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med_intent_classification

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so let's also look here you have a history of diabetes and so you're on that five hundred milligrams of metformin daily now have you been taking that as well
[ "Personal History", "Therapeutic History" ]
[ "Subjective" ]
2,400
okay alright so let's talk a little bit about that now i know that you have a history of coronary disease you know you had had a heart attack back in twenty eighteen we put that stent in your right coronary artery i know that the pumping function of your heart was a little low you know that what we call that ejection fraction was about thirty five percent have you been watching your salt intake
[ "Personal History" ]
[ "Subjective" ]
2,401
can you get what now
[ "Discussion", "Medication" ]
[ "Plan" ]
2,402
yeah if you if you stop walking the chest pain goes away you do n't have to take the pill but if you are walking or you stop and the chest pain does not go away i would take the pill and see if it goes away if it does not
[ "Discussion", "Medication" ]
[ "Plan" ]
2,403
okay are you taking what's that
[ "Personal History" ]
[ "Subjective" ]
2,404
every other day okay so i do see that you know the nurse took your your vital signs this morning that your blood pressure is running quite a bit high it was like one seventy two over ninety eight so that's that's really a little higher than where we want it to be especially that you're on your medication but what we're gon na do is we're gon na take i'm gon na take a look at you real quick and then we can discuss you know maybe there's some changes that we can do in terms of your current regimen how about diet and your have you been sticking with that low sodium diet at all
[ "Physical Examination", "Personal History" ]
[ "Subjective", "Objective" ]
2,405
good , good . and the vision is better with the cataract surgery ? that's been good ?
[ "Personal History" ]
[ "Subjective" ]
2,406
okay and have you ever injured your knees before
[ "Personal History" ]
[ "Subjective" ]
2,407
and you still wear the splint only on the right wrist ?
[ "Acute Symptoms", "Personal History" ]
[ "Subjective" ]
2,408
roger is a 62 year old male here for emergency room follow-up for some chest pain . so , roger , i heard you went to the er for some chest discomfort .
[ "Acute Symptoms", "Personal History" ]
[ "Subjective" ]
2,409
it does okay and so you do have some pain on extension and if you pull your your hand wrist up towards you does that cause the pain also
[ "Physical Examination" ]
[ "Objective" ]
2,410
i also am gon na proceed with allergy testing have you ever had an allergy test before
[ "Discussion", "Diagnostic Testing" ]
[ "Plan" ]
2,411
two puffs every four hours as needed for wheezing or for shortness of breath . and , i'd like to go ahead and order a pulmonary referral for you , okay . do you have any questions about that ?
[ "Discussion", "Diagnostic Testing", "Medication" ]
[ "Plan" ]
2,412
i was wondering where you were going to go with that .
[ "Chitchat" ]
[ "Null" ]
2,413
so to review , um , continue using the same face wash , continue with metro cream , and increase the use of doxycycline to twice a day .
[ "Medication" ]
[ "Plan" ]
2,414
and we'll just continue you on the keppra , okay ?
[ "Medication" ]
[ "Plan" ]
2,415
okay . peeing okay ?
[ "Vegetative History" ]
[ "Subjective" ]
2,416
well , my thoughts are that you actually should be vaccinated . i think you are high risk . if you get covid it's not going to be good for you .
[ "Discussion", "Medication" ]
[ "Plan" ]
2,417
all right . that sounds good . all right , well , it's good to see you .
[ "Chitchat" ]
[ "Null" ]
2,418
okay . and then do you feel like your activities are limited because of the size ?
[ "Other Socials" ]
[ "Subjective" ]
2,419
okay and what do you con- consider the same ? are you eating lots of sugar ? like , teas and coffees and-
[ "Personal History", "Vegetative History" ]
[ "Subjective" ]
2,420
little nauseated yeah that's we expected so have you do you have a family history of kidney stones i know some people when they have them like their parents have them stuff but
[ "Family History" ]
[ "Subjective" ]
2,421
okay that's good to hear you mentioned exercise and biking i love to bike myself i've got a track seventy one hundred hybrid have you been on the the new trails they opened it was the old the old rail the old rail road right away they've opened that up it's like sixty miles of trails
[ "Other Socials" ]
[ "Subjective" ]
2,422
okay , and did we set up physical therapy for you last time you were here ?
[ "Discussion", "Referral" ]
[ "Plan" ]
2,423
good . let me take a quick listen to you .
[ "Physical Examination" ]
[ "Objective" ]
2,424
okay . all right . do you ever wake up acutely short of breath at night ?
[ "Vegetative History" ]
[ "Subjective" ]
2,425
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 .
[ "Discussion", "Medication" ]
[ "Plan" ]
2,426
hi richard how are you the medical assistant told me that you have a tick bite is that what happened
[ "Acute Symptoms", "Greetings" ]
[ "Subjective" ]
2,427
gotcha . and did i hear that she gave you some prednisone and some oral steroids , or ?
[ "Therapeutic History" ]
[ "Subjective" ]
2,428
hey dragon . show me the vital signs . so here in the office . i agree . your blood pressure looks good . uh , i think you're doing a good job with that so keep up the good work . i'm gon na go ahead and take a listen to your heart and lungs , i'll let you know what i find .
[ "Physical Examination" ]
[ "Objective" ]
2,429
and when did that happen
[ "Acute Symptoms" ]
[ "Subjective" ]
2,430
lem me go ahead and have you lay back on the table and i'll take a listen to your stomach
[ "Physical Examination" ]
[ "Objective" ]
2,431
your ankle twisted outward and where are you having the most pain is it is it kind of like right on your outer ankle or is it more in your foot
[ "Acute Symptoms" ]
[ "Subjective" ]
2,432
i mean okay so you know what like maybe maybe pamela would be better like we could maybe talk talk about a referral if that would make you more comfortable
[ "Discussion", "Referral" ]
[ "Plan" ]
2,433
okay alright and then do you smoke
[ "Vegetative History" ]
[ "Subjective" ]
2,434
okay that that that that's not good how old are your niece
[ "Other Socials" ]
[ "Subjective" ]
2,435
big toe joint that okay and let me move it up where as i bend it up does that hurt
[ "Physical Examination" ]
[ "Objective" ]
2,436
okay . so , on physical examination , um , you know , everything looks really good . on your heart examination , i do appreciate a slight 2/6 systolic- systolic ejection murmur , um , which we've heard in the past so i'm not worried at that . you're in the- a nice regular rate and rhythm at this time . your lungs are nice and clear . on your right elbow , i do notice some edema and some erythema . does it hurt when i press it ?
[ "Physical Examination" ]
[ "Objective" ]
2,437
mm-hmm .
[ "Acute Symptoms" ]
[ "Subjective" ]
2,438
that is awesome .
[ "Chitchat" ]
[ "Null" ]
2,439
irritable because he is n't feeling good ?
[ "Acute Symptoms" ]
[ "Subjective" ]
2,440
miralax ?
[ "Therapeutic History" ]
[ "Subjective" ]
2,441
i'm going to recommend we give you some motrin , 800 milligrams . uh , you can take it about every six hours , uh , with food . uh , and we'll give you about a two week supply .
[ "Medication" ]
[ "Plan" ]
2,442
okay . great .
[ "Personal History" ]
[ "Subjective" ]
2,443
and we would then lift them and elevate the nipple position in order to help with your back pain , neck pain , and because i'm a plastic surgeon , of course i want them to look nice as well .
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
2,444
alright thanks hope you feel better
[ "Chitchat" ]
[ "Null" ]
2,445
okay . and have you been , um , having any heavy menstrual bleeding or anything like that ?
[ "Acute Symptoms", "Vegetative History" ]
[ "Subjective" ]
2,446
okay have they helped at all with the cough
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
2,447
okay okay great yeah you've learned a lot about it and and the treatments including the the term analgesic and all of that that's pretty impressive you've been you've been through the ringer i think with with those so okay and so you're taking excedrin when you get a migraine and then sort of would you say maybe for breakthrough migraines or worse migraines you'd take a sumatriptan occasionally
[ "Personal History", "Therapeutic History" ]
[ "Subjective" ]
2,448
okay , and this all started when you were walking ?
[ "Acute Symptoms" ]
[ "Subjective" ]
2,449
uh , the one i recommend for the chest and back is the , the PanOxyl 10 % . uh , we actually have samples of it and coupons . so i can send you home with those .
[ "Medication" ]
[ "Plan" ]
2,450
a hundred percent so how about this right now you're like i what i'm hearing is that you're experiencing bilateral knee pain like both of your knees hurt but i'm assuming that like your right knee hurts more is that correct
[ "Acute Symptoms" ]
[ "Subjective" ]
2,451
mm-hmm
[ "Discussion" ]
[ "Plan" ]
2,452
mm-hmm .
[ "Therapeutic History" ]
[ "Subjective" ]
2,453
okay and you're right handed correct
[ "Other Socials" ]
[ "Subjective" ]
2,454
okay . those wives , always making you do stuff .
[ "Chitchat" ]
[ "Null" ]
2,455
it's good to see you as well . so i know the nurse told you about dax .
[ "Chitchat" ]
[ "Null" ]
2,456
okay anything else
[ "Discussion" ]
[ "Plan" ]
2,457
if i'm pushing down on your feet can you push push your feet back
[ "Physical Examination" ]
[ "Objective" ]
2,458
okay alright so i'll see you at your next visit
[ "Chitchat" ]
[ "Null" ]
2,459
okay alright okay so i'm just gon na go ahead and feel on your fingers really quickly alright metacarpals intact noticed some obvious swelling ecchymosis obvious swelling and bruising tenderness on palpation throughout there is evidence of potential fracture feeling some bony crepitus alright so this pain is it like chronic i wanted to ask you
[ "Physical Examination" ]
[ "Objective" ]
2,460
okay great and since this i'm the reason i'm asking all these questions i'm a little concerned about the inactivity with your your knee pain and you know how diabetes you need to be very you know active and and taking your medicine to keep that under control so you know may wan na continue to follow up with your pcp for that diabetes as we go through here and just watch your blood sugars extra as we go through that now i'm gon na go ahead and examine your your right knee and when i push on the outside does that hurt at all
[ "Physical Examination" ]
[ "Objective" ]
2,461
like preemie type stuff ?
[ "Personal History" ]
[ "Subjective" ]
2,462
okay so what's going on
[ "Chitchat" ]
[ "Null" ]
2,463
okay , good . and what i would have you do is continue with the gabapentin . um , are you taking 300 or 100 ?
[ "Medication", "Therapeutic History" ]
[ "Subjective", "Plan" ]
2,464
okay sounds good like i said i will see you in two weeks if you have any questions or if you have a lot of pain come back in we'll reevaluate otherwise i think you're headed in the right direction and i'll see you again in two weeks
[ "Discussion", "Follow-up" ]
[ "Plan" ]
2,465
okay so pain on flexion what about extension when you pick your wrist up
[ "Physical Examination" ]
[ "Objective" ]
2,466
good . lungs and heart sound great . all right-y . so your physical exam , you know , everything we see up here is ... you know , you're a well-appearing female , alert and oriented , sitting comfortably on my chair today , i hope , uh , with not acute distress . exam , um , otherwise with norm ... within normal limits . okay . so where does that all leave us ? the good news is that her kidney functions do look good as- as does her blood pressure . we'll wan na keep on eye on both of those things , as she is at a higher risk for developing high blood pressure and something that we call proteinuria , which is where your kidneys do n't work as well as they should and we end of seeing protein in your pee .
[ "Physical Examination", "Acute Assessment" ]
[ "Objective", "Assessment" ]
2,467
that's great .
[ "Chitchat" ]
[ "Null" ]
2,468
it's pretty bad
[ "Chitchat" ]
[ "Null" ]
2,469
okay tell me more about that cough
[ "Acute Symptoms" ]
[ "Subjective" ]
2,470
you took tylenol
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
2,471
the er is full of these vaccines .
[ "Discussion", "Medication" ]
[ "Plan" ]
2,472
um , i do have a lot of people that have thyroid , thyroid issues and they have vitamin d deficiency .
[ "Discussion" ]
[ "Plan" ]
2,473
in severe pain .
[ "Acute Symptoms" ]
[ "Subjective" ]
2,474
then in terms of your depression , how are you doing ? i know that we did n't start you on medication , since you're on a bunch of other medications . what- what are your strategies for dealing with that and how are you doing ?
[ "Personal History" ]
[ "Subjective" ]
2,475
so i'm just curious talking about your symptoms here have you had any fevers you mentioned something about nausea but have you actually vomited from those symptoms
[ "Vegetative History" ]
[ "Subjective" ]
2,476
and then for your diabetes i'm just keep you on that on that five hundred of metformin okay i think you're doing well with that as well also but i do want you to start taking your blood sugars if you can take them before every meal
[ "Discussion", "Reassessment" ]
[ "Assessment", "Plan" ]
2,477
hey dragon ? order lisinopril 20 mg daily . and for your last problem , your osteoarthritis , i-i think that you were doing a really good job , in terms of you know what , monitoring your knee and uh ...
[ "Reassessment", "Medication" ]
[ "Assessment", "Plan" ]
2,478
okay . that was a lot . do we need any additional questions clarified or anything ? um , you can always give us or your primary a call if you think of anything or if ... certainly , if symptoms worse .
[ "Discussion", "Follow-up" ]
[ "Plan" ]
2,479
okay alright and any any no nausea vomiting or diarrhea or any other side effects from the metformin or anything like that
[ "Vegetative History" ]
[ "Subjective" ]
2,480
little bit how about when i press on the outs the outside gon na press on the outside is that painful
[ "Physical Examination" ]
[ "Objective" ]
2,481
okay alright okay we'll we'll we'll we'll take a look at that okay now tell me have you had any issues you know with growing growing up bones are feeling okay you feel like you're growing okay
[ "Personal History" ]
[ "Subjective" ]
2,482
okay . good . so , no- no issues with any stiffness or pain or flare ups over the last year ?
[ "Personal History" ]
[ "Subjective" ]
2,483
your second problem is your chronic back pain , that's been doing really well . um , keep swimming , that's okay after this gets better .
[ "Discussion", "Reassessment" ]
[ "Assessment", "Plan" ]
2,484
okay okay so you you started having some mucus with it
[ "Acute Symptoms" ]
[ "Subjective" ]
2,485
have- have you been able to walk on it ?
[ "Acute Symptoms" ]
[ "Subjective" ]
2,486
doctor: alright thanks
[ "Chitchat" ]
[ "Null" ]
2,487
okay . and are you experiencing fever or chills ?
[ "Acute Symptoms" ]
[ "Subjective" ]
2,488
actually , i will . i'll go ahead and just give you some as well .
[ "Medication" ]
[ "Plan" ]
2,489
okay well i like to drink wine too what's your favorite type of wine
[ "Chitchat" ]
[ "Null" ]
2,490
i'm good . you ready to get started ?
[ "Chitchat" ]
[ "Null" ]
2,491
okay now when you fell did you feel or hear a pop or anything like that
[ "Acute Symptoms" ]
[ "Subjective" ]
2,492
alright thanks
[ "Chitchat" ]
[ "Null" ]
2,493
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 .
[ "Discussion" ]
[ "Plan" ]
2,494
mm-hmm alright so are you having problems walking can you bear weight
[ "Physical Examination" ]
[ "Objective" ]
2,495
well you know patients are different so what we do is we will monitor you and we see how you respond to the injection and the patient's intervals can be different as well but we usually do not do more than four times a year
[ "Discussion" ]
[ "Plan" ]
2,496
so i do n't wan na change any other medications at this point in time , so let's just leave that as it is .
[ "Discussion", "Medication" ]
[ "Plan" ]
2,497
okay and when you first had the headaches what would you rate the headache at zero no pain ten the worst pain ever
[ "Acute Symptoms" ]
[ "Subjective" ]
2,498
okay . um , hey dragon , go ahead and order any medications or procedures discussed . um , do you have any questions for me ?
[ "Discussion" ]
[ "Plan" ]
2,499