly let your doctor know about this if it gets any worse or reoccurs .	557
doctor: now , let's go over your lab work . so , when you took that pill , the dexamethasone test , you passed , which means you do n't have cushing's syndrome . on that test , at least . the salivary cortisol , though , unless you did one wrong ... two of them were completely normal and one was abnormal , so , we might need to repeat that in the future . patient: okay , that's okay .	D2N021	33	[ "Lab Examination" ]	[ "Objective" ]	now , let's go over your lab work . so , when you took that pill , the dexamethasone test , you passed , which means you do n't have cushing's syndrome . on that test , at least . the salivary cortisol , though , unless you did one wrong ... two of them were completely normal and one was abnormal , so , we might need to repeat that in the future .	558
doctor: all right , so , your cholesterol was quite high . the total cholesterol was 222 . the good cholesterol was about 44 . the bad was 153 , and it should be less than 100 . the non-hdl was about 178 , and it should be less than 130 . the good cholesterol should be over 50 , and it was 44 . so , your screen for diabetes is ... was fine . you do have a vitamin d deficiency , and , i do n't know if we started the vitamin d yet , or not . patient: yes , we did . i- i do need to take one today , though .	D2N021	34	[ "Lab Examination" ]	[ "Objective" ]	all right , so , your cholesterol was quite high . the total cholesterol was 222 . the good cholesterol was about 44 . the bad was 153 , and it should be less than 100 . the non-hdl was about 178 , and it should be less than 130 . the good cholesterol should be over 50 , and it was 44 . so , your screen for diabetes is ... was fine . you do have a vitamin d deficiency , and , i do n't know if we started the vitamin d yet , or not .	559
doctor: okay . so , i also checked a lot of other pituitary hormones , iron levels ... everything else seemed to be pretty good , and in decent range . patient: okay , that sounds great . so , i wanted to also show you my liver enzymes , um , because i have n't come back since then ... but i was also happy , because one of them was back to normal .	D2N021	35	[ "Lab Examination" ]	[ "Objective" ]	okay . so , i also checked a lot of other pituitary hormones , iron levels ... everything else seemed to be pretty good , and in decent range .	560
doctor: okay , great . let's see them . patient: okay . so , the one that's 30 , that was almost 200 not so long ago .	D2N021	36	[ "Lab Examination" ]	[ "Objective" ]	okay , great . let's see them .	561
doctor: yeah , your alt was about 128 . patient: okay , and , and back in october was 254 .	D2N021	37	[ "Personal History", "Lab Examination" ]	[ "Subjective", "Objective" ]	yeah , your alt was about 128 .	562
doctor: yeah , this is much better . patient: okay , great . and then it dropped in january , and then it dropped a little more in march , since i stopped taking the medicine in december .	D2N021	38	[ "Personal History" ]	[ "Subjective", "Objective" ]	yeah , this is much better .	563
doctor: okay , that's good . so ... i'm proud of you with the course of your labs , so before i forget , i'm going to , uh , just put your labs into the computer today , and i wo n't be checking your vitamin d level for some time . patient: okay . so , with the thyroid , and the low vitamin d , does that always happen together ?	D2N021	39	[ "Discussion" ]	[ "Plan" ]	okay , that's good . so ... i'm proud of you with the course of your labs , so before i forget , i'm going to , uh , just put your labs into the computer today , and i wo n't be checking your vitamin d level for some time .	564
doctor: um , i do have a lot of people that have thyroid , thyroid issues and they have vitamin d deficiency . patient: okay .	D2N021	40	[ "Discussion" ]	[ "Plan" ]	um , i do have a lot of people that have thyroid , thyroid issues and they have vitamin d deficiency .	565
doctor: this is what i'm , um , i'm going to do . i'm going to put , print out your prescriptions , so you can shop around at the pharmacies and see if you can find better prices . patient: okay , that way i can go ask them and try cvs .	D2N021	41	[ "Discussion", "Medication" ]	[ "Plan" ]	this is what i'm , um , i'm going to do . i'm going to put , print out your prescriptions , so you can shop around at the pharmacies and see if you can find better prices .	566
doctor: yeah , that sounds like a plan . patient: okay , good . so , the weight loss study that you mentioned , when does that start ? or , how does that work ?	D2N021	42	[ "Discussion" ]	[ "Plan" ]	yeah , that sounds like a plan .	567
doctor: so , we are about to start , as we just got approval last week , and we are just waiting on our paperwork so we can get started . patient: okay , and what's involved with that ?	D2N021	43	[ "Discussion" ]	[ "Plan" ]	so , we are about to start , as we just got approval last week , and we are just waiting on our paperwork so we can get started .	568
doctor: so , it'll involve you receiving a medication which has been used for diabetes treatment , and it works mostly in the gut on satiety , or satiety hormones . um , the most common side effects are going to be nausea , vomiting , diarrhea and constipation . they are s- uh , six arms , to the study . one is a placebo , the other ones are a , various as ... various dosages of the medication , excuse me . um , you would receive an injection once a week . also , keep in mind that most of the weight loss medications are not covered by insurance . patient: okay .	D2N021	44	[ "Discussion", "Medication" ]	[ "Plan" ]	so , it'll involve you receiving a medication which has been used for diabetes treatment , and it works mostly in the gut on satiety , or satiety hormones . um , the most common side effects are going to be nausea , vomiting , diarrhea and constipation . they are s- uh , six arms , to the study . one is a placebo , the other ones are a , various as ... various dosages of the medication , excuse me . um , you would receive an injection once a week . also , keep in mind that most of the weight loss medications are not covered by insurance .	569
doctor: so , it's a way of getting them , but , the odds of getting one of the arms with the medication that are in your favor , right , might be only one out of five of our hundred patients that we have on the list for the study that will receive the placebo . patient: okay .	D2N021	45	[ "Discussion", "Medication" ]	[ "Plan" ]	so , it's a way of getting them , but , the odds of getting one of the arms with the medication that are in your favor , right , might be only one out of five of our hundred patients that we have on the list for the study that will receive the placebo .	570
doctor: does that make sense ? patient: yes , it does .	D2N021	46	[ "Chitchat" ]	[ "Null" ]	does that make sense ?	571
doctor: so , we do expect pretty big weight loss , because of what we learn in diabetes study . so , it's a year long , uh , process , and it's an injection once a week . you come in weekly for the first four , five weeks , i believe . and then , after that , it's once a month . you do get a stipend for partici- for participating in the study , and parking is validated , and whatever else that you need for the study . patient: okay , do you know how much the stipend is ?	D2N021	47	[ "Discussion" ]	[ "Plan" ]	so , we do expect pretty big weight loss , because of what we learn in diabetes study . so , it's a year long , uh , process , and it's an injection once a week . you come in weekly for the first four , five weeks , i believe . and then , after that , it's once a month . you do get a stipend for partici- for participating in the study , and parking is validated , and whatever else that you need for the study .	572
doctor: um , i will have to double check for you , and , you do n't have to be my patient , you just have to meet the criteria . so the criteria is a bmi greater than 30 , if you do n't have any other medical condition . or , a bmi greater than 27 , if you do have another medical condition , like your cholesterol . um , a bmi greater than 27 would quali- uh , qualify you . patient: i have a friend who might be interested , and she does have diabetes .	D2N021	48	[ "Discussion" ]	[ "Plan" ]	um , i will have to double check for you , and , you do n't have to be my patient , you just have to meet the criteria . so the criteria is a bmi greater than 30 , if you do n't have any other medical condition . or , a bmi greater than 27 , if you do have another medical condition , like your cholesterol . um , a bmi greater than 27 would quali- uh , qualify you .	573
doctor: if she has d- diabetes , then she wo n't qualify . patient: okay , you ca n't if you ... if you have diabetes , got it .	D2N021	49	[ "Discussion" ]	[ "Plan" ]	if she has d- diabetes , then she wo n't qualify .	574
doctor: correct . yeah , the only thing that , um , they can not have , really , is diabetes . so , either a psychiatric disease , or schizophrenia , bipolar , things like that . patient: okay .	D2N021	50	[ "Discussion" ]	[ "Plan" ]	correct . yeah , the only thing that , um , they can not have , really , is diabetes . so , either a psychiatric disease , or schizophrenia , bipolar , things like that .	575
doctor: but , if they have hypertension , high cholesterol , things like that ... they can definitely sign up . patient: and they can , okay . thank you for explaining that .	D2N021	51	[ "Discussion" ]	[ "Plan" ]	but , if they have hypertension , high cholesterol , things like that ... they can definitely sign up .	576
doctor: of course . so , do you want me to try to get you into that study ? or , would you just like to try , me to prescribe something ? it's kind of up to you . patient: i think i'll just wait for a little bit now .	D2N021	52	[ "Discussion" ]	[ "Plan" ]	of course . so , do you want me to try to get you into that study ? or , would you just like to try , me to prescribe something ? it's kind of up to you .	577
doctor: all right , sounds good . i'll give you the information for the research , it's just in my office . um , it is a different phone number , though . so then , if you're interested , just call us within a month , because i do n't know how long , uh , the , the wait will be . patient: okay , will do .	D2N021	53	[ "Discussion", "Follow-up" ]	[ "Plan" ]	all right , sounds good . i'll give you the information for the research , it's just in my office . um , it is a different phone number , though . so then , if you're interested , just call us within a month , because i do n't know how long , uh , the , the wait will be .	578
doctor: perfect . so , let me go grab your discount card for the unithroid . um , when you go in to activate it , the instructions are on this card , and then you use your insurance ... then , show them this , and ask how much it'll cost . if it's too expensive , just let me know . patient: i will . thank you so much for your help on that .	D2N021	54	[ "Discussion", "Medication" ]	[ "Plan" ]	perfect . so , let me go grab your discount card for the unithroid . um , when you go in to activate it , the instructions are on this card , and then you use your insurance ... then , show them this , and ask how much it'll cost . if it's too expensive , just let me know .	579
doctor: you're welcome . then , what i did is , i gave you a topical antibiotic , plus i gave you the benzoyl peroxide . so , the peroxide may bleach your sheets , but , you want to make sure to take it and apply it at night , so you do n't have a reaction from the sun during the day . patient: okay , i can do that .	D2N021	55	[ "Discussion", "Medication" ]	[ "Plan" ]	you're welcome . then , what i did is , i gave you a topical antibiotic , plus i gave you the benzoyl peroxide . so , the peroxide may bleach your sheets , but , you want to make sure to take it and apply it at night , so you do n't have a reaction from the sun during the day .	580
doctor: but , you do also want to make sure that you do n't mess up your sheets . patient: okay , sounds good .	D2N021	56	[ "Chitchat" ]	[ "Null" ]	but , you do also want to make sure that you do n't mess up your sheets .	581
doctor: um , so , that's that . and then , let's see how you do on the other medications . i think this will , this will get better . in the meantime , a low-carb diet , avoid alcohol and fatty foods , and low chole- cholesterol foods . patient: okay .	D2N021	57	[ "Medication", "Other Treatments", "Drug History" ]	[ "Plan" ]	um , so , that's that . and then , let's see how you do on the other medications . i think this will , this will get better . in the meantime , a low-carb diet , avoid alcohol and fatty foods , and low chole- cholesterol foods .	582
doctor: and again , once you finish your dose of vitamin d , for the vitamin d deficiency , you're gon na start with the 2000iu daily , so that you're able to maintain those levels . sound good ? patient: yes , that sounds great .	D2N021	58	[ "Medication" ]	[ "Plan" ]	and again , once you finish your dose of vitamin d , for the vitamin d deficiency , you're gon na start with the 2000iu daily , so that you're able to maintain those levels . sound good ?	583
doctor: i really think your liver enzymes are going to get better once you lose the weight , though . patient: okay , that would be great .	D2N021	59	[ "Discussion", "Other Treatments" ]	[ "Plan" ]	i really think your liver enzymes are going to get better once you lose the weight , though .	584
doctor: since we stopped your birth control , we can try once called phexxi , which is kind of like a spermicide , basically . patient: okay .	D2N021	60	[ "Discussion", "Medication" ]	[ "Plan" ]	since we stopped your birth control , we can try once called phexxi , which is kind of like a spermicide , basically .	585
doctor: and you just apply it before intercourse . patient: okay .	D2N021	61	[ "Discussion", "Medication" ]	[ "Plan" ]	and you just apply it before intercourse .	586
doctor: if you need some , uh , just let me know . patient: okay , i will . i'll let you know .	D2N021	62	[ "Chitchat" ]	[ "Null" ]	if you need some , uh , just let me know .	587
doctor: okay , perfect . so , stay put for me now . i'm going to go see if they have discount samples , and bring you that prescription . and then , i'm going to order the labs for next time . patient: okay , great , thank you so much .	D2N021	63	[ "Discussion", "Diagnostic Testing" ]	[ "Plan" ]	okay , perfect . so , stay put for me now . i'm going to go see if they have discount samples , and bring you that prescription . and then , i'm going to order the labs for next time .	588
doctor: you're welcome . so , under the plan , under abnormal liver enzymes , they have improved since discontinuation of her birth control . under abnormal weight gain , her dexamethasone suppression test was normal . two out of three salivary cortisol tests were normal , not consistent with cushing's , and therefore we're ruling out cushing's . under her hirsutism , her androgen levels were normal . for the acne vulgaris , the epiduo was not covered , so we'll try benzoyl peroxide with clindamycin , and remove the previous information . on the hyperthyroidism , we'll print out her prescriptions . unithroid should be better priced with the discount card , and we'll repeat levels of everything before next visit . thanks .	D2N021	64	[ "Follow-up", "Medication", "Reassessment" ]	[ "Assessment", "Plan" ]	doctor: you're welcome . so , under the plan , under abnormal liver enzymes , they have improved since discontinuation of her birth control . under abnormal weight gain , her dexamethasone suppression test was normal . two out of three salivary cortisol tests were normal , not consistent with cushing's , and therefore we're ruling out cushing's . under her hirsutism , her androgen levels were normal . for the acne vulgaris , the epiduo was not covered , so we'll try benzoyl peroxide with clindamycin , and remove the previous information . on the hyperthyroidism , we'll print out her prescriptions . unithroid should be better priced with the discount card , and we'll repeat levels of everything before next visit . thanks .	589
doctor: this is philip gutierrez , date of birth 1/12/71 . he is a 50-year-old male here for a second opinion regarding the index finger on the right hand . he had a hyperextension injury of that index finger during a motor vehicle accident in march of this year . he was offered an injection of the a1 polyregion , but did not want any steroid because of the reaction to dexamethasone , which causes his heart to race . he was scheduled to see dr. alice davis , which it does n't appear he did . he had an mri of that finger , because there was concern about a capsular strain plus or minus rupture of , quote , " fds tendon , " end quote . he has been seen at point may orthopedics largely by the physical therapy staff and a pr , pa at that institution . at that practice , an mri was obtained on 4/24/2021 , which showed just focal soft tissue swelling over the right index mcp joint , partial-thickness tear of the right fds , and fluid consistent with tenosynovitis around the fdp and fds tendons . radial and ulnar collateral ligaments of the index mcp joint were intact , as the mcp joint capsule . extensor tendons also deemed intact . his x-rays , four views of the right hand today , show no bony abnormalities , joint congruency throughout all lesser digits on the right hand , no soft tissue shadows of concern , no arthritis . hi , how are you , mr . gutierrez ? patient: i'm good , how about you ?	D2N022	0	[ "Personal History", "Greetings", "Radiology Examination" ]	[ "Subjective", "Objective" ]	this is philip gutierrez , date of birth 1/12/71 . he is a 50-year-old male here for a second opinion regarding the index finger on the right hand . he had a hyperextension injury of that index finger during a motor vehicle accident in march of this year . he was offered an injection of the a1 polyregion , but did not want any steroid because of the reaction to dexamethasone , which causes his heart to race . he was scheduled to see dr. alice davis , which it does n't appear he did . he had an mri of that finger , because there was concern about a capsular strain plus or minus rupture of , quote , " fds tendon , " end quote . he has been seen at point may orthopedics largely by the physical therapy staff and a pr , pa at that institution . at that practice , an mri was obtained on 4/24/2021 , which showed just focal soft tissue swelling over the right index mcp joint , partial-thickness tear of the right fds , and fluid consistent with tenosynovitis around the fdp and fds tendons . radial and ulnar collateral ligaments of the index mcp joint were intact , as the mcp joint capsule . extensor tendons also deemed intact . his x-rays , four views of the right hand today , show no bony abnormalities , joint congruency throughout all lesser digits on the right hand , no soft tissue shadows of concern , no arthritis . hi , how are you , mr . gutierrez ?	590
doctor: well , how can i help you today ? patient: so i was a passenger in , uh , a car that was rear-ended , and we were hit multiple times . i felt two bumps , which slung me forward and caused me to stretch out my right index finger .	D2N022	1	[ "Acute Symptoms" ]	[ "Subjective" ]	well , how can i help you today ?	591
doctor: so hitting the car in front of you all made that finger go backwards ? patient: um , i do n't really know . i just felt , like , it felt like i laid on my finger , and so , i felt like it went back , and it's been hurting since about march . and it's been like that ever , ever since the wreck happened . so i , and i ca n't make a fist , but sometimes the pain's unbearable . and , like , even driving hurts .	D2N022	2	[ "Acute Symptoms" ]	[ "Subjective" ]	so hitting the car in front of you all made that finger go backwards ?	592
doctor: okay , so this was march of this year , so maybe about three months ago ? patient: yeah , and it's still swollen . so i was seeing , uh , an orthopedist , and they sent me to an occupational therapist . and i've been doing therapy with them , and then they sent me to go back and get an mri . so i went and got the mri . uh , then they told me that the mri came back , and it said i had a tear in my finger , but he was n't gon na give me an injection , because the injection was going to make the tear worse .	D2N022	3	[ "Personal History" ]	[ "Subjective" ]	okay , so this was march of this year , so maybe about three months ago ?	593
doctor: mm-hmm . patient: and then , after he got the mri , he said that i have , uh , a tear in my finger , and that he did n't wan na do surgery , but he would do an injection . then i'm thinking that you told me you would n't do an injection in there , and then the oper- , occupational therapy says it's because of the tear . and then , they do n't want me to keep rubbing the thing , and doing things with my hand . so i feel like i'm not getting medical care , really .	D2N022	4	[ "Personal History" ]	[ "Subjective" ]	mm-hmm .	594
doctor: yeah , i see that . patient: so i came to see if you could do anything for this hand , because i am right-handed , and i kinda need that hand .	D2N022	5	[ "Personal History" ]	[ "Subjective" ]	yeah , i see that .	595
doctor: what do you do for a living ? patient: uh , i'm an x-ray tech .	D2N022	6	[ "Other Socials" ]	[ "Subjective" ]	what do you do for a living ?	596
doctor: well , um , so do you have any diabetes or rheumatoid arthritis ? patient: nope .	D2N022	7	[ "Personal History" ]	[ "Subjective" ]	well , um , so do you have any diabetes or rheumatoid arthritis ?	597
doctor: uh , do you take any chronic medications of su- , significance ? patient: uh , i do take a blood pressure pill , and that's it .	D2N022	8	[ "Therapeutic History" ]	[ "Subjective" ]	uh , do you take any chronic medications of su- , significance ?	598
doctor: okay , and it looks like you suffer from itching with the methylprednisolone ? patient: uh , that's correct .	D2N022	9	[ "Therapeutic History", "Personal History" ]	[ "Subjective" ]	okay , and it looks like you suffer from itching with the methylprednisolone ?	599

doctor: okay . so on exam you've got some tenderness over your lateral epicondyle . uh , you have some swelling there and some redness . uh , you have some pain with flexion , extension of your elbow as well . uh , and you have some pain on the dorsal aspect of your- of your forearm as well . okay ? so let's look at your x-rays . hey dragon , show me the x-rays . all right . your x-ray of your elbow-it looks like , i mean , the bones are lined up properly . there's no fracture- . it , uh , there's a little bit of swelling there on the lateral elbow but i do n't see any fracture , so that's good . so , looking at the x-ray and looking at your exam , uh , my diagnosis here would be lateral epicondylitis , and this is basically inflammation of this area where this tendon in- inserts . and probably that happened when you were moving those boxes . so we'll try some motrin , uh , about 800 milligrams every six hours . uh , i'll give you a sling for comfort , just so you can use it if- if it's causing a lot of pain . patient: hmm .

D2N019

19

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

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

okay . so on exam you've got some tenderness over your lateral epicondyle . uh , you have some swelling there and some redness . uh , you have some pain with flexion , extension of your elbow as well . uh , and you have some pain on the dorsal aspect of your- of your forearm as well . okay ? so let's look at your x-rays . hey dragon , show me the x-rays . all right . your x-ray of your elbow-it looks like , i mean , the bones are lined up properly . there's no fracture- . it , uh , there's a little bit of swelling there on the lateral elbow but i do n't see any fracture , so that's good . so , looking at the x-ray and looking at your exam , uh , my diagnosis here would be lateral epicondylitis , and this is basically inflammation of this area where this tendon in- inserts . and probably that happened when you were moving those boxes . so we'll try some motrin , uh , about 800 milligrams every six hours . uh , i'll give you a sling for comfort , just so you can use it if- if it's causing a lot of pain .

500

doctor: and it should get better , uh , in about , you know , in a couple of days it should be improved . and if it does n't get better , give us a call and we'll see you some time next week . okay ? so we'll give you a sling , we'll give you the motrin , i'll give you about , uh , 30 , uh , uh , 30 , uh , uh , medications for that . uh , do you have any questions ? patient: no , no . thank you .

D2N019

20

[ "Discussion", "Follow-up" ]

[ "Plan" ]

and it should get better , uh , in about , you know , in a couple of days it should be improved . and if it does n't get better , give us a call and we'll see you some time next week . okay ? so we'll give you a sling , we'll give you the motrin , i'll give you about , uh , 30 , uh , uh , 30 , uh , uh , medications for that . uh , do you have any questions ?

501

doctor: hey dragon , order the medications and the procedures . all right , why do n't you come with me and we'll get you signed out ? patient: okay , sounds good .

D2N019

21

[ "Chitchat" ]

[ "Null" ]

hey dragon , order the medications and the procedures . all right , why do n't you come with me and we'll get you signed out ?

502

doctor: hey dragon , finalize the report .

D2N019

22

[ "Chitchat" ]

[ "Null" ]

doctor: hey dragon , finalize the report .

503

doctor: hi , vincent . how are you ? patient: i'm good . how about you ?

D2N020

0

[ "Greetings" ]

[ "Subjective" ]

hi , vincent . how are you ?

504

doctor: i'm good . so le- are you ready to get started ? patient: i am .

D2N020

1

[ "Chitchat" ]

[ "Null" ]

i'm good . so le- are you ready to get started ?

505

doctor: okay . vincent is a 56-year-old male here with abnormal lab findings . so , i've heard you were in the er , vincent , and they found that you had a low hemoglobin . patient: yup .

D2N020

2

[ "Personal History" ]

[ "Subjective" ]

okay . vincent is a 56-year-old male here with abnormal lab findings . so , i've heard you were in the er , vincent , and they found that you had a low hemoglobin .

506

doctor: were you having some dizziness and some lightheadedness ? patient: i was very lightheaded . i- i do n't know . very lightheaded .

D2N020

3

[ "Personal History", "Vegetative History" ]

[ "Subjective" ]

were you having some dizziness and some lightheadedness ?

507

doctor: okay . and have you noticed bleeding from anywhere ? patient: i have not . i have n't hurt myself in quite a while . maybe a slight nick from a knife while chopping some onions , but nothing more than that .

D2N020

4

[ "Personal History" ]

[ "Subjective" ]

okay . and have you noticed bleeding from anywhere ?

508

doctor: but no blood in your stools or- patient: no .

D2N020

5

[ "Vegetative History" ]

[ "Subjective" ]

but no blood in your stools or-

509

doctor: . anything like that ? patient: no .

D2N020

6

[ "Vegetative History" ]

[ "Subjective" ]

. anything like that ?

510

doctor: okay . and any type of weight loss or decreased appetite or night sweats ? coughs ? patient: uh , s- slightly decreased appetite , but i wish i had some weight loss .

D2N020

7

[ "Vegetative History" ]

[ "Subjective" ]

okay . and any type of weight loss or decreased appetite or night sweats ? coughs ?

511

doctor: um , okay . and how about any abdominal pain ? fever , chills ? patient: uh , none of that .

D2N020

8

[ "Vegetative History" ]

[ "Subjective" ]

um , okay . and how about any abdominal pain ? fever , chills ?

512

doctor: okay . all right . um , any nausea or vomiting ? patient: not really . yeah . maybe a bit of nausea .

D2N020

9

[ "Vegetative History" ]

[ "Subjective" ]

okay . all right . um , any nausea or vomiting ?

513

doctor: okay . all right . um , well , how are you doing in terms of your knee replacement . i know you had that done last year . that's going okay ? patient: mm , it seems okay . yeah .

D2N020

11

[ "Personal History" ]

[ "Subjective" ]

okay . all right . um , well , how are you doing in terms of your knee replacement . i know you had that done last year . that's going okay ?

514

doctor: okay . you're walking around without a problem ? patient: yup , yup . just not good enough to run yet , but everything else works just fine .

D2N020

12

[ "Personal History" ]

[ "Subjective" ]

okay . you're walking around without a problem ?

515

doctor: all right .um , and i know a few years ago , you had , had that scare with the possible lung cancer , but then they did the biopsy and , and you've been fine . patient: yup , yup . all good .

D2N020

13

[ "Personal History" ]

[ "Subjective" ]

all right .um , and i know a few years ago , you had , had that scare with the possible lung cancer , but then they did the biopsy and , and you've been fine .

516

doctor: turned out to be benign . patient: yup .

D2N020

14

[ "Personal History" ]

[ "Subjective" ]

turned out to be benign .

517

doctor: okay . great . all right . well , let's go ahead and do a quick physical exam . so looking at you , you do n't appear in any distress . your heart is regular . your lungs sound nice and clear . you have some tenderness to the right lower quadrant to palpation of your abdomen . your lower extremities have no edema . um , all right . well , let's go ahead and look at your labs , okay ? patient: yup .

D2N020

15

[ "Physical Examination" ]

[ "Objective" ]

okay . great . all right . well , let's go ahead and do a quick physical exam . so looking at you , you do n't appear in any distress . your heart is regular . your lungs sound nice and clear . you have some tenderness to the right lower quadrant to palpation of your abdomen . your lower extremities have no edema . um , all right . well , let's go ahead and look at your labs , okay ?

518

doctor: hey , dragon , show me the hemoglobin . yeah , so your hemoglobin is 8.2 , which is quite low for somebody of your height and weight , so we'll have to look into that a , a little bit further . i know that they did the endoscopy in the emergency room . hey , dragon , show me the endoscope results . good . so it looks like you had some gastritis , which is just inflammation of your stomach and they also found a slight polyp , which i know that they biopsied and the results are pending at this time . um , so , you may have had some bleeding from the gastritis . it's not usual for people to have bleeding from that . um , okay , well , hey , dragon , show me the anemia panel . okay . anyway , okay . well , vincent , i think , you know , in terms of , my impression of you is that you've had this newfound anemia and for that , i think that we should go ahead and put you on protonix , 40 milligrams , once a day to help with the gastritis . does that sound okay to you ? patient: it does . you're the doctor . i do n't know what it is .

D2N020

16

[ "Reassessment", "Radiology Examination", "Lab Examination", "Medication" ]

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

hey , dragon , show me the hemoglobin . yeah , so your hemoglobin is 8.2 , which is quite low for somebody of your height and weight , so we'll have to look into that a , a little bit further . i know that they did the endoscopy in the emergency room . hey , dragon , show me the endoscope results . good . so it looks like you had some gastritis , which is just inflammation of your stomach and they also found a slight polyp , which i know that they biopsied and the results are pending at this time . um , so , you may have had some bleeding from the gastritis . it's not usual for people to have bleeding from that . um , okay , well , hey , dragon , show me the anemia panel . okay . anyway , okay . well , vincent , i think , you know , in terms of , my impression of you is that you've had this newfound anemia and for that , i think that we should go ahead and put you on protonix , 40 milligrams , once a day to help with the gastritis . does that sound okay to you ?

519

doctor: so that's just , uh , what we call a proton pump inhibitor which , uh , helps decrease the amount of acid secreted within your stomach . patient: got it . makes sense .

D2N020

17

[ "Discussion" ]

[ "Plan" ]

so that's just , uh , what we call a proton pump inhibitor which , uh , helps decrease the amount of acid secreted within your stomach .

520

doctor: hey , hey , dragon , order protonix , 40 milligrams , once a day . and i'd like you to try to cut down on your caffeine 'cause that can also irritate your stomach . try not to take any ibuprofen and try to cut down on any alcohol intake , okay ? patient: yup , yup . the coffee's the hard part .

D2N020

18

[ "Other Treatments", "Medication", "Drug History" ]

[ "Plan" ]

hey , hey , dragon , order protonix , 40 milligrams , once a day . and i'd like you to try to cut down on your caffeine 'cause that can also irritate your stomach . try not to take any ibuprofen and try to cut down on any alcohol intake , okay ?

521

doctor: yeah . it always is . how about one , one , one eight-ounce cup a day ? okay ? patient: sure .

D2N020

19

[ "Discussion", "Other Treatments" ]

[ "Plan" ]

yeah . it always is . how about one , one , one eight-ounce cup a day ? okay ?

522

doctor: um , and we'll go ahead and we'll see you in a couple weeks , okay ? patient: sure thing .

D2N020

20

[ "Follow-up" ]

[ "Plan" ]

um , and we'll go ahead and we'll see you in a couple weeks , okay ?

523

doctor: i'm going through , uh , i'll also order another , uh , cbc on you . hey , dragon , order a complete blood count . all right . the nurse will be in soon . it's , you know , settle all that . i'll see you soon . patient: see you .

D2N020

21

[ "Diagnostic Testing" ]

[ "Plan" ]

i'm going through , uh , i'll also order another , uh , cbc on you . hey , dragon , order a complete blood count . all right . the nurse will be in soon . it's , you know , settle all that . i'll see you soon .

524

doctor: hey , dragon , finalize the note .

D2N020

22

[ "Chitchat" ]

[ "Null" ]

doctor: hey , dragon , finalize the note .

525

doctor: next patient is christine hernandez , uh , date of birth is january 13th , 1982 . hey , miss christine , how are you doing today ? patient: i'm good , thanks . how are you ?

D2N021

0

[ "Greetings" ]

[ "Subjective" ]

next patient is christine hernandez , uh , date of birth is january 13th , 1982 . hey , miss christine , how are you doing today ?

526

doctor: i'm pretty good . so it looks like you've completed the covid vaccine , that's great . patient: yes , i did .

D2N021

1

[ "Therapeutic History" ]

[ "Subjective" ]

i'm pretty good . so it looks like you've completed the covid vaccine , that's great .

527

doctor: anything new since your last visit ? patient: no , i did all the tests that you had recommended me to take . i have n't been able to take the thyroid medicine , the one that you prescribed , as i'm still taking my old one . um , the price was a little high on the new one .

D2N021

2

[ "Personal History" ]

[ "Subjective" ]

anything new since your last visit ?

528

doctor: okay , so did ... did you try the coupon that i gave you ? patient: i did not try the coupon , uh , there was a charge of $ 75 .

D2N021

3

[ "Therapeutic History", "Other Socials" ]

[ "Subjective" ]

okay , so did ... did you try the coupon that i gave you ?

529

doctor: okay , well , next time that ... that coupon should help , and it should only be about $ 3 . patient: okay , um ... i do n't have it , do you happen to have another one you can give me ?

D2N021

4

[ "Discussion" ]

[ "Plan" ]

okay , well , next time that ... that coupon should help , and it should only be about $ 3 .

530

doctor: yep , right here . patient: wonderful , thank you so much , and ... and then the gel , they are charging me $ 100 for it . so , i do n't know if this is because it's a ... it's wal-mart , or if i should try somewhere else , or ... maybe you know how or where i can get it cheaper .

D2N021

5

[ "Other Socials" ]

[ "Subjective" ]

yep , right here .

531

doctor: yeah , let's try something else , um ... sometimes it can be cheaper if we just prescribe you the individual ingredients of a medication , rather than the , the combined medication itself . patient: that would be great .

D2N021

6

[ "Discussion", "Medication" ]

[ "Plan" ]

yeah , let's try something else , um ... sometimes it can be cheaper if we just prescribe you the individual ingredients of a medication , rather than the , the combined medication itself .

532

doctor: so , that's clindamycin gel and benzoyl peroxide , uh , maybe by doing them separately , they could be a lot cheaper . so , that we can do . the unithroid , with the discount code , should only be about $ 9 for 90 days . patient: okay , that would be great . yeah , they were charging me $ 75 , and i just could n't pay that .

D2N021

7

[ "Discussion", "Medication" ]

[ "Plan" ]

so , that's clindamycin gel and benzoyl peroxide , uh , maybe by doing them separately , they could be a lot cheaper . so , that we can do . the unithroid , with the discount code , should only be about $ 9 for 90 days .

533

doctor: maybe we'll try different pharmacy , as well . patient: okay . so , do you think that my weight gain could have been the birth control that i was taking before that caused it ?

D2N021

8

[ "Medication", "Discussion" ]

[ "Plan" ]

maybe we'll try different pharmacy , as well .

534

doctor: maybe . i do n't really see an endocrine cause for it , at least , so i would need to see the , the hyperandrogynism or high testosterone . or , a high dhea , to cause acne , or hair growth , or any of that stuff . but , the numbers are n't showing up out of range . patient: okay .

D2N021

9

[ "Discussion", "Medication" ]

[ "Plan" ]

maybe . i do n't really see an endocrine cause for it , at least , so i would need to see the , the hyperandrogynism or high testosterone . or , a high dhea , to cause acne , or hair growth , or any of that stuff . but , the numbers are n't showing up out of range .

535

doctor: i really do n't see any endocrine cause for it , like i said . your growth hormone was fine , but we definitely want to and need to treat it . um , i do n't know if we talked about maybe a little weight loss study . patient: you mentioned the weight loss study , and you mentioned that i have some meal plans , um , that you had given me . i still have those , too .

D2N021

10

[ "Discussion", "Medication" ]

[ "Plan" ]

i really do n't see any endocrine cause for it , like i said . your growth hormone was fine , but we definitely want to and need to treat it . um , i do n't know if we talked about maybe a little weight loss study .

536

doctor: have you tried to make any changes in the diet since the last time we spoke ? patient: i've been trying to get better . i will start back at the gym in july , because of my contract , i had to put a hold on it until then .

D2N021

11

[ "Personal History" ]

[ "Subjective" ]

have you tried to make any changes in the diet since the last time we spoke ?

537

doctor: okay , good . patient: and then my cousin was telling me to ask you about cla , because it's supposed to help your metabolism . is that okay to take ?

D2N021

13

[ "Discussion", "Medication" ]

[ "Plan" ]

okay , good .

538

doctor: um , i'm not sure . what is c , cla ? patient: i'm not sure what it is , either .

D2N021

14

[ "Discussion", "Medication" ]

[ "Plan" ]

um , i'm not sure . what is c , cla ?

539

doctor: okay , well , i'm unfamiliar with it , so ... patient: okay . i also have a coworker who has a thyroid issue too , and she suggested to try chromium for weight loss .

D2N021

15

[ "Discussion" ]

[ "Subjective", "Plan" ]

okay , well , i'm unfamiliar with it , so ...

540

doctor: so , that likely will not help too much . you can try either , if you really want to , but then ... it will not accept you into the weight loss study if you try those two . patient: okay .

D2N021

16

[ "Discussion", "Medication" ]

[ "Plan" ]

so , that likely will not help too much . you can try either , if you really want to , but then ... it will not accept you into the weight loss study if you try those two .

541

doctor: chromium is just a supplement and it wo n't help that much . patient: it wo n't , okay , thank you .

D2N021

17

[ "Discussion", "Medication" ]

[ "Plan" ]

chromium is just a supplement and it wo n't help that much .

542

doctor: it wo n't hurt ... okay , i should n't say that it wo n't hurt , but , it also wo n't help that much . so , it's up to you . patient: okay . and so , my cousin also suggested amino acids , and that i might find them in certain foods , i guess , for my workout .

D2N021

18

[ "Discussion", "Medication" ]

[ "Plan" ]

it wo n't hurt ... okay , i should n't say that it wo n't hurt , but , it also wo n't help that much . so , it's up to you .

543

doctor: yeah . amino acids are fine , they wo n't , wo n't really help with weight loss either , but it might help , uh , you replenish , and just kind of , feel hydrated . patient: okay . are they proteins ? um , my cousin said she had lost some weight , and has been working out every day , but she does n't work , so ... i do n't know .

D2N021

19

[ "Discussion" ]

[ "Plan" ]

yeah . amino acids are fine , they wo n't , wo n't really help with weight loss either , but it might help , uh , you replenish , and just kind of , feel hydrated .

544

doctor: yes , amino acids are what make up the protein , which is in any food you eat , with any protein . so , meats , dairy , nuts , any of that sort of thing . patient: okay , thank you . got it .

D2N021

20

[ "Discussion" ]

[ "Plan" ]

yes , amino acids are what make up the protein , which is in any food you eat , with any protein . so , meats , dairy , nuts , any of that sort of thing .

545

doctor: all right . um , are you allergic to any medications ? patient: no , not that i know of .

D2N021

21

[ "Personal History" ]

[ "Subjective" ]

all right . um , are you allergic to any medications ?

546

doctor: okay . is your s- skin pretty sensitive ? patient: yes .

D2N021

22

[ "Personal History" ]

[ "Subjective" ]

okay . is your s- skin pretty sensitive ?

547

doctor: all right . patient: um , yeah , my size , i will start getting rashes , with different products .

D2N021

23

[ "Personal History" ]

[ "Subjective" ]

all right .

548

doctor: and have you ever tried clindamycin topical , as an antibiotic for your acne ? patient: no , i've never tried anything for it .

D2N021

24

[ "Personal History", "Therapeutic History" ]

[ "Subjective" ]

and have you ever tried clindamycin topical , as an antibiotic for your acne ?

549

doctor: okay . we might give you some of that . patient: okay . and i also want to mention that my feet do swell up a lot .

D2N021

25

[ "Medication" ]

[ "Plan" ]

okay . we might give you some of that .

550

doctor: okay . i'm ... let me take a look at that for just a moment . um , any constipation ? patient: yes , i also do have that problem .

D2N021

26

[ "Vegetative History" ]

[ "Subjective" ]

okay . i'm ... let me take a look at that for just a moment . um , any constipation ?

551

doctor: all right . mira- miralax will definitely help with that . patient: okay , yes , my doctor did also recommend that .

D2N021

27

[ "Medication" ]

[ "Plan" ]

all right . mira- miralax will definitely help with that .

552

doctor: great . all right , let's do an exam real quick . please have a seat on this table and i'll listen to your lungs and heart . patient: okay .

D2N021

28

[ "Physical Examination" ]

[ "Objective" ]

great . all right , let's do an exam real quick . please have a seat on this table and i'll listen to your lungs and heart .

553

doctor: all right , deep breath . all right , again . patient: okay .

D2N021

29

[ "Physical Examination" ]

[ "Objective" ]

all right , deep breath . all right , again .

554

doctor: all right , sounds good . patient: great .

D2N021

30

[ "Physical Examination" ]

[ "Objective" ]

all right , sounds good .

555

doctor: let me take a look at your feet and ankles . patient: okay .

D2N021

31

[ "Physical Examination" ]

[ "Objective" ]

let me take a look at your feet and ankles .

556

doctor: all right , they look okay right now , certainly let your doctor know about this if it gets any worse or reoccurs . patient: okay , i will do that .

D2N021

32

[ "Physical Examination", "Follow-up" ]

[ "Objective", "Plan" ]

all right , they look okay right now , certainly let your doctor know about this if it gets any worse or reoccurs .

557

doctor: now , let's go over your lab work . so , when you took that pill , the dexamethasone test , you passed , which means you do n't have cushing's syndrome . on that test , at least . the salivary cortisol , though , unless you did one wrong ... two of them were completely normal and one was abnormal , so , we might need to repeat that in the future . patient: okay , that's okay .

D2N021

33

[ "Lab Examination" ]

[ "Objective" ]

now , let's go over your lab work . so , when you took that pill , the dexamethasone test , you passed , which means you do n't have cushing's syndrome . on that test , at least . the salivary cortisol , though , unless you did one wrong ... two of them were completely normal and one was abnormal , so , we might need to repeat that in the future .

558

doctor: all right , so , your cholesterol was quite high . the total cholesterol was 222 . the good cholesterol was about 44 . the bad was 153 , and it should be less than 100 . the non-hdl was about 178 , and it should be less than 130 . the good cholesterol should be over 50 , and it was 44 . so , your screen for diabetes is ... was fine . you do have a vitamin d deficiency , and , i do n't know if we started the vitamin d yet , or not . patient: yes , we did . i- i do need to take one today , though .

D2N021

34

[ "Lab Examination" ]

[ "Objective" ]

all right , so , your cholesterol was quite high . the total cholesterol was 222 . the good cholesterol was about 44 . the bad was 153 , and it should be less than 100 . the non-hdl was about 178 , and it should be less than 130 . the good cholesterol should be over 50 , and it was 44 . so , your screen for diabetes is ... was fine . you do have a vitamin d deficiency , and , i do n't know if we started the vitamin d yet , or not .

559

doctor: okay . so , i also checked a lot of other pituitary hormones , iron levels ... everything else seemed to be pretty good , and in decent range . patient: okay , that sounds great . so , i wanted to also show you my liver enzymes , um , because i have n't come back since then ... but i was also happy , because one of them was back to normal .

D2N021

35

[ "Lab Examination" ]

[ "Objective" ]

okay . so , i also checked a lot of other pituitary hormones , iron levels ... everything else seemed to be pretty good , and in decent range .

560

doctor: okay , great . let's see them . patient: okay . so , the one that's 30 , that was almost 200 not so long ago .

D2N021

36

[ "Lab Examination" ]

[ "Objective" ]

okay , great . let's see them .

561

doctor: yeah , your alt was about 128 . patient: okay , and , and back in october was 254 .

D2N021

37

[ "Personal History", "Lab Examination" ]

[ "Subjective", "Objective" ]

yeah , your alt was about 128 .

562

doctor: yeah , this is much better . patient: okay , great . and then it dropped in january , and then it dropped a little more in march , since i stopped taking the medicine in december .

D2N021

38

[ "Personal History" ]

[ "Subjective", "Objective" ]

yeah , this is much better .

563

doctor: okay , that's good . so ... i'm proud of you with the course of your labs , so before i forget , i'm going to , uh , just put your labs into the computer today , and i wo n't be checking your vitamin d level for some time . patient: okay . so , with the thyroid , and the low vitamin d , does that always happen together ?

D2N021

39

[ "Discussion" ]

[ "Plan" ]

okay , that's good . so ... i'm proud of you with the course of your labs , so before i forget , i'm going to , uh , just put your labs into the computer today , and i wo n't be checking your vitamin d level for some time .

564

doctor: um , i do have a lot of people that have thyroid , thyroid issues and they have vitamin d deficiency . patient: okay .

D2N021

40

[ "Discussion" ]

[ "Plan" ]

um , i do have a lot of people that have thyroid , thyroid issues and they have vitamin d deficiency .

565

doctor: this is what i'm , um , i'm going to do . i'm going to put , print out your prescriptions , so you can shop around at the pharmacies and see if you can find better prices . patient: okay , that way i can go ask them and try cvs .

D2N021

41

[ "Discussion", "Medication" ]

[ "Plan" ]

this is what i'm , um , i'm going to do . i'm going to put , print out your prescriptions , so you can shop around at the pharmacies and see if you can find better prices .

566

doctor: yeah , that sounds like a plan . patient: okay , good . so , the weight loss study that you mentioned , when does that start ? or , how does that work ?

D2N021

42

[ "Discussion" ]

[ "Plan" ]

yeah , that sounds like a plan .

567

doctor: so , we are about to start , as we just got approval last week , and we are just waiting on our paperwork so we can get started . patient: okay , and what's involved with that ?

D2N021

43

[ "Discussion" ]

[ "Plan" ]

so , we are about to start , as we just got approval last week , and we are just waiting on our paperwork so we can get started .

568

doctor: so , it'll involve you receiving a medication which has been used for diabetes treatment , and it works mostly in the gut on satiety , or satiety hormones . um , the most common side effects are going to be nausea , vomiting , diarrhea and constipation . they are s- uh , six arms , to the study . one is a placebo , the other ones are a , various as ... various dosages of the medication , excuse me . um , you would receive an injection once a week . also , keep in mind that most of the weight loss medications are not covered by insurance . patient: okay .

D2N021

44

[ "Discussion", "Medication" ]

[ "Plan" ]

so , it'll involve you receiving a medication which has been used for diabetes treatment , and it works mostly in the gut on satiety , or satiety hormones . um , the most common side effects are going to be nausea , vomiting , diarrhea and constipation . they are s- uh , six arms , to the study . one is a placebo , the other ones are a , various as ... various dosages of the medication , excuse me . um , you would receive an injection once a week . also , keep in mind that most of the weight loss medications are not covered by insurance .

569

doctor: so , it's a way of getting them , but , the odds of getting one of the arms with the medication that are in your favor , right , might be only one out of five of our hundred patients that we have on the list for the study that will receive the placebo . patient: okay .

D2N021

45

[ "Discussion", "Medication" ]

[ "Plan" ]

so , it's a way of getting them , but , the odds of getting one of the arms with the medication that are in your favor , right , might be only one out of five of our hundred patients that we have on the list for the study that will receive the placebo .

570

doctor: does that make sense ? patient: yes , it does .

D2N021

46

[ "Chitchat" ]

[ "Null" ]

does that make sense ?

571

doctor: so , we do expect pretty big weight loss , because of what we learn in diabetes study . so , it's a year long , uh , process , and it's an injection once a week . you come in weekly for the first four , five weeks , i believe . and then , after that , it's once a month . you do get a stipend for partici- for participating in the study , and parking is validated , and whatever else that you need for the study . patient: okay , do you know how much the stipend is ?

D2N021

47

[ "Discussion" ]

[ "Plan" ]

so , we do expect pretty big weight loss , because of what we learn in diabetes study . so , it's a year long , uh , process , and it's an injection once a week . you come in weekly for the first four , five weeks , i believe . and then , after that , it's once a month . you do get a stipend for partici- for participating in the study , and parking is validated , and whatever else that you need for the study .

572

doctor: um , i will have to double check for you , and , you do n't have to be my patient , you just have to meet the criteria . so the criteria is a bmi greater than 30 , if you do n't have any other medical condition . or , a bmi greater than 27 , if you do have another medical condition , like your cholesterol . um , a bmi greater than 27 would quali- uh , qualify you . patient: i have a friend who might be interested , and she does have diabetes .

D2N021

48

[ "Discussion" ]

[ "Plan" ]

um , i will have to double check for you , and , you do n't have to be my patient , you just have to meet the criteria . so the criteria is a bmi greater than 30 , if you do n't have any other medical condition . or , a bmi greater than 27 , if you do have another medical condition , like your cholesterol . um , a bmi greater than 27 would quali- uh , qualify you .

573

doctor: if she has d- diabetes , then she wo n't qualify . patient: okay , you ca n't if you ... if you have diabetes , got it .

D2N021

49

[ "Discussion" ]

[ "Plan" ]

if she has d- diabetes , then she wo n't qualify .

574

doctor: correct . yeah , the only thing that , um , they can not have , really , is diabetes . so , either a psychiatric disease , or schizophrenia , bipolar , things like that . patient: okay .

D2N021

50

[ "Discussion" ]

[ "Plan" ]

correct . yeah , the only thing that , um , they can not have , really , is diabetes . so , either a psychiatric disease , or schizophrenia , bipolar , things like that .

575

doctor: but , if they have hypertension , high cholesterol , things like that ... they can definitely sign up . patient: and they can , okay . thank you for explaining that .

D2N021

51

[ "Discussion" ]

[ "Plan" ]

but , if they have hypertension , high cholesterol , things like that ... they can definitely sign up .

576

doctor: of course . so , do you want me to try to get you into that study ? or , would you just like to try , me to prescribe something ? it's kind of up to you . patient: i think i'll just wait for a little bit now .

D2N021

52

[ "Discussion" ]

[ "Plan" ]

of course . so , do you want me to try to get you into that study ? or , would you just like to try , me to prescribe something ? it's kind of up to you .

577

doctor: all right , sounds good . i'll give you the information for the research , it's just in my office . um , it is a different phone number , though . so then , if you're interested , just call us within a month , because i do n't know how long , uh , the , the wait will be . patient: okay , will do .

D2N021

53

[ "Discussion", "Follow-up" ]

[ "Plan" ]

all right , sounds good . i'll give you the information for the research , it's just in my office . um , it is a different phone number , though . so then , if you're interested , just call us within a month , because i do n't know how long , uh , the , the wait will be .

578

doctor: perfect . so , let me go grab your discount card for the unithroid . um , when you go in to activate it , the instructions are on this card , and then you use your insurance ... then , show them this , and ask how much it'll cost . if it's too expensive , just let me know . patient: i will . thank you so much for your help on that .

D2N021

54

[ "Discussion", "Medication" ]

[ "Plan" ]

perfect . so , let me go grab your discount card for the unithroid . um , when you go in to activate it , the instructions are on this card , and then you use your insurance ... then , show them this , and ask how much it'll cost . if it's too expensive , just let me know .

579

doctor: you're welcome . then , what i did is , i gave you a topical antibiotic , plus i gave you the benzoyl peroxide . so , the peroxide may bleach your sheets , but , you want to make sure to take it and apply it at night , so you do n't have a reaction from the sun during the day . patient: okay , i can do that .

D2N021

55

[ "Discussion", "Medication" ]

[ "Plan" ]

you're welcome . then , what i did is , i gave you a topical antibiotic , plus i gave you the benzoyl peroxide . so , the peroxide may bleach your sheets , but , you want to make sure to take it and apply it at night , so you do n't have a reaction from the sun during the day .

580

doctor: but , you do also want to make sure that you do n't mess up your sheets . patient: okay , sounds good .

D2N021

56

[ "Chitchat" ]

[ "Null" ]

but , you do also want to make sure that you do n't mess up your sheets .

581

doctor: um , so , that's that . and then , let's see how you do on the other medications . i think this will , this will get better . in the meantime , a low-carb diet , avoid alcohol and fatty foods , and low chole- cholesterol foods . patient: okay .

D2N021

57

[ "Medication", "Other Treatments", "Drug History" ]

[ "Plan" ]

um , so , that's that . and then , let's see how you do on the other medications . i think this will , this will get better . in the meantime , a low-carb diet , avoid alcohol and fatty foods , and low chole- cholesterol foods .

582

doctor: and again , once you finish your dose of vitamin d , for the vitamin d deficiency , you're gon na start with the 2000iu daily , so that you're able to maintain those levels . sound good ? patient: yes , that sounds great .

D2N021

58

[ "Medication" ]

[ "Plan" ]

and again , once you finish your dose of vitamin d , for the vitamin d deficiency , you're gon na start with the 2000iu daily , so that you're able to maintain those levels . sound good ?

583

doctor: i really think your liver enzymes are going to get better once you lose the weight , though . patient: okay , that would be great .

D2N021

59

[ "Discussion", "Other Treatments" ]

[ "Plan" ]

i really think your liver enzymes are going to get better once you lose the weight , though .

584

doctor: since we stopped your birth control , we can try once called phexxi , which is kind of like a spermicide , basically . patient: okay .

D2N021

60

[ "Discussion", "Medication" ]

[ "Plan" ]

since we stopped your birth control , we can try once called phexxi , which is kind of like a spermicide , basically .

585

doctor: and you just apply it before intercourse . patient: okay .

D2N021

61

[ "Discussion", "Medication" ]

[ "Plan" ]

and you just apply it before intercourse .

586

doctor: if you need some , uh , just let me know . patient: okay , i will . i'll let you know .

D2N021

62

[ "Chitchat" ]

[ "Null" ]

if you need some , uh , just let me know .

587

doctor: okay , perfect . so , stay put for me now . i'm going to go see if they have discount samples , and bring you that prescription . and then , i'm going to order the labs for next time . patient: okay , great , thank you so much .

D2N021

63

[ "Discussion", "Diagnostic Testing" ]

[ "Plan" ]

okay , perfect . so , stay put for me now . i'm going to go see if they have discount samples , and bring you that prescription . and then , i'm going to order the labs for next time .

588

doctor: you're welcome . so , under the plan , under abnormal liver enzymes , they have improved since discontinuation of her birth control . under abnormal weight gain , her dexamethasone suppression test was normal . two out of three salivary cortisol tests were normal , not consistent with cushing's , and therefore we're ruling out cushing's . under her hirsutism , her androgen levels were normal . for the acne vulgaris , the epiduo was not covered , so we'll try benzoyl peroxide with clindamycin , and remove the previous information . on the hyperthyroidism , we'll print out her prescriptions . unithroid should be better priced with the discount card , and we'll repeat levels of everything before next visit . thanks .

D2N021

64

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

[ "Assessment", "Plan" ]

doctor: you're welcome . so , under the plan , under abnormal liver enzymes , they have improved since discontinuation of her birth control . under abnormal weight gain , her dexamethasone suppression test was normal . two out of three salivary cortisol tests were normal , not consistent with cushing's , and therefore we're ruling out cushing's . under her hirsutism , her androgen levels were normal . for the acne vulgaris , the epiduo was not covered , so we'll try benzoyl peroxide with clindamycin , and remove the previous information . on the hyperthyroidism , we'll print out her prescriptions . unithroid should be better priced with the discount card , and we'll repeat levels of everything before next visit . thanks .

589

doctor: this is philip gutierrez , date of birth 1/12/71 . he is a 50-year-old male here for a second opinion regarding the index finger on the right hand . he had a hyperextension injury of that index finger during a motor vehicle accident in march of this year . he was offered an injection of the a1 polyregion , but did not want any steroid because of the reaction to dexamethasone , which causes his heart to race . he was scheduled to see dr. alice davis , which it does n't appear he did . he had an mri of that finger , because there was concern about a capsular strain plus or minus rupture of , quote , " fds tendon , " end quote . he has been seen at point may orthopedics largely by the physical therapy staff and a pr , pa at that institution . at that practice , an mri was obtained on 4/24/2021 , which showed just focal soft tissue swelling over the right index mcp joint , partial-thickness tear of the right fds , and fluid consistent with tenosynovitis around the fdp and fds tendons . radial and ulnar collateral ligaments of the index mcp joint were intact , as the mcp joint capsule . extensor tendons also deemed intact . his x-rays , four views of the right hand today , show no bony abnormalities , joint congruency throughout all lesser digits on the right hand , no soft tissue shadows of concern , no arthritis . hi , how are you , mr . gutierrez ? patient: i'm good , how about you ?

D2N022

0

[ "Personal History", "Greetings", "Radiology Examination" ]

[ "Subjective", "Objective" ]

this is philip gutierrez , date of birth 1/12/71 . he is a 50-year-old male here for a second opinion regarding the index finger on the right hand . he had a hyperextension injury of that index finger during a motor vehicle accident in march of this year . he was offered an injection of the a1 polyregion , but did not want any steroid because of the reaction to dexamethasone , which causes his heart to race . he was scheduled to see dr. alice davis , which it does n't appear he did . he had an mri of that finger , because there was concern about a capsular strain plus or minus rupture of , quote , " fds tendon , " end quote . he has been seen at point may orthopedics largely by the physical therapy staff and a pr , pa at that institution . at that practice , an mri was obtained on 4/24/2021 , which showed just focal soft tissue swelling over the right index mcp joint , partial-thickness tear of the right fds , and fluid consistent with tenosynovitis around the fdp and fds tendons . radial and ulnar collateral ligaments of the index mcp joint were intact , as the mcp joint capsule . extensor tendons also deemed intact . his x-rays , four views of the right hand today , show no bony abnormalities , joint congruency throughout all lesser digits on the right hand , no soft tissue shadows of concern , no arthritis . hi , how are you , mr . gutierrez ?

590

doctor: well , how can i help you today ? patient: so i was a passenger in , uh , a car that was rear-ended , and we were hit multiple times . i felt two bumps , which slung me forward and caused me to stretch out my right index finger .

D2N022

1

[ "Acute Symptoms" ]

[ "Subjective" ]

well , how can i help you today ?

591

doctor: so hitting the car in front of you all made that finger go backwards ? patient: um , i do n't really know . i just felt , like , it felt like i laid on my finger , and so , i felt like it went back , and it's been hurting since about march . and it's been like that ever , ever since the wreck happened . so i , and i ca n't make a fist , but sometimes the pain's unbearable . and , like , even driving hurts .

D2N022

2

[ "Acute Symptoms" ]

[ "Subjective" ]

so hitting the car in front of you all made that finger go backwards ?

592

doctor: okay , so this was march of this year , so maybe about three months ago ? patient: yeah , and it's still swollen . so i was seeing , uh , an orthopedist , and they sent me to an occupational therapist . and i've been doing therapy with them , and then they sent me to go back and get an mri . so i went and got the mri . uh , then they told me that the mri came back , and it said i had a tear in my finger , but he was n't gon na give me an injection , because the injection was going to make the tear worse .

D2N022

3

[ "Personal History" ]

[ "Subjective" ]

okay , so this was march of this year , so maybe about three months ago ?

593

doctor: mm-hmm . patient: and then , after he got the mri , he said that i have , uh , a tear in my finger , and that he did n't wan na do surgery , but he would do an injection . then i'm thinking that you told me you would n't do an injection in there , and then the oper- , occupational therapy says it's because of the tear . and then , they do n't want me to keep rubbing the thing , and doing things with my hand . so i feel like i'm not getting medical care , really .

D2N022

4

[ "Personal History" ]

[ "Subjective" ]

mm-hmm .

594

doctor: yeah , i see that . patient: so i came to see if you could do anything for this hand , because i am right-handed , and i kinda need that hand .

D2N022

5

[ "Personal History" ]

[ "Subjective" ]

yeah , i see that .

595

doctor: what do you do for a living ? patient: uh , i'm an x-ray tech .

D2N022

6

[ "Other Socials" ]

[ "Subjective" ]

what do you do for a living ?

596

doctor: well , um , so do you have any diabetes or rheumatoid arthritis ? patient: nope .

D2N022

7

[ "Personal History" ]

[ "Subjective" ]

well , um , so do you have any diabetes or rheumatoid arthritis ?

597

doctor: uh , do you take any chronic medications of su- , significance ? patient: uh , i do take a blood pressure pill , and that's it .

D2N022

8

[ "Therapeutic History" ]

[ "Subjective" ]

uh , do you take any chronic medications of su- , significance ?

598

doctor: okay , and it looks like you suffer from itching with the methylprednisolone ? patient: uh , that's correct .

D2N022

9

[ "Therapeutic History", "Personal History" ]

[ "Subjective" ]

okay , and it looks like you suffer from itching with the methylprednisolone ?

599