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|---|---|---|---|---|---|---|
doctor: well , come have a seat here and lay back so i can examine you . patient: okay . | D2N028 | 26 | [
"Physical Examination"
] | [
"Objective"
] | well , come have a seat here and lay back so i can examine you . | 800 |
doctor: i'm gon na start by listening to your belly with my steth- stethoscope . and i hear bowel sounds in all four quadrants . patient: what does that mean ? is everything okay ? | D2N028 | 27 | [
"Physical Examination"
] | [
"Objective"
] | i'm gon na start by listening to your belly with my steth- stethoscope . and i hear bowel sounds in all four quadrants . | 801 |
doctor: it just means that i can hear little noises in all areas of your belly , which means your bowels are active and working . patient: okay , good . | D2N028 | 28 | [
"Physical Examination"
] | [
"Objective"
] | it just means that i can hear little noises in all areas of your belly , which means your bowels are active and working . | 802 |
doctor: so now , i'm going to push on your upper and lower abdomen . let me know if you have any pain . patient: it hurts a little when you push right there on the left side , near my belly button . | D2N028 | 29 | [
"Physical Examination"
] | [
"Objective"
] | so now , i'm going to push on your upper and lower abdomen . let me know if you have any pain . | 803 |
doctor: okay . i do feel stool in your lower colon , which would coincide with constipation , but i also feel a slight enlargement of your liver here on the upper right side . have you had any lab work done recently ? patient: yes , i have a physical about four months ago and they ... i had blood drawn then . | D2N028 | 30 | [
"Physical Examination"
] | [
"Objective"
] | okay . i do feel stool in your lower colon , which would coincide with constipation , but i also feel a slight enlargement of your liver here on the upper right side . have you had any lab work done recently ? | 804 |
doctor: okay . and did your primary care physician say anything about the lab results ? patient: he said i had some very slightly elevated liver enzymes , but we would recheck them in about six months . | D2N028 | 31 | [
"Lab Examination"
] | [
"Objective"
] | okay . and did your primary care physician say anything about the lab results ? | 805 |
doctor: and you remember what enzymes were elevated , alt , ast , alp ? patient: he said the alt and the ast were elevated . | D2N028 | 32 | [
"Lab Examination"
] | [
"Objective"
] | and you remember what enzymes were elevated , alt , ast , alp ? | 806 |
doctor: and do you take any medications , either prescription or over-the-counter ? patient: i take crestor and olmesartan daily and then tylenol for occasion- occasional pain . | D2N028 | 33 | [
"Therapeutic History"
] | [
"Subjective"
] | and do you take any medications , either prescription or over-the-counter ? | 807 |
doctor: and how frequently do you take the tylenol ? patient: hardly ever . maybe once a month . | D2N028 | 34 | [
"Therapeutic History"
] | [
"Subjective"
] | and how frequently do you take the tylenol ? | 808 |
doctor: and do you consume alcohol ? patient: uh , yes , but only a couple of beers after working in the yard on saturdays . | D2N028 | 35 | [
"Drug History"
] | [
"Subjective"
] | and do you consume alcohol ? | 809 |
doctor: okay . and no previous history of heavy alcohol or drug use ? patient: nope . | D2N028 | 36 | [
"Drug History"
] | [
"Subjective"
] | okay . and no previous history of heavy alcohol or drug use ? | 810 |
doctor: and have you had any recent issues with excessive bruising or bleeding ? patient: nope . | D2N028 | 37 | [
"Personal History"
] | [
"Subjective"
] | and have you had any recent issues with excessive bruising or bleeding ? | 811 |
doctor: and how about any issues with your ankles or feet swelling ? patient: no . | D2N028 | 38 | [
"Personal History"
] | [
"Subjective"
] | and how about any issues with your ankles or feet swelling ? | 812 |
doctor: okay . i'm gon na take a look at your eyes and skin . i do n't see any jaundice . patient: what would cause that ? | D2N028 | 39 | [
"Physical Examination"
] | [
"Objective"
] | okay . i'm gon na take a look at your eyes and skin . i do n't see any jaundice . | 813 |
doctor: issues with your liver . let me take a quick listen to your heart and lungs . patient: okay . | D2N028 | 40 | [
"Physical Examination"
] | [
"Objective"
] | issues with your liver . let me take a quick listen to your heart and lungs . | 814 |
doctor: lungs are clear , bilateral heart sounds are normal , no murmurs , gallops , or rubs noted . patient: that's good . | D2N028 | 41 | [
"Physical Examination"
] | [
"Objective"
] | lungs are clear , bilateral heart sounds are normal , no murmurs , gallops , or rubs noted . | 815 |
doctor: yes . the rest of your physical exam is normal other than what seems to be an increased stool burden in your colon and a slight hepatomegaly . patient: what's that ? | D2N028 | 42 | [
"Physical Examination"
] | [
"Objective"
] | yes . the rest of your physical exam is normal other than what seems to be an increased stool burden in your colon and a slight hepatomegaly . | 816 |
doctor: increase stool burden means that there's a lot of stool sitting in your colon . patient: and that's the constipation , right ? but what about the other thing ? | D2N028 | 43 | [
"Physical Examination"
] | [
"Objective"
] | increase stool burden means that there's a lot of stool sitting in your colon . | 817 |
doctor: the hepatomegaly means the liver is enlarged . patient: but you said mine was slightly enlarged ? | D2N028 | 44 | [
"Physical Examination"
] | [
"Objective"
] | the hepatomegaly means the liver is enlarged . | 818 |
doctor: correct . patient: so what does that mean ? | D2N028 | 45 | [
"Physical Examination"
] | [
"Objective"
] | correct . | 819 |
doctor: well , let's talk about what we found and then some possible next steps if you're in agreement . patient: okay . | D2N028 | 46 | [
"Chitchat"
] | [
"Null"
] | well , let's talk about what we found and then some possible next steps if you're in agreement . | 820 |
doctor: so as i said , the hepatomegaly means your liver is enlarged . patient: could that be why my stomach is hurting and i'm having issues with the constipation and diarrhea ? | D2N028 | 47 | [
"Acute Assessment"
] | [
"Assessment"
] | so as i said , the hepatomegaly means your liver is enlarged . | 821 |
doctor: no , i think you're constipated and have occasional bouts of diarrhea because of certain foods you eat . and we can get you started right away on a fiber supplement that should help with that . patient: so what about my liver ? why is it enlarged ? | D2N028 | 48 | [
"Medication",
"Acute Assessment"
] | [
"Assessment",
"Plan"
] | no , i think you're constipated and have occasional bouts of diarrhea because of certain foods you eat . and we can get you started right away on a fiber supplement that should help with that . | 822 |
doctor: well , there are many reasons why people can have an elevated liver enzymes and also enlarged liver . some possible causes are certain medications that can be toxic to liver , alcohol abuse , fatty liver disease , hepatitis , cirrhosis , and other liver diseases like wilson's disease . patient: so what do i nee... | D2N028 | 49 | [
"Discussion",
"Drug History"
] | [
"Plan"
] | well , there are many reasons why people can have an elevated liver enzymes and also enlarged liver . some possible causes are certain medications that can be toxic to liver , alcohol abuse , fatty liver disease , hepatitis , cirrhosis , and other liver diseases like wilson's disease . | 823 |
doctor: well , i think since it's been about four months since your blood work was done , we should check your liver enzymes in addition to a few other labs . patient: okay . and then what ? | D2N028 | 50 | [
"Discussion",
"Diagnostic Testing"
] | [
"Plan"
] | well , i think since it's been about four months since your blood work was done , we should check your liver enzymes in addition to a few other labs . | 824 |
doctor: we will get those drawn today and then depending upon the results you may need an ultrasound of your liver . i think we need to talk about your medications too . patient: which medications ? | D2N028 | 51 | [
"Discussion"
] | [
"Plan"
] | we will get those drawn today and then depending upon the results you may need an ultrasound of your liver . i think we need to talk about your medications too . | 825 |
doctor: crestor , how long have you been taking that ? patient: about 18 months . | D2N028 | 52 | [
"Discussion",
"Medication",
"Therapeutic History"
] | [
"Subjective",
"Plan"
] | crestor , how long have you been taking that ? | 826 |
doctor: okay . well , crestor is one of the medications that can cause liver toxicity so it may be a good idea to discuss other alternatives . patient: should i talk to my primary care or can you change it ? | D2N028 | 53 | [
"Discussion",
"Medication"
] | [
"Plan"
] | okay . well , crestor is one of the medications that can cause liver toxicity so it may be a good idea to discuss other alternatives . | 827 |
doctor: i would recommend calling your primary care and discuss that with him since he follows you for your blood pressure and cholesterol . patient: okay . i'll call him this afternoon . | D2N028 | 54 | [
"Discussion"
] | [
"Plan"
] | i would recommend calling your primary care and discuss that with him since he follows you for your blood pressure and cholesterol . | 828 |
doctor: great . i also think we should go ahead and get you scheduled for a liver ultrasound . if your blood work looks good , then we can always cancel that . patient: okay . when do you think i'll be able to get the ultrasound done ? | D2N028 | 55 | [
"Diagnostic Testing"
] | [
"Plan"
] | great . i also think we should go ahead and get you scheduled for a liver ultrasound . if your blood work looks good , then we can always cancel that . | 829 |
doctor: hopefully , within the next two weeks . you will receive a call from the radiology scheduling this afternoon to get it set up . patient: okay . and then what happens ? | D2N028 | 56 | [
"Discussion"
] | [
"Plan"
] | hopefully , within the next two weeks . you will receive a call from the radiology scheduling this afternoon to get it set up . | 830 |
doctor: when i get the results from the test , i will contact you . and depending upon what we find , we'll come up with our next steps . patient: and when should i see you again ? | D2N028 | 57 | [
"Discussion"
] | [
"Plan"
] | when i get the results from the test , i will contact you . and depending upon what we find , we'll come up with our next steps . | 831 |
doctor: uh , let's schedule an appointment when you check out to return in four weeks . we'll discuss how you're doing with the fiber supplement and your constipation and review test results to determine if we need to do further testing on your liver . patient: okay . is there anything else i can do to help with these ... | D2N028 | 58 | [
"Follow-up",
"Diagnostic Testing"
] | [
"Plan"
] | uh , let's schedule an appointment when you check out to return in four weeks . we'll discuss how you're doing with the fiber supplement and your constipation and review test results to determine if we need to do further testing on your liver . | 832 |
doctor: definitely refrain from drinking any alcohol , increase your water intake to at least 48 ounces a day in addition to taking the fiber supplement to help with your constipation . and be mindful of eating foods that you were sensitive to so you can avoid the bouts of diarrhea . patient: okay . and i'll talk to my... | D2N028 | 59 | [
"Medication",
"Other Treatments",
"Drug History"
] | [
"Plan"
] | definitely refrain from drinking any alcohol , increase your water intake to at least 48 ounces a day in addition to taking the fiber supplement to help with your constipation . and be mindful of eating foods that you were sensitive to so you can avoid the bouts of diarrhea . | 833 |
doctor: excellent . and do you have any other questions for me ? patient: i do n't think so . | D2N028 | 60 | [
"Chitchat"
] | [
"Null"
] | excellent . and do you have any other questions for me ? | 834 |
doctor: great . so remember when you check out the front desk , schedule follow-up appointment with me for four weeks and then go to the lab to get your blood work drawn . patient: okay . sounds good . | D2N028 | 61 | [
"Follow-up",
"Diagnostic Testing"
] | [
"Plan"
] | great . so remember when you check out the front desk , schedule follow-up appointment with me for four weeks and then go to the lab to get your blood work drawn . | 835 |
doctor: and expect a call from radiology scheduling about setting up your ultrasound . patient: all right . thanks , dr. edwards . | D2N028 | 62 | [
"Diagnostic Testing"
] | [
"Plan"
] | and expect a call from radiology scheduling about setting up your ultrasound . | 836 |
doctor: thank you , mr. allen . | D2N028 | 63 | [
"Chitchat"
] | [
"Null"
] | doctor: thank you , mr. allen . | 837 |
doctor: next patient is sophia jackson , mrnr472348 . she's a 57 year old female who is here for a surgical consult . her dermatologist referred her . she biopsied a 0.7 millimeter lesion which was located on right inferior back . pathology came back as melanoma . mrs. jackson , it's good to meet you . patient: likewis... | D2N029 | 0 | [
"Personal History",
"Greetings"
] | [
"Subjective"
] | next patient is sophia jackson , mrnr472348 . she's a 57 year old female who is here for a surgical consult . her dermatologist referred her . she biopsied a 0.7 millimeter lesion which was located on right inferior back . pathology came back as melanoma . mrs. jackson , it's good to meet you . | 838 |
doctor: yeah , i hear your dermatologist sent you to me 'cause she found a melanoma ? patient: yes , that's what the biopsy said . | D2N029 | 1 | [
"Personal History"
] | [
"Subjective"
] | yeah , i hear your dermatologist sent you to me 'cause she found a melanoma ? | 839 |
doctor: okay and when did you first notice the spot ? patient: my mom noticed it when i was visiting her last month . | D2N029 | 2 | [
"Personal History"
] | [
"Subjective"
] | okay and when did you first notice the spot ? | 840 |
doctor: i see . and so you went to the dermatologist on april 10th to get it checked out , right ? patient: yes , i wanted to be extra cautious because skin cancer does run in my family . | D2N029 | 3 | [
"Personal History"
] | [
"Subjective"
] | i see . and so you went to the dermatologist on april 10th to get it checked out , right ? | 841 |
doctor: well i'm really glad you took it seriously and got it checked . who in your family has had skin cancer , and do you know if it was melanoma or was it basal cell or squamous cell ? patient: my mom and her sister , i think they both had melanoma . | D2N029 | 4 | [
"Family History"
] | [
"Subjective"
] | well i'm really glad you took it seriously and got it checked . who in your family has had skin cancer , and do you know if it was melanoma or was it basal cell or squamous cell ? | 842 |
doctor: okay . do you have any other types of cancer in the family , like breast or ovarian ? patient: my grandfather had pancreatic cancer . | D2N029 | 5 | [
"Family History"
] | [
"Subjective"
] | okay . do you have any other types of cancer in the family , like breast or ovarian ? | 843 |
doctor: okay , and was that your mom or dad's father ? patient: mother's . | D2N029 | 6 | [
"Family History"
] | [
"Subjective"
] | okay , and was that your mom or dad's father ? | 844 |
doctor: okay . and , um , have you personally had any skin spots in the past that you got checked out and they were cancerous or precancerous ? patient: no , this was the first time i've been to a dermatologist . um , but my primary care doctor looks over all of my moles every year at my physical and has n't said , um ... | D2N029 | 7 | [
"Personal History"
] | [
"Subjective"
] | okay . and , um , have you personally had any skin spots in the past that you got checked out and they were cancerous or precancerous ? | 845 |
doctor: good- good . uh , let's go over your medical history from your chart . i have that you're not taking any medications and do n't have any health problems listed , but that you're allergic to augmentin , is that right ? patient: yes , that's correct . | D2N029 | 8 | [
"Personal History",
"Therapeutic History"
] | [
"Subjective"
] | good- good . uh , let's go over your medical history from your chart . i have that you're not taking any medications and do n't have any health problems listed , but that you're allergic to augmentin , is that right ? | 846 |
doctor: okay , and for social history can you tell me what you do for work ? patient: i own an auto repair shop . | D2N029 | 9 | [
"Other Socials"
] | [
"Subjective"
] | okay , and for social history can you tell me what you do for work ? | 847 |
doctor: okay and have you ever been a smoker ? patient: yeah , i still smoke from time to time . i started that awful habit in my teens and it's hard to break , but i'm trying . | D2N029 | 10 | [
"Vegetative History"
] | [
"Subjective"
] | okay and have you ever been a smoker ? | 848 |
doctor: i'm glad you're trying to quit . uh , what about your surgical history , have you had any surgeries ? patient: i had gall bladder and appendix . | D2N029 | 11 | [
"Personal History"
] | [
"Subjective"
] | i'm glad you're trying to quit . uh , what about your surgical history , have you had any surgeries ? | 849 |
doctor: okay , great , we can get your chart up to date now , thank you . and other than the melanoma , how has your health been , any unintentional weight changes , headaches , fatigue , nausea , vomiting , vision changes ? patient: no , i've been feelin' great . | D2N029 | 12 | [
"Personal History",
"Vegetative History"
] | [
"Subjective"
] | okay , great , we can get your chart up to date now , thank you . and other than the melanoma , how has your health been , any unintentional weight changes , headaches , fatigue , nausea , vomiting , vision changes ? | 850 |
doctor: good . well let me take a look at your back here where they did the biopsy if you do n't mind . patient: sure . | D2N029 | 13 | [
"Physical Examination"
] | [
"Objective"
] | good . well let me take a look at your back here where they did the biopsy if you do n't mind . | 851 |
doctor: okay , i'm gon na describe it in medical jargon what i'm seeing here , so that the recording can capture it , but you and i are gon na go over it together in just a moment , okay ? patient: okay , that's fine . | D2N029 | 14 | [
"Chitchat"
] | [
"Null"
] | okay , i'm gon na describe it in medical jargon what i'm seeing here , so that the recording can capture it , but you and i are gon na go over it together in just a moment , okay ? | 852 |
doctor: all right , so on the right inferior back there's a one centimeter shave biopsy site , including all of the dermis with no residual pigmentation . there's no intrinsic or satellite lesions , no other suspicious moles , no axillary , cervical , or supraclavicular lymphadenopathy . there is a soft lymph node in t... | D2N029 | 15 | [
"Physical Examination",
"Diagnostic Testing"
] | [
"Objective",
"Plan"
] | all right , so on the right inferior back there's a one centimeter shave biopsy site , including all of the dermis with no residual pigmentation . there's no intrinsic or satellite lesions , no other suspicious moles , no axillary , cervical , or supraclavicular lymphadenopathy . there is a soft lymph node in the right... | 853 |
doctor: no , i have a low suspicion that it will show anything . patient: okay , good . | D2N029 | 16 | [
"Discussion",
"Diagnostic Testing"
] | [
"Plan"
] | no , i have a low suspicion that it will show anything . | 854 |
doctor: so assuming that the ultrasound is normal , the treatment for you melanoma is to cut out the area where the lesion was . with lesions that are 0.7 millimeters or less , um , and that's what we recommend , and yours was exactly 0.7 millimeters . if it were any bigger , we would have had to do a more complex surg... | D2N029 | 17 | [
"Other Treatments"
] | [
"Plan"
] | so assuming that the ultrasound is normal , the treatment for you melanoma is to cut out the area where the lesion was . with lesions that are 0.7 millimeters or less , um , and that's what we recommend , and yours was exactly 0.7 millimeters . if it were any bigger , we would have had to do a more complex surgery . bu... | 855 |
doctor: yeah , your wife can tell you what it looks like and she may need to help care for the incision at it , as it heals . um , but since we're , we are n't doing the more complex surgery , i actually do n't need to see you back unless you want to check in with me or have any problems . however , it is very importan... | D2N029 | 18 | [
"Discussion",
"Follow-up"
] | [
"Plan"
] | yeah , your wife can tell you what it looks like and she may need to help care for the incision at it , as it heals . um , but since we're , we are n't doing the more complex surgery , i actually do n't need to see you back unless you want to check in with me or have any problems . however , it is very important that y... | 856 |
doctor: good , and i'm sure she's already told you , but it's very important that you apply sunscreen anytime and anywhere that your skin is exposed to sunlight . patient: yeah , she definitely went over that , um , several times with me . | D2N029 | 19 | [
"Medication"
] | [
"Plan"
] | good , and i'm sure she's already told you , but it's very important that you apply sunscreen anytime and anywhere that your skin is exposed to sunlight . | 857 |
doctor: good . other than that , i think that's all for me . um , we'll get you set up for the ultrasound , the procedure . do you have any questions for me ? patient: um , no i ca n't think of any at this time . | D2N029 | 20 | [
"Diagnostic Testing"
] | [
"Plan"
] | good . other than that , i think that's all for me . um , we'll get you set up for the ultrasound , the procedure . do you have any questions for me ? | 858 |
doctor: okay , my nurse will be in to get you scheduled , so sit tight . it was very good to meet you . patient: thank you , nice to meet you as well . | D2N029 | 21 | [
"Chitchat"
] | [
"Null"
] | okay , my nurse will be in to get you scheduled , so sit tight . it was very good to meet you . | 859 |
doctor: please add the following pathology r- , to results . a pathology , shave of right inferior back , malignant melanoma , invasive , superficial spreading . histology , superficial spreading . clark level 4 , breslow thickness 0.7 millimeters , radial growth phase present , vertical growth phase not identified . m... | D2N029 | 22 | [
"Physical Examination",
"Diagnostic Testing",
"Acute Assessment",
"Other Treatments"
] | [
"Objective",
"Assessment",
"Plan"
] | doctor: please add the following pathology r- , to results . a pathology , shave of right inferior back , malignant melanoma , invasive , superficial spreading . histology , superficial spreading . clark level 4 , breslow thickness 0.7 millimeters , radial growth phase present , vertical growth phase not identified . m... | 860 |
doctor: donna torres , date of birth , 08/01/1980 . hi donna ! how are you ? patient: i'm good . how about you ? | D2N030 | 0 | [
"Personal History",
"Greetings"
] | [
"Subjective"
] | donna torres , date of birth , 08/01/1980 . hi donna ! how are you ? | 861 |
doctor: i'm doing well , thank you . and so , i saw that dr. brown put you on buspar . have you been on that before ? patient: no , that's new . | D2N030 | 1 | [
"Therapeutic History"
] | [
"Subjective"
] | i'm doing well , thank you . and so , i saw that dr. brown put you on buspar . have you been on that before ? | 862 |
doctor: okay . how is it working for you ? patient: my anxiety is going good now , thankfully . i'm serious , it was brutal in november and december . finally , i was like , " i can not do this . " i have no idea why it happened . dr. ward did put me on singulair , and she did say we need to be careful because singulai... | D2N030 | 2 | [
"Personal History",
"Therapeutic History"
] | [
"Subjective"
] | okay . how is it working for you ? | 863 |
doctor: mm . okay . patient: and it would , um , start usually during the day , at work . | D2N030 | 3 | [
"Personal History"
] | [
"Subjective"
] | mm . okay . | 864 |
doctor: well , that's good , that things have settled . i do wonder if some of what you are dealing with is hormonal , and that's why i was asking . 'cause you were on the progesterone , and i feel like you were having some irritability back then too . patient: i did . | D2N030 | 5 | [
"Therapeutic History"
] | [
"Subjective"
] | well , that's good , that things have settled . i do wonder if some of what you are dealing with is hormonal , and that's why i was asking . 'cause you were on the progesterone , and i feel like you were having some irritability back then too . | 865 |
doctor: and that was before we started the progesterone . patient: yes . | D2N030 | 6 | [
"Personal History"
] | [
"Subjective"
] | and that was before we started the progesterone . | 866 |
doctor: so i know we started it for regulating your periods , but perhaps it helped with this also . patient: yeah . and before , in november and december , i noticed that the week before my period , my anxiety would go through the roof . which then , i knew my period was coming . then it turned into my anxiety spiking... | D2N030 | 7 | [
"Personal History"
] | [
"Subjective"
] | so i know we started it for regulating your periods , but perhaps it helped with this also . | 867 |
doctor: hmm , okay . patient: and it seemed like it was for no reason . | D2N030 | 8 | [
"Personal History"
] | [
"Subjective"
] | hmm , okay . | 868 |
doctor: but november and december you were on the progesterone at that time . patient: yes . | D2N030 | 9 | [
"Personal History",
"Therapeutic History"
] | [
"Subjective"
] | but november and december you were on the progesterone at that time . | 869 |
doctor: all right . so not really a link there , all right . patient: yeah , i do n't know . | D2N030 | 10 | [
"Personal History"
] | [
"Subjective"
] | all right . so not really a link there , all right . | 870 |
doctor: yeah , i do n't know either . um , sometimes with the aging process , that can happen too . patient: i figured maybe that's what it was . | D2N030 | 11 | [
"Personal History"
] | [
"Subjective"
] | yeah , i do n't know either . um , sometimes with the aging process , that can happen too . | 871 |
doctor: and we did go through the golive in november and december , so that can be pretty stressful also . patient: yeah , and at work , that's when i first started to lead the process of delivering the results to patients with covid . in the beginning of the whole pandemic , patients would have to wait nine days befor... | D2N030 | 12 | [
"Personal History",
"Other Socials"
] | [
"Subjective"
] | and we did go through the golive in november and december , so that can be pretty stressful also . | 872 |
doctor: yeah , i can absolutely see that . patient: yeah , and then i was feeling selfish because i was n't even on the front lines . i mean , i was supporting people , sure , but i was n't in the icu . so i felt selfish and guilty . i mean , hands down , the physicians and nurses were in the thick of it and there i wa... | D2N030 | 13 | [
"Other Socials"
] | [
"Subjective"
] | yeah , i can absolutely see that . | 873 |
doctor: well , honestly , you feel how you feel and what you were doing was n't easy as well , so ... but let's see . i need to just put this dax back to work . all right , so no other issues whatsoever ? patient: no . | D2N030 | 14 | [
"Acute Symptoms"
] | [
"Subjective"
] | well , honestly , you feel how you feel and what you were doing was n't easy as well , so ... but let's see . i need to just put this dax back to work . all right , so no other issues whatsoever ? | 874 |
doctor: have you lost weight ? patient: no , but i stopped taking the camila birth control . my hunger level was at a new high . i mean , i was eating constantly . i felt like , " what is going on ? " | D2N030 | 15 | [
"Acute Symptoms",
"Vegetative History"
] | [
"Subjective"
] | have you lost weight ? | 875 |
doctor: all right . patient: and now i am feeling better . | D2N030 | 16 | [
"Acute Symptoms"
] | [
"Subjective"
] | all right . | 876 |
doctor: okay , that's good . and your masked face , though , it does look thinner . patient: well , the past six months i have lost some weight . | D2N030 | 17 | [
"Acute Symptoms"
] | [
"Subjective"
] | okay , that's good . and your masked face , though , it does look thinner . | 877 |
doctor: okay , good . um , anything else going on ? patient: no . | D2N030 | 18 | [
"Acute Symptoms"
] | [
"Subjective"
] | okay , good . um , anything else going on ? | 878 |
doctor: all right . so your pap was in 2019 . i do n't think that we need to repeat that because it was negative/negative . um , have you ever had an abnormal pap ? patient: not with you , but i did around 2009 , and then i had to be seen every six months for a while . and then i had a normal pap . | D2N030 | 19 | [
"Personal History"
] | [
"Subjective"
] | all right . so your pap was in 2019 . i do n't think that we need to repeat that because it was negative/negative . um , have you ever had an abnormal pap ? | 879 |
doctor: all right , well , let's just repeat it then . patient: yeah , that's fine with me , to be safe . | D2N030 | 20 | [
"Diagnostic Testing"
] | [
"Plan"
] | all right , well , let's just repeat it then . | 880 |
doctor: okay . i know it sounds superstitious , but i feel like with all the immunocompromising , the pressure , the stress that people's bodies have been under , and the potential for getting covid or the vaccine ... i have actually seen some , um , an increase in abnormal paps in people who have been fine for a while... | D2N030 | 21 | [
"Discussion",
"Diagnostic Testing"
] | [
"Plan"
] | okay . i know it sounds superstitious , but i feel like with all the immunocompromising , the pressure , the stress that people's bodies have been under , and the potential for getting covid or the vaccine ... i have actually seen some , um , an increase in abnormal paps in people who have been fine for a while . so th... | 881 |
doctor: have you had the vaccine ? patient: yes , i have . and so has my son . he , um , has had his first already . | D2N030 | 22 | [
"Therapeutic History"
] | [
"Subjective"
] | have you had the vaccine ? | 882 |
doctor: okay . well , you know , you can only do what you can do . patient: yeah , i agree . | D2N030 | 23 | [
"Chitchat"
] | [
"Null"
] | okay . well , you know , you can only do what you can do . | 883 |
doctor: all right . well , let's complete your exam . patient: all right . | D2N030 | 24 | [
"Chitchat"
] | [
"Null"
] | all right . well , let's complete your exam . | 884 |
doctor: so let's take a deep breath . and again . all right , you can breathe normally . all right , and take one more deep breath . okay , now i'm gon na touch your neck . go ahead and swallow . perfect . and just place your hand above your head . okay , i do feel some little bumps . patient: yeah , but they're not as... | D2N030 | 25 | [
"Physical Examination"
] | [
"Objective"
] | so let's take a deep breath . and again . all right , you can breathe normally . all right , and take one more deep breath . okay , now i'm gon na touch your neck . go ahead and swallow . perfect . and just place your hand above your head . okay , i do feel some little bumps . | 885 |
doctor: mm-hmm . okay , in this breast it does feel a little bit denser . does it hurt at all ? patient: it does , where your left hand just was . | D2N030 | 26 | [
"Physical Examination"
] | [
"Objective"
] | mm-hmm . okay , in this breast it does feel a little bit denser . does it hurt at all ? | 886 |
doctor: okay , right here ? patient: yeah , down here . but whenever i breastfed , it was always sore there too . i had a clog and something else . the lumps do feel smaller , but they are still there , unfortunately . | D2N030 | 27 | [
"Physical Examination"
] | [
"Objective"
] | okay , right here ? | 887 |
doctor: yeah , they are . uh , well now i do n't know , because if it was the progesterone , they would've gone away . patient: yeah . | D2N030 | 28 | [
"Physical Examination"
] | [
"Objective"
] | yeah , they are . uh , well now i do n't know , because if it was the progesterone , they would've gone away . | 888 |
doctor: all right , well just let your knees just op- relax and open . how's the itching or discomfort ? are you still using the cream ? patient: yes , and i actually need to get that refilled for the first time ever . | D2N030 | 29 | [
"Physical Examination",
"Therapeutic History"
] | [
"Subjective",
"Objective"
] | all right , well just let your knees just op- relax and open . how's the itching or discomfort ? are you still using the cream ? | 889 |
doctor: okay , great . all right , looks good . patient: good . | D2N030 | 31 | [
"Physical Examination"
] | [
"Objective"
] | okay , great . all right , looks good . | 890 |
doctor: you can go ahead and sit up . patient: thank you . | D2N030 | 32 | [
"Physical Examination"
] | [
"Objective"
] | you can go ahead and sit up . | 891 |
doctor: all right , so typically the lumps would often just shrink up pretty quickly after you've had one or two cycles , and you've had two cycles so far . so i think let's just keep monitoring them for now . patient: okay . and what could that mean ? | D2N030 | 33 | [
"Discussion"
] | [
"Assessment",
"Plan"
] | all right , so typically the lumps would often just shrink up pretty quickly after you've had one or two cycles , and you've had two cycles so far . so i think let's just keep monitoring them for now . | 892 |
doctor: well , so just like people have an increased risk of breast cancer , there's also an increased risk for breast issues . you know what i mean ? so for example , cysts and lumps and fibroadenomas , those are all benign things . they're annoying and require some workup , but they're all benign . patient: and i'm- ... | D2N030 | 34 | [
"Discussion"
] | [
"Plan"
] | well , so just like people have an increased risk of breast cancer , there's also an increased risk for breast issues . you know what i mean ? so for example , cysts and lumps and fibroadenomas , those are all benign things . they're annoying and require some workup , but they're all benign . | 893 |
doctor: well , i would n't say that . i mean , i feel like we're at a point where we have a good cadence for you having surveillance on things , and i think you are more aware of your breasts than ever before , and things actually have n't changed . patient: yeah . | D2N030 | 35 | [
"Discussion"
] | [
"Plan"
] | well , i would n't say that . i mean , i feel like we're at a point where we have a good cadence for you having surveillance on things , and i think you are more aware of your breasts than ever before , and things actually have n't changed . | 894 |
doctor: so those are all good things . patient: okay . | D2N030 | 36 | [
"Discussion"
] | [
"Plan"
] | so those are all good things . | 895 |
doctor: because , um , if it was cancer , we'd actually , we would see some change . patient: we would ? okay , thank you for explaining that . | D2N030 | 37 | [
"Discussion"
] | [
"Plan"
] | because , um , if it was cancer , we'd actually , we would see some change . | 896 |
doctor: yeah . so i know it's annoying and distressing , but i think that's where we're at . it's annoying that you have the breast issue , and it's annoying that we have to follow them . patient: yeah , i agree there . | D2N030 | 38 | [
"Discussion"
] | [
"Plan"
] | yeah . so i know it's annoying and distressing , but i think that's where we're at . it's annoying that you have the breast issue , and it's annoying that we have to follow them . | 897 |
doctor: um , but the only extra that i could po- , uh , potentially do , is we could get a breast specialist on the team and have you start to follow with them . and one of the advantages there is that they sometimes will do an ultrasound as an extension of their physical exam , in the office , to check out it- check i... | D2N030 | 39 | [
"Diagnostic Testing"
] | [
"Plan"
] | um , but the only extra that i could po- , uh , potentially do , is we could get a breast specialist on the team and have you start to follow with them . and one of the advantages there is that they sometimes will do an ultrasound as an extension of their physical exam , in the office , to check out it- check it out on... | 898 |
doctor: all right . well , i think since you're feeling worried , let's go ahead and we can get them on board . i'll send out a referral and they will call you within the next couple of business days to schedule . patient: okay , i think that sounds great . | D2N030 | 40 | [
"Follow-up"
] | [
"Plan"
] | all right . well , i think since you're feeling worried , let's go ahead and we can get them on board . i'll send out a referral and they will call you within the next couple of business days to schedule . | 899 |
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