DATEXIS/med_intent_classification · Datasets at Hugging Face

text stringlengths 6 3.62k	intents listlengths 1 9	sections listlengths 1 4	__index_level_0__ int64 0 3.89k
okay and then you said you do n't vape so no vaping or e-cigarette use at all	[ "Vegetative History" ]	[ "Subjective" ]	800
hey , dragon , order carvedilol 25 milligrams , twice a day . uh , i'd also like to go ahead and , uh , get a lipid panel and some routine labs on you just to make sure that everything is okay .	[ "Diagnostic Testing", "Medication" ]	[ "Plan" ]	801
well you know where to find me okay	[ "Chitchat" ]	[ "Null" ]	802
doctor: hey , dragon , finalize the report .	[ "Chitchat" ]	[ "Null" ]	803
wow wow how fun that's fantastic well congrats good stuff alright well listen so so you're still taking your your lisinopril how about for your hyperlipidemia your your high cholesterol there are you still taking that atorvastatin	[ "Therapeutic History" ]	[ "Subjective" ]	804
most people can get the pain control with that but there are some people where the medications are n't gon na be enough and in that situation we would consider surgery i would n't i would n't recommend that now we usually try the medications first . for considering a surgery to decompress the nerve the root cause of the problem is the compression of the blood vessel against the nerve	[ "Discussion" ]	[ "Plan" ]	805
doctor: hey , dragon , finalize the note .	[ "Chitchat" ]	[ "Null" ]	806
yeah so let's try to let's try to use the lasix and let's try to let's try to you know use the breathing treatments and and do that for the second problem the diabetes that we just talked about i like to go ahead and order another blood test another hemoglobin a1c i think we need to your blood sugars have been running a little bit high in the past and we've had a hard time but it's been a while since we checked your last one so i wan na check another one today to see where we are and when we have you come back in a couple days we should have the results back we can then adjust your metformin or we may have to adjust some of the you know add a different medication at that point but but right now i'm gon na order some blood tests we'll have you come back in a couple of days and then we can reassess at that point okay	[ "Discussion", "Follow-up", "Medication", "Diagnostic Testing" ]	[ "Plan" ]	807
okay , so , that brings me to your diabetes . so , how have your blood sugars been ?	[ "Personal History" ]	[ "Subjective" ]	808
okay okay so there is a lot of desk setting at home is your office upstairs or is it i mean do you have to go up or downstairs to get to it	[ "Other Socials" ]	[ "Subjective" ]	809
mm-hmm . also , please continue to ice , especially your shoulder , and rest as much as you can .	[ "Discussion", "Medication" ]	[ "Plan" ]	810
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 .	[ "Discussion" ]	[ "Plan" ]	811
okay and before what would you how long would you say it took you to pass the other stones or how was that that resolved	[ "Acute Symptoms" ]	[ "Subjective" ]	812
so , we do expect pretty big weight loss , because of what we learn in diabetes study . so , it's a year long , uh , process , and it's an injection once a week . you come in weekly for the first four , five weeks , i believe . and then , after that , it's once a month . you do get a stipend for partici- for participating in the study , and parking is validated , and whatever else that you need for the study .	[ "Discussion" ]	[ "Plan" ]	813
okay and how bad would you say the pain is like it's a zero to ten on a scale today	[ "Acute Symptoms" ]	[ "Subjective" ]	814
are you able to move your wrist towards your arm like	[ "Physical Examination" ]	[ "Objective" ]	815
okay no i understand okay so i know that you also have like a history of hypertension and that we have you on ten milligrams of lisinopril have you been checking your blood pressures regularly	[ "Personal History", "Therapeutic History" ]	[ "Subjective" ]	816
okay . if i lift your leg up like this , does that hurt ?	[ "Physical Examination" ]	[ "Objective" ]	817
i need you to come back in a week	[ "Follow-up" ]	[ "Plan" ]	818
so for your first problem , your rheumatoid arthritis , again , everything looks good . i wan na just continue you on the methotrexate 2.5 mg , once weekly . um , and uh , if you need a referral back to see the rheumatologist , let me know , but i think everything seems stable now . do you need a refill of the methotrexate ?	[ "Discussion", "Medication", "Acute Assessment" ]	[ "Assessment", "Plan" ]	819
hey , dragon , order prozac , 40 milligrams , once a day . and then in terms of your ... the heart bypass that you've had ... let's go ahead and just order another echocardiogram for you , and i wan na continue you on the aspirin for now , okay ?	[ "Medication", "Diagnostic Testing" ]	[ "Plan" ]	820
okay sometimes alright that's fine i i just i'm not seeing one here today so that's okay alright so with that being said i do wan na ask have you been experiencing any fatigue are you tired	[ "Vegetative History" ]	[ "Subjective" ]	821
no ? okay . okay . all right , and in terms of your lupus , we have , you know , this is something that was kinda back in the , in the background for you , and we have n't had to do a whole lot . you know , your kidney function's been really good . um , any , any issues as far as you know ?	[ "Personal History" ]	[ "Subjective" ]	822
okay . and , can you feel me touch you down here ?	[ "Physical Examination" ]	[ "Objective" ]	823
okay alright and along with the pain have you had any nausea or vomiting or diarrhea	[ "Vegetative History" ]	[ "Subjective" ]	824
yep . nah , that does sound like a cause for concern . how long have you been with him ?	[ "Acute Symptoms" ]	[ "Subjective" ]	825
okay alright now tell me are you able to lay flat at night when you sleep or	[ "Acute Symptoms" ]	[ "Subjective" ]	826
and , i certainly want you to call me if you have any other symptoms of shortness of breath , and i wan na go ahead and order another echocardiogram , okay ?	[ "Follow-up", "Diagnostic Testing" ]	[ "Plan" ]	827
yeah . okay . and do you have any blood in your urine ?	[ "Acute Symptoms", "Vegetative History" ]	[ "Subjective" ]	828
okay okay well so since you're in how about your blood pressure how how is it doing and have you been taking your blood pressures at home like we talked about	[ "Personal History" ]	[ "Subjective" ]	829
okay . all right , well i know you did a review of systems sheet when you checked in .	[ "Physical Examination" ]	[ "Objective" ]	830
no shortness of breath okay and what have you been doing for your cough	[ "Acute Symptoms", "Therapeutic History" ]	[ "Subjective" ]	831
okay do you feel like your symptoms are getting worse or better	[ "Acute Symptoms" ]	[ "Subjective" ]	832
hey jose how are you doing it's been about you know three or four months since i last saw you what's going on	[ "Greetings" ]	[ "Subjective" ]	833
great . so here are my thoughts .	[ "Chitchat" ]	[ "Null" ]	834
okay and you said that's been ongoing for several months do you know what caused this type of pain or is it just something that started slowly or	[ "Acute Symptoms" ]	[ "Subjective" ]	835
it's tender on the medial joint line but actually negative mcmurray negative lateral side negative mcmurray good so pretty stable you you feel like you you're kinda shifting back a little bit on this side compared to the other side does it feel unstable when you walk does it feel like it shifts	[ "Acute Symptoms", "Physical Examination" ]	[ "Subjective", "Objective" ]	836
all right . elizabeth is a 66-year-old female with a past medical history of significant for depression and hypertension who presents for her annual exam . so elizabeth , it's been a year since i've seen you .	[ "Personal History" ]	[ "Subjective" ]	837
okay when you took it did it did it help at all did it change your your pain score	[ "Acute Symptoms", "Therapeutic History" ]	[ "Subjective" ]	838
so we are getting close there	[ "Acute Symptoms" ]	[ "Subjective" ]	839
okay coughing headache	[ "Vegetative History" ]	[ "Subjective" ]	840
okay ? let's take a look at some of your results . okay ?	[ "Chitchat" ]	[ "Null" ]	841
jelly beans ?	[ "Chitchat" ]	[ "Null" ]	842
okay . um , and , you're checking your blood pressures at home , it sounds like ?	[ "Personal History" ]	[ "Subjective" ]	843
okay alrighty so taking a look at your x-ray and you do have you you have a large spur there on the top of your big toe joint	[ "Radiology Examination" ]	[ "Objective", "Assessment" ]	844
okay . well , so you are 100 , so we ca n't really get around that one . so i expect that you probably do n't move quite as fast as maybe you used to ?	[ "Other Socials" ]	[ "Subjective" ]	845
okay yeah yeah i mean that's that's definitely understandable it says you had a four point four centimeter left upper lobe nodule in there so it's kinda big but that's understandable and we're doing the chemo to try to reduce that that that tumor that you do have so how often do you normally run with your dogs	[ "Other Socials" ]	[ "Subjective" ]	846
hey , dragon ? show me the blood sugar . hey , dragon ? show me the blood glucose . hey , dragon ? show me the hemoglobin a1c . okay , so i see here that both your blood sugar and your hemoglobin a1c are elevated . so your blood sugars have probably been running high for probably a few months . okay ? um , let's go ahead and look at some of your other results . hey , dragon ? show me the diabetes labs . yeah . okay . yeah , so , um , my impression of you at this time , um , for your high blood sugars , that you do have this diagnosis of diabetes . now , we're not sure if it's type i or type ii . even patients in , you know , in their mid-twenties can develop type i diabetes , so we're gon na go off and , we're gon na go ahead and , and send some labs to work that up . hey , dragon ? order a complete metabolic panel . and i'd like to start you on metformin , 500 milligrams , twice a day . that will help keep your blood sugars down .	[ "Reassessment", "Diagnostic Testing", "Medication" ]	[ "Assessment", "Plan" ]	847
okay yeah i like to run too and i use nike	[ "Chitchat" ]	[ "Null" ]	848
okay alright tell me have you ever had pain in that shoulder before	[ "Personal History" ]	[ "Subjective" ]	849
it's with ibuprofen okay what's your pain level without then	[ "Acute Symptoms" ]	[ "Subjective" ]	850
just that i would like to leave the shunt set for another two to three months before we go in changing it . like i said , if you're not having any headaches or pain and you have improved so that's all good for me . so really there's , there's nothing to worry about .	[ "Discussion" ]	[ "Plan" ]	851
i love it absolutely yeah my dad one time took me to play racquet ball and i learned the very bruisy way that that was n't for me yeah	[ "Chitchat" ]	[ "Null" ]	852
okay . all right . and any weight loss ? anything like that ?	[ "Vegetative History" ]	[ "Subjective" ]	853
all right . let me take a quick look at her .	[ "Physical Examination" ]	[ "Objective" ]	854
. and see how you do , okay ?	[ "Chitchat" ]	[ "Null" ]	855
okay . i think we , we might have to look into it a little bit further with this knee pain that you're having .	[ "Acute Symptoms" ]	[ "Subjective" ]	856
congratulations . that's great . and then , um-	[ "Chitchat" ]	[ "Null" ]	857
and go ahead take a big breath in and out . good , your lungs sound terrific . i'll listen to your heart , breathe quietly . okay very good .	[ "Physical Examination" ]	[ "Objective" ]	858
yeah , sure , no problem . and we do n't have to make any decisions today , just , you know , wanted to go over a couple of these things . um , but sometimes we can also perform a surgical aortic valve replacement , or it's called an savr . but really , because of your age and medical history , um , unfortunately , that would n't be a good option for you .	[ "Discussion", "Other Treatments" ]	[ "Plan" ]	859
wow okay alright and are you taking i know you were supposed to be taking lasix and we had you on you know diet control to to prevent to limit your salt intake how is that going	[ "Personal History", "Therapeutic History" ]	[ "Subjective" ]	860
all right . let's uh , let's look at your x-ray . hey dragon . show me the last radiograph . so this is looking at your right arm , and what i see is a proximal humerus fracture . so you kinda think of your humerus as a snow cone , and you knocked the top of the snow cone ? the top off the snow cone . um , so i'll be gentle but i want to examine your arm .	[ "Physical Examination", "Acute Assessment", "Radiology Examination" ]	[ "Objective", "Assessment" ]	861
okay yeah i yeah we have a lot of that yes so let me go ahead and and look at this a little closer here the first off i wan na tell you the the vital signs that the my assistant took when you came in your blood pressure is one thirty over sixty eight your heart rate was ninety eight and your respiratory rate was eighteen so those all look good and appear normal and your temperature was ninety seven . seven and that is all normal now when i look at your scalp here i do notice that you have demarcated scaly erythematous plaques and that's just kind of explaining technically what's going on those patches and they're they're in a patchy format they're diffusely present across the back of your skull and that's probably why you you see all that that that white dander you know on your on your your clothes as you go through the day now lem me talk a little bit about my impression and plan i think that you have a scalp psoriasis and let's and here is my thoughts on that what i would like you to use is to use clobetasol that's a zero . zero five percent solution and i want you to use that twice daily on the the affected areas of your scalp so you're just gon na put this on and just kinda gently rub it in now i know to do it twice daily is going to be difficult but if you can do it first thing in the morning when you get up and then before you go to bed you know get a shower and before you go to bed that will be great i want you to continue to use t-gel shampoo that you listed when you first came in that's a very good solution shampoo for that and that will help with controlling a lot of this now there is no cure for this unfortunately and flareups can be unpredictable but we see that you know not a we do n't have a great finger on what causes the flare ups but i'm gon na give you some steroids that will help and we're gon na have to manage that on a ongoing basis but when you get do get a flare up i want you to be using these flare steroid that i give you as we go through that and then i wan na see you back here in three months or sooner if it gets significantly worse do you have any questions for me	[ "Physical Examination", "Discussion", "Follow-up", "Medication", "Acute Assessment" ]	[ "Objective", "Assessment", "Plan" ]	862
so donna is a 37 -year-old female she is here with complaint of headache she has a history of hypertension and diabetes so donna tell me what's going on	[ "Acute Symptoms", "Personal History", "Greetings" ]	[ "Subjective" ]	863
uh- . um , okay . do you ... have you ever had an irregular pap smear ?	[ "Acute Symptoms" ]	[ "Subjective" ]	864
great okay david do you have any other questions	[ "Discussion" ]	[ "Plan" ]	865
any pain shooting down your legs when i do that ?	[ "Physical Examination" ]	[ "Objective" ]	866
you heard a crack	[ "Acute Symptoms" ]	[ "Subjective" ]	867
um , and then again , when did you go down to just taking the doxycycline once a day ?	[ "Therapeutic History" ]	[ "Subjective" ]	868
several times in a row , okay .	[ "Acute Symptoms" ]	[ "Subjective" ]	869
well yeah that would be better	[ "Discussion" ]	[ "Subjective" ]	870
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 .	[ "Personal History" ]	[ "Subjective" ]	871
okay what makes you think that have you been taking them	[ "Personal History" ]	[ "Subjective" ]	872
okay got it	[ "Chitchat" ]	[ "Null" ]	873
you're probably still gon na have aches and pains occasionally . i usually tell people it's two or three months before you feel like you're back to yourself again , so you're doing really well .	[ "Discussion" ]	[ "Plan" ]	874
okay and do you think that they are running okay	[ "Personal History" ]	[ "Subjective" ]	875
hey dragon ? show me the vital signs . so here your vital signs look really good , i'm- i'm happy to see that your blood pressure is under- under good control , and your oxygenation is fine , so i'm just gon na take a listen to your heart and lungs , and i'll let you know if i find anything , okay ?	[ "Physical Examination" ]	[ "Objective" ]	876
okay . and how long has this been going on ?	[ "Personal History" ]	[ "Subjective" ]	877
okay great . so i will call that in for you , it will be the lower dose , 80 mcg , and you'll have to do two puffs twice a day .	[ "Medication" ]	[ "Plan" ]	878
alright and has the has the ibuprofen been helping you at all	[ "Acute Symptoms", "Therapeutic History" ]	[ "Subjective" ]	879
unloving the spectrum that we have right here let's see if we can dig down and get some details well a couple of things i wan na ask have you been a bit more tired than lately	[ "Vegetative History" ]	[ "Subjective" ]	880
okay do you think you need something stronger than meloxicam	[ "Discussion", "Medication" ]	[ "Plan" ]	881
okay how about i do n't think i've prescribed you anything yet do you think you would need anything	[ "Discussion", "Medication" ]	[ "Plan" ]	882
fingers ? okay , good . all right , well , um , lem me do a quick exam if that's okay ?	[ "Physical Examination" ]	[ "Objective" ]	883
so you're not down in the 120s yet ?	[ "Personal History" ]	[ "Subjective" ]	884
well , um , so do you have any diabetes or rheumatoid arthritis ?	[ "Personal History" ]	[ "Subjective" ]	885
okay and what seemed to bring it on anything exacerbated or relieve it	[ "Acute Symptoms", "Therapeutic History" ]	[ "Subjective" ]	886
okay , and it looks like you suffer from itching with the methylprednisolone ?	[ "Therapeutic History", "Personal History" ]	[ "Subjective" ]	887
okay let's venture a little bit more because i need five minutes so where so where were you skiing at	[ "Other Socials" ]	[ "Subjective" ]	888
it's been about a week okay now have you ever experienced these symptoms before	[ "Personal History" ]	[ "Subjective" ]	889
okay and are you able to move the arm or is it kinda just stuck	[ "Acute Symptoms" ]	[ "Subjective" ]	890
okay . all right . and how have you been feeling since that time ?	[ "Acute Symptoms" ]	[ "Subjective" ]	891
okay the left knee	[ "Acute Symptoms" ]	[ "Subjective" ]	892
okay . all right . um , and you're watching your blood sugars at home ?	[ "Personal History" ]	[ "Subjective" ]	893
okay . all right . um , and did you have any trauma before that happened ? were you doing anything strenuous like crossfit or lifting boxes or anything like that before you went for , for the walk ?	[ "Personal History" ]	[ "Subjective" ]	894
on your heart exam . which you've had in the past .	[ "Physical Examination" ]	[ "Objective" ]	895
okay . and what happened ?	[ "Personal History" ]	[ "Subjective" ]	896
okay . all right . i know you did a review of system sheet when you checked in .	[ "Chitchat" ]	[ "Null" ]	897
so , um , uh , i'm not gon na change your medication . i think this is diet related , so i want you to try to cut down on the snacking and additional sweets , okay ?	[ "Discussion", "Medication", "Other Treatments" ]	[ "Plan" ]	898
great . and here's a handout that you can look over . it goes over the dietary recommendations and what to avoid .	[ "Chitchat" ]	[ "Null" ]	899

okay and then you said you do n't vape so no vaping or e-cigarette use at all

[ "Vegetative History" ]

[ "Subjective" ]

800

hey , dragon , order carvedilol 25 milligrams , twice a day . uh , i'd also like to go ahead and , uh , get a lipid panel and some routine labs on you just to make sure that everything is okay .

[ "Diagnostic Testing", "Medication" ]

[ "Plan" ]

801

well you know where to find me okay

[ "Chitchat" ]

[ "Null" ]

802

doctor: hey , dragon , finalize the report .

[ "Chitchat" ]

[ "Null" ]

803

wow wow how fun that's fantastic well congrats good stuff alright well listen so so you're still taking your your lisinopril how about for your hyperlipidemia your your high cholesterol there are you still taking that atorvastatin

[ "Therapeutic History" ]

[ "Subjective" ]

804

most people can get the pain control with that but there are some people where the medications are n't gon na be enough and in that situation we would consider surgery i would n't i would n't recommend that now we usually try the medications first . for considering a surgery to decompress the nerve the root cause of the problem is the compression of the blood vessel against the nerve

[ "Discussion" ]

[ "Plan" ]

805

doctor: hey , dragon , finalize the note .

[ "Chitchat" ]

[ "Null" ]

806

yeah so let's try to let's try to use the lasix and let's try to let's try to you know use the breathing treatments and and do that for the second problem the diabetes that we just talked about i like to go ahead and order another blood test another hemoglobin a1c i think we need to your blood sugars have been running a little bit high in the past and we've had a hard time but it's been a while since we checked your last one so i wan na check another one today to see where we are and when we have you come back in a couple days we should have the results back we can then adjust your metformin or we may have to adjust some of the you know add a different medication at that point but but right now i'm gon na order some blood tests we'll have you come back in a couple of days and then we can reassess at that point okay

[ "Discussion", "Follow-up", "Medication", "Diagnostic Testing" ]

[ "Plan" ]

807

okay , so , that brings me to your diabetes . so , how have your blood sugars been ?

[ "Personal History" ]

[ "Subjective" ]

808

okay okay so there is a lot of desk setting at home is your office upstairs or is it i mean do you have to go up or downstairs to get to it

[ "Other Socials" ]

[ "Subjective" ]

809

mm-hmm . also , please continue to ice , especially your shoulder , and rest as much as you can .

[ "Discussion", "Medication" ]

[ "Plan" ]

810

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 .

[ "Discussion" ]

[ "Plan" ]

811

okay and before what would you how long would you say it took you to pass the other stones or how was that that resolved

[ "Acute Symptoms" ]

[ "Subjective" ]

812

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

[ "Discussion" ]

[ "Plan" ]

813

okay and how bad would you say the pain is like it's a zero to ten on a scale today

[ "Acute Symptoms" ]

[ "Subjective" ]

814

are you able to move your wrist towards your arm like

[ "Physical Examination" ]

[ "Objective" ]

815

okay no i understand okay so i know that you also have like a history of hypertension and that we have you on ten milligrams of lisinopril have you been checking your blood pressures regularly

[ "Personal History", "Therapeutic History" ]

[ "Subjective" ]

816

okay . if i lift your leg up like this , does that hurt ?

[ "Physical Examination" ]

[ "Objective" ]

817

i need you to come back in a week

[ "Follow-up" ]

[ "Plan" ]

818

so for your first problem , your rheumatoid arthritis , again , everything looks good . i wan na just continue you on the methotrexate 2.5 mg , once weekly . um , and uh , if you need a referral back to see the rheumatologist , let me know , but i think everything seems stable now . do you need a refill of the methotrexate ?

[ "Discussion", "Medication", "Acute Assessment" ]

[ "Assessment", "Plan" ]

819

hey , dragon , order prozac , 40 milligrams , once a day . and then in terms of your ... the heart bypass that you've had ... let's go ahead and just order another echocardiogram for you , and i wan na continue you on the aspirin for now , okay ?

[ "Medication", "Diagnostic Testing" ]

[ "Plan" ]

820

okay sometimes alright that's fine i i just i'm not seeing one here today so that's okay alright so with that being said i do wan na ask have you been experiencing any fatigue are you tired

[ "Vegetative History" ]

[ "Subjective" ]

821

no ? okay . okay . all right , and in terms of your lupus , we have , you know , this is something that was kinda back in the , in the background for you , and we have n't had to do a whole lot . you know , your kidney function's been really good . um , any , any issues as far as you know ?

[ "Personal History" ]

[ "Subjective" ]

822

okay . and , can you feel me touch you down here ?

[ "Physical Examination" ]

[ "Objective" ]

823

okay alright and along with the pain have you had any nausea or vomiting or diarrhea

[ "Vegetative History" ]

[ "Subjective" ]

824

yep . nah , that does sound like a cause for concern . how long have you been with him ?

[ "Acute Symptoms" ]

[ "Subjective" ]

825

okay alright now tell me are you able to lay flat at night when you sleep or

[ "Acute Symptoms" ]

[ "Subjective" ]

826

and , i certainly want you to call me if you have any other symptoms of shortness of breath , and i wan na go ahead and order another echocardiogram , okay ?

[ "Follow-up", "Diagnostic Testing" ]

[ "Plan" ]

827

yeah . okay . and do you have any blood in your urine ?

[ "Acute Symptoms", "Vegetative History" ]

[ "Subjective" ]

828

okay okay well so since you're in how about your blood pressure how how is it doing and have you been taking your blood pressures at home like we talked about

[ "Personal History" ]

[ "Subjective" ]

829

okay . all right , well i know you did a review of systems sheet when you checked in .

[ "Physical Examination" ]

[ "Objective" ]

830

no shortness of breath okay and what have you been doing for your cough

[ "Acute Symptoms", "Therapeutic History" ]

[ "Subjective" ]

831

okay do you feel like your symptoms are getting worse or better

[ "Acute Symptoms" ]

[ "Subjective" ]

832

hey jose how are you doing it's been about you know three or four months since i last saw you what's going on

[ "Greetings" ]

[ "Subjective" ]

833

great . so here are my thoughts .

[ "Chitchat" ]

[ "Null" ]

834

okay and you said that's been ongoing for several months do you know what caused this type of pain or is it just something that started slowly or

[ "Acute Symptoms" ]

[ "Subjective" ]

835

it's tender on the medial joint line but actually negative mcmurray negative lateral side negative mcmurray good so pretty stable you you feel like you you're kinda shifting back a little bit on this side compared to the other side does it feel unstable when you walk does it feel like it shifts

[ "Acute Symptoms", "Physical Examination" ]

[ "Subjective", "Objective" ]

836

all right . elizabeth is a 66-year-old female with a past medical history of significant for depression and hypertension who presents for her annual exam . so elizabeth , it's been a year since i've seen you .

[ "Personal History" ]

[ "Subjective" ]

837

okay when you took it did it did it help at all did it change your your pain score

[ "Acute Symptoms", "Therapeutic History" ]

[ "Subjective" ]

838

so we are getting close there

[ "Acute Symptoms" ]

[ "Subjective" ]

839

okay coughing headache

[ "Vegetative History" ]

[ "Subjective" ]

840

okay ? let's take a look at some of your results . okay ?

[ "Chitchat" ]

[ "Null" ]

841

jelly beans ?

[ "Chitchat" ]

[ "Null" ]

842

okay . um , and , you're checking your blood pressures at home , it sounds like ?

[ "Personal History" ]

[ "Subjective" ]

843

okay alrighty so taking a look at your x-ray and you do have you you have a large spur there on the top of your big toe joint

[ "Radiology Examination" ]

[ "Objective", "Assessment" ]

844

okay . well , so you are 100 , so we ca n't really get around that one . so i expect that you probably do n't move quite as fast as maybe you used to ?

[ "Other Socials" ]

[ "Subjective" ]

845

okay yeah yeah i mean that's that's definitely understandable it says you had a four point four centimeter left upper lobe nodule in there so it's kinda big but that's understandable and we're doing the chemo to try to reduce that that that tumor that you do have so how often do you normally run with your dogs

[ "Other Socials" ]

[ "Subjective" ]

846

hey , dragon ? show me the blood sugar . hey , dragon ? show me the blood glucose . hey , dragon ? show me the hemoglobin a1c . okay , so i see here that both your blood sugar and your hemoglobin a1c are elevated . so your blood sugars have probably been running high for probably a few months . okay ? um , let's go ahead and look at some of your other results . hey , dragon ? show me the diabetes labs . yeah . okay . yeah , so , um , my impression of you at this time , um , for your high blood sugars , that you do have this diagnosis of diabetes . now , we're not sure if it's type i or type ii . even patients in , you know , in their mid-twenties can develop type i diabetes , so we're gon na go off and , we're gon na go ahead and , and send some labs to work that up . hey , dragon ? order a complete metabolic panel . and i'd like to start you on metformin , 500 milligrams , twice a day . that will help keep your blood sugars down .

[ "Reassessment", "Diagnostic Testing", "Medication" ]

[ "Assessment", "Plan" ]

847

okay yeah i like to run too and i use nike

[ "Chitchat" ]

[ "Null" ]

848

okay alright tell me have you ever had pain in that shoulder before

[ "Personal History" ]

[ "Subjective" ]

849

it's with ibuprofen okay what's your pain level without then

[ "Acute Symptoms" ]

[ "Subjective" ]

850

just that i would like to leave the shunt set for another two to three months before we go in changing it . like i said , if you're not having any headaches or pain and you have improved so that's all good for me . so really there's , there's nothing to worry about .

[ "Discussion" ]

[ "Plan" ]

851

i love it absolutely yeah my dad one time took me to play racquet ball and i learned the very bruisy way that that was n't for me yeah

[ "Chitchat" ]

[ "Null" ]

852

okay . all right . and any weight loss ? anything like that ?

[ "Vegetative History" ]

[ "Subjective" ]

853

all right . let me take a quick look at her .

[ "Physical Examination" ]

[ "Objective" ]

854

. and see how you do , okay ?

[ "Chitchat" ]

[ "Null" ]

855

okay . i think we , we might have to look into it a little bit further with this knee pain that you're having .

[ "Acute Symptoms" ]

[ "Subjective" ]

856

congratulations . that's great . and then , um-

[ "Chitchat" ]

[ "Null" ]

857

and go ahead take a big breath in and out . good , your lungs sound terrific . i'll listen to your heart , breathe quietly . okay very good .

[ "Physical Examination" ]

[ "Objective" ]

858

yeah , sure , no problem . and we do n't have to make any decisions today , just , you know , wanted to go over a couple of these things . um , but sometimes we can also perform a surgical aortic valve replacement , or it's called an savr . but really , because of your age and medical history , um , unfortunately , that would n't be a good option for you .

[ "Discussion", "Other Treatments" ]

[ "Plan" ]

859

wow okay alright and are you taking i know you were supposed to be taking lasix and we had you on you know diet control to to prevent to limit your salt intake how is that going

[ "Personal History", "Therapeutic History" ]

[ "Subjective" ]

860

all right . let's uh , let's look at your x-ray . hey dragon . show me the last radiograph . so this is looking at your right arm , and what i see is a proximal humerus fracture . so you kinda think of your humerus as a snow cone , and you knocked the top of the snow cone ? the top off the snow cone . um , so i'll be gentle but i want to examine your arm .

[ "Physical Examination", "Acute Assessment", "Radiology Examination" ]

[ "Objective", "Assessment" ]

861

okay yeah i yeah we have a lot of that yes so let me go ahead and and look at this a little closer here the first off i wan na tell you the the vital signs that the my assistant took when you came in your blood pressure is one thirty over sixty eight your heart rate was ninety eight and your respiratory rate was eighteen so those all look good and appear normal and your temperature was ninety seven . seven and that is all normal now when i look at your scalp here i do notice that you have demarcated scaly erythematous plaques and that's just kind of explaining technically what's going on those patches and they're they're in a patchy format they're diffusely present across the back of your skull and that's probably why you you see all that that that white dander you know on your on your your clothes as you go through the day now lem me talk a little bit about my impression and plan i think that you have a scalp psoriasis and let's and here is my thoughts on that what i would like you to use is to use clobetasol that's a zero . zero five percent solution and i want you to use that twice daily on the the affected areas of your scalp so you're just gon na put this on and just kinda gently rub it in now i know to do it twice daily is going to be difficult but if you can do it first thing in the morning when you get up and then before you go to bed you know get a shower and before you go to bed that will be great i want you to continue to use t-gel shampoo that you listed when you first came in that's a very good solution shampoo for that and that will help with controlling a lot of this now there is no cure for this unfortunately and flareups can be unpredictable but we see that you know not a we do n't have a great finger on what causes the flare ups but i'm gon na give you some steroids that will help and we're gon na have to manage that on a ongoing basis but when you get do get a flare up i want you to be using these flare steroid that i give you as we go through that and then i wan na see you back here in three months or sooner if it gets significantly worse do you have any questions for me

[ "Physical Examination", "Discussion", "Follow-up", "Medication", "Acute Assessment" ]

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

862

so donna is a 37 -year-old female she is here with complaint of headache she has a history of hypertension and diabetes so donna tell me what's going on

[ "Acute Symptoms", "Personal History", "Greetings" ]

[ "Subjective" ]

863

uh- . um , okay . do you ... have you ever had an irregular pap smear ?

[ "Acute Symptoms" ]

[ "Subjective" ]

864

great okay david do you have any other questions

[ "Discussion" ]

[ "Plan" ]

865

any pain shooting down your legs when i do that ?

[ "Physical Examination" ]

[ "Objective" ]

866

you heard a crack

[ "Acute Symptoms" ]

[ "Subjective" ]

867

um , and then again , when did you go down to just taking the doxycycline once a day ?

[ "Therapeutic History" ]

[ "Subjective" ]

868

several times in a row , okay .

[ "Acute Symptoms" ]

[ "Subjective" ]

869

well yeah that would be better

[ "Discussion" ]

[ "Subjective" ]

870

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 .

[ "Personal History" ]

[ "Subjective" ]

871

okay what makes you think that have you been taking them

[ "Personal History" ]

[ "Subjective" ]

872

okay got it

[ "Chitchat" ]

[ "Null" ]

873

you're probably still gon na have aches and pains occasionally . i usually tell people it's two or three months before you feel like you're back to yourself again , so you're doing really well .

[ "Discussion" ]

[ "Plan" ]

874

okay and do you think that they are running okay

[ "Personal History" ]

[ "Subjective" ]

875

hey dragon ? show me the vital signs . so here your vital signs look really good , i'm- i'm happy to see that your blood pressure is under- under good control , and your oxygenation is fine , so i'm just gon na take a listen to your heart and lungs , and i'll let you know if i find anything , okay ?

[ "Physical Examination" ]

[ "Objective" ]

876

okay . and how long has this been going on ?

[ "Personal History" ]

[ "Subjective" ]

877

okay great . so i will call that in for you , it will be the lower dose , 80 mcg , and you'll have to do two puffs twice a day .

[ "Medication" ]

[ "Plan" ]

878

alright and has the has the ibuprofen been helping you at all

[ "Acute Symptoms", "Therapeutic History" ]

[ "Subjective" ]

879

unloving the spectrum that we have right here let's see if we can dig down and get some details well a couple of things i wan na ask have you been a bit more tired than lately

[ "Vegetative History" ]

[ "Subjective" ]

880

okay do you think you need something stronger than meloxicam

[ "Discussion", "Medication" ]

[ "Plan" ]

881

okay how about i do n't think i've prescribed you anything yet do you think you would need anything

[ "Discussion", "Medication" ]

[ "Plan" ]

882

fingers ? okay , good . all right , well , um , lem me do a quick exam if that's okay ?

[ "Physical Examination" ]

[ "Objective" ]

883

so you're not down in the 120s yet ?

[ "Personal History" ]

[ "Subjective" ]

884

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

[ "Personal History" ]

[ "Subjective" ]

885

okay and what seemed to bring it on anything exacerbated or relieve it

[ "Acute Symptoms", "Therapeutic History" ]

[ "Subjective" ]

886

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

[ "Therapeutic History", "Personal History" ]

[ "Subjective" ]

887

okay let's venture a little bit more because i need five minutes so where so where were you skiing at

[ "Other Socials" ]

[ "Subjective" ]

888

it's been about a week okay now have you ever experienced these symptoms before

[ "Personal History" ]

[ "Subjective" ]

889

okay and are you able to move the arm or is it kinda just stuck

[ "Acute Symptoms" ]

[ "Subjective" ]

890

okay . all right . and how have you been feeling since that time ?

[ "Acute Symptoms" ]

[ "Subjective" ]

891

okay the left knee

[ "Acute Symptoms" ]

[ "Subjective" ]

892

okay . all right . um , and you're watching your blood sugars at home ?

[ "Personal History" ]

[ "Subjective" ]

893

okay . all right . um , and did you have any trauma before that happened ? were you doing anything strenuous like crossfit or lifting boxes or anything like that before you went for , for the walk ?

[ "Personal History" ]

[ "Subjective" ]

894

on your heart exam . which you've had in the past .

[ "Physical Examination" ]

[ "Objective" ]

895

okay . and what happened ?

[ "Personal History" ]

[ "Subjective" ]

896

okay . all right . i know you did a review of system sheet when you checked in .

[ "Chitchat" ]

[ "Null" ]

897

so , um , uh , i'm not gon na change your medication . i think this is diet related , so i want you to try to cut down on the snacking and additional sweets , okay ?

[ "Discussion", "Medication", "Other Treatments" ]

[ "Plan" ]

898

great . and here's a handout that you can look over . it goes over the dietary recommendations and what to avoid .

[ "Chitchat" ]

[ "Null" ]

899