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: all right , well , i'm gon na scoot up closer and just take a quick look at your hand . all right , so , lean over here . all right , so on this exam today , we have a very pleasant , cooperative , healthy male , no distress . his heart rate is regular rate , rhythm , 2+ radial pulse , no swelling or bruise , bruising in the palm over the volar surface of his index finger , normal creases , slightly diminished over the pip of the index finger compared to the middle finger . his index finger rests in a 10-degree pip-flexed , uh , position . all right , is that uncomfortable to correct that , and is it uncomfortable now here ? patient: yeah , uh , when you push on it , yeah . | D2N022 | 10 | [
"Physical Examination"
] | [
"Objective"
] | all right , well , i'm gon na scoot up closer and just take a quick look at your hand . all right , so , lean over here . all right , so on this exam today , we have a very pleasant , cooperative , healthy male , no distress . his heart rate is regular rate , rhythm , 2+ radial pulse , no swelling or bruise , bruising in the palm over the volar surface of his index finger , normal creases , slightly diminished over the pip of the index finger compared to the middle finger . his index finger rests in a 10-degree pip-flexed , uh , position . all right , is that uncomfortable to correct that , and is it uncomfortable now here ? | 600 |
doctor: all right , how about here ? patient: um , there , it's not . | D2N022 | 11 | [
"Physical Examination"
] | [
"Objective"
] | all right , how about here ? | 601 |
doctor: okay , not as bad ? patient: yeah , it feels , uh , a little numb . | D2N022 | 12 | [
"Physical Examination"
] | [
"Objective"
] | okay , not as bad ? | 602 |
doctor: gotcha , all right . bend , bend the tip of this finger . bend it as hard as you can . keep bending . keep bending . all right , straighten it out . all right , and now , bend it for me as best you can . patient: my goodness . it feels like it's , it's tearing in there . | D2N022 | 13 | [
"Physical Examination"
] | [
"Objective"
] | gotcha , all right . bend , bend the tip of this finger . bend it as hard as you can . keep bending . keep bending . all right , straighten it out . all right , and now , bend it for me as best you can . | 603 |
doctor: okay , okay . well , bend the tip of this finger , and bend it as hard as you can . keep bending . all right , straighten that out , and now , bend it for me as best you can . all right , good . now , bend that finger , and i'm going to pull , put it down like this . and then bend that finger for me . okay , sorry , can you bend it for me ? all right . now , make a fist . great , so relax the finger . all right , so just keep it , keep , when i bend the finger , we're just going to bend that finger where it meets the hand . is that okay there ? patient: ow , . | D2N022 | 14 | [
"Physical Examination"
] | [
"Objective"
] | okay , okay . well , bend the tip of this finger , and bend it as hard as you can . keep bending . all right , straighten that out , and now , bend it for me as best you can . all right , good . now , bend that finger , and i'm going to pull , put it down like this . and then bend that finger for me . okay , sorry , can you bend it for me ? all right . now , make a fist . great , so relax the finger . all right , so just keep it , keep , when i bend the finger , we're just going to bend that finger where it meets the hand . is that okay there ? | 604 |
doctor: okay , okay . so all the hurt , it seems , is stretching , because you have n't been doing this for so long . so , you know what i mean ? so , um , you're going to have to start really doing that . patient: well , i've tried . i even bought myself a splint . | D2N022 | 15 | [
"Discussion",
"Acute Assessment",
"Other Treatments"
] | [
"Assessment",
"Plan"
] | okay , okay . so all the hurt , it seems , is stretching , because you have n't been doing this for so long . so , you know what i mean ? so , um , you're going to have to start really doing that . | 605 |
doctor: well , but a splint does n't help move you . it actually immobilizes you . patient: okay . i thought it would straighten it out . | D2N022 | 16 | [
"Discussion",
"Other Treatments"
] | [
"Plan"
] | well , but a splint does n't help move you . it actually immobilizes you . | 606 |
doctor: no , no . so , so you really need to start bending the finger right here for me , as hard as you can , and keep going , going . all right , so , so you're okay . all right , so i would say the following , that there is a partial tear in one of the two flexor tendons . there is the fdp and the fds , and the fds is the least important of the two . so the mri shows that it's the fds , the flexor digitorum superficialis , which is the least important of the two . patient: okay . | D2N022 | 17 | [
"Physical Examination",
"Acute Assessment",
"Radiology Examination"
] | [
"Objective",
"Assessment"
] | no , no . so , so you really need to start bending the finger right here for me , as hard as you can , and keep going , going . all right , so , so you're okay . all right , so i would say the following , that there is a partial tear in one of the two flexor tendons . there is the fdp and the fds , and the fds is the least important of the two . so the mri shows that it's the fds , the flexor digitorum superficialis , which is the least important of the two . | 607 |
doctor: uh , now , there's two halves of it . so it's a partial tear of one half of a whole tendon . that's not that important , and the other one is just fine . patient: so the good one is good ? | D2N022 | 18 | [
"Radiology Examination"
] | [
"Objective"
] | uh , now , there's two halves of it . so it's a partial tear of one half of a whole tendon . that's not that important , and the other one is just fine . | 608 |
doctor: yes , correct . so the one that goes all the way to the tip is good . patient: okay , good . | D2N022 | 19 | [
"Radiology Examination"
] | [
"Objective"
] | yes , correct . so the one that goes all the way to the tip is good . | 609 |
doctor: yeah , so you know , i think what you have got so much scar tissue and inflammation around the fds tendon blocking excursion of these other tendons , that they ca n't get through to the pulley . patient: okay , all right . | D2N022 | 20 | [
"Acute Assessment"
] | [
"Assessment"
] | yeah , so you know , i think what you have got so much scar tissue and inflammation around the fds tendon blocking excursion of these other tendons , that they ca n't get through to the pulley . | 610 |
doctor: so what i would recommend what we try is a cortisone injection , and i would avoid the dexamethasone , because i saw you have a little reaction to that . but we could use the betamethasone , which is a celestone . patient: i've gotten another , uh , methylprednisolone , and that itched me like crazy . | D2N022 | 21 | [
"Medication"
] | [
"Plan"
] | so what i would recommend what we try is a cortisone injection , and i would avoid the dexamethasone , because i saw you have a little reaction to that . but we could use the betamethasone , which is a celestone . | 611 |
doctor: did it ? yeah , this one is water-soluble , and i think it's fairly low toxicity , but high benefit , and i think decreasing the pain will encourage you to move that finger . patient: all right , we'll give it a try . | D2N022 | 22 | [
"Discussion",
"Medication"
] | [
"Plan"
] | did it ? yeah , this one is water-soluble , and i think it's fairly low toxicity , but high benefit , and i think decreasing the pain will encourage you to move that finger . | 612 |
doctor: good . so , you do the shot , and it's going to take about three to five days before it starts feeling better . and then probably over the next couple of weeks , it'll start feeling even better . patient: perfect . | D2N022 | 23 | [
"Discussion",
"Medication"
] | [
"Plan"
] | good . so , you do the shot , and it's going to take about three to five days before it starts feeling better . and then probably over the next couple of weeks , it'll start feeling even better . | 613 |
doctor: all right , so take advantage of that . you've got ta start moving the finger . you're not going to tear anything or break a bone , uh , because your intensors , extensors are intact . but your collateral ligaments are intact , so you've got a stiff , sore finger . i'm going to try to help as much as i can with this soreness part , and then you have to do all the stiff part . patient: the lady in occupational therapy tried some maneuvers to straighten the finger out , but it even hurt after i left . the whole thing just swelled up . | D2N022 | 24 | [
"Discussion",
"Other Treatments"
] | [
"Plan"
] | all right , so take advantage of that . you've got ta start moving the finger . you're not going to tear anything or break a bone , uh , because your intensors , extensors are intact . but your collateral ligaments are intact , so you've got a stiff , sore finger . i'm going to try to help as much as i can with this soreness part , and then you have to do all the stiff part . | 614 |
doctor: hmm . okay , so it was injured , and you had scar tissue . and then , you had post-traumatic inflammation . and so , this will help some with all of that . it's not going to make it to where your finger is like , , my finger does n't hurt at all , but it will make it to where at least tolerable , to where you can make some gains . and we actually might need to repeat this as well . patient: will i be able to drive ? i drove myself here today , so ... | D2N022 | 25 | [
"Discussion",
"Medication"
] | [
"Plan"
] | hmm . okay , so it was injured , and you had scar tissue . and then , you had post-traumatic inflammation . and so , this will help some with all of that . it's not going to make it to where your finger is like , , my finger does n't hurt at all , but it will make it to where at least tolerable , to where you can make some gains . and we actually might need to repeat this as well . | 615 |
doctor: yeah , it may feel a little weird , but it's totally safe for you to drive . patient: okay , good . | D2N022 | 26 | [
"Discussion"
] | [
"Plan"
] | yeah , it may feel a little weird , but it's totally safe for you to drive . | 616 |
doctor: so for mr . gutierrez , just put that he has a post-traumatic rather severe stenosing tenosynovitis of his right index finger , and the plan is steroid injection today , do a trigger injection , but i'm using a cc of betamethasone . so , mr . gutierrez , do you have , um , therapy scheduled or set up ? patient: uh , not at the moment . | D2N022 | 27 | [
"Discussion",
"Acute Assessment",
"Referral",
"Medication"
] | [
"Assessment",
"Plan"
] | so for mr . gutierrez , just put that he has a post-traumatic rather severe stenosing tenosynovitis of his right index finger , and the plan is steroid injection today , do a trigger injection , but i'm using a cc of betamethasone . so , mr . gutierrez , do you have , um , therapy scheduled or set up ? | 617 |
doctor: all right , well , i mean , you know that you need to move that finger , and i think to the degree that they can help you do that . so i want you to move that finger , finger , but i think it would be , uh , beneficial for you to have an accountability , um , so at least you know to check in with them once a week with somebody . patient: um , okay . that's kinda why i'm here , for you to tell me what needs to be done , you know ? | D2N022 | 28 | [
"Discussion",
"Referral"
] | [
"Plan"
] | all right , well , i mean , you know that you need to move that finger , and i think to the degree that they can help you do that . so i want you to move that finger , finger , but i think it would be , uh , beneficial for you to have an accountability , um , so at least you know to check in with them once a week with somebody . | 618 |
doctor: yeah , so i'll write you out , um , an outpatient prescription . i think if you go back to the same people where you were before , i'm hoping that after this injection , you're going to be able to do a whole lot more with them . so let's do outpatient once a week for six weeks , um , and then full active and passive range of motion is the goal with no restrictions . patient: all right , sounds like a plan . | D2N022 | 29 | [
"Referral"
] | [
"Plan"
] | yeah , so i'll write you out , um , an outpatient prescription . i think if you go back to the same people where you were before , i'm hoping that after this injection , you're going to be able to do a whole lot more with them . so let's do outpatient once a week for six weeks , um , and then full active and passive range of motion is the goal with no restrictions . | 619 |
doctor: all right , well , i will have the nurse set up the injection procedure , and we'll , and i'll be back shortly . patient: thanks , doc . | D2N022 | 30 | [
"Chitchat"
] | [
"Null"
] | all right , well , i will have the nurse set up the injection procedure , and we'll , and i'll be back shortly . | 620 |
doctor: right trigger finger injection template . attempted to inject one cc of celestone with f- , a half a cc of lidocaine . however , the patient had a dramatic and violent painful reaction to the introduction of the needle , with contortions of the hand , and with dangerously withdrawing the hand with concerns for secondary needle stick . needle was withdrawn . the patient was counseled as to the importance of attempting to get some therapeutic steroid in the flexor tendon sheath . we attempted a second time for a similar injection using the same technique with one cc of celestone and half a cc of lidocaine . a small parma- , uh , palmar vein bled a scant amount , which was cleaned up and band-aid applied . reassured on multiple occasions that no harm was done to his finger . recommended icing in it this evening , and taking ibuprofen . | D2N022 | 31 | [
"Medication",
"Discussion"
] | [
"Plan"
] | doctor: right trigger finger injection template . attempted to inject one cc of celestone with f- , a half a cc of lidocaine . however , the patient had a dramatic and violent painful reaction to the introduction of the needle , with contortions of the hand , and with dangerously withdrawing the hand with concerns for secondary needle stick . needle was withdrawn . the patient was counseled as to the importance of attempting to get some therapeutic steroid in the flexor tendon sheath . we attempted a second time for a similar injection using the same technique with one cc of celestone and half a cc of lidocaine . a small parma- , uh , palmar vein bled a scant amount , which was cleaned up and band-aid applied . reassured on multiple occasions that no harm was done to his finger . recommended icing in it this evening , and taking ibuprofen . | 621 |
doctor: next patient is paul edwards , date of birth is january 15th 1962 . so he's a 59 year old hiv positive gentleman here for hypogonadism . patient was last seen on november 24th 2020 . his notable things are number one , he is on 1 milliliter every 10 days , uh , his levels were less than 300 to begin with . he's on finasteride currently . he also takes cialis daily so he takes all his pills just from me . um , patient's other area of concern is gynecomastia which is ... which we will discuss with him today . his last psa was 0.66 and his last testosterone was greater than 1,500 . hey , how are you today ? patient: all right , how have you been ? | D2N023 | 0 | [
"Acute Symptoms",
"Personal History",
"Therapeutic History",
"Lab Examination"
] | [
"Subjective",
"Objective"
] | next patient is paul edwards , date of birth is january 15th 1962 . so he's a 59 year old hiv positive gentleman here for hypogonadism . patient was last seen on november 24th 2020 . his notable things are number one , he is on 1 milliliter every 10 days , uh , his levels were less than 300 to begin with . he's on finasteride currently . he also takes cialis daily so he takes all his pills just from me . um , patient's other area of concern is gynecomastia which is ... which we will discuss with him today . his last psa was 0.66 and his last testosterone was greater than 1,500 . hey , how are you today ? | 622 |
doctor: i'm good . patient: good , good . | D2N023 | 1 | [
"Chitchat"
] | [
"Null"
] | i'm good . | 623 |
doctor: have you lost some weight or are you at least putting on some muscle ? you look trim . patient: no , i think i'm pretty much the same as i've always been . | D2N023 | 2 | [
"Personal History",
"Vegetative History"
] | [
"Subjective"
] | have you lost some weight or are you at least putting on some muscle ? you look trim . | 624 |
doctor: really ? okay , maybe it's just your black shirt . makes you look thin . patient: yeah , i guess that's it . | D2N023 | 3 | [
"Chitchat"
] | [
"Null"
] | really ? okay , maybe it's just your black shirt . makes you look thin . | 625 |
doctor: so health wise , how is everything going ? patient: good , the testosterone's going well . | D2N023 | 4 | [
"Personal History"
] | [
"Subjective"
] | so health wise , how is everything going ? | 626 |
doctor: that's great . patient: uh , it helped me out . i feel good , more vigorous , sleeping well and i think it's having some positive effects . not so much physically because like i said i've- i've been this way my whole life , but i'm seeing some good improvements in my bloodwork . | D2N023 | 5 | [
"Personal History",
"Vegetative History"
] | [
"Subjective"
] | that's great . | 627 |
doctor: okay , well that's good . patient: so the finasteride i'm only taking half a pill , it's the 5 milligram one . | D2N023 | 6 | [
"Personal History",
"Therapeutic History"
] | [
"Subjective"
] | okay , well that's good . | 628 |
doctor: yeah , i remember you telling me that . patient: and cialis , on the days i work out i take 5 milligrams otherwise i take two and a half milligram pills , but , uh , i have been out of it . | D2N023 | 7 | [
"Personal History",
"Therapeutic History"
] | [
"Subjective"
] | yeah , i remember you telling me that . | 629 |
doctor: good . it's always great to hear . well let's take a look . uhm , i'm gon na listen to your heart and lungs . patient: okay . | D2N023 | 9 | [
"Physical Examination"
] | [
"Objective"
] | good . it's always great to hear . well let's take a look . uhm , i'm gon na listen to your heart and lungs . | 630 |
doctor: please use my general exam template , all right . just take a few breaths . patient: okay . | D2N023 | 10 | [
"Chitchat"
] | [
"Null"
] | please use my general exam template , all right . just take a few breaths . | 631 |
doctor: in and out . patient: okay . | D2N023 | 11 | [
"Chitchat"
] | [
"Null"
] | in and out . | 632 |
doctor: all right , everything sounds good , no concerns there . patient: great . so i wanted to show you something . | D2N023 | 12 | [
"Physical Examination"
] | [
"Objective"
] | all right , everything sounds good , no concerns there . | 633 |
doctor: okay , this is your cholesterol ? patient: yeah , my cholesterol and triglycerides . uh , i used to have high triglycerides , you see they were 265 milligrams per deciliter , and i took my first dose of the testosterone on the 28th . | D2N023 | 14 | [
"Lab Examination"
] | [
"Objective"
] | okay , this is your cholesterol ? | 634 |
doctor: right . patient: now 5 months later look at my numbers . | D2N023 | 15 | [
"Lab Examination"
] | [
"Objective"
] | right . | 635 |
doctor: wow , that's remarkable . patient: is it the test ? it's the only change . | D2N023 | 16 | [
"Lab Examination"
] | [
"Objective"
] | wow , that's remarkable . | 636 |
doctor: i do n't know , i have n't honestly seen many guys over the years that have cholesterol problems and this . i mean there's a big correlation between diabetic control and testosterone replacement , meaning those who get good levels of their test see their diabetic control improve . patient: yeah . | D2N023 | 17 | [
"Discussion",
"Lab Examination"
] | [
"Objective",
"Plan"
] | i do n't know , i have n't honestly seen many guys over the years that have cholesterol problems and this . i mean there's a big correlation between diabetic control and testosterone replacement , meaning those who get good levels of their test see their diabetic control improve . | 637 |
doctor: but i have n't seen a lot of data on the impact on cholesterol . regardless , we will take it . patient: i agree . i was very impressed with my triglycerides and was just wondering if the test may be what's helping . | D2N023 | 18 | [
"Lab Examination"
] | [
"Objective"
] | but i have n't seen a lot of data on the impact on cholesterol . regardless , we will take it . | 638 |
doctor: yeah , that's an unbelievable difference . patient: 145 milligrams per deciliter from 265 milligrams per deciliter is awesome . i also read that it- it's cardioprotective . | D2N023 | 19 | [
"Lab Examination"
] | [
"Objective"
] | yeah , that's an unbelievable difference . | 639 |
doctor: absolutely . patient: my red blood cell count has increased . | D2N023 | 20 | [
"Lab Examination"
] | [
"Objective"
] | absolutely . | 640 |
doctor: yeah , i saw that . it's fine though . patient: stable . | D2N023 | 21 | [
"Lab Examination"
] | [
"Objective"
] | yeah , i saw that . it's fine though . | 641 |
doctor: your psa today is also , uh , is good also . it's , uh , .6 i think . patient: yeah . , is it ? | D2N023 | 22 | [
"Lab Examination"
] | [
"Objective"
] | your psa today is also , uh , is good also . it's , uh , .6 i think . | 642 |
doctor: yeah , it was .5 last year and anything under 4 is good . patient: nice , that's good news . | D2N023 | 23 | [
"Lab Examination"
] | [
"Objective"
] | yeah , it was .5 last year and anything under 4 is good . | 643 |
doctor: so it just needs to be checked every year or so . patient: so in terms of , uh , estrogen control i've been hearing that indole-3-carbinol , or broccoli extract , supposedly can improve my estrogen levels . have you ever heard of it ? | D2N023 | 24 | [
"Lab Examination"
] | [
"Objective"
] | so it just needs to be checked every year or so . | 644 |
doctor: yeah , i've heard of it but i have n't had anybody consistently use it . i mean , your levels are fine and we checked your estra- estradiol and it was not elevated , so . patient: okay . | D2N023 | 25 | [
"Discussion"
] | [
"Plan"
] | yeah , i've heard of it but i have n't had anybody consistently use it . i mean , your levels are fine and we checked your estra- estradiol and it was not elevated , so . | 645 |
doctor: i would argue that we could test that in the fall if you want , but we do n't need to do , uh , do any more tests ... any more than test once a year , excuse me . patient: okay , what about increasing my testosterone to 175 milligrams ? i'm at 140 now . | D2N023 | 26 | [
"Discussion",
"Diagnostic Testing"
] | [
"Plan"
] | i would argue that we could test that in the fall if you want , but we do n't need to do , uh , do any more tests ... any more than test once a year , excuse me . | 646 |
doctor: well , your levels are high . patient: are they right now ? | D2N023 | 27 | [
"Lab Examination"
] | [
"Objective"
] | well , your levels are high . | 647 |
doctor: well , i mean they were last time . patient: yeah but i just- just injected though , or i had right before that was taken . | D2N023 | 28 | [
"Lab Examination"
] | [
"Objective",
"Plan"
] | well , i mean they were last time . | 648 |
doctor: i know . i know you had then , uh , when did you inject this time ? patient: i figure i'm on my eighth day today . | D2N023 | 29 | [
"Therapeutic History"
] | [
"Subjective"
] | i know . i know you had then , uh , when did you inject this time ? | 649 |
doctor: all right . patient: i have a little med calendar and i put checks and ts on it . that helps me . | D2N023 | 31 | [
"Chitchat"
] | [
"Null"
] | all right . | 650 |
doctor: that's a great idea . so look , the biggest issue i've seen , even if your levels today are around 700 , is that your peaks are getting greater than 1,500 , putting you at a higher chance of needing to come off due to blood thickness . and your risk will only astronomically go up the higher the dose that we go on . patient: okay . | D2N023 | 32 | [
"Discussion"
] | [
"Plan"
] | that's a great idea . so look , the biggest issue i've seen , even if your levels today are around 700 , is that your peaks are getting greater than 1,500 , putting you at a higher chance of needing to come off due to blood thickness . and your risk will only astronomically go up the higher the dose that we go on . | 651 |
doctor: you look well , your levels are good and you're feeling well . patient: yeah , i'm feeling good . | D2N023 | 33 | [
"Reassessment"
] | [
"Assessment"
] | you look well , your levels are good and you're feeling well . | 652 |
doctor: i'm going to be blunt . unfortunately this happens often where you're feeling good but you want to feel really good . i mean , i get it and this is why people get into problems with this stuff , right ? it's like , back in the day when it was n't prescribed by doctors and people would get it at gyms and stuff and they would take huge doses . and then they would have a heart attack at 50 . patient: yeah , they have to be taking a lot . | D2N023 | 34 | [
"Discussion",
"Medication"
] | [
"Plan"
] | i'm going to be blunt . unfortunately this happens often where you're feeling good but you want to feel really good . i mean , i get it and this is why people get into problems with this stuff , right ? it's like , back in the day when it was n't prescribed by doctors and people would get it at gyms and stuff and they would take huge doses . and then they would have a heart attack at 50 . | 653 |
doctor: likely they are taking more than testosterone , but still . patient: and they are taking stuff for a long time . | D2N023 | 35 | [
"Discussion",
"Medication"
] | [
"Plan"
] | likely they are taking more than testosterone , but still . | 654 |
doctor: true . but right now i would not change your dose . patient: okay . | D2N023 | 36 | [
"Medication"
] | [
"Plan"
] | true . but right now i would not change your dose . | 655 |
doctor: make sense ? patient: it does , i appreciate the discussion . | D2N023 | 37 | [
"Chitchat"
] | [
"Null"
] | make sense ? | 656 |
doctor: no problem . what pharmacy are you using ? have you changed it or anything ? patient: no changes , i use walmart pharmacy . i do need more cialis and finasteride . | D2N023 | 38 | [
"Therapeutic History",
"Other Socials"
] | [
"Subjective"
] | no problem . what pharmacy are you using ? have you changed it or anything ? | 657 |
doctor: for all of them ? patient: sure . | D2N023 | 40 | [
"Chitchat"
] | [
"Null"
] | for all of them ? | 658 |
doctor: all right , will do . i'm gon na get your prescriptions . patient: okay , thank you . | D2N023 | 41 | [
"Chitchat"
] | [
"Null"
] | all right , will do . i'm gon na get your prescriptions . | 659 |
doctor: patient is pamela cook . medical record number is 123546 . she's a 36-year-old female post bilateral reduction mammoplasty on 10-10 20-20 . hey , how are you ? patient: good . how are you ? | D2N024 | 0 | [
"Personal History",
"Greetings"
] | [
"Subjective"
] | patient is pamela cook . medical record number is 123546 . she's a 36-year-old female post bilateral reduction mammoplasty on 10-10 20-20 . hey , how are you ? | 660 |
doctor: i'm doing well . it's good to see you . how have you been ? patient: i've been doing good . | D2N024 | 1 | [
"Personal History"
] | [
"Subjective"
] | i'm doing well . it's good to see you . how have you been ? | 661 |
doctor: great . how about your breasts , are they doing all right ? patient: great . | D2N024 | 2 | [
"Personal History"
] | [
"Subjective"
] | great . how about your breasts , are they doing all right ? | 662 |
doctor: are you having any chills , fever , nausea , or vomiting ? patient: no . | D2N024 | 3 | [
"Vegetative History"
] | [
"Subjective"
] | are you having any chills , fever , nausea , or vomiting ? | 663 |
doctor: good . all right . let's take a peek real quick . patient: sure . | D2N024 | 4 | [
"Chitchat"
] | [
"Null"
] | good . all right . let's take a peek real quick . | 664 |
doctor: how's life otherwise ? pretty good ? nothing new ? patient: no , just enjoying summertime . | D2N024 | 5 | [
"Other Socials"
] | [
"Subjective"
] | how's life otherwise ? pretty good ? nothing new ? | 665 |
doctor: okay . how's your family ? patient: they're good . | D2N024 | 6 | [
"Chitchat"
] | [
"Null"
] | okay . how's your family ? | 666 |
doctor: good . all right . i'm going to take a look at your breast now . if you would just open up your gown for me . everything looks good . patient: yeah . | D2N024 | 7 | [
"Physical Examination"
] | [
"Objective"
] | good . all right . i'm going to take a look at your breast now . if you would just open up your gown for me . everything looks good . | 667 |
doctor: how's your back pain ? patient: i'm not really having any more . | D2N024 | 8 | [
"Acute Symptoms"
] | [
"Subjective"
] | how's your back pain ? | 668 |
doctor: any hard spots , lumps , or bumps that you've noticed ? patient: i did when i came in last time when i saw your pa , ruth sanchez in march . she said i , she said she found a lump right here under my left breast , but i have n't felt it since then . but i did the massages . | D2N024 | 9 | [
"Personal History"
] | [
"Subjective"
] | any hard spots , lumps , or bumps that you've noticed ? | 669 |
doctor: okay , well . that that's good . uh , it's probably just the scar tissue , but everything looks good and you're healing wonderful , so . patient: i told her that the scars here was kind of bothering me and i got scar gel . i was using it everyday , but i do n't think i need it now . | D2N024 | 10 | [
"Physical Examination"
] | [
"Objective"
] | okay , well . that that's good . uh , it's probably just the scar tissue , but everything looks good and you're healing wonderful , so . | 670 |
doctor: yeah , that scar did widen a little bit . let me take a closer look , hang on . this one widened a little too , ? the incisions are well healed though with no signs of infection or any redness on either breast , so i'm not concerned . patient: yeah , but this one just bothered me a little bit more . | D2N024 | 11 | [
"Physical Examination"
] | [
"Objective"
] | yeah , that scar did widen a little bit . let me take a closer look , hang on . this one widened a little too , ? the incisions are well healed though with no signs of infection or any redness on either breast , so i'm not concerned . | 671 |
doctor: i understand . um , you can close your gown now . the only thing that is really going to help out that is to uh , to cut it out and re-close it . patient: okay | D2N024 | 12 | [
"Discussion",
"Other Treatments"
] | [
"Plan"
] | i understand . um , you can close your gown now . the only thing that is really going to help out that is to uh , to cut it out and re-close it . | 672 |
doctor: and you do n't want that , ? patient: i mean , not right now . | D2N024 | 13 | [
"Discussion",
"Other Treatments"
] | [
"Plan"
] | and you do n't want that , ? | 673 |
doctor: um , you want to come back and revisit um , maybe six months ? patient: yeah , i will do that . i still have n't , i still have some more of the gel and i can try using that again . | D2N024 | 14 | [
"Discussion",
"Follow-up"
] | [
"Plan"
] | um , you want to come back and revisit um , maybe six months ? | 674 |
doctor: okay . keep doing that twice a day . the gel is going to lighten the color a little bit , which is already pretty light . um , but , just in that area , and it's high tension , so it's going to rub a little bit . patient: yeah , but it kind of bothers me a little bit . | D2N024 | 15 | [
"Discussion",
"Medication"
] | [
"Plan"
] | okay . keep doing that twice a day . the gel is going to lighten the color a little bit , which is already pretty light . um , but , just in that area , and it's high tension , so it's going to rub a little bit . | 675 |
doctor: uh , i do see that . like i said , the only way to really fix that is to cut it out . patient: uh- . | D2N024 | 16 | [
"Discussion",
"Other Treatments"
] | [
"Plan"
] | uh , i do see that . like i said , the only way to really fix that is to cut it out . | 676 |
doctor: um , let's take a look in six months and then we'll go from there . sound like a plan ? patient: but we have n't hit a full year yet . | D2N024 | 17 | [
"Follow-up"
] | [
"Plan"
] | um , let's take a look in six months and then we'll go from there . sound like a plan ? | 677 |
doctor: i know . um , i would n't do any revisions anyway for scar tissue until we're at least a year out anyway . patient: okay . | D2N024 | 18 | [
"Discussion",
"Follow-up"
] | [
"Plan"
] | i know . um , i would n't do any revisions anyway for scar tissue until we're at least a year out anyway . | 678 |
doctor: so let's wait those six months . you can keep using uh , the mederma scar gel twice a day . massage and scar gel will help for the scars . um , you can put it on other scars too , if you need . patient: okay . | D2N024 | 19 | [
"Discussion",
"Follow-up",
"Medication"
] | [
"Plan"
] | so let's wait those six months . you can keep using uh , the mederma scar gel twice a day . massage and scar gel will help for the scars . um , you can put it on other scars too , if you need . | 679 |
doctor: um , so that's what i would do . let's just get some pictures today so we can keep up um , with them . and keep an eye on these scars and then we'll go from there . patient: sounds good . | D2N024 | 20 | [
"Diagnostic Testing"
] | [
"Plan"
] | um , so that's what i would do . let's just get some pictures today so we can keep up um , with them . and keep an eye on these scars and then we'll go from there . | 680 |
doctor: all right , well it's good to see you . i'm glad you're doing well . patient: yeah , same here . | D2N024 | 21 | [
"Chitchat"
] | [
"Null"
] | all right , well it's good to see you . i'm glad you're doing well . | 681 |
doctor: all right . well , i'm going to tell the front desk six months and we'll revisit those scars . patient: all right . | D2N024 | 22 | [
"Follow-up"
] | [
"Plan"
] | all right . well , i'm going to tell the front desk six months and we'll revisit those scars . | 682 |
doctor: thank you . they're gon na come get your photos now , okay ? patient: okay . | D2N024 | 23 | [
"Chitchat"
] | [
"Null"
] | thank you . they're gon na come get your photos now , okay ? | 683 |
doctor: next patient is nicole miller . date of birth is 09/18/1949 . patient was called for a follow-up with me for chronic congestive heart failure with diastolic dysfunction . bmp's been , uh , 3,000 in march , and is about six- was up to 6,000 in april . she was increasingly dyspneic . we changed her furosemide and torsemide 20 milligrams by mouth daily . uh to note , the patient is not currently on potassium supplement . her lisinopril had- has also been increased up to 10 milligrams daily in march . also did when i saw her last april . she reported being interested in having her right knee replaced this summer at east metro . it was recommended that we work to control her cardiovascular status before surgery . hey , miss miller , how are you today ? patient: i'm doing okay , thank you . | D2N025 | 0 | [
"Therapeutic History",
"Personal History",
"Greetings"
] | [
"Subjective"
] | next patient is nicole miller . date of birth is 09/18/1949 . patient was called for a follow-up with me for chronic congestive heart failure with diastolic dysfunction . bmp's been , uh , 3,000 in march , and is about six- was up to 6,000 in april . she was increasingly dyspneic . we changed her furosemide and torsemide 20 milligrams by mouth daily . uh to note , the patient is not currently on potassium supplement . her lisinopril had- has also been increased up to 10 milligrams daily in march . also did when i saw her last april . she reported being interested in having her right knee replaced this summer at east metro . it was recommended that we work to control her cardiovascular status before surgery . hey , miss miller , how are you today ? | 684 |
doctor: i asked you to come in today because we want to keep- we want you to have this knee surgery this summer but we want to keep a close eye on you to make sure a week before your surgery you do n't suddenly go into congestive heart failure and it gets postponed . patient: yeah , that would not be good . | D2N025 | 1 | [
"Personal History"
] | [
"Subjective"
] | i asked you to come in today because we want to keep- we want you to have this knee surgery this summer but we want to keep a close eye on you to make sure a week before your surgery you do n't suddenly go into congestive heart failure and it gets postponed . | 685 |
doctor: i see you're scheduled on the 24th for surgery . patient: yeah , that's right . | D2N025 | 2 | [
"Personal History"
] | [
"Subjective"
] | i see you're scheduled on the 24th for surgery . | 686 |
doctor: okay , good . well it looks like you have lost about 3 , 3 and a half pounds since i saw you last in april . some of that might be water weight , but still , this is positive . patient: yeah , i noticed that too . i think the oxyglutinine is helping as well . my urgency to use the bathroom is much better . | D2N025 | 3 | [
"Personal History"
] | [
"Subjective"
] | okay , good . well it looks like you have lost about 3 , 3 and a half pounds since i saw you last in april . some of that might be water weight , but still , this is positive . | 687 |
doctor: well that's great . patient: yeah , i , i'm pleased about it too . | D2N025 | 4 | [
"Chitchat"
] | [
"Null"
] | well that's great . | 688 |
doctor: you ever get leg or finger cramps or anything like that ? patient: yeah , i had leg cramps the other day , but i thought it might , was maybe just because i was cold as i had my ceiling fan on and fell asleep . i had cramps when i woke up in both legs right here . um i drank pickle juice and it went right away . | D2N025 | 5 | [
"Personal History"
] | [
"Subjective"
] | you ever get leg or finger cramps or anything like that ? | 689 |
doctor: well do n't , do n't get crazy with the pickle juice because all of the salt in it . patient: haha , i know , i only drink about 4 ounces or so . | D2N025 | 6 | [
"Chitchat"
] | [
"Null"
] | well do n't , do n't get crazy with the pickle juice because all of the salt in it . | 690 |
doctor: okay good . patient: um it went away so i did n't drink anymore . i find it works a lot better than trying to put some cream on my leg . | D2N025 | 7 | [
"Chitchat"
] | [
"Null"
] | okay good . | 691 |
doctor: sure just , just keep it in moderation . patient: okay . | D2N025 | 8 | [
"Chitchat"
] | [
"Null"
] | sure just , just keep it in moderation . | 692 |
doctor: and then are you still on an iron supplement ? and are you using the bathroom okay ? patient: uh yes , everything is good . | D2N025 | 9 | [
"Therapeutic History",
"Vegetative History"
] | [
"Subjective"
] | and then are you still on an iron supplement ? and are you using the bathroom okay ? | 693 |
doctor: good . how is your heart burn doing ? any problems with that ? patient: no , it did get bad for a while so i tried to take some prilosec and then stopped that other one . | D2N025 | 10 | [
"Personal History"
] | [
"Subjective"
] | good . how is your heart burn doing ? any problems with that ? | 694 |
doctor: great . patient: um and after i stopped taking that um i went back to the stomach one , so i'm doing good now . | D2N025 | 12 | [
"Personal History"
] | [
"Subjective"
] | great . | 695 |
doctor: okay and you're still due for a colonoscopy , correct ? patient: uh yeah , that's right . | D2N025 | 13 | [
"Personal History"
] | [
"Subjective"
] | okay and you're still due for a colonoscopy , correct ? | 696 |
doctor: all right , let's review your blood work real quick . i checked your hemoglobin level because you have had some anemia in the past but that is still doing great . patient: good , that's a relief to hear . | D2N025 | 14 | [
"Lab Examination"
] | [
"Objective"
] | all right , let's review your blood work real quick . i checked your hemoglobin level because you have had some anemia in the past but that is still doing great . | 697 |
doctor: your potassium is 3.9 so it's holding steady on the torsemide . your creatinine was .7 not .8 so you're doing well with kidney numbers . your bun may be a tiny bit elevated at 23 which is the number we look for for dehydration sometimes the kidneys , but it's not terrible . um so when i look at your numbers as a whole i think you're tolerating the torsemide okay at the current dose . i also sent out to look at the heart failure number- i sent to look at your heart failure number . there is a test called a bmp that i was monitoring and in march it was up to 3,000 and then went up to 6,000 in april before i made the change . i'm still waiting for those results . patient: okay . | D2N025 | 15 | [
"Lab Examination"
] | [
"Objective"
] | your potassium is 3.9 so it's holding steady on the torsemide . your creatinine was .7 not .8 so you're doing well with kidney numbers . your bun may be a tiny bit elevated at 23 which is the number we look for for dehydration sometimes the kidneys , but it's not terrible . um so when i look at your numbers as a whole i think you're tolerating the torsemide okay at the current dose . i also sent out to look at the heart failure number- i sent to look at your heart failure number . there is a test called a bmp that i was monitoring and in march it was up to 3,000 and then went up to 6,000 in april before i made the change . i'm still waiting for those results . | 698 |
doctor: all in all i think you're doing good on paper though . patient: what about , um what's it called , a1c ? does that show up ? | D2N025 | 16 | [
"Lab Examination"
] | [
"Objective"
] | all in all i think you're doing good on paper though . | 699 |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.